Educators’Handbook2020

Table of Contents

Introduction ....................................................................................................................................................... 2

Our Missions ...................................................................................................................................................... 3

Facilitating a Meaningful Conversation ............................................................................................... 4

Pillars of the Curriculum ............................................................................................................................ 6

Curriculum Overview .................................................................................................................................... 8

Limited Time Objectives .......................................................................................................................... 10

Marijuana Fact Sheet ................................................................................................................................... 11

Marijuana FAQ ................................................................................................................................................. 12

Resources ............................................................................................................................................................15

References .........................................................................................................................................................16

IntroductionWelcome to the Youth Marijuana Prevention Project’s Educators’ Handbook! This handbook will provide educators with the tools, knowledge and philosophy to provide effective marijuana prevention education to students grades 5-12. It will require you to absorb health-based and data-driven information to best serve your student population. As you familiarize yourself with the topic of marijuana and how it relates to youth, keep your manual close – it will continue to serve as your road map while navigating the complex, ever-changing topic of marijuana.

As you move through the materials, you will find that this manual speaks to more than just “marijuana prevention”. In order for prevention education to be effective, educators need to be intentional about creating a safe, affirming, non-judgmental, and respectful environment where students feel supported.

Ultimately, as educators it is our responsibility to provide young people with fact-based information and risks associated with marijuana use. By creating an affirming classroom and promoting the postponement of marijuana use, we are empowering students to make healthier choices and potentially decreasing the risk of experiencing negative consequences due to substance use.

Aside from survey data—which we will review—the outcomes of prevention are often difficult to identify as effective substance use prevention is often the absence of negative consequences, addiction, and sometimes tragedy. When approached strategically, prevention education does work. Never underestimate the impact you could have on a student’s life just from facilitating one meaningful conversation.

This curriculum was developed in partnership with Prevention Education Solutions LLC, Be a Part of The Conversation, and funded by the Montgomery County Office of Drug and Alcohol through the Youth Marijuana Prevention Project.

Contact Information

Katie Greeley, LCSW Founder and Senior Prevention Consultant, Prevention Education Solutions

Katie@preventioned.org

Kim Porter, CFRS Executive Director, Be a Part of the Conversation

kim@conversation.zone

Nia Coaxum, MPH, CHES Prevention Specialist, Montgomery County Office of Drug & Alcohol

ncoaxum@montcopa.org

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Our Missions

Prevention Education Solutions

To empower youth with the facts, understanding, and critical thinking skills they need to make informed, thoughtful, and healthy choices about alcohol, marijuana, nicotine and other drugs.

Be a Part of The Conversation addresses substance use, misuse and addiction and its impact on individuals and their families by building a culture of awareness and support.

The Montgomery County Department of Health and Human Services collaboratively provides an accessible network of resources that fosters, supports, and enhances the health and well-being of Montgomery County residents.

Montgomery County residents are the focus of everything we do. Embracing a comprehensive approach, we treat each person with care and dignity.

Youth Marijuana Prevention Project (YMPP)

To raise awareness of the effects of marijuana use on the developing teenage adolescent brain.

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Facilitating a Meaningful Conversation

As educators, you already know that confidence in your knowledge of the curriculum you’re delivering is only half of what it takes to be an impactful teacher. Here are a couple things to keep in mind while delivering prevention education to students.

Beginner’s Mind Set

Staying informed on the topic of marijuana requires an ongoing commitment to the subject matter. Fostering a beginner’s mind set requires educators to be open minded, curious, willing to listen, and remain teachable. Even though we are the educators, it’s important to remember in each class we have young people in the room that are experts on their own experience and how marijuana is relevant or not relevant in their life. You will continue to learn from your students about new ways to engage with them on the topic of marijuana prevention.

Listen

If we don’t take the time to listen to our students as educators we may be missing the mark on providing young people with the most relevant information empowering them to make a healthy choice. Even though they might not have all the facts straight about marijuana, by listening we are assessing the level of knowledge among students and giving them a voice in a conversation that young people often feel is one-sided.

