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- [00:01]
Gwyneth Paltrow
Travel has always been such a big part of my life, and in a way, it's really what inspired me to start goop. I love discovering new places, new experiences, and finding those really special stays that make a trip even more memorable. Hosting on Airbnb is a great way to make the most of your time away. It's a wonderful option if you have extra space, own a seasonal home, or tend to travel at the same time every year. Hosting is incredibly flexible. You set the dates, welcome guests on your terms, and create memorable stays that reflect the warmth and uniqueness you seek in your own travels. If you've ever thought about hosting, your home might be worth more than you think. Find out how much@airbnb.com host Acura's all new ADX. A compact SUV that isn't just built for one thing. It's precision crafted for everything to escape the grind. With available all wheel drive to go with your flow. With available Google built in.
- [01:01]
Megan Tuohy
Hey, Google, turn it up. Okay.
- [01:03]
Dr. Kevin Gray
Turning up the volume.
- [01:04]
Gwyneth Paltrow
And crafted to be heard with an available bang. And Olufsen premium sound system. The all new Acura adx. Crafted to match your energy. Acura precision crafted performance take your vibes on.
- [01:16]
Megan Tuohy
Go, go, go, go. Google is a trademark of Google llc. When you are pioneering anything or introducing new ideas to the culture, you get criticized.
- [01:30]
Gwyneth Paltrow
You do. Yeah.
- [01:31]
Megan Tuohy
Did you hear about that?
- [01:33]
Dr. Kevin Gray
I didn't find the one. I found someone I respected and we made it the one. In the sort of longing kind of view of love.
- [01:40]
Megan Tuohy
People understand each other as if by magic. Nothing in itself is addictive on the one hand. On the other hand, everything could be addictive if there's an emptiness in that person that needs to be filled.
- [01:50]
Dr. Kevin Gray
I now know that nobody changes until.
- [01:54]
Gwyneth Paltrow
They change their energy.
- [01:55]
Dr. Kevin Gray
And when you change your energy, you change your life. Gwyneth.
- [01:58]
Gwyneth Paltrow
I'm Gwyneth Paltrow. This is the GOOP Podcast, bringing together thought leaders, culture changers, creatives, founders and CEOs, scientists, doctors, healers and seekers. Here to start conversations. Because simply asking questions and listening has the power to change the way we see the world. Here we go. Hi, everyone, and welcome to the Goop Podcast. I'm Gwyneth Paltrow, and today we're diving into the complex realities of marijuana use in modern culture. Joining me are two incredible experts. Megan Tuohy, a Pulitzer Prize winning journalist for the New York Times, who's been investigating the evolving role of cannabis in our society. And Dr. Kevin Gray, an addiction specialist and professor at the Medical University of South Carolina. From its therapeutic uses to its effects on mental health. We will be uncovering surprising truths about self medicating addiction and the risks associated with the increased potency and accessibility of marijuana. Today day. Hi.
- [03:07]
Megan Tuohy
Hi.
- [03:09]
Gwyneth Paltrow
How are you?
- [03:10]
Megan Tuohy
I'm good. Nice to see you.
- [03:13]
Gwyneth Paltrow
Nice to see you too. How have you been?
- [03:16]
Megan Tuohy
Very busy the end of like the year at the times. Trying to like get stories in before the new year is a little intense, but. Yeah, but we'll make it to the finish line and otherwise like, everything's. Everything's great. How about you?
- [03:30]
Gwyneth Paltrow
Fine. You know, kind of the same. Just trying to squeeze everything in before we finish everything and you know, travel and. And whatnot. It's just, you know, it's.
- [03:42]
Megan Tuohy
Yeah, yeah. And are you filming something right now? Did you.
- [03:46]
Gwyneth Paltrow
I finished. I was doing a film in New York all fall and I'm finished now, which is great. But it was a nice respite from my empty house. You know, I'm an empty nester, so it was great not to come back to Los Angeles and just do something completely different.
- [04:04]
Megan Tuohy
Yeah, yeah, I can imagine.
- [04:06]
Gwyneth Paltrow
I can imagine. It was really good.
- [04:08]
Megan Tuohy
Kevin, it's nice to see you. I'm so glad that you were able to join even with the last minute invite.
- [04:15]
Dr. Kevin Gray
Yeah, happy to hop aboard. Actually, our empty nest is repopulating. My younger one's back from college, the older ones finishing med school semester this week, and so I'm excited to repopulate the house.
- [04:26]
Gwyneth Paltrow
I know, me too. My daughter came. Came back on Saturday and my son comes back day after tomorrow. So I know, I'm excited. This college thing is. It's a big, A big shift.
- [04:39]
Dr. Kevin Gray
It is. It's good and bad. You know, I'm a. I'm a child psychiatrist. Development is good, but selfishly, you can be a little sad every now and again about them moving on. But I think it's so much fun to have them repopulating the house and then like see them growing up even outside of your. You're witnessing it is really cool.
- [04:57]
Gwyneth Paltrow
Yeah. Yeah.
- [04:59]
Megan Tuohy
Oh my God. It's. It's a bit terrifying. My. I'm like dealing with. We. We're on the phone with my daughter's school because she's having a tough second grade, which is like, I'm like, how am I going to survive? Like, how am I going to possibly survive junior high school, let alone high.
- [05:13]
Gwyneth Paltrow
School, let alone, like it's a. It's a funny time to raise kids. It's, you know, like we have these digitally native kids and everything that comes along. With that and how it impacts their little cultures at school and I don't know, it's a little. It's a lot.
- [05:33]
Megan Tuohy
Yeah, yeah.
- [05:35]
Dr. Kevin Gray
Mine roll their eyes when I express my concerns about their digital lives, but so be it.
- [05:42]
Gwyneth Paltrow
We just decided when we're. We're gonna go to Italy for Christmas, and we just decided that we're all gonna try not to have our phones with us for the whole week and just leave them.
- [05:52]
Megan Tuohy
Everybody.
- [05:53]
Gwyneth Paltrow
We're going to delete our social media, and then we're just going to try not to, like, have them with us all the time. We'll see how that goes.
- [06:03]
Megan Tuohy
Yeah, I mean, that's. That's the thing is like, you know, with a smaller child, you know, who does not have a phone and only gets an iPad. If we're, like, traveling on airplanes and is, like, always asking when she's going to get a phone, and we're like, you know, maybe 12 at the earliest, but, you know, the. But like, of course we use our. Like, we're constantly checking our phones. We even use it to, like, put on music or, you know, and so that recognition that, like, we have to. We have to also, like, restrict our use, like, if we're ever going to Model it. Yeah, yeah, model it. But.
- [06:36]
Gwyneth Paltrow
Okay, well, I could talk to you guys about a variety of subjects ad nauseam, but I guess we should get to the business. So, Megan, I've known you. In fact, we've known each other a long time because you were saying you have a second grader and you were breastfeeding when I met you.
- [06:53]
Megan Tuohy
I. Yes. Yeah. She was. Yes. I was, like, coming off of breastfeeding, but still in that very first year of parenting when we first met. Yep.
- [07:03]
Gwyneth Paltrow
And now she's a second grader.
