New Challenges in the Anti-Drug Scene: Cannabis

New Challenges in the

Anti-Drug Scene: Cannabis

Kevin A. Sabet, Ph.D. Director, Drug Policy Institute, University of Florida Co-Founder, Project SAM (Smart Approaches to Marijuana) www.learnaboutsam.org www.kevinsabet.com 1

2 The false dichotomy: “Legalization OR Incarceration?” Legalization = Big Marijuana

4 Why should we care about marijuana?

5 Myth

Marijuana Is Harmless and Non-addictive

6 Cannabinoid Receptors Are Located Throughout the Brain and Regulate:

• Brain Development ...... • Memory & Cognition ...... • Motivational Systems ...... & Reward ...... • Appetite ...... • Immunological Function ......

• Reproduction

• Movement Coordination

• Pain Regulation & Analgesia

1 in 6 teens become addicted

1 in 11 adults and 1 in 6 adolescents who try marijuana will become addicted to it.

• The adolescent brain • When kids use, they is especially have a greater chance susceptible to of addiction since marijuana use. their brains are being primed. Wagner, F.A. & Anthony, J.C. , 2002; Giedd. J. N., 2004 8 Long Term Effects of Marijuana Addiction: About 9% of adult users may become dependent, 1 in 6 who start use in adolescence Estimated Prevalence of Dependence Among Users 35 32 30 25 23 20 17 15 15 11

Percent 9 10 8 5 5 0

* *

Source: Anthony JC et al., 1994 14 Average THC and CBD Levels

12 in the US: 1960 - 2011

THC: 8 Psychoactive Ingredient 6 CBD: NON-

MARIJUANA POTENCY Psychoactive 4 Ingredient

0 196 196 197 197 197 198 198 198 198 198 199 199 199 199 199 199 199 199 20 20 20 20 20 20 20 20 20 20 201 201 0 5 0 4 8 0 3 4 5 6 0 2 3 5 6 7 8 9 00 01 02 03 04 05 06 07 08 09 0 1 THC 0 0 0 0 1 1 2 3 3 4 4 3 3 4 5 5 5 5 5 6 7 7 8 8 9 10 10 10 11 11 CBD 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0

Copyright SAM and the Slides' Authors. Mehmedic et al., 2010 10 Use with permission. 98% Pure Marijuana: “Just a Plant” ?

“Green Crack” wax “Ear Wax” Butane Hash Oil (BHO)

“Shatter”

“Budder”

Copyright SAM and the Slides' Authors. 11 Hash Oil Capsules Use with permission. High Times 5/7/14 “With dabs your local action news team gets to do a marijuana story that shows crack pipe torches used on sticky heroin - looking goo made from a process that blows up like meth labs.”

Copyright SAM and the Slides' Authors. 12 Use with permission. Early Marijuana Use and Intensity of Use are Associated with Educational Attainment

High School Completion University Entrance Score

Low Intensity Med/High Intensity < Age 14 > Age 14 < Age 14 > Age 14 0.4%

-1% -1.9% -2.4% For those that do -12%** - successfully complete 11%*** high school and obtain a Young people who begin university entrance score, marijuana use at a young med-high intensity use is age and use it intensively - associated with scores on have a higher probability 10.1%* average 10 percentiles - of dropping out of high ** lower than their peers. 28%*** school. *** p<0.01, ** p<0.05 Source: Cobb-Clark et al. http://ftp.iza.org/dp7790.pdf Reductions in IQ

Adolescent Vulnerability 0.4 Dunedin 1 Diagnosis 2 Diagnoses 3 Diagnoses prospective 0.2 study of

1037 Ss born 0 Scale Scale IQ

- 1972/73, -0.2

Tested for IQ at age 13 -0.4 and 38y. in Full Change -0.6

Tested THC units) deviation standard (in use ages 18, -0.8 p=.44 p=.09 p=.02 Cannabis Not Cannabis Cannabis Not Cannabis Cannabis Not Cannabis Dependent Dependent Dependent Dependent Dependent Dependent 21, 26, 32 Before Age 18 Before Age 18 Before Age 18 Before Age 18 Before Age 18 Before Age 18 and 38y (n=17) (n=57) (n=12) (n=21) (n=23) (n=14) Source: Meier MH et al., PNAS Early Edition 2012. More Use of Cannabis Associated with Worse Social Outcomes at Age 25 (New Zealand Study)

400+ % welfare 300 to dependent 399

(ages 21-25) 200 to 299

% Unemployed 100 to 199 (ages 21-25) 1 to 99

mean personal # of occasionsNever income Number of occasionsusing using at age 25 CannabisCannabis between ages ages 14 14-21- 21 % gained university degree by age 25

Source: Fergusson and Boden. Addiction, 103, pp. 969-976, 2008.