Open Mind

Discussing marijuana with young people requires educators to keep an open mind. The moment students sense an unwillingness from educators to consider both sides of a conversation or listen to their take on the topic, students will feel less comfortable sharing their thoughts and chalk up the lesson plan to another “drug talk.” When discussing marijuana, there is no way to avoid the intersection of medicine, social justice, discrimination, politics and morality. We can validate and (briefly) explore these talking points with students while also always bringing the conversation back to the risk marijuana presents to their health. Tip: Check the FAQ section of the Handbook for how to answer questions relating to the above topics.

Sense of Humor

Laughter is a sign that students feel comfortable with you. Jokes will be made, slang terms will be used, references will be made – laugh with your class when appropriate and keep it moving.

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Non-judgmental

If students feel judged or that being open about the topic of marijuana could potentially impact their teacher/student relationship the conversation will remain one-sided. Take time at the very beginning of class to lay out the purpose of the lesson plan – to provide students with fact-based information, not to moralize marijuana use, but to prioritize how it can impact their health. Tip: Saying the following can help set the stage for a more open classroom:

“I’m not here to judge students who uses marijuana or who don’t think marijuana use presents a risk, I’m here to say I’m concerned about the health of those students and here to provide all of you with information to make the best choice for you moving forward.”

Safe Not Confidential

Let students know that you are a mandated reporter and if they say something that indicates immediate harm to themselves or someone else that you must share that information with counselors or other adults. At the same time, students should be encouraged to freely share their thoughts and real-life perspectives on the topic of marijuana.

Boundaries

Students might inquire about an educator’s experience with marijuana or what their own “personal” opinion on legalization is. Let students know that although they have the freedom to ask those questions, as their teacher you have boundaries when it comes to your own personal life. Additionally, getting into your own personal

beliefs about the legalization of marijuana moves away from focusing on marijuana as a health issue facings young people today. Tip: Check the FAQ section of the Handbook for more information on how to answer questions about personal topics.

Flexibility

Many factors go into having a successful lesson with a class– sometimes those factors are out of our control. Pay attention to energy levels, anything out of the ordinary in the classroom, or recent events in the community that could impact the conversation. Be ready to switch up the lesson based on the class and what they’re willing to give. Ask students what they want to talk about related to marijuana – go there with them, and continue to bring those conversations back to the lesson at hand while continuing to highlight the purpose of discussing marijuana and its impact on health.

Not Having All the Answers

There are questions you will get asked that you will not know the answer to – saying, “I don’t know,” to these questions is the right answer. It will build your credibility with students. If time allows, look up the answer to the question from students by modeling using a credible source to model media literacy. Tip: If time does not allow for this during the lesson, let them know that you will find that piece of information out for them, and be sure to follow up!

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Pillars of the CurriculumEach of the following are the “pillars” of the YMPP curriculum – these are philosophies, theories, approaches, and facts that are necessary for delivering effect marijuana prevention education to students while also engaging them in the critical thought process.

Social Norms

The social norms approach to prevention is based on research that illustrates how much young people and adults consistently overestimate marijuana, alcohol, nicotine, and other drug use by their peers and other students. Throughout the YMPP curriculum, you will see notes that remind educators to highlight that the majority of young people make the choice not to use marijuana – and that the false belief that “everyone is doing it” is a risk factor for students.

You will rely on two separate surveys that support the social norms theory. The first is data on national youth use from University of Michigan’s Monitoring the Future Survey (MTF). MTF has been collecting data relating to youth substance use in 8th, 10th and 12th graders for over three decades. MTF data overwhelming supports that t

of young people don’t use marijuana, although it has highlighted a slight increase in marijuana use over the past several years.

The second survey that you will speak to that will support social norms in the classroom is the Pennsylvania Youth Survey (PAYS). PAYS has been measuring behaviors, attitudes, and knowledge relating to marijuana, alcohol, nicotine and other drugs since 1989 among 6th,8th,10 and 12th graders. The data in the YMPP curriculum represents youth use rates specific to Montgomery County.

