Cannabis Culture: The Risks, Benefits + Myths

27:01But then, you know, they quickly increase their use and become dependent on it that so that they feel like they can't actually go out and succeed in the world and function in the world without it. And when they stop, that anxiety increases in this sort of double whammy of how do you get somebody through the withdrawal symptoms that can sometimes basically be an even greater manifestation of the underlying issue that they were using the drug for in the first place. Yeah, it is layering. And it's double whammy, I guess, is the right term because I'm seeking this out for relief. I feel relief. And so I will continue using it.

27:38But this is part of what happens with any intoxicant that provides relief during intoxication is that your body acclimates to that. That's what allostasis is about. And so it, in many cases, requires higher doses. And for those who use daily, then they get into this pattern of then any absence of it, their brain sort of panics that it's actually worse than the pre-existing anxiety, mood, etc. etc. So it's a real challenge in folks who really come in sincerely seeking relief. Again, this does not happen with every patient. But when I see them, it's very challenging to navigate this and also try to isolate which things are contributing.

28:13And how do we address all of those in parallel rather than like, oh, we'll wait until you quit using them, we'll see how your mood is. I think you, you know, as a clinician, I want to address all these things at once and help provide relief. Can we double click for a second on the sort of on the young person. I mean, that's your purview. And, and I just because, you know, it is really disturbing for parents, I think, you know, especially, like, we grew up when marijuana was like, not that big of a deal, you know, I mean, I always personally had like, my reaction to it was always, it always kind of made me catatonic.

28:51I never really, I never really was like a big pot user, which by the way, no one says pot anymore. Do you know that my kids make fun. Yes, yes. You know that because you've investigated it for the New York Times. Sorry, we, you know, I never had a good reaction to it. But, you know, I understand that, like, obviously, women, a lot of young people do it, they try it, and it's so available now. And are you concerned? I mean, so for the parents out there, like, what are the concerns? I know you've done some research on brain development for, you know, adolescents who are using marijuana, can you give us a little bit of the lay of the land of what you're seeing?

29:36Sure. So we're, I'm lucky to co-lead with Dr. Lindsay Swiglia, the MUSC site of the NIH adolescent brain cognitive development study, the ABCD study. And we've got - Wow, that's a mouthful. It is. So sorry, it's acronym city, but we have 12 ,000 youth and families enrolled in this study where we started ages nine to 10, and we're serially following them into adulthood. And we're getting all kinds of assessments around genetics, around scholastic performance, behaviors, substance use, but we're also getting neuroimaging, etc. And we're sort of prospectively following this huge cohort during a time when a lot of people use substances.

30:12And so we're going to learn all kinds of things from ABCD. We already have a lot of published studies from this. Again, I'm part of a larger group that's doing this work. But one of the things is to really tease out the specific role of cannabis in being related to what predicts cannabis use, what cannabis use predicts in terms of longer term health outcomes. And, you know, it's, you know, science is always advancing. We're learning intervally over time, but we certainly know at least behaviorally with adolescents is that cannabis use is associated with impairment in cognition. We certainly impairs driving performance.

30:44And then what we're concerned about is the youth who use cannabis versus those who don't tend to have poor scholastic outcomes and poor occupational outcomes longer term. How that plays into neuroimaging and brain findings is it's a little bit complicated, but we do see some differences, particularly among frequent users versus non-users. We're trying to correlate those behaviorally. But generally speaking, there does seem to be some differences, but also we recognize that there are some shared predictors of cannabis use and other problem behaviors, et cetera. Hmm. Yeah. And I think it's interesting to note that the, you know, obviously there's the sort of scientific research that's done to identify health issues that are occurring with adolescents and others with marijuana.

