Drug Talk Q&A #2 with Dr. Julie Holland

type of drugs. Hello Psychoactive listeners. Back last year, I asked a dear friend of mine, who I think is one of the smartest thinkers and writers and advisers about drugs to join me on Psychoactive to answer questions from you, the audience, and a bunch of you left you know, some great questions, So we're gonna do that again. My friend's name is Dr Julie Holland, and she is a psychiatrist and a psychopharmacologist. She has been a willow and commentator on National TV. She um has an advisor to

Psychedelics Company. She has edited or authored five books. Her first book was called Weekends at Bellevue, nine years on the night shift at the psyche R and her last two books. One was called Moody Bitches and the next one the most recent, Good Chemistry, The Science of Connection from Soul to Psychedelics. So, Julie, thank you so much for joining me again as a sort of co host and question answer on Psychoactive I'm very happy to be here Ethan any time that I can help you educate

the populace, you know, that's what I love to do. Okay, Well, actually let's just start the last two books. Just tell me first of all with Moody Itches. I mean, it's got a great title. What was that book about? It is really about how women are sort of over pathologized, over diagnosed, and over medicated in today's sort of psychiatric ecosystem, that women uh can't have sort of a natural emotionality to them which we can make good use of and we don't need to pathologize it. So that's mostly what

Moody Bitches was. And it was also just giving a lot of practical information to women about hormones, about psychiatric medicine, about inflammation, which I care deeply about. And the subtitle of Moody Bitches, is the truth about the drugs you're taking, the sleep you're missing, the sex you're not having, and what's really making you crazy and what is really making people crazy. What I wrote about towards the end of Moody Bitches was about how disconnected we are, disconnected from ourselves,

from nature, from each other. And this was all way before COVID. So the book after Moody Bitch has really continued with this idea of connection versus disconnection. What good chemistry is all about. It's all about how if we are feeling safe and connected, our natural chemistry will make us feel good. And the reason why so many of us feel terrible and are taking other drugs or medications is that we aren't really enjoying that connection that's really

our birthright and that we're sort of wired for. I'm just curious. It's been on my mind recently. I don't even know if this is drug related. But when you say about inflammation, if that was something you were very curious about and thought I had a lot to say, what what was the key elements of what you wanted to share with people? That the key elements is that inflammation underlies almost any disease process you can think of.

If you don't have inflammation, you won't have diabetes. If you don't have inflammation, you won't have arthritis, you won't have Alzheimer's, you won't have cancer. So it is in the setting of inflammation that a lot of other really bad things happen to your body. And it's also true with your brain. When your body has any kind of inflammation, your brain suffers. And there are times where the brain has inflammation and then we're you're going to get into

issues like anxiety or depression or insomnia. So Moody Bitches talks a lot about how to have sort of an anti inflammatory lifestyle, and good chemistry does as well. So anti inflammatory, you know, most of us know what anti inflammatory diet doesn't have flour and sugar. It's just got like whole foods that are sort of recognizable that grow outside in the sunshine. Anti inflammatory activities will be things like yoga or meditation or mindfulness. And then you have

anti inflammatory medicines. Right, We all know about a leave and advil in these kind of name brand anti inflammatories, but many of us forget that cannabis and CBD are potent and anti inflammatories, as are some psychedelics. They are

also anti inflammatory. So part of a healthy, anti inflammatory lifestyle, besides eating healthy food and staying as relaxed as you can be, is the sort of judicious addition of some drug as if you're comfortable with them, using things like cannabis or CBD or psychedelics, keeping in mind that they have anti inflammatory effects and therefore they're actually good for

your body. You know, I'm curious. I've been thinking about doing an episode on sugar as it drunk, and when it comes to sugar inflammation, I mean, you see, generally a good idea that significantly reducing sugar intake can can make some real difference there. Absolutely. I mean what I wrote about it in Moody Bitches was really just eat the colored foods. Don't eat the white foods. As much as they taste good. The bread and dairy products, they're

really not that great for you. Flour and sugar. White flour white sugar, for sure, are pro inflammatory. And sugar is its own little uh has got all kinds of issues. It is true that it really does act as a drug in the brain, and you can get sort of a tolerant to it. Or have withdrawal. If you're not having it, it does rereak havoc on your pancreas and your insulin levels. What's good to remember is that things like cannabis and CBD help to balance out your blood

sugar levels. And you've mentioned the psychedelics would be helpful with inflammation as well, So psychedelics, yeah, well, I mean the truth is, the most anti inflammatory psychedelic is something called d o I, which is not commonly mentioned when we think about psychedelics, and for good reason. It actually has an incredibly long half life, so it's just not a practical thing to take. So, you know, let's go to the questions and soviets listeners to call into a

phone number. The phone number is eight three three psycho zero or or A three three seven seven nine two four zero and just leave a question. And I'm hoping that Julie will be want to do this again with me sometime later this year early next and uh, and we'll do this again. So let's go to the first question from our listeners. Hi there, um, I was wondering if you could talk a little bit about substances and mental health and how that works differently for different people.

We're going to psychiatric hospital, and obviously I see a lot of negative interactions with regards to certain substances and certain mental health diagnoses. So I'm just wondering if you can expand a little bit on how this works differently for different people and why, and maybe some research that might be coming down that UM speaks to these areas.