- [07:04]
Megan Tuohy
So now she's a second grader. I know. And we met when we met your kids. I mean, we met your kids sitting around a dinner table like, way before they were the, you know, older, poised young adults they would seem to be today.
- [07:19]
Gwyneth Paltrow
It's crazy.
- [07:19]
Megan Tuohy
Always poised.
- [07:20]
Gwyneth Paltrow
But thank you.
- [07:22]
Megan Tuohy
Much younger.
- [07:23]
Gwyneth Paltrow
Much younger. It's. It is. It's wild how it. It really is an axiom how quickly this whole thing tends to go. But you. I mean, we met, of course, when you were reporting on the Harvey Weinstein Story. That's a podcast for another day.
- [07:41]
Megan Tuohy
Indeed, indeed.
- [07:42]
Gwyneth Paltrow
But you, you know, you choose. You choose really interesting subjects. I think you choose subjects that really like bend or break culture or explore them. So I'm just wondering, how did this first. How did this topic first get into your. Come across your desk and why was it intriguing?
- [08:02]
Megan Tuohy
So you're right. I mean, when I met you as a reporter working for an investigative reporter at the New York Times, you know, years ago, and I still am on the investigations team at the New York Times and always on the lookout for stories, stories that feel meaningful and identifying hidden harms and dangers and injustice. And over the last couple years, I had been really struck, as I suspect many other people have been, by the explosion in marijuana in this country. And we. Over the last 10 years, there's been this rapid acceleration of more and more states legalizing recreational marijuana. There's now dispensaries, at least here in New York, on what feels like almost every corner. I see that when I go to other cities and travel to other parts of the country. And, you know, you can also feel it like I'm. You can feel the marketing of marijuana happening with targeted ads and other types of promotional material that's now kind of constantly popping up in front of us. And so I wanted to. And so I knew that. I knew that there was now also a $33 billion commercial industry marijuana industry that had sprung up. And I was starting to hear in sort of social orbits about people who were having problems with the drug that I was talking to moms and dads who, you know, had teenagers who appeared to be addicted, and they didn't know what to do about it. I was hearing about, you know, other folks who had family members who had experienced psychotic episodes that would appear to stem from marijuana use experience. And so I wanted to sort of juxtapose what appeared to be this, like, explosion of use and all this messaging around this, you know, the popularity and also safety of this drug. It's been promoted as something that's totally natural and totally safe. And yet I was starting to hear this sort of, you know, troubling things percolating up. And I wanted to, like, probe that and. And really find out, okay, what is the effect of this drug? Are there harms that are playing out? If so, what are the extent of those harms? And how can we really, like arm readers with. They can use. As they navigate, you know, the, The.
- [10:24]
Dr. Kevin Gray
The.
- [10:24]
Megan Tuohy
The appearance of this drug in their lives.
- [10:26]
Gwyneth Paltrow
And Dr. Gray, as we discussed, you're a child psychiatrist and an addiction specialist and a professor. Were you a professor? South Carolina. South Carolina.
- [10:35]
Dr. Kevin Gray
The Medical University of South Carolina. Yep.
- [10:37]
Gwyneth Paltrow
Yeah. So how did you two hook up?
- [10:40]
Dr. Kevin Gray
This was actually. Megan approached me. She was doing a story for the Times and approached me as one of the Content experts. And so we had a really rich discussion around this. And what a fascinating topic. Right? Both from a scientific standpoint, but also from medical standpoint, but also societally, we do these pendulum swings between sort of forbidding certain behaviors versus welcoming and being really excited about certain drugs or behaviors, et cetera. And I think we're at this interesting pendulum swing point. And where I come at this is as a clinician scientist. And so I work with young people who struggle with substance use, and I realize there's lots of voices to bring to discussion around cannabis and cannabinoids. But I'm also a scientist and super excited about learning about the endocannabinoid system, learning about therapeutic cannabinoids. At the same time, I can't help but talk about my clinical experience and also young people who really struggled with their use.
- [11:32]
Gwyneth Paltrow
Right. It does seem, you know, to your point, Megan, that there has been an absolute explosion of cannabis use and how it's marketed and, and oftentimes in a pretty, like, it's sort of framed in a pretty benign way. Right. Like it's better for you than, it's better for you than alcohol or people are California sober. And I wonder because, you know, and I don't know if maybe it's was just under reported back in the day, but when I was a kid all those years ago and people were sort of messing around with marijuana, it seemed like it was a completely different drug, like the potency. And so is it true that they're kind of engineering the, the drug now and, and, and is, does that make it like, is that sort of why you're finding addiction where, you know, they used to say, like, it's not addictive or psychosis or some of the more serious things, like, is that kind of, is there a correlation between engineering it for it to be this incredibly strong, you know, or much more so than it was, and, and the, the bad effects of it?
- [12:49]
Megan Tuohy
Well, what we found is twofold. So, you know, in the last decade, the use of marijuana has gone up substantially. And you know, you're, you're sort of, you make a good point in comparing it to alcohol use. Like, there's now in the last year or two, daily use of marijuana has now superseded daily use of alcohol in this country. There are tens of millions of people who use the drug, roughly almost 20 million people who use it every day. And so not only has use of the drug changed, but the drug itself has changed substantially. You know, the THC is the intoxicating component of marijuana, and the THC content of, you know, marijuana flour that can be used, you know, smoked in a joint or a blunt or you know, in a bong has skyrocketed. You know, when we were young it was like 3, 4% THC. Now it's as high as 20, 25%. So now the THC content is as high in mar. Marijuana flower is as high as 25%, even 30%. And beyond that, this commercial marijuana industry is now putting out concentrates of almost pure THC, which can come in the form of vapes or other types of concentrates that can be consumed. They're like dabs, waxes, shatters are some of the terms. So it's the combination of the shift in use and the shift in product that has pushed us into a realm in which doctors are now noting that there, that especially chronic users, chronic users of these heavy products are experiencing much more serious health consequences than they did before. And that's addiction. There's now as many as 18 million people who basically identify as having a cannabis use disorder, mean that it's, they continue to use even though it has a negative effect on their lives. And an estimated 3 million people in the grips of actual full on addiction. You know, there's growing numbers of people who are experiencing either temporary psychotic disorders or there's a growing association between marijuana use and actually people experiencing chronic psychotic disorders like schizophrenia. And there's also this new syndrome that has emerged which almost maps directly onto the rise of legalization and commercialization and the transformation of this product here, which is this basically cycles of vomiting and nausea that can be, you know, that can be very debilitating and you know, cause people to go to the emergency room over and over and over again. And that's been a really confusing thing because this drug can and has been.
- [15:30]
Gwyneth Paltrow
Used to anti nausea. Right? Like exactly. So chemotherapy patients used to, you know, it was like. And seasickness.
- [15:38]
Megan Tuohy
Yeah, there's. And that's been. So what we identified was not just like sort of growing these like growing harms, but also growing confusion that this drug that is perceived to be useful for, you know, dealing with mental health issues is having, you know, can cause psychosis. The fact that this drug can be used for people with like experiencing up upset stomachs can actually create that to such a severe degree that they're, you know, have to go to the emergency room over and over again. And we found cases of, in which it had actually been deadly.
