The Mindspace Podcast #10: Cannabis and Mental Health with Dr. Claude Cyr

The Mindspace Podcast #10: Cannabis and Mental Health with Dr. Claude Cyr


welcome to the Mindspace podcast I’m
Joe Flanders October 17th 2018 that’s the date the Cannabis Act came
into effect across Canada essentially means that people aged 18 years and
older can possess up to 30 grams of legal cannabis in public obviously this
was a big deal and believe Canada became the first large industrialized country
to legalize cannabis and the consequences are far ranging we’re
seeing a lot of movement in industry in medicine in education and employment
issues so a lot to untangle here and we’ll see the the impact as time goes on
I of course am especially interested in understanding the impact on people’s
mental health and well-being and to help me make sense of all of this I reached
out to dr. Claude Cyr cloade is a family physician he’s been in practice for over
20 years and he’s been judiciously prescribing medical cannabis for a few
years now more importantly for our purposes he’s the founder of something
called doctors for Responsible access and this is a not-for-profit Association
of doctors and nurse practitioners whose mission is to protect the health of all
Canadians by advocating for an informed medical perspective on cannabis
legalization I really enjoyed my conversation with Claude as you’ll hear
he’s smart he’s funny and he’s extremely knowledgeable about
the basic science clinical issues and everyday practical concerns that
recreational users might have our conversation covered some basic science
about cannabis and the cannabinoid system in the body the impact of
legalization and what it means to consume responsibly how cannabis relates
to a variety of mental health issues including anxiety depression and the
risks to the teenage brain we got close recommendations to parents
how to speak to teenagers about cannabis and we even got into the trend toward
legalization of psychedelics which turned out to be an interesting
interlude in our conversation if you have any concerns about your own
consumption or your loved ones consumptions of cannabis please do reach
out to mindspace one of our psychologists can help you work through
those concerns and if you’re a physician who’d like more information about
doctors for Responsible access please visit doctors for Responsible access
comm and I’d love to hear your questions your ideas your stories about
legalization and how it’s affecting you so please do reach out to me on Facebook
or Twitter in both cases I am at dr. Joe Flanders
finally if you think this episode would be meaningful to anyone you know please
do share it we’d like as many people as possible to be informed about these
issues to ensure safe and responsible consumption and prescription okay so
here is my conversation with dr. Claude Cyr dr. cloud welcome to the podcast hi Joe
thanks for having me over it’s a real pleasure to have you here it’s a
pleasure to be here Joe okay so let’s start maybe you can just tell us who you
are and what you do well I’m a family physician I’m working here at Montreal
been here for about 20 years and I my own eyes medical cannabis as part of my
job yeah okay and how did you get into the medical cannabis space well I I was
I was totally ignorant of the well city medical virtues of cannabis until around
2001 when I arrived here in Montreal and I sent one of my patients over to the
McGill University Health Centre and that patient was evaluated by dr. mark ware
who is now known as one of the foremost investigators in medical cannabis around
the world and patient came back with a prescription of of cannabis and I was
quite scandalized at the time so I I called up dr. ware and he invited me
generously to his office and he explained to me the whole the whole deal
behind his decision to to treat this patient with cannabis and that’s where
that’s where that little seed was as it was sown and from then on I started
authorizing it to other patients in specific circumstances and I gradually
came to realize that it was a very effective treatment for certain
conditions what was it about the meeting with dr. where that kind of piqued your
interest or convinced you that there might be something there well it’s it’s
especially the fact that he was quoting the science behind it because I didn’t
even know there was science behind metal cannabis before that time I thought it
was basically used by you know recreational users and who were self
diagnosing and self treating themselves but there were actually studies that
were that were made and that’s when I realized oh my gosh there’s there’s
there’s clinical stuff being being done here what can you tell us sort of in
general terms about the state of the science on using cannabis as medicine
well the sad part is the because of prohibition and because of
the fact that most of the science comes out of the United States we’re just at
the beginning right now where the science should be if I was gonna put a
number on it I’d say we know about 1% of what the therapeutic potential of
cannabis is we know that there are like hundreds of cannabinoids I know there’s
at least 100 cannabinoids in cannabis only two of which are actually being
researched clinically right now THC and CBD and there are probably a half a
dozen cannabinoid receptors in the body and the only one that we really know
about right now is the cd1 receptor in the central nervous system so right now
the science is pretty good in terms of the cb1 receptor and THC but if we want
to look at the science for the 110 other cannabinoids and the other half doesn’t
receptors we’re just at the beginning so when it comes to pain and muscle spasms
and nausea and and all the other symptoms that that respond to THC its
it’s starting to look pretty good but the rest is well we’ll talk in five or
10 years and I’ll tell you about it okay but you know enough about the science
and you have your sort of clinical experience and so what are you looking
for what are the principles or the guiding principles for prescribing that
that’s the tough part because usually in in in in medicine we rely on our
regulatory authorities right the Society of experts who tell us okay this is good
for that and take this medication for this condition but cannabis
unfortunately there is not one Society of experts that actually recognizes the
use of cannabis in any medical conditions so we’re pretty much left on
our own sort of physicians who authorize cannabis and we’re about 5 percent right
now physicians in Canada who authorized it we’re all on our size you know
reading the literature by ourselves making up our own minds and I would say
that in my opinion there’s about three different types of cannabis authorizers
there’s the ones who authorized it for like the one single condition that’s
been recognized by the College of Family Physicians which is chronic neuropathic
pain that doesn’t respond to anything and then there’s the people in the
middle ground who authorized it for three or four other conditions including
chronic in nausea with chemotherapy in spasms
and in multiple sclerosis in HIV related illnesses and then there are the the
pioneers and the evangelicals at the other end who believe that it should
replace probably a whole slew of different medications including mental
health conditions neurological diseases even in childhood diseases
apart from epilepsy so so there’s there’s no consensus right now
so I I’m more into that middle ground area right and I think that middle
ground area is what you tried to stake out in a way with this nonprofit you
started precisely the doctors for Responsible acess yeah there was a
non-profit that we started as legalization was was approaching I had I
realized that physicians who authorized cannabis were not voicing themselves as
a group on the on the risks and the advantages of course of legalization so
I decided to put this thing together sent out invitations to all the the
practicing the practicing physicians and nurse practitioners who authorize
cannabis as well and and came out with a with a what our series of site
guidelines to appropriately introduce legalization that we that we that we
sent to the task force and we were included among the 200 other people or
organizations that had like an opinion on how to implement legalization yeah
so what did you learn what I learned is that curiously enough that physicians
who authorize cannabis when it comes to the legal age the the vast majority
seventy-five percent of our members believe that the legal age should be 25
years of age and these are doctors who authorize medical cannabis yes there
were a few who thought that was 21 and very few who thought it was 18 so which
