Arnold Hanuman Deputy Director Colorado District Attorneys' Council

MADELINE SINGAS DISTRICT ATTORNEY

Nassau County District Attorney's Office

Criminal Justice Conference 2019

Legalization of Marijuana in Colorado: A Retrospective

Presenters: Jennifer Knudsen & Arnold Hanuman Colorado District Attorneys’ Council

April 12, 2019 7KLVSUHVHQWDWLRQLQFOXGHVWKH FUHDWLYHZRUNVRIRWKHUVZKLFKLV EHLQJXVHGE\SHUPLVVLRQOLFHQVHRU XQGHUDFODLPRIIDLUXVH 86& 7KLVSUHVHQWDWLRQZDVFUHDWHG XQGHUWKH)DLU8VH*XLGHOLQHVIRU PXOWLPHGLDSUHVHQWDWLRQVDQGIXUWKHU XVHRUGLVWULEXWLRQRILWLVQRW SHUPLWWHG 10

CO Legalized Cannabis Legislature allowed for Legislature recreational January 1 - A20 allowed for marijuana retail (medical MJ) medical marijuana passes marijuana stores open

A64 Ogden Memo (recreational MJ) Cole Memo passes

2JGHQ0HPR 2FWREHU &ROH0HPR $XJXVW

6HVVLRQV0HPR -DQXDU\

³7RGD\¶VPHPRRQIHGHUDOPDULMXDQD HQIRUFHPHQWVLPSO\GLUHFWVDOO86$WWRUQH\VWR XVHSUHYLRXVO\HVWDEOLVKHG SURVHFXWRULDO SULQFLSOHVWKDWSURYLGHWKHPDOOWKH QHFHVVDU\WRROVWRGLVUXSWFULPLQDORUJDQL]DWLRQV WDFNOHWKHJURZLQJGUXJFULVLVDQGWKZDUW YLROHQWFULPHDFURVVRXUFRXQWU\´ 1DWLRQDO/DQGVFDSHRI0DULMXDQD /DZV

Medical & Recreational: 9 States & DC --- Medical only: 22 States --- CBD only: 15 States --- None: 4 States

Source: National Conference of State Legislatures (2018), http://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx Note: Not all states’ laws are currently in effect.

Marijuana Sales

2014 $699,198,805

2015 - $996,184,7884,788

2016 - $1.3 BILLION

2017 - $1.7 BILLION 6KDUHRI6WDWHZLGH7RWDO$GXOW8VH6DOHVLQ State Regulators

237 McDonald’s

322 Starbucks

473 medical dispensaries

549 recreational dispensaries https://www.coloradopotguide.com/where-to-buy-marijuana/ (9.23.16)

) 9

Not Your Grandma’s Weed

A dispensary tour . . . WHAT IS MARIJUANA?

Schedule I drugs, substances, or chemicals are defined as drugs with no currently accepted medical use and a high potential for abuse. Some examples of Schedule I drugs are:

heroin, lysergic acid diethylamide (LSD), marijuana (cannabis), 3,4- methylenedioxymethamphetamine (ecstasy), methaqualone, and peyote GreenGreen LeafyLeafy Material?Material? Traditional Cannabis Gene Pools

C. Sativa or C. afghanica? Or “sativa” “indica”

Fiber/Seed Marijuana Hashish HashishHashish

South Asia, North India, Russia, AfghanistanAfghanistan Southeast Asia, Nepal, Mediterranean andand PakistanPakistan Africa Middle East & Far East & New World & North Africa HighHigh THC/THC/ Low THC/ High THC/ High THC/ LowLow – Med. – Low – Low CBD HighHigh CBD High CBD Med. CBD

Most modern medical Cannabis varieties are a blend of traditional “sativa” marijuana varieties with “indica” hashish varieties. Drug (THC/CBD ratio >1)

Fiber (THC/CBD ratio <1)

Intermediate (THC/CBD ratio close to 1)

&DQQDELJHURO &%* &DQQDELGLRO &%' ǻၯWHWUDK\GURFDQQDELQRO 7+& &DQQDELQRO &%1

&DQQDELYDULQ &%9 &DQQDELFKURPHQH &%& $UDFKLGRQR\OJO\FHURO $* &DQQDELF\FORO &%/

$UDFKLGRQ\OJO\FHU\OHWKHU $*( &DQQDELGLYDULQ &%'9 7HWUDK\GURFDQQDELYDULQ

+\GUR[\7+&

N$UDFKLGRQR\O GRSDPLQH 9LURGKDPLQH 1$'$ $QDQGDPLGH $($ 1RUFDUER[\7+&

Cannabis: % THC Over Time 45 42% 40 THC Nationally 35

30 THC Colorado

20 CBD Only

% Dry Weight 15 THC: Psychoactive 10 Ingredient CBD: 5 NON-Psychoactive 0.2% Ingredient ~0.4% 0 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 Year Courtesy: S. Urfer (adapted from Mehmedic et al., 2010)

Hash

Kief

Sampling of Concentrates ButaneButanne HashHHasas Oil (BHO)

EarEar WWaxax

Sauceuce

BudderBudder Shatter Vaping 6.5 65mg Active Servings THC 8

The Black Market Disappeared Basement Grows

Outdoor Grows Altered Structures

Altered Electrical Panels Theft of Utilities

Fire Hazards Grow House Damage

Firearms The Almighty Black Market $

Black Market Distribution 7

The Science Just Isn’t There HOW DOES MARIJUANA WORK IN THE BODY?

