Marijuana is the Most Commonly Used Illicit Drug In the U.S.

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2 Marijuana is the Most Commonly Used Illicit Drug In the U.S. Over 114 million Americans have tried it at least once An estimated 2.4 million Americans used it for the first time in 2013 Tetrahydrocannabinol (THC) Active Ingredient in Marijuana 2013 National Survey on Drug Use and Health, SAMHSA, 2014.

3 Percentage of U.S. 12 th Grade Students Reporting Past Month Use of Cigarettes, Marijuana and Alcohol Alcohol Marijuana Cigarettes SOURCE: University of Michigan, 2014 Monitoring the Future Study.

4 Legalization Status As of November states have legalized recreational marijuana 28 states legalized marijuana for medical purposes

5 Marijuana Extracts: Products and Devices

6 Marijuana Concentrates/Extracts 80-90% THC Used in Medibles Stems, leaves & stalks (sometimes buds) are ground up and placed in a PVC, glass, or aluminum tube Butane gas is passed through the tube and strips the resins (nearly pure THC) from the cannabis As the butane passes through the tube the THC resin & butane run out the bottom

7 But it s just a plant (80-90% THC) Concentrates Green Crack wax Ear Wax Butane Hash Oil (BHO) Hash Oil Capsules Budder Shatter Slide Courtesy of Marijuana Impact on Public Health & Safety in Co.

8 Electronic Delivery Devices (E.D.D s) Allows user to inhale vapor containing nicotine and/or other substances. Disposable or rechargeable and/or refillable. Contain a cartridge filled with liquid nicotine, flavorings and glycerin or propylene glycol. When coil heats, it converts the contents of the cartridge into vapor. Devices can easily be concealed as pens and pencils.

9 Butane Hash Oil (BHO) Hazards Butane is odorless, colorless, and heavier than air Butane is a highly flammable gas and the canisters are compressed & pressurized If exposed to flame, the canisters are hand sized fire grenades and most scenes have hundreds of cans Butane seeps into low lying areas, like basements where there are pilot flames Butane Hash Oil (BHO)

10 Michigan State Police Western Wayne Narcotics Case 2013

11 Myth: No one dies from marijuana use DENVER (AP/CBS 4) April 2, 2014 A Wyoming college student visiting Denver on spring break jumped to his death after eating a marijuana cookie that his friend legally purchased in one of Colorado's recreational pot shops, authorities said Wednesday. An autopsy report lists marijuana intoxication as a "significant contributing factor" in the death of 19-year-old Levi Thamba Pongi, a native of the Republic of Congo who fell from a motel balcony on March 11. Pongi's friends told investigators he ate the cookie and "exhibited hostile behavior" that included pulling things off walls and speaking erratically, the report said. Attempts by the three friends to calm Pongi seemed to work until he went outside and jumped over the balcony railing, according to the report. Denver police ruled the death an accident and their investigation remains open. Colorado law bans the sale of recreational marijuana products to people under 21. Possession by people under 21 is also against the law. Authorities said one of Pongi's friends was old enough to buy the cookie from a pot shop. The medical examiner's office had Pongi's body tested for at least 250 different substances, including bath salts and synthetic marijuana, which are known to cause strange behavior. His blood tested positive only for THC, the psychoactive ingredient in marijuana, according to the report. One of Pongi's friends also tried the cookie but stopped after feeling sick, said Michelle Weiss-Samaras, a spokeswoman for the Denver County medical examiner's office. The marijuana concentration in Pongi's blood was 7.2 nanograms of active THC per milliliter of blood. Colorado law says juries can assume someone is driving while impaired by marijuana if their blood contains more than 5 nanograms per milliliter of the chemical. Officials at Northwest College in Powell, Wyo., say Pongi started taking classes as an exchange student in January. He was studying engineering. Source: CBS Denver News

12 Consequences of Marijuana Legalization and Expanded Availability

13 The Attractiveness of Provisioning Centers in Michigan Marijuana Growers Math 72 Plants x 3 Grow Cycles Per Year = 216 Plants per Year PER GROWER 1 Lb. of Marijuana per Plant = 216 Lbs. of Marijuana per year PER GROWER 216 Lbs. / 6 Patients = 36 lbs. PER PATIENT 1 Marijuana Cigarette = ½ gram 56 Marijuana Cigarettes in 1 oz. (28.35 grams) 896 Marijuana Cigarettes in a Pound (16 ounces) 896 Marijuana Cigarettes x 36 lbs. PER PATIENT = 32,256 Marijuana Cigarettes PER PATIENT THAT S 88 Marijuana Cigarettes Per Day PER PATIENT

