In this episode, Dr. Mike Hart and Alex Berenson discuss the pros and cons of medical marijuana, the dangers and benefits of edibles and edibles, and whether or not they should be legalized. Dr. Hart is a family physician in London, Ontario, Canada and has been practicing cannabis medicine for over 5 years. He is also the author of the new book, Tell Your Children: The Truth About Marijuana, Mental Illness and Violence, which was released last month and has not endeared him to the cannabis advocacy community. Alex is a spy novelist and has written for the New York Times and the New Yorker, and is a best-selling author. He is a regular contributor to NPR and has appeared on the Tonight Show with Jay Shetty and Bill Maher, and he is a frequent guest on The Late Show with Stephen Colbert. He's also a regular guest on HBO's Hard Knocks and The Late Night with Seth Meyers, and hosts the podcast, and is the host of the show's new show, . and he's also the host and creator of on the podcast , which you can catch on Comedy Central, HBO, and CBS Radio. and other network shows. Dr. Michael Hart sits down with him to talk about his new book. . He's a family doctor, author, spy novelist, and author, and former spy novelist. , and he also writes about cannabis and mental illness. The Truth about Mental illness and violence, which he wrote. And he's a book called about marijuana and mental health. which is out now, which you should be listening to right now. to find out what he thinks of it. If you don't know who he's talking about, then you're in for a good ol' time! or if you want to get your own copy of the book, listen to it here. I'll tell you what he's up to, and you'll get a discount code for a discount on the book at the end of the episode. Thank you for listening to this episode! Thanks for listening and tweet me what you think of it? if you think it's a good one! if it's good, I'll send me a review! and I'll have me on the next one. Tweet me :) to let me know what you thought of it!
00:00:38.000And most recently, I wrote the book Tell Your Children, The Truth About Marijuana, Mental Illness, and Violence, which came out last month and has not endeared me to the cannabis advocacy community, I'd say.
00:00:50.000Have they attacked you mercilessly for this book?
00:00:58.000I've also heard from a lot of parents, you know, some users, but parents who've told me that the book really encapsulates their family's problems in the last couple of years.
00:01:09.000I suspect my real thoughts here, before we even get started, is that we're going to find that the truth is somewhere in the middle here.
00:01:24.000I know too many people that have had experiences where they took too much, particularly edibles, and I don't want to say I know anybody who had psychotic breaks, but I know some people that freaked out for weeks In fact,
00:01:39.000we just had a comedian here from Brazil a couple days ago, Rafi Bastos, who said he took a couple of hits of a vape pen.
00:02:29.000And this is one of the reasons why I want to state this because I'm a well-known marijuana advocate.
00:02:33.000But I believe absolutely there are great benefits to it.
00:02:38.000I think there's great benefits in terms of relieving pressure, ocular pressure for people that have glaucoma, people with AIDS who are on medication, people with cancer.
00:02:48.000They're going through chemotherapy, find great benefit in terms of helping them.
00:02:52.000And then there's also some people with autism.
00:02:55.000I know people that they're children of autism and they give them small amounts of edible marijuana and stop seizures.
00:03:01.000It's incredibly beneficial in the form of CBD for a lot of different ailments.
00:03:05.000But I think with all things, and this is a stance that I've kind of like really come to accept over the last few years, with all things that affect the mind, they affect everyone slightly differently.
00:05:01.000I mean, you just have to look at the death rate, right?
00:05:04.000More people die from alcohol than almost all drugs combined.
00:05:09.000But when we're looking at cannabis, there's zero deaths attributed to the use of cannabis itself.
00:05:15.000Sure, you could say, you know, someone could use cannabis and jump off a cliff or something like that, but we're talking about the lethal dose.
00:06:04.000And all those numbers are basically based on studies from the 90s and before where people looked at traffic accidents and there were a certain number of those accidents where people had a blood alcohol content of higher than 0.1%.
00:06:17.000They said, okay, that's an alcohol-associated death.
00:06:20.000That's a fine way to count as far as I'm concerned.
00:06:23.000Nobody has ever done that count for cannabis, and I can tell you based on the talk screens that I've seen from Colorado where people had cannabis in their blood and committed suicide, people had cannabis in their, I should say THC in their blood, and got into fatal confrontations with police officers.
00:06:41.000If and when we do this number for cannabis, which we need to do as soon as possible, the number's going to be a lot higher than zero.
00:06:48.000I suspect it will be in the 10,000 to 20,000 range.
00:06:51.000We won't know until we actually do it.
00:06:52.000Okay, but let's eliminate, let's go even over the alcohol.
00:06:56.000Let's eliminate all things like violence, and let's eliminate suicide, and let's assume those people would have committed violence and committed suicide without it.
00:07:04.000You're still looking at a giant number of people who drink themselves to death.
00:07:08.000Thousands and thousands and thousands of people every year versus zero with marijuana.
00:07:12.000And you're aware, I'm sure, that correlation does not equal causation and that, especially in a place like Colorado, where you're dealing with cannabis, something that stays in the system for many, many weeks, if you're testing people and they test positive for marijuana and they wind up committing suicide or they wind up committing violence,
00:07:31.000they don't even necessarily have to have been under the influence of it.
00:07:34.000Well, as you know, when you test the blood, you can test both the active metabolite and the inactive metabolite of THC. So the test, when you do a blood test on somebody who's committed suicide, it's sophisticated enough to tease that out.
00:07:48.000So there's a lot of people who have the active metabolite in their blood.
00:08:08.000It leads to a lot of metabolic disturbances.
00:08:10.000I think you could say that for some people with marijuana, too.
00:08:12.000I think you could say some people, especially weight gain, that some people smoke a lot of pot and they get lazy and they start eating Cheetos all day.
00:08:21.000With some people, you know, the waking bakers that, you know, seem to be wasting their lives away, and that's like the stereotypical negative, you know, when you're talking about a negative description of a marijuana user, it's the waking baker, right?
00:08:58.000That can be extremely beneficial for a variety of different disorders that people have.
00:09:02.000So we need to be careful about using cannabis versus using THC because it's really the THC that can do that.
00:09:09.000And to your point, you say THC can cause the munchies and of course that's not good for someone who doesn't want to gain weight.
00:09:18.000And just so people know, the way that it does do that is when THC attaches to the CB1 receptor, you get an increase in a hormone called ghrelin and ghrelin can actually induce hunger and that's why people get the munchies.
00:09:32.000But that is not necessarily a bad thing if you're someone who has cancer or if you're someone who's wasting away from a terrible illness.
00:09:41.000So sometimes having the munchies is definitely a good thing.
00:09:47.000And I know a lot of people have said to me, it's not available, so you should probably not talk about it as much, but there is another cannabinoid called THCV. So there's over 100 cannabinoids in cannabis.
00:10:02.000Those are the main ones that people know about.
00:10:04.000So THCV has been shown to actually reduce appetite.
00:10:08.000So if we can get that out there in the market, you know, like we have with CBD, then we can almost, you know, eliminate or potentially, you know, substantially reduce the problem that people have with THC by using it with THCV. Dr. Hart,
00:11:16.000So I think the word is out there that CBD is non-psychoactive and it doesn't get you high.
00:11:23.000And I think that a lot of people are really interested in that compound.
00:11:27.000And, you know, if the people didn't have the success that they've had over the past few years, you know, it wouldn't be as popular as it is.
00:11:34.000So, you know, I think that, you know, we do need to look at the scientific evidence, but we do need to listen to others.
00:11:40.000And the anecdotal evidence is, you know, something that we should consider because it is so strong.
00:14:48.000What I'm saying is that the reason we have clinical trials is because Science, the way you know whether a medicine works or not, whether a chemical compound works, whatever that compound is, the best way to know is you give the real medicine to one group of people and you give a placebo to the other group.
00:15:07.000And you see the changes in those two groups over time.
00:15:09.000And you find out whether or not your theory about whether this works on a population level basis is real or not.
00:15:16.000That is at the core of medical science.
00:15:19.000And we've basically thrown that rule out for THC. Well, that's not entirely correct.
00:15:24.000You do know that there were studies that were run during the Nixon administration that showed the efficacy of marijuana and the safety of it, and those were all squashed.
00:15:31.000And you also, I'm sure you know, like when we're talking about marijuana, you're talking about something that's federally illegal.
00:15:37.000It's not something that's easy to run these FDA studies on.
00:15:41.000Yes, and I say at the end of the book, I think we should drop that.
00:15:44.000I think anybody who's got a legitimate interest in researching either THC or cannabis or any of the compounds for a medical condition, let them run phase one, phase two, phase three trials.
00:15:54.000Let's see if this plant is good for these things.
00:15:58.000I think that's a great idea, but still, why are you saying that you don't think it is medicine when all these people find benefit in it?
00:16:06.000Do you think they're getting it from just the CBD, the minimal amount of CBD in marijuana?
00:16:11.000No, I think that, again, there's been a lot of research done on THC and cannabis to see whether or not those...
00:16:19.000Whether THC is a compound and whether smoke cannabis can treat these conditions.
00:16:23.000And for the most part, the studies have been negative.
00:16:44.000On cancer, on Alzheimer's disease, on irritable bowel syndrome, on all kinds of things.
00:16:49.000So, Alex, I mean, you're throwing a few different things out there, and I appreciate the fact that we can't be going around saying things like, you know, cannabis cures cancer, right?
00:17:00.000And I've done videos on this even recently stating that.
00:17:05.000But if you look at the research, I mean, specifically, if you look at specific cancers, there are studies that have shown that THC and CBD can help.
00:17:14.000Say if we're talking about breast cancer, and I did a video on this recently.
00:17:18.000If you are HER2 positive, And you see CBD, it can in fact reduce tumor size and it can reduce tumor growth.
00:17:53.000So I do agree with you, Alex, in the fact that we have to be careful about using terms like that.
00:18:00.000But that just doesn't mean that we can't say that cannabis is no good for cancer at all.
00:18:03.000And I mean, even in the National Mechanics of Science and Engineering report, they said that cancer was great for chemotherapy-induced nausea and vomiting, right?
00:18:12.000So it's definitely a really good medicine for a lot of different things.
00:18:18.000And when we're talking about THC, I said earlier, of course, we need to be careful about THC. But it definitely is still a medicine.
00:18:27.000And to your point with regards to not being a medicine, say, for something like PTSD, I come from it from a clinician's point of view.
00:18:47.000And I understand that doing something sometimes is not going to be beneficial just because you're doing something.
00:18:54.000You have to do something that actually works.
00:18:56.000But we do have epidemiological studies and we have other studies that have shown that when patients are given cannabis, it can reduce their symptoms of PTSD. There's also another study, I don't use this drug too often,
00:19:12.000So Nabilone is just pure THC. Nabalone was shown to reduce nightmares in people who have PTSD. So just because THC is psychoactive doesn't mean that it's not a medicine.
00:19:25.000And just to keep on the topic of PTSD, in addition to that, we've identified mechanisms of action.
00:19:32.000I know there's one study, I think Matt Hill was one of the authors of that study, and he noted that in people who have PTSD, there's an over 50% decrease in levels of anandamide.
00:19:47.000Which is the naturally occurring cannabinoid in your brain.
00:19:50.000Yes, which is the naturally occurring endocannabinoid, correct.
00:19:52.000So you can get that through exercise, which is one excellent way to do it.
00:19:57.000And that's part of the high that you get after you exercise.
00:20:01.000But the other way that you can get it is by using cannabis.
00:20:04.000So when THC attaches to those CB1 receptors, you can get a release of anandamide.
00:20:09.000And cannabidiol can actually increase anandamide by another mechanism of action as well.
