Joe Rogan hosts Alex Berenson, a critic of cannabis, and Dr. Michael Hart, a medical advocate, debating its risks—Berenson cites 10K–20K indirect U.S. deaths (e.g., Colorado data) and psychosis-linked violence, while Hart counters with zero direct fatalities vs. alcohol’s 90K, genetic predispositions (MAPK14, AKT1), and medical benefits like PTSD relief and reduced TBI mortality. Both agree cannabis triggers psychosis in susceptible individuals, with Berenson linking legalization to rising violent crime in early states (2013–2017 FBI data) and Hart warning of THC’s neural pruning effects in teens. Ultimately, they stress cannabis’s complexity, urging caution amid its medical potential and biological variability. [Automatically generated summary]
And 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.
I'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.
I 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.
I don't think marijuana is 100% safe.
Honestly, for everybody.
I really don't.
I 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, we 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.
He was high for 14 days.
Went to a psychiatrist, and he's a big guy.
He's like 6'5", 6'6".
And they told him to keep taking it, because he's like, you're so big, just keep smoking.
And so he doesn't smoke, so he just kept hitting his vape pen.
And this is one of the reasons why I want to state this because I'm a well-known marijuana advocate.
But I believe absolutely there are great benefits to it.
I 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.
They're going through chemotherapy, find great benefit in terms of helping them.
And then there's also some people with autism.
I know people that they're children of autism and they give them small amounts of edible marijuana and stop seizures.
It's incredibly beneficial in the form of CBD for a lot of different ailments.
But 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.
The normal number that's used for U.S. deaths from alcohol is about 90,000.
Now, about 30,000 to 40,000 of those deaths are deaths from the physical effects of alcohol, right?
Essentially liver damage, either chronic liver damage, you get cirrhosis, you die.
In some cases, you can drink so much that you kill yourself in a night.
So that's about 30,000 to 40,000 deaths.
The other deaths are generally associated with alcohol, meaning...
Violence.
Exactly.
Violence, suicide, car accidents.
And 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%.
They said, okay, that's an alcohol-associated death.
That's a fine way to count as far as I'm concerned.
Nobody 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.
If 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.
I suspect it will be in the 10,000 to 20,000 range.
Okay, but let's eliminate, let's go even over the alcohol.
Let'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.
You're still looking at a giant number of people who drink themselves to death.
Thousands and thousands and thousands of people every year versus zero with marijuana.
And 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, they don't even necessarily have to have been under the influence of it.
Well, 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.
So there's a lot of people who have the active metabolite in their blood.
I think you could say that for some people with marijuana, too.
I 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.
And you could also say that...
With 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?
The person who's high all the time.
You could absolutely say that that could ruin relationships.
You could absolutely say that it would ruin your job.
That can be extremely beneficial for a variety of different disorders that people have.
So we need to be careful about using cannabis versus using THC because it's really the THC that can do that.
And 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.
And 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.
But 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.
So sometimes having the munchies is definitely a good thing.
And 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.
THC and CBD are only two of them.
Those are the main ones that people know about.
So THCV has been shown to actually reduce appetite.
So 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, I have a question for you.
And I'm not saying that your friend's situation didn't happen.
I'm not saying it's not real.
What 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.
And you see the changes in those two groups over time.
And you find out whether or not your theory about whether this works on a population level basis is real or not.
That is at the core of medical science.
And we've basically thrown that rule out for THC. Well, that's not entirely correct.
You 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.
And you also, I'm sure you know, like when we're talking about marijuana, you're talking about something that's federally illegal.
It's not something that's easy to run these FDA studies on.
Yes, and I say at the end of the book, I think we should drop that.
I 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.
So, 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?
Right.
And I've done videos on this even recently stating that.
But 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.
Say if we're talking about breast cancer, and I did a video on this recently.
If you are HER2 positive, And you see CBD, it can in fact reduce tumor size and it can reduce tumor growth.
Right, so there's different types of breast cancer and that's just one subset of breast cancer.
So there are other breast cancers which do not express cannabinoid receptors.
And I've seen one study, at least.
Again, it's only one study that showed that when they gave CHC in that animal model, it actually caused a proliferation of tumors.
So it worsened them.
So I do agree with you, Alex, in the fact that we have to be careful about using terms like that.
But that just doesn't mean that we can't say that cannabis is no good for cancer at all.
And 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?
So it's definitely a really good medicine for a lot of different things.
And 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.
And 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.
So I'm not a researcher.
So I need to make sure that my patients are getting better.
It's very frustrating for me just to say to someone, oh, there's nothing I can do for you.
There's nothing I can do for you.
And I understand that doing something sometimes is not going to be beneficial just because you're doing something.
You have to do something that actually works.
But 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, called Nabilone.
So 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.
And just to keep on the topic of PTSD, in addition to that, we've identified mechanisms of action.
I 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.
unidentified
Which is the naturally occurring cannabinoid in your brain.
Yes, which is the naturally occurring endocannabinoid, correct.
So you can get that through exercise, which is one excellent way to do it.
And that's part of the high that you get after you exercise.
But the other way that you can get it is by using cannabis.
So when THC attaches to those CB1 receptors, you can get a release of anandamide.
And cannabidiol can actually increase anandamide by another mechanism of action as well.
So, you know, there's different ways where we can, you know, raise a level of deficiency.
So, 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, right?
I've been working for over five years just with cannabis.
I mean, I do other medicines.
I prescribe other medicines as well, but I've been doing cannabis medicine for over five years.
And there's a lot that I've learned, right?
So 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.
And the things that my patients tell me is that THC is really effective for their sleep at night.
And a lot of my patients, especially my veteran patients, have done really, really well with that.
And just one further point, too.
I know it was in 2015, I believe it was.
There was a meta-analysis done.
I can pull it up if we need to.
