MARIJUANA TRENDS 2016

Transcription

1 MARIJUANA TRENDS 2016 American Academy of Pediatrics March 8 & 10, 2016 Fu n d e d by t h e C o u n t y o f S a n D i e g o, H e a l t h a n d H u m a n S e r v i c e s A g e n c y, B e h av i o r a l H e a l t h S e r v i c e s

2 MPI INITIATIVE FOCUS Problem Statement: High levels of marijuana use by youth (12-25) in the county negatively affect overall health and contributes to family and community problems. Other Initiatives: Binge Underage Drinking Meth Initiative Prescription Drug 2

3 CA 2016? Possibly several ballot initiatives for recreational use need to get enough signatures? 3

4 STATE PACKAGED LEGISLATION California Medical Marijuana Regulation and Safety Act (MMRSA). Bureau of Medical Marijuana Regulation (BMMR), which will be part of the Department of Consumer Affairs. (New law will govern processing, cultivating, testing, transporting and distributing medical marijuana.) Only took 20 years to come up with this! 4

5 PERFECT STORM Decrease in perceived risk of harm. Favorable policies & attitudes toward marijuana. Higher potency products produced and marketed. Increase in access to marijuana (delivery, masked products). The good news. Increasingly available research regarding the effects of marijuana on the adolescent brain. Some studies link use to mental health issues and poor academic performance. 5

6 THC INCREASE Strength of weed seized by federal authorities has steadily risen over time. Denver retail outlets advertise strains containing 25 +% THC*. *THC is tetrahydrocannabinol the main psychoactive ingredient in marijuana. 6

7 CONCENTRATES SUCH AS WAX, BUTANE HASH OIL, EDIBLES ( AV E R A G E J O I N T C O N TA I N S 1-3 % T H C, C O N C E N T R AT E S M AY C O N TA I N % T H C )

8 Data

9 PAST 30-DAY MARIJUANA USE AMONG SAN DIEGO COUNTY YOUTH 16% of 11 th graders reported smoking marijuana in the past 30 days in All students have seen reductions in past 30-day use since % 45% 40% 35% 30% 36% 36% 43% 47% 31% 39% Past 30-day use for 7 th and 9 th graders is at an all-time low. S o u r c e : C H K S, * I n , t h e r e s p o n s e r a te for non - t r a d i t i o n a l s t u d e n t s p a r t i c i p a t i n g i n t h e s u r vey w a s l o w e r t h a n i n p r ev i o u s year s, w h i c h c o u l d b e a f a c to r for the decrease i n r e p o r ted past 30 - d ay u s e r a tes for that year. 25% 20% 15% 10% 5% 0% 23% 21% 21% 19% 19% 18% 16% 16% 16% 15% 13% 14% 15% 16% 13% 11% 10% 9% 6% 6% 6% 4% 4% 5% 5% 6% 3% Grade 7 Grade 9 Grade 11 Non-Traditional* 9

10 DAILY MARIJUANA USE AMONG SAN DIEGO COUNTY YOUTH Daily marijuana use is defined as smoking pot 20 or more times in the past 30 days. 20% 18% 16% 14% 14% 15% 18% 17% Daily marijuana use among 7 th, 9 th, and 11 th graders has been declining since % 10% 8% 12% 11% S ource: C HKS, * In 2013, the response rate for non - traditional s tudents par ticipating in the sur vey was lower than in previous year s, which could be a factor for the decrease in repor ted daily use rates for that year. 6% 4% 2% 0% 6% 5% 5% 5% 4% 4% 4% 3% 3% 3% 3% 3% 3% 3% 3% 2% 2% 2% 2% 1% 1% 1% 1% 1% 1% 0% 0% Grade 7 Grade 9 Grade 11 Non-Traditional* 10

11 HARM PERCEPTION! Perceptions of Harm among youth have been decreasing for both prescription drug use and synthetic drug use! 11

12 ACCESS Nearly 20% of 7 th graders in the County believe Pot is easy to get. Over 50% of 9 th and 11 th graders believe Pot it is easy to get. 12

13 NATIONAL DATA: PERCEPTION OF HARM 13

14 USE AMONG YOUNG ADULTS NATIONALLY (AGES 19-28) Past 30 Day Marijuana Use among young adults ages at the highest level since Daily Marijuana Use among young adults ages (19-28) at the highest since 1986! S o u r c e : M o n i to r i n g t h e Fu t u r e S u r vey vo l u m e 2 - C o l l e g e S t u d e n t a n d A d u l t a g e s