00:20:16.000So, you know, there's different ways where we can, you know, raise a level of deficiency.
00:20:21.000So, you know, to me, as a clinician, you know, if I have someone who is not doing very well, you know, they've been on a bunch of different medications, I've identified that, you know, they have PTSD, we have a mechanism of action, we have studies, and then again, too, you know, don't discount my clinical experience,
00:20:45.000I prescribe other medicines as well, but I've been doing cannabis medicine for over five years.
00:20:50.000And there's a lot that I've learned, right?
00:20:52.000So as much as I've learned through reading studies and through going to conferences and things like that, for sure, the best resource as a clinician is to learn from your patients and to hear what your patients tell me.
00:21:07.000And the things that my patients tell me is that THC is really effective for their sleep at night.
00:21:13.000And a lot of my patients, especially my veteran patients, have done really, really well with that.
00:21:27.000That indicated that a lot of the medicines that are being used now for PTSD are just simply ineffective.
00:21:33.000And the other thing, too, is that there's never been a medicine made specifically for PTSD. So all the medicines that people are using are for anxiety, or they're for depression, or they're for insomnia, or they're for something else.
00:21:45.000But when we look at a study that says people with PTSD have a lower level of anandamide, and if you can increase that level of anandamide, that's a good way to treat someone.
00:21:57.000It doesn't matter whether it's a vitamin, whether it's a hormone.
00:21:59.000As long as you are correcting a deficiency, you're generally going to get excellent clinical results.
00:22:26.000It has some positive biological qualities and some negative biological qualities.
00:22:31.000And there was an argument, I think, 10 to 20 years ago, should we recommend that people drink moderately, one to two drinks a day?
00:22:39.000And I think for the most part, the medical profession has come down on the side of saying, let's not do that.
00:22:44.000There's too many non-cardiac negative side effects with alcohol.
00:22:49.000Just on that note though, Alex, in Canada right now, I know the safe alcohol drinking guidelines are 14 drinks a week for men and 9 drinks a week for women.
00:22:58.000So, you know, basically two a day for men, one and a half for women.
00:23:01.000So you're saying, okay, like, we don't see huge negative consequences at that level.
00:23:35.000And when those trials have been done, and a lot of them have been done, Joe, a lot of them have been done, they've almost unequivocally shown that cannabis doesn't work as a medicine.
00:23:44.000The only actual place where, beyond these sort of very limited conditions, like chemotherapy-associated nausea, which obviously is terrible for people who have it, but isn't that common, fortunately, Cannabis has been shown to work as a pain reliever.
00:23:57.000Probably for the same reasons that alcohol works as a pain reliever.
00:24:03.000But even in that study, or even in those studies, they're mostly done against placebo, not against opioids or against NSAIDs like ibuprofen.
00:24:14.000And there was a very big study for cannabis use in chronic pain over a multi-year period in Australia that came out last year that showed that people who used cannabis had more pain and used more opiates at the end of four years than people who didn't.
00:24:33.000So we're almost arguing about what medicine is.
00:24:36.000Yeah, that study, though, had a lot of flaws in it.
00:24:40.000And the other thing is that you need to look at someone who is already using cannabis versus someone who is just using opioids.
00:24:47.000So if someone is just using opioids and they want to come off cannabis, you know, there's multiple...
00:24:54.000Sorry, come off of opiates with cannabis.
00:24:56.000You know, multiple studies have shown that that can be effective.
00:25:00.000And that's not what was done in the Australian study that you're referring to.
00:25:03.000Right, it's a more naturalistic approach.
00:25:06.000And also, too, they didn't have access to medical marijuana during that whole time.
00:25:13.000Those are all self-reported, and they were getting it from recreational sources.
00:25:19.000That's a big distinction, though, Alex.
00:25:21.000They weren't getting it from a doctor who prescribed it to them.
00:25:25.000This was a self-reported study, and people were getting cannabis that they didn't really know what they were getting.
00:25:31.000It wasn't They weren't given any information from a doctor.
00:25:34.000And that's why it's a medicine, Alex, because you can tell someone, you can tell a patient to take a certain amount of CBD every single day.
00:25:43.000And when you take a certain amount every single day, it can reduce your symptoms.
00:25:46.000And sometimes you need to increase that, and sometimes you need to decrease that.
00:27:11.000But if you're an epidemiologist or a researcher who's trying to guide the views and the medical practice of hundreds of thousands of doctors, that's not good enough.
00:27:23.000And I think, you know, this epidemiologist in Britain who I talked to, he said to me, he said, you know, I try not to draw conclusions because so often when I try to draw them, I'm wrong.
00:27:35.000Yeah, and we need to be, you know, careful about that, right?
00:27:38.000And Alex, you know, one thing that was mentioned in your book, you know, is that, you know, you often cited the National Academies of Science and Engineering, right?
00:27:48.000But, you know, Ziva Cooper, you know, she's a member of that committee.
00:27:51.000I mean, she put out on her Twitter, I mean, you can go to it, it's from January 9th of 2019. She says, in response in the recent New York Times editorial on cannabis and as a committee member of Which, by the way, that came out of something that I wrote that came out of the book.
00:28:06.000No, no, I'm just trying to give people context of where it came from.
00:28:08.000Right, but this is someone you cited, right?
00:28:11.000No, I didn't cite her, I cited the report.
00:28:12.000Okay, you cited the report, and she's a member of that, okay?
00:28:17.000So she said, in response to the recent New York Times editorial on Canada, says a committee member on NASM, which is that committee, And Cannabinoid's report, we did not conclude that cannabis causes schizophrenia.
00:28:29.000Then, the Drug Alliance policy also said the report did not reach that conclusion.
00:28:35.000So, you know, those are pretty two authoritative sources that are saying that, you know, in your book, you didn't cite the research properly, right?
00:28:45.000And then also, they're saying that you left a lot out, right?
00:28:48.000They said that They have found an association between marijuana use and improved cognitive outcomes in individuals with psychotic disorders.
00:29:01.000So I think that when we're writing books or when we're giving out information, you want to do it from a balanced approach and you don't want to just...
00:29:09.000Select the small amount of material that's just going to support your study.
00:29:26.000And in Canada, we have really strict guidelines to follow.
00:29:30.000Basically, no one prescribes cheat seed to anyone under the age of 25. And, you know, all the conferences and stuff that I go to, you know, we don't really have too many discussions about that.
00:29:41.000Like, the doctors don't really have much of a backlash about that.
00:29:49.000So, 25 basically is when your brain is fully developed.
00:29:55.000And when you do look at the studies that do show an association between cannabis and psychosis, it's almost all in adolescence.
00:30:04.000I think that Alex only has one study in his book that shows an extremely weak correlation between an adult using cannabis and then developing any type of mental illness later.
00:30:17.000So, you know, 25 is a good age, but it's definitely a, you know, kind of a conservative-ish age.
00:30:26.000But, you know, it's something that we follow, and I think that, you know, we've done well with that in Canada.
00:30:30.000So, Alex, why did you leave those conclusions?
00:31:19.000They said we don't see nearly as high risk for depression as psychosis.
00:31:24.000Even though, by the way, today, just today, JAMA Psychiatry, the Journal of the American Medical Association of Psychiatry, I put out a meta-analysis showing that cannabis is associated with depression and suicidal thinking, and actually suicide attempts at a 3.5 to 1 rate.
00:31:45.000But to go back, Ziva is one of 16 members of that committee.
00:31:49.000So if you're going to say that I misquoted the report, which I didn't, I quoted it entirely accurately, you need to say, well, why aren't the other 15 members of that committee saying that I misquoted?
00:31:59.000Why is one person who works for the Cannabis Research Initiative at UCLA, which takes money from cannabis investors and users, she's the one who said that I misquoted it?
00:32:09.000Maybe we should ask why the other members of the committee are not speaking out against my book.
00:32:15.000Well, I think that she was just one of the 16 members that came out, but you can't really expect all the other members to potentially come out with that as well.
00:32:56.000And, you know, I even spoke to Ziva on the phone about this.
00:32:59.000And, you know, she said that, yeah, you know, I don't – that she agrees with everything that was in the report, but she doesn't agree with your conclusions.
00:33:09.000My conclusions are – Quoted from the report.
00:33:11.000But you're only quoting the parts that back your opinions.
00:33:23.000Why did you leave out the part that said they have found an association between marijuana use and improved cognitive outcomes in individuals with psychotic disorders?
00:33:35.000If you can Find me a psychiatrist who thinks that it's a good idea for somebody with an active psychotic disorder to use CGC. Why'd you leave out that part?
00:33:43.000Well, my book presents, it makes a case, right?
00:33:46.000It makes a case that this is a big issue that we have not heard about at all, and the reasons that we haven't heard about it have a lot to do with the advocacy community and the way they've presented this data for 25 years.
00:33:58.000I wrote a book that is trying to break through a lot of noise.
00:34:03.000So, but still, to get a balanced approach, did you decide that you were only going to write about things that confirm the belief that you held when you were writing this and what you were trying to push in the title of the book and in the conclusion of the book?
00:34:22.000I think that's a really great question.
00:34:24.000I say in the introduction of the book, this book is not balanced.
00:34:27.000There's not a lot of evidence in there.
00:34:28.000If you want to read about how indica and sativa strains are different, you're not going to read that in this book.
00:35:13.000This sounds like reefer madness to me.
00:35:15.000And, you know, ultimately my wife, who's the one who went to, you know, she actually, as I was talking to Dr. Hart about this, she grew up in Newfoundland too.
00:35:23.000She went to the Memorial University of Newfoundland Medical School.
00:35:26.000And she went to Harvard and Columbia for her postgraduate training.
00:35:30.000You know, eventually she got tired of me yapping back at her and she said, why don't you go read the studies yourself?
00:35:35.000And it was that that led me to write this book because when I read the studies, I could not believe the strength of the evidence, Joe.
00:35:42.000But you're still, even in saying that, you're still seeing positive results that you're excluding from your book.
00:35:51.000Again, there's this one sentence, I mean it's not just one sentence, but there are a few sentences about how it may be that cannabis helps people's positive, it helps cognition in people with psychosis.
00:36:10.000No, it wouldn't be approved as medicine if it's causing them to have other psychotic episodes.
00:36:14.000But if these people have psychotic breaks and improves cognitive function in people with psychotic breaks, wouldn't that be something that you would prescribe to someone?
00:36:24.000No, again, you need to think about how the FDA is looking at medicine.
00:36:27.000No, I understand the FDA's position, but I mean, looking at it as medicine, I mean, if we could prove this through studies and through some sort of clinical trials.
00:36:35.000If it is improving your IQ to points on a test, I'm not saying it is.
00:36:53.000Well, it's not necessarily at the same time.
00:36:54.000One of the things that I read about schizophrenia was that people were trying to make a correlation between marijuana use and schizophrenia, but the problem with that correlation, and what I read, and maybe you could help me on this...
00:37:04.000Was that it's the exact same number that you find the general population.
00:37:08.000Essentially 1% of the general population has schizophrenia, which is 1 out of 100 people.
00:37:13.000And when you have marijuana users, you see essentially that same number mirrored, and so they're saying a small number of people...
00:37:23.000In a small number of people, what they were saying essentially in what I read was that marijuana use was associated with the onset of schizophrenia.
00:37:32.000They were disputing this in this study because the same number is mirrored in the general population.
00:37:38.000Again, correlation does not equal causation, right?
00:37:40.000Dr. Hart, I think you've got to tell them that's not true.
00:37:44.000So traditionally, yes, when you look at the stats, you'll see that the people who use cannabis versus the people who don't use cannabis have very similar rates.