Impairment peaks quickly Marijuana is and & levels out ingested OR is drawn-out

THC binds to the THC crosses the fat receptors in the “blood/brain body/brain barrier” quickly

%ORRGUHVXOWVFDQVKRZWKDWdelta-9 THC and 11 Hydroxy THC DUHLQWKHSHUVRQ¶V V\VWHPDWWKHWLPH RIWKHEORRGGUDZ Cannabinoid Pharmacokinetics SMOKED

Smoked THC Time-Concentration Curve

THC concentrations fall to about 60% of their peak within 15 minutes after the end of smoking.

To about 20% of their peak 30 minutes after the end of smoking.

Courtesy Marilyn Huestis, Borkenstein Drug Course, 2012

Cannabis: Smoked vs Oral Chronic Frequent? Occasional? Other?

THC Effects - No Tolerance 12

0 Memory Loss Somnolence Motor Impairment High Anti-nausea

THC Effects - Tolerance 12

0 Memory Loss Somnolence Motor Impairment High Anti-nausea NTLC Prosecutors’ Encyclopedia

FLSB-FORENSIC-LIBRARY- [email protected] 6

Violent Crime is Down

The Magic Number Permissible Inferences

<.05: presumed that the defendant was NOT under the influence of alcohol and that the defendant’s ability to operate a vehicle was NOT impaired by the consumption of alcohol. .05-08: DWAI .08+: DUI 5+ ng/mL delta-9 THC: DUI

QDQRJUDPV RIDFWLYH7+&SHUPLOOLOLWHU RIEORRG

/HY\7KDPEDD\HDUROGVWXGHQWDW 1RUWKZHVW&ROOHJHLQ3RZHOO:\R Continued psychomotor impairment after 3 weeks of abstinence in chronic frequent users, suggesting the ability to drive is impaired at the time of these low blood THC concentrations

Phase I and II Cannabinoid Disposition in Blood and Plasma of Occasional and Frequent Smokers Following Controlled Smoked Cannabis – Desrosiers, et. al (2014)

'HOWD7+& &RQFHQWUDWLRQ

3,946 cannabinoid screens

27% Negative Cannabinoid Screen 73% Positive Cannabinoid Screen

Source: State Judicial Department, Denver County Court, CBI, andChemaTox THC in ng/mL Distribution n=2715 1400

1230 1200

1000

800 757

Count 600

400 316

200 144

59 73 54 25 17 18 22 0 Trace 1-5 6-10 11-15 16-20 21-25 26-30 31-35 36-40 41-50 >50 THC ng/mL “The research, synopsized in a document on view below, argues that 13.1 nanograms per milliliter is the actual equivalent to the .08 BAC alcohol intoxication level”

“But the results definitely argue that Colorado's 5 nanogram limit is far too low”

An Evaluation of Data from Drivers Arrested for Driving Under the Influence in Relation to Per Se Limits for Cannabis, Barry Logan, Ph.D., f-ABFT, et al. Based on this analysis, a quantitative threshold for per se laws for THC following cannabis use cannot be scientifically supported

We Got It Right the First Time “Debilitating Medical Condition”

Cancer HIV/AIDS Glaucoma Cachexia Seizures Muscle Spasms Nausea Severe Pain Any other condition must be approved by CDPHE* - Currently no new conditions (including PTSD) have been added. Permissible medical amounts

6 plants 2 oz. . . . or whatever amount is “medically necessary to address the patient’s debilitating medical condition.” 3HUVRQ0D\3RVVHVV8VH'LVSOD\ 3XUFKDVHR]RUOHVV«

Pound = About 16 bills Person ≥ 21 Possess, Grow, Process up to 6 marijuana plants?

Growing Yield

Harvest unlimited amount, must remain on the premises Assisting > 21

Person ≥ 21 Grow, Process or Transport 6 Plants for Person ≥ 21.

Marijuana Accessories/ Paraphernalia

A person ≥ 21 can lawfully . . . Possess or purchase marijuana accessories. Manufacture and sell marijuana accessories to someone ≥ 21. Open,Open, BrokenBroken Seal,Seal, CContentsontents PPartiallyartially Removed;Removed; EvidenceEvidence ofof ConsumptionConsumption

SFSTs Aren’t Validated for Drugs Courtesy: C. Popp

PHYSICAL PSYCHOMOTOR COGNITION MOVEMENT FUNCTION

Movement & Coordination Manipulation & Dexterity Grace Can I Can I Strength register physically Speed that it’s act on that happening thought

Modified Romberg Balance

Moritz Heinrich Romberg German neurologist (1795–1873) where defendant touched face held finger repeatedly forgot instructions anticipated commands slow in responding to commands eye lid tremors sway leg and body tremors confusion and disoriented missed nose/used pad searching dragging pad of the finger holding

False Positives

2 DO NOT Collect Data Now Marijuana-related Fatalities on Colorado Roadways

160 139 140 125 8 120 25 98 100 8 32 75 26 80 6 55 6 22 46 60 36 Total fatalities 5 26 31 40 9 18 20 42 45 46 23 32 0 2013 (N=481) 2014 (N=488) 2015 (N=546) 2016 (N=608) 2017 (N=648) Cannabinoid Cannabinoid & Cannabinoid & Cannabinoid, any alcohol, and only any alcohol other drugs any other drugs

Source: Colorado Department of Transportation, Data Intelligence Group, Toxicology Data (2018). Note: a) Numbers are based on toxicology results where at least one driver was tested for drugs after a crash. b) The presence of a cannabinoid does not necessarily indicate recent use of marijuana or impairment. 1

(QDEOHVPHQWDOKHDOWK SURIHVVLRQDOVWR GHWHUPLQH

± (1) whether clients merit one or more diagnoses and, if they do, ± (2) what those diagnoses are.

May, 2013 Cannabis-related psychosis OR Schizophrenic psychosis?

