Project SAM (Smart Approaches to Marijuana)

Transcription

1 C IN THE 21 st CENTURY BEN CORT What You ll Need to Know. Project SAM (Smart Approaches to Marijuana) INFORM Inform public policy with the science of today s marijuana DISCUSS Discuss reducing the unintended consequences of marijuana policies PREVENT Prevent the establishment of Big Marijuana that would market marijuana to children and to prevent Big Tobacco from taking over Big Marijuana PROMOTE Promote research on medical marijuana and produce pharmacy-attainable medications 1

2 What I Do Kids Recovery Book A bit of speaking Consulting Treatment Community (The Beach House) Professional and Collegiate Athletics States Other Affiliations - NALGAP - NMI - University of Florida Agenda The science and current potency Little bit about the market Social Justice Consumption trends - Concentrates - Vape - Edibles Mental and physical health Interventions and recovery Resources 2

3 Real Science & Honest Information Nothing subjective about REAL science Demand peer reviewed and published studies Watch the spin! Adverse Health Effects of Recreation Cannabis Use Wayne Hall, 2014 Dr. Nora Volkow s summary of recent research published NEJM 2014 Legal Marijuana Coming into Focus Colorado Health Institute Lancet Journal, Feb 2015 Volume 2, No. 3, p The Legalization of *Marijuana in Colorado: The Impact Rocky Mountain HIDTA, Report Volume 1-4 The Times They Are A Changin 3

4 Average U.S.THC & CBD Levels MARIJUANA POTENCY THC: Psychoactive Ingredient CBD: Non- Psychoactive Ingredient THC CBD Mehmedic et al.,

5 THC Potency in Colorado THC in CO THC in CO Cannabis: % THC Over Time 45 42% THC Nationally % Dry Weight % THC Colorado THC: Psychoactive Ingredient CBD Only CBD: NON-Psychoactive Ingredient ~0.4% Year Slide use with permission from Sarah Urfer 5

6 Gardening vs. Chemistry Marijuana & Addiction marijuana is addictive. Estimates from research suggest that about 9% of users become addicted; this number increases among those who start young (up to about 17 (1 in 6) and dramatically increases (25-50%) when certain conditions exist NIDA 6

7 Marijuana & Addiction The DSM-5 clearly spells out the objective criteria for addiction, and for the first time cannabis withdrawal is listed as a diagnosis. Retail Outlet Penetration

8 Econ Additional 376 facilities in 2017 (not shown on graph) *Colorado Department of Revenue 2017 annual update How can Colorado support this amount of retail? How does this growth continue? Why does the old 80/20 rule matter here? (actually more like 84/20 in CO) Contributing Factors to Marijuana Dependence Age of Onset Frequency of Use THC Potency 8

9 Normalization of Cannabis Too Close for Comfort 9

10 Too Close for Comfort Too Close for Comfort 10

11 Targeting Youth 11

12 Placement and Brand Association Pushing Frequency 12

13 Subsidize and Normalize 13

14 Tough to Counter 14

15 Social (In)Justice? (Isn t it High time for this conversation?) Denver s pot businesses is mostly located in low-income minority neighborhoods. Denver Post 1/2/16 Recreational marijuana stores are clustered in low-income areas of Denver and Seattle. Marijuana Business Daily 7/31/17 The marijuana industry s war on the poor... Politico 5/19/16 Annual Income vs. Regular Cannabis Use Under $25k: 19.8% $25-$49.9: 12.3% Over $50k: 11.1% 15

16 Juvenile Arrests Post Commercialization Less white kids arrested (-8%) More Hispanic (+29%) Many more African-American (+58%) Surprising Truths About Legalizing Cannabis 16

17 C CONSUMPTION TRENDS Consumption Trends Beyond Smoking Concentrates Edibles Vape 17

18 Why The Lancet Study Really Matters 16% Lancet Study of Skunk Weed Daily use sees a 5x increase in psychosis Weekend use sees a 3x increase 24% of psychosis cases in the study group caused by weed alone 18

19 Concentrates; Our Cannabis Future? 19

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21 Ralph Was Right! Since 2014 the Colorado Department of Revenue Marijuana Enforcement Division has released an Annual Update In 2014 the word concentrate is found nowhere in the 42 page report In 2015 concentrates show up once in the report under Retail Testing. this reference includes a one sentence summary of what they are and a note that 4% of the concentrates tested each month failed a contaminant test 2016 continues to mention concentrates only in relation to containments found within them but not part of the market alongside flowers and edibles By 2017 s report we see that 27,890 lbs of concentrates sold in the state totaling 4,559,597 units Concentrate Consumption 21