00:37:52.000But getting to the exact rates, so in the U.S., they say that the range for schizophrenia is between 0.25% to 0.64%.
00:38:02.000Globally, they say it's 0.33% to 0.75%.
00:38:06.000So, right there, it's apparently lower in the US. And the US has the highest percentage of cannabis consumption in the world.
00:38:15.000And the US also has a lot of people that are using high-potency THC. I think that we really need to be careful about throwing out stats like that because when you do look at the stats that we have, it shows that even though there's a lot of cannabis use in the United States,
00:38:35.000schizophrenia rates have remained the same.
00:38:37.000So I have to push back really hard on this.
00:38:38.000This is one of the great myths of legalization.
00:38:42.000No one knows what the schizophrenia or psychosis rate is in the US. Suddenly,
00:39:02.000changed its estimate for the percentage of people with schizophrenia in the US from 1.1% to 0.3%.
00:39:08.000They did it with no public notice, and then this researcher said, hey, this is a miracle.
00:39:13.000They just cured 2 million people with schizophrenia.
00:39:15.000And then, in response to that, the director of the NIMH said, well, we actually don't know how many people have schizophrenia in the United States.
00:39:26.000The only countries where they can count noses on this With any accuracy are in Northern Europe, because they have good healthcare, because they have slightly, you know, less protections around sort of individual privacy and mental health privacy, and so they are able to count cases.
00:39:42.000And in Denmark and Finland, Which are the two places where they've actually done this research in the last 20 years.
00:39:49.000They've shown increasing rates of schizophrenia between about 1995 and about 2010. And that goes side by side with increasing rates of cannabis use in the 90s.
00:39:59.000So the people who are saying that there's no evidence of population-wide increases in psychosis are just wrong.
00:40:05.000But isn't it possible that there's other factors?
00:40:12.000We absolutely don't have the evidence at this point to say that cannabis use in the U.S. is causing a population-level increase in psychosis and schizophrenia, which are, by the way, those are sort of different illnesses, and we can talk about that, too.
00:40:26.000So we don't have the evidence to say there's a definite increase.
00:40:29.000But what I'm saying is that what you have been told is That there is no increase in schizophrenia or psychosis rates in the U.S. We don't know if that's true or not.
00:41:13.000It bottomed out in the early 90s, increased again, increased in the 90s, flattened out between about 2000, 2006, and since then has been going up again, especially in, let's say, the last three, four years.
00:41:24.000And the other thing is that potency in the last 15 years has gone way up.
00:41:28.000I don't think anybody would dispute that.
00:41:35.000There is now evidence on a population level basis in those other countries that schizophrenia and psychosis has gone up.
00:41:43.000And there's for the first time in 2017, there's data showing that serious mental illness, which is not the same as psychosis or schizophrenia, in the U.S., Doubled between 2008 and 2017 in people aged 18 to 25. And those are the people who are most likely to be using.
00:42:01.000So for the first time, there's actually evidence of what you're talking about, which is a population-wide increase.
00:42:13.000So serious mental illness, so this was defined, there's a study called the National Survey on Drug Use and Health.
00:42:19.000It's done every year, covers 70,000 people, federal government funds it.
00:42:22.000It's sort of the best data source we have on all this stuff.
00:42:26.000It showed that, and they're not counting cases either.
00:42:30.000Let me just be as clear as I can on this.
00:42:32.000Nobody's counting schizophrenia cases on a national or even state-level basis in the U.S., But you say to people, did you have depression so bad that you couldn't get out of bed?
00:42:43.000Were you hospitalized this year for any inpatient psychiatric reason?
00:42:49.000And if you look at those numbers, in 2008, 3.8% of Americans, 18 to 25, reported at least one symptom.
00:43:02.000So they were categorized as having serious mental illness that year.
00:43:50.000And one of the things they talk about is the onset of social media.
00:43:54.000Jonathan Haidt talked about that as well.
00:43:55.000And the onset of social media is actually more hate than Yuval Harati.
00:44:02.000But Jonathan Haidt talks about it with young people.
00:44:05.000I think it's the coddling of the American mind.
00:44:07.000I think that social media and the pressures of social media have led an incredible amount of young people to serious mental distress and, you know, serious anxiety, serious depression, and suicide amongst young girls has increased some 50% according to Haight over the period of 2007 to,
00:44:27.000I think, 2000, whenever his book was written.
00:44:30.000I think they're directly correlating that to the pressures of social media and to anonymous online bullying and all these different factors that are affecting kids.
00:44:39.000So I think that could be considered a far more significant new form of distress to children and young people than even marijuana.
00:44:53.000Because I think that what makes people really depressed, maybe more so than anxious, but definitely both, is that when you compare yourself to someone else.
00:45:02.000And people, obviously we've done that, all humans have done that since history began.
00:46:49.000Part of it, one worry I had, I haven't looked into the statistics yet, was when you're growing up and when you're in high school, if you want to be part of the cool crowd, so to say, you usually drink or you smoke pot.
00:47:50.000And their mental health doesn't seem to have changed that much based on the NSDUH data, okay?
00:47:56.000The data shows a big change in kids 18 to 25. They go to college, something goes wrong for a lot of those kids, at least in the last few years.
00:48:07.000But wait a minute, when you're talking about suicide rates, suicide rates, especially with young girls, who are apparently more affected by social media, they've gone up significantly since the rise of social media.
00:48:50.000Well, let's find out what the numbers are.
00:48:52.000Because when Jonathan Haidt was on the podcast and he discussed it, he showed this chart and it's an alarming increase directly correlating with the increase in use of social media.
00:49:39.000Look, Jonathan Haidt's work is very well respected.
00:49:43.000What I'm saying to you is that there's a clear increase in psychological distress in kids and young adults 18 to 25. There's a clear increase.
00:49:52.000And those are the people who are most likely to be using cannabis right now.
00:49:56.000Those are the people that are most likely on social media as well.
00:50:08.000And I've said at the beginning of the program that I think that marijuana, with some people, is not beneficial and, in fact, could be negative.
00:50:14.000But I don't understand why you're not willing to admit that social media has a significant and unprecedented impact on young people that we've never seen before.
00:50:54.000I don't think there's anything that would point to that.
00:50:57.000Well, what I can tell you is proven is that kids today, I'm talking about teens, 12 to 17, have less psychological distress by all these measures.
00:51:07.000I'm talking about their actual behaviors are better, or better or worse, that's a moral judgment, but they're healthier than they were 10 or 20 or 30 years ago.
00:51:16.000They're less likely to have sex when they're 14, which I think most people say is a good thing.
00:51:25.000Well, less likely to be drinking, less likely to be smoking, less likely to have sex does not correlate to positive mental outlook and less suicide.
00:52:45.000I think we actually talked about that yesterday with Andrew Yang, that suicide amongst men in their 50s, and then they start to feel useless.
00:53:36.000Okay, that means for every 100,000 American girls in 2015, five committed suicide.
00:53:41.000That's not a very high number, but I mean, that's also someone who's pushed to the extreme of taking their life.
00:53:47.000How many girls are experiencing severe depression but don't commit suicide?
00:53:52.000That's the real factor, because this is what hate directly connects to social media.
00:53:58.000Again, the 50% increase, you're talking about a relatively small number because not as many girls commit suicide as men.
00:54:04.000But still, you were talking about depression, and you were talking about these significant factors that would lead people to have poor mental health.
00:54:14.000This could be a huge factor in this, right?
00:54:17.000And I think that, too, it leads people to suicidal ideations and depression and anxiety.
00:54:22.000I mean, right here we're just looking at suicide, which is the worst endpoint possible.
00:54:27.000Which is very rare amongst girls, period.
00:54:33.000Men do commit suicide more than women do.
00:54:36.000But we really have to be careful about that because, again, suicide is the end.
00:54:42.000It's the worst thing that could possibly happen.
00:54:44.000So what about all the things leading up to it?
00:54:48.000Are there people who don't commit suicide but suffer from terrible depression, suffer from terrible anxiety, suffer from terrible insomnia?
00:54:56.000Those people are not accounted for in that graph.
00:55:01.000And what I'm saying is that cannabis use has spiked in the United States in the last 15 years.
00:55:07.000And teens notwithstanding, we've seen a large degradation in a number of these social outcomes.
00:55:13.000And now just today, we have a JAMA psychiatry paper that looked at a bunch of other studies that said cannabis use in teenagers is associated with depression, suicidal ideation, and suicide attempts in people once they get to 18 to 30. It could possibly be a factor.
00:55:44.000You know, we are conceding the fact that, you know, you just said again that study was done on adolescence.
00:55:50.000You know, Joe and I have both conceded multiple times that, you know, we do not think high THC cannabis is good for people in that age category.
00:56:00.000But, you know, just to back up just a little bit again, you know, I don't, like I said earlier that I don't prescribe THC generally to anyone under the age of 25, and most other doctors in Canada don't.
00:56:10.000But I think that we should be prescribing CBD to these kids.
00:56:14.000Like a lot of those kids who have suicidal ideations, depression, I mean, you could never do a study on it, but how many of those kids wouldn't have committed suicide or wouldn't be feeling this way if they were using CBD? Because we know SSRI,
00:56:30.000selective serotonin reuptake inhibitors, You know, which are the most commonly prescribed medication for depression and anxiety, even in adolescence.
00:56:37.000We know that they can increase suicidal ideation.
00:56:52.000Treating people with something that's not effective or that has horrible side effects, you're going to look at other alternative treatments.
00:57:00.000A lot of people have had excellent results with CBD in that age category.
00:57:07.000I've had it done in my practice and lots of other physicians have had it done in their practice.
00:57:13.000So it's really important that when we're talking about teenagers and when you're talking about that study, you're talking about high potency...
00:57:23.000That's where Joe and I both can see that THC is not a good medicine.
00:57:30.000Look, if GW Pharma or somebody else can do a study with CBD and depression or some other cannabinoids, a non-intoxicating cannabinoid and depression and get it approved for that, that'd be great.
00:57:41.000We need all the treatments for depression and boy do we need treatments for psychosis that we can get.
00:57:57.000No, and they should try to also stay away from the other medications.
00:58:02.000So I want to push back on this, on the alcohol versus cannabis for teens thing.
00:58:06.000And I know that this is a common feeling among people in Brooklyn, among people in LA, and sort of right, when I mean right thinking, I mean sort of the general center left to left view everywhere is that cannabis is better for teens than alcohol.
00:58:34.000I think you have to really be careful with anything that severely perturbs your sense of reality.
00:58:41.000When you're a young kid and you're trying to form your vision of the world.
00:58:46.000I think to unpack what we're saying here is that there is an increase in mental health disorders amongst young kids that corresponds to the increased use of social media and may correspond to the use of cannabis, but that's not necessarily proven.
00:59:02.000What we guarantee, almost universally, is these kids are on social media.
00:59:09.000I think much more likely that they're on social media than use cannabis.
00:59:45.000I 100% agree, and I think that it has a severe impact on kids when they're trying to study for tests, when they're trying to take their SATs, when they're trying to get into a good college.
00:59:56.000I know so many people that are on that shit.
00:59:59.000I know so many people, whether they're journalists, I know comedians, I know a lot of fucking people who are on Adderall.
01:00:07.000And you need to develop that toughness when you're young.
01:00:10.000You shouldn't just be 14 years old and then you run into your first bit of trouble in your life and then you reach for a pill.
01:00:23.000So, when you teach that to kids at an early age, and when you tell them, it's such a terrible thing to tell someone, oh, you're 14 years old, you have major depressive disorder, you're going to take this pill, you need it for the rest of your life.
