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It's a new year. Maybe you're taking a month off from drinking, you know, dry January, and maybe you're replacing it with something else. Puff, puff, puff.

Some like one in five people who do dry January say they're smoking weed instead. And more Americans are now smoking weed daily than drinking daily. Current president is into it. No one should be in jail merely for using or possessing marijuana. Period. Future president is into it. I've had friends and I've had others and doctors telling me that it's been absolutely amazing, the medical experience.

Marijuana. Failed president and former prosecutor was down to clown. People shouldn't have to go to jail for smoking weed. Even health conscious brain worm guy likes it. My position on marijuana is that it should be federally legalized. Everyone's getting down with pot, but legislatively, we're still stuck with a hot mess in the United States. We're going to see what we can do about that on Today Explained.

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Maren Kogan, senior correspondent at Vox. What's up with weed right now? So researchers found in 2022, for the first time, more Americans were using marijuana every day or nearly every day than consuming alcohol at the same rate. More Americans are doing daily weed than daily booze.

Yeah, it's a huge phenomenon. And if you think about it, the numbers are something like 17.7 million Americans say that they're getting a little high or smoking a little weed daily or near daily. That's not nothing. That's like 5% of the American public. So I smoke marijuana sometimes a lot every day. And I'll tell you, I smoke weed all day. So I would, yeah, I would imagine it would be worse if I didn't. How much do you smoke a day?

Probably an ounce, like a cool kid. We burning the cool ounce. This is all based on survey data. It's self-reported use. So are these people taking a little hit of a vape pen before they go to bed to deal with insomnia? BRB, about to escape and enter my magical fantasy world. It just calms me down. I'm able to sleep comfortably.

And I stay asleep. It's much easier and much more pleasant, the whole experience, because when you do sleep, you sleep like a log. I sleep really well. Are they people who wake and bake? You thinking what I'm thinking? Wake and bake. Let's go. Good morning to all the wake and bakers. It's time to wake and bake.

Are they people who are basically getting a little high before they go to class, before they go to their jobs? Getting lit before work, guys. Cheers. It's called self-care. Look it up. So I'm on my way to school and I gotta smoke. I gotta smoke before school.

We don't know how many times a day those people are using. We also don't know the potency of what they're using. So there's a huge range and variation. What we do know is that the market right now for marijuana and the number of sales are really going towards customers who are using very heavily. So we're talking multiple times a day. What we don't know exactly is what that means for personal or for public health. So essentially, Americans are conducting this real-time experiment on their own bodies.

Are people getting addicted to weed? Can you get addicted to weed? Yeah, so contrary to popular belief, it can be habit-forming for some people. It can increase risk of dependence on other substances. And a recent analysis by Columbia University researchers found that as many as 18 million people in the U.S. might have some form of cannabis use disorder, in other words, addiction. So it's simply not true that it's completely harmless for everyone.

Tell me more. What do we know about the harms, especially as we undergo this massive nationwide experiment and see more people smoking weed every day?

So one really good example of this is cannabinoid hyperemesis syndrome. Cannabinoid hyperemesis syndrome. It's a really fancy term for people who have used a lot of marijuana, heavy amounts over a long period of time, who begin throwing up really violently and are sort of unable to stop these cycles of nausea and vomiting. Huh.

Doctors and hospitals across the country are seeing people come in with cannabinoid hypermesis syndrome, and it can be really, really bad. Crazy stomach pains and migraines and nausea and diarrhea and all this other stuff. I was losing weight.

I was getting nauseous. I wasn't throwing up, but I was getting the joint pain. I really couldn't work out anymore without massive amounts of discomfort. If you're having crazy vomiting and nausea episodes and you smoke weed and nothing helps you except for laying in a very hot shower...

You likely have CHS. I'm not a doctor, I'm saying likely. You likely have CHS. There have been all sorts of horror stories of people who have burned themselves because one of the few things that makes people with this syndrome feel better is heat, so they'll take hot baths repeatedly. And yeah, people have actually burned themselves trying to get relief from the nausea they feel because they've been smoking so much weed.

Is cannabinoid hypermesis syndrome the only negative health impact we're seeing amongst people who are smoking more weed? No. So high levels of consumption is being associated with higher risk of stroke, cardiovascular disease. But the real issue here, and I think the real concern that a number of researchers have, is what regular marijuana use is doing to teens. Hmm.