INCREASED RISK

User Age 19-21 High Concentration Products 20-year-old man

no prior or family history of psychosis

severe and persistent paranoia after mild paranoia after smoking first time smoking second time DSM-IV psychosis (not otherwise specified)

gastrointestinal distress

tremors auditory hallucinations (ex-girlfriend’s voice)

persistent fatigue drowsiness

unable to attend school acne

olfactory hallucinations somatic hallucinations (strong, persistent burning smell) SIGNIFICANCE 1.“SEVERAL FIRST-TIME, NONCHRONIC CANNABIS USERS HAVE PRESENTED TO OUR CLINIC WITH PSYCHOSIS OR THOUGHT DISORDERS LASTING MONTHS AFTER FIRST- OR SECOND- TIME CANNABIS USE”

2.“ANTIPSYCHOTICS PRESCRIBED TO TREAT THE PATRIENT’S PSYCHOSIS WERE AN IATROGENIC CAUSE OF ITS WORSENING”

POSSIBILITIES FOR ASSOCIATION OF RISK WITH CANNABIS USE GENETICS

CONTAMINANTS CARDIAC & STROKE RISK

Cannabis Impairment Quick Assessment Document Observations of MENTAL & PHYSICAL Impairment

EYES MUSCLES ODOR Conjunctiva Tissue Tremors Observed Smell Burnt mari- (looks like pink eye in in extremities, up- juana, additive both eyes), Lack of Convergence, Dilated per torso, & eyelids flavor for vaping, Pupils, No HGN (when (closed eyes). & maybe for cannabis alone). edibles.

Indica: Produces a ‘stoned’ feeling. Physically and mentally relaxing. Centered on the body. Enhances sensations of taste, touch, & sound. Sativa: Produces the ‘high’ feeling (energetic). Less overpowering than the Indica ‘stone.’ Less likely to produce drowsiness. High described as: cerebral, energetic, creative, giggly & or psychedelic. Psycho-Physical Tests: Generally slow performance; muscle tremors, especially in legs & arms. Information processing: Likely diminished. May forget certain parts of instructions. Likened to attention deficit disorder, cognitive impairment. Modified Romberg: Distorted internal clock. Eyelid Tremors.

Impairment Peak: 0-30 mins Impairment may last up to 24 hours, High Experience: 2-3 hours without awareness effects.

ONSET OF EFFECTS DIFFERS DEPENDING ON MANNER OF INGESTION Delta-9-THC - The main psychoactive substance found in marijuana. 11-Hydroxy-THC - The main psychoactive metabolite of THC formed in the body after consumption. 11-nor-9- Carboxy- HC - The main secondary metabolite of THC formed after consumption. Not active, but indicates historical use. Cannabinoids - Group of active compounds found in marijuana. Cannabidiol (CBD) - Non-psychoactive (a/k/a not impairing) cannabinoid. Cannabinol (CBN) - THC metabolite (10% as psychoactive as THC). Measurement of Uncertainty - Best estimate of how far a quantity might be from “true value.” CO Permissible Inference 5 ng/mL - If at time of driving, driver had 5 ng/mL delta-9 in whole blood, jury may infer defendant was DUI. CO does not have a per se law (statutory assignment of a blood concentration above which is an offense to drive)! Titrate - Continuously measure & adjust the balance of [a substance].

INTERNET RESOURCES www.wsp.wa.gov/breathtest/dredocs.php (NHTSA/IACP Manuals) www.ndaajustice.org/ntlc_home.html (Nat’l Traffic Law Center) www.nih.gov/research-training (Research) www.decp.org (Int’l Drug Eval. & Classification Program)