01:00:36.000And that's said to people all the time.
01:00:38.000They say, oh, you have a biochemical deficiency and this is what you need.
01:01:52.000We have this TV set up with this dance game that they play, and they're sweating and dancing, and after it's over, they're giggling and laughing.
01:02:00.000It's a massive alleviator of physical stress because they're constantly got to follow this thing, and it's an exercise routine.
01:02:09.000I mean, their cardiovascular rate gets up, and they really feel good afterwards.
01:02:15.000So it's not entirely negative, but it's mostly negative.
01:02:19.000Yeah, but if you have, I don't know, is it Nintendo Wii or whatever it is?
01:02:40.000So, like, you mimic this thing that the person on the screen is doing.
01:02:45.000But, I mean, that's one thing that could be considered positive.
01:02:50.000I think, for the most part, the real issue is social pressure and anxiety that comes from kids talking shit about each other, and they push buttons.
01:02:59.000They push buttons on each other because they know that they can.
01:03:02.000But do you think that's always been part of high school?
01:03:10.000These kids are waking up in the middle of the night and checking their Twitter account and finding that their friends are talking shit about them, whether it's on Facebook or whatever, and this girl from school, that fucking bitch, and she commented on my YouTube video.
01:04:33.000Some people are in a really bad situation, right?
01:04:35.000If you look at worldwide levels of psychosis, okay?
01:04:37.000Again, it's less than 1% for schizophrenia, which is the most severe version.
01:04:41.000You add bipolar disorder with psychosis, depressive psychosis, other kinds of psychosis.
01:04:45.000Maybe you get to about 3% to 4% of the population is going to be diagnosed clinically with one of these illnesses over the course of their life.
01:04:54.000So, okay, on the one hand, that's a lot of people.
01:04:56.000On the other hand, most people are not going to get psychotic.
01:04:59.000And most of the time, if they do, there's either a genetic component that's obvious, because psychosis and schizophrenia often do run in families, or there's an environmental component that's pretty obvious.
01:06:29.000And we do know, too, this is a good time, too, to talk a little bit about genetics after we kind of look at this.
01:06:36.000Because we can tease out a few things by looking at genetics.
01:06:40.000Antipsychotic Abilify is the biggest selling prescription drug in the U.S. To be a top seller drug has to be expensive and also widely used Abilify is both.
01:06:47.000It's the 14th most prescribed brand name medication.
01:07:16.000So, a lot of people need something sometimes at the end of the day or during the day to help them get through the day.
01:07:24.000Cannabis, especially the CBD component, and also the THC component, when used properly, is okay.
01:07:32.000I tell people all the time, I've made social media posts about it, that if you need to use a little bit of cannabis at the end of the day, just to help you sleep, man, you're doing great, and you're staying away from drugs, and prostitution, gambling, and all these other brutal habits that people have.
01:08:03.000By the way, I think giving people handheld devices that are inherently addictive where they can bet on sports every 15 seconds is a super bad idea.
01:09:13.000He took it and he experienced suicidal thoughts and all these, he had like severe consequences.
01:09:19.000I think that human beings, we vary so much biologically that to just make this overall blanket statement, what's good for you is good for me, is irresponsible and I've been irresponsible saying that before.
01:09:32.000Well, one reason, it's interesting, one reason I think that alcohol is so widely accepted, despite all the problems it causes and Again, alcohol can certainly cause problems.
01:09:41.000Is that alcohol affects most people pretty much the same way?
01:09:45.000And you sort of know what somebody looks like when they have one drink, when they have five drinks, if they have ten drinks.
01:09:52.000I've got some friends that get those gerbilized.
01:09:54.000You ever see when people get shark eyes?
01:11:02.000All these people have a way to get high that's clearly safer than alcohol.
01:11:06.000And unfortunately, that's just not true.
01:11:08.000I think you're right, and I think the issue that people, from what I've read, are having with your book are people that are marijuana advocates that think that your position is unbalanced and that you've ignored the positive aspects of THC in terms of, like, what he was talking about,
01:11:24.000cognitive benefits for people with psychotic episodes, and that you're only focusing on the negative.
01:11:35.000I think that's also, I'll plead guilty to that myself because I think that I've only been discussing the positives.
01:11:41.000And one of the things that I've tried very hard to do and one of the things I've learned how to do from doing this podcast and experiencing criticism and communicating with a bunch of different people with a lot of different viewpoints is Is examine my own positions and try to figure out, am I coming at this from a truly balanced position or am I trying to support a conclusion that I started out with and I'm trying to,
01:12:02.000you know, somehow or another back up my own work or back up my own statements and sort of prop them up instead of being really honest and objective.
01:12:13.000Listen, I wrote a book called Tell Your Children the Truth About Marijuana Mental Illness and Violence.
01:12:17.000I don't think you can think that that book is going to be a compendium of the pros and cons of marijuana.
01:12:25.000Well, if you want to tell your children the truth, though, you really do want to tell them the pros and cons.
01:12:30.000And you did indicate, Alex, you said we should tell people the truth in the book, right?
01:12:35.000So I think that when you're telling, and you're saying that you're telling the truth, and Alex, I'm agreeing with you that you're telling part of the truth, but part of the truth is...
01:12:46.000It's a little bit deceiving and deceptive in some ways, right?
01:13:16.000But to me, the last 20 years have been an exercise in the other side, in the legalization side, doing a very, very good job talking up its arguments.
01:13:26.000And essentially, there's almost nobody on the other side.
01:13:28.000There's this one guy, Kevin Sabet, who's gotten killed.
01:14:15.000But you can go to a casino and see people who've lost their houses.
01:14:18.000It doesn't mean that gambling should be illegal.
01:14:20.000It also means that there's less and more dangerous forms.
01:14:23.000That device in your hand where you can bet on what the next pitch is going to be, if it's going to be a ball or a strike, That's more dangerous than my having to drive to the commerce and play there.
01:14:31.000And 100% or 98% THC that an 18-year-old vapes is a lot more dangerous than a 5% CBD, 15% THC product that Dr. Hart might suggest his patient uses once a night to go to sleep.
01:14:45.000But that's the message that we should be putting out there, right?
01:14:49.000We shouldn't just be focusing on one side of the story.
01:14:52.000That part should also be included in the book.
01:14:56.000And your book, in some ways, has made me rethink the way that I write.
01:15:01.000Because my first book was co-authored with Jeremy Koston called Friendly Fire.
01:15:06.000My second book that I'm writing now is called Cannabis for PTG. So it's how to transform post-traumatic stress into post-traumatic growth.
01:15:13.000Because I feel that and we all know examples of people that have encountered really difficult obstacles in their life and some people have succumbed to that stress and they've gone down the wrong path kind of thing and then other people have used that stress to their advantage and they've actually become better because of it.
01:15:32.000And, you know, CBD and THC can both help facilitate that process.
01:15:39.000You know, when you're looking at someone like a veteran, for example, you know, the hallmark of someone with PTSD is someone who doesn't leave their home and they can't sleep at night.
01:15:48.000So like when I see a vet in my office, a lot of the times they'll be leaving their home like five to ten days a month.
01:15:55.000When you give them CBD, and this is really important for people to understand, CBD has been shown to decrease learned fear.
01:16:04.000If you can get people outside of their home, because I'm not talking about, again, someone who's too nervous to go to the bar with their friends or something like that.
01:16:15.000I'm talking to people who it's difficult for them to go to the grocery store, just pick up a few things.
01:16:21.000Those are the type of people that I see in my practice.
01:16:38.000I don't use Nabilone very much because it's only one cannabinoid and I do believe in the entourage effect and using all of the cannabinoids so I don't use that that much but that shows that THC can reduce nightmares and you know if you have PTSD I mean,
01:16:54.000if you talk to someone who has PTSD, and again, this comes from a clinician's point of view, they will tell you, I will try anything.
01:17:02.000And that's the same way when you get with the parents of kids who have seizures all day.
01:17:35.000I think no one really is arguing, except maybe the federal government in certain levels is arguing against CBD. That's probably some pushback from the pharmaceutical industry.
01:17:43.000The reality is CBD has proven to be...
01:17:46.000At least as far as I've read, very safe and very effective for a bunch of different disorders, especially those that have something to do with inflammation.
01:18:08.000Why do you think it is that people in legal states where they can really express a preference, they can go into a dispensary and know exactly what they're buying, Why is it that they want such high-potency THC product?
01:18:26.000Every year we do this thing called Sober October where we don't do no drinking, no pot, and we do some sort of crazy challenge, me and three of my buddies.
01:18:37.000When we do it, it's very interesting how your tolerance is radically reduced.
01:18:42.000Like, I'll smoke pot at the end of that month, and I'm like, holy shit!
01:18:46.000Like, I don't even know what I'm talking about in the mid-sentence, and I'm just blitzkrieged.
01:18:50.000Whereas, you know, now, like, I smoked a little weed last night, did some stand-up, had a great old time.
01:18:55.000There was no issues with it at all, but I'm used to it.
01:18:57.000And if the weed that I smoked last night, I assume you don't smoke marijuana.
01:19:02.000Okay, if you and me were together last night and I gave you a hit of my joint, you'd be still there in the corner in the fetal position going, what in the fuck is going on?
01:19:10.000Because the marijuana is ridiculously powerful, but once you're accustomed to it, once your body acclimates, it's really not that big of a deal.
01:19:16.000The problem is you're dealing with a lot of habitual daily users, and for those people, like my friend Joey Diaz, there's a video of him giving this other comedian, how many milligrams of those stars of death?
01:19:54.000Well, I think there's a real argument to be made, particularly with him.
01:19:58.000Well, I was going to make two points on that.
01:20:01.000So you definitely can develop a tolerance.
01:20:04.000And I tell people all the time, try and take at least one three-week break.
01:20:08.000But the evidence does show that if you stop for four weeks, generally all your receptors return and it'll be like you've never used cannabis before.
01:21:51.000I think we should really stop talking about CBD. I just wanted to make a note on the tolerance of the CB1. I just wanted to make a note that CB2, there doesn't appear to be tolerance.
01:22:04.000There's just such a significant impact when it comes to especially edible THC. There's a significant impact on people's state of mind.
01:23:21.000She said, and I'd used, you know, I'd smoked in college.
01:23:26.000But this was just a totally different experience for her.
01:23:28.000I think there's a big problem with education.
01:23:30.000A big problem with the education that edible marijuana, as we talked about before, I think you were in the bathroom, the 11-hydroxymetabolite as it's processed by the liver, it's a radically different drug.
01:24:23.000What I like about the paranoia that comes with edible marijuana is it allows me to check myself.
01:24:30.000It allows me to put myself, examine all of my behavior in the darkest recesses of my mind, my thoughts, and gives me a And it makes me a nicer person.
01:24:41.000It might knock down the ego just a little tiny bit.
01:24:46.000I think it just, it gives you just a little, it knocks down the ego just a little.
01:24:50.000I mean, some people use it at the end of the day and then, like Joe said, I think it makes you reflect sometimes better and more objectively.
01:25:00.000Meaning that, like, you know, maybe you had an encounter with someone earlier in the day, and then, you know, late at night, you talk up a bit, and you're like, oh, man, I probably should have done things a little bit differently.
01:25:09.000You know, like, that happens to people all the time.
01:25:12.000It forces you to reflect in a different state, and sometimes when you reflect in that state, you come up with thoughts that you just wouldn't have come up with before.
01:25:23.000My patients say to me all the time, it just kind of breaks this negative state that I have.
01:25:29.000I'm just able to break out of a negative state and think logically.