31:28But the other way to kind of try to gauge what's happening with users is, you know, there are surveys that are done, general population surveys that ask, like there's a national survey that's done every year that asks people of all ages about their drug use. And in that, we ended up kind of going in and doing some with working with a researcher at Columbia to do some more in-depth analysis of that, the findings of that survey. And we found that, you know, the, you know, especially at 18 to 25 year olds today, you know, the, the, like more than 4.5 million use the drug daily or near daily. And 81 % of them report, like basically meet the criteria for cannabis use disorder, which is, there's basically 11 criteria that are used to identify if you have got issues.

32:18You know, if you've got problem use of a drug, like are you building up tolerance? Do you, you know, are you not able to stop even if it's negatively impacting your life? So the fact that 81 % of 18 to 25-year-olds say that, you know, that they're meeting the criteria, they're reporting that back in the survey we thought was striking. And for 12 to 17 year olds, the cannabis use rates have actually stayed relatively flat, even with recreational, with the drug becoming legalized and commercialized. But the cannabis use disorder rates are ticking up and they're higher than the rates of alcohol use disorder among adolescents.

32:57And so I think that those are some pretty striking evidence of problematic use. And then I was also just one of the things that I think was most striking to me and a lot of the readers of our work was this association with psychosis. And, you know, that was really scary to read about, honestly. And that's something where there were so many doctors who just said, you know, people would be so much better off not starting this drug until they were 25 and their brain was like fully developed. because, you know, it's in that adolescence period of brain development that people can, you know, tip into chronic psychotic disorders like schizophrenia.

33:34And, you know, there's now this growing body of research of scientific evidence that shows that those who are using marijuana and who are using it at a young age and who are using like more potent products, their association with developing chronic psychotic disorders is much higher. And there was a - And would that be because they're latent in these people anyway? and this brings it out? Or can it like net new cause psychosis in someone who would otherwise not be not have it? So the best to understand is there is likely a genetic predisposition. So I do clinically is when I take a history, I try to find out, is there any history of psychosis, or even bipolar disorder, anything in that spectrum.

34:15And I'll try to provide guidance to that youth or that family that I think your risks with cannabis are higher than the average person. So like you want to treat yourself like you're addicted, sorry, that you're allergic to it, that this is something that you probably ought not get exposed to. So way back when I was in medical school, one of the first cases I saw as a third year medical student on my psychiatry rotation was someone who was acutely psychotic. So responding to unseen others, very distressed. And it turned out that that was a cannabis induced psychosis, which was rare enough at the time that everybody sort of scratched their head and was puzzled at it.

34:49But now it's relatively routine that we see it. And I think, and you're right on the money in terms of what we think is there's a gene environment interaction. And Megan got at this is that the brain is still developing into the mid-20s. And there's something very specific about the teen years and the role of the endocannabinoid system. I don't want to over-science this, but it's really important in development. And during this vulnerable period, if you think, say, if a hurricane is going to hit, is it the fully built house or is it the house that's under construction that's going to be damaged?

35:16It's the latter. And so the developing brain is more prone to these adverse effects. And we think that there's something to do with the endocannabinoid system that's protective against even people who are prone to psychotic disorders, that it's protective. And that a lot of THC intruding on that system may tip people toward expression of psychosis, which is a really concerning disorder. So it's a really interesting - Sorry to be dumb, but when you're tipped into that, is that then a permanent state? It varies. So, and in some cases, somebody can become acutely psychotic when they take a very high dose product.

35:52So somebody who's naive to say dabs and they have a really high dose, they can become transiently psychotic and say, whoa, I'm not doing that again. In some cases, that may be a precursor to what may happen chronically, not always the case. But certainly we see a lot of cases where it's hard to tease out whether was this going to happen anyway. But what we do tend to think is that it happens earlier and can be more severe if you add cannabis to the mix. And so those are young people with any family history that I say you really ought to avoid using during this vulnerable period. Generally speaking is, you know, I don't want to talk down to kids and to families and we should provide information rather than a finger wag and say, don't use drugs is I think it's much more of like, let's talk about drugs and let's talk about substances, including cannabis, alcohol, and otherwise.