15 Health

16 THE POT PLANT The pot/cannabis plant has over 400 chemicals. Delta 9 THC (Tetrahydrocannabinol) is the chemical responsible for most of marijuana's high. Some chemicals derived from the pot plant may help control seizures and aid with appetite. (Dronabinol to treat nausea caused by chemotherapy and boost appetite in patients with AIDS wasting syndrome and Nabilone - MS) You do not need the psychoactive components to get the medical value!!!!!!! 16

17 ADOLESCENT BRAIN The adolescent brain continues to develop well into the mid 20s. The brain continues to be streamlined during this period. (pruning) THC interferes with the connections being made to different areas of the brain, creating an imbalance in the cannabinoid system. Adolescence is a crucial time, both academically and developmentally. 17

18 ACADEMIC ACHIEVEMENT Marijuana use is associated with: Attention and memory problems Slower brain processing Difficulty problem-solving Anxiety/Depression Sleep pattern issues Verbal Learning. S o u r c e s : A r r i a e t al., ; Fe r g u s s o n e t a l ; H u n t e t a l., ; M e d i n a e t a l., ; S A M H S A,

19 HEALTHY COPING SKILLS Adolescents who use substances to cope with traumatic situations, often become adults who do the same. Navigating life s ups and downs are good exercise for the developing brain. Getting drunk or drugged to deal with an issue, leaves you with the problem in the morning! 19

20 OVER ALL HEALTH- DR. LEV Many people who smoke marijuana have lung issues including chronic bronchitis. Marijuana smoke contains many of the same cancer causing carcinogens as cigarettes. Too much marijuana, has resulted in Cyclical Vomiting Syndrome, severe abdominal pain and vomiting. 20

21 ED DISCHARGE DATA CANNABIS USE Source: Of fice of Statewide Health Planning and Development, Emergency Depar tment Discharge Database,

22 Treatment Data

23 TREATMENT 2015 Marijuana is the primary drug of choice for youth ages in county funded drug treatment, 8 out of every 10 youth were admitted for marijuana addiction in March

24 TREATMENT DATA: ADOLESCENT ADMISSIONS BY REGION* (98 OUT OF 117 ADMISSIONS) Treatment Percent of adolescents admitted to a County-funded treatment facility in March 2015 reporting marijuana/hashish as their primary drug of choice. Central 33% East N. Inland 21% 22% N. Coastal 11% South N. Central 4% 5% Out of County Out of State Homeless 1% 1% 2% 0% 5% 10% 15% 20% 25% 30% 35% *Region is determined by the zip code of reported client residence. 24

25 DR. NORA VOLKOW - NIDA Once tolerance sets in, dependence can form. If someone uses a drug often enough, the brain will become accustomed to it. In an attempt to return to baseline, it will compensate for the difference, raising a function that the drug lowered (like heart rate) or reducing a function that the drug boosted (like mood ). This means that when the drug wears off, the person s heart could start to race, he or she could become irritable or depressed, or any number of other reactions called withdrawal. 25

26 CONTINUED Withdrawal is the mirror-image of what the drug does! If cannabis makes you mellow, then you re irritable, grumpy. Instead of marijuana s sedating effects, a person might get insomnia. Loss of appetite and nausea replace the munchies. And instead of marijuana s characteristic dream suppression, someone in marijuana withdrawal might have intense, vivid dreams when he or she finally does sleep. When doing the drug becomes more important than spending time with friends or doing favorite hobbies or despite major consequences, such as a suspended driver s license or prison time. 26

27 FOOD PRODUCTS 27

28 UNREGULATED FOOD PRODUCTS Marijuana food products are currently unregulated! While all food products and drug products are regulated, there is no federal (FDA) or state oversight of marijuana food products. There are no quality control requirements regarding dosage or use to safeguard against unintentional poisoning or overdose Food and snack packaging is youth friendly 28

29 COLORADO AND EDIBLES The proliferation of marijuana-infused edibles stunned state and industry leaders, making it one of the biggest surprises during the first year of legal recreational marijuana sales. Potent cookies, candies and drinks once considered a niche market now account for roughly 45 percent of the legal marijuana marketplace. 29