- [16:08]
Gwyneth Paltrow
Dr. Gray, are there certain sort of markers or personality things people should be aware of to know if they have like a predisposition to some of this stuff, I mean it, it feels like this obviously isn't a pharmaceutical product, right? So it's not, it's not necessarily given in like doses that are like prescriptive for certain things. So like, how can people avoid that? Or is this something that everybody is susceptible to in large amounts of this kind of concentration of thc?
- [16:43]
Dr. Kevin Gray
Well, obviously one of the wonderful things about humans is we're all different from one another, but we try to look for patterns and predictors, right? And so if you're concerned about the potential for addictive behaviors, we try to look at personal and family history if there's addiction across different substances. So some of our genetic genetics of addiction are really not substance specific. And I think another one that's a predictor is early exposure. So the early exposure, the higher the THC content. So, you know, I don't want to draw an exact parallel to tobacco's history, but it's an interesting one in that for many centuries humans used tobacco, but it was too harsh to use large amounts to get a lot of nicotine. And so people were not typically addicted to tobacco until the cigarette was invented. And there was a way to non harshly deliver a high nicotine content that was very reinforcing in a somewhat different way. Cannabis is now available in such a wide variety of ways and is so normalized in use is that people wind up tolerating very early, very high doses of thc, which is the addictive ingredient. I think we look at genetic predisposition. We also are concerned about people with pre existing mental health problems. And it is this interesting thing, right? People self medicate with cannabis because they might perceive or actually really have immediate relief of some of their symptoms in real time. What's challenging with this is our bodies are very good at homeostasis. And so if we get a new ingredient, it makes us feel better, we seek more of that. And then there's this thing called allostasis where our body adjusts to having more and more of another thing, and that's where tolerance and withdrawal happen. So I think many people may have higher risk than other people do. But even with enough exposure, people might wind up with an adverse consequence from cannabis use. So part of it is waiting as long as possible so we could get into adolescence and their particular risks with this. But also be mindful of not falling into the trap of escalating dose. And especially if it's in the interest of trying to relieve feeling badly in some way, particularly sort of in a mental health way way.
- [18:51]
Gwyneth Paltrow
Why was there earlier consensus that marijuana was not addictive?
- [18:57]
Dr. Kevin Gray
So that's a kind of a tricky one. And I think part of that may be owing to what was available was very low potency thc. And so the normative use, even at the peak age of, say, young adulthood, we're talking decades ago, was occasional weekend use. And so what we're seeing is just essentially more frequent availability and more frequent use and more sort of sanctioning of use. So I think that part of that is getting a better sense of what addiction is. And it is both physiologic, it has to do with tolerance and withdrawal, but also has to do with consequences where people are having social difficulties, occupational difficulties, psychological problems, and they find themselves driven to continue using despite those consequences.
- [19:41]
Megan Tuohy
I would just like to pick up there and just point out, I think that one of the things that's really important to understand is that the science on marijuana is hugely lacking. I mean, we reviewed, you know, we basically went through all of the scientific literature and we ended up, you know, interviewing hundreds of doctors across the country and actually surveying doctors from all different backgrounds because we realized that the scientific literature isn't answering a lot of these pressing questions. And there's a couple reasons for that. But one of the reasons is that in our country, marijuana has remained legal at the federal level. And so there have been all these restrictions on doing research. And so, you know, what does it look like? How, you know, what does, what is, what are the effects of these cannabis products that are now, you know, two times, three times, 10 times, 20 times as potent as the ones that people were using 10, 15, 20 years ago? We don't have all the answers to that because there's been such little research that's been done.
- [20:43]
Gwyneth Paltrow
And I remember probably exacerbated by the fact that it's not, I mean, not to be a cynic, but it's not patentable. Right. So it can't be a pharmacist pharmaceutical.
- [20:51]
Megan Tuohy
Right? There's a couple, there's a couple basically marijuana based pharmaceutical drugs that have been approved by the fda. But by and large, the vast majority of marijuana that's on the market today in the United States, whether you're going on the recreational market or even in the medical markets that have been legalized in states, has not undergone FDA approval and is not basically out there with a lot of scientific research underlying it and spelling out the clear risks and benefits. And I think that that's, that's one of the dangers here. And the states that have legalized have done, you know, a really poor job in educating consumers, like the public health. Messaging is all over the place and in many cases does not address addiction, does not address the fact that there's now this new risk of this cyclical vomiting which is known as cannabinoid hyperemesis syndrome.
- [21:41]
Gwyneth Paltrow
That was crazy. I read about that in your article and I just thought that was, I mean, I had never heard of that before and had no idea that that could occur. And, you know, it was also. Must have been so demoralizing to have something like that and have it go undiagnosed for such a long time, especially since prescribed to her right for migraines.
- [22:02]
Megan Tuohy
I was going to point out, we ended up surveying 600 people who have experienced this cannabinoid hyperemesis syndrome, which is known as CHS for short. And so many people had, you know, presented to the emergency departments, had, you know, told family and friends and other people about the symptoms that they were experiencing, only to have like, be brushed off and because people didn't believe that you could be getting sick from marijuana in this way. And some of those people included patients who were taking marijuana to treat all, you know, to treat basically pain or other health issues that they were dealing with. You're, you know, we, we focused on one young, one woman in Illinois who had been advised to start taking it for migraines. And you know, she, you know, within weeks of taking it, her migraine symptoms started to lift. But weeks after that, she started to experience the nausea and the vomiting that became so debilitating that she had to stop working and was hospitalized over and over before she finally identified what was going on. And the good news there is when you stop, stop taking marijuana, when you stop using it, those symptoms go away. It can be a rough withdrawal period. But in so many cases, people suffered for years because nobody was identifying this.
- [23:21]
Gwyneth Paltrow
Acura's all new adx. A compact SUV that isn't just built for one thing. It's precision crafted for everything. To escape the grind. With available all wheel drive to go with your flow. With available Google built in.
- [23:32]
Megan Tuohy
Hey, Google, turn it up.
- [23:33]
Gwyneth Paltrow
Okay.
- [23:33]
Dr. Kevin Gray
Turning up the volume.
- [23:34]
Gwyneth Paltrow
And crafted to be heard with an available bang and Olufsen premium sound system. The all new Acura adx. Crafted to match your energy. Acura precision crafted performance.
- [23:48]
Megan Tuohy
Google is a trademark of Google LLC. @ Designer Shoe Warehouse, we believe that shoes are an important part of, well, everything from first steps to first dates, from all nighters to all time personal best, from building Pillow forts to building a life for all the big and small moments that make up your whole world. DSW is there and we've got just the shoes. Find a shoe for every you from brands you love at brag worthy prices at your DSW store or DSW.com.
- [24:24]
Dr. Kevin Gray
So.
- [24:25]
Gwyneth Paltrow
You can have, I mean I know you sort of said Dr. Gray, that the addiction is kind of multi be pronged in this sense, but you can have a chemical addiction that you need to withdraw from. From marijuana.