36:39And why I think that it might be in your best interest to delay your use. Right. I think though, it's really important to make the distinction between like the, obviously the association with the way that marijuana has been associated with developing a chronic psychotic disorder like schizophrenia. I mean, there's one of the experts on this at Yale said, likened it to cigarette smoking and cancer saying, you know, after decades and decades, you know, there's, we know it used to be that people would question the, we now know that there's a very strong association between cigarette smoking and cancer.

37:16And it doesn't mean that everybody who smokes cigarettes gets cancer and it doesn't mean that everybody who has cancer smokes cigarettes, but we now know that there's a really important association there and that the same is true for cannabis and psychosis. And obviously for young people using that presents the most danger, but the acute, like the sort of temporary episode of a temporary Every psychotic episode can happen to cannabis users of any age. And those are, you know, doctors are reporting that they're seeing both those things, the association with chronic psychotic disorders, but also people who maybe they're using for the first time, maybe they're using for like the 50th time.

37:56But whatever the case, that particular product relate, you know, interfaces with their system in a way in which they're all of a sudden experiencing paranoia, hallucinations. And so there are more of those cases showing up to the emergency rooms as well. And we interviewed, we talked to, you know, a man in Colorado. We've talked to, we interviewed a variety of people who have experienced all different types of psychosis. And one of them was a man in Colorado who was using marijuana. He had been serving in Afghanistan and he had come back. No, sorry. I can't remember if he had been in Iraq or Afghanistan, but he'd come back to Colorado and he didn't have like a history of psychotic problems at all.

38:35and his girlfriend had said, oh, you know, this is marijuana can be like a nice way to chill out. And his very second attempt, basically his very second like puff of it sent him into like a horrible episode of psychosis in which he became convinced. I mean, he basically he ended up shooting his girlfriend and they, you know, they're still together and they've moved beyond it, beyond it. Wow. Yeah. Yeah. That's like Jesus level forgiveness, right? Yeah. No, no, no. It It was, I mean, he was hospitalized and immediately diagnosed with, you know, with drug-induced hallucinations. But to interview them, to like interview them talking about this horrific experience that they tipped into without having any idea that it could happen.

39:18And I think that that's one of the issues that we identified was that a lot of the people that we talked to said, listen, we don't think that marijuana should be, that we should kind of go back into the dark ages of prohibition. And obviously there are so many people who can use this drug and be totally fine. And it does absolutely have medical purposes and benefits, but that people deserve to know the risks and benefits when they're going into this. They should know that there's a risk of psychosis. And, you know, you purchase so many of these products and that doesn't, it's not going to say that on the label and states aren't going to require it as part of their regulations.

39:53So like, I want to ask about alcohol and also the other benefits, but I think first I would like to ask, like, in terms of delivery mechanism, is there one that's worse or safer or better, you know, if it's an edible, and it's don't, you know, there, there is a measured dose, I don't, what's, what's the kind of thinking there? Well, so it's, there's sort of a catch 22 in this. And so I think smoking or vaporizing gets THC to the brain very quickly. And so if somebody is an experienced user, they're going to know the effect they get and they can kind of titrate their dose. Edibles, one of the challenges with edibles is the classic story.

40:34Somebody eats a brownie, they feel nothing, they wait, they wait 10 minutes, they eat another brownie. And so people can sit way over the edge in terms of their desired effect. And at certain doses, cannabis can be anxiolytic, it can reduce your anxiety, but at a higher dose, it can give you a panic attack. And so the vaporized or smoked gives you earlier exposure. However, we know with smoke. There's carcinogens in burnt cannabis plant material. And also with vaporizers, if you recall the issues where there's what it takes to aerosolize THC, there's an ingredient called vitamin E acetate that caused a lot of acute lung problems.

