Speaker 1: No, really, no, really, they really don't really fans. It's
Speaker 1: David Google.
Speaker 2: I'm Google.
Speaker 1: I'm here with you today with a bonus edition of
Speaker 1: really No Really Now. In the most recent edition of
Speaker 1: the show, we had doctor Ryan Sultan, the assistant professor
Speaker 1: of clinical psychiatry at Columbia University. Now he came on
Speaker 1: to talk about people behaving badly, the Karens at the
Speaker 1: pool or the people going crazy on airport, right, and
Speaker 1: so we were having that discussion. But during the taping,
Speaker 1: Peter admitted that he was coming could Turkey off of
Speaker 1: the use of marijuana that had gotten out of hand
Speaker 1: since COVID, so much so that when he went off
Speaker 1: of it, he was he was having a hard time. Well,
Speaker 1: thankfully for us. Doctor Sultan is an expert in the
Speaker 1: areas of anxiety disorders depression ADHD, and substance abuse ketamine
Speaker 1: and cannabis youth, so he was the perfect person to
Speaker 1: talk to the research the new extensive research showing issues
Speaker 1: with heart issues with parts of the brain actually shrinking
Speaker 1: with extended cannabis youth.
Speaker 3: So we wasn't.
Speaker 1: Really part of the behaving Badly type of show that
Speaker 1: we were doing for you, but we felt that it
Speaker 1: was an important, helpful conversation that we wanted to share
Speaker 1: with you. So without further ado, let's go to Jason
Speaker 1: and Peter for really, no, really, it's.
Speaker 2: Starting because the oscars happened recently and.
Speaker 4: You got through them without smoking.
Speaker 3: Leave. That's really I've given up. So I gave up.
Speaker 2: I could do a medical podcast and we just did
Speaker 2: a report. Just literate the latest report. I'm having a
Speaker 2: tough time even talking today.
Speaker 4: So what should I call renegade Parana and get it
Speaker 4: back over.
Speaker 3: Boot roller blood.
Speaker 2: So in the report, and this is not a small sampling,
Speaker 2: this is like over four hundred thousand people now that's
Speaker 2: been not legalized for all, they found the stroke risk is.
Speaker 3: Through the roof.
Speaker 2: The lord caught smoking for smoking even for edibles. The
Speaker 2: lung cancer risk is through the roof. And I went
Speaker 2: out the other night, and you know, I've been smoking heavily. Heavily,
Speaker 2: Oh I know. Yeah, And I'm not proud of it
Speaker 2: because I started using it to go to sleep, and
Speaker 2: I was using it to eat dinner, and then I
Speaker 2: was using it to have.
Speaker 3: Cereal, right, So and it was so easy to do.
Speaker 2: I sprinkle it knowing that I'm not going to go
Speaker 2: dumpster diving and throw it out. And it's been three
Speaker 2: days and I've quit before, but this time has been
Speaker 2: really difficult. My cold turkey cold turkey, and I can
Speaker 2: feel it. I can really feel it because the stroke.
Speaker 2: When I read those statistics, it was incredible. But as
Speaker 2: far as the oscar, I'm the same way with sugar.
Speaker 4: I've been off sugar now for twenty three twenty four days.
Speaker 3: And congratulationships down and wait your cholesterols down. My cholesterol
Speaker 3: fell one hundred points.
Speaker 2: So today's lesson is if you lose weight, your cholesterol
Speaker 2: goes down down, and if you stop pot you're ready
Speaker 2: to kill the guy whose cholesterol has gone down. So
Speaker 2: joining us now is doctor Ryan Sultan, Assistant Professor of
Speaker 2: Clinical Psychiatry in the Department of Psychiatry at Columbia University
Speaker 2: and the Irving Medical Center in New York State Psychiatric Institute.
Speaker 2: He's an expert in the area's ADHD and cannabis use.
Speaker 2: Will talk about that. Welcome well, but I wanted to
Speaker 2: ask you something really important. We had opened this by
Speaker 2: talking about cannabis, and I'm very candid about my cannabis
Speaker 2: use that I got really out of hand during COVID.
Speaker 3: Oh boy, yeah, and a lot of people's did well.
Speaker 2: And I didn't even realize it started for bed that
Speaker 2: The story I told myself was I needed to go
Speaker 2: to sleep because I don't sleep well, and then I
Speaker 2: needed to eat dinner and I needed to get up,
Speaker 2: and I needed this.
Speaker 3: Because my kids are going through this stuff.
Speaker 2: You specialize in cannabis use ADHD and especially with antipsychotic
Speaker 2: treatment and teen if you had to give us an umbrella,
Speaker 2: because as I said, to start this, the cannabis you is,
Speaker 2: they just found out with one of the bigger tests
Speaker 2: ever that they've done that increases the risk of stroke
Speaker 2: tremendously and lung disease, et cetera. So I threw it
Speaker 2: out and this is day three and I can feel it.