There is particular concern about what regular heavy marijuana use does to adolescent and teen brains. So there have been studies that have shown an increased likelihood of depression and suicidal ideation associated with heavy marijuana use. In a few cases, it has been associated with the development of

schizophrenia and other psychotic disorders among young people. Studies have also shown disruptions in the anatomy of a developing brain. And teens often have, and honestly adult consumers too, often have really no idea what they're consuming and how safe it is. A big issue is a lot of people don't know dosing. So they tend to overconsume and then they have a very bad experience. Last time that I caught myself taking an edible, I legit

quote the ambulance because I thought I was having a heart attack. Once those edibles kicked in, my whole entire soul left my body and I'm not being dramatic. I literally disassociated. I was talking to the refrigerator, bawling my eyes out, throwing... Why don't we know more about what we're consuming and how safe it is? A lot of

Yeah.

For the consumers, it's confusing for the researchers, too. The regulations basically have not caught up to where the market is evolving. Poor K, no. One of the big reasons is that the federal government has basically allowed the states to...

their marijuana laws, so decriminalizing or legalizing in different cases. Today, marijuana is legal for medical use in 38 states and recreational use in roughly half of all states, plus the District of Columbia. But it still kept marijuana as illegal on a federal level.

as a Schedule I drug, so the government doesn't recognize it for medical use, and that's made getting safety approvals and government funding necessary to study the drug really difficult. So essentially, researchers say it's like they've been handcuffed all these years, right? And the handcuffs are just sort of coming off. Should we use it in place of an opioid? Should we use it in the place of another pain medication? Where and how should it fit into medicine?

We don't know. So now you'll see these scientists emerging in this natural health field, really opening up the field so that they can evaluate the therapeutic effects, which patients already know that cannabis has. Meanwhile, all these states have legalized marijuana and they're trying to figure out now, how do we establish a public health response to make sure people are safe?

aware of what they're taking as consumers, aware of what they're putting in their bodies, similar to what we have around, say, cigarettes or alcohol. Okay. And has there been success on that front? Is there consistency in what people are getting across this country, or at least consistency in the labeling of what people are getting across this country? Oh, no, absolutely not. Certain states have better, I think, testing and safety standards than others.

But no, I mean, essentially, it's on you to sort of be an expert both about like reading labels and figuring out what it is exactly you're taking and then also figure out what amount works for your body. I mean, and it seems like there is really wide variations. The problem is that

you know, people don't always know their own limits. They don't always know what they're taking and there can be real health consequences as a result. Not to mention this stuff's just generally a lot stronger than it used to be, right? Yeah. So the products out there are a lot stronger than the sort of dime bags that were floating around, you know, in the early 2000s. Over the last 25 years,

The government has been testing the percentage of THC in marijuana seized by the Drug Enforcement Agency, and they have seen that the percentage of THC has more than tripled in those samples from 5% to 16%. This sounds all very messy, Maren. As we enter a new year and approach this country with this potent drug that a whole lot of people love to take, that increasingly people are taking every day with this patchwork of

of laws and a whole, you know, inconsistent patchwork of regulations. Is anyone having buyer's remorse on all the legalization we've done?

Definitely. There are some people who argue that legalization was a mistake, as they point to these health consequences that I've been noting. They say that it hasn't really had the sort of positive impact on racial disparity in the criminal justice system that they expected it to. And they point out that, yeah, essentially, this is creating a new public health problem that researchers

just really have not had the time or ability to get a handle on before so many people started consuming marijuana. It is unfortunate that it's on the consumers to kind of figure out what is...

going into their bodies and whether or not it's good for them. But that is the reality of where we're at right now. It is a brave new world with regard to marijuana legalization in this country. It is probably harmless for a huge number and helpful even for a huge number of people out there. But it doesn't mean that it's perfectly safe and harmless for everyone. And I think people are going to have to, while the government sort of figures out a public health response to this, they're going to have to really think about themselves and make sure that they feel healthy with what they use.

Maren Kogan, you can read her joint on weed at Vox.com. It's called How Weed Won Over America. I'm Sean Ramos from Next Up on Today Explained. As we so often do, we're heading to Canada to find out if we can learn anything from our neighbors to the north who didn't just legalize state by state or province by province in their case. They legalized federally.