goes to show you that when the people who read the literature the most I would
suppose in the physicians are the ones who authorized it these are there were
actually the most conservative which is strange when you consider that the
Association of pediatricians for example believe that 18
would be a the the minimum age which is something that was very you know
fascinating to me but the conditions though another on the other side on the
other end if we look at the conditions that that should be treated with the
cannabis most of the physicians in the in the organization believe that the the
conditions should be a lot there should be along a longer list of conditions
that should be accepted and notwithstanding that the science is very
was very slim on these conditions most physicians who authorized medical
cannabis believe that the science we shouldn’t wait for these the science
considering the safety profile of cannabis and just we should just move
forward and authorize it and then see what the science says later have you
ever come across or like had to work through this level of uncertainty or
lack of information in dealing with certain conditions or a medication like
this is really intense the fact that you’re prescribing a medication that you
think works you’re using your instincts in your clinical practice but we
actually don’t know have you ever come across that before well when you look at
the history of how it works in in modern medicine companies that would synthesize
new drugs they especially in the 20th century when chemistry became really
invoke the the requirements for safety and efficacy were very slim in the early
20th century and usually a couple of you know studies in mice and if it was safe
perfectly no problem it was in the market and then thalidomide came out
right in 1960 and when they found out that ten thousand deformed babies were
born across the world obviously the laws changed dramatically and the paradigm
that we have right now is descends from that one of those that and among other
events so today any new drug that comes out the the requirements before it is
recognized are extremely strict but we that hasn’t been around forever it’s
only been around for about fifty or sixty years now cannabis the people who
believe that cannabis should bypass this these requirements there
argument is that cannabis has been around for 5000 years it’s been it’s
been in historical textbooks in antiquity there’s mentions of it
everywhere that’s been used medically and therefore the safety profile at
least the safety profile aspect should be accepted and then we should wait for
the science for the efficacy and their other argument is that okay if we’re
looking for efficacy you know in in the sense that if you have a patient who’s
tried all kinds of different medications for a condition and nothing works then
if you’re at that point where like a gets the last resort kind of situation
then it should be an acceptable it should be an acceptable treatment plan
in those especially specific circumstances but the but the there are
medical or regulatory authorities but now are still pretty adamant that no
this is the paradigm right now it’s got to go through the different hoops right
it’s got to go through the different process the different steps and they’re
not budging it seems what’s all the excitement about
cannabis why is the medical community so why is there so much research going on
why are doctors so passionate about it why are you passionate about it like
what’s the big deal what’s what’s special about this chemical well when I
was in medical school and I first started medical school back in the late
1980s or the 1990s we didn’t even know there was an endocannabinoid system
right the the receptors were only discovered in the early 1990s and we’ve
always known that there were these orphan receptors in the body’s receptors
that we’d find on cells but we didn’t know which ligand or which product
actually connected to them and lo and behold were realizing that a lot of
these receptors at least almost a half a dozen if not more right now are and a
cannabinoid receptor so they have they have soaked the cannabinoids whether
there are endocannabinoids or external cannabinoids they interact with these
receptors and they’re almost everywhere in the body so we know that these
receptors are in the brain they’re in the liver the lungs kidneys the
reproductive system the skin bones bone marrow so for the time being what’s
exciting is that there’s these receptors everywhere and we know that cannabinoids
interact with them and there is over a different cannabinoids in the candidates
plan so theoretically there could be an in an enormous therapeutic potential so
that’s that’s what’s exciting and it’s probably safe that’s the other good
thing can you make that link for me you said so there’s over a hundred types of
receptors no no there’s at least half a dozen types of but I do not mana monoids
about a hundred candidates in the cannabis plant okay
just because there’s a lot of receptors and there’s a lot and they’re all over
the body why does that mean that it has the potential to be very therapeutic
well receptors usually are a sign that there’s an intracellular
action once that’s set that the receptor is stimulated now what that action is is
is who knows what it is right but if there is an action and that action may
have a therapeutic potential so well we know right now is that there’s a
potential because there’s a receptor and we have an external cannabinoid that
will interact with it and if there’s one thing that we know also about
endocannabinoid receptors is that depending on the cannabinoid that will
that will that will that will tide that will you know bond bind to it thank you
the the intracellular action will be different so we can we can increase
potentially all the different cannabinoids plus the receptors but is
it possible that the impact of the the molecule binding with the receptor could
be negative totally absolutely so I’m oh yeah I can go both ways there’s no doubt
about that but even if it does go both ways if we find a receptor for example
then we stimulate it with a specific cannabinoid and it has a negative effect
well that doesn’t stop the industry from
taking that molecule and tweaking it and making it a blocker instead of a
stimulator right so you can just say okay we all in it we don’t need to
stimulate we have to block it to get the therapeutic effect so the receptor is
there so and we can do whatever you want with the receptor so that’s also a
potential and that’s where the industry also is going right now we’re taking all
these cannabinoids and they’re synthesizing them so we don’t have to
really take the plant so we can just use the
synthetic cannabinoid and see what happens on the receptor and that’s what
we like in medicine we like like one compound one receptor one action we
don’t like plants with a thousand different things in them we like things
that are simple right so that’s what we’re hoping is that the industry will
take all the cannabinoids and they just pick all of them out one by one and test
them one by one on each different receptor and see what happens that’s
real that is really exciting oh it is extremely exciting I want to ask you one
more series of questions about in like continuing in this sort of health and
medical context so as you know I’m a psychologist and I’ve been monitoring my
clients and the sort of the the trends in consumption of cannabis just sort of
in in my community and it’s incredible to me how little we know about the
impact of cannabis use on mental health mm-hmm so I actually want to kind of
just take this take advantage of my time with you to answer some of my own
questions for myself here so number one is that I see a ton of clients smoking
to self-medicate for anxiety totally what’s your take on that the short answer bad idea okay long
answer let’s wait for the studies to come out and see what role cannabinoids
play in mental health because they may play a super positive role down the road
when we find out which cannabinoids at what dose okay and which combination of
cannabinoids who knows maybe one day we’ll find out that a little bit of th
seen a lot of CBD and a certain dose may have profoundly positive impacts long
term with no tolerance and no psychoactive effects and no impact on
cognitive function but right now the word on the street is that people who
tend to self-medicate use way too much cannabis and they use way too much THC
and the cannabis it’s on the street right now has
no CBD so they’re probably not doing as well as they could and in oftentimes