Media Literacy

A common thing you will hear substance use prevention educators and sex and sexuality educators say is, “If they don’t get the information from you, they will find it some other way.” The massive amount of misinformation available to young people online is a risk factor. It is our responsibility as educators to be proactive in prevention and provide students with fact-based, health-based information starting at a young age.

Media literacy is defined as is the ability to identify different types of media and understand the messages each is sending. Focusing on media literacy as a talking point in the YMPP curriculum and during class discussions can significantly support the prevention impact of these conversation. Understanding the messages behind the media and the importance of getting information from a credible source can help teens

healthfully navigate away from substance use.

Here are some media literacy activities you can use to enhance the YMPP curriculum:

• Intervene on misinformation in the classroom. On your smart board or projector, pull up fact-based information about marijuana. Provide students with hard-copy, credible scientific journal articles exploring the research of marijuana as an addictive and risky drug, especially for teens.

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• Help young people draw parallels between Big Tobacco and Big Marijuana. Provide students with recent news articles about business acquisitions and mergers in the marijuana industry. Break students into small groups to create a summary of the information.

• Underscore the importance of using credible resources when learning, both in general and especially when it comes to learning about the health impacts of marijuana.

• Present arguments both for and against marijuana legalization. Engage the students by examining each side’s campaign strategies, intended impacts, and real-life effects.

• Task students with designing their own public service announcement about the negative health consequences associated with youth use of marijuana, using credible sources.

Focus on Health

Throughout the YMPP curriculum, educators should be focused on providing content through the health perspective. Focusing on health allows educators to steer the conversation towards the mission of empowering students to make the most informed choice about marijuana, alcohol, nicotine or other drugs.

What often makes teaching students about marijuana intimidating for educators is the constant influx of marijuana related news, research findings, polarizing political views, new methods of use, slang terminology and how marijuana is represented in pop-culture. By focusing on how marijuana presents risks to the still-developing teenage brain and overall health, educators can acknowledge and validate the impact marijuana has on society as a whole while always bringing the conversation back to the impact

marijuana can have on an individual’s health.

Postponement of Use

It’s likely that you’ve heard it before, “Just say no,” “Don’t do drugs,” or even, “Drugs are bad” – your students have too. Our role as educators is to provide students with as much information — not to tell them how to behave. Instead of using abstinence-based prevention slogans and approaches, educators should focus on the well documented, research supported fact that postponing substance use decreases an individual’s likelihood of experiencing addiction. Postponement of use is a core of the fact and health-based prevention curriculum.

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Curriculum OverviewEducators should familiarize themselves with each lesson plan by downloading the PowerPoint and accompanying curriculum for in-class activities. Talking points for each presentation are found in the Notes section of the PowerPoint. Each lesson plan comes with an activity, either a worksheet or supplemental materials for students to review during class. This section of the Handbook view reviews the differences in facilitating conversations with older versus younger students, as well as break down both middle school and high school materials.

PowerPoint Navigation and Supplementals

A total of five PowerPoints have been developed for high school discussions and four PowerPoints for middle school discussions. Additionally, a PowerPoint lesson plan for younger students (5th/6th grade) has been developed to discuss basics of addiction, medication, and marijuana at an age-appropriate level.

In each Note section below the individual slides you will find more detailed talking points for facilitating classroom conversations, as well as an asterisk (*) marking where an educator should “click” to reveal more information or pause to ask the class a question about the subject matter.

Educators are encouraged to use each of these PowerPoints as tools to develop lesson plans that may be time limited or focused on areas of interest depending on what students are requesting.

5th and 6th Grade Curriculum

The 5th and 6th grade curriculum was developed to help younger students develop a fundamental understanding of what addiction is, the difference between drugs and medication, the difference between adult use and use by young people and the very basics of marijuana. This curriculum was developed based on focused groups facilitated with students in 5th grade – district by district questions, knowledge and understanding of what marijuana is varied. Educators should be aware of where their students fall on the spectrum of knowledge pertaining to the topic when prepping for this lesson.