01:26:20.000But they may need to be intervened before.
01:26:23.000And to Joe's point, though, they have shown in studies that if you make an intervention outside of the psychotic symptoms, you can actually reduce the incidence of violence.
01:26:36.000And also, too, I think it's a good point.
01:26:38.000I was going to mention earlier to bring up genetics because we are teasing out genetics for people and we are discovering that certain people do have certain genetics that do predispose them to certain cannabis disorders, right?
01:26:51.000So, you know, I'm involved with a company that's doing that right now.
01:26:57.000Cannabis genetic test for people, right?
01:26:59.000And there's three genes that we've identified so far.
01:27:03.000You know, one of them is the MAPK14 genotype, and that has been shown to be associated with a deficit in brain volume when you do use cannabis.
01:27:14.000And then there's two other genes, the AKT1 and the CADM2 genotype.
01:27:19.000Both of those have also been shown to be associated with cannabis.
01:27:47.000So if we can identify the people who are at risk, then we can maybe potentially use the medicine in a way where only the people who don't have these genetics are using the medicine.
01:28:00.000And then for the people who do have these genetics, they stick mostly to...
01:28:05.000CBD. I just think that's a better approach than just prohibiting cannabis or saying that we shouldn't use it at all or saying that it's not medicine.
01:28:17.000I think that it should be held to the same standard as any other medicine.
01:28:21.000And I think that if we had an incredible medicine that worked for some people and that didn't work for others, then what we would do is we would try to figure out why.
01:28:34.000You know, full disclosure, I am on the board, enantlife.com.
01:28:38.000And, you know, when we use these different strategies, you know, then we can actually reduce the overall harm.
01:28:46.000And that should be another thing that we can add into the mix because, for sure, there's people who are definitely more predisposed to mental illness and definitely more predisposed to psychosis.
01:28:56.000I mean, there do seem to be some people who just – it breaks really fast, and I'm not sure why.
01:29:06.000You mentioned your friend whose child has autism, and you said, well, you know – If that were my child, of course, I would want to do anything possible.
01:29:17.000But I have to tell you, in the last month since the book came out, I've heard the other side of this.
01:29:22.000I've heard from so many parents whose children, and in many cases, high-functioning children, college graduates, because by the way, those are the people who've read the book or heard about the book and who have the resources to stay involved with their kids when they have these terrible breaks, who have gone completely It's completely off the rails.
01:29:40.000And the worst story that I've heard so far came from a woman in Connecticut whose son graduated from Haverford.
01:31:46.000So you think, well, okay, the worst thing that can happen to you as a parent, the worst thing is your child becomes an opioid addict and you wait for the call that he overdosed and died.
01:31:57.000It turns out that that's the second worst thing.
01:32:01.000Your son, the college graduate, the want-to-be do-gooder, becomes a schizophrenic living on the streets, and then you're waiting for the call that he killed himself or he killed somebody else.
01:32:12.000And so my view of this is in a couple more years, probably, I mean, this book has taken over my life, obviously, but in a couple years, I'm going to be back to writing novels.
01:32:25.000But this woman, these parents, They are going to spend their lives trying to destroy the cannabis industry, and that is real.
01:32:32.000Well, I think that would be a foolish thing to do, but I think there is a real possibility that some people who have a tendency to schizophrenia could be triggered by cannabis.
01:33:15.000I mean, I know people that have gone to medical school and then one semester they just can't handle the course load and then Their life just goes to shit.
01:33:43.000And it affects a certain percentage of the population regardless of cannabis use.
01:33:47.000There's a lot of people out there that have schizophrenia that have never used cannabis ever, and they've gone completely off the edge.
01:33:55.000I don't know if you can necessarily blame cannabis for that.
01:33:59.000And it would be really interesting to find out if there was some form of a treatment, like you were saying with CBD, that could counteract that.
01:34:07.000So CBD has been shown in early stage studies to have some moderate impact on psychosis.
01:34:13.000I don't think from the numbers that I've seen suggest it really isn't that strong as an antipsychotic.
01:34:18.000But I do think that if I were a researcher in schizophrenia, I would be looking at the endocannabinoid system.
01:34:24.000Yeah, you have to look at this from a clinical perspective.
01:34:29.000The antipsychotics that we have out there are not good.
01:34:49.000So, if you have something like CBD that doesn't have any of those side effects, of course, as a clinician, you're going to want to try it.
01:34:56.000Because you know that the other tools that you have are not really that effective.
01:35:00.000So, CBD should definitely be utilized for people who have psychosis and schizophrenia.
01:35:07.000Well, I think, you know, we talked about life changes, like things that happen badly in your life, losing your job, losing your girlfriend, deaths in the family can trigger these breaks with some folks, but psychedelic drugs can as well.
01:35:20.000For some people, psychedelic drugs have tremendous benefits for PTSD, quitting alcohol, quitting hard drugs.
01:35:28.000There's a lot of people that have used mushrooms, MDMA for PTSD is a huge thing that MAPS is studying right now.
01:35:34.000But you can't deny that there's other people, well-documented, that have taken LSD, that have taken psilocybin, and taken them in large doses, and gone.
01:35:45.000And that's why, too, I forget who it was, maybe it was McKenna who was on, and you guys were saying that, like, you know, we need to use psychedelic medicines, but we need to use them properly, right?
01:35:57.000And that's the same way with cannabis, as well.
01:36:00.000I consider cannabis a psychedelic, particularly when you eat it.
01:36:25.000And that's the message that I think people should be hearing.
01:36:28.000People shouldn't be hearing just part of the truth.
01:36:30.000They should be hearing the whole truth.
01:36:32.000And again, in your book, you compared Mexico and India, right?
01:36:37.000And, you know, I talked to German Lopez on the phone about this, you know, who talked to Isaac Campos, right?
01:36:43.000And he said that, so Isaac Campos, you know, he's the guy who basically, you know, told the story of how in Mexico, you know, people were blaming marijuana, people were blaming marijuana on causing psychosis during kind of like the early 1900s.
01:37:02.000And then there was some evidence as well in India at that time.
01:37:05.000So Alex kind of made the connection, 9,000 miles apart.
01:37:31.000I bought your book, so in some ways I did support you.
01:37:36.000So I read your book, and like I said, you did address in the part on India that...
01:37:42.000Yeah, you know, some of the report was wrong.
01:37:46.000But I mean, the fact is that almost a lot of those cases in India were actually attributed to alcohol or opiates or other things.
01:37:54.000And then the other thing in Mexico is that it was in those environments.
01:37:58.000So, you know, basically what I'm kind of getting at here is like, you know, the National Academy of Sciences and Engineering, you know, they...
01:38:06.000You know, disagree with how you interpreted their findings and then these people disagree with how you interpreted their findings.
01:38:14.000Okay, but Ziva is only one of the 16 members.
01:38:18.000But if we asked other members, I think that they would all say the same thing because Alex, wouldn't you be upset?
01:38:25.000If someone just quoted one part of your book and then left out all the other parts.
01:38:31.000I mean, I would think that would be a huge disservice to my work.
01:38:34.000I would not have put in a ton of effort into something, and then for someone to only have, you know, just to pick out the part that, you know...
01:38:43.000Well, that really depends on what it ignores nuance.
01:38:45.000Honestly, if I had written the NASEM report, the NAM report...
01:38:49.000And it came out in 2017 and nobody had paid any attention to it, which nobody did, and nobody did for two years.
01:38:55.000And suddenly people were paying attention to it.
01:38:58.000But what Dr. Hart is talking about is in the first chapter of the book, which I guess you haven't read, and I really should have a copy for you.
01:39:19.000The British, you know, they colonized India and they set up what they call lunatic asylums, really psychiatric hospitals, sort of very primitive psychiatric hospitals.
01:39:28.000And they were really initially for soldiers in the Indian army and they were run by British doctors.
01:39:33.000And what these doctors really as early as like the late 1850s, 1860s noticed was that a lot of the people who showed up in these hospitals were showing up with what they called ganja actually.
01:40:25.000It's like any psychiatrist today, certainly any forensic psychiatrist like my wife, would – like everything in the book would ring completely true.
01:40:34.000And it was so fascinating to me to stumble on this and realize this is something people have been talking about for more than 100 years.
01:40:41.000So – Could we agree that there are some people where cannabis is not a good idea?
01:41:58.000So the use of the drug, which could possibly trigger psychosis and schizophrenia, which are correlated with murder, is that what you're saying?
01:42:06.000They're not correlated, they're triggers.
01:42:16.000Okay, so the numbers are if you have a diagnosis of schizophrenia, you are 20 times as likely to commit homicide as somebody who's healthy.
01:42:24.000Now, it's actually worse than that for cannabis, okay?
01:42:35.000Obviously because it stigmatizes people with mental illness.
01:42:38.000So what they say, and this is true, is if you have a diagnosis but you're taking your antipsychotics, even though the side effects might be unpleasant, you're in treatment...
01:42:50.000Your risk for violence isn't that high.
01:42:52.000It's not that much higher than a healthy person.
01:42:55.000Fortunately, healthy people don't commit murder that often.
01:43:00.000The problem is, if you think about the math for half a second, if there's this one group of people who don't have a very high risk for murder or serious violence, because they're not using, because they're on antipsychotics, it means that the excess risk in the people who are using and whose psychosis is untreated,
01:43:44.000Well, you know, there's a study here, and I just sent it to you, Jamie, and it's titled Risk Factors for Violence in Psychosis, a Systemic Review and Matter Analysis of 110 Studies.
01:43:57.000So, you know, it's quite a few studies, okay?
01:44:00.000So, you know, let me just read part of it out to you.
01:44:04.000So violence was strongly associated with a history of polysubstance abuse, strongly associated with a diagnosis of co-related substance use disorder, and recent substance misuse, and moderately associated with a history of alcohol misuse, a history of substance misuse, recent alcohol misuse,
01:44:20.000recent drug misuse, and a history of drug misuse.
01:44:23.000It was unclear if there was an association between violence and a history of cannabis misuse.
01:44:51.000So, cannabis use in there is going to get locked in with polysubstance use, because a lot of people who use are going to be using other drugs.
01:44:58.000Polysubstance means multiple substances, alcohol, cannabis.
01:45:12.000Without looking at it, I can't push back as hard as I would like.
01:45:16.000What I can tell you is that I have Many studies in the book that show that cannabis use is associated with violence in people with psychosis.
01:45:26.000And more broadly, it's associated with violence in the general population in large studies, in studies of high school students and bullying, in studies of people who were vacationing in Ibiza, in studies of young men in China and the UK. There are big studies out there that show cannabis use is associated with violence.
01:46:12.000Yeah, the way the people in Spain pronounce words was directly affected by this one person, apparently.
01:46:21.000So this correlation between people that have schizophrenia and using cannabis, is schizophrenia a diagnosis that's purely based on behavior?
01:46:47.000Because you're asking someone basically a series of questions.
01:46:50.000I mean, it's no different than depression, really.
01:46:54.000I mean, you're just asking someone a series of questions, and then based upon that, which is very subjective, then you're going to make a clinical decision.
01:47:02.000Whereas when it's like a blood test, like if someone passes a certain amount of hemoglobin A1C, depending on which chart you're looking at, Then you're going to call that person pre-diabetic or diabetic.
01:47:13.000But unfortunately, we just don't have those objective measurements.
01:47:16.000And again, that's why Alex was saying earlier that they couldn't really figure out how many people in the United States had schizophrenia.
01:47:27.000At the same time, too, it's okay to adjust the way that you diagnose someone over the course of the years and you learn things because you could easily say that almost everyone has some type of mental illness.