what they’re getting is at that little period of euphoria okay that is often
accompanied by THC and they’re getting that little buzz but after that buzzes
goes away there they end up with you know those residual symptoms which may
be a little bit of a depression a bit of a higher anxiety of some withdrawal
symptoms so right now self diagnosing and self
treating with cannabis not a good idea I wouldn’t in my experience I wouldn’t say
that people are explicitly saying to themselves I feel anxious and this is a
chemical or this is a substance that helps me with that it just becomes a
habit because there is as you say at least a temporary relief for sure and a
lot you’re right I think a lot of people don’t realize they have an anxiety issue
or they have depressive issues but once they discover quote-unquote cannabis and
I say wow I feel great with this and it’s only down the road when they
finally decide to consult that they realize oh you know what I’ve been self
treating my depression or my dysthymia or my anxiety with cannabis for years
and years and years what about interactions with antidepressants that’s
a good question I’m not aware of any studies that have that have that have
looked at the interactions or if if cannabis either decreases the effect of
antidepressants all I know is that at normal therapeutic doses that we used
like for pain the interactions in terms of like medical like drug interactions
and in the liver are are very are almost non-existent so that’s not a huge issue
in that department now no studies have been done with people who use like huge
doses of THC like for example when you’re looking at pain control you were
talking about twenty to thirty milligrams of THC per day which is
usually those are very small doses but some people can take 2,000 milligrams of
THC per day and tolerate it quite well so at those doses if does it interact
with antidepressants I have no idea I’ll have to wait and see what about risk for
psychosis that’s the big one that is the that’s the big big huge risk right
now because we know that psychosis with the studies that have been done with the
pharmaceutical cannabinoids like like an abalone or in a big smalls we know that
there is a threshold after which you know the risk of psychosis greatly
increases and that’s mainly due to th see now the CBD has been shown to reduce
those risks of psychosis and so that people have a greater tolerance to see
when they add CBD to the mix but the the issue the main issue is that cannabis
recreationally if you look at what’s available now as opposed to what was
available 30 years ago there’s no doubt that today people can take a huge dose a
huge dose of THC in a very short period and very easily which was something that
was probably very difficult to do 30 years ago I mean 30 years ago if you
wanted to take a thousand milligrams of THC you had to smoke like 20 joints
right but today you can spoke three joints okay and you can get a thousand
milligrams of THC that’s just because the plants have been bred in a certain
way or totally totally the the the genetics behind behind the cannabis
plant have been known for a long time and people who’ve been breeding cannabis
illegally have been extremely clever in in finding the best possible hybrids to
increase the potential of THC and they pretty much maxed it out we know that
the plan can prove up to words up to hours of 30 percent THC that’s about the
maximum amount of THC that a plant can produce and they’ve reached it and also
they with all this cross hybridization they actually reached that maximum
threshold so where they are right now we have a plant that produces through my
weight 30 percent THC by weight which is amazing and now if you couldn’t go on
YouTube and anyone can take a can of butane and a bottle of Pepsi and fill it
with cannabis and make their own butane hash oil which can contain up to 800 and
900 milligrams of THC per milliliter so you can take one syringe of that and
you’ve got a thousand and you’re just you’re just you’re
wasted you’re baked as they say in the in the industry another thing that I see
a lot in my practice is people who smoke a lot having difficulty with motivation
and some cognitive functioning as well is that just me or or or no it’s it’s
that’s been proven again and again in a study after study people who consume
cannabis and while THC at least on a regular basis have trouble with memory
with attention span concentration and the good news is is that when people
stop using cannabis in in about 30 days most of these symptoms gradually go away
except maybe attention the attention problem has a tendency to persist beyond
30 days so we don’t know right now how long that lasts when people stop
consuming cannabis what about motivation motivation that’s a pretty controversial
issue that the aim of the amotivational syndrome it was very popular back in the
1970s back in 1980s but people are talking less about that right now what
does it actually do – I really can’t say is it because people sort of let become
sort of less anxious and they don’t feel like you know just getting involved in
things as much or or is it some other effect or they become more lethargic and
who knows but I can’t I really don’t I really don’t know enough about that
specific syndrome and I we don’t really talk about it amongst the physicians we
mostly see the other effects like attention you know and things like that
some people believe that it’s because of since it does impact on the executive
functioning like people who have to like carry out complex tasks for example
since it becomes more difficult for people who consume cannabis to carry out
complex tasks and they they have a tendency to you know throw in the towel
if it gets too complicated right so there they decide to stop doing
complicated things like studying for example because it requires too much
mental effort so that may be like the reason why they’re having this a
motivational syndrome because they just did you
just too requires too much brainpower right is cannabis addictive of course it
is yeah I think if it causes euphoria if it
releases dopamine it’s addictive there’s no doubt about that like any other drug
but the good news is is that when you compare it to other drugs that have the
same effect like cocaine or heroin or whatever it is the the the rate of
addiction is much lower it’s around 9% when you consider that cocaine is around
I think 20% nicotine is around 30% the the problem is that in young people the
rate of addiction is much higher than in adults if you look at teenagers the rate
of addiction has been estimated to be around 16% which is almost twice as high
as as with as with adults so we know that in teenagers the effect is much
more pronounced and they have a much higher tolerance to higher doses and so
there’s there’s something about the teenage brain and cannabis which is
different than the adult brain in cannabis the effects are quite different
clothes what about can cannabis have any detrimental effects on sleep detrimental
a lot of people use it for sleep it’s very very popular as as a sleep aid does
it produce like restful sleep does it is it doesn’t preserve the architecture it
depends there’s not for a lot of less studies that have been done with that
right but according to some people yeah it’s it does but CBD may actually cause
insomnia so that’s the other thing so THC is mainly the big sleep aid I know
that some people who tried every sleep medication under the Sun and have not
really responded to anything I would give them synthetic THC which is the NAB
alone and in some people it just finally permitted them to sleep that happens to
me for years but they it’s chronic insomniacs so I there is probably a
place for it I wouldn’t use it as a first-line
sleep aid no doubt in my mind I would probably go try every single thing and
then obviously there’s a room for it but some people like I said earlier some
positions patients coming to have a sleep problems
the first line boom you know cannabis right because it’s well it’s safer than
valium is not as addictive and so there’s all these this reason there’s
this rationalization but if you compare it to other sleeping drugs yeah now
sleep drugs like you know amitriptyline and all this stuff then it’s some people
say that oh it’s probably safer so let’s just use it but I’m not convinced that
the data actually is proven without doubt that THC is safer than the other
sleep drugs okay close what about using cannabis to
help people with post-traumatic stress I know that it’s extremely popular a lot
of vets are using it okay very high dose obviously for some odd
reason I mean you look at the average dose used in Canada is about 2 to 3