That indicated that a lot of the medicines that are being used now for PTSD are just simply ineffective.
And 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.
But 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.
It doesn't matter whether it's a vitamin, whether it's a hormone.
As long as you are correcting a deficiency, you're generally going to get excellent clinical results.
Just 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.
So, you know, basically two a day for men, one and a half for women.
So you're saying, okay, like, we don't see huge negative consequences at that level.
Okay.
That's fine.
That's a totally reasonable way to think about alcohol.
But what we're not saying to people is, this is a medicine.
And I think that's where the confusion really around high THC cannabis lies.
And again, I don't mean to say that your friend's child is not benefiting.
If you say he or she's benefiting, I believe you.
What I'm saying is that that's not good enough for science.
We need randomized controlled trials.
And 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.
The 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.
Probably for the same reasons that alcohol works as a pain reliever.
It dulls your awareness of your pain.
But even in that study, or even in those studies, they're mostly done against placebo, not against opioids or against NSAIDs like ibuprofen.
And 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.
I think I said to the extent, I'm trying to meet you halfway, but I'll stop doing that.
But, you know, I think you said something else that was really interesting to me, and this came up in the book, too.
So you're a clinician.
You see sick people.
And, you know, it's funny, my wife's a doctor, too.
She's a psychiatrist.
That's how I sort of got in this.
But my wife is a forensic psychiatrist less than a clinician these days.
Her job is to evaluate people, not so much to treat people.
Your job is to treat people.
You see sick people.
You want to help them feel better.
And you don't want to tell them, there's nothing I can do for you.
There's no hope for your pain.
There's no hope for your PTSD. You want to help them.
And I totally get that.
But 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.
So you need to step back.
And 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.
Yeah, and we need to be, you know, careful about that, right?
And 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?
But, you know, Ziva Cooper, you know, she's a member of that committee.
I 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.
Okay, you cited the report, and she's a member of that, okay?
So 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.
Then, the Drug Alliance policy also said the report did not reach that conclusion.
So, 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?
And then also, they're saying that you left a lot out, right?
They said that They have found an association between marijuana use and improved cognitive outcomes in individuals with psychotic disorders.
That's straight from the same report.
And you failed to mention that.
So 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...
Select the small amount of material that's just going to support your study.
We want to be truthful here.
Joe's show has always been very truthful.
I mean, Joe said right at the beginning, he doesn't think that cannabis is perfect for everyone.
And I don't think that either.
And in Canada, we have really strict guidelines to follow.
Basically, 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.
Like, the doctors don't really have much of a backlash about that.
So, 25 basically is when your brain is fully developed.
And when you do look at the studies that do show an association between cannabis and psychosis, it's almost all in adolescence.
I 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.
So, you know, 25 is a good age, but it's definitely a, you know, kind of a conservative-ish age.
But, you know, it's something that we follow, and I think that, you know, we've done well with that in Canada.
So the National Academy of Medicine report was drawn up by a committee of 16 researchers.
Ziva Cooper is the one who's publicly said, the report said this, but I think that we should have emphasized that it also said this.
What I wrote in that New York Times op-ed, what I wrote in the book, is the plain language of the report.
And the plain language is this.
Cannabis use is associated with a risk of developing schizophrenia and other psychoses.
The higher the use, the greater the risk.
I may have a word or two wrong in that because I'm doing it from memory, but that's what it said.
And by the way, the committee was very clear.
They separated depression.
They said we don't see nearly as high risk for depression as psychosis.
Even 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.
This literally was released today.
But to go back, Ziva is one of 16 members of that committee.
So 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?
Why 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?
Maybe we should ask why the other members of the committee are not speaking out against my book.
Well, 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.
So, you know, I don't think that most people on that committee are into social media.
You know, Ziva just happens to be.
And, you know, I even spoke to Ziva on the phone about this.
And, 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.
But you're only quoting the parts that back your opinions.
You're not quoting the entire part.
Why 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?
If 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?
Well, my book presents, it makes a case, right?
It 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.
I wrote a book that is trying to break through a lot of noise.
So, 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?
I say in the introduction of the book, this book is not balanced.
There's not a lot of evidence in there.
If you want to read about how indica and sativa strains are different, you're not going to read that in this book.
But I also want to say this.
I didn't come at this, and I say this in the introduction of the book, too, as an anti-cannabis crusader.
In fact, when my wife said to me, as she said to me over and over again in 2014 and 15 and 16, these are the cases that I'm seeing.
These are the terrible things that people are doing after cannabis use.
I sort of said to her, first of all, why do I always have to hear about this at the dinner table?
But more importantly, you know, why...
Why is it that maybe these people are using other drugs?
Maybe you're seeing a slice of the population that's not representative.
Why is it that I should believe this?
This sounds like reefer madness to me.
And, 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.
She went to the Memorial University of Newfoundland Medical School.
And she went to Harvard and Columbia for her postgraduate training.
You know, eventually she got tired of me yapping back at her and she said, why don't you go read the studies yourself?
And 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.
Again, 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.
But 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?
No, 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.
One 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...
Was that it's the exact same number that you find the general population.
Essentially 1% of the general population has schizophrenia, which is 1 out of 100 people.
And when you have marijuana users, you see essentially that same number mirrored, and so they're saying a small number of people...
So 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.
But getting to the exact rates, so in the U.S., they say that the range for schizophrenia is between 0.25% to 0.64%.
Globally, they say it's 0.33% to 0.75%.
So, right there, it's apparently lower in the US. And the US has the highest percentage of cannabis consumption in the world.
And 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, schizophrenia rates have remained the same.
No one knows what the schizophrenia or psychosis rate is in the US. Suddenly, changed its estimate for the percentage of people with schizophrenia in the US from 1.1% to 0.3%.
They did it with no public notice, and then this researcher said, hey, this is a miracle.
They just cured 2 million people with schizophrenia.
And 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.