14 Plant Size

15 Illicit Drugs vs. Prescription Drugs Schedule 1 drugs- No medicinal purposes- illegal substances with high potential for abuse such as Opiates, LSD, ecstasy, MARIJUANA/MARIHUANA Schedule 2 drugs- high potential for abuse with currently accepted medical treatment use such as: morphine, oxycodone, fentanyl, etc. Schedule 3 drugs- some potential for abuse; stimulants and depressant medications as prescribed by a doctor (sleeping pills, xanax, anti-anxiety medications etc) Schedule 4- over the counter drugs such as tylenol and cold medicines

16 MI Medical Marihuana Voted into law for the sick and dying Less than 12% of card carriers have a terminal diagnosis (2015) The Federal government still recognizes this as an illegal substance

17 The most common Marijuana myths talksooner.org

18 Medical Marihuana vs Regular Marijuana Medical Marihuana is still Marijuana. The drug comes from the same grow operations. Having a medical card doesn t mean it can be picked up at a pharmacy like a prescription.

19 Before the FDA approves a drug as a medicine, testing is done to: Determine the benefits and risks of the drug Determine how it may interact with other drugs Assure standardization of the drug Determine the appropriate dosage levels Identify and monitor side effects Identify safe drug administration Marijuana bypasses these FDA processes! 19

20 Marinol Pill containing synthetic THC Used for appetite stimulation in AIDS patients and other terminal diagnosis cases. Marinol is widely available at pharmacies to treat nausea/vomiting from cancer chemotherapy Not to be used in combination with: alcohol, marijuana and other drugs that affect the central nervous system such as diazepam (Valium), or Xanax.

21 Understanding the Impact of Youth Marijuana Use

22 % of Basal Release % of Basal Release % of Basal Release Natural and Drug Reinforcers Increase Dopamine in NAc frontal cortex AMPHETAMINE hr MARIJUANA nucleus accumbens VTA/SN FOOD Drugs of abuse increase DA in the Nucleus Accumbens, which is believed to trigger the neuroadaptions that result in addiction 100 Empty Time (min) Tanda, et al, Science Di Chiara et al.

23 Percent Long Term Effects of Marijuana: Addiction Estimated Prevalence of Dependence Among Users About 9% of users may become dependent 25-50% of teen daily users become addicted * Nonmedical Use, Source: Anthony JC et al., 1994 * * 1 in 6 who start use in adolescence become addicted

24 Odds ratio Mental Health Impact The risk of schizophrenia and psychosis increases with frequency of use and potency Earlier age of first use increases risk Marijuana use increases severity of psychosis in those with schizophrenia Brain abnormalities (smaller hippocampus and amygdala volume) seen in heavy long-term users- linked with impaired memory performance Risk of schizophrenia-like psychosis at age 26 years 4.5 Cannabis users by age 15 years 1.6 Cannabis users by age 18 years Arseneault et al BMJ 2002

25 Average Point Difference in IQ score (IQ at age 13 IQ at age 38) 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 Non-users Slide Courtesy of Marijuana Impact on Public Health & Safety in Co. used 1 Dx used 2 Dx used 3 Dx Source: Meier MH et al., PNAS Early Edition 2012

26 More Use of Cannabis Associated with Worse Social Outcomes at Age 25 (New Zealand Study) % welfare dependent (ages 21-25) % Unemployed (ages 21-25) mean personal income at age 25 % gained university degree by age to to to to 99 # of occasions Never using Number of occasions using Cannabis between ages Cannabis ages Slide Courtesy of Marijuana Impact on Public Health & Safety in Co. Source: Fergusson and Boden. Addiction, 103, pp , 2008.

27 Physical Health Impacts

28 Lungs and Cardiovascular System Lungs Higher risk of bronchitis Higher risk of respiratory infections Increased risk of lung cancer in heavy smokers Cardiovascular System Higher heart rate and blood pressure Heart attack, stroke, and other adverse events are rare, but have been reported.