EYES MUSCLES ODOR Conjunctiva Tissue (looks like pink eye in both eyes), Lack of Tremors Observed in extremities, up- Smell Burnt marijuana, additive flavor for vaping, & maybe for Convergence, Dilated Pupils, & No HGN (when cannabis alone). per torso, & eyelids (closed eyes). edibles. OBSERVATIONS Indica: Produces a ‘stoned’ feeling. Physically & mentally relaxing. Centered on the body. distance perception. Enhances sensations of taste, touch, & sound. Euphoria & relaxed inhibitions. Modified Romberg: Distorted internal clock. Eyelid Tremors. Sativa: Produces the ‘high’ feeling (energetic). Less overpowering than the Indica ‘stone.’ Mood Changes: Including panic & paranoia. Less likely to produce drowsiness. High described as: cerebral, energetic, creative, giggly & Mouth: Flecks of Green Vegetable Matter (GVM - marijuana) in teeth. Possible green or or psychedelic. white coating on tongue. Psycho-Physical Tests: Generally slow performance; muscle tremors, especially in legs & arms. IMPORTANT STUDIES TO KNOW Information processing: Likely diminished. Impaired memory & comprehension. Jumbled thought formation & lack of concentration.  National Highway Traffic Safety Administration, Drug and Alcohol Crash Risk, (Report No. DOT HS 812 117) Washington DC: Likened to attention deficit disorder, cognitive impairment. Altered U.S. Government Printing Office (2015). Often cited by defense- Virginia Beach Study  Hartman, R.L., Huestis, M.A., et al., Cannabis Effects on Driving Lateral Control With and Without Alcohol, *MUST KNOW* Drug Smoked: Impairment Peak: 0-30 mins and Alcohol Dependence, http://dx.doi.org/10.1016/j.drugalcdep.2015.06.015 (2015). High Experience: 1-3 hours  Huestis, M.A., et al., Estimating the Time of Last Cannabis Use from Plasma Δ9-Tetrahydrocannabinol and 11-nor-Carboxy- Δ 9 Impairment may last up to 24 hours, without awareness effects. -Tetrahydrocannabinol Concentrations, Clinical Chemistry, 51(12), 2289-2295, doi:10.1373/clinchem.2005.056838 (2005). Oral/ Edible: Impairment Peak: 1-3 hours  Hiroven, J., Huestis, M.A., et al., Reversible and Regionally Selective Downregulation of Brain Cannabinoid CB 1 Receptors in Chronic Daily Cannabis Smokers, Molecular Psychiatry, 59(3), 642-649, doi:10.1038/mp.2011.82 (2012). High Experience: 4-8 hours  Bosker, W., Hiroven, J., Huestis, M.A., Ramaekers, J.S., et al., Psychomotor Function in Chronic Daily Cannabis Smokers During Residual effects depend on dose. Sustained Abstinence, PLoS ONE, 8(1), e53127, doi:10.1371/journal.pone.0053127(2013).  Hartman, R.L., Huestis, M.A., et al., Effect of Blood Collection Time on Measured Δ9-Tetrahydrocannabinol Concentrations: Implications for Driving Interpretation and Drug Policy, Clinical Chemistry, 62:2, 367-377, doi:10.1373/clinchem.2015.248492 GET. BLOOD. FAST. (2016).  Hartman, R.L., Huestis, M.A., et al., Controlled Cannabis Vaporizer Administration: Blood and Plasma Cannabinoids With and Without Alcohol, Clinical Chemistry, 61(6), 850-869, doi:10.1373/clinchem.2015.238287(2015).  Bergamaschi, M., Hiroven, J., Huestis, M.A., et al., Impact of Prolonged Cannabinoid Excretion in Chronic Daily Cannabis Smok- ers’ Blood on Per Se Drugged Driving Laws, Clinical Chemistry, 59(3), 519-526, doi:10.1373/clinchem.2012.195503 (2013).  Desrosiers, N., Huestis, M.A., et al., Phase I and II Cannabinoid Disposition in Blood and Plasma of Occasional and Frequent Smokers Following Controlled Smoked Cannabis, Clinical Chemistry, 60(4), doi:10.1373/clinchem.2013.216507 (2014).  DRUID, Analytical Evaluation of Oral Fluid Screening Devices and Preceding Selection Procedures, (Project No. TREN-05- FP6TR-S07.61320-518404) Finland (2010).  Grotenhermen, F., Drummer, O.H., Ramaekers, J.G., et al., Developing Limits for Driving Under Cannabis, Addiction, 102, 1910- 1917, doi:10.1111/j.1360-0443.2007.02009.x (2007).  Grotenhermen, F.,Ramaekers, J.G., et al., Developing Science-Based Per Se Limits for Driving Under the Influence of Can- nabis (DUIC): Findings and Recommendations by an Expert Panel, DUIC Report (2005).  Papafotiou, K., et al., An Evaluation of the Sensitivity of the Standardized Field Sobriety Tests (SFSTs) to Detect Impairment Due to Marijuana Intoxication, Psychopharmacology, 180, 107-114, doi:10.1007/s00213-004-2119-9 (2005).  Hartman, R.L., & Huestis, M.A., Cannabis Effects on Driving Skills, Clinical Chemistry, 59(3), 478-492, http://dx.doi.org/10.1373/ clinchem.2012.194381 (2013).  Hartman, R.L., Huestis, M.A., et al., Drug Recognition Expert (DRE) Examination Characteristics of Cannabis Impairment, Acci- dent Analysis & Prevention, 92, 219-229, http://dx.doi.org/10.1016/j.aap.2016.04.012 (2016).

“The Cycle” created by Courtney Popp, WA TSRP Delta-9-THC - The main psychoactive substance found in marijuana. Measurement of Uncertainty - Best estimate of how far a quantity might be AKA: delta-9-tetrahydrocannabinol (Δ9-THC), dronabinol from “true value.” If two people measure one cup of flour, the amount will 11- Hydroxy-THC - The main psychoactive metabolite of THC formed in the always be different even if it’s not noticeable to the naked eye. body after marijuana consumption. AKA: Hydroxy THC, 11-Hydroxy-Δ9- Metabolite - A chemical created in the body as part of the process of tetrahydrocannabinol (11-Hydroxy-Δ9-THC), 11-OH-THC breaking down the parent compound (e.g. 11-OH-THC and THC-COOH). 11- nor-9- Carboxy-THC - The main secondary metabolite of THC formed Parent compound or parent drug - The drug in the original form that it is in- after marijuana is consumed. It is NOT active, but indicates historical use. gested (e.g. THC). AKA: THC-COOH (most often seen this way), Carboxy THC, 11-nor-9-carboxy- Per Se Law - Statutory assignment of a blood concentration above which is delta-9-tetrahydrocannabinol (11-nor-9-carboxy-Δ9-THC), 11-COOH-THC an offense to drive. Cannabinoids - Group of active compounds found in marijuana. Permissible Inference - A legally specified fact that the fact finder may infer. Cannabidiol (CBD) - Non-psychoactive (a/k/a not impairing) cannabinoid. Pharmacokinetics - The movement of a drug into, through & out of the body Found in medical strains. - the time course of its absorption. Cannabinol (CBN) - THC metabolite (10% as psychoactive as THC), which Plasma vs. Whole Blood may show recent or heavy use. Plasma - The colorless fluid part of blood, lymph, or milk, in which Chronic vs. Occasional - Terms denoting frequency of use. corpuscles or fat globules are suspended. Chronic - Continuing for a long time or recurring frequently. Whole Blood - Blood drawn directly from the body from which none Occasional - Happening infrequently and irregularly. of the components (such as plasma or platelets) have been Psychoactive or Active - Causes euphoric and impairing effects (THC and removed. 11-OH-THC). Titrate - Continuously measure & adjust the balance of [a substance]. Not active or inactive - Does NOT cause euphoric or impairing effects Tolerance - The capacity of the body to endure or become less responsive (THC-COOH). to a substance.