Speaker 2: I can feel that I'm a different guy. I'm a
Speaker 2: bit scattered, and I'll come coming down. Do I also
Speaker 2: noticed that when I was using it, the more and
Speaker 2: more I used it, the more I got edgy, the
Speaker 2: more I got shaky, and I knew that rationally, Buddy
Speaker 2: didn't stop. So if you can address that, so.
Speaker 5: Many things going on with cannabis right now, you know
Speaker 5: one of the main things that has come up is
Speaker 5: that we had this pendulum shift from cannabis is the
Speaker 5: worst thing ever to it's a totally natural, benign tennessee.
Speaker 5: And like both of those things are wrong, actually right,
Speaker 5: Like those are those are extreme examples. And and so
Speaker 5: there's this idea that that cannabis has no negative side effects,
Speaker 5: which is just incorrect. Another thing that's important about cannabis
Speaker 5: is the cannabis that you have access to now is
Speaker 5: not the cannabis you had access to when you were
Speaker 5: a teenager. It is substantially stronger by design. By design,
Speaker 5: it is substantially stronger than the stuff that you had before.
Speaker 5: And when you think about like whenever we've done that before, right,
Speaker 5: like morphine versus fentanyl, Like fentyl is like one hundred
Speaker 5: times stronger than morphine, like and we didn't have an
Speaker 5: opioid crisis when we only had fentanyl, when we only
Speaker 5: had a morphine, right like it was when we created
Speaker 5: this much stronger version. So like the cannabis of today,
Speaker 5: it's it's you know, you got natural cannabinoids in your
Speaker 5: in your body that we all just have that are
Speaker 5: binding to the cabina receptors, and like you know the
Speaker 5: weed of probably my parents' generation. You put a little
Speaker 5: bit in a joint, you take one hit, like it
Speaker 5: would bind to that, it would feel nice. The weed
Speaker 5: now is much stronger, is binding to that receptor and
Speaker 5: is clinging on to it so much. And then now
Speaker 5: that it's binding to it so much, your body says, oh, oh,
Speaker 5: I don't need as many cannabina receptors, so they make
Speaker 5: well less caannabino receptors. We can see that on a
Speaker 5: function MRI that you have reduction of the cannabinoid receptors.
Speaker 3: So now when you stop, you feel awful.
Speaker 5: You feel awful because there isn't enough naturally circulating cannabinoids
Speaker 5: to compensate, and you don't have the the receptors that
Speaker 5: you had before because it's down regular and the more
Speaker 5: potent is the stronger it is, the more that phenomenon
Speaker 5: is going to happen.
Speaker 2: So when you talk about it, because I had done
Speaker 2: this on the radio years, this is why you.
Speaker 3: Have this rebound anxiety. By the way, how long does
Speaker 3: that last?
Speaker 5: By the way, Uh, you know, the fMRI data shows
Speaker 5: that you know, on a scan it looks pretty much
Speaker 5: normal after about thirty days of no use.
Speaker 2: You're almost there, Pete, No not. But I got to
Speaker 2: push back anytime I talk about this on radio. And
Speaker 2: this was before I had to use that I do.
Speaker 2: Now you get to call from every stone in the
Speaker 2: world going that's because you're doing it wrong.
Speaker 3: You got the wrong dude, you got the wrong strain. Yep.
Speaker 2: So the point being, I always got the pushback people
Speaker 2: yelling everybody does podcast, you're doing it, You're doing it wrong,
Speaker 2: you got the wrong kind of pot. You have to
Speaker 2: this that. How do you even answer that? Because people
Speaker 2: on pod that are using a lot of it are
Speaker 2: going to be really resistant because, like I said, if
Speaker 2: you said it's thirty days of this, I'm in. I'm
Speaker 2: in because I don't want have a stroke. But how
Speaker 2: do you tell somebody thirty years old who's taking it
Speaker 2: because they're convinced that it helps with their ADHD or
Speaker 2: it's helping me whatever they have.
Speaker 5: And and and and it might actually it might help
Speaker 5: with their ADHD. There's a little bit of data that
Speaker 5: that that that some that strains, and we don't have
Speaker 5: this downright, meaning we can't replicate it in a medical
Speaker 5: way that it might it might do that. So I
Speaker 5: want to validate for them, it does reduce anxiety and
Speaker 5: it does improve mood symptoms. So everyone who says, hey, like, no,
Speaker 5: it actually made me feel better, they're right. But but
Speaker 5: the thing that that they need to think about is
Speaker 5: the flip side of it, particularly with the anxiety and
Speaker 5: depression stuff, which is that you know, if you the
Speaker 5: more you're using it, it's probably making that condition.
Speaker 3: Worse for you. I can feel it. I can feel
Speaker 3: and you don't realize that.