01:47:41.000People should understand that there's seven different basic human emotions.
01:47:55.000You know, depending on which way surprise goes, I mean, six out of those seven are negative, right?
01:48:01.000Because we're wired to basically detect threats.
01:48:04.000So, you know, when we're making all these diagnoses, I think we have to be careful because...
01:48:10.000Some people are calling themselves depressed and some people are calling themselves anxious when really they're just not dealing with basic human emotions that they need to understand and need to deal with.
01:48:21.000People are getting angry about being angry or depressed about being depressed.
01:48:25.000If you feel one of these emotions, just kind of sit with it and just kind of reflect on it.
01:48:30.000And I think that's a much, much better way to tease things out.
01:48:35.000But to come back to my original point, I think that more people are understanding that we don't just need to give out a pill for everything and that everyone shouldn't just be labeled as having a mental health diagnosis because if things just keep going the way they are,
01:48:51.000By 2040, it's going to be like 50% of people are going to have a mental health disorder.
01:48:55.000People just need to understand that life is hard.
01:48:58.000You've got to deal with these emotions sometimes.
01:49:40.000Because I think people, you know, as controversial as the book has been about cannabis and psychosis, this violence issue is even more controversial.
01:49:49.000And obviously for a fair number of people, it doesn't really...
01:50:25.000Marijuana use increases violent behavior.
01:50:27.000A 50-year study finds casual link between cannabis and subsequent violent behavior.
01:50:33.000New research published online in advance of print of the journal Psychological Medicine concludes that continued use of cannabis causes violent behavior as a direct result of changes in brain function that are caused by smoking weed over many years.
01:50:48.000Researchers have long debated a possible link between the use of marijuana and violent crime.
01:50:52.000In contrast to alcohol, meth, and many other illegal drugs, the mellowing effects of cannabis seemed unsuited to promoting violent behavior.
01:50:59.000However, ample previous research has linked marijuana use to increased violent behavior.
01:51:05.000The sticky problem in such studies are that many co-founding factors involved in interpreting this correlation.
01:51:16.000It is very difficult to determine whether or not any statistical correlation between marijuana use and violent behavior are causally linked or instead the two are associated through some other factors such as socioeconomic status,
01:51:35.000personality traits, or many other variables that are related to the propensity to use marijuana.
01:51:40.000So I think that's a fairly good summary of the issues.
01:51:45.000To add, the study came from 411 boys who were born in 1953 in London, 97% of which were Caucasian, and all of them are raised in two-parent households.
01:51:57.000So those people are relatively stable if they're two-parent households.
01:52:37.000But at the same time, everybody knows that you can have a drink, you know, you can have a beer at the back of your barbecue, you can have...
01:53:56.000So even though for many people cannabis isn't going to cause violence, that doesn't mean it can't cause violence in some people, especially- Or at least could be a factor.
01:54:08.000At least could be a factor, especially with the kind of violence that I am talking about and that I write about in the book, which is, again, so alcohol- It maybe makes an argument into a brawl.
01:54:19.000It makes a brawl into something where somebody picks up a stick.
01:54:21.000It makes that into something where somebody pulls out a knife.
01:54:27.000Cannabis causes paranoia and psychosis.
01:54:30.000And it certainly causes those things temporarily, even if it doesn't cause them permanently.
01:54:34.000So a distortion in reality that could lead to you doing something- Something terrible, and it's usually to somebody you're not actually fighting with.
01:54:43.000The worst cases that I've, and I've really seen a lot of these cases, are basically innocent family members who are just in the way when somebody loses touch with the reality and literally thinks, like, my 85-year-old grandmother is going to kill me,
01:55:04.000And if you look at the amount of violence that people with psychosis commit on a population level basis, it looks like people with schizophrenia commit about 6 to 10% of all the murders in this country.
01:55:15.000And it looks like people with sort of broader, more broadly defined psychosis, again, bipolar with psychosis, other psychotic conditions, temporary psychosis, they might be responsible for as much as 20% of the violent crime in the United States.
01:55:30.000And what I'm saying is that it is quite clear that drug use mediates that violent crime.
01:55:36.000In other words, if you're not using, you can keep your impulses in check.
01:55:40.000But when you do use, you become dangerous.
01:55:43.000So when we're talking about biological variability, if we factor in schizophrenia, essentially what you're saying is that there are people that have schizophrenia that don't.
01:56:15.000So when you get that, you get paranoia from two sources.
01:56:18.000And the only good thing about cannabis from this point of view is it kind of knocks people down a little bit, but meth brings them right back up.
01:56:24.000So is it fair to say that what we don't know is that we don't know whether or not these people, like this young man with this terrible story from Connecticut, We don't know whether or not he would have become schizophrenic and exhibited those symptoms without the marijuana.
01:56:40.000We really don't know, but we do know he did with it.
01:56:43.000And what I would also say is that for somebody like that, and this is quite clear on a population-level basis with people with schizophrenia, is you've got to discourage them from using.
01:56:52.000They really have to be discouraged because it brings out the worst.
01:56:55.000And somebody said this, a friend of mine, an old friend of mine from the New York Times said, so every time there's a hurricane, some people on the right say, well, you can't prove that global warming caused that one hurricane.
01:57:22.000And the synthetic cannabinoids, K2 and Spice, those can clearly produce psychosis in people.
01:57:27.000And people with psychosis tend to slip back into it if they use.
01:57:31.000At some point, you've got to start to say to yourself, why does everything go the same way?
01:57:35.000Yeah, I also have a personal friend, and I really didn't think about this guy, but there's another personal friend that I know that is a martial arts instructor that had a psychotic break.
01:57:43.000He became schizophrenic and he's a regular marijuana user and the people around him associated that with that.
01:57:50.000In fact, people that are regular cannabis users were trying to get him to stop using marijuana.
01:57:55.000If you're close to being on the edge and you use a little bit of cannabis, for sure it can induce that.
01:58:01.000This guy was not on the edge when I knew him.
01:58:25.000I mean, whatever it was that triggered him, I mean, when I was around him when he was younger, I would have said he's a total normal guy, and I would have never saw that coming.
01:59:13.000So the place that you can criticize— Why are they bad, though?
01:59:15.000Because state-level data is not great.
01:59:17.000The place the book has been criticized— There was a Rand review, though, in 2013, and I mean, again, that stated that marijuana use does not induce violent crime, and the links between marijuana use and property crime are thin.
01:59:50.000I think we have to be really careful because...
01:59:54.000Just like with diet, just like with food, allergies, all these different variabilities when it comes to human beings, I think we have to be really careful about lumping all people together when it comes to how they get affected by various compounds.
02:00:13.000So the state level thing, if you want, I'll, so the place the book has been criticized, in my mind, sort of the most fairly is, it points out that in the four states that legalized first, which is Alaska, Washington, Oregon, Colorado, if you look at 2013,
02:00:28.000and then you compare that to 2017, murders and ag assaults, violent crime, are up substantially in those states, and substantially more Can I stop you there?
02:00:40.000Is there a possibility there's a correlation between organized crime?
02:00:43.000Because one of the things about selling marijuana is the people that have always been selling marijuana have been criminals.
02:00:48.000When you make things legal in a state, the people that were selling it illegal flock to that state, and that's been It's been proven to be true.
02:00:57.000There's a direct correlation between people being robbed.
02:01:01.000There was also a significant problem with credit cards and banks, where everyone was having to do all their transactions with cash.
02:01:08.000There was a lot of violence that was associated with marijuana in regards to that.
02:01:12.000And also, massive increase in population.
02:01:15.000And that's part of the reason why Trump is actually not really against cannabis in some ways.
02:01:21.000It's because he feels that if we have medical marijuana laws, especially the states that are border states, that the crime is going to drop tremendously.
02:01:38.000And then again, you know, Benjamin Hansen, who's an economist, he said that the murder rate did not demonstrate that marijuana legalization increases violence, and then it may have actually demonstrated that legalization slightly decreased violence.
02:01:57.000And he thinks that the reason that there was an increase in the murder rate, particularly in Washington, is because there is a large income gap.
02:02:04.000They say that Washington has the 10th largest income gap in In the United States.
02:02:09.000But how did that change, though, the correspondence to the murder rate?
02:02:20.000Well, I mean, that is one thing that has been shown to increase mental illness like we talked about and can definitely increase violence is when you have an income gap.
02:02:31.000But how has the income gap shifted that directly correlates to the legalization of marijuana?
02:02:36.000Because during the same period, the income gap, particularly in Washington, increased.
02:03:01.000Violent crime in those four states increased more rapidly than in the U.S. Period.
02:03:07.000Between 2013 and 2017. Here, Jamie just posted this up here.
02:03:11.000Conjecture aside, no credible data exists.
02:03:13.000It supports a significant association between the increased violent crime and marijuana legalization.
02:03:17.000Furthermore, studies suggest that, so far, violent crime decreases in states with legalized medical marijuana until new research credibly suggests otherwise that claim that a demonstratable link between the two exists will remain classified.
02:04:47.000Well, first of all, population did increase.
02:04:50.000It's also possible that these states, quote-unquote, imported violent crime.
02:04:53.000In other words, that you've got a population of transients coming in, in part, because marijuana was legal, and those people are likely to commit violent crime.
02:05:00.000And on top of that, organized crime people that are selling.
02:05:11.000But what I am saying is that unequivocally, unequivocally, the people who said legalization is going to decrease violent crime, and people did say that, and Cory Booker in 2017 said it, he said that it actually had decreased violent crime in states that legalize.
02:05:51.000Because the FBI reported that the murder rate went up 1% from 2015 to 2016 as compared to the nationwide, which went up 7.9%, and then it dropped by 11.6% between 2016 and 2017. Those are FBI numbers.
02:06:06.000You do not know what you're talking about, okay?
02:07:22.000He used a data set that includes justifiable homicides, meaning I'm in my house, you come in, I shoot you and kill you, the police don't charge me with anything, and police homicides.
02:07:32.000But the data sets you use in your book aren't even published.
02:07:37.000Those two categories of crime are not likely to be impacted by cannabis use.
02:07:42.000Cops are not smoking when they're on patrol, I hope, and if you are using, you're very unlikely to have your murder viewed as justifiable homicide.
02:07:50.000The fair comparison is Is the base murder rate in the U.S. And that's the number that I used.
02:07:57.000And I am telling you, I mean, I know these numbers.
02:08:00.000I sleep, you know, I wake up with these numbers.
02:08:03.000Cannabis, the four cannabis legal states on a per capita basis, crime murders rose 31% on a per capita basis in those four states over the 2013-2017 period.
02:08:16.000I'm sorry, I said 31%, maybe it's 29%, so maybe I woke up.
02:09:08.000But if it's causing heavy use and some of those people are sliding into, you know, paranoia and psychosis, you'd sort of expect the gap to increase over time and that's what's happened.
02:09:20.000Okay, so, you know, I'm going to go back again to the Netherlands, okay, because they've had, you know, cannabis legalized forever and they have one-fifth of the homicide rate that the United States does.
02:09:31.000Right, but they also have a lower cannabis use.
02:09:47.000And again, you know, Alex, you know, I appreciate some of the...
02:09:50.000When we're talking about the correlation between cannabis use, one of the things that we have to accept in America is that When you're in a place like the Netherlands that has a long and accepted history of use, people are accustomed to it.
02:10:04.000I think one of the things that we're dealing with with the United States is people that have just, they don't have a long history of experience and it becomes legal and then they use it and maybe some of them, like we're talking about, don't have a tolerance for it, have too much, and Like I was talking about with my friend who's like this really...