41:08And we have some concerns about vaping as well. So there's no perfect way to go about it. I think from a medical standpoint, chronically, I think oral intake tends to have more safety potential than vaporized or smoked. That said, some people get different effects with oral because it's sort of a smoother pathway rather than an acute effect. And so some people desire the way that they feel with smoking or vaping versus edibles. Oh, because their felt experience of it is different? Yes. Yeah, it can be chemically the same thing that's causing that effect, but it's sort of the profile of your exposure in your brain can give you a different sensation from it.

41:51And so for some people, it's if they're, so say if you wanted to experience the high from cannabis, people will often tell you is that if they were to smoke or vape it, they get a more potent high. If they use edibles, it's sort of like, and oftentimes people will use edibles or oral products or pill form of THC if they want to induce appetite or reduce nausea during chemotherapy. Sometimes they find that to be more effective.

42:20so let's talk a little bit about the medical uses like you just you just touched on so i would love to know you know i for example i had someone that i know during chemotherapy was very helpful for them for nausea and loss of appetite it was it was a very productive drug for them so are there other Are there cases where it's not entirely terrible? Oh, so, and I want to be really clear. I'm not a zealot. I'm somebody who loves the science of cannabinoids. And I think that there is room at the table for therapeutic use, for benign recreational use, and to be very, very thoughtful about the risks associated with it.

43:00And so I want to be very clear about that. What we know in terms of therapeutic use, I don't want to go too far down the rabbit hole, but part of why it's tricky to do this work is because in Western medicine, we study specific compounds at a specific dose so we can be precise about what we're recommending, right? So we prescribe aspirin rather than willow tree. And so when we study cannabinoids, we usually will isolate. And so there are FDA approved oral forms of THC, something called dronabinol, which is FDA approved for reducing nausea and chemotherapy, also for inducing appetite and HIV AIDS.

43:34So there are indications there. And then CBD, which I don't think we've even touched on very much. Oh, yeah. That thing. So CBD is so interesting, too, because it's a cannabinoid, but acts in a very different way. And we're still trying to uncover the full mechanism. But it's been a really, really wonderful treatment for specific types of seizure disorders, and some childhood conditions. And so it has an FDA approval for specifically isolated CBD. Very exciting. CBD does not cause the high that THC does. It works in a very different way. And so in some drug development in terms of cannabinoid therapeutics mixes THC and CBD at different doses as well.

44:14So I don't know if that went too far down the rabbit hole, but those are a few places where there's very clear evidence up to the point of FDA approval for cannabinoid indications. I always think it's interesting. I mean, you throw out the term cannabinoid and endocannabinoid system. And I think that there are a lot of people who don't know exactly what that means. And my editor is always like, was always trying to get me to not prevent me from putting the term endocannabinoid system in the, you know, in a written story because she thought it would be too confusing to readers. But I do think it's a pretty important thing for people to understand.

44:46First of all, that - Can you guys explain what these are? Yes, yes. Yeah, I think it's like, it's good. So I would just, I'm going to take a crack at it, Kevin, and then you can come in with your sort of scientific hat and make corrections. But the body, you know, one of the things that people always wonder, and I think just people who are critics of marijuana without actually having a deeper understanding of it will always say, like, how could it be presented as this miracle drug that can, you know, treat of like what other drug can actually treat so many different things? That's impossible. And I think that those people, what they don't understand is that, well, first of all, there are marijuana is a plant that has dozens and dozens of components to it.

45:27And, you know, would be the term that Kevin is using. And THC, one of the intoxicating components of it is what is most commonly used and seen in a lot of the products that people are using. And CBD is another one, which is a non-intoxicating component of it that can sort of have some therapeutic properties to it. I mean, THC can be, have medical benefits as well. But what's so fascinating and what I ended up geeking out on is like, I'm not a science reporter. I don't have a background in scientific research at all, but was to learn that our bodies have this and they researchers didn't discover this, I think until the 1990s, but our bodies have an endocannabinoid system, which is basically like helps regulate all the other systems in our body.

