Some Reefer Sanity In the Marijuana Discussion

Transcription

1 Some Reefer Sanity In the Marijuana Discussion Kevin A. Sabet, Ph.D. Director, Drug Policy Institute, University of Florida Co-Founder and Pres., Project SAM (Smart Approaches to Marijuana) 1

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3 What drugs do we use? Current use among persons 12 and older: % 52% 50% 40% 30% 26% 20% 10% 7.5% 0% NSDUH, 2013 Alcohol Tobacco Marijuana 3

4 Percentage"of"U.S."12 th "Grade"Students"" Reporting"Past"Month"Use"of"Alcohol," Cigarettes,"and"Marijuana" SOURCE:"University"of"Michigan,"2013"Monitoring"the"Future" Study." 60" 50" 40" 30" 20" 10" 0" Alcohol" Marijuana" Cigarettes" 91" 92" 93"94"95"96"97"98"99"00" 01" 02" 03" 04" 05" 06" 07" 08"09" 10" 11" 12" 13"

5 Daily Use Among College Students Have Tripled since 1992 Potency has grown fold Marijuana is now 2 nd leading cause of impaired driving Marijuana now surpasses tobacco for most young people Only non-increases in marijuana are among year olds as of past 2 yrs Copyright SAM and the Slides' Authors. Use with permission. 5

6 Primary Drug of Abuse at Substance Abuse Treatment Admission, Ages 12 and Older, 1992 to % Marijuana Percentage of All Admissions 16% 12% 8% 4% Heroin Other Opiates Cocaine Methamphetamine 0% SOURCE: SAMHSA, Treatment Episode Dataset (TEDS) Highlights 2011, National Admissions to Substance Abuse Treatment Services, Copyright SAM and the Slides' Authors. Use with permission. 6

7 What do we know about marijuana? Copyright SAM and the Slides' Authors. Use with permission. 7

8 14 12 Average THC and CBD Levels in the US: MARIJUANA POTENCY THC: Psychoactive Ingredient CBD: NON- Psychoactive Ingredient THC CBD Mehmedic et al., 2010 Copyright SAM and the Slides' Authors. Use with permission. 8

9 But it s just a plant (80-90% THC) Concentrates Green Crack wax Ear Wax Butane Hash Oil (BHO) Shatter Budder Hash Oil Capsules Copyright SAM and the Slides' Authors. Use with permission. 9

10 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. Use with permission. 10

11 More"Use"of"Cannabis"Associated"with"Worse"" Social"Outcomes"at"Age"25"(New"Zealand"Study)" %"welfare" dependent" (ages"21v25)" " %"Unemployed" "(ages"21v25)" " "mean"personal" income" at"age"25" " %"gained"university" degree" by"age"25" " " " 400+' ' 300'to' 399' ' 200'to' 299' ' 100'to' 199' ' 1'to'99' ' Never' #"of"occasions" using"" Cannabis"ages" 14V21" Number'of'occasions'using'' Cannabis'between'ages'14521' Source:"Fergusson"and"Boden."Addiction,"103,"pp."969V976,"2008

12 CannabisVAssociated"Psychosis" CANNABIS"AND"SCHIZOPHRENIA"" Study"of"Swedish"Conscripts"(n=45570)" Cases"of"Sz" "per"1,000" 30" 20" 10" 0" 0" 1" 2" 10" <50" >50" No"of"times"cannabis"taken" Andréasson"et"al"Lancet,"1987." " Odds"ratio" CANNABIS"AND"SCHIZOPHRENIAVLike"" Longitudinal"prospective"Dunedin"study" (n=1037)" 9 Risk"of"schizophreniaVlike" 8 psychosis"at"age"26"years" Cannabis users by age 15 years Arseneault"et"al""BMJ"2002" 1.6 Cannabis users by age 18 years

13 Persistent"Marijuana"Users"Show"A"Significant"IQ"Drop"" between"childhood"and"midlife" " Followed"1,037"individuals"from"birth"to"age"38.""Tested"marijuana" use"at"18,"21,"26,"32"and"38.""tested"for"iq"at"ages"13"and"38" " Average'Point'Difference'in'IQ'score'' (IQ'at'age'13' 'IQ'at'age'38)' NonVusers" used"" 1"Dx" used"" 2"Dx" used"" 3"Dx" Source:'Meier'MH'et'al.,'PNAS'Early'Edition'2012'

14 What we know Vs What matters Copyright SAM and the Slides' Authors. Use with permission. 14

15 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. Use with permission. 15

16 Support for marijuana has risen rapidly in last 10 years

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19 We built a coalition of senior citizens, housewives, professionals, doctors, lawyers, nurses. You know, politics is illusions. It s pictures, it's photos, it s the AP Wire. So I've changed the face from a long hair hippie to Hazel Rogers. It s kind of like a fantasy story that I could do something in the middle of the war on drugs like that and get away with it!"