22 Concentrate Consumption Concentrate Consumption 22

23 Concentrate Consumption Consumption Trends 23

24 Consumption Trends Consumption Trends 24

25 Consumption Trends Consumption Trends 25

26 Weed Redefined 26

27 The Times They Are A Changin Pop, you can t catch a buzz off that old 5% shit! 27

28 Weed Redefined Weed Redefined 28

29 Weed Redefined Weed Redefined 29

30 Weed Redefined Weed Redefined 30

31 Weed Redefined Weed Redefined 31

32 Weed Redefined Weed Redefined 32

33 Weed Redefined Weed Redefined 33

34 Weed Redefined Weed Redefined 34

35 Weed Redefined Celebrity Endorsements 35

36 Celebrity Endorsements Celebrity Endorsements 36

37 Part of Pop & Fashion Culture Part of Pop & Fashion Culture 37

38 Concentrates It s Natural 38

39 Driving Trial, Sound Familiar? Vapes 39

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41 Vapes Vapes 41

42 Vapes 42

43 Vapes Vapes 43

44 Vapes The Incredible, Edible Weed Eat Me! 44

45 Edibles 10 mg is a legal dose Servings are unregulated Edibles 45

46 Infused Everything Edibles 46

47 Edibles A New Record! 47

48 Edibles (Look-a-likes) 48

49 Edibles 49

50 50

51 Edibles Infused Everything 51

52 Edibles Edibles 52

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56 EVERYTHING! 56

57 Medicinal Value of Cannabis Therapeutic values: Relieves nausea Increases appetite Reduces muscle spasms and spasticity Anti Convulsant *Relieves chronic pain* *Reduces intraocular pressure* *Relieves anxiety* Components of marijuana have been used to treat symptoms of cancer, chemotherapy, wasting disease associated with AIDS/HIV, spasticity of multiple sclerosis, epilepsy, Dravet syndrome (CBD) 57

58 Prevention Identify high risk individuals - Individuals with depression - Adolescents and young adults - Adults in states with commercialized marijuana Feingold et al 2014, Walton et al 2014 Engage in your community on many levels Make friends, know local resources, work together! Consider harm reduction Interventions & Implications Consider: Age of onset, Potency, Frequency Presentations will differ depending on method of ingestion and potency Understand The long game and what they believe Community needs to stay well educated Many with issues will not be willing to admit those problems, how do we communicate with them? Seriously, I m asking you all. 58

59 Recovery It s Possible! Not a second class addiction Watch your own bias and microaggressions, intervene when patients experience these. To Learn More... Project SAM (Smart Approaches to Marijuana) NIDA SAMSHA Lots of others, but use a critical eye (I subscribe to lots of pro-cannabis and commercial cannabis sites and newsletters) 59

