Some Reefer Sanity In the Marijuana Discussion Kevin A. Sabet, Ph.D. Director, Drug Policy Institute, University of Florida Co-Founder and Pres., Project SAM (Smart Approaches to Marijuana) www.learnaboutsam.org www.kevinsabet.com 1
What drugs do we use? Current use among persons 12 and older: 2012 60% 52% 50% 40% 30% 26% 20% 10% 7.5% 0% NSDUH, 2013 Alcohol Tobacco Marijuana 3
Percentage"of"U.S."12 th "Grade"Students"" Reporting"Past"Month"Use"of"Alcohol," Cigarettes,"and"Marijuana" SOURCE:"University"of"Michigan,"2013"Monitoring"the"Future" Study." 60" 50" 40" 30" 20" 10" 0" Alcohol" Marijuana" Cigarettes" 91" 92" 93"94"95"96"97"98"99"00" 01" 02" 03" 04" 05" 06" 07" 08"09" 10" 11" 12" 13"
Daily Use Among College Students Have Tripled since 1992 Potency has grown 10-20 fold Marijuana is now 2 nd leading cause of impaired driving Marijuana now surpasses tobacco for most young people Only non-increases in marijuana are among 13-14 year olds as of past 2 yrs Copyright SAM and the Slides' Authors. Use with permission. 5
Primary Drug of Abuse at Substance Abuse Treatment Admission, Ages 12 and Older, 1992 to 2011 20% Marijuana Percentage of All Admissions 16% 12% 8% 4% Heroin Other Opiates Cocaine Methamphetamine 0% 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 SOURCE: SAMHSA, Treatment Episode Dataset (TEDS) Highlights 2011, National Admissions to Substance Abuse Treatment Services, 2013. Copyright SAM and the Slides' Authors. Use with permission. 6
What do we know about marijuana? Copyright SAM and the Slides' Authors. Use with permission. 7
14 12 Average THC and CBD Levels in the US: 1960-2011 10 MARIJUANA POTENCY 8 6 4 THC: Psychoactive Ingredient CBD: NON- Psychoactive Ingredient 2 0 196 0 196 197 197 197 5 0 4 8 198 0 198 3 198 4 198 198 199 199 199 199 199 199 199 5 6 0 2 3 5 6 7 8 199 9 200 0 200 200 200 200 200 200 200 200 200 1 2 3 4 5 6 7 8 9 201 201 0 1 THC 0.2 0.2 0.4 0.5 1 1 1.5 3.3 3.3 3.5 3.5 3.1 3.1 4 4.5 5.2 5 4.7 5.4 6.2 7.3 7.2 8.3 8.1 9.1 10 10 9.9 11 11 CBD 0.3 0.3 0.4 0.4 0.3 0.3 0.4 0.4 0.4 0.4 0.5 0.5 0.4 0.5 0.5 0.5 0.5 0.5 0.4 Mehmedic et al., 2010 Copyright SAM and the Slides' Authors. Use with permission. 8
But it s just a plant (80-90% THC) Concentrates Green Crack wax Ear Wax Butane Hash Oil (BHO) Shatter Budder Hash Oil Capsules Copyright SAM and the Slides' Authors. Use with permission. 9
High Times 5/7/14 With dabs your local action news team gets to do a marijuana story that shows crack pipe torches used on sticky heroin-looking goo made from a process that blows up like meth labs. Copyright SAM and the Slides' Authors. Use with permission. 10
More"Use"of"Cannabis"Associated"with"Worse"" Social"Outcomes"at"Age"25"(New"Zealand"Study)" %"welfare" dependent" (ages"21v25)" " %"Unemployed" "(ages"21v25)" " "mean"personal" income" at"age"25" " %"gained"university" degree" by"age"25" " " " 400+' ' 300'to' 399' ' 200'to' 299' ' 100'to' 199' ' 1'to'99' ' Never' #"of"occasions" using"" Cannabis"ages" 14V21" Number'of'occasions'using'' Cannabis'between'ages'14521' Source:"Fergusson"and"Boden."Addiction,"103,"pp."969V976,"2008