Nobody knows.
Nobody knows if the rate is increasing.
Nobody knows if it's decreasing.
The 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.
And in Denmark and Finland, Which are the two places where they've actually done this research in the last 20 years.
They'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.
So the people who are saying that there's no evidence of population-wide increases in psychosis are just wrong.
We 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.
So we don't have the evidence to say there's a definite increase.
But 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.
It 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.
And the other thing is that potency in the last 15 years has gone way up.
There is now evidence on a population level basis in those other countries that schizophrenia and psychosis has gone up.
And 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.
So for the first time, there's actually evidence of what you're talking about, which is a population-wide increase.
So serious mental illness, so this was defined, there's a study called the National Survey on Drug Use and Health.
It's done every year, covers 70,000 people, federal government funds it.
It's sort of the best data source we have on all this stuff.
It showed that, and they're not counting cases either.
Let me just be as clear as I can on this.
Nobody'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?
Were you hospitalized this year for any inpatient psychiatric reason?
And if you look at those numbers, in 2008, 3.8% of Americans, 18 to 25, reported at least one symptom.
So they were categorized as having serious mental illness that year.
In 2017, that number was 7.5%.
So that's a doubling.
So again, I am not going to say that proves that the increase in cannabis use has caused this population level increase.
But something bad has happened.
And if you look at kids 12 to 17, interestingly, they, over that time period, didn't have a big increase in cannabis use.
In general, teenagers are actually...
Are pretty healthy now, although Juul and vaping may be undoing that.
And those kids didn't have a population level increase in serious mental illness.
And one of the things they talk about is the onset of social media.
Jonathan Haidt talked about that as well.
And the onset of social media is actually more hate than Yuval Harati.
But Jonathan Haidt talks about it with young people.
I think it's the coddling of the American mind.
I 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, I think, 2000, whenever his book was written.
I 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.
So I think that could be considered a far more significant new form of distress to children and young people than even marijuana.
Because 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.
And people, obviously we've done that, all humans have done that since history began.
But now, everything is online.
You can compare your life to everyone.
And people are doing it all the time.
And even worse than that, and we should talk about this too, is that the income gap is getting wider.
So it's like people's lives, not only are they getting better than other people's lives, but now it's on display so everyone can see it.
Whereas before, maybe you wouldn't have seen it because it wasn't on social media.
But now it's on social media.
So you have this huge income gap that just keeps getting bigger and bigger and bigger.
And then you have people going on social media and they're comparing themselves.
And you're absolutely right, especially in that age population.
I mean, people under the age of 30, you know, they're definitely, you know, they're being bullied online.
Like I see it every day in my office.
Like literally every day people are being bullied online.
And that's, you know, something that I never had, you know, to deal with growing up.
Part 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.
That's what people do.
I hope that that doesn't change because pot's seen as medicine.
I hope that people don't move on to or do something harsher because they don't see pot as cool anymore.
But 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.
Because 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.
And 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.
But 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.
Well, 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.
I'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.
They're less likely to have sex when they're 14, which I think most people say is a good thing.
And what I'm saying is that cannabis use has spiked in the United States in the last 15 years.
And teens notwithstanding, we've seen a large degradation in a number of these social outcomes.
And 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.
You know, we are conceding the fact that, you know, you just said again that study was done on adolescence.
You 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.
But, 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.
But I think that we should be prescribing CBD to these kids.
Like 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, selective serotonin reuptake inhibitors, You know, which are the most commonly prescribed medication for depression and anxiety, even in adolescence.
We know that they can increase suicidal ideation.
That's been shown.
I mean, it's written right on the package.
So again, as a clinician, you have to treat your patients.
If you're just...
Treating people with something that's not effective or that has horrible side effects, you're going to look at other alternative treatments.
A lot of people have had excellent results with CBD in that age category.
I've had it done in my practice and lots of other physicians have had it done in their practice.
So 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...
THC in adolescence.
That's where Joe and I both can see that THC is not a good medicine.
Look, 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.
We need all the treatments for depression and boy do we need treatments for psychosis that we can get.
I totally agree with that.
And I'm really glad to hear you say you don't think that adolescents should be using high potency or any hard drugs.
So I want to push back on this, on the alcohol versus cannabis for teens thing.
And 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.
I think you have to really be careful with anything that severely perturbs your sense of reality.
When you're a young kid and you're trying to form your vision of the world.
I 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.
What we guarantee, almost universally, is these kids are on social media.
I think much more likely that they're on social media than use cannabis.
I 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.
I know so many people that are on that shit.
I know so many people, whether they're journalists, I know comedians, I know a lot of fucking people who are on Adderall.
And you need to develop that toughness when you're young.
You 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.
That's terrible, right?
That's a terrible coping mechanism.
So, 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.
And that's said to people all the time.
They say, oh, you have a biochemical deficiency and this is what you need.
We need kids to be tougher, right?
So you need them to build up some resiliency so that when they do go through hard times, they have better coping mechanisms.
Like Joe talks about diet and exercise all the time.
It has, but you would get free from it when you went home.
You're not free from it ever now.
These 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.
This is what they're dealing with.
You know, look at her with her fat face, LOL. And then this little 12-year-old is like, oh!
That's a severe, severe factor that no one had to consider before.
If you look at worldwide levels of psychosis, okay?
Again, it's less than 1% for schizophrenia, which is the most severe version.
You add bipolar disorder with psychosis, depressive psychosis, other kinds of psychosis.
Maybe 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.
So, okay, on the one hand, that's a lot of people.
On the other hand, most people are not going to get psychotic.
And 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.
I mean, people can get psychotic.
They can get a brain tumor that can make them psychotic.
They can, you know, late in life, they can get dementia that makes them psychotic.
There's oftentimes a pretty clear organic cause, okay?
So, when we're talking...
The brain is a relatively strong and healthy organ, and it takes a lot to break it.