The lesson plan:

• What are Drugs, Addiction and Marijuana?

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Middle School Curriculum

Marijuana prevention education during middle school is a necessary component of keeping Montgomery County students of all ages healthy. Effective prevention is proactive, and by starting these conversations at a young-age, students are intellectually and practically prepared to make informed decisions about postponing the use of marijuana. Educators should engage students in the learning process with the goal of students understanding basic facts about marijuana and its risks. The middle school YMPP curriculum is designed to do exactly that: arm students with basic knowledge about marijuana and the risks involved in youth use. At this stage in prevention with younger students, educators should take more of a “lecture” approach to the curriculum while also answering students’ questions and correcting misinformation.

Middle school lesson plans are as follows:1. Marijuana Basics2. Marijuana and the Brain3. Marijuana and Our Health 4. Staying Healthy and Refusal Skills

High School Curriculum

The high school curriculum is driven by student engagement and meaningful conversations. Educators can increase engagement by setting the tone early on by creating a safe, non-judgmental space and affirming student’s natural curiosity on the topic while validating older students’ ranges of experiences and opinions. If you are ready to be challenged and are willing to work with instead of against resistance, you are likely to be pleasantly surprised about resulting conversations. If you feel that you are falling flat with the audience, get students more actively engaged, take a poll by a raising of hands, ask the students what they want to talk about, and proceed in that direction while keeping a health framing for the conversation.

High school lesson plans are as follows:1. Marijuana 1012. Marijuana and the Developing Brain3. Marijuana and Our Health 4. Marijuana and Media Literacy 5. Staying Healthy and Helping Others

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Limited Time ObjectivesAs educators, we are all too familiar with the time restraints placed on curriculum due to regulation, accreditation, funding, etc.. When it comes to substance use prevention, the topic may not be considered “essential” and therefore is not given the time/space for a multiple class or multiple day curriculum. If you find yourself without the time to review all lesson plans with your students consider the focusing on the following lessons.

Middle School1. Marijuana Basics2. Marijuana and the Brain3. Staying Healthy and Refusal Skills

High School1. Marijuana 1012. Marijuana and the Developing Brain3. Marijuana and Media Literacy

Also, feel free to use the PowerPoint lesson plans as a resource to create and build your own lessons based on the most pertinent information above, tailoring the content of interest to your student population.

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YMPP Marijuana Fact Sheet

• Marijuana is the most commonly used substance in the United States, following alcohol.

• Most teens do not use marijuana at all. In a 2019 survey of U.S. high school students, only 39% of students had ever used marijuana in their lives, while the majority – 61% of students – had not.

• The earlier teens start using marijuana, the more likely they are to become dependent on the drug.

• Research from National Institute on Drug Abuse (NIDA) suggest that about 9% of users become addicted to marijuana; this number increases among those who start young (to about 17%) and among daily users (25-50%).

• Marijuana edibles present different risks than smoking marijuana, including a greater risk of THC poisoning.

• Frequent marijuana use has been linked to increased risk of early onset of psychosis or psychotic disorders such as schizophrenia in some users. This risk increases in individuals who are genetically pre-disposed to psychotic disorders.

• The effects of chronic marijuana use include diminished memory, deteriorating motor skills, learning difficulties, lack of motivation, and dependency on the substance to manage feelings of discomfort.

• More young people in the United States are in treatment for marijuana than any other illicit substance.

• Consuming THC seriously impairs judgment and motor coordination. For this reason, the use of marijuana contributes to accidents while driving, more than doubling a driver’s risk of being in an accident.

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Visit conversation.zone/whoknew to learn about our media messaging campagin. You’ll find facts, not opinions.

TM

Get facts, not opinions. conversation.zone/whoknew

Youth Marijuana Prevention ProjectFrequently Asked Questions for Educators

Q: If marijuana is so unhealthy why is it legal recreationally and medically?