Speaker 5: You don't realize it, and and and and and the
Speaker 5: cannabis is sneaky. It's really sneaky. It plays a trick
Speaker 5: on you. You're using it more and more. Eventually you get
Speaker 5: to a point where where if you you need it
Speaker 5: just to feel normal, uh, and and to just sort
Speaker 5: of function. I really I spend a lot of time
Speaker 5: talking with people about that. And you know, one of
Speaker 5: the ways I start with is just like, let's let's
Speaker 5: just write down how often and like how much we
Speaker 5: think we're using Like you don't have to change anything,
Speaker 5: like just write it down, just record it, like no judgments,
Speaker 5: like because most of the time when we do that,
Speaker 5: it turns out it's it's more than we thought it was,
Speaker 5: right and same thing with drinking. You ask anyone how
Speaker 5: much they drink, almost everyone is going to underestimate.
Speaker 2: And the amazing thing about the phenomena is aware of it.
Speaker 2: As I was, I'd be in my day and I'd
Speaker 2: be going, I feel pretty good, feel pretty good today,
Speaker 2: everything's going well on PERF doing whatever, and I go,
Speaker 2: but I'm still going and I know what it's doing that,
Speaker 2: but I'm still going to do I'm.
Speaker 3: Still going to do it.
Speaker 4: Of that, it wasn't I always will with sugar. And
Speaker 4: I realized that when I was in an acting class.
Speaker 4: My acting teacher said, you go out for an audition
Speaker 4: and you do a bad job.
Speaker 3: What do you do?
Speaker 4: I go get a Snickers bar? Right now? You go
Speaker 4: out for the audition, you do a great job. What
Speaker 4: are you doing?
Speaker 3: I go out for I think as well, there you go.
Speaker 2: Yeah, but just thing scared. This thing scared me, I
Speaker 2: mean it scared. This report was a pretty valid report.
Speaker 5: And again I'm sure people are going to work and
Speaker 5: there are other aspects of it, so that one is
Speaker 5: is uh, in some ways not surprising because uh, you're
Speaker 5: you're the inhalation of any kind of smoke damage is
Speaker 5: going to damage your runks, right, I mean this is
Speaker 5: like you are burning something, okay, like so like you know,
Speaker 5: just like if you were in a fire, that wouldn't
Speaker 5: be good for you either. The other thing that I
Speaker 5: worry actually more about, because the lung thing is the
Speaker 5: obvious thing to be worried about.
Speaker 3: The thing that I worry.
Speaker 5: About is all this data that we have on the
Speaker 5: on the changes in the structure of your brain.
Speaker 3: That's what I worry about.
Speaker 5: So in kids, which by the way, is under twenty five, okay,
Speaker 5: under twenty five, is your brain is developing to lease
Speaker 5: till twenty five your ADHD it's probably even later than that,
Speaker 5: there's evidence of structural changes. And then in long term
Speaker 5: cannabis users, and you know in in Scandinavian countries, they
Speaker 5: you know, their socialized system, they monitor everyone, they have
Speaker 5: records and everyone, so they are to look at people
Speaker 5: for many years. Cannabis users, their hippo campus is smaller.
Speaker 5: Your hippo campus is a big memory center. And one
Speaker 5: of the most acute effects of cannabis is the effect
Speaker 5: on memory. I mean, anyone who smokes pot is aware
Speaker 5: of this, and so like what does that what does
Speaker 5: that mean? I actually don't know the answer, right, like
Speaker 5: I don't. I don't know the answer. No one has
Speaker 5: the answer.
Speaker 2: Thing.
Speaker 4: But then you get the superstars, like I'm assuming based
Speaker 4: on what they themselves have said, superstars like Snoop Dogg
Speaker 4: or who are who are able to I mean, they
Speaker 4: seem to be completely functional. In fact, there seth Rogen's
Speaker 4: probably doing a hundred times more in a day that I'm.
Speaker 3: Capable of do it.
Speaker 5: And you know, the thing with with uh mind altering substances,
Speaker 5: and this was true for alcohol too, is that uh,
Speaker 5: we all don't respond the same to them. And also
Speaker 5: the situation that we're in the life, we're in, the
Speaker 5: environment we're in is going to affect that too. And
Speaker 5: and and yes, there are people that seem to be
Speaker 5: really heavy cannabis users and there does not appear to
Speaker 5: be any negative comment for them, but that's not gonna
Speaker 5: be everyone.
Speaker 2: May I wrap this episode up by saying, in the
Speaker 2: words of your mother, don't worry so much about Snoop Dogg.
Speaker 3: Worry about you, your mother, your mother, we should hear.
Speaker 2: Sorry to wrap every episode, don't don't worry about seth Rog.
Speaker 6: Seth Rogen jumps off of U right now as another
Speaker 6: episode of Really No Really comes to a close. Let's
Speaker 6: thank our guest, doctor Ryan Sultan. He's the director of
Speaker 6: Integrative psych as well as being director of Sultan Live
Speaker 6: at Columbia University. You can follow him on Instagram where
Speaker 6: he is at Our Sultan MD and on x where
Speaker 6: he is at Doctor Ryan Sultan. Our little show hangs
Speaker 6: out on Instagram, TikTok, YouTube, and threads at Really No
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