Compensation - Behavior that develops either consciously or unconsciously INTERNET RESOURCES to offset a deficiency. Critical Tracking - A set of tasks used to determine impairment in a clinical www.wsp.wa.gov/breathtest/dredocs.php (NHTSA/IACP Manuals) setting. www.ndaajustice.org/ntlc_home.html (Nat’l Traffic Law Center) Epidemiological - Is the study and analysis of the patterns, causes, and www.nih.gov/research-training (Research) effects of health and disease conditions in defined populations. www.decp.org (Int’l Drug Eval. & Classification Program) First-order Elimination Kinetics - Elimination of a constant fraction per time unit of the drug quantity present and is proportional to the drug concentration. Lateral Control - Control of side- to-side or sideways movement. Limit of Detection (LOD) - Lowest quantity of a drug that can be distinguished from the absence of that drug. Copyright © 2018 Colorado District Attorneys’ Council. All rights reserved. We would Limit of Quantitation (LOQ) - Lowest amount of a drug in a sample that can like to thank Sarah Urfer (ChemaTox) and Carson Nuss (KS DRE) for their be quantitatively determined.

Jennifer R. Knudsen Traffic Safety Resource Prosecutor Colorado District Attorneys' Council 3600 S. Yosemite Street, Suite 200 Denver, CO 80237 (303) 830-9115 3/18 Edition [email protected]

Marijuana-Impaired DUI: Using Research to Prove Your Case

Colorado – Jennifer Knudsen Washington – Courtney Popp Oregon – Deena Ryerson Wyoming – Ashley Schluck Words matter When interpreting scientific studies, lab results, or even news stories, remember: “Marijuana” or “Cannabis” are umbrella terms covering a broad category of compounds. Precise language matters! Delta-9 Tetrahydrocannabinol (THC)  ACTIVE  The primary psychoactive component in cannabis  Makes the user feel high  Causes the Euphoric Effect  Detectible in blood for HOURS after last use (and MINISCULE amounts days & rarely weeks after last use by chronic users) Metabolites 11 HYDROXY THC  The main psychoactive metabolite of THC formed in the body after marijuana consumption 11-nor-9-Carboxy-THC (Carboxy-THC)  Inactive metabolite  Present in urine and blood  Detectible hours/days after last use  Not reliable without further evidence to prove impairment We are looking for WEED in all the wrong places! Biggest misconception – there has to be THC in the blood for the user to be impaired by marijuana There are so many variables that will affect the nanograms in the blood…not the least is TIMING Time of last use Time of the blood draw Time for the Search Warrant Marijuana is LIPOPHILIC (FAT Soluble) How does marijuana work in the body?  Marijuana is ingested  Impairment peaks quickly and then seems to level out

 THC binds to the fat receptors in the body/brain  THC crosses the “blood/brain barrier” quickly Kool-Aid example The Takeaway? Marijuana impairment peaks AFTER the majority of THC has moved out of the blood. We test a subject’s blood to determine the concentration of THC. That number in the blood isn’t quite the “tell all” as it might be for alcohol in the blood. It’s the Brain, Stupid Mental v. Physical Impairment MARIJUANA - impairment (generally) more of mental impairment. ALCOHOL AND OTHER DRUGS - (generally) include more obvious (when you know what you are looking for) physical impairment Executive Function – Where marijuana goes to impair. What are executive functions?  Goal-directed Behaviors  Organizational Abilities  Time Management Activities  Strategic, Purposeful, Analytic, and Critical Thinking Executive function challenges (Dr. Thomas Brown) Action – monitoring and self-regulating actions Memory – utilizing working memory and accessing recall Emotion – managing frustrations and modulating emotions Effort – regulating alertness, sustained effort and speed Focus – focusing, sustaining and shifting attention to tasks Activation – organizing, prioritizing and activation to work

Cognition + Physical Movement -> Psychomotor Function Psychomotor Impairment Affects:  Movement and Coordination  Manipulation and Dexterity  Grace  Strength  Speed  Vigilance  *Cannabis impairs psychomotor performance  *Leads to altered driving ability in driving simulators & on-the-road driving tests

2 How marijuana affects the brain (sources: Igor Grant, University of California Center from Medicinal Cannabis Research; WSJ research) THC, a key ingredient in marijuana, attaches to cannabinoid receptors throughout the body. Several areas of the brain have high densities of these receptors, which helps explain the different effects of the drug. How the receptors work – nerve cells communicate by passing chemical messages across contact points called synapses. The most active ingredient in marijuana, delta-9 THC, attaches to cannabinoid receptors and modifies never action. Some areas with high concentrations of cannabinoid receptors: Cerebral Cortex – plays a role in memory, thinking, perceptual awareness and consciousness. Corresponding effects of marijuana – altered consciousness; perceptual distortions; memory impairment; occasional delusions and hallucinations Hypothalamus – governs metabolic processes such as appetite. Corresponding effects of marijuana – increase appetite Brain stem – controls many basic functions including arousal, the vomiting reflex, blood pressure and heart rate. Corresponding effects of marijuana – nausea relief; rapid heart rate; reduced blood pressure; drowsiness. Also plays a role in pain sensation, muscle tone and movement. Corresponding effects of marijuana – pain reduction; reduced spasticity; reduced tremor Hippocampus – is key to memory storage and recall. Corresponding effects of marijuana – impairment in memory Cerebellum – governs coordination and muscle control. Corresponding effects of marijuana – reduced spasticity; impaired coordination Amygdala – plays a role in emotions. Corresponding effects of marijuana – Anxiety and panic in some cases; reduced anxiety and blocking of traumatic memories in other cases; reduced hostility Executive Function (Dr. Huestis) Attention - Selectively attending to one cue while ignoring others, including divided & sustained attention Concentration - Intense mental application Decision-making - Process of selecting a course of action Impulsivity -Initiation of behavior without adequate forethought Inhibition - Imposing restrain on behavior or another mental process Reaction Time - Lapse of time between presentation of a stimulus & a response Risk Taking- Engaging in behaviors that have the potential to be harmful or dangerous Verbal Fluency - Generating multiple, verbal responses associated with a specified conceptual category