I myself suffer from mental health conditions like anxiety and depression, and I find substances are very helpful in certain settings or context, but obviously I see a lot of negative impacts. I'm just wondering if you can elaborate or explain the science behind behind some of that, and maybe some of the policy that might inform that. Yeah, UM, so where would you like to jump in on that one? I'll

start with what I know. For nine years, every Saturday night and Sunday night, I was the doctor in charge of the psychiatric emergency room at Bellevue Hospital, and I was in charge of it like a fifteen to sixty hour overnight shift, and far and away the substances that reak the most havoc and in the psychiatric patients that I saw in Bellevue number one alcohol, no question and number two cocaine, So these are also drugs. They can

be detrimental. You know, the thing that people always kind of forget about alcohol is that it really is a depressant, and if you're using a depressant regularly, you're going to get depressed and stay depressed. And a lot of the people that I saw who had problems with alcohol, we're significantly depressed, were suicidal. And you know, part of the problem is that once you get to the point of being sort of dysfunctional and addicted, you're also not able

to work or support yourself. You're not able to keep up your relationships and your connections, so you become more disconnected. Maybe you end up on the street or homeless and you have no money, and all of those things are

obviously going to make you more miserable, more suicidal. But far and away, alcohol was the biggest sort of problematic drug that I saw in all my work in psychiatry, and then with cocaine, and it was really in particular crack cocaine that we had people who would come in off of binges where they've been smoking crack for days and they were very paranoid or they were psychotic, or they were crashing from their cocaine binge and they were

terribly depressed. So from a practical point of view, these are the two drugs that I think are most sort of problematic for mental health maintenance. But on the flip side of that, what we know, or what we're learning now is that there are some drugs that people might consider them to be drugs of abuse, but they can actually be helpful for people who have psychiatric diagnoses. The most sort of advanced research I can think of now is m d m A assisted therapy for the treatment

of post traumatic stress disorder. So most of you, I imagine know that m d m A is also known as as ecstasy or molly. It's methylene dioxy methamphetamine. It is typically used, certainly in research context. It is used alongside of psychotherapy to make the therapy go deeper and

be more efficient and more effective. So we're seeing m d m A therapy as a potential treatment for psychiatric diagnoses like post traumatic stress disorder, possibly also for anorexia, possibly also for the kind of existential anks and anxiety that comes with a terminal diagnosis. Say you just found out that you have cancer and you're trying to sort of wrap your head around not existing anymore. So there are ongoing clinical studies looking at using m DUMA to

treat psychiatric diagnoses. And there's also ongoing clinical studies looking at psilocybin, the active ingredient in quote magic mushrooms, to treat some psychiatric disorders. So there's sort of a wide

range of an interaction between substances and mental health. You know, one of the things I always like to remind people is when you're looking at the m d m A research or the psilocybin research, keep in mind that anybody with a history of psychosis, anybody who carries the diagnosis of schizophrenia or has a history of being psychotic, and even people who have a first degree relative who has a history being psychotic, like say you have a sister

with schizophrenia or a father who gets psychotic when he's manic, You're not going to be allowed into these studies. We just don't know yet how what the interaction of psychedelics is going to be with people who have got sort of chronic, persistent mental illness. So I think it's safer to talk about anxiety and depression. But when we start talking about bipolar disorder or schizoaffective or schizophrenia, some of

the really sort of heavy duty psychiatric diagnoses. It is probably safer to not partake while we figure out what the effects are going to be. Bellvue is a New York City hospital, which makes you probably seeing a lot more crack cocaine, you know, back in the nineties early two thousands. But I mean, could the Saint thing about

meth amphetamine and people who are smoking or injecting it. Yeah, that's really important to mention because you know, there's some sort of unwritten law that like east of the Mississippi you're gonna see more cocaine, and west of the Mississippi you're gonna see more methamphetamine. We never really had a huge methamphetamine problem in New York City. Certainly when I was at Bellevue, which was like mid nineties to mid

two thousand's, there wasn't a lot of methamphetamine. But we would occasionally see somebody again who was coming off off of a run or a binge where they've been using methamphetamine for several days, where they would be psychotic or paranoid or agitated. And keep in mind that part of that agitation and psychosis just comes from sleep deprivation. You keep somebody awake for two or three nights, even without drugs,

you're going to have psychiatric symptoms in that person. So it's just that much worse if you're also giving a dopamine agonis. But you definitely can get psychotic from methamphetamine US and typically the psychosis takes long to clear to go away than it does from cocaine, and that may just be because the half life of methymphetamine is significantly

longer than the half life for cocaine. The only other form of methamphetamine that I've heard about on and off over the years was something that people called ice, which is basically like the crack version of meth where it's like a smokable methamphetamine. Obviously, people can smoke methamphetamine, they can snort it, they can inject it. UM So I don't know about it like a particularly super strong meth but I honestly think the one we have is sort

of is strong enough. Um it can really rereak havoc on your reality testing, not quite knowing what's real and what's not. What about for people who are borderline or schizophrenic. Well, we normally tend to think stay away from psychedelics. Um is that generally the rule? But are there also cases where it actually can be therapeutic? Any? Yeah, Well, I mean the first the first answer, the first layer of the ant sir, is we don't have all the data yet.

Then the second layer is that if you have a chronic, persistent mental illness or a very serious diagnosis like bipolar or schizo effective or schizophrenia, it is probably safer to not engage with these drugs. That being said, there is definitely research going on. I mean, I'm particularly interested in whether m D m A may be able to help the negative symptoms of schizophrenia. There was a researcher, Burnt Angrist, many decades ago who actually gave methemphetamine to people with

schizophrenia who had negative symptoms. So, I know when people think of schizophrenia, they think of somebody here in voices, or being paranoid, or being disorganized. Those things are all true, but those are the positive symptoms. The negative symptoms, which are harder to treat with medication and more sort of pervasive, is things like not wanting to do anything, not having a lot of motivation, not thinking a lot, not speaking a lot. You know, you're just kind of like a

bump on a log. And it may be that giving m d m A assisted therapy can get people a little bit more motivated, a little bit more engaged, and also potentially to have more of a therapeutic alliance with their therapist. So there are some very small pilot studies in early stages of planning to look at whether m d M A might be helpful and negative symptoms in schizophrenia. In terms of bipolar, I just think people are kind of holding off. But I know there's one person who

feels like ayahuasca might be helpful and bipolar. But I know of multiple case studies and people who have gotten destabilized from ayahuasca. So I think that if you're bipolar, and if you have any history of getting manic, you really want to be very very careful and probably air on not taking these medicines because they are potentially destabilizing. I mean, even cannabis can be destabilizing in some of

these patient populations. M You know, there was this article in late May in New York Times about new approaches emerging in terms of mental illness and about patients and patient advocates saying, you know, rather than trying to suppress the voices we're hearing, maybe it's more about learning to

