Talking Points (2018) Talal Khan MD Mariah DeYoung LMSW CAADC

Talking Points (2018) Talal Khan MD Mariah DeYoung LMSW CAADC

Cannabis - Key Chemicals Marijuana comes from the plant Cannabis sativa. It has more than 500 chemicals. Many Psychoactive (mind-altering). Active ingredient is Delta 9 Tetrahydrocannabinol - THC: This is the main psychoactive agent in marijuana. When you smoke cannabis, THC goes from your lungs into your bloodstream and then into your brain. It stimulates the Mesolimbic Dopamine system of the brain The reward pathway It is a known neurotoxin and carcinogen Another chemical within the 500+ is Cannabidiol - CBD Which May have medicinal potential Medicine already exists - Dronabinol, Nabilone, Sativex The science is NOT READY FOR PRIME TIME

Cannabis Effects Short Term Long Term Short-term memory problems Increased risk of Respiratory illnesses Severe anxiety, Panic Paranoia Psychosis: Loss of reality, Hallucinations Loss of sense of personal identity Lowered reaction time Altered time space perception Increased risk of cancers Increased psychiatric conditions Depression, schizophrenia Decline in IQ ( average 8-10 points reduction if prolonged use started in adolescent age) Poor school performance and higher chance of dropping out Increased risk of heart attack Increased risk of stroke Problems with coordination (impairing safe driving or playing sports) Sexual problems (for males) Increased likelihood of contracting STDs Impaired thinking and ability to learn and perform complex tasks Lower life satisfaction, poor motivation Addiction (about 9% if adulthood onset and 17% if teen) increased potential development of opiate use disorder. Relationship problems, intimate partner violence Increased criminal behaviors Financial difficulties, unemployment Increased dependence on Welfare

Is It Medicine? Facebook videos and people s opinions are not evidence. JAMA did a meta analysis. A total of 79 studies qualified to be non biased (6462 participants). There was moderate-quality evidence to support the use of cannabinoids for the treatment of chronic pain and spasticity. Newer research states that effect is affective rather than sensory. There was low-quality evidence suggesting with some improvements in nausea and vomiting due to chemotherapy, weight gain in HIV, sleep disorders, and Tourette syndrome. Minimal to no evidence on improvement in psychosis, anxiety and depression. Only 2 studies studied Cannabis. In all the studies Cannabinoids were associated with an increased risk of serious and common Adverse Effects.

Is It Medicine? (continued) Psychiatric effects: Worsening Depression, Mood disorders, Psychosis, Anxiety, increased Suicide risk Marijuana has effects on metabolism of other medications Marijuana has serious effects on pregnancy The Cannabis now has increased potency about 8-10 x more potent. Concentrations up to 70-90% THC. There is a lot of misinformation regarding cannabis and Opioids

The Medical Organizations Stance The American Medical Association (AMA) The American Society of Addiction Medicine s (ASAM) The American Academy of Addiction Psychiatry (AAAP) The American Cancer Society (ACS) The American Glaucoma Society (AGS) The Glaucoma Research Foundation (GRF) The American Academy of Pediatrics (AAP) The American Academy of Child and Adolescent Psychiatry (AACAP) The National Multiple Sclerosis Society (NMSS) The National Association of School Nurses (NASN The American Psychiatric Association (APA)

Traffic Accidents Marijuana more than doubles the risk of accidents. Cannabis effects Vision, Reaction Time, Coordination, Tracking Ability, Attention and Judgement Chronic marijuana use can impair a person s ability to drive for up to 3 weeks after stopping it. Measuring Cannabis in system is not easy.

ER and Hospital Cost In Colorado, the annual rate of marijuana-related emergency room visits increased 35% between the years 2011 and 2015 (CDPHE, 2017). Central Oregon hospitals saw a nearly 2,000% increase in emergency room visits due to marijuana poisoning, with 434 marijuana-related emergency visits in January 2016 alone, compared to a maximum of 32 visits per month prior to legalization (Kent, 2016). In Colorado, calls to poison control centers have risen 210%. Washington has seen a 70% increase in calls after legalization. One hospital in Bend, Oregon, also had an increase in marijuana-related emergency room visits from 229 in 2012 to 2,251 in 2015; the average number of marijuana-related emergency room visits per month in the same hospital in 2016 was 552 (Hawryluk, 2017). Many psychiatric admissions are directly or indirectly cannabis related.

Unintentional Pediatric Exposure There were 985 unintentional marijuana exposures reported from 2005 through 2011 in children aged 9 years and younger: 496 in non-legal states, 93 in transitional states, and 396 in decriminalized states.