29 Lessons Learned from legalization

30 Lesson #1 Colorado Futures Center Tax Estimates The Plan: 15% excise tax will yield $21.7 Million 10% special sales tax will yield $90.9 Million 2.9% existing state sales will yield $17.6 Million Estimated taxes, licenses and fees: $130.2 Million Actual Amount Collected in 2014: $63.4 Million The Difference: -$66.8 Million (That s more than 50% less than expected!) Source: Colorado Department of Revenue Prepared by: Office of Research and Analysis, dor_ora@state.co.us The Fiscal Impact of Amendment 64 on State Revenues April 24, 2013 Prepared by: Charles Brown Phyllis Resnick Director Lead Economist Colorado Futures Center Colorado Futures Center

31 Colorado & Washington Past-Year Statistics Courtesy of SMART Approaches to Marijuana

32 Alcohol & Tobacco: Money Makers or Dollar Drainers? Alcohol Costs Tobacco Costs Costs $185 billion $200 billion $14 billion Revenues $25 billion Revenues State estimates found at Federal estimates found at Also see Campaign for Tobacco Free Kids, see Smoking-caused costs, on p.2. 32

33 Myth: Legalizing Marijuana will create an Economic Stimulus Will legalizing marijuana create an Economic stimulus? Jobs are created and tax revenue is collected; we won't deny that. Let's first consider some of the potential other costs associated with legalizing marijuana: 1. Increased medical costs such as ER visits 2. Increased car crashes 3. The cost associated with treating addiction 4. Loss of productivity at work 5. Unintentional exposure to children talksooner.org

34 Lesson #2 Summary This is not the marijuana that the public and our lawmakers remember from college Average THC levels in 1980 were 1.5% From 1999 to 2011, THC levels increased 144% (4.67% %) The last 4 years in Colorado, THC levels increased 155% to 28% THC (Return on Investment/Increase market share = a more potent drug) There are no studies on marijuana with these THC levels (THC<12%) And these THC levels pale in comparison to Medibles.

35 MARIJUANA POTENCY Average THC and CBD Levels in the US: % THC increase % % THC: Psychoactive Ingredient CBD: Non-Psychoactive Ingredient % THC CBD Mehmedic et al., 2010 Slide Courtesy of Marijuana Impact on Public Health & Safety in Co. 35

36 The Last 4 Years in Colorado 10.96% Slide Courtesy of Marijuana Impact on Public Health & Safety in Co.

37 Statistics Courtesy of SMART Approaches to Marijuana

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39 Incarceration Rates In total, one tenth of one percent (0.1 percent) of all state prisoners were marijuana-possession offenders with no prior sentences. There are very few people in state or federal prison for marijuana-related crimes. It is useful to look at all drug offenses for context. Among sentenced prisoners under state jurisdiction in 2008, 18% were sentenced for drug offenses. For federal prisoners, who represent 13% of the total prison population, about half (51%) had a drug offense as the most serious offense in And federal data shows that the vast majority (99.8%) of federal prisoners sentenced for drug offenses were incarcerated for drug trafficking. (Sources are in the notes)

40 Lesson # 3 Product Advertising and Un-Regulated Commercialization of Marijuana

41 What Will Michigan Look Like with Provisioning Centers? 632 Starbucks & McDonald s Combined in Colorado in Marijuana Dispensaries in Colorado in Colorado Denver Starbucks McDonalds Medical Marijuana Dispensaries Recreational Marijuana Disp. Statistics Courtesy of Colorado HIDTA As of: Jan 2015

42 Use of Cartoons and Caricatures Slide Courtesy of Marijuana Impact on Public Health & Safety in Co.

43 Slide Courtesy of Marijuana Impact on Public Health & Safety in Co.

44 SO WHEN SHOULD I WORRY?ABUSE Academic Decline & Absenteeism Peer Group Drift Loss of Interest in normal hobbies, sports or other activities Sudden Changes in Behavior or Mood Drug Paraphernalia (i.e.: roach clips, syringes, eye drops, lighters, rolling papers) Withdrawal from family members Lying Unexplained medical issues such as nose bleeds, excessive bronchitis, red or glassy eyes Erratic Sleep Patterns or Lack of Energy Physical Violence or Suicidal Ideation Stealing or Sudden requests for money without explanation Home Truancy

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