30 HASH OR HONEY OIL Oil can be whipped into a budder and cooked into products like brownies, cookies, etc. Sprayed onto generic candies Vaped in vape pens Made into drops known as tinctures 30

31 EXPLOSIONS SAN DIEGO 31

32 VERY DANGEROUS PROCESS! Uses butane gas to extract a potent liquid out of the plant. 32

33 BUTANE GAS COLORLESS, ODORLESS, HIGHLY FLAMMABLE 33

34 90% 2 ND AND 3 RD DEGREE BURNS 34

35 EDIBLE EFFECTS May not feel anything for 30 to 60 minutes (on a full stomach may take nearly two hours to feel full effects). The high can last 4 to 8 hours while the effects from smoking can wear off in an hour or less. 35

36 HOW MUCH IS TOO MUCH? The pot infused cookie contained as much THC as six high-quality joints. His blood intoxication level was at 7.2 nanograms per milliliter (the legal driving limit is 5 nanograms per milliliter) in Colorado. 36

37 23 YEAR OLD LUKE GOODMAN Consumed 5 peach tart candies Each candy containing 10mg of THC. Started becoming jittery and speaking incoherently. Shot himself 37

38 COLORADO 911 SHOOTING Suspect shot wife while she was on the phone with 911. The victim, told dispatchers her husband was so impaired after eating the "Karma Kandy Orange Ginger" that he was crawling through a bedroom window and cutting his legs on broken glass. Only substance found in Kirk's blood was THC. 38

39 CRAWFORD HS - OCT 23,

40 SIDE EFFECTS Hallucinations Paranoia Anxiety Panic Depression 40

41 SMOKING VS. EATING Most people don't realize when we smoke cannabis, 80% of the cannabinoids are burnt off. We can absorb into the blood stream, about 20% of the cannabinoids that end up in our lungs. When eating cannabis, we can absorb most of the THC content. 41

42 ALCOHOL AND MARIJUANA The bodies response when consuming too much alcohol is to vomit, when taken with marijuana can inhibit an individuals ability to vomit. This may lead to alcohol poisoning! Alcohol enhances the THC levels in the blood. 42

43 POPULAR COMBO Benzodiazepines (Depressant) and Marijuana Xanax (aka alprazolam, bars, footballs), Klonopin (aka clonazepam, klonies), Valium (aka diazepam, blues), Ativan (lorazepam), Versed (midazolam). When mixed with marijuana, the sedative effects of benzodiazepines are increased causing impaired memory, poor concentration and confusion. 43

44 MENTAL HEALTH 44

45 NATIONAL ALLIANCE ON MENTAL ILLNESS The overwhelming consensus from mental health professionals is that marijuana is not helpful and potentially dangerous for people with mental illness. Marijuana can directly worsen symptoms of anxiety, depression or schizophrenia through its actions on the brain. Approximately one-third of people in America with schizophrenia regularly abuse marijuana. 45

46 SCHIZOPHRENIA The association between adolescent marijuana abuse and future development of psychosis has become accepted in literature. The risk of developing long-term psychosis has been found to increase proportionally with increasing frequency of marijuana use. Adolescence have an age related risk of developing longterm hallucinations or schizophrenia from abusing marijuana. S o u r c e : I n p r e s s C a n n a b i s a n d t h e A d o l e s c e n t B r a i n - P e d i a t r i c A n n a l s, M a r c h 2 014; D r. Ro b e r t J. H i l t, M D, FA A P, A s s i s t a n t P r o f e s s o r o f P s y c h i a t r y, U n i v e r s i t y o f Wa s h i n g to n 46

47 AMERICAN PSYCHIATRIC ASSOCIATION There is no current scientific evidence that marijuana is in any way beneficial for the treatment of any psychiatric disorder. In contrast, current evidence supports, at minimum, a strong association of cannabis use with the onset of psychiatric disorders. 47

48 DO NOT TAKE YOURSELF OFF OF DR. PRESCRIBED MEDICATION! Law Enforcement, increasingly responding to calls for service for people that have taken themselves off of Doctor prescribed mental health medications supplementing with marijuana. Most psychotropic drugs require a weaning off period. 48