Antipsychotic 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.
It's the 14th most prescribed brand name medication.
What that means, though, too, is that people are struggling, man.
Like, life is hard for a lot of people.
Like, very hard, Alex.
Very difficult, okay?
So, a lot of people need something sometimes at the end of the day or during the day to help them get through the day.
Cannabis, especially the CBD component, and also the THC component, when used properly, is okay.
I 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.
He took it and he experienced suicidal thoughts and all these, he had like severe consequences.
I 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.
Well, 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.
Is that alcohol affects most people pretty much the same way?
And you sort of know what somebody looks like when they have one drink, when they have five drinks, if they have ten drinks.
I 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, cognitive benefits for people with psychotic episodes, and that you're only focusing on the negative.
I think that's also, I'll plead guilty to that myself because I think that I've only been discussing the positives.
And 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, you 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.
And you did indicate, Alex, you said we should tell people the truth in the book, right?
So 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...
It's a little bit deceiving and deceptive in some ways, right?
You want to tell the whole truth.
When you tell the whole truth, then you give the whole story, and then people can actually make a good, informed decision based upon that.
If people are going to just read one part of the story, then, of course, they're going to make a decision just based upon that one part.
They're not going to make an informed decision based upon all of the parts.
And because of that, people are going to make some very poor choices.
But you can go to a casino and see people who've lost their houses.
It doesn't mean that gambling should be illegal.
It also means that there's less and more dangerous forms.
That 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.
And 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.
But that's the message that we should be putting out there, right?
We shouldn't just be focusing on one side of the story.
That part should also be included in the book.
And your book, in some ways, has made me rethink the way that I write.
Because my first book was co-authored with Jeremy Koston called Friendly Fire.
My 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.
Because 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.
And, you know, CBD and THC can both help facilitate that process.
You 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.
So 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.
When you give them CBD, and this is really important for people to understand, CBD has been shown to decrease learned fear.
That's incredible.
If 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.
I'm talking to people who it's difficult for them to go to the grocery store, just pick up a few things.
Those are the type of people that I see in my practice.
CBD is really excellent for that.
Then when you look at the nighttime component, THC, again, is excellent for reducing nightmares.
That's been shown in studies.
And it was even shown with one pharmaceutical drug, Nablon.
Again, I don't really...
I 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, if 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.
And that's the same way when you get with the parents of kids who have seizures all day.
Nobody wants to see that.
And like, Alex, if your kids ever started getting seizures, which I hope they don't because it's terrible what it can do to people.
But, you know, if that ever happened, you know, I would hope that you would consider, you know, CBD as a potential treatment option.
I think we have to be really clear on this distinction.
Like, CBD, you're not against CBD at all.
And I don't think anybody is.
I 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.
The reality is CBD has proven to be...
At 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.
Why 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?
Every 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.
When we do it, it's very interesting how your tolerance is radically reduced.
Like, I'll smoke pot at the end of that month, and I'm like, holy shit!
Like, I don't even know what I'm talking about in the mid-sentence, and I'm just blitzkrieged.
Whereas, you know, now, like, I smoked a little weed last night, did some stand-up, had a great old time.
There was no issues with it at all, but I'm used to it.
And if the weed that I smoked last night, I assume you don't smoke marijuana.
Okay, 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?
Because 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.
The 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?
I 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.
A 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.
Radically different.
And it's really a psychedelic.
For me, personally, edible marijuana and flotation tanks, I might as well be taking a fucking bucket of acid.
Because it is a crazy goddamn experience.
Now, I personally enjoy being paranoid.
And I know this sounds crazy, but I think with me, it gives me...
I think I live a pretty blessed life.
And I like the feeling of paranoia because it allows me to explore maybe some areas...
It might knock down the ego just a little tiny bit.
Just like the other psychedelics.
I think it just, it gives you just a little, it knocks down the ego just a little.
I 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.
Meaning 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.
You know, like, that happens to people all the time.
It 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.
My patients say to me all the time, it just kind of breaks this negative state that I have.
I'm just able to break out of a negative state and think logically.
And 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.
I 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?
So, you know, I'm involved with a company that's doing that right now.
We're trying to create...
Cannabis genetic test for people, right?
And there's three genes that we've identified so far.
You 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.
And then there's two other genes, the AKT1 and the CADM2 genotype.
Both of those have also been shown to be associated with cannabis.
But again, how many people have them?
The MAPK14 is roughly about 8% is what we're seeing.
So 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.
And then for the people who do have these genetics, they stick mostly to...
CBD. 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.
I think that it should be held to the same standard as any other medicine.
And 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.
And, you know, I've been doing that.
My company's been doing that.
It's called Enant Life.
You know, full disclosure, I am on the board, enantlife.com.
And, you know, when we use these different strategies, you know, then we can actually reduce the overall harm.
And 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.
You 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.
But I have to tell you, in the last month since the book came out, I've heard the other side of this.
I'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.
And the worst story that I've heard so far came from a woman in Connecticut whose son graduated from Haverford.
It's a college in the East.
And sounds like a really good guy.
He wanted to teach disadvantaged kids.
He had a girlfriend who was going to med or was a pre-med trying to go to med school.
They moved to New Mexico.
And for some reason, the guy decided to start smoking.
This was 2012, and within a few months, he'd lost everything, okay?
The girlfriend had left.
He'd lost his job.
He had his first inpatient hospitalization.
Now, this is a family with money, okay?
This is Connecticut, suburban, and they have spent the last six years trying to save their son, and they have failed.
She told me that they've spent more than half a million dollars.
So 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.
It turns out that that's the second worst thing.
The worst thing that can happen is...
Your 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.
And 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.
This will still be part of my life.
But this woman, these parents, They are going to spend their lives trying to destroy the cannabis industry, and that is real.
Well, 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.