grams a day we have vets using 30 40 grams of cannabis for PTSD a day that’s
like huge quantities right how much of that is due to tolerance we don’t know
some studies have shown that it can be effective for example we know that
cannabis when used for example in in in palliative care I like to use it in
palliative care it it does have a tendency to make people forget stuff
right it’s it this would be called mimic you know aversive memory extinction so
people who have go through bad experiences if they’re going through
chemo they’re going through the radiation therapy they’re going through
whatever kind of really awful treatment and if they’re using cannabis after
during or or immediately after it’ll help not it’ll help sort of like prevent
from that memory from sticking right and this is one of the things we often
complain about people who use cannabis is they they they become forgetful right
and they become easily distracted so they’re starting one thing and then they
go off to another thing and they completely forgot what they were doing
five minutes earlier but in in certain circumstances if you’re like for example
flying a plane that’s a bad thing right but if you’re gonna be for example going
through chemo and you’re just out of your chemo favourite recession or your
radiation therapy session forgetting what happened maybe 15 minutes ago is
probably a good thing right so preventing for those memories from from
actually getting hard why it could be beneficial it could be
beneficial in certain circumstances but is it effective long term for people who
had PTSD and who were treated years after the fact if you look at certain
studies it’s it sometimes the outcomes are worse and if you look at other
studies patients claim that it makes them feel better than all the other
medications that they’ve been using up to date so the patients especially in
the vets who’ve been who being claiming that it’s been helping them well it’s
their own personal story right as opposed to like large studies but there
aren’t they haven’t been very large studies that have been made and we don’t
know what the dose is again we don’t know if they should add CBD we don’t
know how often should take it the other cannabinoids so there’s all these
mysteries surrounding cannabis that we’re probably going to answer in the
next 5 or 10 15 years what about depression cloade another interesting
another interesting aspect there’s there’s been two very interesting
studies that came out a couple of years ago one of them followed patients who
were treating themselves like self treating themselves for depression and
the outcomes were unfavorable right the long-term they were doing they weren’t
doing as well for patients were being followed by physicians and who were
medicated with cannabis but who were followed they actually fared better okay
so again I go back to the dosage issue I think that cannabis a lot of people who
self diagnosed and self treat are probably using five 10 15 a hundred
times the dose that it’s necessary but since they don’t know how to titrate
they’ll just use whatever dose they feel is effective for them and so they end up
using way too much and probably not the right kind and that may be one of the
aspects that we’re going to discover the next few years that it’s that’s playing
that big role in terms of how come in certain studies that people have a good
outcome and other studies they have a negative outcome it may have to do with
dose and variety of cannabis but I I’m just speculating of course here okay so
I want to start moving us towards the whole legalization issue because it’s
Cisco it’s it’s it’s and important it’s huge since
legalization became a thing I’m starting to hear all kinds of terms and things
about you know cannabis that I never had heard about before so you started on one
of them and it’s the it’s the THC is one of the active compounds but there’s CBD
which is also receiving a lot of attention now so what’s the difference
between what are those two things and what’s the difference well like you say
when we mentioned earlier in the plant there are several different substances
as the cannabinoids okay that interact with our receptors we’ve discovered at
least 112 right now there may be more like it says the research goes on the
most abundant cannabinoids are THC and CBD but there are other substances as
well like terpenes people know that terpenes are what give the odor to to
cannabis because the cannabinoids themselves are completely odorless okay
and this is an in this is an important fact to know because when you when you
when you make an extract with cannabis you can remove the terpenes at one point
if you distal ate it so you can make a totally odorless extract and this is
what we call you know there’s it’s called the distillates THC distillates
with a they call them so people can vaporize this and there’s absolutely no
odor all right and it’s extremely discreet so just a side line so people
they saw there shouldn’t be smoking in the parks and stuff like this but you
know what in about five or ten years from now that’s not going to become an
issue because tea people take one hit of this stuff and they’re gonna be
completely baked and no one’s gonna know about it it’s extremely discreet so
that’s one thing no the let’s go back to the cannabinoids the cannabinoids the
THC CBD the ones that have been most studied now the other ones like the 110
other cannabinoids they are in much lower quantities in the cannabis plant
but some some plants some hype some species of varieties have higher
concentrations of these secondary cannabinoids but the only ones that have
been studied clinically or THC CBD so I don’t talk about this secondary
cannabinoids because the only studies that we have our preclinical studies
there’s studies that don’t that are done in the lab or on mice and yeah they may
have potential for inflammation and all kinds of these
of other applications but it’s very it’s very tricky to transpose preclinical
data to clinical data because we’ve been burned so many times in the past so it’s
it works great on mice but when you put it in humans it doesn’t really work
right but some people like they want to believe that it works and that’s fine
for them but I’m not going to go around telling people that CBG or cbc or CBD a
is good for inflammation or crohn’s disease or whatever it is until i see
data in humans and that’s that’s where I draw the line what about on the
subjective experience like the high what gives the euphoric feeling the the THC
right now is probably the only cannabinoid that has been shown to cause
those those types of psychoactive effects there’s another type called
Delta a THC which may have mildly psychoactive effects but that’s not
really been shown that Munich’s conclusively so THC is the one that
causes the high all other cannabinoids do not cause those types of psychoactive
effects I’ve heard that there people talk about two different types of plants
is that a thing the sativa indica thing yeah it’s a thing right historically
cannabis there were two varieties one that came from Afghanistan which was
called the indica plant which was a short stubby plant with wide leaves and
then there was the sativa variety that came from Southeast Asia which was a
tall plant very very tall and with very narrow leaves and anecdotally people
would say that when they would consume indica they would have a sort of a
relaxing effect right people will use it to go to sleep and it was helpful to
keep you know to keep them relaxed and whereas sativum was anecdotally known to
produce that what they call the the the head high where people would become
stimulated and it would be energetic and they would you know get them going and
they wouldn’t take it before going to bed because they would keep him from
sleeping now these were these were anecdotal reports right and some people
believe that it may not be due to the cannabinoids that it could be the
terpenes that actually may be producing this effect and it could be like the
ratio of the different terpenes and the terpenes was about 200 of them in the
cannabis plant and they all have different
chose from one variety to the next none of this is proven at all some people
actually believe that there’s no such thing as the indica sativa denomination
that those are just different varieties of the same single plant and even if
there was an original indica and there was an original sativa those plants
don’t exist anymore because they’ve been so hybridized that right now about 80%
of the plants that are available in the market are hybrids between the two they
may look like a sativa indica but the actual genetics of the chemistry