02:10:22.000The one who had an edible and became suicidal and was fucked up for weeks.
02:10:28.000Guy's very confident, very articulate, very intelligent.
02:10:31.000He's not a weirdo, not a transient, extremely successful.
02:10:37.000You know, I think there are variables that we need to take into consideration.
02:10:41.000There's certain human beings that exhibit a pattern of behavior that's directly correlated to cannabis use that I don't experience.
02:10:49.000So if I could say from my own personal biases that that's bullshit, that's nothing, it doesn't do anything, I've been smoking for years, doesn't do shit.
02:10:56.000Well, you probably don't have one of those three genes that we were talking about earlier.
02:11:02.000And you probably also, too, don't overuse or you have some type of legitimacy as to why you are using it.
02:11:12.000And I want to keep going with this, but at the end of the show, I think that we should make some type of recommendations for people just because...
02:11:22.000I hate when, you know, you have this big, you know, three-hour podcast and then at the end of it, it's just like, hey guys, just be safe.
02:13:11.000I'm not an expert on this subject but it's because of something called pruning that we go through.
02:13:17.000So everyone goes through this and basically if you're adolescents you're going to drop off some weak neural connections to kind of pick up some stronger ones.
02:13:26.000It's the best way to kind of explain it.
02:13:29.000When you use cannabis, you can potentially accelerate that process.
02:13:33.000And then because you accelerate that process, you don't get those good neural connections.
02:13:39.000And then people, unfortunately, develop things like psychosis and schizophrenia.
02:13:45.000So that's kind of where the issue lies.
02:13:48.000You know, one thing that I am, you know, very happy that we're talking about, and I know Alex will be too, is that, you know, we want to discuss the benefits in this podcast, make sure that people understand that, you know, I believe that marijuana is medicine.
02:14:03.000But the other thing, though, too, is we do want to mitigate the risks because there are real risks out there.
02:14:10.000So, you know, I do appreciate, you know, us talking about adolescents and making sure that they do stay away from cannabis.
02:14:17.000Yeah, and I mean, especially that's like, I read these, you know, these cases, case files sometimes, you know, the kid started using when he was 11, and, you know, it's like that kid never had a chance, right?
02:14:28.000And obviously, oftentimes, these are kids coming from disadvantaged backgrounds anyway, but, you know, they're using by 11, and at 16, they put a, you know, put a gun to somebody's head and pull the trigger.
02:14:38.000I mean, the pre-adolescent and early teen use, we got to do everything we can to stop it.
02:14:45.000The problem is, yeah, if you smoke pot in junior high, say 7, 8, 9, you're probably going to smoke pot in high school.
02:14:52.000That's what I saw when I was growing up.
02:14:56.000Even when I was home for Christmas for a few days, a couple of my friends even talked about some people that we knew smoked a ton of pot in high school and now they're crazy or they're not really doing too much.
02:15:15.000We're dealing with a lot of ignorance.
02:15:16.000We're dealing with a lot of ignorance when it comes to biological variability, right?
02:15:22.000We don't really understand how a lot of these different things affect people, including like just diet and what causes depression, like how much of what we constitute or what we decide is depression is inflammation, poor gut health.
02:15:49.000And so I see these people where it's pretty obvious to me that something's going on and that marijuana is not a good idea for them.
02:15:56.000And I just think, you know, like I said, in the past, I myself have been guilty of using this sort of blanket description of it as being a positive influence and that it's a good thing for people.
02:16:10.000I don't think it's a good thing for everybody.
02:16:11.000No, it's definitely not a good thing for everybody, and it's definitely not a good thing for the people who have those genetics that I discussed earlier.
02:16:19.000Also, too, you need to have some type of self-awareness.
02:16:25.000The people who don't do well with cannabis, you shouldn't have to have your friends tell you that, okay, man, you're not doing too well with this.
02:16:34.000You should be able to figure out yourself.
02:16:37.000I mean, it's one of the most difficult things for people to do is to self-assess, you know, to be objective.
02:16:42.000You know, and I've obviously heard from a lot of people who used heavily and have seen other people who've used heavily in the last month.
02:16:48.000And I think it's very interesting why people continue to use when they're getting paranoid.
02:16:53.000And And, you know, the most cogent argument – and again, I'm not – you know, I've smoked a handful of times in college and after college.
02:17:01.000I actually don't think I'd be comfortable using high THC cannabis now knowing what I know.
02:17:05.000But anyway, so the people – I got some right here.
02:17:16.000I'll give you the shit to put Elon on the moon.
02:17:21.000But the most cogent argument, I thought it was so interesting.
02:17:25.000This guy said, well, you know, my friends, I would talk to them and say, I'm paranoid now, but I'm going to smoke through it.
02:17:30.000I'm going to smoke so much that I'm almost comfortable being paranoid.
02:17:34.000And I think that's a dangerous thing to do to your mind.
02:17:38.000Because you're sort of counting on being able to step back from that and stop using.
02:17:43.000Yeah, that's a silly way of looking at it.
02:17:46.000I think that some of what we call paranoia, just normal paranoia, is hypersensitivity and hyper-awareness and awareness to a lot of things that you're putting off in the back of your head because in order to function as a normal person and get through this life,
02:18:02.000you can't really be aware of everything.
02:18:50.000So there's only so much you really can think about, and some of what paranoia is, is this hyper-awareness of all these variables that you really haven't considered.
02:18:59.000And then also, we were talking about before, things that can be beneficial, the hyper-awareness of how you communicated with people, and maybe you could have done a better job with that, maybe you You came in hot.
02:19:09.000Maybe you were upset about something else when you ran into them.
02:19:11.000You were already at a seven, and they brought you to a ten, and it was totally unnecessary.
02:19:15.000With a normal situation, you would have only been at a two.
02:19:18.000Those things are real, and sometimes marijuana helps highlight all the errors in your way.
02:19:24.000I think it can be a tool, but my description of it is like any other tool, like a hammer.
02:19:29.000You can build a house with a hammer, or you can just hit yourself in the dick if you're fucking crazy.
02:19:33.000And this is something that I think we should consider when we're discussing almost any psychedelic medicine.
02:19:40.000And I think that I really do believe that marijuana is a psychedelic.
02:19:43.000And I don't even think it's a mild one, especially when it's in edible form.
02:20:05.000Yeah, it's just a feeling of they're not someone who can just sit and be by themselves.
02:20:13.000They just give me the impression that they're not going to do well with cannabis because If they have any type of change in their psyche, they're going to see that as bad.
02:20:28.000When you're using cannabis, you have to be someone who knows that, okay, I'm going to get a little bit of maybe paranoia now, or at least my psyche is going to change a little bit.
02:20:43.000But some people, I know that if they use a little bit of THC, they probably would have a freak out.
02:20:50.000They probably would have a bad experience.
02:20:52.000Generally, it's people who are very, very fearful.
02:20:55.000Now, the other side of that coin, though, is that if you use CBD, and like we discussed earlier, that can decrease learned fear.
02:21:01.000So that's something that's really helpful for those patients.
02:21:06.000I do agree that we have to be careful about using high THC in certain groups of people, for sure.
02:21:15.000You know, I think one of the, and it's great to hear Dr. Hart say this, one of the real disappointments for me with this book has been, really the biggest disappointment for me, has been that the DPA, the Drug Policy Alliance, and that some of the other advocates, they just want to yell at me.
02:21:31.000And they want to say that I don't understand correlation and causation and that I'm cherry-picking studies.
02:21:36.000Let's acknowledge that a lot of people use this drug.
02:21:39.000And that's true whether it's legal or not.
02:21:42.000And let's acknowledge that probably in 2020, certainly if there's a Democrat elected, most of the Democratic candidates have said they favor legalization.
02:21:49.000There will – legalized cannabis will probably be the law in the United States, okay?
02:21:53.000And let's talk about what we're going to tell people who are using.
02:21:57.000And I had this roundtable with the executive director of the DPA and some other people.
02:22:03.000This was about a month ago, shortly after the book came out.
02:22:07.000And I proposed what I thought were really common sense warnings.
02:22:16.000It was stuff like, you know, if cannabis, if you have a family history of severe mental illness, you probably should not use cannabis.
02:22:22.000You probably, you should not use cannabis or try to delay your use until you're in your 20s, I think was one of them.
02:22:28.000And one of them, I mean, I thought, I couldn't believe I was getting pushback on this, was something like, So if you're having strange thoughts, especially paranoid thoughts while using cannabis, the drug may be increasing your risk for severe mental illness and you should not use it.
02:22:45.000I mean, I think that's – I think if – now look, we can argue about how severe is, right?
02:22:50.000But certainly if you wind up in the ER even once – That's a bad sign.
02:22:55.000I just don't understand why the legalization...
02:22:58.000Look, I can understand why people who are selling this drug don't care.
02:23:02.000We know if tobacco has taught us one thing, it's that when you're selling a product, you will sell it to people even if it kills them.
02:23:09.000But I don't understand why these people who are supposed to be...
02:23:13.000Science-driven and supposed to be thinking about the greater good won't agree to reasonable discussions about what the warning should be on this.
02:23:21.000I think you did yourself a slight disservice by not including some of the beneficial aspects of cannabis.
02:23:58.000Complicated discussion that has to do with biological variabilities.
02:24:01.000It has to do with unique situations with human psychology, the way the brain functions, whether or not it can act as a trigger to schizophrenia where someone may not have ever experienced that trigger without it.
02:24:14.000Maybe if they just became a long-distance runner and they would have lived a healthy life with no psychotic breaks at all.
02:24:36.000You know, some people can't eat fish, you know?
02:24:39.000They eat fucking shellfish and their throat seizes up.
02:24:43.000There's so many variables when it comes to the human body, whether it's your genetics or what you've eaten in the past and how it's shaped your gut biome.
02:24:54.000There's so much that we don't know and don't understand about how we interact with all the various substances that we take into our body.
02:25:02.000One thing, though, too, I noted in your book, Alex, is that you said that you didn't think that cannabis can help the opioid epidemic.
02:25:15.000So, you know, I have seen a lot of people in my practice come off of opioids with cannabis use, and there are various medical studies that do show that people who use cannabis can replace opioids with cannabis use.
02:25:31.000A lot of folks feel, though, that that's just a patch.
02:25:35.000And really the best way to get off of opiates is Ibogaine.
02:25:39.000And that Ibogaine, the repeat rate of addiction or people try it again afterwards is really low.
02:25:46.000I think one of the things with that is just the accessibility, the affordability.
02:25:51.000I've never administered Ibogaine before.
02:25:55.000Well, it's just because it's illegal in the United States, and it's a particularly ruthless medication that I've never tried personally.
02:26:01.000But the people that I know that have tried it have had spectacular results, especially people that have had problems with pills.
02:26:07.000In fact, a friend of mine, my friend Ed Clay, he opened up a clinic in Mexico based on his own interaction with pills.
02:26:14.000He had an injury, he got hooked on the pills, and really had a fucking problem, so went down to Mexico and went through an Ibogaine session and cured him.
02:26:23.000It literally changes the way your brain interfaces with your addiction.
02:26:28.000It's not simply a perspective enhancer.
02:26:31.000It changes how your body and your brain deal with opiates.
02:26:36.000I think Tim Ferriss has actually talked about that before as well.
02:26:41.000But, I mean, you know, I've seen it in my practice and there are medical studies, so I don't think that we should throw out the fact that, you know, cannabis can help the opioid crisis.
02:26:52.000And then also, too, you want to look at it from a clinical perspective, right?
02:26:56.000So we know that opioids can kill people, right?