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Why do so many of us get happiness wrong? And how can we start to get it right? I mean, I think we assume that happiness is about positive emotion on all the time, right? Often very high arousal positive emotion, but that's not really what we're talking about. I'm Preet Bharara, and this week, Dr. Laurie Santos joins me on my podcast, Stay Tuned with Preet, to discuss the science behind happiness.

We explore job crafting, the parenting paradox, the arrival fallacy, and why acts of kindness might be the simplest path to fulfillment. The episode is out now. Search and follow Stay Tuned with Preet wherever you get your podcasts. Oh, today explains.

James McKillop sits in the Peter Boris Chair in Addictions Research at McMaster University and St. Joseph's Healthcare in Hamilton, Ontario. But he's also from the United States, so he was the ideal doc to ask, what's up with legalization?

Legal weed in Canada compared to America, we started with weed's legal status north of the border. Well, cannabis has been legal now federally for just over six years. And even before that, cannabis was legal for medical purposes since 2001. So it's been legal in one form or another for nearly 25 years. And...

Why did Canada legalize weed fully? So fundamentally, the approach was to apply a public health strategy to cannabis and in particular to try to reduce harms and maximize benefits. The three big goals were to reduce youth access, to create a legal framework for adults to access cannabis, and to reduce burden on the criminal justice system.

Okay, so how are we doing on those three goals to reduce youth access, increase adult access, and reduce burdens on the criminal justice system six years into this experiment? Well, the good news is we haven't seen a sharp increase in youth consumption, which was a fear that a lot of people had. And although we haven't seen big decreases, it does seem like there haven't been those feared increases.

There have also been some other consequences that are not so positive, but the other things that are good include certainly many fewer arrests for cannabis and a fully realized large economic cannabis sector now. Okay. So we did reduce burdens on the criminal justice. We didn't necessarily increase youth access.

I assume adults are smoking more? That is the case. So right now, the rates of cannabis use in Canada are certainly at all-time highs. Some of that happened before legalization, but that's a trend that hasn't gone away. And especially if you look at not youth like teenagers, but young adults in their 20s, the rates are close to half in terms of folks reporting any use in the last year. So the overall rates of cannabis use are certainly high.

Where does that put Canada in terms of, I don't know, world rankings of pot smokers? Well, historically, Canada lagged the U.S. only in terms of overall rates. I think that actually the rate may be higher than the U.S. now, although it depends on the survey that you look at. But certainly it is near the top, if not at the top, globally. Wow. So Canadians are smoking a ton of weed. And it sounds like

You think that's not a good thing? Well, I think that it's a complicated picture six years in.

So as I said, some of the good things are it's a real economic marketplace. There's a lot of sales. The illegal market has been substantially displaced, but there have been some downsides too. I think the overall high rate of use is not great. But the other reality is a lot of people are concerned about how many storefronts we have. There's a cannabis shop on every corner, it feels like.

And there are concerns about burdens on the healthcare system too. Worrying uptakes in terms of the number of individuals going to emergency departments or urgent care centers, the number of individuals who are experiencing cannabinoid hyperemesis syndrome, that very unusual syndrome of acute nausea and vomiting that takes place in people who use cannabis frequently. There are increases in pregnant women who are seeking care for cannabis.

and increases in the proportion of impaired drivers who are testing positive for cannabis. So those are all kind of canaries in the coal mine for some pretty troubling trends.

How do the medical concerns compare to those with alcohol? And are we seeing fewer alcohol-related hospitalizations or driving infractions as a result? That's a great question. So I think that alcohol is in some ways the best comparator drug. And the reality is alcohol, despite being legal, has lots of harms. And those range from

acute harms like driving while intoxicated and physical and sexual assaults to chronic harms like cancer. The U.S. Surgeon General this morning is calling for new warnings on alcohol products. In a statement in the last few hours, the Surgeon General said alcoholic beverages are a leading cause of cancer and should carry labels similar to those you find on cigarettes.