- [24:37]
Dr. Kevin Gray
Yes. So not everybody who's a regular user develops this withdrawal syndrome, but when you see it, it's really striking. So people can have great difficulty with sleep, with irritability, with reduced appetite. So some people really have a hard time where they then become dependent on using to maintain their appetite. And there's significant weight loss that can occur during withdrawal with some people. So. And there can be these issues with, you know, it can be craving, it can be sleep difficulties, anxiety, irritability. It can be this constellation of symptoms that's just menopause. Okay, well this is one of the things that's really tricky to characterize that right. So. And I, I also know that was made in light. But also taking seriously is when we do a differential diagnosis as to why somebody's experiencing these symptoms, sometimes people are reticent to talk about their use and how these symptoms. And also sometimes when I'm treating somebody for depression who may have irritability and they've been using cannabis, may not have been very open with talking about that and they're faceting their use, all these things could occur together. But certainly withdrawal is a huge barrier for even very motivated people who are wanting to reduce their use or quit.
- [25:48]
Megan Tuohy
Yeah, I always thought, Kevin, when, you know, you were. One of my first phone calls when I was starting this reporting journey with and I there were, I had colleagues at the times who joined me on this. But I remember you describing this as, especially in treating young people who are struggling with a dependence on marijuana that there's oftentimes a double whammy, I think was the phrase that you use that they've started using marijuana because they're experiencing anxiety, social anxiety, and at first it helps them, but then, you know, they quickly increase their use and become dependent on it that so that they feel like they can't actually go out and succeed in the world and function in the world without it. And when they stop that anxiety increases in this sort of double whammy of how do you get somebody through the withdrawal symptoms that can sometimes basically be an even greater manifestation of the underlying issue that they were using the drug for in the first place.
- [26:41]
Dr. Kevin Gray
Yeah, it is layering and it's double whammy I guess is the right term because it is. I'm seeking this out for relief. I feel relief and so I will continue using it. But this is part of what happens with any intoxicant that provides relief during intoxication is that your body acclimates to that. That's what allostasis is about. And so it in many cases requires higher doses. And for those who use daily, then they get into this pattern of then any absence of it, their body sort of, their brain sort of panics that it's actually worse than the pre existing anxiety, mood, et cetera. So it's a real challenge in folks who really come in sincerely seeking relief. Again, this does not happen with every patient. But when I see them, it's very challenging to navigate this and also try to isolate which things are contributing. And how do we address all of those in parallel ra than like, oh, we'll wait until you quit using, then we'll see how your mood is. I think you, you know, as a clinician, I want to address all these things at once and help provide relief.
- [27:38]
Gwyneth Paltrow
Can we double click for a second on the sort of, on the young person? I mean, that's your purview. And, and I, I just. Because, you know, it is really disturbing for parents, I think, you know, especially like we grew up when marijuana was like not that big of a deal. You know, I mean, I always personally had like a, my reaction to it was always, it always kind of made me catatonic. I never really, I never really was like a big pot user. Which by the way, no one says pot anymore. Do you know that my kids make fun of.
- [28:13]
Megan Tuohy
Yes, yes.
- [28:14]
Gwyneth Paltrow
You know that because you've investigated it for the New York Times. Sorry, we, you know, I, I never had a good reaction to it, but, but you know, I understand that like obviously women, a lot of young people do it, they try it and it's so available now. And are you concerned? I mean, so for the parents out there, like, what are the concerns? I know you've done some research on brain development for, you know, adolescents who are using marijuana. Can you give us a little bit of the lay of the land of what you're seeing?
- [28:49]
Dr. Kevin Gray
Sure. So we're, I'm lucky to CO lead with Dr. Lindsay Squigley at the MUSC site of the NIH Adolescent Brain Cognitive Development Study, the ABCD study.
- [28:58]
Gwyneth Paltrow
And we've wow, that's a mouthful.
- [29:00]
Dr. Kevin Gray
It is. So Sorry, it's acronym City, but we have 12,000 youth and families enrolled in this study where we started, ages 9 to 10. And we're serially following them into adulthood. And we're getting all kinds of assessments around genetics, around scholastic performance, behavior. There's substance use, but we're also getting neuroimaging, et cetera. And we're sort of prospectively following this huge cohort during a time when a lot of people use substances. And so we're going to learn all kinds of things from abcd. We already have a lot of published studies from this. Again, I'm part of a larger group that's doing this work. But one of the things is to really tease out the specific role of cannabis in being related to what predicts cannabis use, what cannabis use predicts in terms of longer term health outcomes. And so it's, you know, science is always advancing. We're learning intervally over time, but we certainly know, at least behaviorally with adolescence, is that cannabis use is associated with impairment in cognition. We certainly impairs driving performance. And then what we're concerned about is youth who use cannabis versus those who don't tend to have poor scholastic outcomes and poorer occupational outcomes. Longer term, how that plays into neuroimaging and brain findings is, it's a little bit complicated, but we do see some differences, particularly among frequent users versus non users. And we're trying to correlate those behaviorally. But generally speaking, as there does seem to be some differences, but also we recognize that there are some shared predictors of cannabis use and other problem behaviors, et cetera.
- [30:29]
Megan Tuohy
Yeah. And I think it's interesting to note that the, you know, obviously there's the sort of scientific research that's done to identify health issues that are occurring with adolescents and others with marijuana. But the other way to kind of of try to gauge what's happening with users is, you know, there are, there are surveys that are done, general population surveys that ask like there's a national survey that's done every year that asks people of all ages about their drug use. And in that we ended up kind of going in and doing some with working with a researcher at Columbia to do some more in depth analysis of that, the, the findings of that survey. And we found that, you know, especially at 18 to 25 year olds today, more than 4.5 million use the drug daily or near daily. And 81% of them report basically meet the criteria for cannabis use disorder, which is there's basically 11 criteria that are used to identify if you have got issues, if you've got problem use of a drug, are you building up tolerance? Are you not able to stop even if it's negatively impacting your life? The fact that 81% of 18 to 25 year olds say that they're meeting the criteria, they're reporting that back in the survey we thought was striking. And for 12 to 17 year olds, the cannabis use rates have actually stayed relatively flat even with recreational, with the drug becoming legalized and commercialized. But the cannabis use disorder rates are ticking up and they're higher than the rates of alcohol use disorder among adolescents. And so I think that, you know, those are some pretty striking evidence of problematic use. And then I was also just one of the things that I think was most striking to me and a lot of the readers of our work was this association with psychosis. And you know, that was really scary.
- [32:27]
Gwyneth Paltrow
To read about, honestly.
- [32:28]
Megan Tuohy
And that's something where there were so many doctors who just said, you know, people would be so much better off not starting this drug until they were 25 and their brain was like fully developed because, you know, it's in that adolescent adolescence period of brain development that people can, you know, tip into chronic psychotic disorders like schizophrenia. And you know, there's now this growing body of research of scientific evidence that shows that those who are using marijuana and who are using it at a young age and who are using like more potent products, their association with developing chronic psychotic disorders is, is, is much higher. And the result would that be because.