49 CANNABIS USE AND PREGNANCY 49

50 PREGNANCY Marijuana use in pregnancy is not preferable, nor less risky, compared to most other drugs when a side-by-side comparison is made. (NIDA) The developing embryo (and fetus) is dependent on the mother for oxygen, nutrients and a balance of hormones, chemicals and other substances to grow normally. Disrupting the normal fetal environment, through the introduction of marijuana or other recreational drugs, puts the pregnancy at risk in the short-term and possibly the long term as well. 50

51 PRE NATAL USE - STUDIED SINCE THE 60 S Associations between marijuana smoking and growth restriction and lower birth weight, particularly in women who keep smoking through delivery or late in pregnancy. An Australian study of almost 420,000 live births reported a higher risk for neonatal intensive care admission for newborns exposed prenatally to pot and lower birth weight. Also, there are reports of abnormal responses or behaviors in the newborn period and this suggests a toxicity or withdrawal. The symptoms include exaggerated and prolonged startle reflexes (sleep cycle disturbances with high-pitched crying.) S o u r c e : B i r t h o u t c o m e s a s s o c i a t e d w i t h c a n n a b i s u s e b e f o r e a n d d u r i n g p r e g n a n c y M o h a m m a d R. H a y a t b a k h s h, V i c k i J. F l e n a d y, K r i s t e n S. G i b b o n s, A n n M. K i n g s b u r y, E l i z a b e t h H u r r i o n, A b d u l l a h A. M a m u n & J a k e M. N a j m a n 51

52 NEWBORNS Studies of use with higher potency products during pregnancy. In a Brazilian study, exposed newborns were more irritable and less responsive to calming, cried more during the examination, and exhibited more jitteriness and startles than the non-exposed neonates. Studies of 3, 10 and 14-year old prenatally exposed children suggest that the prenatal exposure to high doses of marijuana may make it harder for children to learn and may affect their emotions (increased aggression) and increase depression symptoms. S o u r c e : E x p o s u r e t o m a r i j u a n a d u r i n g p r e g n a n c y a l t e r s n e u r o b e h a v i o r i n t h e e a r l y n e o n a t a l p e r i o d M a r i n a C a r v a l h o d e M o r a e s B a r r o s, M D, P h D, R u t h G u i n s b u r g, M D, P h D c o r r e s p o n d e n c e, C l o v i s d e A r a ú j o P e r e s, P h D, S a n d r o M i t s u h i r o, M D, E l i s a C h a l e m, R o n a l d o R a m o s L a r a n j e i r a, M D, P h D D i v i s i o n o f N e o n a t a l M e d i c i n e, D i v i s i o n o f B i o s t a t i s t i c s, a n d R e s e a r c h U n i t o n A l c o h o l a n d D r u g s, F e d e r a l U n i v e r s i t y o f S ã o P a u l o, S ã o P a u l o, B r a z i l 52

53 DR. VISITS? Marijuana users are also less likely to actively participate in their treatment missing more appointments and having more difficulty with medicationadherence. If you need medical advice get it from a licensed primary care physician, not the media or politicians! 53

54 CAMPAIGN KICK OFF JUNE 11, 2015 MPI AND NORTH INLAND COMMUNITY PREVENTION PROGRAM

55 OUR KIDS! More than 40% of high school students attending nontraditional schools have driven or been driven by someone while under the influence of marijuana. S o u r c e : C H K S, S a n D i e g o C o u n t y,

56 PUT DRUGGED DRIVING ON YOUR RADAR! 56

57 NO STATEWIDE STANDARDS OF IMPAIRMENT No uniform Nano-gram limit (Alcohol.08) Stricter laws to obtain blood samples. Perceived risk of impairment from THC is low. Prosecutions are low when drugs only are involved! Metabolism marijuana can stay in system for 30 to 40 days, does not mean impaired. 57

58 2014 SD COUNTY: MEDICAL EXAMINER REPORT Motor vehicle-related fatalities: In 2014 fatalities are up 18% from the previous year. Accidental pedestrian deaths made up 88 of those cases. Those 88 cases are up from 64 deaths the previous year. Almost half of the accidental pedestrian deaths who were tested were under the influence of alcohol and/or illicit drugs most commonly methamphetamine or THC. Many of those killed were people running across freeways while it was dark outside. 58

59 ACCESS

60 DRUG DEALING IN

61 AVAILABILITY OF DRUGS AND SOCIAL MEDIA Easy access to many products. Apps for Delivery services GPS locators Access to many people! Constant posting of activities! 61