Light to moderate drinking was associated with reductions in overall brain volume. There's a really complicated and important relationship between alcohol and things like depression and anxiety in particular. And in a lot of ways, cannabis has a somewhat more favorable profile, although we don't have a great sense for whether the increase in cannabis use and the increase in cannabis sales...

legal sales has offset some of the harms from alcohol. What I can tell you is that if you look nationally, the alcohol retail sales have not changed all that dramatically. So Canadians spend about $2 billion a month on alcohol, and that has been very stable from prior to legalization to the current date.

Along that same time period, there has been a skyrocketing sales of legal cannabis. And so it seems like what's happening is the legal cannabis market is displacing the illegal market, but it's not really changing the amount of drinking all that much, which probably suggests that the amount of benefits in terms of reducing alcohol harms are going to be limited. You mentioned that there's a pot shop on every corner, it seems like, in Canada these days. Are you seeing an economic...

boom? There have been aspects of the cannabis economy that have been boom-like, but also bust-like. The reality is the stocks for a lot of the producers prior to legalization were sky high. And those stocks unfortunately dropped in value after legalization when things recalibrated a bit. A lot of the pot shops open and then unfortunately close because it turns out the markets are already somewhat saturated.

And there are some pretty insidious aspects of this, too, because when you have cannabis shops on every corner, even though advertising is prohibited, that becomes a form of advertising. So I have young kids and they see cannabis stores all over the place, sometimes two or three in a given strip mall.

And the other thing is, I've heard from my patients that when they're trying to quit or even reduce, having cannabis stores everywhere is a real challenge. And so I think that even though there are some economic benefits, we are right now reckoning with some of the harms also. Has someone done this better than Canada? I mean, do you guys look at the Netherlands and say, you know, oh, they had a great model. Is there a good model?

example of how to legalize marijuana out there? I'll tell you, Sean, what I think is the best model. And I think that Canada has done on balance a good job, but maybe not a great job. And where I see the best implementation is actually in Quebec. Also Canada. Also Canada. So one of the things that's interesting about Canada is that

cannabis is federally legal, but it is implemented by the provinces. So there are slightly different models across the provinces and territories. And there are some interesting natural experiments that are happening as a result. And as you probably know, Quebec often marches to the beat of a different drum compared to other provinces in Canada. They speak a whole different language. They speak French and

And there are many great qualities about Quebec, but in this case, they are probably the most different from the other provinces and territories because they have a higher age of access, 21 rather than 19.

They prohibit any edibles that look like candy to keep them out of the hands of children. So you can get cannabis cauliflower or cannabis broccoli or beets, but you can't get cannabis chocolate. They have a provincial monopoly, which means you can only buy cannabis from stores that are administered by the province, which means you can control how many stores you have.

And you can have really rigorous ways of making sure that kids or teenagers are not coming in and buying cannabis because they're similar to, for example, the ABC store in North Carolina or other state monopolies around alcohol. So in many ways, Quebec has implemented a

more stringent public health model. And we've actually seen in studies, not from my group, but from other groups, that some of the harms that are observed in Canada are not present when you look specifically at Quebec. So if there was a model I would recommend, it's probably that one. You know, let me close by asking you this, James. It's a new year. People are thinking about who they want to be, how they want to change, what resolutions they're making and whatnot.

For people who are smoking a lot of weed, considering taking up weed, considering quitting weed, as a medical professional who, yes, lives in Canada, but is actually from the United States, what would you say to your fellow Americans who are living in a state where this is now legal and who are certainly living in a country where their federal government isn't in a rush to solve this problem of the marijuana patchwork we have across the United States?

Well, Sean, given that it's January and a lot of people already consider dry January and abstaining from alcohol, I would absolutely encourage them to think about taking a month off from weed also, especially if they're frequent users.

The reality is, as a psychologist, I see a lot of people who struggle with their cannabis use. It's the number one problem in our young adult substance use program. And taking a month off is a great way to kind of take stock of whether or not you have a problem. If it's easy, then you'll save some money. You might clean out the mental cobwebs. Your lungs will thank you.

If it's hard, you may want to think about whether you need to talk to a health professional. And so to me, new year, new you, it's a great time to think hard about your relationship with pop. Dr. James McKillop, McMaster University. Go Marauders? That's a good one. Abhishek Artsy made our show today. He was edited by Amna Alsadi, fact-checked by Laura Bullard, and mixed by Andrea Christensdottir and Patrick Boyd. This is Today Explained. Today Explained.