- [33:06]
Gwyneth Paltrow
They'Re latent in these people anyway and it's this brings it out or can it like net new ca psychosis in someone who would otherwise not be, not have it.
- [33:16]
Dr. Kevin Gray
So the best we understand is there is a likely a genetic predisposition. So I do clinically is when I take a history, I, I try to find out is there any history of psychosis or even bipolar disorder, anything in that spectrum. And I'll try to provide guidance to that youth or that family that I think your risks with cannabis are higher than the average person. So like you want to treat, treat yourself like you're addicted, sorry, that you're allergic to it, that this is something that you probably ought not get exposed to. So way back when I was in medical school, one of the first cases I saw as a third year medical student on my psychiatry rotation was someone who was acutely psychotic. So responding to unseen others, very distressed. And it turned out that that was a cannabis induced psychosis, which was rare. Enough at the time that everybody sort of scratched their head and was puzzled at it. But now it's relatively routine that we see it. And I think, and you're right on the money in terms of what we think is there's a gene environment interaction and Megan got it, this is that the brain is still developing into the mid-20s. And there's something very specific about the teen years and the role of the endocannabinoid system. I don't want to over science this, but it's really important in development. And during this vulnerable period. If you think, say if a hurricane is going to hit, is it the fully built house or is it a house that's under construction that's going to be damaged? It's the latter. And so the developing brain is more prone to these adverse effects. And we think that there's something to do with the endocannabinoid system that's protective against even people who are prone own psy psychotic disorders, that it's protective and that a lot of THC intruding on that symptom on that system may tip people toward expression of psychosis, which is a really concerning disorder.
- [34:51]
Gwyneth Paltrow
So there a really sorry to be dumb but when you're tipped into that, is that then a permanent state?
- [34:58]
Dr. Kevin Gray
It varies. So, and in some cases somebody can become acutely psychotic when they, when they take a very high dose product. So some say somebody who's naive to say dabs and they have a really high dose, they can become transiently psychotic and say whoa, I'm not doing that again, in some cases that may be a precursor to what may happen chronically. Not always the case, but certainly we see a lot of cases where it's hard to tease out whether was this going to happen anyway. But what we do tend to think is that it happens earlier and can be more severe if you add cannabis to the mix. And so those are young people with any family history that I say you really ought to avoid using during this vulnerable period, generally speaking is, you know, I don't want to talk down to kids and to families and we should provide information rather than a finger wag and say don't use drugs is I think it's much more of like let's talk about drugs and let's talk about substances including cannabis, alcohol and otherwise. And why I think that it might be in your best interest to delay your use.
- [35:57]
Gwyneth Paltrow
Right.
- [35:57]
Megan Tuohy
I think though it's really important to make the distinction between like the, obviously the association with the way that marijuana has been associated with developing A chronic psychotic disorder like schizophrenia. I mean, there's. One of the experts on this at Yale said likened it to cigarette smoking and cancer, saying, you know, after decades and decades, you know, there's. We know it used to be that people would question the. We now know that there's a very strong association between cigarette smoking and cancer. And it doesn't mean that everybody who smokes cigarettes gets cancer, and it doesn't mean that everybody who has cancer smokes cigarettes. But we now know that there's a really important association there and that the same is true for cannabis and psychosis and obviously for young people using that presents the most danger. But you know, the acute, like the sort of temporary episode of a temporary psychotic episode can happen to cannabis users of any age. And, and those are, you know, doctors are reporting that they're seeing both those things, the association with chronic psychotic disorders, but also people who, maybe they're using for the first time, maybe they're using for like the 50th time. But whatever the case, that particular product relates, you know, interfaces with their system in a way in which they're all of a sudden experiencing paranoia, hallucinations. And so there are more of those cases showing up to the emergency rooms as well. And we interviewed, we talked to, you know, a man in Colorado. We've talked to, we interviewed a variety of people who have experienced all different types of psychosis. And one of them was a man in Colorado who was using marijuana. He had been serving in Afghanistan and he had come back, no, sorry, I can't remember if he had been in Iraq or Afghanistan, but he'd come back to Colorado and he didn't have like a history of psychotic problems at all. And his, his girlfriend had said, oh, you know, this is. Marijuana can be like a nice way to chill out. And his very second attempt, basically his very second, like puff of it, sent him into like a horrible episode of psychosis in which he became convinced. I mean, he basically, he ended up shooting his girlfriend. And they, you know, they're still together and they've moved beyond it. Beyond it.
- [38:12]
Gwyneth Paltrow
Wow, that's a real. Yeah, yeah, that's like Jesus level forgiveness right there.
- [38:16]
Megan Tuohy
Yeah, no, no, no, it was, I mean, and he was, he was, he was hospitalized and immediately diagnosed with, you know, with drug induced hallucination. Hallucinations. But to interview them, to like interview them talking about this horrific experience that they tipped into without having any idea that it could happen. And I think that that's one of the issues that we identified was that a lot of the people that we talked to said, listen, we don't think that marijuana should be. That we should kind of go back into the dark ages of prohibition. And obviously there are so many people who can use this drug and be totally fine. And, and it does absolutely have medical purposes and benefits. But people deserve to know the risks and benefits when they're going into this. They should know that there's a risk of psychosis. And you purchase so many of these products and it's not going to say that on the label and states aren't going to require it as part of their regulations.
- [39:05]
Gwyneth Paltrow
So I want to ask about alcohol and also the other benefits. But I think first I would like to ask, like, in terms of delivery mechanism, is there one that's worse or safer or better? You know, if it's inedible? And it's. Do you know there. There is a measured dose? Like, I don't. What's. What's the kind of thinking there?
- [39:31]
Dr. Kevin Gray
Well, so it's. There's sort of a catch 22 in this. And so I think smoking or vaporizing gets THC to the brain very quickly. And so if somebody's an experienced user, they're going to know the effect they get and they can kind of titrate their dose. Dose edibles. One of the challenges with edibles is the classic story. Somebody eats a brownie, they feel nothing, they wait, they wait 10 minutes, they eat another brownie. And so people can tip way over the edge in terms of their desired effect. And at certain doses, cannabis can be anxiolytic, it can reduce your anxiety, but at a higher dose, it can give you a panic attack. And so the vaporized or smoked gives you earlier exposure. However, we know with smoke there's carcinogens in burn burnt cannabis plant material. And also with vaporizers, if you recall the issues where there's what it takes to aerosolize thc, there's an ingredient called vitamin E acetate that caused a lot of acute lung problems. And we have some concerns about vaping as well. So there's no perfect way to go about it. I think from a medical standpoint, chronically, I think oral intake tends to have more safety potential than vaporized or smoking smoked. That said, some people get different effects with oral because it's sort of a smoother pathway rather than an acute effect. And so some people desire the way that they feel with. With smoking or vaping versus edibles.
- [40:49]
Gwyneth Paltrow
Oh, because their experience, their felt experience of it is different.
- [40:53]
Megan Tuohy
Yes.