46:12Like our digestive systems are, you know, our sort of emotional well-being. It's a really critical system that affects all the other systems. And if you have an endocannabinoid system that's out of whack and you have THC or any of these other compounds come in, it can lock into your endocannabinoid system and bring it back into balance and sometimes offer relief from symptoms of disease and succeed where pharmaceutical drugs have failed. And that's so cool and it's so exciting and it explains how it can help treat a variety of diseases. But, you know, and some of the medical marijuana experts that I talked to who treat patients, you know, talked about treating, you know, patients of all ages with all different backgrounds, with very specific regimens of the drug, and with much success.

47:02But of course, they'll also be the first people to tell you that if you overload your endocannabinoid system with THC, then it starts to like shut down. And that's when you start you need more and more and you develop tolerance. And that's when like all these bad things can happen. But I was, some of the coolest people I talked to were the people who have like committed their lives to using this drug to help treat people. And I came away completely sold with the therapeutic benefits, but unfortunately, so few people are using the drug under the guidance of a true medical marijuana expert. So often, even in the states that have legalized medical marijuana, I mean, that's not marijuana that has been approved by the FDA.

47:43And oftentimes people just have like any kind of doctor will sign off on the use of it after five minutes without paying close attention. But there are doctors out there who can walk you through like how to use it in a beneficial way for certain diseases and certain ailments. And I just like I anyway, I would just encourage anybody who actually wants to use it for medical purposes to really find those experts and to do it under their guidance. Yeah. I mean, it's interesting because we do have an age old system of using plants as medicine, right? Whether essential oils or Arnica, or as you say, willow for aspirin, like this is, we have a whole system where, you know, we do integrate with these natural compounds and and they can be helpful.

48:31And, you know, certainly in certain cases, like pharmaceuticals can have more impactful side effects, right? Like, so if you can use marijuana correctly, I mean, from what I've, from the very little bit of research that I've done, you know, there tend to be less, for example, impact on liver or, you know, or certain cancers, right? If you're using it in a medical way? So everything in medicine is a risk-benefit ratio. And so I always think about, so say, if you're using it for nausea and chemotherapy, you're dealing with a very acute condition where the risk of, say, dependence or otherwise is very low on your scale in terms of risk.

49:14If you're talking about an adolescent where you want to treat it for something where there's less evidence, I'd be worried because the young age and higher risk and also less evidence to be beneficial. So I really try to tailor that to each clinical encounter that I have as to whether I would say, you know, that makes sense versus that really doesn't make sense. And there's room in between too. And I think people are rightly frustrated because science does move slowly. And I think in some ways, cannabis has given us a little bit of a peek into our endocannabinoid system. I am old enough. I went to medical school where it was not mentioned once ever, but we're catching up to our endocannabinoid system and how it has to do with our immune function, our metabolism, our cognition, our development, super important.

49:58And it may be that cannabis has helped us to understand and characterize it, but also there's a whole host of scientists working on other ways to modulate the system in a way that it can be better balanced for our healthy development and overall health. So I think there's a lot of potential there. I think what's tricky is, is that people have a lot of products and not necessarily clarity on where the risk benefit is favorable for them. And I think Megan's right in terms of trying to get as much information as you can and not sort of be blind to something is all good or all bad. I'm a big believer in most things are both, sometimes an equal measure, sometimes unequal, and that should guide our decisions.

50:35Right. So what is the guidance then? Like what both recreationally and medically? Obviously medically, it depends on what's going on, but like, what is the guidance? It's so confusing. So, so here's where I'll say is where we say where there should be the most caution about cannabis use in adolescence and young adulthood. So in youth during pregnancy, which we haven't talked about in great detail on this, and also in people with existing mental health conditions, those three categories I'm most worried about. And then also use in the context of driving is something I think that's under emphasized.