live with these voices. I saw that. I saw that article and this this was a really brave, unusual article that they're talking about that there are groups of people who carry a diagnosis of schizophrenia who don't want to take the medications and want to find other ways to manage their symptoms. So the big risk when you hear voices, it really comes down to who you think is speaking to and whether you're going to do what they say

or not. And you know, the joke I sort of make is like, you know, usually do what your mother tells you, right, So if it's your mother's voice and she's saying, you know, kill someone, and that that's really a much more dangerous situation. Then like let's say you think it's the voice of the devil, but you know you're a good Christian or something, and then you're not going to be following the voices. So this idea of like a delusional framework within like what is the context

of these voices? How do you perceive the voices? I had a patient who bit off his fingertips because he thought that it was the voice of Buddha telling him to prove his worth as a disciple to Buddha, and he felt that this was a way to prove his worth as a disciple. He clearly believed that the voice was the voice of buddhas So who who you think is speaking to has a lot to do with how

you're going to behave. It's a complicated, sort of dangerous area to talk about somebody who's psychotic, who doesn't want to take medicine. But the bottom line is that you know, this is America, and we have a lot of freedoms here, We have a lot of civil liberties here. And I don't think people should be medicated against their will under

any circumstances. But the truth is, at Bellevue, there was a certain amount of people getting medicated against their will where they were dangerous to themselves or they were dangerous to other people's and at least temporarily, we had to sedate them just to sort of defuse the situation, to make things safer. So I was really intrigued by that article.

I like that there are places, you know, there are places in Western Massachusetts that if you have schizophrenia and you don't want to take medication, that maybe you can go and they will help you learn how to live with your voices or how to manage your symptoms without meds.

It's nice to have all of these options. Well, it made me think also just about you know, m d n A assisted psychotherapy, because you know, a big part of m d n A is the ability to listen in ways that one does not normally listen to a lover, partner, friend, whatever it might be. And I was wondering, you know, to imagine m d NA with people in schizophrenia. Has anybody ever tried that? Or would one never get submission

to do such a study? So I edited a book about m d m A called Ecstasy the Complete Guide, back in two thousand and one. I have a chapter on using m d m A in psychiatry and a chapter on using m DMA in the treatment of schizophrenia. And in that chapter I told the story of I

think it was a four sort of case studies. You know, people who had gotten in touch with me, people who had a diagnosis of schizophrenia, who had had m d m A, who had a respite from their symptoms, their voices got quieter, their paranoia came down, they felt that sort of heart opening toward their family or toward their caregivers. So I have been saying, you know, for thirty years,

like this is something we should look at. I mean, I also talked about the very first time I ever took M d m A, my head was so quiet. It's not that I hear voices, but you know, there's a little bit of chitter chat to chat, you know, there's like a little inner, inner monologue going on. And when the M D M A came on, I was

like luxuriating and how quiet my head was. And one of the first things that I thought of was, wouldn't this be lovely for somebody who's hearing voices to just have that quiet, Like, even if it didn't do anything else, even if it just gave you quiet for an hour or two, that would be a lovely gift to give someone. So these studies haven't been done. There is a schizophrenia researcher named Stephen Martyr at U c l A I believe,

who is starting to look at this. And there's another schizophrena researcher named John caine on Long Island, and they are going to start to look at whether m d m A might be helpful. But the first group of patients, and that my recommendation was find people who have a lot of negative symptoms, because I don't think you're going

to make them worse. But we just don't know. I guess the only thing I would maybe at, you know, she asked about drug policy, how how drug policy is reflected in this intersection between mental health and substance abuse, And I would say that we are seeing, first of all, many sort of municipalities and cities around the United States America are decriminalizing possession of some psychedelics or at least de prioritizing any sort of persecution from a legal perspective.

But then you have Oregon, which is actually really trying to formulate a new way of thinking about psilocybin mushrooms as be therapeutic. And Oregon is starting to look at using using psilocybin therapeutically in various patient populations, not just post traumatic stress disorder. So I think that is a real example of a big change in our drug policies, going from you don't take this, it's dangerous it's gonna give you psychiatric symptoms to you may be able to

use this to ease some of your psychiatric symptoms. You know, it's very interesting in Oregon now because I think there's a very serious, mature effort to try to make sure the rollout of this Oregon psilocybin you know, medical psilocybin initiative. You know, it kind of rolls out effectively and carefully, and I think there are plans under way to do

similar sorts of initiatives in other states. Yeah. Well, I will tell you that I I was contacted by some policymakers in Washington State who were really watching what Oregon was doing and thought that they would go next. We'll be talking more after we hear this add Okay, let's go to question number two. Hey, I am a gay man in New York, and I've been noticing a growing trend in the gay community here around the prevalence of

the drug g hb UM. I've always known the combination of g HP and alcohol can be deadly, and I guess what I'm now seeing is men swearing off alcohol entirely and instead taking g HP regularly, almost with the same frequency as just regular social drinking. Many of these guys are even citing their physical health and their ability to stay in shape and avoid hangovers as the motivation. I guess I was wondering if you could talk to

the overall health and safety around g HB. I mean, obviously alcohol is unhealthy for a whole host of reasons, but is g HB significantly better? What can you tell us about g h B? And it's you know, safety margin, safety levels and risks. Well, first of all, it is kind of funny how things come around. It was very big at the nine Dies, and then it somehow sort of fell off the map, and now it's coming back around.

So look in terms of safety. Unfortunately, and you know, this is often the case that because of our drug policy, because of our nation's drug policy, these things end up less safe and more dangerous. The biggest issue with g HB is that you don't always know what you've got, right. It's a clear, colorless liquid. I mean typically it's a powder that is dissolved into water. How much powder and how much water is going to decide how strong that is.

So if you haven't made this batch yourself, you're really relying on somebody else to figure out how many grams is in how many milli leaders, and that's gonna have everything to do with how potent it is and what your effect is. But it's true that you shouldn't mix JHB with alcohol, and it may even be true that if you know exactly what your doses that it is sort of harm reduction to use g HB instead of alcohol. However, the harm comes from not knowing what your dosage is.