60 References Giordano, G. N., Ohlsson, H., Sundquist, K., Sundquist, J., & Kendler, K. S. (2015). The association between cannabis abuse and subsequent schizophrenia: a Swedish national co-relative control study. Psychological medicine, 45(02), Hall, W. (2015). What has research over the past two decades revealed about the adverse health effects of recreational cannabis use?. Addiction, 110(1), Hodcroft, C. J., Rossiter, M. C., & Buch, A. N. (2014). Cannabis-associated Myocardial Infarction in a Young Man with Normal Coronary Arteries. The Journal of emergency medicine, 47(3), Masten, S. V., & Guenzburger, G. V. (2014). Changes in driver cannabinoid prevalence in 12 US states after implementing medical marijuana laws. Journal of Safety Research, 50, Meola, S. D., Tearney, C. C., Haas, S. A., Hackett, T. B., & Mazzaferro, E. M. (2012). Evaluation of trends in marijuana toxicosis in dogs living in a state with legalized medical marijuana: 125 dogs ( ). Journal of Veterinary Emergency, 22(6), Monte, Zane and Heard. (2014). The Implications of Marijuana Legalization in Colorado. JAMA Richmond, M. K., Page, K., Rivera, L. S., Reimann, B., & Fischer, L. (2013). Trends in detection rates of risky marijuana use in Colorado health care settings. Substance abuse, 34(3), Salomonsen-Sautel, S., Min, S. J., Sakai, J. T., Thurstone, C., & Hopfer, C. (2014). Trends in fatal motor vehicle crashes before and after marijuana commercialization in Colorado. Drug and alcohol dependence. Salomonsen-Sautel, S., Sakai, J. T., Thurstone, C., Corley, R., & Hopfer, C. (2012). Medical marijuana use among adolescents in substance abuse treatment. Journal of the American Academy of Child & Adolescent Psychiatry, 51(7), Schuermeyer, J., Salomonsen-Sautel, S., Price, R. K., Balan, S., Thurstone, C., Min, S. J., & Sakai, J. T. (2014). Temporal trends in marijuana attitudes, availability and use in Colorado compared to non-medical marijuana states: Drug and alcohol dependence. Sevigny, E. L., Pacula, R. L., & Heaton, P. (2014). The effects of medical marijuana laws on potency. IJDP, 25(2), Volkow, N. D., Baler, R. D., Compton, W. M., & Weiss, S. R. (2014). Adverse Health Effects of Marijuana Use. New England Journal of Medicine, 370(23), Wall, M. M., Poh, E., Cerdá, M., Keyes, K. M., Galea, S., & Hasin, D. S. (2011). Adolescent marijuana use from 2002 to 2008: higher in states with medical marijuana laws, cause still unclear. Annals of epidemiology, 21(9), Walton, M. A., Resko, S., Barry, K. L., Chermack, S. T., Zucker, R. A., Zimmerman, M. A.,... & Blow, F. C. (2014). A randomized controlled trial testing the efficacy of a brief cannabis universal prevention program among adolescents in primary care. Wang, G. S., Roosevelt, G., & Heard, K. (2013). Pediatric marijuana exposures in a medical marijuana state. JAMA pediatrics, 167(7), References Allsop, D. J., Copeland, J., Lintzeris, N., Dunlop, A. J., Montebello, M., Sadler, C.,... & McGregor, I. S. (2014). Nabiximols as an Agonist Replacement Therapy During Cannabis Withdrawal: A Randomized Clinical Trial. JAMA psychiatry, 71(3), Asbridge, M., Mann, R., Cusimano, M. D., Tallon, J. M., Pauley, C., & Rehm, J. (2014). Cycling-related crash risk and the role of cannabis and alcohol: a case-crossover study. Preventive medicine, 66, Bachhuber, M. A., Saloner, B., Cunningham, C. O., & Barry, C. L. (2014). Medical cannabis laws and opioid analgesic overdose mortality in the United States, JAMA internal medicine, 174(10), BARRY, R. A., HIILAMO, H., & GLANTZ, S. A. (2014). Waiting for the Opportune Moment: The Tobacco Industry and Marijuana Legalization. Milbank Quarterly, 92(2), Bonnet, U., Specka, M., Stratmann, U., Ochwadt, R., & Scherbaum, N. (2014). Abstinence phenomena of chronic cannabis-addicts prospectively monitored during controlled inpatient detoxification: Cannabis withdrawal syndrome and its correlation with delta-9-tetrahydrocannabinol and-metabolites in serum. Drug and alcohol dependence, 143, Brady, J. E., & Li, G. (2014). Trends in Alcohol and Other Drugs Detected in Fatally Injured Drivers in the United States, American journal of epidemiology, 179(6), Campbell, A. N., Nunes, E. V., Matthews, A. G., Stitzer, M., Miele, G. M., Polsky, D.,... & Ghitza, U. E. (2014). Internetdelivered treatment for substance abuse: a multisite randomized controlled trial. Am J Psychiatry, 171, 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), Compton, W. M., Grant, B. F., Colliver, J. D., Glantz, M. D., & Stinson, F. S. (2004). Prevalence of marijuana use disorders in the United States: and Jama, 291(17), Di Forti, M., Iyegbe, C., Falcone, A., Powell, J., & Murray, R. (2014). Vulnerability to cannabis-related psychosis: association with frequency and potency of cannabis use, and interaction with genes regulating dopamine signalling. The Lancet, 383, S41. Feingold, D., Weiser, M., Rehm, J., & Lev-Ran, S. (2015). The association between cannabis use and mood disorders: A longitudinal study. Journal of affective disorders, 172,

61 And then there s this 61