3 Working Memory - Ability to hold & manipulate information & remember it after a short delay Science Has (SOME) of the Answers Be a Critical Reader  Know what you are reading or what’s being referenced  Relative analytical weight  Bias  Peer-reviewed  Methodology More things to consider  Research design  Measurement  Analysis  Statistical methods and conclusions  Terminology  Matrix the study is using Not all Studies are Created Equal THC Concentration Used in Most Government Studies is between 3-6% THC Does this mean the studies are invalid? Titration? Gold fish example Drug Impaired Driving Approaches (Studies)  Empirical  Epidemiological  Experimental o Laboratory o Simulator o On-the-road Traffic Crash Epidemiology  Culpability Data  Case Control  Meta-Analysis Early culpability studies have a lot of issues and problems with them which is why they don’t carry much weight or meaning – remember to be a critical reader Problems in Epidemiological Studies  Not blind to drug condition  Lack statistical power  Small number of cases

4  Delays in collection of specimen  Lack of sensitive quantitative analysis  Documented presence of drug with inactive metabolite rather than active THC More problems ahead  Inconsistent Results  No Adequate Control Group  Blood Not Drawn for Many Hours  No Quantification of Results  Testing for Metabolites  High LOQ (level of quantification)  Few Cannabis Only cases  Good for demonstrating alcohol impairment, less successful for marijuana impairment for the above reasons Virginia Beach – NHTSA Alcohol & Drug Crash Risk Study Used to support defense positions. WHY? Performance Assessment Laboratory  Psychological Functions  Cognitive and Psychomotor skills related to driving  Memory  Divided and Sustained Attention  Reaction Time  Tracking Performance  Motor Control Issues  Can the results be generalized to driving?  Are they relevant to driving? Simulator and On-Road Driving Studies Assess effects of cannabis on actual driving  Road tracking (weaving, SDLP)  Car following (brake reaction time, speed adaptation)  City driving (visual search, anticipation to traffic, decision making) Prediction Models Controlled administration use to construct models for predicting the time of last THC use within 95% CI (confidence interval) Accuracy when applying Model I and II with 95% CI Following 1st cigarette – 99.5% No underestimations, max overestimation 4 min

Following 2nd cigarette– 98.6% No underestimations, same max overestimation Take Model 1 and Model 2 – take the lowest number and the highest number of your two models for your range - 100% fell within the range Benefit of the doubt goes to the defendant because no underestimations shown Both models can be used in court to estimate time since last cannabis use Use this information to corroborate or discount the accused person’s story The models are NOT retrograde  Models work well with occasional users anytime and chronic frequent users during use, won’t work when you are down to residual THC left in the tissue  Models fail with sustained abstinence in chronic frequent users due to residual  Good rule of thumb not to use the models on chronic frequent user  For the models you must have THC and Carboxy-THC in blood Counter-Clockwise Hysteresis – Concentration Curves (Dr. Huestis) VAS Feel Drug Heart Rate Generally Passive Inhalation is NOT a Valid Defense The non-realistic situation is so severe it is noxious and participants had to wear goggles AND if there is THC in the blood they would feel the effects An Evolution of the Sensitivity of the Standardized Field Sobriety Tests to Detect Impairment Due to Marijuana Smoking. Papafotiou, Carter and Stough (2004)  Study evaluated One Leg Stand, Walk & Turn and HGN  Subjects tested at 5 minutes, 55 minutes and 105 minutes after smoking  Subjects were dosed with either Placebo, 1.74% THC or 2.93% THC The Results 50 45 40 35 30 25 Placebo-0% THC 20 1.74% THC 15 2.93% THC

% Classifed % Classifed as Impaired 10 5 0 5 Min 50-55 min 100-105 min Minutes After Smoking

Placebo at 5 min – blood THC ng/mL = 0; Impairment observed = 2.5% Placebo at 50-55 min – blood THC ng/mL = 0; Impairment observed = 7.5% Placebo at 100-105 min – blood THC ng/mL = 0; Impairment observed = 5% 1.74% THC at 5 min - blood THC ng/mL = 55.5; Impairment observed = 23% 1.74% THC at 50-55 min - blood THC ng/mL = 6.8; Impairment observed = 23% 1.74% THC at 100-105 min - blood THC ng/mL = 3.7; Impairment observed = 15% 2.93% THC at 5 min - blood THC ng/mL = 70.6; Impairment observed = 46% 2.93% THC at 50-55 min - blood THC ng/mL = 6.2; Impairment = 41% 2.93% THC at 100-105 min - blood THC ng/mL = 3.2; Impairment = 28%