51:11Cannabis use does impair driving. Sometimes people are tolerant to those effects and can maybe do okay. But really the big three is youth, pregnancy, and mental health conditions. And beyond that, I think it's really down to there's a lot of different scientists and practitioners working on developing evidence in different facets and areas. But we're really not at a place beyond what I've already said about what's FDA indicated is where we say we recommend this specific cannabinoid or cannabis for this condition. Is that coming? Well, so and Megan got to this, which is really tricky because a regulatory system, we approve drugs based on a specific dose of a specific compound.

51:51And with botanicals, that's really hard to do. I don't have an easy solution for that, but it's really hard because people will rightly argue that part of the benefit of botanicals may be that there's a rich matrix of different things that are doing something together. Whereas in Western medicine, we're very big on isolate that compound and test that alone. And so I don't know that there's a right answer there, but I think we deserve more clarity because marijuana or cannabis is too big an umbrella term to speak about it as all one thing. I was going to say that in doing, you know, when I first started to dig into this with my colleagues, I came across the, you know, there's the National Academies of Sciences, Engineering and Medicine, which kind of brings together all these scientific experts from a variety of fields.

52:35And they had in 2017, they had published this like massive report they had done. They'd gone in and they'd reviewed all the scientific research on marijuana and basically produced a report saying, here's what the research shows on the evidence of benefits and evidence of harms. And they went through and like listed them one by one. You know, when you're talking about treating chronic pain, this is what the research shows. When you're talking about sort of psychosis, this is what the research shows. And so they it was interesting because that the National Academies of Sciences had just over this past year reconvened to look at marijuana.

53:13And this time around, they basically just looked at like whether or not policies, government policies, state policies, what effect they were having. But I had in the process of my reporting a chance to talk to some of the people who had been part of this group and to say like, OK, you know, you guys did this report in 2017. Like, are you going to update it? Like, what's the, you know, where do things stand today? Like, where is that go-to manual with, that can guide us through the use of this for medically, you know, recreationally? And they said, you know, the science has fallen so far behind how much the product has changed.

53:51Like the drug has changed so much, even since 2017. And the science is now even further behind that we didn't feel like we could, you know, adequately update and create a manual for people along those lines. And even in 2017, they had said, like, in reviewing the research on the health effects, they had warned that the lack of evidence-based information posed a public health risk. And, you know, here we are seven years later, and there were some of those folks who, you know, very, very prominent experts saying that it's even worse. And one of the neuroscientists leading this group said, and I'll even quote her, she said, until we do research on the drastically transformed cannabis in all its forms, I think putting them under the umbrella of a safe legal drug is wrong.

54:38It's misleading at best and dangerous at worst. Wow. Which was scary. It's, you know, that was sort of scary to hear that. And it's because of the modification of the drug itself. Both the modification of the drug itself and the way that it's used. And I think that there's a good, you know, just is one causing the other, right? And this is something where the science is also lagging. But there's, you know, early indications that as this commercial industry puts out is like in a race to produce the most potent products, you know, are they creating more addicting products and causing more addiction?

55:12You know, are people becoming hooked on these products because of the way that they're transforming?

55:24well if you look you know even at food industries like industry does this right they engineer things so that people use them more and it's sort of an age-old tale but this is really terrifying because i think there is a pervasive and it would seem that there are like i mean i was i was really shocked by the risks and just to understand more broadly what's happening in the culture. And I guess just from both of you, I would love to also understand, is this, you know, you talk about the wider use of this, especially in young people. And is this, like, is this just since, you know, the beginning of society that like people kind of do this, they find ways to anesthetize and we're just tracking this more heavily?

56:13Or do you feel like this is a symptom of a broader malaise or disenchantment? Well, another thing that I learned in the course of this reporting, and another thing that people might not realize is that the United States, as these growing numbers of states have legalized not just medical marijuana, but recreational marijuana, that has made us a real global outlier. There are only several other countries that have done the same, Canada being one of them. And so I just think that we have, there's an aspect of this that has been happening under our noses without people, like there's been this really dramatic shift that's been happening under our noses and people haven't really had the right language or just kind of evidence to identify it and talk about it.