- [40:54]
Dr. Kevin Gray
Yeah. It can be chemically, the Same thing that's causing that effect, but it's sort of the, the profile of your exposure in your brain give can give you a different sensation from it. And so for some people it's if they're so say if you wanted to experience the high from cannabis, people will often tell you is that if they were to smoke or vape it, they get a more potent high. If they use edibles, it's sort of like oftentimes people use edibles or oral products or pill form of THC if they want to induce appetite or reduce nausea during chemotherapy. Sometimes they find that to be more effective.
- [41:31]
Gwyneth Paltrow
I have very dry lips, so I've always been something of a lip balm and lip mask connoisseur, if I do say so myself. So I wanted to make the best ever lip mask. Like better than anything on the market, better than anything I ever tried because it's what I needed. That's why I'm excited to share our newest GOOP product with you. The Nourishing repair lip Mask. Formulated with high performance clean ingredients, this mask delivers clinical grade results results increasing hydration by over 160% with just one swipe. The result, smoother, softer and more protected lips that look as good as they feel immediately and over time. At goop, we believe in beauty as wellness. That's why our products are carefully crafted to be clean, holistic and results driven. To try our nourishing lip repair mask or any of our GOOP beauty products, use code code goop lips@goop.com for 15 off your first goop beauty purchase. I'm really excited for you to try our products and I hope you love them as much as I do. So let's talk a little bit about the medical uses like you just, you just touched on. So I would love to know, you know, for example, I had someone that I know during chemotherapy was very helpful for them them for nausea and loss of appetite. It was, it was a very productive drug for them. So are there other, are there cases where it's not entirely terrible?
- [43:03]
Dr. Kevin Gray
Oh, so. And I, I want to be really clear. I'm not a zealot. I'm somebody who loves the science of cannabinoids. And I think that there is room at the table for therapeutic use, for benign recreational use and to be very, very thoughtful about the risks associated with it. And so I want to be very clear about that. What we know in terms of therapeutic use, I don't want to go too far down the rabbit hole, but part of why it's tricky to do this work is because in Western medicine, we study specific compounds at a specific dose so we can be precise about what we're recommending. We prescribe aspirin rather than willow tree. When we study cannabinoids, we usually will isolate. And so there are FDA approved oral forms of thc, something called dronabinol, which is FDA approved for reducing nausea and chemotherapy, also for inducing appetite and HIV aids. So there are indications there. And then cbd, which I don't think we've even touched on very much, is that thing. So CBD is so interesting, too, because it's a cannabinoid, but acts in a very different way. And we're still trying to uncover the full mechanism, but it's been a really, really wonderful treatment for specific types of seizure disorders and some childhood conditions. And so it has an FDA approval for specifically isolated cbd. Very exciting. CBD does not cause the high that THC does. It works in a very different way. And so in some drug development, in terms of cannabinoid therapeutics mixes THC and CBD at different doses as well. So I don't know if that went too far down the rabbit hole, but those are a few places where there's very clear evidence up to the point of FDA approval for cannabinoid medications.
- [44:42]
Megan Tuohy
I always think it's interesting. I mean, you throw out the term cannabinoid and endocannabinoid system, and I think that there are a lot of people who don't know exactly what that means. And my editor is always, like, was always trying to get me to not prevent me from putting the term endocannabinoid system in the. You know, in a written story, because she thought it would be too confusing to readers. But I do think it's a pretty important thing for people to understand.
- [45:04]
Gwyneth Paltrow
First of all, can you guys explain what these.
- [45:07]
Megan Tuohy
Yes. Yeah, I think it's like, it's good. So I would just. I'm going to take a crack at it, Kevin, and then you can. You can come in with your sort of scientific hat and make corrections. But the body. You know, one of the things that people always wonder and I think just people who are critics of marijuana without actually having a deeper understanding of it, will always say, like, how could it be presented as this miracle drug that can, you know, treat. Like, what other drug can actually treat so many, many different things? That's impossible. And I think that those people. What they don't understand is that, well, first of all, there are. Marijuana is a plant that has dozens and dozens of components to it and you know, would be the term that Kevin is using. And thc, the intoxicate, one of the intoxicating components of it is what is most commonly used and seen in a lot of the products that people are using. And CBD is another one which is a non intoxicating component of it that can, that can sort of have some therapeutic properties to it. I mean THC can be, have medical benefits as well. But what's so fascinating and what I ended up geeking out on is like I'm not a science reporter, I don't have a background in scientific research at all, but was to learn that our bodies have this. And they researchers didn't discover this I think until the 1990s. But our bodies have an endocannabinoid system which is basically like helps regulate all the other systems in our body, like our digestive systems, our, you know, our, like our sort of emotional well being. It's a really critical system that affects all the other systems. And if you have an endocannabinoid system that's out of whack and you like have, you know, THC or any of these other compounds come in, can like lock into your endocannabinoid system and bring it back into balance and sometimes offer relief, relief from symptoms of disease and succeed where pharmaceutical drugs have failed. And that's so cool and it's so exciting and it explains how it can, it can help treat a variety of diseases. But you know, and, and some of the medical marijuana experts that I talked to who treat patients, you know, talked about treating, you know, patients of all ages with all different backgrounds with very specific regimens of the drug and with much success. Success. But of course they'll all, they'll also be the first people to tell you that you, if you overload your endocannabinoid system with thc, then it starts to like shut down. And that's when you start, you need more and more and you develop tolerance and, and that's when like all these bad things can happen. But I was, I. Some of the, some of the coolest people I talked to were the people who have like committed their lives to using this drug to help treat people. And I came away completely sold with the therapeutic benefits. Benefits. But unfortunately so few people are using the drug under the guidance of a true medical marijuana expert. So often even in the states that have legalized medical marijuana, I mean that's, that, that, that's not marijuana that has been approved by the FDA and oftentimes people just have like any kind of doctor will sign off on their use of it after five minutes without paying close attention. But there are doctors out there who can walk you through like how to use it in a beneficial way for certain diseases and certain ailments. And I just, like, I. Anyway, I would just encourage anybody who actually wants to use it for medical purposes to really find those experts and to do it under their guidance.
- [48:26]
Gwyneth Paltrow
Yeah, I mean, it's interesting because we, we do have an age old system of using plants as medicine. Right. Whether essential oils or arnica or as you say, willow for aspirin. Like this is, we have a whole system where, you know, we do integrate with these natural compounds and, and they can be helpful. And you know, certainly in, in certain cases, like pharmaceuticals can have more impactful side effects. Right. Like, so if you can use marijuana correctly, I mean, from what I, I've, from, from the very little bit of research that I've done, you know, there tend to be less, for example, impact on liver or, you know, or certain cancers. Right. If, if you're using it in, in a medical way.
