to you today. As Dr. Hannafin said, I'm an addiction psychiatrist, but it's perfectly appropriate that I speak to a room full of sports doctors and orthopedic surgeons. Both of the things I'm going to talk to you about today are very relevant to your practice, and I hope you'll find them useful. It's also fitting that I speak after my colleague John Coyles, who at Major League Baseball has been a true leader in bringing mental health services to our players and to our employees. It's also fitting that I speak after General McCaffrey, who through the length of my career has been a fierce advocate for practical and effective drug policy. I'm going to talk to you about two things today. The first thing is mental health first aid, which is a proprietary program for teaching non-clinicians to engage with and deal with mental health problems in people they are working with or care about. The second thing I'm going to talk to you about is also a mental health issue, and that is cannabis as it stands in 2021. I'll give you four reasons to sign up for being a mental health first aid person, and I would say this to each of you, and I would say this to your colleagues who are not mental health professionals. Learning about mental health first aid helps you be prepared for when a mental health crisis happens to know what to do. Like with regular first aid, you don't have to freeze when you see a problem in front of you in the same way that someone trained in first aid would not freeze if he or she sees a possible fracture or a heart attack or a spurting artery. You can help people with mental health illnesses often suffer alone because of stigma. Mental illnesses are common. One in five Americans will meet DSM criteria this year for a mental health problem, and also you can show how you care for your colleagues, for your friends, and for your family members. If you or your co-workers decide to take a course in mental health first aid, here's what will happen. You'll learn the risk factors and warning signs for mental health problems. You'll get good information about depression, anxiety, psychosis, and addictive disorders. You'll learn to make a five-step action plan for actually doing something about the problem in front of you and doing something in an effective way. You'll also find out how to direct someone to professional help and to peer-led support groups, which are enormously important for the person suffering from a mental health problem. Here's the format for a mental health first aid class, and I took the class in New York about two years ago, and I was sitting in a room with a bunch of human resources professionals, administrators, and New York City teachers who wanted to learn how to help someone who they cared about who has a mental health problem. It was a very effective and well-spent day. It's about eight hours long. There are some virtual trainings still in place now with COVID. You'll learn about the material. You'll learn about doing role plays. It's not a sit-down lecture type of training. You'll be able to practice saying the things that are quite awkward and difficult to say if you have not practiced them in the past. The instructors are certified in mental health work. They're also certified in being able to train non-mental health professionals about dealing with mental health problems. I'll give you the basics right now, and mental health first aid uses acronyms just like first aid training does, just like medical school does. First is A, assess for risk of suicide or harm. First things first. We want to rule out big problems first and make sure that small problems don't turn into big problems, so that's the first thing one asks about. You learn how to listen non-judgmentally, which is not as easy as it sounds. That's why the role plays are in place. You learn how to give realistic reassurance and information, not like you'll be okay, but more like I'm going to be here for you. I'm going to help you with this process. I care about you, and I'm going to get you to some help. You learn how to encourage that professional help, and you learn where the resources are that you can direct someone to from all levels, from psychiatrists, psychologists, to mental health counselors, to what an addiction counselor does. And if you take this course, you'll find yourself much more effective in making those kinds of recommendations. Finally, you'll learn about self-help strategies like AA and Narcotics Anonymous and how to refer there. So that's the first thing I want to promote to you is mental health first aid training. The second thing I want to talk to you about is mental health and cannabis. As everyone in this room knows, cannabis is increasingly decriminalized and legalized across this country, which is a whole different debate, but the Delta THC molecule has not changed one bit given the legal changes. And I'll tell you some facts about cannabis that are incontrovertible, and I have a few of the citations here if you feel like looking them up. Available cannabis products have increased in potency over the last 40 years, conservatively about two or three times more potent than they were in 1970, especially with vape, especially with essences that people use, especially with gummy bears. People can ingest a massive amount of THC into their body in a very short period of time. In the last month, I've had two young men hospitalized and one of them intubated because of his massive use of THC. Cannabis intoxication can and does cause hallucinations, delusions, and erratic behavior. This shouldn't be surprising. The molecule is a sedative and it's a hallucinogenic molecule. You can look it up. People who take large amounts of THC experience these symptoms. People who, a common phenomenon is someone will smoke a joint after not smoking since college 10 years ago and will end up in an emergency department with hallucinations because he or she was not aware of the tremendously increased potency. Cannabis use is associated with freestanding psychiatric illness, certainly with depression and anxiety. It's also associated with first-break schizophrenia. We used to say that sentence is associated with don't know if the people who have their first break of schizophrenia are simply smoking a lot of pot or what is happening. It's become clear over the last five years that heavy use of THC is provoking first breaks in schizophrenia, possibly before they would have happened otherwise. So it's looking like it's more causative than it's simply an association. What are cannabis effects on the athlete? The same as any other human being, but luckily there are some data sets would look at what happens to actual athletes. Athletes will sometimes tell you, it helps me sleep, makes me less anxious when I go on the field, makes me less anxious when I'm dealing with my spouse at home, all of which may be true short-term effects of cannabis. I would argue that there are much better treatments for all of those things, including therapies, including medications. What cannabis certainly does to every human being who takes it is it increases fatigue, increases memory impairment, it causes impaired judgment, and causes reduced coordination. I want to say very clearly that although I understand there are some medical indications for cannabis, there are no psychiatric indications for cannabis. Although it's touted as a treatment for anxiety and sleep problems, and also for PTSD, these are in no way the standard of care in the field, at least now. It's really important to treat cannabis-related problems. As an addiction psychiatrist, I see people whose lives are destroyed by cannabis, although I fully understand that some people, or maybe most people who use cannabis don't have any particular problems with it. What we say in the field is that the person needs an effective treatment. They need treatment of cannabis withdrawal, which certainly exists. It's been in the DSM since 2013. It consists of craving, insomnia, agitation. It's the reason most people who try to stop cannabis can't and don't. There are directed, manualized psychotherapies which are effective, motivational enhancement therapy, cognitive behavioral therapy, and contingency management. There are peer-led support groups like Marijuana Anonymous that are effective. There are some off-label medications and supplements that are modestly effective for treating cannabis withdrawal and cannabis craving, including N-acetylcysteine and gabapentin. So I wanted to bring those two subjects to your attention, and hopefully we'll have a time to answer some questions in a few minutes. Here's the contact information, both for Mental Health First Aid and for me, if you have any questions afterwards. Thanks for your attention.

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