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New Challenges in the Anti-Drug Scene: Cannabis

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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 10 THC: 8 Psychoactive Ingredient 6 CBD: NON- MARIJUANA POTENCY Psychoactive 4 Ingredient 2 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 IQ - 1972/73, -0.2 Tested for IQ at age 13 -0.4 and 38y. Change in 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. Maximum Frequency Of Cannabis Use Before Age 17 Years, And Each Young Adult Outcome clear and consistent associations and dose-response relations were found between the frequency of adolescent cannabis use and all adverse young adult outcomes Less than Monthly 1.4 20 Monthly or More 18 1.2 16 Weekly or More 14 Daily 12 1 10 8 6 0.8 4 2 0.6 0 0.4 Adjusted Odds Ratios Odds Adjusted 0.2 0 High School Degee Depression Welfare Completion Attainment Dependence Silins E et al., The Lancet September 2014. 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 4 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 25 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. Copyright SAM and the Slides' Authors. 31 Use with permission. Early Days of Big Tobacco Messaging 33 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 36 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.
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