Hot Topics in Healthcare Osher Lifelong Learning Institute University of California at San Diego. October 17, 2017

Transcription

1 Hot Topics in Healthcare Osher Lifelong Learning Institute University of California at San Diego October 17, 2017

2 Format Notes Speakers present pro and con perspectives Goal is to inform..not have one side or the other win

3 Marijuana Legalization: Pros and Cons Pros Boost in revenue Decrease use of law enforcement resources Less money for organized crime Safety controls Medical use access Personal freedom Less street justice Decreased revenue for drug dealers Cons Addictive nature Altered perception Gateway drug Impaired driving Increased access for children Lung damage to smokers/second hand smoke Brain damage Predispose to schizophrenia/psychosis

4 Marijuana Pharmacology Cannabis sativa: THC + ~ 100 cannabinoids Administration: smoke, oral, vaporization 22 million users in US, use more common in young (36% of 12 th graders) Common effects: euphoria and relaxation Less common effects: anxiety, fear, distrust, panic, acute psychosis, schizophrenia There is a natural cannabinoid receptor system: THC mimics a natural neurotransmitter Impairs judgement and reaction time Addiction: 30% marijuana use disorder, 9% addicted Long-term effects on brain: needs more study Gateway drug: Conflicting data

5 Health Effects of Marijuana National Academies of Sciences, Engineering and Medicine Literature review, >10,000 abstracts since 1999 Therapeutic effects: chronic pain, chemotherapy N&V, multiple-sclerosis Increased motor vehicle accidents Increased accidental pediatric exposure More data needed for causation of: cancer, diabetes, heart attack, stroke, immunity Some harm to lungs (e.g., bronchitis) Increased risk of: schizophrenia, social anxiety disorders, depression Impaired learning, memory, attention Some harm in pregnancy

6 Marijuana Legalization: The Con Position James C. Mannion, PhD

7 The Con Position Marijuana should be de-criminalized Marijuana is not harmless and has scientifically documented dangers Marijuana can be addictive Marijuana disproportionately harms the young Long-term effects on brain not known Marijuana legalization results in more auto deaths (e.g., Colorado) There is no rational national regulatory policy for marijuana Given what we now know about alcohol and tobacco effects would we legalize them? Commercialization will increase use through advertising/marketing Current supply is much more potent pharmacology unknown Gateway drug? Police opposition

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9 50,000 ft. View of Cannabis Use

10 No Consistent National Policy

11 The Netherlands Cannabis technically illegal Tolerated within certain guidelines Individual No more than 5 grams Use only in certain locations (e.g., coffeeshops ) Growing is illegal and NOT tolerated Regulations on growing are changing Concern about pesticide contamination

12 The Colorado Experience Proportion of marijuanapositive drivers involved in fatal motor vehicle crash nearly doubles following expansion of availability.

13 Growing perception that marijuana is harmless Well-documented evidence for use disorders and addiction

14 Long-Term Effects Marijuana also affects brain development. When people begin using marijuana as teenagers, the drug may impair thinking, memory, and learning functions and affect how the brain builds connections between the areas necessary for these functions. Researchers are still studying how long marijuana's effects last and whether some changes may be permanent.

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16 A Public Health Framework for Legalized Retail Marijuana Based on the US Experience: Avoiding a New Tobacco Industry Rachel Ann Barry, Stanton Glantz Published: September 27, Summary Points The US states that have legalized retail marijuana are using US alcohol policies as a model for regulating retail marijuana, which prioritizes business interests over public health. The history of major multinational corporations using aggressive marketing strategies to increase and sustain tobacco and alcohol use illustrates the risks of corporate domination of a legalized marijuana market. To protect public health, marijuana should be treated like tobacco, not as the US treats alcohol: legal but subject to a robust demand reduction program modeled on successful evidence-based tobacco control programs. Because marijuana is illegal in most places, jurisdictions worldwide (including other US states) considering legalization can learn from the US experience to shape regulations that prioritize public health over profits.

17 Key Points Prioritize public health perspective Rationalize regulatory framework from the various jurisdictions Tobacco model - High product cost - Education to decrease use Alcohol model - Low cost - Widespread misuse Marijuana harms - Increased car crashed - Prenatal effects - Lung effects - Addictive

18 Canadian Sourcing as a Solution to High US Prescription Drug Prices James C. Mannion, PhD

19 Legalize Drug Importation from Canada: Pros and Cons Pros Decreased cost Limited to drugs approved in US Trusted neighbor Cons Minimal macro impact on cost Counterfeit drug potential Most Canadian pharmaceutical products are controlled outside of Canada

20 Population ~ 36 million ~2% of global pharm. market Total sales ~$25 B R&D expenditure is < $1 B Annual domestic production ~$10B (more than half is exported, primarily to US)

21 The Con Position Legalizing importation of prescription drugs from Canada will significantly control US drug prices. Doing the math Counterfeit Few true Canadian pharmaceutical companies

22 The Headline: $7B Savings

23 The Math Behind the Headline Proposed savings over 10 years : $7B (CBO estimate) Projected US pharmaceutical sales : $5,147 B Percentage savings: 0.14%

24 The Washington Times Key Points A 2005 investigation by FDA examined 4,000 drug shipments to US. Almost half claimed to be from Canada. 85% of Canadian drugs were actually from countries such as India, Vanuatu and Costa Rica. Many Canadian pharmacies stock drugs from the European Union under a parallel trade system. It s a sound-bite solution that won t offer lower prices but will result in a public health calamity.

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27 Americans need to realize that there is no free-market mechanism that will reduce drug prices, that regulation or single-payer strategies are the only options to do so. -Rafi Mohammad