A: Policy and law makers don’t always create laws based on what is best for our health. There are many reasons why certain states have moved towards legalizing marijuana, but just because marijuana is becoming legal does not mean there is no risk involved with use, especially for young people.

Q: What’s the difference between THC and CBD? Can CBD get you high?

A: THC is the psychoactive ingredient known as a cannabinoid in marijuana, CBD is another cannabinoid in the marijuana plant that has been identified to have potentially medical benefits by researchers – CBD cannot produce a high and the validity of its benefits are still be examined.

Q: Is CBD good for you?

A: This is a great question. We know based on our lesson plans that CBD is the non-psychoactive ingredient cannabinoid in marijuana that has sparked interest in researchers for its potential medical benefits. You may even know teens or adults that report using CBD as a homeopathic medicine. There is even a CBD-based FDA-approved medication called Epidiolex that treat seizures in rare forms of epilepsy in both children and adults.

With that being said, there’s a big difference between CBD that’s studied by researchers for medical conditions like epilepsy and CBD products that are sold to consumers in stores.

We are still learning more about CBD every day, the question isn’t so much “is it good for you” but rather are there other proven therapies or medication I can try to treat myself.

Bottom line, anytime you decide to put something into your body you should consult your doctor. Side effects from CBD are typically minor (dry mouth, dizziness, nausea), but there can be serious negative consequences if CBD products interact with other medications you are taking.

Q: I have friends who use marijuana to help manage their anxiety and depression and it works, shouldn’t we allow them to use marijuana if its helpful?

A: Yes, marijuana may provide individuals who use it with temporary relief from symptoms of anxiety and depression – the issue is that marijuana has also been identified by researchers in disrupting adolescent brain development that includes the development of the areas that impact mood and maturity.

Additionally, if young people start to rely on marijuana to manage their symptoms of depression and anxiety they may stop developing natural coping skills to manage everyday stressors. This can create a cycle where young people rely on marijuana to relieve their

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symptoms but in actuality their symptoms tend to worsen over time due to physical dependence on the substance and lack of healthy coping skills.

Q: Do you support the legalization of marijuana?

A: I do have an opinion on the legalization of marijuana. I have concerns about the mix messages it sends to young people, how it increases accessibility and how the changing legal status of marijuana can make it seem “less risky” to young people.

Q: Have you ever used marijuana?

A: I appreciate that you feel comfortable enough with me to ask me that question, however as your teacher there are some boundaries I need to set about asking personal questions.

Q: What’s worse, marijuana, nicotine or alcohol?

A: In terms of what’s “worse” the answer is, it depends. Everyone in this classroom has very different brain chemistry from each other, the way we may experience the effects of a certain drug could vary widely. Therefore, depending on the individual, certain substance like marijuana, alcohol or nicotine might have varying effects. The substance that is the “most dangerous” is whatever substance that your brain likes the most, because that substance has the potential to cause the most negative consequences in your life and could be the hardest one for you to quit.

Q: Exactly how much marijuana would someone have to use to experience these negative health consequences?

A: When an individual uses marijuana, it’s important to know that although the intoxicating effects only last for several hours, THC is fat soluble and it is stored in the body for up to thirty days after consumption. Because of this, individuals who use marijuana can experiences the negative consequences of their use even when they are not under the influence.

Any repetitive use of marijuana can lead to someone to start experiencing these negative consequences. It’s also important

to remember that as someone’s marijuana use progresses, tolerance increases – and many researchers have yet to conclude the impact of higher potency rates in more modern marijuana and what those health consequences may look like for young people today.

Additionally, aside from the short-term and long-term consequences of marijuana use – today’s marijuana products

such as edibles, oils and concentrates present more acute risk to individuals and serious negative consequences such as driving while

intoxicated, psychosis or hospitalization can be the result of first-time or one-time use.

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Q: What do I do if I’m concerned about a friend’s marijuana use?