20 10 18 14 16 12 0 8 4 6 2 clear dose and associations consistent and Adjusted Odds Ratios adverse young all and use frequency cannabis between adolescent the of

Age 17 Age 17 Years, AndEach Young Outcome Adult Maximum Frequency Of Cannabis Use Before Before Use Of Cannabis Frequency Maximum Silins Daily More or Weekly or More Monthly Monthly Less than

E etal., The LancetSeptember 2014.

adult outcomes adult

0.8 0.4 0.6 0.2 1.4 1.2 0 1

High School Completion - response relations were found

Attainment Degee

Depression

Dependence

Welfare Welfare

Cannabis-Associated Psychosis

CANNABIS AND SCHIZOPHRENIA CANNABIS AND SCHIZOPHRENIA-Like Study of Swedish Conscripts (n=45570) Longitudinal prospective Dunedin study (n=1037)9 Cases of Sz per 1,000 8 30 7 Risk of schizophrenia-like 6 psychosis at age 26 years 5 4.5 20

3 10 2 1.6

Odds ratio Odds 1 0 0 0 1 2 10 <50 >50 Cannabis users Cannabis users No of times cannabis taken by age 15 years by age 18 years Andr éasson et al Lancet, 1987. Arseneault et al BMJ 2002 Increased use can lead to increased drugged driving

• “Drivers who test positive for marijuana or self-report using marijuana are more than twice as likely as other drivers to be involved in motor vehicle crashes.”

Mu-Chen Li, J.E., et al., 2011 18 The Gulf Has Never Been Greater Between

The Scientific Understanding of Marijuana’s Harms

and

The Public’s Misunderstanding Copyright SAM and the Slides' Authors. 19 Use with permission. Myth

Smoked Marijuana is Medicine

20 Legalization behind the smokescreen

“We will use [medical marijuana] as a red-herring to give marijuana a good name.” —Keith Stroup, head of NORML to the Emory Wheel, 1979

• Advocates have pushed their agenda through “medicine by popular vote” rather than the rigorous scientific testing system devised by the FDA.

Emory Wheel Entertainment Staff, 6 February 1979 21 Is Marijuana Medicine?

NO: SMOKED OR INHALED RAW MARIJUANA IS NOT MEDICINE

YES: THERE ARE MARIJUANA-BASED PILLS AVAILABLE AND OTHER MEDICATIONS COMING SOON

MAYBE: RESEARCH IS ONGOING Compassionate care or increased access to marijuana?

<5%

• Less than 5% of card holders are cancer, HIV/AIDS, or glaucoma patients

• Average user: 32 WM, no illness Bottom Line

We don’t smoke opium to get the effects of morphine.

So why would we smoke marijuana to get its potential medical effects? Cannabis-Based Medicines

 Research on the efficacy of cannabinoids is not focused on raw/crude marijuana, but in the individual components that may have medical use.

 Sativex is in the process of being studied (phase III trials)

 Approved in Canada and across Europe

 Administered via an oral spray

Epidiolex™

 98% pure CBD

 Some effectiveness for seizures

 Many versions on market which are not purified or standardized

26 Myth

The Legality of Alcohol and Tobacco Strengthen the Case for Marijuana Legalization

27 Alcohol and Tobacco: A Model?

• Use levels for alcohol and tobacco are much higher than marijuana

• Industries promote addiction and target kids

Schiller JS, Lucas JW, Peregoy JA. Summary health statistics for U.S. adults: National Health Interview Survey, 2011. National Center for Health Statistics. Vital Health Stat 10(256). 2012.

Centers for Disease Control and Prevention. Vital Signs: Current Cigarette Smoking Among Adults Aged ≥ 18 Years—United States, 2005–2010. Morbidity and Mortality Weekly Report 2011;60(33):1207–12 28 Will legalization diminish the power of cartels and the black market?

• In a legal market, where drugs are taxed and regulated (for instance to keep THC potency below a certain level or to prevent sale to minors), the black market has every incentive to remain • Would legalizing marijuana would not deter these groups from continuing to operate?

Kilmer, B., et al., 2010 29 ‘Big Marijuana’

Can we trust companies and Big Corporations not to target youth and the vulnerable?

30 Privateer Holdings: The first equity company dedicated to the marijuana industry.

Early Days of Big Tobacco Messaging

Alcohol & Tobacco: Money Makers or Dollar Drainers?

Alcohol T obacco Costs Costs

$185 $200 Costs billion billion

$25 $14 billion billion

Revenues Revenues

State estimates found at http://www.nytimes.com/2008/08/31/weekinreview/31saul.html?em; Federal estimates found at https://www.policyarchive.org/bitstream/handle/10207/3314/RS20343_20020110.pdf; Also see http://www.tobaccofreekids.org/research/factsheets/pdf/0072.pdf; Campaign for Tobacco Free Kids, see “Smoking-caused 35 costs,” on p.2.

Myth

Portugal and Holland Provide Successful Examples of Legalization

Neither Holland nor Portugal have legalized ANY drug

37 Legalization: Experience elsewhere? No modern nation has tried legalization, though most Western countries do not imprison people for simple marijuana possession. • Use rates in the Netherlands, Portugal, and Italy in the last 10 years are lower for some drugs and higher for others. • The Dutch experienced a three-fold increase in marijuana use among young adults after commercialization expanded.