You know, it's not legal to buy, so you have to kind of go to the black market or at least a gray market when you're purchasing these things. So you just back in the nineties, I think it was, and it was more use and I think DA or whoever you know, then scheduled it in two thousand one or so, right, there was a time when when you could buy it online and it went by all sorts of names. It was like a computer keyboard cleaner. That was one of the ways, like clean your keyboard with

this special cleanser. So there were ways to buy it online. So because it's clear and colorless, someone can put it in your drink and you're not going to know it, so and that way it could be dangerous. But like let's say you knew exactly how much you were taking. I still sort of take issue with this idea of regular use. There's don't thing called g b L, which uh I know that some bodybuilders were using g b L, you know, scoops of g b L in sort of

a smoothie as a way to build muscle. And I did want to see a guy at Bellevue who abruptly stopped using g b L and was completely delirious and basically psychotic because he was in withdrawal. So I believe that it is safe for me to say that if somebody is using large amounts of g h B day after day after day and they abruptly discontinue it, there is going to be a withdrawal syndrome that is going to be pretty hard to predict exactly what's going to

happen for user. So the big issue at g h B. Yes, it makes you feel sort of floaty and less anxious, um and maybe a little separated from your body, but it higher doses. It's basically just gonna put you to sleep. It induces an un arousable sleep, which which some people will call a coma because it is really hard to get somebody out of the state of sleep, but you

do eventually wake up. So it's just really comes down to the dosage and safety, knowing what you have, knowing what the dosage is, figuring out what works for you where you maybe feel a little relaxed but you're not comatose. It is dangerous to mix with alcohol, and it is dangerous to use regularly. I think I would say, I don't know, Ethan what you want to add that, well, you know, I just think you know, we obviously we say that, you know, so many overdose fatalities, especially before

the advent of fentanyl. We're not actually, you know, pure heroine or pharmaceutical overdoses. They were typically drugs being mixed with alcohol or ben zones. And of course, I think when quick could say is that when when mixes opioids and alcohol in lower doses, it can be a remarkable high. And the danger is is that if you simply go double or triple that it may stop you breathing. And

I wonder what g HB is. It's similar that g HB combined with alcohol and very low doses may give especially nice high, but that the toxicity ratio you know the amount that will kill you. That's you know, that much more than the normal dose is a very risky thing. You know, I don't know exactly, you know, the bottom line is you have to keep breathing right and if you're if you're really drunk and you're sort of face

down on a pillow, you can stop breathing. And you know, your brain is set up to always remind you to breathe, and there's conscious reminders and sort of unconscious reminders that you keep breathing. And when you start combining depressants, you lose the conscious reminder to breathe, and then eventually you also lose the unconscious reminder. Now, opiates are very particular and that they really suppress the drive to breathe more than most other drugs. Obiit's like even in sort of

safe medical dosages, you're breathing less frequently. So combining any depressants and you increase that risk of not breathing. Like Heath Ledger was was a terrible accident. It was an accidental overdose. He wasn't trying to kill himself, and he had a number, Yeah, he had a number of depressants in his system. He also had a lung infection, and

he was also faced down on the bed. It's if any of those things were different, if he didn't have a pneumonia, if he was lying on his side, if he had taken one fewer depressant than he would probably still be with us. So that it's it's often a confluence of events, multiple drugs, and other sort of extenuing circumstances that that lead to these problems. So let's go to the next question. Okay, Hey, Julian Ethan, this is Matt from Chattanooga, Tennessee. Big Fann, you both, thank you

for everything that you do. My question is do you view the war on drugs as a house of cards that could topple if we chip away at it consistently? For example, m d m A becoming a medicine, psilocybin, mushrooms gaining popularity and even decriminalization in some places, and federal legalization of cannabis seemingly around the corner. What do think the tipping point is or is it going to be more of a bitter fight to the end incrementally substance by substance, state by state. Let me know what

you think. Okay, Well, Julie made I'll start off on this one and then hand it over to you. Yeah,

I definitely want you to start off. I mean, I'll tell you with the line I've used for many, many years is that when it comes to ending drug prohibition, there is no eighteenth Amendment of drug prohibition that will repeal this alcohol prohibition was with the twenty first Amendment, And there is no Berrilin Wall of drug prohibition that's gonna come crumbling down in the way the Berlin Wall, did you know, back in was or whatever exactly that was.

So I think it is inevitably an incremental process. I think we can see very clearly the ways in which starting with the legalization of marijuana for medical purposes back in ninety six, first through the initiative process and then through the state legislative process, really did transform the broader popular discussion around marijuana in ways that he you know, result in marijuana getting legalized first in Colorado and Washington, uh in twelve and now and I think nineteen states

around the country. And in fact, I've oftime said that if you ask, how could it be that the United States, which was the great champion of the drug war for so long, including the War on Marijuana. Nonetheless, became the world leader on decriminalizing and legalizing marijuana, first for medical and other purposes. It was because we did that sort of incremental process with medical marijuana and then moving into

marijuana decriminate, attacking marijuana arrest, and the ultimate legalization. And you can see to some extent the ways in which that has evolved. It's clearly inspired some of the reforms that are going on on psychedelics, especially the decriminalization element. It's also inspired the push for a broader decriminalization of

all drug possession. Right Oregon did not just legalize psychedelic therapy in but they also became the first state to basically legalize the Portugal model of decriminalization where nobody goes

to jail ample for drug possession. Now how far that goes and how that relates for the fentinel crisis going on now you see legislators introducing all kinds of stupid drug war legislation to increase penalties, impose mandatory minimum penalties to punish the boyfriend who gave it to a girlfriend or vice versa where one of them, you know, died of an overdose. You know, there is, there is a

spillover effect. It does carry that way, but I think it's going to be a long time process, and they're gonna be periods where we roll backwards and the pendulum swings back the other way, as it you know and inevitably does in any area of social policy. But what

are your thoughts. I agree with everything you said. Just like cannabis, which went sort of state by state, first a lot of medical cannabis, then more legalization, I think you're going to see the same thing with psychedelics, where it's going to kind of go state by state and first you're going to see medical and de krim and it's going to take a longer time to do legalization.

