1 Opioid Review and MAT Clinic Marijuana April 18, 2018
Learning Objectives Describe the societal impact of marijuana Explain the long-term ramifications of early initiation of marijuana use 2
Disclosure UNM CME policy, in compliance with the ACCME Standards of Commercial Support, requires that anyone who is in a position to control the content of an activity disclose all relevant financial relationships they have had within the last 12 months with a commercial interest related to the content of this activity. The following planners and faculty disclose that they have no financial relationships with any commercial interest: Kurt DeVine, MD; Heather Bell, MD and Katie Stangl. 3
4 Announcements NO ECHO next week, April 25
Announcements CME evaluation forms are due to Katie Stangl by Friday, April 20 th at 4:00pm. 5
Special Speakers May 2: Shannon Whitman Program Administrator for the Prescription Monitoring Program May 16: Jessie Everts, VP of Clinical Programs at Wayside Treatment Centers The Treatment Experience May 30: Dr. Brian Grahan BUP and MAT 6
Addictiveness Long-term marijuana use can lead to addiction. Approximately 9 percent of users will become addicted to marijuana. This number increases to 17 percent among those who start young. 7
Addictiveness So 1 in 6 young people who start using marijuana in adolescence become addicted. National Institutes of Health, National Institute on Drug Abuse. 2011. Topics in Brief: Marijuana. Available: http://www.drugabuse.gov/publications/topics-in-brief/marijuana 8
Alcohol and Tobacco In Colorado, adult marijuana use is now HIGHEST in the country 13.6% of adults in CO are regular users, with rates of 18.5% in Denver Just like tobacco and alcohol, a report prepared for the Colorado Department of Revenue showed that the vast majority of marijuana demand in that state emanates from the regular users those who consume daily or near daily In CO, the top 21.8% of users make up almost 67% of demand for marijuana in the state 9
Increased Use Among Teens Pacula et al found that two features of medical marijuana home cultivation and dispensaries are positively associated with youth marijuana use and have important implications for states considering legalization of marijuana. An Emory University study found an 8.3% increase in the baseline prevalence rate caused by having retail dispensaries, as well as a 5% increase in youth initiation rates for marijuana related to medical marijuana laws Wall, M., et al., 2011; Johnston, L.D., et al., 2011. and Pacula et al 2013 Wen, Hefei. Hockenberry, Jason M. Cummings, Janet R. The effect of medical marijuana laws on adolescent and adult use of marijuana, alcohol, and other substances. 22 May 2014. Journal of Health Economics. 10
Marijuana January 17, 2017 - the National Academies of Science, Engineering, and Medicine releases comprehensive report on Marijuana The report examined: Health Effects of Recreational and Therapeutic Use of Cannabis and Cannabis-Derived Products 11
NIDA While cannabis use, particularly smoked cannabis, poses some long-term health and safety risks, there is evidence that cannabis or cannabinoids can treat certain medical conditions, which include nausea and vomiting from chemotherapy, spasticity from multiple sclerosis, and pain. I have concerns that the report summary and press coverage may give the impression that the findings apply equally to the cannabis plant ( medical marijuana ) and to the cannabinoid formulations that have undergone rigorous clinical trials. Dr. Nora Volkow Director (National Institute on Drug Abuse, NIH) 12
Is Botanical Marijuana a Medicine? Impure plant: with 750+ chemicals, 100+ cannabinoids; actions, interactions unknown Doses: THC, CBD, inconsistent, unregulated Smoking: most common route, health hazard to lungs Evidence for Safety: no long term studies or adverse events Evidence for effectiveness: Poor quality or non-existent Edibles, vapors, resins: evidence zero or very limited Short, long term adverse effects: Cognitive- and motorimpairment; amotivation, psychosis, etc. 13
FDA Approved Cannabinoids Marinol Capsules (1985): THC to treat nausea and vomiting associated with cancer chemotherapy only if safer conventional antiemetics are ineffective Marinol Capsules (1992): THC to treat anorexia associated with weight loss in patients with AIDS only if safer conventional antiemetics are ineffective Syndros (dronabinol oral solution): same indications Cesamet Capsules (1985): Nabilone to treat nausea and vomiting associated with chemotherapy only if safer conventional antiemetics are ineffective 14
Marijuana and Adolescence Use by age 15= 3.6 times less likely to graduate from high school 2.3 times less likely to enroll in college 3.7 times less likely to get college degree. Thurstone, Christian, Dr. Marijuana Use & Pregnancy. May 14, 2014. Available at http://drthurstone.com/?s=pregnancy&x=0&y=0. 15