There are people, though, too, who just kind of have a decline with or without cannabis.
You do hear of people with schizophrenia.
It's just a breakup.
They just can't handle life.
I 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.
Well, 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.
I mean, it's a fact.
For some people, psychedelic drugs have tremendous benefits for PTSD, quitting alcohol, quitting hard drugs.
There's a lot of people that have used mushrooms, MDMA for PTSD is a huge thing that MAPS is studying right now.
But 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.
And 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?
And we need to tease out the risks and tease out the benefits and make sure that people are...
But Alex, we need to make sure that people are informed and they get the entire picture.
Right?
So, you know...
Does your book have some truth in it?
Yes, of course it does.
But does it tell the whole truth?
Absolutely not, right?
And that's the message that I think people should be hearing.
People shouldn't be hearing just part of the truth.
They should be hearing the whole truth.
And again, in your book, you compared Mexico and India, right?
And, you know, I talked to German Lopez on the phone about this, you know, who talked to Isaac Campos, right?
And 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.
And then there was some evidence as well in India at that time.
So Alex kind of made the connection, 9,000 miles apart.
They're both saying the same thing.
But he said that you did misinterpret the evidence on it, right?
And German told me that on the phone.
And I mean, all the cannabis that was used in Mexico at that time was in really marginalized environments.
And then when you look at the India study, And I know that you addressed this in your book, because I did read your book.
The British, you know, they colonized India and they set up what they call lunatic asylums, really psychiatric hospitals, sort of very primitive psychiatric hospitals.
And they were really initially for soldiers in the Indian army and they were run by British doctors.
And 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.
In India it's called ganja.
Or bong, which is a very weak preparation of basically Indian hemp, just sort of low-grade cannabis.
And so they started counting, and they realized that 20 to 30 percent of the people who were coming to asylums...
were heavy cannabis users.
And that was way more than alcohol.
It was more than opium.
And this really fascinating doctor named George Francis William Ewens wrote a book in 1908, and he looked at the evidence.
And it is amazing to hear how he describes schizophrenia, how he describes cannabis, how he describes the cases of violence around cannabis.
It's like any psychiatrist today, certainly any forensic psychiatrist like my wife, would like everything in the book would ring completely true And 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.
Okay, 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.
Now, it's actually worse than that for cannabis, okay?
And here's why.
So the National Alliance for Mental Illness and the Mental Illness Advocacy Groups hate talking about this.
Why do they hate talking about it?
Obviously because it stigmatizes people with mental illness.
So 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...
You're not using recreational drugs.
Your risk for violence isn't that high.
It's not that much higher than a healthy person.
Fortunately, healthy people don't commit murder that often.
The 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, it must be spectacularly high.
And the numbers bear that out.
So there's a really good study from last year, 2018, a small group of patients in Switzerland.
Now, Switzerland is a safe country.
It's a low base crime rate.
But 50% of the people who were using cannabis and had psychosis over a three-year period committed violence in that group of people.
Well, 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.
So, you know, it's quite a few studies, okay?
So, you know, let me just read part of it out to you.
So 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, recent drug misuse, and a history of drug misuse.
It was unclear if there was an association between violence and a history of cannabis misuse.
So again, this is 110 studies.
They very carefully looked at all of the different risk factors as to what could trigger violence.
Just let me finish, Alex.
And what they said, again, it was unclear if there was an association between violence and a history of cannabis misuse.
And I have not, I do not know the study that Dr. Hart is talking about.
I'd like to look at it.
Without looking at it, I can't push back as hard as I would like.
What 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.
And 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.
Because you're asking someone basically a series of questions.
I mean, it's no different than depression, really.
I 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.
Whereas 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.
But unfortunately, we just don't have those objective measurements.
And again, that's why Alex was saying earlier that they couldn't really figure out how many people in the United States had schizophrenia.
And I understand that.
At 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.
People should understand that there's seven different basic human emotions.
You know, depending on which way surprise goes, I mean, six out of those seven are negative, right?
Because we're wired to basically detect threats.
So, you know, when we're making all these diagnoses, I think we have to be careful because...
Some 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.
People are getting angry about being angry or depressed about being depressed.
If you feel one of these emotions, just kind of sit with it and just kind of reflect on it.
And I think that's a much, much better way to tease things out.
But 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, By 2040, it's going to be like 50% of people are going to have a mental health disorder.
People just need to understand that life is hard.
You've got to deal with these emotions sometimes.
It's not that big of a deal.
For some folks.
For some folks.
Yeah, for some folks.
And that's why I'm such a big fan of Jordan Peterson because he's kind of tough on people and he said that.
A 50-year study finds casual link between cannabis and subsequent violent behavior.
New 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.
Researchers have long debated a possible link between the use of marijuana and violent crime.
In contrast to alcohol, meth, and many other illegal drugs, the mellowing effects of cannabis seemed unsuited to promoting violent behavior.
However, ample previous research has linked marijuana use to increased violent behavior.
The sticky problem in such studies are that many co-founding factors involved in interpreting this correlation.
It 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, personality traits, or many other variables that are related to the propensity to use marijuana.
To 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.
So 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.
At 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.
It makes a brawl into something where somebody picks up a stick.
It makes that into something where somebody pulls out a knife.
It escalates.
Cannabis is different.
Cannabis causes paranoia and psychosis.
And it certainly causes those things temporarily, even if it doesn't cause them permanently.
So 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.
It's a family member.
The 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, so I better stab her to death first.
That happens.
It happens a lot.
And 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.
And 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.
That's a lot of violent crime.
And what I'm saying is that it is quite clear that drug use mediates that violent crime.
In other words, if you're not using, you can keep your impulses in check.
So 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 commit violence, but that they're much more likely to commit violence if you add some sort of psych medication, whether it's marijuana, whether it's something else that perturbs reality for them, and particularly whether it's something else that perturbs reality for them, and particularly Well, antipsychotics bring down the use.