I also, I know when it comes to the sort of the poisoning overdose crisis, people want to do something, and the knee jerk reaction is just to do what, you know, what they've always done before, with mandatory minimums and sort of you know, cranking up the rhetoric. I am less, sort of optimistic. I think just about our government in general and how effective or efficient our our government is going to be these days, and you know, some of it depends on the mid terms. And what

happens in the next election. You know, this is a very slow process. I have been championing cannabis and m D m A and psychedelics since the mid eighties, you know, it's like thirty something years, knowing that it was going to be a slow process, knowing I had to be very patient, and that if I wanted to be alive to see like the fruits of my labors, I was going to have to follow an anti inflammatory diet and watch my blood pressure in my cholesterol. Um, it's a

it's a long game. It's a slow game, and it is definitely fits and starts, and one step forward to steps back. I mean, the major area we need to see some big reform now is in dealing with the overdose crisis and the fact that a hundred thousand people died last year, the majority involving fent at all, basically an unregulated drug supply, invroving a very dangerous form of

an opioid, very highly potent one. You see British Columbia just recently, I think in early June, getting permission from the federal government of Canada to basically implement a safe supply approach where a decriminalization approach, whereby people are not going to be getting busted for possessing small amounts of any drug. Now, the activists will say the amounts that they allow her too small, and it's still still too restrictive, and it's time limited and all this sort of stuff.

But I think if there's gonna be a significant movement in the US, the next stage will probably be in people getting more innovative and in responding to the overdose crisis. By great frustration has been that we've not seen you know, heroin maintenance, heroin prescribing trials going on in the United States, like like we've in Europe, you know, for the less thirty years, to the point where this is now national policy in many European countries, but still nobody in the

US is doing that. But I do think that could be the next frontier. I would really like to see that happen. I mean, I have been pushing for supervised injection facilities for a very long time, and there's finally one open in New York. But I think anything that we can do to create a safer supply, you know, again, it's because of our nation's drug policy that we are having some of these problems, So it makes sense that that's where we have to have some of the solutions

is through problems. Well, next question, Hi, My question is is if there's any research into tolerance and also perhaps withdrawal symptoms from cannabis. Use my own personal experience, and this is in recent years. Is I only need a small fraction of a Graham smoking it to yet a very desirable high effect, like I'm talking like four or five hits in a bowl. And I know other people who smoke massive, massive amounts. For me, I bought an ounce of medical grade uh, you know, medical marijuana, and

and it actually lasted me an entire year. Uh. And I know other people who might go through that in you know, perhaps a month. And what is it that's different about people? Why does my physical tolerance for the drugs seem to reset every weeking day? Why do other people need massive amounts? And and you know, is there much research going on? Has the research been done? I also when I stopped, I had no physical withdrawal symptoms. And of course I know other people have reported significant

you know, sleep disruption, appetite disruption and everything else. So so what's the difference? And I the special snowflake or are the other people a typical ones? Thanks well, Julie. As the editor of a book called The Pot Book, what's your answer to this fellow's questions, We are all special snowflakes, I guess would be the first answer. So there has been some clinical research on cannabis tolerance and withdrawal.

Most of it came out of um a unit at at Columbia Hospital in New York City where they would keep people on the unit and then give them cannabis a lot and then abruptly stop and see how they did. And they were able to show for some people there were withdrawal symptoms along the lines of irritability, more difficulty initiating sleep, less of an appetite. They're pretty short lived. They're not in any way dangerous. I mean, I always

one of our mind people. If you're a heavy drinker and you drink every single day and you abruptly stopped drinking, that is potentially a life threatening situation. It's very medically dangerous. There is a chance that you can have seizures, and if you start having seized years, there's about a thirty percent chance that you will not stop having seizures and you will actually die. So if you are heavily addicted to alcohol and you abruptly stop, that is potentially fatal.

So if you compare that with some irritability and lack of appetite and difficulty falling asleep for a night or two, it's just nowhere. It's not not even comparable. But I also want to talk about this issue of tolerance. Um Some people talk about trying to take a tolerance break where they stop smoking for some amount of time so that they can sort of reset and use a lower dose.

And there's a cannabis doctor in Maine, Dustin Sulac, who has sort of figured out that for most people they really only need to stop for about four full days and that is enough to reset the tolerance. So some people are more tolerant than others. A lot of people switch between strains which they think will help to delay or defer the tolerance from happening. But I think it's safe to say that it's not clinically significant. It's not

medically significant. If people have a withdrawal, it is not in any way dangerous, And lots of people don't have tolerance, don't have withdrawal, I think to some degree it depends on how much you smoke and how frequently you smoke. Is that is the case with any tolerance or withdrawal, But it is certainly possible that some people are more

sensitive to tolerance and withdrawal than other people are. And you know, one of the things they showed in like cannabis with driving is that people who are regular smokers being intoxicated with cannabis didn't really have a negative impact on their driving. But if you had somebody who was not a regular smoker who was having a large response to the cannabis and wasn't used to those effects, it

would have more of an impact on their driving. I also want to say one thing about dreams and remembering dreams, because I've heard this from so many patients. If you are a regular pot smoker, you you don't always dream, or you think you're not dreaming, or you don't remember your dreams. And then when people abruptly stop, they will report very vivid dreams and they will report remembering their dreams. I've heard this from a number of people, so I

am assuming it is true. I don't know if there's any medical literature on it, but it is sort of one of the more interesting things to me about withdrawal is that you have more intense dreams or you remember your dreams. I'm curious also when it comes how dose connects to this. If you're using it much higher doses on a regular basis, is it more likely that you'll have more substantial withdrawal symptoms after that or is this