A: Talking to a friend that we are worried about can be intimidating – but we do it because we care for and respect that individual. Here are a few tips to help with the conversation:

1. Start by letting them know how much your friendship means to you2. Tell them that their marijuana use concerns you 3. Give an example of how their marijuana use has impacted your relationship4. Offer to go talk to an adult with them if they are struggling5. If time goes on and their use continues, get a trusted adult involved

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ResourcesEvidence-backed resources and scientific research are an important component of student marijuana education. This section of the Handbook includes credible resources to use yourself or point students towards.

CDC Websites and Webpages: CDC: Marijuana and Public HealthCDC: Marijuana Health Effects CDC: Data and Statistics CDC: Marijuana FAQs

NIDA Websites and Webpages:drugabuse.govteens.drugabuse.goveasyread.drugabuse.govdrugabuse.gov/drugs-abuse/marijuanaresearchstudies.drugabuse.govirp.drugabuse.gov

The National Institute on Drug Abuse: How does marijuana produce its effects?https://www.drugabuse.gov/publications/research-reports/marijuana/how-does-marijuana-produce-its-effects

The National Institute on Drug Abuse for Teen’s “Brain Development: The Teen Brain” and “Brain and Addiction”

https://teens.drugabuse.gov/drug-facts/brain-and-addiction

McGill University’s The Brain from Top to Bottom http://thebrain.mcgill.ca/flash/pop/pop_plan/plan_d.html

The University of Utah’s Genetics Science Learning Center https://learn.genetics.utah.edu/content/addiction/

Brainstorm: The Power and Purpose of the Teenage Brain https://www.drdansiegel.com/books/brainstorm/https://www.youtube.com/watch?v=H1pf1xTMUng

More information about the June 2020 “Need to Know” trainings:https://conversation.zone/needtoknow

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Substance Abuse Center for Behavioral Health Statistics and Quality. Results from the 2018 National Survey on Drug Use and Health: Detailed Tables, SAMHSA

Timberlake DS. A comparison of drug use and dependence between blunt smokers and other cannabis users. Subst Use Misuse. 2009;44(3):401-415. doi:10.1080/10826080802347651

ElSohly MA, Mehmedic Z, Foster S, Gon C, Chandra S, Church JC. Changes in Cannabis Potency Over the Last 2 Decades (1995-2014): Analysis of Current Data in the United States. Biol Psychiatry. 2016;79(7):613-9.

Johnston L, O’Malley P, Miech R, Bachman J, Schulenberg J. Monitoring the Future National Survey Results on Drug Use: 1975-2019: Overview: Key Findings on Adolescent Drug Use. Ann Arbor, MI: Institute for Social Research, The University of Michigan; 2019.

Pennsylvania Department of Drug and Alcohol Programs. 2019 Pennsylvania Youth Survey; Montgomery County. Montgomery County Profile Report 2019. https://www.pccd.pa.gov/Juvenile-Justice/PAYS/Montgomery County Profile Report 2019.pdf. Accessed May 11, 2020.

Antonelli T, Tomasini MC, Tattoli M, et al. Prenatal exposure to the CB1 receptor agonist WIN 55,212-2 causes learning disruption associated with impaired cortical NMDA receptor function and emotional reactivity changes in rat offspring. Cereb Cortex N Y N 1991. 2005;15(12):2013-2020. doi:10.1093/cercor/bhi076

Verrico CD, Gu H, Peterson ML, Sampson AR, Lewis DA. Repeated Δ9-tetrahydrocannabinol exposure in adolescent monkeys: persistent effects selective for spatial working memory. Am J Psychiatry. 2014;171(4):416-425. doi:10.1176/appi.ajp.2013.13030335

Batalla A, Bhattacharyya S, Yücel M, et al. Structural and functional imaging studies in chronic cannabis users: a systematic review of adolescent and adult findings. PloS One. 2013;8(2):e55821. doi:10.1371/journal.pone.0055821