- [49:18]
Dr. Kevin Gray
So everything in medicine's a risk benefit ratio. And so I always think about. So say if you're using it for nausea and chemotherapy, you're dealing with a very acute condition where the risk of say, dependence or otherwise is very low on your scale in terms of risk. If you're talking about an adolescent where you want to treat it for something where there's less evidence, I'd be worried because the young age and higher risk and also less evidence to be beneficial. So I really try to tailor that to each clinical encounter that I have as to whether I would say, you know, that makes sense versus that really doesn't make sense. And there's room in between too. And I think people are rightly frustrated because science does move slowly. And I think in some ways cannabis has given us a little bit of a peek into our endocannabinoid system. I am old enough, I went to medical school where it was not mentioned once ever. But we're catching up to our endocannabinoid system and how it has to do with our immune function, our, you know, metabolism, our cognition, our development. Super important. And it may be that cannabis has helped us to understand and characterize it, but also there's a whole host of scientists working on other ways to modulate the system in a way that it can be better balanced for our healthy defense, develop and overall health. So I think there's a lot of potential there I think what's tricky is that people have a lot of products and not necessarily clarity on where the risk benefit is favorable for them. And I think Megan's right in terms of trying to get as much information as you can and not sort of be blind to something is all good or all bad. I'm a big believer in most things are both, sometimes an equal measure, sometimes unequal, and that should guide our decisions.
- [50:54]
Gwyneth Paltrow
Right, so what is the guidance then? Like what? Both recreationally and. And medically. Obviously, medically it depends on what's going on. But, like, what is the guidance? It's so confusing.
- [51:07]
Dr. Kevin Gray
So. So here's where I'll say is where we say where there should be the most caution about cannabis use in adolescence, young adulthood. So in youth during pregnancy, which we haven't talked about in great detail on this, this, and also in people with existing mental health conditions, those three categories I'm most worried about. And then also use in the context of driving is something I think that's under emphasized. Cannabis use does impair driving. Sometimes people are tolerant to those effects and can maybe do okay. But really the big three is youth, pregnancy and mental health conditions. And beyond that, I think it's really down to. There's a lot of different scientists and practitioners working on. On developing evidence in different facets and areas, but we're really not at a place beyond what I've already said about what's FDA indicated as to where we say we recommend this specific cannabinoid or cannabis for this condition.
- [51:59]
Gwyneth Paltrow
Is that coming?
- [52:01]
Dr. Kevin Gray
Well, so. And Megan got to this, which is really tricky because a regulatory system, we approve drugs based on a specific dose of a specific compound. And with botanicals, that's really hard to do. I don't have an easy solution for that, but it's really hard because. Because people will rightly argue that part of the benefit of botanicals may be that there's a rich matrix of different things that are doing something together. Whereas in Western medicine, we're very big on isolate that compound and test that alone. And so I don't know that there's a right answer there, but I think we deserve more clarity because marijuana or cannabis is too big an umbrella term to speak about it as all one thing.
- [52:38]
Megan Tuohy
I was going to say that in doing. When I first started to dig into this with my colleagues, colleagues, I came across the. You know, there's the National Academies of Sciences, Engineering and Medicine, which kind of brings together all these scientific experts from a variety of fields. And they had, in 2017, they had published this like massive report they had done. They had gone in and they'd reviewed all the scientific research on marijuana and basically produced a report saying here's what the research shows on the evidence of benefits and evidence of harm. And they went through and like listed them one by one. You know, when it, when you're talking about treating chronic pain, this is what the research shows. When you're talking about sort of psychosis, this is what the research shows. And so they, it was interesting because that the National Academies of Sciences had just over this past year reconvened to look at marijuana. And this time around they basically just looked at like whether or not policies, government policies, state policies, policies, what effect they were having. But I had in the process of my reporting a chance to talk to some of the people who had been part of this group and to say like, okay, you know, you guys did this report in 2017, like are you going to update it? Like what's the, you know, where's the, where do, where do things stand today? Like where is that go to manual with that can guide us through the use of this for medically, you know, recreationally. And they said, said, you know, we, the science has fallen, the science has fallen so far behind how much the product has changed. Like the drug has changed so much even since 2017 and the science is now even further behind that we didn't feel like we could, you know, adequately update and create a manual for people along those lines. And even in 2017, they had said like in reviewing the research of, on the health effects they had worn the, that the lack of evidence based information posed a public health risk. And here we are seven years later and there were some of those folks who very, very prominent experts saying that it's even worse. And one of the neuroscientists leading this group said, and I'll even quote her, she said, until we do research on the drastically transformed cannabis in all its forms, I think putting them under the umbrella of a safe legal drug is wrong. It's misleading at best and dangerous at worst.
- [55:00]
Gwyneth Paltrow
Wow.
- [55:01]
Megan Tuohy
Which was scary. It's, you know, that was sort of scary to hear that.
- [55:05]
Gwyneth Paltrow
And, and it's because of the modification of the drug itself.
- [55:09]
Megan Tuohy
The, both the modification and the, of the drug itself and the way that it's used. And I think that there's a good, you know, does, is one causing the other. Right. And this is something where the science is also lagging. But there's, you know, early indications that as this commercial industry puts out is like In a race to produce the most potent products, you know, are they creating more addicting products and causing more addiction? You know, are people becoming hooked on these products because of the way that they're transforming?
- [55:42]
Gwyneth Paltrow
Well, if you look, you know, even at food industries, like industry does this, right? They engineer things so that people use them more. And it's sort of an age old tale. But this is really terrifying because I think there is a pervasive. And it would seem that there are like, I mean, I was, I was really shocked by the risks and, and just to understand more broadly what's, what's happening in the culture and I guess just from both of you, I would love to also understand is this, you know, you talk about the wider use of this, especially in young people, and is this like, is this just since, you know, the beginning of society that like people kind of do this, they find ways to anesthetize and we're just tracking this more heavily, or do you feel like this is a symptom of a broader malaise or disenchantment?
- [56:38]
Megan Tuohy
Well, another thing that I, that I learned in the course of this reporting and another thing that people might not realize is that the United States, as these growing numbers of states have legalized not just medical marijuana, but recreational marijuana, that has made us a real global outlier. You know, there are only like several other countries that have done the same, Canada being one of them. And so I just think that we have, there's an aspect of this that has been happening under our nose, noses without people. Like there's been this really dramatic shift that's been happening under our noses and people haven't really had the right, like language or, or just kind of evidence to identify it and talk about it. And so I think that that's one thing. And I just hope that, you know, I hope that we're at a point, you know, where the people who are legalizing the state, states that are legalizing it and that the industry will do more to, to educate the consumers. Because as legalization and commercialization has accelerated over the last 10 years. You're absolutely right, Gwyneth. Like the, as the product has changed and become so much more potent and what many experts would say as a result, like also more dangerous public sentiment has like shifted. And people now, the majority see this as a totally safe, safe and beneficial drug. And there's this perception that because it's natural, it's safe and you know, and especially in contrast to some other substances that have been used. And. But as Dr. You know, as Kevin, Dr. Gray pointed out, you know, there are many, many natural substances that just because something's natural doesn't mean it can't turn dangerous. And especially with the manipulation of the product, you just see growing. Worry about it.
- [58:25]
Gwyneth Paltrow
Yeah. I mean, it seems like, you know, 200 years ago, if you found marijuana plant and you dried it and smoked it, you probably not have this kind of level of adverse impact. I mean, there. Yeah, it's. It's really. I was. I have to say, I was really stunned when you reached out and we started. When I started looking into this, I really had no idea. You know, it definitely hasn't reached, like, a mainstream cultural conversation that, that, that the impact it, you know, the negative impact that it's having.