Why the 5 nanogram?  Limited supporting research  Whole Blood v. Serum  A nearly impossible feat  NOT like alcohol  Picked the Middle Ground Meanwhile, in Colorado… PRO MJ Position -> wanted 10-30 nanogram Per Se TOTAL impairment BILL SUPPORTERS -> No whole blood/serum conversion led to… COMPROMISE -> Using Ramaekers study to reach 5 ng Δ-9-THC (whole blood) permissible inference Studies and existing data aren’t exactly mirroring what we are experiencing on the roads  Edibles and Concentrates  Chronic, Frequent versus Naïve users  Small Sample Populations WA State Fatal Crash Data 2015  85% of drivers in fatal crashes tested positive for active THC  Approx. 50% were over 5ng  50% also had alcohol  Highest was 70ng Wait for it… DRE survey of 302 MJ-only cases  114 below 5ng (38%)  188 at or above 5 ng (62%)  Mean blood: 8.1 ng Peer Reviewed Study coming this summer 2016 HUGE number of variables influence how much THC is stored and for how long it is detectable in the blood, peaks of the drug, user self-reported impairment, and overall impairment  Metabolism  Frequency of Use

 Method of Ingestion  Strain and Potency of Drug ESTIMATED Duration of Effects Marijuana  Peak 20-30 minutes  Duration 2-3 hours  Dissipates 3-6 hours  Residual Effects Up to 24 hours The method of ingestion (e.g. smoked versus consumed in an edible) will affect the peak and duration of effects (and generally result in a lower high). Effects of Cannabis on Driving Cannabis & Alcohol Affect Driving Differently (Dr. Huestis)

Cannabis Alcohol – Attempted compensation – Lowered inhibitions – Caution in experimental settings – Faster driving – Can perform simple tasks, but – Decline in visual and auditory impaired higher-level cognitive perception and processing function functions Both Alcohol and Cannabis – Control loss – Inability to process changes – Divided attention – Concentration – Tracking/Lane position – Increased reaction time Cannabis Effects on Driving  Decision-making  Divided attention  Visual search  Focus, concentration  Process changes  Reaction Time  Road tracking, vehicle control Cannabis Effects on Driving Lateral Control with or without Alcohol Hartman, R.L., et al. (2015) First study to look at blood THC concentrations and its effect on SDLP (Standard Deviation of Lane Position) 18 adults

Use marijuana more than 2x a month but less than 3x a week Light to moderate drinkers Driving more than 2 years Study Procedure Entered study 10-16hrs before first dose Alcohol provided to reach .065 2.9% THC or 6.7% THC Placebo 45 min drive – began 30 min after dosing various combinations Three Scenarios Varied Event Orders Same number of curves and turns Pedestrians Potential Hazards URBAN SEGMENT  25-45 mph  Controlled and Uncontrolled Intersections INTERSTATE SEGMENT  4 lane express  72mph posted RURAL SEGMENT  2 lane, undivided  Curves  Gravel portions  10 min straightaway Blood Collection Measured THC Concentrations Measured BrAC TIME INTERVALS COLLECTED POST DOSE  10min  25min  60min (during drive time)  1 hr. 25 min (immediately post drive time)  2 hr. 18 min

 3 hr. 18 min  Additional intervals ending with 8 hr. 18 min* STANDARD DEVIATION OF LANE POSITION .05 BrAC ~ 8.2ng THC in in blood .08 BrAC ~ 13.1ng THC in blood .08 BrAC ~ .05 BrAC + 5ng THC in blood CANNABIS ALCOHOL  5ng: SDLP increase 4.1%  .05 BrAC: SDLP increase 6.7%  10ng: SDLP increase 8.2%  .08 BrAC: SDLP increase 11%  20ng+: SDLP increase 16%  .10 BrAC: SDLP increase 13% What else? Additive effect Blood was collected during drive time to determine THC blood concentrates and/or Breath Alcohol Content Effects of Blood Collection Time on Measured ∆9-Tetrahydrocannabinol Concentrations: Implications for Driving Interpretation and Drug Policy Hartman, R.L., et al. (2016) Objective: To analyze blood THC concentrations  Post inhalation  During driving  Post driving

Compare THC concentration at the time of driving with post driving concentration associated with the collection of forensic draws Study Procedure Same study criteria and data Alcohol provided to reach .065 2.9% and 6.7% THC used - titration Placebo 45 min drive – began 30 min after dosing various combinations Time after Inhalation: 10 min 60 min (during drive)  38.2ng w/o alc (11.4-137ng)  6.0ng w/o alc (1.4-19.8ng)  47.9ng w/alc (13-210ng)  6.2ng w/alc (1.8-26.7ng) 25 min 1 h 25 min (end drive)  11.9ng w/o alc (1.6-40.8ng)  4.1ng w/o alc (0-14.7ng)  11.8ng w/alc (3.1-43.9ng)  4.4ng w/alc (1.3-18.4ng)

2 h 18 min

 2.7ng w/o alc  2.5ng w/alc Rate of Decrease of THC in the Blood 10min to 25min = 73.5% (75.1%) 25min to 60min = 85.3% (87.3%) 60min to 1h 25min = 90.3% (91.3%) 1hr 25min to 2h 18min = 94.6% (95.5%) 2h 18min to 3h 18min = 96.9% (97.9%)

Residual THC in the Blood RESIDUAL THC CONCENTRATIONS + PLACEBO  Blood concentrations fluctuated around pre-dose baseline during all time intervals  RESIDUAL THC CONCENTRATIONS + ACTIVE DOSE  The rate of decrease of THC concentrations in the blood was similar to those without residual THC  Both groups returned to respective baselines ***1 participant had residual concentrations of 4.9-6.3 in all sessions KEY POINTS  Median blood THC concentrations did not exceed 5ng by 2hours post drive (3h 18min post dose)  Those with driving blood concentrations associated with impaired lateral controls (SDLP) (≥8.2ng) had median THC conc. between 2-5ng 2 hours post drive  Cannot use back extrapolation due to variability in – Amount of intake and oral vs. smoked – Frequency of use – Metabolism/elimination rate  THC effects are directly related to brain concentrations  It is not possible to assess brain concentrations  Peak effects DO NOT coincide with maximum blood concentrations  Blood concentrations at time of blood collection in typical DUID cases will be substantially lower than concentrations during driving – Per se laws are unworkable Chronic Frequent Cannabis Smokers Impairment in Chronic Frequent Cannabis Smokers Cognitive Measures in Long-Term Cannabis Users Pope et al., (2002)