So 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.
We really don't know, but we do know he did with it.
And 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.
They really have to be discouraged because it brings out the worst.
And 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.
That would have happened anyway.
And they're right.
You can't prove it.
And you can't prove that any one case of psychosis was caused by marijuana.
But when you look at the big studies, at the population level data, the association is really clear.
And everything points the same way.
And the synthetic cannabinoids, K2 and Spice, those can clearly produce psychosis in people.
And people with psychosis tend to slip back into it if they use.
At some point, you've got to start to say to yourself, why does everything go the same way?
Yeah, 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.
He became schizophrenic and he's a regular marijuana user and the people around him associated that with that.
In fact, people that are regular cannabis users were trying to get him to stop using marijuana.
I 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.
The 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.
I think we all agree that marijuana use by itself with people that aren't schizophrenic probably doesn't induce violent crime.
But with people that are schizophrenic or people where it triggers schizophrenia, it could potentially induce violent crime.
My friend did not get violent, although he did do a violent thing.
It wasn't to a person.
I think we have to be really careful because...
Just 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.
So 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, and 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?
And that's part of the reason why Trump is actually not really against cannabis in some ways.
It'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.
And it has dropped.
They did a study last year and it dropped over 15% in Colorado.
And it dropped 7% in Arizona.
And 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.
And 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.
They say that Washington has the 10th largest income gap in In the United States.
Well, 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.
It supports a significant association between the increased violent crime and marijuana legalization.
Furthermore, 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.
If you adjust for population, you still get big increases.
In Denver, 2018, almost 70 murders.
There were about 35 in 2013. Seattle, 2018, There were 34, 35 murders.
There were, I think, 19 in 2013. These increases are real.
Now, can we say that marijuana legalization caused those increases?
We cannot yet.
There are other possibilities.
What are those?
Well, first of all, population did increase.
It's also possible that these states, quote-unquote, imported violent crime.
In 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.
There may have been some people who are exporting to Nebraska, to Minnesota, to other states.
There's crime associated with that.
But 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.
And he didn't say it randomly.
He said it when he was introducing legislation to legalize marijuana on the federal level.
Those people are wrong, and they need to stop saying it.
I know, and by the way, that Oregon economist used...
He used the wrong data set for his charts.
I used the real numbers, the FBI homicide numbers.
He used numbers that include justifiable homicides and police homicides.
Because 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.
He 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.
Those two categories of crime are not likely to be impacted by cannabis use.
Cops 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.
The fair comparison is Is the base murder rate in the U.S. And that's the number that I used.
And I am telling you, I mean, I know these numbers.
I sleep, you know, I wake up with these numbers.
Cannabis, 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.
I'm sorry, I said 31%, maybe it's 29%, so maybe I woke up.
Anyway, for the U.S., it's 18%.
29% versus 18%.
That's the gap.
And I am not saying that I know that cannabis legalization caused that gap.
What I'm saying is people need to stop claiming that cannabis legalization reduces violent crime.
And what's also interesting, Joe, if you really want to go into the numbers, is the gap actually widened year by year.
So that's sort of what you would expect if this is the result of a psychomimetic effect.
In other words, a psychosis-causing effect.
Because cannabis doesn't cause psychosis right away.
People break down.
But 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.
Okay, 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.
When 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.
So I think things kind of even out.
I 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...
The one who had an edible and became suicidal and was fucked up for weeks.
Guy's very confident, very articulate, very intelligent.
He's not a weirdo, not a transient, extremely successful.
You know, I think there are variables that we need to take into consideration.
There's certain human beings that exhibit a pattern of behavior that's directly correlated to cannabis use that I don't experience.
So 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.
I'm not an expert on this subject but it's because of something called pruning that we go through.
So 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.
It's the best way to kind of explain it.
When you use cannabis, you can potentially accelerate that process.
And then because you accelerate that process, you don't get those good neural connections.
And then people, unfortunately, develop things like psychosis and schizophrenia.
So that's kind of where the issue lies.
You 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.
It's an excellent medicine.
But the other thing, though, too, is we do want to mitigate the risks because there are real risks out there.
So, you know, I do appreciate, you know, us talking about adolescents and making sure that they do stay away from cannabis.
Yeah, 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?
And 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.
I mean, the pre-adolescent and early teen use, we got to do everything we can to stop it.
The problem is, yeah, if you smoke pot in junior high, say 7, 8, 9, you're probably going to smoke pot in high school.
That's what I saw when I was growing up.
Even 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.
We're dealing with a lot of ignorance when it comes to biological variability, right?
We 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.
There's a lot of variables.
There's a lot of them.
Marijuana is absolutely one of those variables.
And again, I don't have an issue with it.
I like it.
I love the stuff.
But it doesn't fuck with me.
But I'm also honest.
And 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.
And 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.
No, 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.
Also, too, you need to have some type of self-awareness.
The 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.
I 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, you can't really be aware of everything.
Yeah, maybe you're going to live to be 300. What do you do?
The universe is infinite.
You know, like, you're going to die.
Like, the sun is going to end.
Like, at the end, I mean, imagine if people do live to an infinite number where we realize our fucking sun is dying.
You're going to freak out about that.
It's all relative, right?
So 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.
And 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.
Maybe you were upset about something else when you ran into them.
You were already at a seven, and they brought you to a ten, and it was totally unnecessary.
With a normal situation, you would have only been at a two.
Those things are real, and sometimes marijuana helps highlight all the errors in your way.
I think it can be a tool, but my description of it is like any other tool, like a hammer.
You can build a house with a hammer, or you can just hit yourself in the dick if you're fucking crazy.
And this is something that I think we should consider when we're discussing almost any psychedelic medicine.
And I think that I really do believe that marijuana is a psychedelic.
And I don't even think it's a mild one, especially when it's in edible form.