independent of the level of dose. Well, based on Louis tolerance and withdrawal works, you should have more of issues if you're smoking more. You know, if you're a heavy smoker and you're smoking more frequently, you're more more likely I think, to get withdrawal symptoms. Then if you're not smoking a lot or you're not smoking frequently as with other drugs. To me, though, it's a little bit of a moot point because it's not like you really see

these things chemically, you know, or clinically. It's not like vomit the psyche are I have somebody coming in and they're an acute cannabis withdrawal and you know they're in this life threatening state. It's just it doesn't rise to

the level of being an issue clinically or medically. Let's take a break here and go to an ad do you know, I mean, now with all this stuff emerging with tirpenes and things like this, if you hold the THHC level of the marijuana of different types of marijuana constant, but you're shifting around the turpines and other things like that, is there any research suggesting that when you switch to a different type or brand or type of marijuana with a different set of turpines and all the other things

that you know, affect the flavor and taste of the marijuana, that it may actually get you high. Yeah. I mean, that's totally what I was saying about, like switching strains like fence. It's medical cannabis patients that really need their medicine every day. Sometimes they will be told to switch strains around a little bit so that they can avoid tolerance. H So that would you're saying, I have to ask

you this question. Actually, you know, for me, um, you know, as I've got a little older, I noticed that my body doesn't tolerate alcohol quite as well, and I don't enjoy drinking as much as I used. I might have maybe a glass, but having multiple doesn't feel right anymore. So I might use five milligrams an edible marijuana just for a sort of social to be in a social environment. And I might take ten milligrams if I was going to go for a long massage or something like that.

And you know, if and if if it's a cannabis infused dinner. I had the cannabis chef Nicki Stewart on some months ago and she was talking about how you know, if you're eating it during the course of of course of a meal. You know, people can take thirty milligrams, maybe even more, and it doesn't have the impact of swallowing fifty milligram gummy or something like that at one time. But then I know a couple of people who are basically consuming a thousand millah graham's a gram of th

HC daily And these are very high functioning people. And one of the most brilliant human beings I've ever known is now consuming between three thousand and five thousand milligrams of th HC daily. And I mean, there's absolutely no research out there right about what kind of effect this has, whether it's negative or beneficial or I mean, do we know anything about No. I'm I am really not familiar

with those high doses. I'm definitely familiar with high dose CBD in the psychiatric literature and that being potentially beneficial even for things like bipolar disorder or schizophrenia. Like most people when they take CBD, they may take like five or fifteen or twenty five milligrams, but the psychiatric literature people are taking six d eight hundred or a thousand milligrams,

which is a gram. But I actually haven't heard about these ultra high th HC doses, but I know that you can build up to any dose that you can, you know, be tolerant. And in terms of like the dinner, the infused dinner, I think if it's over several hours and you're eating, it's gonna sort of slow down the absorption of how much t HC is going to get into your system. So it's again it's like you're saying,

you're not taking it all at once. When you orally ingest th HC, your liver creates a new chemical which is eleven hydroxy th HC, and eleven hydroxy takes longer to come on, last longer, and is more psychedelic than th HC itself. And one other thing I want to say, just in case we've got any real kind of wonky nerds listening who care about receptors. You know, the five H T two A receptor, which is the receptor that

is sort of tickled by most psychedelics. If you have enough th HC, if you take a high enough dose of th HC, you will start to tickle that five H T two A receptor. Because the cannabis receptor, the c B one receptor UH makes a receptor pair with the five H T two A upter, and those two receptors together they make what's called the dimer the cannabis receptor c B one and the serotonin two A receptor.

When they make a dimer. That is one of the reasons why higher dose t HC ends up feeling more psychedelic, is that you are actually agonizing that psychedelic receptor, the serotonin two A. Okay, well, in that highly technical note, which I appreciate, let's turn to the next question. Hi, I just listened to the episode with Brian ear on

Love Drugs. They really liked it, but there's something missing there, and that is, of all the drugs they talked about, what they didn't talk about was cannabis, which is perhaps the most popular aphrategi act of all. So that's my question, what about cannabis when it comes to Love Drugs? Thank you,

bye bye, Julia. I'll tell you. I mean when I interviewed this from Biolysis is Brian was fascinating his book Love Drugs, and it covered a whole spectrum of things, right, including not just peep M D M A and things like that, or alcohol for that matter, but also the ways in which people can use different types of drugs, or their studies that you can forget unpleasant memories, things like that. But at the very end, I said, what about cannabis? And he said, yeah, I I left it out.

But what's your sense about you know, your professional sense, uh, the review of the literature sense about cannabis and love, Well, it's it's so highly variable. First of all, people's reactions to cannabis is very variable. I mean, you can put five people in a circle sharing a joint and maybe some people are gonna get horny, and some people last thing they're gonna want to do is have sex. You know, there's tremendous variability from person to person when you're using

the same cannabis. And then if you've got two or three different strains, you're going to have even more variability. So the first thing I would say is hard to predict, hard to control a lot of variables in that there are so many different kinds of strains of cannabis, and there are so many different people's responses. And I have definitely heard from a number of women who tell me that hash in particular, Hash seems to work better for them than cannabis as sort of a pro sexual agent.

And I don't know if it's because the CBD t HC ratio is a little bit more favorable in hash than cannabis. But some people swear by using cannabis before they have sex. I have a patient who she sort of will only have sex with her husband if they smoke. So some people need it, some people like it. Some people find that it really gets in the way um.

Sometimes cannabis makes it more difficult to climax. Sometimes cannabis puts you so much in your head and you're so busy thinking thinking that you're not really in your body. You're not totally appreciating everything that your body is doing for you. Some people get horny, but they can't climax. And then the other thing I wanted to say about cannabis was that for some people it's a real heart opener.

I have this experience a lot, like you know, I'll be in a fight with Jeremy and I'll have a puffer two and then I will go right back up to Dermy and just being a completely different open hearted You're right, I'm wrong. I see, I see now what you're saying. Like, you know, I was so closed and now I'm so open. So I think anything that sort of opens your heart, it is bound to help you

connect with somebody. But sex is super complicated, and you know, for some people it is about heart opening and intimacy, and then for other people it's much more purely purely physical and and there's no intimacy involved, you know. And it really depends on your childhood experiences with sex or how you were taught about masturbation, or if you masturbate, or if you were taught that that was bad. You know.