completely unknown speaking again about the subjective experience or the high
due set and setting having a big impact and a related question to what extent
does the expectation of the high you’re gonna get make a difference I learned I
remember learning in grad school that more than any other drug what you
experienced after consuming cannabis depends more on what you expect to
happen I believe that as well I think I don’t think there’s any been there
hasn’t been um conclusive studies that have been done in that but when you look
at the studies done with LSD for example and the ones that were done with like
very calm settings versus the ones done with more laboratory cold settings the
outcomes were generally better when the settings were much more you know a
reassuring and friendly and welcoming right and in when it comes to cannabis
anecdotally as well there people have been you know mentioning for years like
Andrew Weil for example who wrote the natural mind and he also at that point
believed that the set in the setting were important factors to find out who
would have liked for example the bad trip
right so people who became paranoid or had an anxiety attack they were trying
to predict for years like what what would you know what what are the
predisposing factors right so the set in a setting were like the original site of
lke if the person is feeling a little anxious and feeling a little sad then
the cannabis might make him feel more anxious and more sad okay then if there
are a little if they don’t know anybody in the room and if they’re with a bunch
of strangers then they may get a little paranoid yeah and that’s true and but
the the main factor that’s going to predict whether
somebody’s gonna have a positive experience or a negative experience is
the dose of THC of all the different factors it’s the dose of THC that’s
gonna have so the setting or setting there’s also those are secondary factors
when it comes to cannabis at least so because if I take one milligram of can’t
have THC now give it to a hundred people who don’t need know each other nothing
bad is gonna happen no one’s gonna feel any affect right so about at two or
three milligrams then some people are gonna get an effect and if I go beyond
10 milligrams then a portion of people will have a negative experience and if I
go beyond 15 or 20 milligrams then a majority of people have a negative
experience so the probability of negative experience is related to the
dose of THC the absence of CBD and all the other factors like personal factors
and set and setting there’s all these different ways to consume it now the
edibles smoking obviously it’s going to be in drinks oils and of course
different concentrations of THC will be in each of these products I know there’s
a famous story about these gummy bears in Colorado that are really dangerous
what can you tell us about these different forms and consumption well
since since we know now that the the dose the especially the initial dose of
THC is going to be the most the single most important factor that’s going to
determine whether or not you’re going to have a positive experience or a negative
experience what we know on how people ingest cannabis makes a huge difference
for example if we look back in 1990 when the average THC of cannabis that was
around back then was about 3% and most people who consume cannabis would would
roll joints and inhale it through joints every inhalation had about 2 or 3
milligrams of THC per inhalation right so that’s like a perfectly reasonable
dose ok but today with the average THC content of the cannabis that’s produced
by licensed producers which is around 18% which mimics pretty much what’s
happening in this treatment the street right now which
when you look at the concentration and illegal cannabis it’s between 15 and 20
percent depending on the batches that you find so we’re looking at an average
about 18 percent THC so if you roll the joint with AD 18 percent THC you’re
getting about 10 to 15 milligrams per inhalation you know if you’re gonna be
like making a round number that’s that’s a large dose for somebody who’s never
consumed cannabis it’s it’s a way way too big of a dose but unfortunately the
industry they’re they’re they’re looking at pleasing the recreational user who
has experience with THC and that with cannabis and and since we know that
there’s a huge there’s a very very quick tolerance that happens with cannabis it
like in the space of a few weeks or a month you can increase the dose tenfold
and eventually you’ll you’ll become ill you will tolerate those higher doses
it’s those initial first experiences that can be really dangerous especially
with teenagers because we know that if you have an acute psychotic episode when
you’re younger due to cannabis your risk of developing
future mental health problems becomes extremely high now we don’t have all the
data yet on what other factors come into play but we know that if you’re like 15
16 years old and you take way too much cannabis in one sitting and you end up
at the hospital with an acute psychosis down the road your chances of becoming
schizophrenic or bipolar are extremely elevated now we’re gonna find out in the
next couple years how elevated that is but right now the word is we should
avoid acute psychosis with high doses of THC we have to avoid those especially in
teenagers before the age of 18 we absolutely need to tell these kids do
not overdose you’re not gonna die and that’s what people keep telling some so
you can’t die from THC overdose right so it’s safe yeah but what’s gonna happen
down the road when to recuperate from your acute psychosis that’s a different
story so that’s that’s one of the main
messages we need to get out there yeah and that is obviously a big concern and
when we were talking the other night you referred to this tsunami of important
cultural changes happening around legalization so let’s get into
that now so first of all why is cannabis legal what’s the history of this dynamic
obviously the news came out cannabis is officially legal as of this fall how did
we get here oh my gosh it actually started back in the early 70s you know
there was a Senate committee that was set up back in the nineteen like in I
think in 1972 by the Trudeau government and their conclusions were back then
that you know what prohibition is not working that prohibition is not working
and we need to legalize we need to legalize cannabis and of course that
Commission was totally shelved but it came back in the 1990s when the federal
that they the federal government was sued by a patient in Ontario who was
arrested for possession of cannabis and then the medical cannabis legalization
became became enacted in 2000 and so it’s been a slow process of returning to
where it was before prohibition before the 1930s when cannabis was used
medically by by most physicians and there were dozens of companies making
you know dozens and dozens of different products that were cannabis based that
were used for anything from from spasms to insomnia to anxiety to menstrual
cramps to whatever so what are you expecting in terms of the public
consuming cannabis well if we had didn’t if we had done this 30 years ago it
would have been a lot less complicated because thirty years ago we didn’t have
extracts and high potency distillates and really fancy little USB vaporizers
and stuff that can deliver high high doses people were like left with you
know cannabis just regular dried flowers that had very low potency and sometimes
people find hashish but it was really mostly it was mostly dried flower and
people were consuming it by inhalation by smoking if we had done that back
you would have given us a long time to sort of get ready to to face these high
potency products and to deal with them later on and to know all the effects the
long-term effects but now we’re stuck with this issue that we have we’re
legalizing it and pretty soon people will have access to massive doses of THC
and I don’t believe that we’re adequately prepared to predict the
outcomes of what’s gonna happen down the road with people who start with from the
start with these massive doses of THC especially young people so it’s a big
mystery now it’s a huge mystery I think in the next five or ten years as the
studies come out we’ll find out which dose is gonna be a safe dose okay which
variety which combination of cannabinoids will be a safer variety and
and we’ll know exactly how to avoid these mishaps because right now we don’t
know what’s gonna happen it’s like alcohol I mean when alcohol
was prohibition if we had stopped prohibition and we say okay we’re gonna
reintroduce beer but it’s not gonna be like the old beer okay the old beer is