Filbey FM, Aslan S, Calhoun VD, et al. Long-term effects of marijuana use on the brain. Proc Natl Acad Sci U S A. 2014;111(47):16913-16918. doi:10.1073/pnas.1415297111

Meghan E. Martz, Elisa M. Trucco, Lora M. Cope, Jillian E. Hardee, Jennifer M. Jester, Robert A. Zucker, Mary M. Heitzeg. Association of Marijuana Use With Blunted Nucleus Accumbens Response to Reward Anticipation. JAMA Psychiatry, 2016; DOI: 10.1001/jamapsychiatry.2016.1161

Miller PM. Interventions for Addiction. Amsterdam: Elsevier Acad. Press; 2013

Rubino T, Realini N, Braida D, et al. Changes in hippocampal morphology and neuroplasticity induced by adolescent THC treatment are associated with cognitive impairment in adulthood. Hippocampus. 2009;19(8):763-772. doi:10.1002/hipo.20554

Tashkin DP. Effects of marijuana smoking on the lung. Ann Am Thorac Soc. 2013;10(3):239-247. doi:10.1513/AnnalsATS.201212-127FR

Owen KP, Sutter ME, Albertson TE. Marijuana: respiratory tract effects. Clin Rev Allergy Immunol. 2014;46(1):65-81. doi:10.1007/s12016-013-8374-y

Campolongo P, Trezza V, Cassano T, et al. Perinatal exposure to delta-9-tetrahydrocannabinol causes enduring cognitive deficits associated with alteration of cortical gene expression and neurotransmission in rats. Addict Biol. 2007;12(3-4):485-495. doi:10.1111/j.1369-1600.2007.00074.x

Lopez-Quintero C, Pérez de los Cobos J, Hasin DS, et al. Probability and predictors of transition from first use to dependence on nicotine, alcohol, cannabis, and cocaine: results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Drug Alcohol Depend. 2011;115(1-2):120-130. doi:10.1016/j.drugalcdep.2010.11.004

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Anthony JC. The epidemiology of cannabis dependence. In: Roffman RA, Stephens RS, eds. Cannabis Dependence: Its Nature, Consequences and Treatment. Cambridge, UK: Cambridge University Press; 2006:58-105.

Brents LK. Marijuana, the endocannabinoid system and the female reproductive system. Yale J Biol Med 2016;89:175-191.

Amoako AA, Marczylo TH, Marczylo EL, et al. Anandamide modulates human sperm motility: Implications for men with asthenozoospermia and oligoasthenoteratozoospermia. Hum Reprod 2013;28:2058-2066.

Macleod J, Oakes R, Copello A, et al. Psychological and social sequelae of cannabis and other illicit drug use by young people: a systematic review of longitudinal, general population studies. Lancet Lond Engl. 2004;363(9421):1579-1588. doi:10.1016/S0140-6736(04)16200-4

Diamond G, Panichelli-Mindel SM, Shera D, Dennis M, Tims F, Ungemack J. Psychiatric Syndromes in Adolescents with Marijuana Abuse and Dependency in Outpatient Treatment. J Child Adolesc Subst Abuse. 2006;15(4):37-54. doi:10.1300/J029v15n04_02

Lenné MG, Dietze PM, Triggs TJ, Walmsley S, Murphy B, Redman JR. The effects of cannabis and alcohol on simulated arterial driving: Influences of driving experience and task demand. Accid Anal Prev. 2010;42(3):859-866. doi:10.1016/j.aap.2009.04.021

Hartman RL, Huestis MA. Cannabis effects on driving skills. Clin Chem. 2013;59(3):478-492. doi:10.1373/clinchem.2012.194381

Fergusson DM, Boden JM. Cannabis use and later life outcomes. Addict Abingdon Engl. 2008;103(6):969-976; discussion 977-978. doi:10.1111/j.1360-0443.2008.02221.

McCaffrey DF, Pacula RL, Han B, Ellickson P. Marijuana Use and High School Dropout: The Influence of Unobservables. Health Econ. 2010;19(11):1281-1299. doi:10.1002/hec.1561

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