Marijuana Lowers your IQ A recent study found that those who used marijuana heavily in their teens and continued through adulthood showed a permanent drop in IQ of 8 points. A loss of 8 IQ points could drop a person of average intelligence into the lowest third of the intelligence range. 1M.H. Meier, Avshalom Caspi, et al. 2012. Persistent cannabis users show neuropsychological decline from childhood to midlife. Proceedings of the National Academy of Sciences 16
For Parents Marijuana use will hurt YOUR child s IQ, grades, and ability to graduate from high school! 17
For Teachers/Schools Increased marijuana use will result in reduced academic achievement for which teachers/school system will be blamed College students with high levels (17 days/month) of marijuana use were twice as likely as those with minimal use (less than 1 day/month) to have an enrollment gap while in college. In 2015, 38 percent of college students indicated that they had used marijuana in the prior 12 months, up from 30 percent in 2006 http://www.monitoringthefuture.org//pressreleases/16collegedrug.pdf 18
Mental Health Regular marijuana use by adolescents and young adults is strongly associated with developing psychotic symptoms and disorders such as schizophrenia in adulthood for those people with an underlying genetic vulnerability to developing this disease This risk is higher among those who start using marijuana at a younger age This risk is higher with more frequent marijuana use 19
Lung Cancer One study found that in 16% of those who smoked 50 or more times, their risk for getting lung cancer doubled. Callaghan RC, Allebeck P, Sidorchuk A. Marijuana use and risk of lung cancer: a 40-year cohort study. Cancer Causes Control. 2013 Oct;24(10):1811-20. doi: 10.1007/s10552-013-0259-0. Epub 2013 Jul 12. PubMed PMID: 23846283.Also see: http://www.wmur.com/health/study-shows-high-rate-of-marijuana-use-among-nhyouth/23987818. 20
Companies Conducting Drug Testing Target Walmart McDonalds Police/Fire departments Military Transportation 21
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Employability 1 in 17 12th graders smoke daily 2016 Monitoring the Future (MTF) Study These students are virtually unemployable 23
Marijuana Impairs Driving A new NIDA study found: Marijuana's active chemical THC affects weaving within a road lane in a similar way to a blood alcohol level of.08, the legal limit in many states. Marilyn Huestis of NIDA: One of the things we know happens with cannabis is that it reduces your field of vision and you get tunnel vision, so you're unable to react as quickly. http://www.dailymail.co.uk/news/article-3137943/marijuana-does-impair-driving-kindcomprehensive-government-study-reveals-cannabis-use-affect-motor-skills-threedrinks.html 24
Impaired Driving Marijuana is the most prevalent illegal drug detected in impaired drivers, fatally injured drivers, and motor vehicle crash victims. National Highway Traffic Safety Administration. Drug Involvement of Fatally Injured Drivers. U.S. Department of Transportation Report No. DOT HS 811 415. Washington, DC: National Highway Traffic Safety Administration, 2010. 25
Impaired Driving Driving under the influence of marijuana is associated with a 92% increased risk of vehicular crashes. Such driving is associated with a 110% increase in fatal crashes. Asbridge, M., Hayden, JA, Cartwirght, JL. Acute cannabis consumption and motor vehicle collision risk: systematic review of observational studies and meta-analysis. British Medical Journal, 2012; 344 (epub): e536. PMID: 22323502. 26
Impaired Driving Researchers at the University of Massachusetts, Amherst, found 44 % of college men said they drove after smoking marijuana in the previous month, compared with 12% who said they drove after drinking. 27
Licensed Marijuana Businesses Medical Marijuana (June 2017) 513 licensed centers 770 marijuana cultivation facilities 251 infused products (edibles) businesses Recreational Marijuana (June 2017) 491 licensed marijuana retail stores 684 licensed marijuana cultivation facilities 263 licenses for infused product (edibles) businesses SOURCE: Colorado Department of Revenue, Licensees- Marijuana Enforcement Division 28
Business Comparisons 2016 Colorado Starbucks 392 McDonalds 208 Medical Marijuana Centers 513 Recreational Marijuana Shops 491 29
Denver --- 210 Licensed Medical Marijuana Centers 108 Pharmacies 30
Traffic Fatalities --- SOURCE: Colorado State Patrol 31
--- --- SOURCE: Colorado DOT 2018 32
--- --- SOURCE: City and County of Denver, March 2017 33
--- --- SOURCE: Colorado Department of Revenue, Colorado Liquor Excise Tax 34
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State of Minnesota Data http://www.health.state.mn.us/topics/cannabis/about/update0418.pdf 36
The New Miracle Elixir? Miracle Elixir- 1945 37