5% alcohol this one’s gonna be 40% alcohol but we’re not gonna tell you
okay you just have to drink usually you usually drink three beers keep drinking
your three beers and we’ll see what happens okay it’s something that’s how I
like to picture it in my head because right now people are people still think
that cannabis is like the cannabis from the 1990s right especially people from
our generation is loved there was no problem back then I mean people just me
got high and it was fine right but we don’t realize that the side effects are
dose related but right now access to high doses is so common so we know with
alcohol one drink is a glass of wine now it’s now a flicker or a beer yep what is
a dose of THC I’m asking you Joe what is a dose of th help we’re all in field
trouble if you’re asking me here so you should know you should know we should
know this everyone should know what a dose of THC is but we don’t know what it
does of THC is we we can surmise about what the experience
like for example in Colorado and Oregon in Washington when they first legalized
and they started seeing hospital admissions shooting up you know people
becoming completely psychotic they said oh wait a second maybe the dose thing
here going on and because people were buying chocolate bars with a thousand
milligrams of THC and you had a hundred milligrams in a gummy bear for example
which is a massive dose for somebody who’s never consumed anything but when
you look at it coming bear it looks so benign right it looks so friendly but a
couple hours later that person’s like you know is locked down in a gurney you
know in the emergency room so if you look at what happens in in Colorado
after the first initial you know years of legalization and the problems they
had with the emergency rooms and the psychosis they came out with public
campaigns the campaign is that that actually you know warned not only people
from Colorado but the tourists that were coming in you know to start with like a
maximum dose of five milligrams of THC so there’s these campaigns called Li was
like first-time 5k for the first time five campaigns which I thought was just
brilliant you know so if you didn’t know what cannabis was and you weren’t sure
what to use and it didn’t matter if you inhaled it it didn’t matter if you ate
it as a candy or a gummy bear or a chocolate bar as long as you didn’t take
more than five milligrams of THC the first time you used it and you never
took a second dose on the first day those were like the main sort of
recommendations to avoid ending up you know at the hospital so of course one of
the advantages of having the substance regulated by the government both
federally and provincially if I understand correctly is that the
government’s going to take care to educate people and provide this
information but I’m not really seeing a lot of that out there what what’s your
take on the level of public education about all this I’m actually a little
disappointed at that that this is all we have right now in terms of public
campaigns I mean I look at the commercials I look at the ads
it’s they’re basically saying avoid it don’t use it if you’re going to be using
it use it safely but not getting into the specifics I believe that we need to
get into specifics it says if alcohol was introduced today
if alcohol never existed and it was introduced today and the only
commercials we said was use it responsibly there would be a lot of you
know we’d have a lot of problems right because people would say what’s
responsible use we have to determine what a responsible use is and we and and
it may change with time but we need to find out right now what we can at least
say to people don’t go beyond this you know but the problem is that industry
right now is pretty much dictating the rules and they’re the ones who are
producing the products and government is not sort of telling them well at least
have most of your products low potency most of the products are high potency so
if even if you wanted a low potency cannabis it’s very difficult to find
they’re very difficult to find so you’re obviously involved in you know with the
community physicians to prescribe responsibly and I do feel like this is
an opening for just a general public education a so and dosage is a big piece
what else do people need to know to be able to consume responsibly a couple of
things my my main worry is is of course the teenage brain right so we’re looking
at teenagers today who are gonna experiment and we know they’re gonna
experiment right we’re not gonna stop that from happening in Canada we have
probably the highest rate of cannabis use in in youths in the world and so
it’s part of the culture we can we can warn them we can tell them not to use it
we can tell them to just wait till they’re 18 or 21 but they will use it
and I think we need to put as much effort as we can into determining first
of all which adolescents shouldn’t be consuming cannabis because we we have a
pretty good idea of the high risk the teenagers the ones with premorbid
psychotic conditions no those angry lonely sad teenagers right that have
difficulty functioning that aren’t doing very well in school those are their ones
that we need to we need to spot those guys and say you know what you’re having
difficulty with your friends you’re you know you’re you often find yourself
alone you’re often angry at the world if you don’t consume cannabis you’re the
guy who’s gonna start like using it and so oh wow this is great right calms me
down you know gets my mind off all the bad stuff that’s going on in my life but
you’re the guy who’s high risk of living playing a psychotic disease okay it may
not happen in your life but if you’re that kind of teenager and you start
smoking cannabis your risk of ending up with a life a lifelong illness
increases dramatically so those are that’s one thing we got to do is it’s
the spot not all the teenagers we can’t just tell teenagers across the board
don’t use it we have to sort of like put them in different tiers like there’s the
high risk in the low risk can you tell us about that study I think large
longitudinal studies happening in Canada and I believe the Netherlands in Finland
and Finland now tell us that’s pretty impactful yeah
those were two studies that came out just this year done on over 10,000
students four thousand here in in in Montreal six thousand in Finland they
were followed here they were followed for 15 years in Finland four years here
basically the same structure of the study what they did is they took a whole
bunch of adolescents around 13 years old before they started consuming cannabis
and run a whole battery of psychological tests on them to find out if they had
these premorbid conditions for psychosis and there are tests that have been
standardized for this and then they was followed then I’ve over the course of a
couple of years and they would take the ones I would start consuming cannabis
and those that didn’t and find out what what are the proportion of students or
adolescents that had premorbid conditions that had that would hurt that
would end up further developing a real psychotic illness and which and which an
there are any protective factors so what they found out is that yes if you have a
premorbid condition your risk of developing a psychotic illness is
extremely high okay and the bad news is is that and this was
one of the things that really really upset the the the advocates for pro
cannabis is that even if you don’t have a pre morbid condition your risk does
increase it doesn’t increase as much as if you did have a pretty morbid
condition but it does increase higher than if you didn’t need to consume
cannabis at all so and and and the the the prevailing message before this these
studies came out was that oh if you’re gonna become schizophrenic cannabis is
not gonna cause it right it’s you’re you’re predisposed to schizophrenia and
you just happen to discover cannabis and it’s not it’s sort of cannabis wasn’t
the cause it was sort of the it was the result yeah it was either the trigger or
you used it to self-medicate for example for anxiety or whatever
but the the message was that cannabis didn’t cause schizophrenia but these two
studies are sort of like it’s the death knell on that sort of philosophy it’s
it’s basically saying yes you know what if your if your trajectory in life is to
become schizophrenic if you consume cannabis well it’ll increase the risk
that it’ll happen probably earlier but even if you have no predisposition to
schizophrenia if you start consuming cannabis as a teenager you may become
schizophrenic and that would never have been your trajectory in life okay so
that’s the scary part okay now not every teenager that has no predisposition is