38 Portuguese policy

In 2001, Portugal changed policy to send users with small amounts of drugs to “dissuasion panels” – social worker panels who refer individuals to treatment, administer fine, etc.

Portugal also implemented robust treatment plan

39 Results are mixed

• Youth use has increased since 2001 • Deaths have gone down • The impact of the policy unclear, despite extreme rhetoric

40 Dutch policy

The Dutch established the Non- enforcement Policy in 1976 and saw the birth of “Coffee Shops”

41 Results

• Experienced a three-fold increase in marijuana use among young adults

• Before Non-Enforcement, the Dutch always had lower rates of drug use than the US. • Holland is now #1 country in Europe with marijuana treatment need

• Scaling back policy • Coffee Shops Closing • Cannot sell to non-residents

42 Colorado and Washington

43 Colorado Didn’t Legalize Overnight 2001 2005 2007-8 2009 2012 2014

1st stores Legalized Denver 700 stores legalizes 3.5% Recreational Medical possession adults Stores open Marijuana have MMJ in license Colorado Nussbaum et al., Am J Psychiatry 168:778-781 45 Vaporizing industries: Nicotine and Marijuana

Pax by Ploom • Japan Tobacco International (JTI) is the third largest international tobacco company behind Philip Morris International.

• In 2011, JTI bought a portion of Ploom – a startup based in Silicon Valley that produces a loose-leaf vaporizer that can be used to inhale heated vapor from marijuana as well as tobacco, called the Pax.

46 47 Marijuana Edible Displays

Copyright SAM and the Slides' Authors. 48 Use with permission. Source of Marijuana* among 12th Graders in 2012 and 2013, by State Policy

100

40 **

** 0

Medical Marijuana States Non-Medical Marijuana States

*Categories not mutually exclusive ** Statistically significant difference SOURCE: University of Michigan, 2013 Monitoring the Future Study

In a report published in the Journal of the American Medical Association last month, Andrew Monte, MD; Richard Zane, MD; and Kennon Heard, MD, pointed to edible marijuana as the culprit behind the most troubling cases arriving at the UCH and Children’s Hospital Colorado emergency departments, including severe burns and cycling vomiting syndrome. Past-Year Marijuana Use (ages 12+)

20% 18.9% 18% 17.5% 16.2% 16% 15.4% 14% 12.3% 11.8% 12% 10% 2011-2012 2012-2013 8% 6% 4% 2% 0% US CO WA Source: NSDUH, 2014 Nº of Children Ages 3-7 Sent to ER for Accidental Marijuana Ingestion

16 14 14

10 8 8

6 4 4

0 2008-2011 2013 2014

Source: Children’s Hospital of Colorado Emergency Department Total Human Marijuana Exposures for 2013 and 2014 YTD (11/30/2014) 40

30 25 20 15

10 Total exposure calls exposure Total 5 0 Mar Jun Jan. Feb. Apr. May July Aug. Sep. Oct. Nov. Dec. . e 2014 13 23 18 24 14 17 21 22 14 34 2013 12 14 25 14 14 8 13 14 11 11 10 12 Source: Washington Poison Center Teen Admissions to Treatment

• Teen admissions to treatment for marijuana use at the Arapahoe House treatment network in CO increased by 66% between 2011 and 2014.

Source: Arapahoe House Treatment Network Workplace Pos MJ Tests: Increase from 2012-2013

National

0 5 10 15 20 25 http://www.questdiagnostics.com/home/physicians/health-trends/drug-testing Jim Johnson said his company has encountered so many job candidates who have failed pre-employment drug tests because of their THC use … it is actively recruiting construction workers from other states. ”

GE Johnson http://gazette.com/drug-use-a-problem-for- employers/article/1548427 “In February,” Leona “Willener said, “more than half the applicants who came to her company looking for work failed the required drug tests because of THC use … 1 in 3 attempted to cheat the ” test.”

http://gazette.com/drug -use-a-problem-for- employers/article/1548427 Colorado Staffing Agency Cities Across Colorado are Banning the Recreational Sales of Marijuana

Cities that Approved banned pot recreational sales sales (16%) • Of the 31 cities in Colorado that voted in November to allow the recreational sales of Banned marijuana, 26* recreational voted to ban it. sales (84%)*

Does marijuana make for better neighbors? Parents? Better kids? Better employees? Better drivers? Drug Policy Alliance “We're at a tipping point where it's starting to feel like marijuana legalization is no longer a question of if -- but when. But what about the other drugs? My colleagues and I at the Drug Policy Alliance are committed to ensuring the decriminalization of all drug use becomes a political priority.”

Now he does not just mean to remove arrests for small amounts… he says: “Many of the reasons why marijuana legalization makes sense can be applied to drugs more generally” --which appears to mean that this is about legalization/full retail sales of all drugs. -HuffPost

Bipartisan Co-Chairs (Kennedy + Frum)

Launch 2013

Over 150,000 press mentions

Public Health Scientific Advisory Board

30 state-wide affiliates

Thank you! [email protected] www.learnaboutsam.org