For some people having a drink or having some pot and they feel a little bit less inhibited, the brakes are off, you know, and then that an opportunity to have more pleasurable sex. But you need gas and brakes, you know. So I'm wondering, actually, if you and Brian ever spoke about a compound called to c B, which to me is sort of the most pro sexual of the psychedelics. And I was wondering if maybe that came up.

I don't remember if we talked about two CP, and I don't know if I want to share my personal experiences on this podcast, well, can you share anything about cannabis and sex? Then I guess that was well, I mean, I'll tell you a funny story Julie. Years ago, before marijuana was legal anywhere. This must have been I don't know, I'm guessing two thousand seven, eight nine, something like that.

We're trying to figure out how to move public opinion further along, and by by that period, I think there was beginning to be a slight majority of men who were in favor of legalizing marijuana for adults. But there was almost between five and sometimes almost ten point gender gap in support for marijuana legalization, with men much more likely to support it. And so I came up with this idea, which was marijuana and sex, especially among older women.

And I knew anecdotally many women who were in their forties, fifties, sixties who say that basically that marijuana played an absolutely essential role in their sexual and intimate relationship with their husband of many decades, and they say, you know, but for marijuana, we probably wouldn't been having sex anymore. Now. In the end, I never proceeded with that. It would have been a hard campaign for DPAH Alliance as a

policy organization to launch. But I will say that anecdotally, I've been struck by how many people, especially women I have encountered, who just feel that cannabis and sex go hand in hand, like basically nothing else you asked before about two c B, right, And in the book by Sasha and Sikal right, and I think almost did a disservice in that because she writes about when she and Sasha are first experimenting with two c B and she takes two c B and she falls into perhaps the

most devastating depression in her life and just can't even pick herself emotionally up off the floor whatever. And then Sasha in the other room and he comes in the door and she sees him and he's like glowing in her you know, because two CB is somewhat psychedelic and all of a sudden thing flips in the other direction, and she describes having the most extraordinary multi orgasmic sex of her entire life with Sasha under the influence of

two CB. And I think what happened was that then people said, oh my god, let's just get some too CP, and we'll have this amazing multi orgasmic sex. And of course it doesn't just work like pivotal. Yeah. I mean, I can say this much. My own personal experience was that when it came to two C B and sex that on the one hand, the negative side was that the sen sile, the touch felt much clammy or not pleasant,

not appealing. On the other hand, there was a kind of colorization of sexual sensation that was sort of erotic and pleasing and all that. But that was my own experience, and I really said, varies dramatically from one person to

the next. Well, I will say I'm doing a lot of consulting for psychedelic companies, and I have spoken to a couple of companies that are really really looking at sort of women's sexual pleasure, and you know, to CB is certainly one of the things that comes up as as a possible sort of catalyst for this process, but it's just too complicated for it to work in everybody,

you know. But I would say in general, I have sampled quite a few psychedelics and last forty something years and two CB is the only psychedelic that I've ever ingested where I would even consider feeling sexy, wanting to have sex, like feeling horny, anything like. Usually it's just not even on the table. But it's also possible that I was very much influenced by pikal Okay, okay. So let's go to the last question we have from our listeners.

Hiathan and Julia. I really appreciate the important work that you're doing, and I love the show. If you had a time machine and you could go a hundred years into the future, how do you say or imagine drugs being integrated and accepted into the broader culture in Western countries in Australia where a little bit behind the times,

and it's very frustrating. So I'm just wondering your thoughts on on how you say the future painting out so truly you want to take a first crack at that or should I. Honestly, I really can't stim and these questions come up. I'm just I don't know what my problem is, but I'm not very good at like imagining or envisioning how things are going to go. Um, I'd love you to start and then maybe it'll give me

some ideas. Yeah, I mean, first of all, to think a hundred years forward too, when you know, God knows what shape planet Earth will be in, what shape human kind will be in. Um, I just find it impossible to answer at that level. What I do think is that we are obviously going to continue to see a

growing proliferation of psychoactive substances. I mean, I remember, even going back thirty years ago Julie, people would say, oh, we're going to see the replacement of cocaine by synthetics, replacement of this by synthetics, blah blah blah blah blah. And I think people always expected that to happen sooner than later. But I do think over time we're head

of that direction. So one question it raises is whether the classic plant psychoactive substances, right, cannabis, coca you know, which becomes cocaine, opium which becomes opiates, tobacco which becomes nicotine,

and some of the psychelics. Whether in fact those things will continue to play, I have to imagine they're going to play an ever diminishing role in the broader consumption of psychoactive substances as synthetics get developed that offer us more and more of the potential upside to these substances and less and less of the downsides. That's one I

think fairly safe prediction. On the other hand, the fact that these substances have been around, these plant products from millennia, sometimes ten thousand years, um, makes me think that they really do have some powerful staying power. Secondly, UM, you know, the notion of how these substances are going to become

more and more integrated. You know, it's like when you imagine just jumping forward a few decades, even imagining Prozac generation seven and m d m A generation four, or when you look at what some of the psycholics research companies are more and more trying to do of developing different psychedelics that give you the upsides without some of the downsides of nausea or physical discomfort or what have you. Um, whether or not we basically see alcohol get essentially displaced.

I mean, alco obviously has so much to do with taste and flavor and culture that I'd be surprised if alcohol really disappears in any substantial way from our society. UM. It's also hard to know whether we'll continue with drug prohibitions or whether some innovations will simply happen that make, you know, the absurdity of prohibitions just so readily apparent

that governments give up. I also wonder about other types of things, you know, virtual reality experiences and things like that, that may in fact offer you know, safer forms of altered states of consciousness than we get from the plant

substances and the synthetic drugs. The one thing I feel highly confident of is that people are going to continue experimenting with and using it, consuming for a broad, almost infinite variety of reasons, all sorts of psychoactive substances, and that the notion of ever there ever being any kind of drug free culture, drug free society is utterly absurd.