going to become a schizophrenic of course and we know that it’s probably
dose related again so I’m going back to the dose issue and and since we can’t
stop all teenagers from smoking cannabis I’m saying there we may have to sort of
put up with a certain amount of risk okay as a society said listen we can’t
we’re not gonna stop all the kids from becoming schizophrenic but if we
couldn’t prevent at least the high-risk ones and reduced the the harm
you know collectively I think that’d be something that’s more real
than just saying just say no to teenagers before they’re 18 so you have
two teenagers yep how are you managing this sort of more on the on the
parenting side and what advice would you have for parents in terms of how to
approach talking to their kids about this issue that’s that’s a very good
question I try to give my kids the facts okay and I believe that kids today are
smart and if they’re told the facts we can just cross our fingers and they’re
gonna take the right decision if we exaggerate the risks well back in my day
we didn’t have the internet right but today they can just go online and say is
it true that yada yada yada and if they find one side that says no that’s BS and
here’s the study that says that that’s not true then they’re not going to trust
us anymore right so the facts are that yes there
are risks it’s probably dose related if you wait long enough those risks reduce
dramatically and the other fact is that most kids who do consume candidates when
they’re 15 16 years old end up with no problems whatsoever okay but it’s a roll
of the dice that’s what we need to tell them it’s a roll of the dice it may
happen to you it may not if you are going to consume at least consume
responsibly and hopefully soon we’ll find out what that is
okay at least for now my my guess as to what a responsible cannabis consumption
is for a 15 year old who says I don’t care what anyone says I’m gonna smoke
cannabis I’m saying okay if you’re gonna smoke use something that has less than 5
or 6% THC and that contains at least the same out of CBD if not twice as much CBD
because there’s been very interesting studies that have shown that if you add
CBD at least in adults you reduce the risk of psychosis so it’s not a hundred
percent guaranteed but the data right now suggests that if you add CBD hey at
least you’re putting on like your winter tires you know it’s it’s something like
that you may get an accident anyway but it’s
a bit of an extra safety thing okay so we’ve got dosage we have special
consideration to the teenage brain any other public information we should all
know the CBD issue like I mention okay doesn’t only pertain to to adolescence I
think most people will probably benefit too if you’re gonna be consuming
cannabis recreationally it’s always good to add a little CBD okay the the problem
with with illegal the illegal market is that there’s almost no CBD now they’ve
they’ve completely you know genetically removed it from the strains because it
has a tendency to lower the buzz a little bit supposedly in certain in
certain circles people call it the buzz killer right the CBD and therefore they
say well you know people want like just to get high right but but adding a bit
of CBD if you add a bit if you take a bit more THC probably will make up for
it so but Adam a CBD will have some kind of protective effect on not only on
psychosis but on other cognitive functions okay like memory and stuff and
things like that so CBD is always a good thing to have around and low low potency
THC I don’t I don’t see anyone who should be using 18 20 25 percent THC
products I don’t know I don’t see the use for it right now unless you’ve
become extremely tolerant over the years and that’s the dose that you need to get
high but if you’re gonna be asked if it can be started with cannabis and to me
I’m the message I’m not sending messages out there to people who already using
are using cannabis because they know exactly what they want and what they
need but the ones who are going to be starting in the cannabis sort of like
you know exploration you need to start with those microscopic doses of THC and
always CBD alright so imagine you’re an adult and you’re having a dinner party
or watching a movie and you smoke a joint and when do you know if it’s okay
to drive home is it okay to operate heavy machinery is it is it
okay to work on your your term paper for school like how about these sort of
safety considerations well I I’ve had a I’ve had a couple of discussions with
some some of my patients for example I have some students you know who Joe
using cannabis and and and they had some difficulty in school I said listen I
mean you can you know if you’re gonna be using cannabis don’t use it during like
during the exam period okay if you want to like put your chances on
your side about two weeks before exams stop using cannabis okay so you know as
a harm reduction strategy two weeks yeah yeah to get it out of your system right
because there’s one study that showed recently that if you stop smoking
cannabis the benefits in terms of memory and attention are appear after about a
week of abstinence okay so about two weeks you’re probably like sort of
maxing out so you’re getting most of the benefits at that point when it comes to
driving latest studies shows that if you inhale and you wait at least five hours
if you consumed orally should wait probably six hours or more okay and if
you get high for example if you take you to a very high dose you may have to wait
up to eight hours before driving and the association of Canadian occupational
health physicians I think recently came out with meanwhile their recommendations
and said that according to their data the the risks are persist after 24 hours
of consumption and that has caused a bit of a bit of a bit of a controversy
especially in in certain fields like aviation for example some companies like
Air Canada and Air Transat have or is it WestJet have banned their pilots from
using it completely recreationally at any point and some some some police
departments in certain cities I’ve also been there their police officer from
using it recreationally and it’s the the studies unfortunately I button that were
used to show this were done mostly with like single doses in in naive patients
okay and they would think they would take a massive dose or a dose of THC or
cannabis and then they would measure their you know psychometric you know
tests 24 hours afterwards and they realized oh my gosh this guy still has
attention problems okay but when you look at other studies that have been
done with medical cannabis users who take it every day okay at least one
studies showed that after about six weeks there’s a very very very high
tolerance did most of these tests most of these effects and the the actual
driving ability in in in regular cannabis users is pretty much near than
normal you know but you have to be using it on on a daily basis as a medicine
right it’s like any N likes most medications so the person who gets
pulled over by the cops for driving poorly could say don’t worry I smoke
every day well that’s going to be a big issue because if if a cop pulls you over
it first of all they have to demonstrate that you’re that you’re that you have
you know like a definite as if I could ever be that you’re yeah they have to
show that they have to show that you’re inebriated so they can’t just say well
I’m going to do a blood test and find out that you have THC in your body they
have to actually demonstrate through tests that you can’t walk a straight
line that knows that thing and the counting the numbers backwards and
whatever all that is that they have so if they do demonstrate that you that you
are inebriated then obviously any finished each scene your blood and your
over the levels that there’s there’s been some levels that have been
determined well then you know you have to probably sort of bite the bullet and
that’s in that in those in those circumstances but if you if you’re
taking cannabis on a regular basis and that’s what I usually tell my patients
is it can I Drive or not it’s well I wouldn’t drive for the first like four
or five weeks if you’re gonna be using until you get to your like to you to
your you know the to the to the dose that’s gonna be effective for you once
you reach that dose you wait you wait for five weeks and then you see how you
feel obviously if you if you’re very sensitive to the effects and you feel
that you’re inebriated then obviously don’t drive but it honestly if you feel
safe enough to drive then you’re probably safe enough to drive you know
but legally right now I keep telling if you’re stopped and the cob determines