02:26:59.000Because it acts on the brainstem, whereas, you know, cannabis doesn't.
02:27:02.000So, you know, you might be saying, you know, you're just substituting one for the other.
02:27:07.000And, you know, sometimes that is true.
02:27:09.000But if you're using a less harmful substance, you know, to me, that's like a huge win, right?
02:27:14.000So if someone, you know, has to drink, you know, 12 beers a night versus smoking like one joint, man, that's awesome.
02:27:23.000And I mean, you look at all these clinics, like you look at like I mean, what are they doing?
02:27:27.000They're trying to get people off one substance to a substance that is a little bit less harmful.
02:27:33.000And I think that when you use cannabis, it can be effective for opioids.
02:27:38.000It can also be effective for benzodiazepines and for other medicines as well.
02:27:44.000It'd be awesome if everyone would just feel happy and great all the time by just exercise and nutrition.
02:27:51.000And that's what I advocate and that's what I try to do personally and that's what I try to say to my patients all the time.
02:27:58.000But I understand though that sometimes life is hard.
02:28:06.000You have personal crisis that can throw off your mental health and then you have You get into a car accident, you know, and you could be in really severe pain.
02:28:14.000And in those times, you know, sometimes diet, exercise, meditation, doing all the right things just isn't quite enough.
02:28:23.000And, you know, I think that it's great that we have cannabis for those situations because It does seem to be very effective and has less side effects compared to some of the other medicines that we have traditionally used.
02:28:38.000And even though I'm talking about opiates and deaths, We can also talk about NSAIDs, right?
02:29:48.000You're not going to want to do things.
02:29:49.000So, you know, if you're giving someone a medicine that nails their testosterone levels down, that's going to really, you know, wreak havoc on their mental health.
02:30:00.000I just want to make a note, too, because Ben Greenfield, who, again, I really, really respect, I like that guy a lot, was talking a little bit with you about testosterone and cannabis and how it can drop it.
02:30:13.000So I think there was three studies I saw done on humans, and two of them noted no statistical difference in dropping testosterone levels, and one study, the other study, noted a small statistical difference.
02:30:29.000So, you know, I think that it may drop your testosterone levels a little bit, but it's not going to, you know, substantially drop them.
02:30:37.000So just so people know that, because I know that comes up all the time, you know.
02:30:43.000Yes, as the dumb anti-drug advocates like to say, doobies cause boobies.
02:31:31.000One argument, and this is actually a pro-legalization argument, is one reason it's a gateway is that if it's illegal, you've got to buy it from your friendly neighborhood dealer.
02:31:40.000He might have access to heroin or cocaine, other drugs.
02:31:44.000And so eventually, maybe you decide to try one of those other drugs.
02:31:47.000So actually, that's really why the Dutch legalized.
02:31:49.000They wanted to create an avenue for people to use cannabis that wasn't connected to other drugs.
02:31:56.000Another possibility is that using an addictive intoxicating substance...
02:32:00.000You might like it, and you might want to try other intoxicating substances, and it might prime your brain.
02:32:05.000And then the third possibility, really, is that there are just some people who are risk-takers out there, right?
02:32:11.000They're going to use cannabis, they're going to gamble, and cannabis is a little bit easier to access than other drugs, so they're probably going to try cannabis first.
02:32:19.000So it's not really that cannabis drives the use, it's just that cannabis is first.
02:32:56.000I think that probably it's a combination of these things, right?
02:32:59.000There's certainly an environmental factor where, again, if you're buying from somebody who's got access to other illegal drugs, maybe you try those drugs.
02:33:40.000And, again, the state-level data is not as good.
02:33:43.000If you want to really figure out what's happening to an individual, the best way to do that is to follow that individual.
02:33:49.000And there's a really good paper that came out in 2017 after the NAM report, so they didn't have it, that shows that people who used cannabis in 2001, this is based on a large national study in the U.S., were three times as likely to be using opioids three years later.
02:34:06.000And that just intuitively makes sense to me.
02:34:09.000And the other thing that people on the legalization side don't ever talk about is, who are the two countries that have the most cannabis use in the West?
02:34:24.000Okay, but there's a real issue with that because the United States is also the only country other than New Zealand that allows pharmaceutical companies to advertise.
02:34:38.000Particularly, I don't know if you ever saw the documentary, the OxyContin Express, but the way Florida used to be structured where they didn't have a database.
02:35:13.000The way the access to opioids in the U.S., I mean, certainly it's come down a little bit in the last couple of years, but, you know, Purdue Pharma, there's a special place in health for those guys.
02:35:50.000And again, everyone here in this room, we're all pretty healthy.
02:35:54.000I don't have a bad back or I don't have a mental health diagnosis or anything going on.
02:36:00.000You know, I have to look at patients that are coming to me, right?
02:36:03.000So, the way I see it is that, you know, we just mentioned a bunch of other drugs, you know, antidepressants, amphetamines, all these types of things.
02:36:10.000You know, cannabis, and again, you know, I'm going to separate the THC and the CBD. It's an incredible medicine and it doesn't kill people, right?
02:36:19.000So as a clinician, you know, that's so comforting for me to know that every single night I go to bed, I killed zero people.
02:36:29.000So that's really, really comforting for me to know.
02:36:32.000Also, I feel, you know, we were just talking about amphetamines and we were just talking about, you know, SSRIs.
02:36:37.000I feel that cannabis, you know, particularly the CBD component is Can actually be more effective.
02:36:42.000That's what I've seen a lot in my practice and other people have seen that as well.
02:36:46.000So I think that we need to take that into consideration when we're using all these drugs.
02:36:51.000And Alex, some of the things that you're saying, they're quite admirable and a lot of things like researchers say, are quite admirable as well and they feel that they can tell clinicians, give them really good advice, but they're not the ones in the trenches.
02:37:09.000They're not the ones in front of the people.
02:37:10.000They're not the ones that have to chat with patients.
02:37:14.000I have an obligation to do something for my patients to make them better.
02:37:18.000I really feel, we just listed a bunch of drugs, that cannabis is a really, really effective tool and it doesn't kill anybody.
02:37:27.000So because of that, I'm going to keep using it.
02:37:32.000But like I said, I'm always looking for other drugs.
02:37:34.000I'm always looking for other alternatives to also help my patients.
02:37:39.000But I think that using cannabis is a really effective tool for a lot of clinicians and it's helped a lot of patients.
02:37:48.000But what do you think about his argument about it being a gateway drug?
02:37:51.000Other than what these people said in the study that there's no evidence that supports it, it's a gateway drug.
02:37:55.000What are your personal feelings about that argument?
02:37:58.000So I don't feel that cannabis is the gateway drug.
02:38:02.000I do feel that one of the things that you mentioned earlier is that some people kind of have this personality where they're like an experiment.
02:38:31.000You could say anything that was easier access.
02:38:34.000If there was some new drug that did something similar to alcohol or similar to cannabis that was introduced in our society, you'd be calling that the gateway drug.
02:38:45.000Well, alcohol has clearly been demonstrated as being the gateway drug to almost all hard drugs because of the loosening of inhibitions, whereas the opposite could be said about cannabis, that it makes you paranoid, you might actually be less likely to try cocaine afterwards.
02:38:58.000And I know that the name, they don't feel that cannabis is a gateway drug either.
02:39:04.000I mean, again, they said they found no compelling evidence to support the gateway theory.
02:39:09.000And again, I mean, these are the people that you are quoting in your book, Alex, right?
02:39:15.000They said, in a retrospective cohort study, Mayette from ETAL in 2016 examined the transition from cannabis use to the use of other illicit drugs.
02:39:25.000They found that the probability of initiating other illicit drugs after cannabis did not differ significantly from the probability of starting with other illicit drugs.
02:39:34.000So it's just that cannabis is there first.
02:39:37.000It's definitely not a gateway drug in any stretch of the imagination.
02:39:43.000And again, there's 50 years of data on this.
02:39:45.000I know the studies that he's quoting, but there are many others.
02:39:49.000And I think the argument is as to why.
02:39:52.000And again, I think the argument that to some extent having access to this drug illegally tends to open you up to other illegal stuff, which to me is an argument for legalization.
02:40:04.000But I do want to throw one thing out there.
02:40:07.000I don't know how many of your viewers have teenage kids.
02:40:11.000They're probably more likely to be teenage kids than to have teenage kids.
02:40:32.000Because, well, first of all, it gets kids, teenagers, used to...
02:40:46.000I think it really worries me and I've heard from a lot of parents in the last month that there is an epidemic of nicotine vaping and THC vaping going on right now.
02:40:57.000And we're talking about 15-, 16-, 17-year-olds inhaling pure THC, the most dangerous form of this drug.
02:41:05.000And I think, unfortunately, it's not going to take long before the mental health consequences of that become apparent.
02:41:11.000And I really do hope that the book gives parents some tools to talk to their kids about that, if nothing else.
02:41:26.000Okay, so, you know, you're a dude, you're over 50, so prostate cancer.
02:41:31.000So, you know, it's been shown that CBD may actually be beneficial for prostate cancer.
02:41:36.000And one thing within that, too, in the same study, they actually found that people who used CBD and were on chemotherapeutics has actually augmented the efficacy of the chemotherapeutics.
02:41:47.000Good for prostate cancer, do you mean to prevent it?
02:41:53.000And then they say THC may actually be a little bit effective because it can, and this comes back to testosterone a little bit, it can antagonize DHT. So DHT is another testosterone hormone, as you know, and that's more linked to prostate cancer.
02:42:10.000One thing, too, we didn't really get to talk about was CTE and concussions.
02:42:16.000I know a lot of your viewers are in MMA and all about that, and I tweeted out a study the other day that you were tweeting.
02:42:23.000It was a three-year study that showed that the mortality rate overall was 9.5% for people who had suffered a TBI. People who tested, I know we talked about correlation causation, but the THC users only had a 2.4% mortality rate.
02:42:39.000The non-THC users had 11.5% mortality rate.
02:43:22.000Again, there's only one study on it, and it was done on rats, but, you know, I'm a keto guy, too.
02:43:28.000But the study on rats, interestingly, showed that if you do have a high-fat diet, that you can actually decrease sensitivity at the CB1 receptor.
02:43:40.000And they think that that's just because there's an increase in your endogenous cannabinoids, 2-AG and anandamide.
02:45:39.000But again, I'm a clinician, so I'm using mechanisms of action.
02:45:43.000I'm using what I see in In clinic, and I'm using epidemiological studies, and I'm also taking into account what other medicines do I have, you know, based upon all the data, this seems to be an effective treatment.
02:45:53.000And I am absolutely not saying that you as a clinician shouldn't do that, especially you're in Canada, cannabis is legal, you should use your best judgment.
02:46:02.000What I'm saying is that when we're talking about...
02:46:04.000Policy decisions around cannabis and THC, and to a much lesser extent CBD, the advocacy groups have seized on this very, very preliminary data to say a lot of things about cannabis and THC that have not been proven.
02:46:20.000You know, a guy I know named Peter Bach, who is very smart.
02:46:49.000We, if we're clinicians, I mean, I'm not a clinician, you're a clinician, want to be able to give people who come into our offices something.
02:46:55.000But that hope is not a substitute for science.
02:47:01.000You want your patients to have hope, okay?
02:47:04.000But the advocates, the people who are using this to push, especially to push THC and to capitalize on the public confusion around THC and CBD, I think that is a real, it's a real disservice to people.
02:47:31.000I've never heard such a detailed analysis of all this stuff in a way where you can get two opposing people that are, you know, very civil about it, but agree on certain aspects of it.
02:47:43.000I think we really highlighted all those things.