CannabisVAssociated"Psychosis" CANNABIS"AND"SCHIZOPHRENIA"" Study"of"Swedish"Conscripts"(n=45570)" Cases"of"Sz" "per"1,000" 30" 20" 10" 0" 0" 1" 2" 10" <50" >50" No"of"times"cannabis"taken" Andréasson"et"al"Lancet,"1987." " Odds"ratio" CANNABIS"AND"SCHIZOPHRENIAVLike"" Longitudinal"prospective"Dunedin"study" (n=1037)" 9 Risk"of"schizophreniaVlike" 8 psychosis"at"age"26"years" 7 6 5 4 3 2 1 0 4.5 Cannabis users by age 15 years Arseneault"et"al""BMJ"2002" 1.6 Cannabis users by age 18 years
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"38" " Average'Point'Difference'in'IQ'score'' (IQ'at'age'13' 'IQ'at'age'38)' 2 0-2 -4-6 -8 NonVusers" used"" 1"Dx" used"" 2"Dx" used"" 3"Dx" Source:'Meier'MH'et'al.,'PNAS'Early'Edition'2012'
What we know Vs What matters Copyright SAM and the Slides' Authors. Use with permission. 14
The Gulf Has Never Been Greater Between The Scientific Understanding of Marijuana s Harms and The Public s Misunderstanding Copyright SAM and the Slides' Authors. Use with permission. 15
Support for marijuana has risen rapidly in last 10 years
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We built a coalition of senior citizens, housewives, professionals, doctors, lawyers, nurses. You know, politics is illusions. It s pictures, it's photos, it s the AP Wire. So I've changed the face from a long hair hippie to Hazel Rogers. It s kind of like a fantasy story that I could do something in the middle of the war on drugs like that and get away with it!"
Is marijuana medicine? No: smoked or inhaled raw marijuana is not medicine Yes: there are marijuana-based pills available and other medications coming soon Maybe: research is ongoing into how marijuana s components could be used as medicine 20
Marijuana-based medicines Sativex is in the process of being studied in the USA. THC:CBD = 1:1 It is administered via an oral mouth spray Already approved in Canada and Europe Also Epidiolex, pure CBD, no THC 21
Does medical marijuana lead to increased use? Cerda et al: Residents of states with medical marijuana laws have abuse/dependence rates almost twice as high as states with no such laws.!! An additional study in the September 2011 issue of Annals of Epidemiology found that, among youths age 12 to 17, marijuana usage rates were higher in states with medical marijuana laws (8.6%) compared with those without such laws (6.9%).!! 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(1-3): 22-27.!! Wall, M. et al (2011). Adolescent Marijuana Use from 2002 to 2008: Higher in States with Medical Marijuana Laws, Cause Still Unclear, Annals of epidemiology, Vol 21 issue 9 Pages 714-716.! 22
Increased use? Vigorous debate, Rees/Anderson: no increase in medical marijuana states (JPAM) Pacula (RAND) and Sevigny: Two features home cultivation and dispensaries are positively associated with marijuana use and have important implications for states considering legalization of marijuana. Source: Pacula et al 2013 23
2.5 States"that"Legalized"Marijuana"Use"For"Medical" Purposes"Have"Significantly"Higher"Rates"Of" Marijuana"Use"and"of"Marijuana"Abuse"and" Dependence" Map"of"States"that"Legalized"" Medical"Marijuana"by"2004" 2 1.81 1.92 Odds"Ratio" 1.5 1 1.03 passed'laws'legalizing' ''medical'mj' 0.5 0 Past Year MJ Abuse/ Dependence " " Past Year MJ Use Past Year MJ Abuse/ Dependence Among Current Users NESARC:"National"Epidemiologic"Survey"on"Alcohol"and"Related"Conditions" Cerda"M"et"al."Drug"and"Alcohol"Dependence""2012;"120:"22" "27."
