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Dr. Ryan Sultan, MD, (@rsultanmd) is a professor of clinical psychiatry at Columbia University. His lab focuses on the interface of electronic databases, mental health, and substance use epidemiology, and evidence-based treatments for common mental health conditions.
In this episode of The Art of Manliness, Brett dives into the world of cannabis with Dr. Ryan Sultan. They discuss which groups are most vulnerable, potentially negative side effects, marijuana and adolescence, mental health impacts, and what safe cannabis use looks like for adults.  
Host: Brett McKay (@brettmckay)
ADHD is a major risk factor for substance use
Most people see marijuana as totally benign and harmless
Most cannabis research is obsolete because research was done before it was federally acceptable to research cannabis and the cannabis of today is significantly more potent than in the past
  • We’re not really dealing with the same substance anymore
Medicinal marijuana: The science is weak; yes, it’s good for nausea and weight gain but that’s mostly it
  • Long-term use actually increases anxiety – it’s not a permanent treatment
The controversy: People staunchly defend marijuana use but it’s not totally benign
Cannabis is becoming an openly used substance but we don’t know what level is problematic and what level is acceptable
The brain is not done developing until around 25 – exposure to cannabis prior can change brain structuring
Stats: overall, about 13% of US teens between 12-17 have had recent cannabis use; about 3% have addictive traits; the remaining use cannabis but don’t qualify as having a substance use problem
  • Keep in mind this is self-reported; rates also change by location
Cannabis use among teenagers has increased over time
Cannabis use among youth has negative associations
  • Cannabis use in young brains changes how the brain develops and connections
  • Use causes cognitive impairment that persists for weeks to months
Youth who use cannabis but don’t have a substance use problem have increases in major depressive episodes, suicidal thoughts, lower GPA – this correlation is meaningfully higher than youth without recent use
The association between cannabis and schizophrenia should be a big deal – treatments for schizophrenia are not great
“Especially among men 18-26 cannabis use increases the likelihood of developing schizophrenia by 4 times.” – Dr. Ryan Sultan
At a minimum, wait until after 25 to smoke cannabis
  • The likelihood of depression, suicidal thoughts, and developing a substance use problem is reduced if you wait
The cannabinoid receptors play in role in how the young brain developing
Cannabis use shows changes in the morphology of the brain in everything from rodent models to humans
Try alternative treatments for depression: exercise, exposure to nature, social and family connections, medications
Lung disease across the board, development of youth who will not progress the same way
When you look at large groups of kids, there’s an undeniable link to negative outcomes
If you’re over 25 and the cannabis you’re getting is of good quality then it’s relatively safe depending on quantity and mode (edible is safer)