I think, even if you imagine, you know, the way that China is going now with ever greater uses of artificial intelligence and surveillance, and all of this, the innate need of a desire of human beings to alter their states of consciousness one way or another, and the ways in which psychoactive substances kind of facilitate that process better than and more effectively, sometimes for good, sometimes for bad, than any other forms of ways instigating an ultrasto consciousness.

I think that even in the most totalitarian and hyper control societies will continue to see people using these substances. So what do you think? Yeah, No, I as usual, I agree with what you're saying. You know, one thing I have seen just in advising some of these psychedelic companies is that there are a number of companies who are looking to sort of tweak the molecules we already know about, to make them last longer or be shorter,

or have some effects and not other effects. So I think we're going to continue to see this sort of you know, alphabet soup of like new chemical entities twists on old molecules. I also think it's worth hoping that there is still going to be payote around, that there will still be boufoil various around that you know, the natural sources that you mentioned, I hope that they don't

get depleted. People have figured out how to sort of preferentially use synthetic mescaline so that they aren't over harvesting payote and find other ways to make five M E O D M T that don't involve, you know, molesting these toads. You know, there was a time member when I was talking to Michael Paullen when he was doing his New Yorker piece. This is the article that became

his treatment. Yeah. Well, I mean when he was writing that New Yorker article, Jeremy and I are like, you're going to write a book, aren't you, Like there's clearly enough here for a book. But I remember talking to him about this idea of like mental health clubs that you know, the same way you can go to a gym and there's a lot of different equipment that you can get on to work your legs or your arms.

Like maybe at some point you'll be able to go to like a mental health club where you will have you know, rooms for meditation or for yoga, but there will be a two C B room or an M D M A room and you will be able to have some sort of psychedelic assistant therapy offered to you. Obviously, integration is important, and you know, screening in preparation. But I am assuming that these sort of processes of having

psychedelic assisted therapy available. I am assuming that they will become more commonplay ace, and people will be sort of more educated about them, and we'll be able to avail themselves. But I see that in like ten or twenty years. I mean, God knows what's going to happen in a hundred years. You know, it's hard enough to sort of predict.

I mean, we know that f d A is going to be presented with some very convincing data on m DUMA assistant therapy for ptsd ine, and it's very possible that m DMA will be FDA approved in and then I think with psilocybin, the data will probably be gathered a year or two after that. So even just in the in the short term, we're going to have big changes where people are going to have access to these medicines and it's going to create its own sort of

cascade of effects. When I talk about the explosive growth right now what's happening in the psychedelic space, I always talk about pruning. You know, if you're a gardener and you've got explosive growth, you need to cut back. You need to prune it. It's too big and too bushy, and you have to make some hard decisions about what stays and what goes. But in the long run, that pruning makes for a healthier plant that will produce more fruit.

So I feel like we are going to be in this, in this expansive growth and pruning phase for at least the next ten, maybe even twenty years. So I don't know what happens if we do all that where we're at in a hundred years. I just know you and

I are not going to be here to see it. Yeah, how much do you fear a crackdown of the sort that you know, there was obviously that psychelic renaissance that have been initially in the fifties and early sixties and then was really obliterated by the late sixties early seventies. What's your fear about that happening? You know? I sort of joke about like too big to fail, or that

there's an awful lot of momentum right now. So I do sort of feel like the two spaces out of the tube and you're not going to be able to put it back. And there are so many people now who who know that these can be used as medicines and that these can help a lot of people, and that we have got a true epidemic of anxiety and depression and suicidality and substance abuse and alcoholism sort of

stemming from isolation and loneliness and loss of meaning. And you know, people are pretty miserable, and COVID did not help. So we really are having a mental health crisis and we're going to need outside the box solutions for these problems. Um, it's just hard to see how everything is going to shake out well on that uncertain No, Julie, I want to thank you for co hosting Psychoactive with me this

second time. I want to encourage our listeners in the hope that Julie will agree to do this again, that if you have questions on your mind, I'll do it right now. In fact, just call a three three psycho zero or eight three three seven seven nine two four six zero three three seven seven nine two six zero, leave a question you'd like Julian or I to answer, and hopefully we'll get to it the next time we do this. But Julius, and thank you ever so much

for doing this with me. It's an incredible pleasure to catch up with you, whether we're doing it with a recording like this or just in person. So thank you, Thank you anytime, Ethan. It's on my absolute pleasure. If you're enjoying Psychoactive, please tell your friends about it, or you can write us a review at Apple Podcasts or wherever you get your podcasts. We love to hear from

our listeners. If you'd like to share your own stories, comments and ideas, then leave us a message at one eight three three seven seven nine sixty that's eight three three psycho zero, or you can email us at Psychoactive at protozoa dot com or find me on Twitter at Ethan natal Man. You can also find contact information in our show notes. Psychoactive is a production of Heart Radio and Protozoa Pictures. It's hosted by me Ethan Naedelman. It's

produced by Noam Osband and Josh Stain. The executive producers are Dylan Golden, Ari Handel, Elizabeth Geesus and Darren Aronofsky from Protozoa Pictures, Alex Williams and Matt Frederick from My Heart Radio, and me Ethan Nadelman. Our music is by Ari Blucien and a special thanks to a. Brios F.

Bianca Grimshaw and Robert BP. Next week I'll be talking with Rick Doblin, who founded the Multidisciplinary Association of Psychedelic Studies otherwise known as MAPS back in and is now leading the way for the legalization of m d m

A as a therapeutic substance. So the journal Science polishes a list of what they consider it to be the world's top ten scientific breakthroughs of the year, and fore they considered our phase three paper published in Nature Medicine as one of the world's top ten scientific breakthroughs of the year. And it was just so satisfac to really speak about m d m A and the therapeutic use of m d m A as one of the world's

top ten scientific breakthroughs of the year. Subscribe to Cycleactive now see it, don't miss it.