57:04And so I think that that's one thing. And I just hope that, you know, I hope that we're at a point, you know, where the people who are legalizing the states that are legalizing it and that the industry will do more to educate the consumers, because as legalization and commercialization has accelerated over the last 10 years, you're absolutely right, Gwyneth, like the, as the product has changed and become so much more potent and what many experts would say, as a result, like also more dangerous, public sentiment has like shifted and people now, the majority see this as a totally safe and beneficial drug.

57:43And there's this perception that because it's natural, it's safe. And, you know, and especially in contrast to some other substances that have been used. And, but as Dr. You know, as Kevin, Dr. Gray pointed out, you know, there are many, many natural substances that just because something's natural doesn't mean it can't turn dangerous. And especially with the manipulation of the product, you just see growing worry about it. Yeah. I mean, it seems like, you know, 200 years ago, if you found a marijuana plant and you dried it and smoked it, you'd probably not have this kind of level of adverse impact.

58:19I mean, there, yeah, it's, it's really, I was, I have to say I was really stunned when you reached out and we started, when I started looking into this, I really had no idea, You know, it definitely hasn't reached like a mainstream cultural conversation that the impact, you know, the negative impact that it's having. Yeah. And listen, I was also struck, you know, from, you know, as a personal, like I have been a consumer of marijuana over the years. Like I am in no way like a goody-tushie. That was going to be my last question. Yeah. I mean, I have dabbled in marijuana, like going back to the 90s.

58:57So I am one of the consumers who another reason that I was driven to do this reporting along with my colleagues was because I wanted to know for myself. I mean, I had had the experience of sort of shifting into the legal commercial market and going into dispensaries and purchasing like five, you know, the lowest level like edible, the edibles with the lowest levels of THC on the market and having them presented as being completely innocuous. and having little bites of them and saying like, this is actually so strong. And I have to imagine that there are other people out there who are grappling with consumers out there who just are in desperate need of more information.

59:39I'm one of them. And so I grew up as a rule follower, which is part of why I became a child and adolescent psychiatrist, because I was so fascinated by adolescents who don't follow the rules and including substance use. So I'm naive myself, but I've got a lot of clinical experience. And I think you've made a really good point, is to, you know, humans over the millennia have sought out intoxicants. And sometimes we love the idea that something that makes me feel good also is therapeutic. And in some cases, in some situations, both things can be the case. But we also sometimes get into a bit of a mania over that.

1:00:13And that's where this pendulum swing happens. And I think we will over time sort out a little bit better in terms of how better to predict those for whom it could be helpful, those for whom it could be benign, but also those for whom it could be quite harmful. And I happen to see the latter in my clinical practice, which informs my voice on this. So I think it's an important one, but I don't think it's the only voice in the conversation. I was just going to make just another point, which is that like sort of generational differences that there are. I talked to a lot of parents who had consumed marijuana when they were younger, like, you know, 80s, 90s, when it was a much less potent product and now had watched teenagers, like teenage daughters, teenage sons kind of start to use.

1:00:59And at first, the parents actually weren't that worried because they had memories of like their experience with the drug. And in some cases, like learned way too late how much the product had changed. I'm thinking of a young, a teenage girl in Connecticut who I talked to who started using her junior year. And her mom, you know, total, you know, was a classic example of this. who was like, yeah, I wasn't too worried. Like I, I had had a pretty good experience with it. It chilled me out when I was younger. And within months of using these, like basically smoking these, you know, the vapes that are so popular with teenagers today, you know, she tipped into psychosis and was hospitalized for months and it took her more than a year and a half to recover.