Yeah, it's just a feeling of they're not someone who can just sit and be by themselves.
They 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.
That's bad.
When 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.
I am using psychoactive substance.
And not be able to freak out.
But some people, I know that if they use a little bit of THC, they probably would have a freak out.
They probably would have a bad experience.
Generally, it's people who are very, very fearful.
Now, the other side of that coin, though, is that if you use CBD, and like we discussed earlier, that can decrease learned fear.
So that's something that's really helpful for those patients.
I do agree that we have to be careful about using high THC in certain groups of people, for sure.
You 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.
And they want to say that I don't understand correlation and causation and that I'm cherry-picking studies.
Let's acknowledge that a lot of people use this drug.
And that's true whether it's legal or not.
And let's acknowledge that probably in 2020, certainly if there's a Democrat elected, most of the Democratic candidates have said they favor legalization.
There will – legalized cannabis will probably be the law in the United States, okay?
And let's talk about what we're going to tell people who are using.
And I had this roundtable with the executive director of the DPA and some other people.
This was about a month ago, shortly after the book came out.
And I proposed what I thought were really common sense warnings.
And she basically wouldn't agree.
I mean, she agreed to like one of the five of them.
It was stuff like, you know, if cannabis, if you have a family history of severe mental illness, you probably should not use cannabis.
You probably, you should not use cannabis or try to delay your use until you're in your 20s, I think was one of them.
And 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.
I mean, I think that's – I think if – now look, we can argue about how severe is, right?
But certainly if you wind up in the ER even once – That's a bad sign.
I just don't understand why the legalization...
Look, I can understand why people who are selling this drug don't care.
We 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.
But I don't understand why these people who are supposed to be...
Science-driven and supposed to be thinking about the greater good won't agree to reasonable discussions about what the warning should be on this.
I think you did yourself a slight disservice by not including some of the beneficial aspects of cannabis.
I understand your perspective.
I understand why you were doing that because you really wanted to highlight the dangers.
But I think that's one of the things that they can point to when they say you cherry-pick data.
But I think that also it's really important when you're having these kind of conversations to have a long one.
I mean, we've really covered the full gamut, right?
And I think that's probably one of the reasons why Bill Maher didn't want to have you on because he's got five other people on the panel.
Everybody's talking over everybody and you have five minutes to get your case out.
And I don't think it's possible.
I think this is a really...
This is a long...
Complicated discussion that has to do with biological variabilities.
It 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.
Maybe if they just became a long-distance runner and they would have lived a healthy life with no psychotic breaks at all.
We don't really know.
And unfortunately, once someone goes off the deep end, we might never find out.
No, I'm just saying, I think we have to be very careful in saying we know what it does.
We know what anything does.
Because you don't know.
You know what it does for you.
You know, some people can't eat fish, you know?
They eat fucking shellfish and their throat seizes up.
There'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.
There'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.
So, 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.
In fact, a friend of mine, my friend Ed Clay, he opened up a clinic in Mexico based on his own interaction with pills.
He 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.
Just whacked it out.
It literally changes the way your brain interfaces with your addiction.
It's not simply a perspective enhancer.
It changes how your body and your brain deal with opiates.
I think Tim Ferriss has actually talked about that before as well.
But, 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.
And then also, too, you want to look at it from a clinical perspective, right?
So we know that opioids can kill people, right?
Because it acts on the brainstem, whereas, you know, cannabis doesn't.
So, you know, you might be saying, you know, you're just substituting one for the other.
And, you know, sometimes that is true.
But if you're using a less harmful substance, you know, to me, that's like a huge win, right?
So if someone, you know, has to drink, you know, 12 beers a night versus smoking like one joint, man, that's awesome.
And I mean, you look at all these clinics, like you look at like I mean, what are they doing?
They're trying to get people off one substance to a substance that is a little bit less harmful.
And I think that when you use cannabis, it can be effective for opioids.
It can also be effective for benzodiazepines and for other medicines as well.
It'd be awesome if everyone would just feel happy and great all the time by just exercise and nutrition.
And 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.
But I understand though that sometimes life is hard.
Sometimes things hit you.
You have crisis in your life.
You 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.
And in those times, you know, sometimes diet, exercise, meditation, doing all the right things just isn't quite enough.
And, 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.
And even though I'm talking about opiates and deaths, We can also talk about NSAIDs, right?
Like non-steroidal anti-inflammatory drugs.
So, these drugs can also wreak havoc on your GI system.
I saw one study, actually, I tweeted out, Rhonda Patrick tweeted out, said that if you use NSAIDs, it was really short.
I got to look it up again, but it was like two weeks.
It can decrease your your gonadotropins, which can stimulate your testosterone level by like 25%.
And on that note too, we should talk about, I can't believe I forgot to talk about this, but opiates can drastically inhibit your testosterone production, right?
Which is a huge thing for depression because I've had guys come in to me before.
That have been, you know, really, really depressed.
You just give them a small amount of testosterone and, man, they're off their antidepressants and they're off to the races.
They're doing great.
So, you know, are we creating a lot of people who are depressed because they're using opiates and their testosterone levels are low?
And, you know, for men, I mean, having low testosterone is horrible.
You know, you're going to have low motivation.
You're not going to feel as well.
You're not going to want to do things.
So, 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.
I 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.
So 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.
So, 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.
So just so people know that, because I know that comes up all the time, you know.
So, it's quite clear that cannabis use oftentimes precedes other drug use, whether it's opioids, cocaine, other drugs.
Now...
One 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.
He might have access to heroin or cocaine, other drugs.
And so eventually, maybe you decide to try one of those other drugs.
So actually, that's really why the Dutch legalized.
They wanted to create an avenue for people to use cannabis that wasn't connected to other drugs.
Okay.
Another possibility is that using an addictive intoxicating substance...