62 APPS TO ACCESS WEED 62

63 DRUG TRANSACTIONS TODAY! 63

64 AVAILABILITY OF DRUGS AND SOCIAL MEDIA Easy access to many products. Apps for Delivery services GPS locators Access to many people! Constant posting of activities! 64

65 ACCESS FROM DISPENSARIES 150 designated locations for dispensaries in Un-incorporated San Diego County. (Lakeside, Valley Center, Ramona) County Collective/Dispensary Ordinance prohibits the sale of edible products! The City of San Diego allows (4) dispensaries per (9) council districts. In , 582 medical cards were issued countywide 65

66 VAPING/E-CIGS

67 E-CIGS, VAPE PENS Don t really have an odor. Can vape a variety of drugs. No easy way to test what is in them.

68 E CIG NEW STUDY Using E Cigs does not help you quit smoking cigarettes. For current smokers trying to quit, the odds of quitting smoking, were 28 percent lower for smokers using e-cigarettes than people not using e-cigarettes. E-cigarettes are not only not helping people quit smoking, they're also inhibiting people from quitting smoking. S o u r c e : C e n t e r f o r To b a c c o C o n t r o l R e s e a r c h a n d E d u c a t i o n a t t h e U n i v e r s i t y o f C a l i f o r n i a, S a n F r a n c i s c o

69 VAPING AND THE BODY While cigarettes have been shown to suppress some immune genes, vaping affects significantly more of those immune genes including broader suppressive effects on respiratory mucosal immune responses. Source: Ilona Jaspers, the Deputy Director of the UNC Center for Environmental Medicine, Asthma and Lung Biology

70 NATIONALLY Among high school students who had used marijuana at least once in their lifetime, 23% reported using e-cigarettes to vaporize dried cannabis leaves; 15% reported using e-cigarettes to vaporize hash oil; and, 10% reported using e-cigarettes to vaporize wax (a high-potency marijuana product) Source: Morean, et al.,

71 VAPING VARIOUS FORMS OF POT Dry Herb Vape Hash Oil & Wax Vape Wax Vape- Dabbing 71

72 DABBING PARAPHERNALIA Paper clips, dental tools, small screw drivers and pens with residue on tip. 72

73 TOOLS FOR DABBING The wax is placed onto the heated coil in the vape devise.

74 ARE THEY SAFE?? 74

75 A LOT WE DO NOT KNOW? 75

76 VAPING DEVICES 76

77 PARAPHERNALIA

78 GRINDERS Youth being caught with grinders. Herb is ground up into small consistent pieces, which maximizes surface area. Provides an even burning/vaporizing No annoying aspect from sticky fingers when breaking up buds by hand, those sticky fingers are soaking up trichomes and hurting potency. 78

79 CONCEALMENT Small and easy to hide. Easy to purchase online.

80 BHO PARAPHERNALIA Paraphernalia related to BHO production. 80

81 LATEST RESULTS COLORADO YOUTH AND ADULT USE 81

82 YOUTH USE IN COLORADO RMHIDTA

83 MORE FROM COLORADO In 2014, the first year in which marijuana retailers began selling recreational pot, calls to the Rocky Mountain Poison and Drug Center for marijuana exposure increased over 70% from 2013 and nearly 150% from 2012 (RMHIDTA, 2015). Additionally, 45 of the 151 calls received in 2014 involved children ages eight or younger (Johnson, 2015). BHO extraction lab explosions increased 167% from 12 in 2013 to 32 in In addition, injuries related to THC extraction lab explosions increased 67% from 18 in 2013 to 30 in 2014 (RMHIDTA, 2015). 83

84 WASHINGTON In the first six months since marijuana was legalized for recreational use, the Washington State Patrol stopped 745 drivers for driving under the influence who tested positive for THC. That compares to 1,000 drivers who tested positive over a two-year period in 2011 and 2012 (RMHIDTA 2014). Calls to the Washington Poison Center for marijuana exposures increased 56% from 158 calls in 2013 to 246 in 2014; 48 of the 246 calls in 2014 involved children ages 12 or under (Johnson, 2015). 84

85 MPI WEBSITE mpisdcounty.net Multiple resources, info cards, data, PowerPoints available for download. Half day trainings available marijuana, RX and synthetics. 85

86 QUESTIONS?