that you’re not you know that you can’t drive and yours THC in your blood
there is no defense okay it’s there so we’re stuck with that but the problem is
that we give patients all kinds of drugs like valium and morphine right and those
affect your ability to drive and we rarely tell our patients you know that
that they could be in serious legal trouble but cannabis has that sort of
special status thing this is so great I feel like I’m drinking from a firehose
right now it’s just not overwhelmed by this amazing information thank you so
much for for doing this with me I love this there’s another class of
psychoactive drugs that are but seem to be following a similar trajectory in
terms of legalization and medical use and that’s the psychedelics mm-hmm
I guess specifically psilocybin the active ingredient of mushrooms LSD MDMA
what what’s your take on what’s happening in that in those sort of
research literature’s and the sort of historical trends that we’re seeing
there is this just is that the next cannabis or is it a different class of
phenomenon do you think I think there’s incredible potential in those drugs when
you look at the initial studies that were done like in the 1950s and 60s I
mean they weren’t like small studies these studies were done on thousands and
thousands of patients and the results and these were very solid studies and
the results were spectacular right but then the 60s came and the counterculture
and then it became a street drug and they was banned but over the last say 10
15 years there’s been a rebirth of research in psychedelics the great thing
about psychedelics is that unlike cannabis cannabis when you’re gonna be
using medically you have to use it pretty much like every day because it’s
for chronic symptoms right psychedelics are usually got one shot deal right
people use it like it’s a couple of sessions three or four sessions eight
sessions it’s it’s it’s usually in in psychotherapy it’s usually used for
psychotherapeutic purposes so it’s not something that you can be using every
day to treat the condition right so the the the the long-term
effects in terms of the impact on your cognition and things like that are
really not a huge issue but I believe that it’s it’s gonna completely
revolutionize some how we practice medicine in the next 10 15 years for
sure totally hold on can you unpack that oh yeah when you look at most of the
problems that we have I mean in in family medicine 50% of the people that
come into my office don’t have a physical problem right 50 50 % right so
it’s it’s anxiety issues it’s it’s depression it’s a lot of mental health
and the drugs that we have and the interventions that we have her now are
effective but it takes a long time it’s it’s it’s and and the results are not
always spectacular right whereas these compounds when we look at people who for
addiction for example for depression for obsessive-compulsive disorders in in
many of these studies the the results were like almost immediate right so
we’re looking at like short-term high-intensity sort of intervention with
long-term results and that’s what we want in in in mental health we don’t
want like this you know very in the drop or kind of thing so just for the record
I am also very excited about this mm-hm and do you think it has tremendous
potential to revolutionize mental health for sure totally without a doubt but to
play devil’s advocate here I’m a little suspicious of the studies because first
of all it is impossible to do a proper control because you know if you got if
you got the active substance or if you didn’t that’s true and just the location
of these studies in history there’s so much excitement and and the researchers
are so passionate and those are all suspicious conditions to sort of
interpret or read the data with what’s your take on that you’re totally right I
totally agree with you on that point and that’s why we need to
we need to remake those studies right we need to take up all that literature out
of the dustbin and remake those studies with today’s standards and and and to
make sure that it wasn’t like you know some kind of you know some a fluke that
they that these results were or so a very powerful placebo or very powerful
placebo but I’m still but you’re right if there was a study that if these all
these studies were done like maybe you know twenty or thirty patients I say
well yeah there’s you know I’m not I’m not convinced yet but when you look at
the number the thousands of patients that were that were that were used in
these studies and you and Nick it the results a placebo effect in most studies
you can get maybe ten fifteen twenty percent right we’re looking at these
studies that had like eighty percent success rate so I agree that it could
all be it could all be smoking mirrors right but the numbers are so spectacular
and and you know maybe it is just gonna be a question of really understanding
what the actual effect size is but you know if you took ten thousand people and
you said okay I’m gonna take you into this special room and I’m gonna give you
this pill it’s something really weird and potentially really cool it’s gonna
happen and I’m gonna be here to support you and this is a safe environment and
just go with it and some really amazing profound things might happen to you and
if they don’t that’s fine mm-hm let’s go yeah like you can give
people like a carrot yeah and a big chunk of those ten thousand people are
gonna have a mind-blowing experience yeah I don’t know found that but maybe
psyched accounts were so much variance in mental health interventions no I
agree but I mean we know one thing that the psychedelics do have an effect I
mean it’s not just placebo I mean the effect people who the the accounts of
the people who had these effects were psychedelics is there’s no doubt it’s
not a placebo effect no it has some impact on and there’s a jealousy both
studies have been done they would take ritalin versus the silo side
but I mean but just to make sure that there was you know of at least a placebo
you know of course something will happen in your subjective experience but that
being therapeutic I think is subject to a placebo I totally agree with that as
well in my opinion though if a patient comes to me and who’s been chronically
depressed or has you know some addiction issues or alcohol issues and takes
psilocybin three times and stops drinking and or feels better and go back
to honestly I don’t care if it’s a placebo or not as long as it works right
and it’s safe right he’s not gonna die from it then he’s not gonna gain 30
pounds and you know cuz he’s taking it to depressants or whatever clothes this
has just been so fascinating I really appreciate it is there anything else
that you want to say before we before we end our conversation here I would I
would I would very much hope that that the Canadian government the provincial
governments stop sort of like pussyfooting around okay and actually
start giving some really concrete advice on how to use cannabis responsibly okay
instead of giving these vague advice okay that would be like my main worry
what’s the obstacle to that why aren’t they stepping up to the plate that’s a
good question I don’t know maybe the data isn’t isn’t there’s not enough data
on what exactly is a reasonable or or an appropriate use of cannabis so they’re
relying on on the experts who basically say don’t use high potency products and
and so forth and don’t drive and but but vague stuff but the people who make up
the guidelines are people who don’t really know what cannabis use is they
basically see people who all have cannabis abuse problems right and for
example the this camh for example the Canadian Association
mental health is it this is in Toronto yeah they’re the ones who came out with
the lower risk guidelines and and the excellent guidelines but there’s no
there’s no mention of any dosage in there at all you know which i think is
the most essential aspect is to find out what what what a dose is so I think I
think we have enough data right now to actually at least present you know until
further data you know arrives what a safe dose is and
we’ll adjust with the years and we define it when we find out later but we
could tell people right now exactly what a dose is how frequently and how long it
lasts and just like basic stuff yeah that’s that’s my big big big worry well
to the extent that people actually listen to this interview and more people
will be informed which is probably a good thing thank you so much again and
later maybe we’ll do a part two after we get a little more data in a few years
that’d be great I’d love that all right thanks a lot quote thanks Joe

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