You might like it, and you might want to try other intoxicating substances, and it might prime your brain.
And then the third possibility, really, is that there are just some people who are risk-takers out there, right?
They'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.
So it's not really that cannabis drives the use, it's just that cannabis is first.
I think that probably it's a combination of these things, right?
There'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.
At the same time...
Getting high feels good, and maybe you want to try other drugs, and at the same time, you're just a risk taker.
Okay.
What nobody seriously ever said until about the last five years is that cannabis could be an off-ramp for opioids, okay?
And there's a lot of reasons to believe that's a really bad idea.
First of all, cannabis, if you actually need opioids for pain relief, cannabis is not a good enough pain reliever.
It's like alcohol.
It's a mild pain reliever.
It's not strong enough.
If you're dying from cancer, cannabis...
It probably is not the pain reliever that you need.
You need opioids, okay?
And, again, the state-level data is not as good.
If you want to really figure out what's happening to an individual, the best way to do that is to follow that individual.
And 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.
And that just intuitively makes sense to me.
And 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?
The US and Canada.
Who are the two countries that have by far the worst opioid epidemic?
Okay, 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.
Yes, but Canada doesn't.
The amount of opiates that are prescribed in the United States is fucking preposterous.
Particularly, 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.
The 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.
Okay, again, just from a clinical perspective, I can't just rely on diet and exercise for all my patients.
I have to use other tools.
And again, everyone here in this room, we're all pretty healthy.
I don't have a bad back or I don't have a mental health diagnosis or anything going on.
You know, I have to look at patients that are coming to me, right?
So, 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.
You 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?
So 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.
I know that, right?
So that's really, really comforting for me to know.
Also, I feel, you know, we were just talking about amphetamines and we were just talking about, you know, SSRIs.
I feel that cannabis, you know, particularly the CBD component is Can actually be more effective.
That's what I've seen a lot in my practice and other people have seen that as well.
So I think that we need to take that into consideration when we're using all these drugs.
And 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.
They're not the ones in front of the people.
They're not the ones that have to chat with patients.
I have an obligation to do something for my patients to make them better.
I really feel, we just listed a bunch of drugs, that cannabis is a really, really effective tool and it doesn't kill anybody.
So because of that, I'm going to keep using it.
But like I said, I'm always looking for other drugs.
I'm always looking for other alternatives to also help my patients.
But I think that using cannabis is a really effective tool for a lot of clinicians and it's helped a lot of patients.
So I don't feel that cannabis is the gateway drug.
I 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.
And they just want to try something.
So, you know, the fact is that alcohol and cannabis just get introduced first most of the time.
Most people, you know, don't do, you know, Coke or LSD and then say, hey man, let's try some cannabis, right?
So it's just that that's the very first one there.
So if we...
You could say anything that was easier access.
If 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.
Well, 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.
And I know that the name, they don't feel that cannabis is a gateway drug either.
I mean, again, they said they found no compelling evidence to support the gateway theory.
And again, I mean, these are the people that you are quoting in your book, Alex, right?
Let me just go a little bit further.
They said, in a retrospective cohort study, Mayette from ETAL in 2016 examined the transition from cannabis use to the use of other illicit drugs.
They found that the probability of initiating other illicit drugs after cannabis did not differ significantly from the probability of starting with other illicit drugs.
So it's just that cannabis is there first.
It's definitely not a gateway drug in any stretch of the imagination.
I know the studies that he's quoting, but there are many others.
And I think the argument is as to why.
And 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.
But I do want to throw one thing out there.
I don't know how many of your viewers have teenage kids.
They're probably more likely to be teenage kids than to have teenage kids.
But the book has...
The one thing that really worries me, if we're talking about gateway drugs, is that Juul and vaping are really a gateway to THC vaping.
Because, well, first of all, it gets kids, teenagers, used to inhaling this illicit substance.
And you can actually retrofit a Juul pod with THC.
They don't sell them, but you can easily go online and look at how to do it.
And I 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.
And we're talking about 15-, 16-, 17-year-olds inhaling pure THC, the most dangerous form of this drug.
And I think, unfortunately, it's not going to take long before the mental health consequences of that become apparent.
And I really do hope that the book gives parents some tools to talk to their kids about that, if nothing else.
Okay, so, you know, you're a dude, you're over 50, so prostate cancer.
So, you know, it's been shown that CBD may actually be beneficial for prostate cancer.
And 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.
And 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.
One thing, too, we didn't really get to talk about was CTE and concussions.
I 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.
I really appreciate that.
It 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.
If someone comes to me and they have a concussion, it's very frustrating just to say to them, hey, physical cognitive rest, go home, okay?
It's really frustrating to say that to someone.
Also, too, the high-fat diet thing, Joe and I both follow a very, very similar diet, so that's something I want to share.
With regards to the Alzheimer's disease, we have really, really poor medications for that.
And we have an aging population.
So again, Alex, you want to look at everything, which is what I'm doing.
I'm looking at everything and I'm trying to make a clinical decision.
Am I using some things without randomized controlled trials?
Of course I am.
But again, I'm a clinician, so I'm using mechanisms of action.
I'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.
And 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.
What I'm saying is that when we're talking about...
Policy 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.
You know, a guy I know named Peter Bach, who is very smart.
He's a pulmonologist.
He's at Memorial Sloan Kettering in New York.
And he wrote a piece in the Wall Street Journal a couple weeks ago talking about cannabis's limits as medicine.
And he said something that I thought was so well put, which is the reason why people want cannabis to work for Alzheimer's and cancer.
And a bunch of things where there's really no evidence that it works is that we don't have good treatments.
We want cures.
We want help.
We, 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.
But that hope is not a substitute for science.
It doesn't mean that it works.
And even...
You want your patients to have hope, okay?
But 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.
And I think it's really important to discuss how complicated it is.
I don't think there's...
I'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.