Source"of"Marijuana*"among"12 th "Graders"in"2012" and"2013,"by"state"policy" " 100 80 60 40 ** 20 0 ** Medical Marijuana States Non-Medical Marijuana States *Categories"not"mutually"exclusive"" **"Statistically"significant"difference" SOURCE:'University'of'Michigan,'2013'Monitoring'the'Future'Study'
Big marijuana Can we trust companies and Big Corporations not to target youth and the vulnerable? 26
Privateer Holdings: The first equity company dedicated to the marijuana industry. Copyright SAM and the Slides' Authors. Use with permission. 27
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Marijuana Edible Displays Copyright SAM and the Slides' Authors. Use with permission. 31
M-Cigarettes (marijuana vaporizers) Brought to you by Groupon! 33
Increasingly popular and accessible 34
Early Days of Big Tobacco Messaging 35
Colorado'Didn t'legalize'overnight' 2001' 2005' 2008' 2009' 2012' 2014' 1st'stores' Legalized' Denver' legalizes' Medical' Marijuana' passes' 700'stores' 3.5%' adults' have'mmj' license' Stores' open' Nussbaum'et'al.,'Am'J'Psychiatry'168:778:781'
Hospital Cannabis Discharge DX #( 2000 1500 1000 500 778 846 837 842 175516981774 1100 1163 1188 1218 1309 1060 0 Source:(Colorado(Department(of(Public(Health(and(the(Environment( 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
How did the first year go? Two deaths Accidental poisonings up Edibles, edibles, edibles Massive underground market Where is the tax revenue? 38
Proportion'Of'Fatal'Crash'Drivers'MJ5Positive'In'Colorado' and'' 34'States'Without'Medical'MJ,'199452011' Salomonsen5Sautel'S'et'al.,'Drug'and'Alcohol'Dependence'2014.' Proportion"of"MJ"Positive"Drivers"(%)""" Date"of"widespread" Medical"MJ" implementation"in" Colorado"(2009)" Year"
edical Marijuana egins, Stays Small Decision to allow UNLIMITED # of caregivers Commercialization begins CO youth use at 10-year high
Projected vs. Actual Tax Revenue (in millions) July '14-July '15 Jan-June February Actual Projected January 0 20 40 60 80 100 120 140
If Marijuana Were Legal, I Would Be More Likely to Use It. (Percent of High School Students Reporting They Agree Strongly or Somewhat, 2012) Agree Somewhat Agree Strongly 100% Percent Agree (Strongly or Somewhat) 80% 60% 40% 65% 38% 78% 67% 20% 0% 4% 16% 12% Never Used Marijuana (n=2,109) 27% Lifetime Marijuana User (n=1,769) 11% Heavy Marijuana User* (20+ per month) (n=270) SOURCE: The Partnership for a Drug-Free Copyright America and SAM the and MetLife the Slides' Foundation, Authors. The Partnership Attitude Tracking Study (PATS): Teens and Parents, 2013. Use with permission. 42
Track, track, track! www.legalizationviolations.com Reporting car crashes, youth use, advertising, workplace +, other costs 43
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So What Are Our Choices? All or nothing? Legalization ( Regulation ) vs. Incarceration ( Prohibition ) 45
Incarceration Agree we don t want people locked up for low-level marijuana use Depending on context, we want drug courts, brief intervention referrals, pre-arrest referral programs 46
If Only We Treated It Like Alcohol 2.7 million Arrests for alcohol-related crimes in 2008 (Does NOT include violence; Includes violations of liquor laws and driving under the influence) 847,000 Marijuana-related arrests in 2008 47
Take homes: (1)Big Marijuana is Coming (2)Things Going Badly Already (3)No False Dichotomies (4)Finally, This Isn t Inevitable 49
Thank you! KevinSabet@ufl.edu www.learnaboutsam.org www.kevinsabet.com www.legalizationviolations.com