1:01:39And so the mother, you know, when she was finally, when a psychiatrist, you know, at Yale finally identified what had happened, you know, just imagine what it felt like for that mom to think, oh my God, here at this, something that I thought was benign has completely like robbed my daughter of these like crucial teenage years. And, you know, I think also we have to be realistic, right? Like we can say to our kids, don't drink a beer or don't like have a, you know, don't, don't smoke a joint. It's, it's no amount is good for you, but, you know, also understanding that, you know, come on, like, this is something that young adults are going to experiment with, not all of them, of course, but, you know, a great, a great number of young kids, or I mean, young, or adolescents, or young adults are gonna, are gonna mess around with it.

1:02:33So is there like, as opposed to giving them the talk, that's like, don't ever try anything ever. Is there some version of that that's like, hey, I mean, I hearken back to the drug talk that I gave my kids, but like, hey, this is, you know, to your point, Dr. Great, here's the here's a risk reward profile of this thing. Like something really bad can happen to you if you have it at too high of a dose, etc. But if you want to try it, like do X or is that just totally unethical? So yeah, these are hard to navigate. I guess what I would say is, I think all of us are probably disavowed of the notion that we'll have like an after school special conversation, then a hug after the birds, right?

1:03:14So you plant seeds over time. And I think a lot of it really has to do with being developmentally appropriate in talking about it and also be mindful of how you're modeling behavior. So one of the classic things parents inadvertently do is they get home after a long day at work and say, oh, I need a drink, right? And sort of modeling that idea of using an intoxicant to feel normal. We don't want to do those subtle things, but over time, I think part of it is, is just not talking down to kids, but talking about the science, including the science of addiction and the science of substitutes. But I think you're right, is that we've lost our kids if we assume that zero tolerance, that means never use ever and never talk to me about it, because that's what might happen.

1:03:53And so I think the layered message, I think that's helpful is my wishes that you don't use at all, because that's where I feel that your brain is going develop the most safely and decrease your risk. Second best is delay as long as possible. Third best is use as little as possible and be as mindful. And if you find yourself in trouble, my number is the first number for you to call or text because no questions asked, I'm here to help you. And I think some parents get really tripped up if they say that last one and feel like they're condoning. But I think you have to emphasize the first one and the second and the third one to get to the last one.

1:04:27I think that layering is super important. I'm not perfect, but I've tried to do some of that and model that for my own family, but also try to work with parents and families and trying to provide a good model for them. And also, you know, be realistic, not talk down to, and I love talking science with kids. I think that's a big part of this too. Wow. We're out of time. I feel like there's, there's, I could have, there's so many more, It's such a fascinating subject. I mean, medically, culturally, psychologically. Well, it's also something that like, you know, sort of landing with the responsibility, placing all the responsibility on parents, I think, also misses the point that like the public health systems in our country, the medical systems, the education systems like have a responsibility here.

1:05:17the states that are legalizing marijuana have a responsibility to come up with like accurate and effective public messaging so that parents don't feel like they have to be like scrambling to do this on their own. And I think in this particular moment in time in this country, we like have, you know, this explosion of this commercialized industry and all these products and these shifts in use and people thinking it's totally safe. And we're really missing the messaging from the responsible public health messaging from the systems that are responsible for doing that. I'm so happy that we had this conversation today because as I say, you know, for myself, it was super illuminating as a parent and a person and a friend.

1:05:59Like I just had no idea what the dangers, you know, these inherent dangers of this super strong THC, like I was really surprised. And I guess, you know, I just want to thank you both so much for coming and sharing your incredible depth of knowledge. And it just has been really amazing to bring more awareness to the topic. Honestly, thank you both so much for being here today. Thank you so much for having us. Thank you for the opportunity. Really appreciate the discussion. It was so great. You guys are amazing. Thank you.

1:06:35This has been a presentation of Cadence 13 Studios. I hope you'll listen, follow, rate, and review all of our episodes, which are available for free on Apple Podcasts, Spotify, Odyssey, or wherever you get your podcasts.