 Heavy cannabis use produces residual neuropsychological deficits that may last for many days after cannabis is discontinued  [D]aily or even near-daily cannabis users will effectively experience cognitive impairment on a continuous basis..  Still a question: “whether long term cannabis use may produce cumulative neurotoxicity” Impact of Prolonged Cannabinoid Excretion in Chronic Daily Cannabis Smokers’ Blood on Per Se Drugged Driving Laws Bergamaschi et al., (2013)  Fewer than 50% of blood samples from chronic daily smokers were THC positive after 16 days  The last THC positive blood samples were from 2 individuals on day 30 (with previous samples being both negative and positive)(15-17yr smokers)  [C]annabinoids can be detected in blood of chronic daily cannabis smokers during a month of sustained abstinence. This is consistent with the time course of persisting neurocognitive impairment reported in recent studies. Psychomotor Function in Chronic Daily Cannabis Smokers during Sustained Abstinence Bergamaschi et al., (2013) • Psychomotor performance in critical tracking & divided attention tasks in daily smokers was impaired at baseline relative to occasional drug users • Sustained cannabis abstinence moderately improved critical tracking & divided attention performance, but impairment still observable in critical tracking after 3 weeks of abstinence • Withdrawal contributed to some impairment but not all impairment • 8 of 12 had THC in blood after 3 weeks of abstinence –mean concentrations were approx. 1-2.5ng Document and Argue in Court Make the argument Other plausible, alternate explanations or defenses to impaired driving do not automatically cause us to not prosecute a case! Look for signs of impairment to decide the strength of the case! Educating the jury and public about marijuana impairment is part of the process Not all impairment looks the same (just like with alcohol) Whose job is it to tie up the loose ends? OBSERVE AND DOCUMENT WITHOUT JUDGMENT What can you SEE? What do you SMELL? What do you HEAR? What can you TOUCH/collect?

The more you can ask about what the suspect uses, how much, how often, for how long, the more evidence you can get out Marijuana isn’t a simple “check these boxes, have this number” type of DUI case. You have to dig little deeper, think critically, use your experts. How to use Scientific Studies in Court Call the defense expert – ask them what studies they are relying on Call your toxicologist and go over those studies Ask if toxicologist has studies providing counter arguments Work with the toxicologist to come up with questions for the defense expert In Court: If the defense expert is referring to the study and/or quoting, ask him/her where that is coming from and then have them read the larger paragraph or rest of the section, etc. to make sure that’s an accurate portrayal of the information Scientific studies are always going to lag behind real-life use and what law enforcement is experiencing in real time on the streets There is no “magic” study that will prove everything we ever wanted to know about marijuana impairment – it’s literally changing daily, along with our understanding of it What is the most effective way to build your case? Go back to “old school” policing – observe and document EVERYTHING you see that demonstrates impairment Contact Information Jennifer R. Knudsen Deena Ryerson Traffic Safety Resource Prosecutor Oregon Department of Justice Colorado District Attorneys' Council 1162 Court Street NE 1580 Logan Street, Suite 420 Salem, OR 97301 Denver, CO 80203 (503) 378-6347 (303) 830-9115 [email protected] [email protected]

Courtney Popp Ashley Schluck Traffic Safety Resource Prosecutor Traffic Safety Resource Prosecutor King County Sheriff’s Office Wyoming Highway Safety Program ATTN: CID ATU P.O. Box C 500 4th Ave., Suite 200 Laramie, WY 82073 Seattle, WA 98104 (307) 721-5321 [email protected] [email protected]

Arnold Hanuman Deputy Director Colorado District Attorneys' Council

Attorney and Counselor at Law: Former trial litigator and prosecutor with substantial criminal law experience at the state, federal and international levels, combined with private sector strengths in areas of business, real estate, and international relations. International development and management professional with significant cross-country experience in implementing policy, projects, and programs across several sectors.

Specialties: Attorney and Counselor at Law: Areas of specialty include criminal law, corporate law, real estate law, international law, domestic relations, economic/white collar. Public sector policy development; Strategy and business process management; new product development; project and portfolio management; high-level negotiation skills, involving executive and senior representatives (government/private) across multiple sectors and geographic boundaries; budget, finance, and HR management skill set.

Colorado District Attorneys’ Council 3600 South Yosemite Street Suite 200 Denver, CO 80237 [email protected] (720) 363-1233 Jennifer Renee Knudsen, Esq. Traffic Safety Resource Prosecutor

Jennifer Knudsen is Colorado’s Traffic Safety Resource Prosecutor (TSRP) for the Colorado District Attorneys’ Council. Her undergraduate degree is from the University of Denver. She then went to the University of Colorado School of Law where she earned a juris doctorate and certificate in taxation.

As TSRP, she produces training for prosecutors, law enforcement, and other prosecutorial partners on traffic safety matters. She is also a member of the Colorado DRE Advisory Committee and the MADD Law Enforcement Awards Selection Committee.

Ms. Knudsen is a co-author of Strategies for Prosecuting DWI Cases, which was published during the summer of 2016 by Aspatore (a division of Thomson Reuters). She was awarded the 2018 Kevin E. Quinlan Award for Excellence in Traffic Safety.

Colorado District Attorneys’ Council 3600 South Yosemite Street Suite 200 Denver, CO 80237 [email protected] (720) 363-1233