Work force Impact Marijuana use impairs the ability to function effectively and safely on the job and increases work-related absences, tardiness, accidents, compensation claims, and job turnover. Marijuana urine test results in Washington and Colorado are now double the national average (Quest Diagnostics, 2016). Insurance claims have become a growing concern among companies in legalized states (Hlavac & Easterly, 2016) because if marijuana use is allowed or drug testing ignored, employers are at risk of liability claims when a marijuana-related injury or illness occurs onsite Colorado construction company GE Johnson was forced to hire out-of-state construction workers because too many Coloradans were failing preemployment drug tests A study conducted in Washington during 2011 2014 found that the percentage of work-related injuries and illnesses was significantly higher (8.9%) among marijuana users than non-users (Marcum, Chin, Anderson, & Bonauto, 2017). Pro-marijuana advocates are pushing to eliminate work force drug testing.

Crime and Homelessness There is clear increase in criminal activities by legalization. The crime rate in Colorado has increased 11 times faster than the rest of the nation since legalization (Mitchell, 2017), reporting an 8.3% increase in property crimes and an 18.6% increase in violent crimes (CBI 2017). The density of marijuana dispensaries was linked to increased property crimes in nearby areas. There was a 54% increase in public consumption of marijuana citations since legalization (Boulder Police Department [BPD], 2017). In Alaska, misdemeanor, larceny and vehicle thefts have dramatically increased since legalization.(alaska Department of Public Safety, 2016). Homelessness increases Reliance on welfare increases Black market and illegal smuggling

The Social Justice Argument Washington, DC, saw public consumption and distribution arrests nearly triple between the years 2015 and 2016. A disproportionate number of those marijuana- related arrests occurred among African- Americans (Moyer, 2017; District of Columbia Metropolitan Police Department [DCMPD], 2016). Colorado marijuana arrests for young African-American and Hispanic youth have increased since legalization (Colorado Department of Public Safety [CDPS], 2016). Colorado schools that had 25% or fewer youth of color had 313 marijuana-related suspensions compared to 658 marijuana-related suspensions for schools comprised of populations with 76% or more youth of color (CDPS, 2016). Legalizing Marijuana is not going to reform the Criminal Justice System or Racism.

Is It All About The Money? Every $1 received in tax revenue from our legal drugs costs society more than $10 in lost social costs, due to workplace, highway, health, criminal justice, and other reasons. Society and businesses will have to bear the cost of decreased productivity, absenteeism, workplace accidents, road accidents, increase of other drug use and increased health cost. The environmental cost is very high / carbon print What is the cost of ruining our future generations?

Effects on the Young Brain In young adults multimodal high resolution MRI studies showed increased gray matter density, volume and changes in shape in the left nucleus accumbens and right amygdala in recreational cannabis users as opposed to controls. Gray matter density changes in prefrontal cortex structures There were alterations in neuronal organization

Our Future Generations Marijuana is Addictive - 1 in 6 teens who start become addicted It is a Gateway Drug It causes permanent changes the teen brain Reduces IQ Lowers School performance Increases school drop out rates Legalizing has made it more accessible at earlier age The Perception of Risk is decreasing

1 in 6 Teens Who Use Will Be Addicted Teens who smoke marijuana regularly Say it is very easy to get Score worse on tests of memory, visual scanning, and cognitive flexibility Have impaired learning, particularly with math and reading Are less likely to graduate high school Are more likely to have psychotic symptoms as adults Are more likely to use other drugs, like heroin and cocaine The younger marijuana is first used, the more likely the use of other drugs Smart Approaches to Marijuana (SAM). (2018). Leassons Learned From Marijuana Legalization in Four U.S. States and D.C. https://learnaboutsam.org/wp-content/uploads/2018/04/sam-lessons-learned-from-marijuana-legalization-digital.pdf Retail Marijuana Public Health Advisory Committee (2016). Monitoring Health Concerns Related to Marijuana in Colorado: 2016. Retrieved on May 2, 2017 from https://www.colorado.gov/pacific/cdphe/marijuana-health-report. Centers for Disease Control and Prevention. (2015). Vital Signs: Today s heroin epidemic. https://www.cdc.gov/vitalsigns/heroin/index.html Olfson, M., Wall, M. M., Liu, S. M., & Blanco, C. (2017). Cannabis use and risk of prescription opioid use disorder in the United States. American Journal of Psychiatry, 175(1), 47-53.

Our Future Generations In Colorado, Washington, Oregon, Alaska, and the District of Columbia (Washington, DC) Use among youth aged 12 17 has increased way above average (National Survey on Drug Use and Health 2006-2017). Alaska and Oregon are leading the nation in past-year marijuana use among youth aged 12 17 Colorado currently holds the top ranking for first-time marijuana use among youth, representing a 65% increase in the years since legalization Young adult use (youth aged 18 25) in legalized states is increasing Colorado toxicology reports show the percentage of adolescent suicide victims testing positive for marijuana has increased (Colorado Department of Public Health & Environment 2017). In Anchorage, school suspensions for marijuana use and possession increased more than 141% from 2015 to 2017 (Wohlforth, 2018).

Treatment Requests for detox, residential and IOP treatment- Insurances not covering it Individual therapy is helpful, but not sufficient in many cases Medications Call 866-852-4001 to set up an assessment to determine treatment options