- [58:59]
Megan Tuohy
Yeah. And listen, I. I was also struck, you know, from a. You know, as a personal. Like, I have been a consumer of marijuana over the years. Like, I am in no way like a good.
- [59:08]
Gwyneth Paltrow
That was gonna be my last question.
- [59:11]
Megan Tuohy
Yeah, I mean, I have dabbled in marijuana, like, going back to the 90s. So I am one of the consumers who. Another reason that I was driven to do this reporting along with my colleagues was because I wanted to know for myself. I mean, I had had the experience of sort of shifting into the legal commercial market and going into dispensaries and purchasing like, five, you know, the lowest level, like, edible. The edibles with the lowest levels of THC on the market and having them presented as being completely innocuous and, you know, having little bites of them and saying, like, this is actually so strong. And I have to imagine that there are other people out there who are grappling with consumers out there who just are in desperate need of more information. I'm one of them.
- [59:59]
Dr. Kevin Gray
And I. So I. I grew up as a rule follower, which is part of why I became a child adolescent psychiatrist, because I was so fascinated by adolescents who don't follow the rules and including substance use. So I'm naive myself, but I've got a lot of clinical experience, and I think. I think you've made a really good point as to, you know, humans over the millennia have sought out intoxicants, and sometimes we love the idea that something that makes me feel good also is therapeutic. And in some cases, in some situations, both things can be the case. But we also sometimes get into a bit of a mania over that. And that's where this pendulum swing happens. And I think we will, over time sort out a little bit better in terms of how better to predict those for whom it could be helpful. Those for whom it could be benign, but also those for whom it could be quite harmful. And I happen to see the latter in my clinical practice, which is. Informs my voice on this. I think it's an important one, but I don't think it's the only voice in the conversation.
- [60:55]
Megan Tuohy
I was just going to make just another point and was. Which is that, like, sort of generational differences that there are. I talked to a lot of parents who had consumed marijuana when they were. When they were younger, like, you know, 80s, 90s, when it was a much less potent product, and now had watched teenagers, like teenage daughters, teenage sons kind of start to use. And at first the parents actually weren't that worried because they had memories of, like, their experience with the drug and in some cases, like, learned way too late how much the product had changed. I'm thinking of a young. A teenage girl in Connecticut who I talked to who started using her junior year. And her mom. Mom, you know, total, you know, was a classic example of this, who was like, yeah, I wasn't too worried. Like, I. I had had a pretty good experience with it. It had chilled me out when I was younger. And within months of using these, like, basically smoking these, you know, the vapes that are so popular with teenagers today, you know, she tipped into psychosis and was hospitalized for months, and it took her more than a year and a half to recover. And so the mother, you know, when she was finally. When a psychiatrist, Psychiatrist, you know, at Yale, finally identified what had happened. You know, just imagine what it felt like for that mom to think, oh, my God, here. This something that I thought was benign has completely, like, robbed my daughter of these, like, crucial teenage years.
- [62:15]
Gwyneth Paltrow
And, you know, I think also we have to be realistic, right? Like, we can say to our kids, don't drink a beer. Don't, like, have a, you know, don't. Don't smoke a joint. Point.
- [62:27]
Megan Tuohy
It's.
- [62:27]
Gwyneth Paltrow
It's. No amount is good for you, but, you know, also understanding that, you know, come on, like, this is something that young adults are gonna experiment with. Not all of them, of course, but, you know, a great, A great number of young kids or, I mean, young or adolescents or young adults are gonna. Are gonna mess around with it. So is there, like. As opposed to giving them the talk that's like, don't ever try anything ever. Is there some version of that that's like, hey, I mean, I hearken back to the drug talk that I gave my kids, but, like, hey, this is, you know, to your point, doctor, Great, here's the here's a risk reward profile of this thing. Like something really bad can happen to you if you have it at too high of a dose, etc, but if you want to try it, like do X or is that just totally unethical.
- [63:23]
Dr. Kevin Gray
So yeah, these are hard to navigate. I guess what I would say is I think all of us are probably disavowed of the notion that we'll have an after school special conversation, then a hug afterwards. You plant seeds over time. I think a lot of it really has to do with being developmentally appropriate and talking about it. And also be mindful of how you're modeling behavior. One of the classic things parents inadvertently do is they get home after a long day at work and say, oh, I need a drink. Modeling that idea of using an intoxicant to feel normal. We don't want to do those subtle things. But over time I think part of it is just not talking down to kids but talking about the science, including the science of addiction and the science of substance use. But I think you're right is that we've lost our kids if we assume that zero tolerance, that means never use ever and never talk to me about it, because that's what might happen. And so I think the layered message, I think that's helpful is my wish is that you don't use at all because that's where I feel that your brain is going to develop the most safely and decrease your.
- [64:22]
Gwyneth Paltrow
Sure.
- [64:22]
Dr. Kevin Gray
Second best is delay as long as possible. Third best is use as little as possible and be as mindful. And if you find yourself in trouble, my number is the first number for you to call or text because no questions asked, I'm here to help you. And I think some parents get really tripped up if they say that last one and feel like they're condoning. But I think you have to emphasize the first one and the second one, the third one to get to the last one. I think that layering is super important. Important. I'm not perfect, but I've tried to do some of that and model that for my own family. But also try to work with parents and families and trying to provide a good model for them and also, you know, be realistic, not talk down to. And I love talking science with kids. I think that's a big part of this too.
- [65:05]
Gwyneth Paltrow
Wow, we're out of time. I feel like there's, there's. I could have. There's so many more. It's such a fascinating subject. I mean medically, culturally, psychologically.
- [65:16]
Megan Tuohy
Well, it's also Something that, like, you know, sort of landing with the responsibility, placing all the responsibility on parents, I think also misses the point that, like, the public health systems in our country, the medical systems, the education systems, like, have a responsibility here. The states that are legalizing marijuana have a responsibility to come up with, like, accurate and effective of public messaging so that parents don't feel like they have to be, like, scrambling to do this on their own. And I think in this particular moment in time in this country, we, like, have this explosion of this commercialized industry and all these products and these shifts in use and people thinking it's totally safe. And we're really missing the messaging from the responsible public health messaging from the systems that are responsible for doing that. That.
- [66:08]
Gwyneth Paltrow
I'm so happy that we had this conversation today because as I say, you know, for myself, it was super illuminating as a parent and a person and a friend. Like, I just had no idea what the dangers, you know, the. These inherent dangers of this super strong thc. Like, I. I was. I was really surprised and I guess, you know, I just want to thank you both so much for coming and sharing your incredible depth of knowledge. And it just has been really amazing to bring more awareness to the topic, honestly. Thank you both so much for being here today.
- [66:42]
Megan Tuohy
Thank you so much for having us.
- [66:44]
Dr. Kevin Gray
Thank you for the opportunity. Really appreciate the discussion.
- [66:46]
Gwyneth Paltrow
It was so great. You guys are amazing. Thank you. This has been a presentation of Cadence 13 Studios. I hope you'll listen, follow rate and review all of our episodes, which are available for free on Apple Podcasts, Spotify, Odyssey, or wherever you get your podcasts.