20 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 into how marijuana s components could be used as medicine 20

21 Marijuana-based medicines Sativex is in the process of being studied in the USA. THC:CBD = 1:1 It is administered via an oral mouth spray Already approved in Canada and Europe Also Epidiolex, pure CBD, no THC 21

22 Does medical marijuana lead to increased use? Cerda et al: Residents of states with medical marijuana laws have abuse/dependence rates almost twice as high as states with no such laws.!! An additional study in the September 2011 issue of Annals of Epidemiology found that, among youths age 12 to 17, marijuana usage rates were higher in states with medical marijuana laws (8.6%) compared with those without such laws (6.9%).!! Cerdá, M., Wall, M., Keyes, K. M., Galea, S., & Hasin, D. (2012). Medical marijuana laws in 50 states: Investigating the relationship between state legalization of medical marijuana and marijuana use, abuse, and dependence. Drug and Alcohol Dependence, 120(1-3): !! Wall, M. et al (2011). Adolescent Marijuana Use from 2002 to 2008: Higher in States with Medical Marijuana Laws, Cause Still Unclear, Annals of epidemiology, Vol 21 issue 9 Pages ! 22

23 Increased use? Vigorous debate, Rees/Anderson: no increase in medical marijuana states (JPAM) Pacula (RAND) and Sevigny: Two features home cultivation and dispensaries are positively associated with marijuana use and have important implications for states considering legalization of marijuana. Source: Pacula et al

24 2.5 States"that"Legalized"Marijuana"Use"For"Medical" Purposes"Have"Significantly"Higher"Rates"Of" Marijuana"Use"and"of"Marijuana"Abuse"and" Dependence" Map"of"States"that"Legalized"" Medical"Marijuana"by"2004" Odds"Ratio" passed'laws'legalizing' ''medical'mj' Past Year MJ Abuse/ Dependence " " Past Year MJ Use Past Year MJ Abuse/ Dependence Among Current Users NESARC:"National"Epidemiologic"Survey"on"Alcohol"and"Related"Conditions" Cerda"M"et"al."Drug"and"Alcohol"Dependence""2012;"120:"22" "27."

25 Source"of"Marijuana*"among"12 th "Graders"in"2012" and"2013,"by"state"policy" " ** 20 0 ** Medical Marijuana States Non-Medical Marijuana States *Categories"not"mutually"exclusive"" **"Statistically"significant"difference" SOURCE:'University'of'Michigan,'2013'Monitoring'the'Future'Study'

26 Big marijuana Can we trust companies and Big Corporations not to target youth and the vulnerable? 26

27 Privateer Holdings: The first equity company dedicated to the marijuana industry. Copyright SAM and the Slides' Authors. Use with permission. 27

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31 Marijuana Edible Displays Copyright SAM and the Slides' Authors. Use with permission. 31

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33 M-Cigarettes (marijuana vaporizers) Brought to you by Groupon! 33

34 Increasingly popular and accessible 34

35 Early Days of Big Tobacco Messaging 35

36 Colorado'Didn t'legalize'overnight' 2001' 2005' 2008' 2009' 2012' 2014' 1st'stores' Legalized' Denver' legalizes' Medical' Marijuana' passes' 700'stores' 3.5%' adults' have'mmj' license' Stores' open' Nussbaum'et'al.,'Am'J'Psychiatry'168:778:781'

37 Hospital Cannabis Discharge DX #( Source:(Colorado(Department(of(Public(Health(and(the(Environment(

38 How did the first year go? Two deaths Accidental poisonings up Edibles, edibles, edibles Massive underground market Where is the tax revenue? 38

39 Proportion'Of'Fatal'Crash'Drivers'MJ5Positive'In'Colorado' and'' 34'States'Without'Medical'MJ,' ' Salomonsen5Sautel'S'et'al.,'Drug'and'Alcohol'Dependence'2014.' Proportion"of"MJ"Positive"Drivers"(%)""" Date"of"widespread" Medical"MJ" implementation"in" Colorado"(2009)" Year"

40 edical Marijuana egins, Stays Small Decision to allow UNLIMITED # of caregivers Commercialization begins CO youth use at 10-year high

41 Projected vs. Actual Tax Revenue (in millions) July '14-July '15 Jan-June February Actual Projected January

42 If Marijuana Were Legal, I Would Be More Likely to Use It. (Percent of High School Students Reporting They Agree Strongly or Somewhat, 2012) Agree Somewhat Agree Strongly 100% Percent Agree (Strongly or Somewhat) 80% 60% 40% 65% 38% 78% 67% 20% 0% 4% 16% 12% Never Used Marijuana (n=2,109) 27% Lifetime Marijuana User (n=1,769) 11% Heavy Marijuana User* (20+ per month) (n=270) SOURCE: The Partnership for a Drug-Free Copyright America and SAM the and MetLife the Slides' Foundation, Authors. The Partnership Attitude Tracking Study (PATS): Teens and Parents, Use with permission. 42

43 Track, track, track! Reporting car crashes, youth use, advertising, workplace +, other costs 43

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45 So What Are Our Choices? All or nothing? Legalization ( Regulation ) vs. Incarceration ( Prohibition ) 45

46 Incarceration Agree we don t want people locked up for low-level marijuana use Depending on context, we want drug courts, brief intervention referrals, pre-arrest referral programs 46

47 If Only We Treated It Like Alcohol 2.7 million Arrests for alcohol-related crimes in 2008 (Does NOT include violence; Includes violations of liquor laws and driving under the influence) 847,000 Marijuana-related arrests in

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49 Take homes: (1)Big Marijuana is Coming (2)Things Going Badly Already (3)No False Dichotomies (4)Finally, This Isn t Inevitable 49

50 Thank you!