Gulf Coast Conference 2016 copy - University of South Alabama€¦ · 10/10/2016 2 General Overview •Marijuana use nearly doubled between 2001‐2002 and 2012‐2013. •Marijuana

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MARIJUANAWeeding out the Facts

October 2016

The AAP Policy Statement“The Impact of Marijuana Policies on Youth: Clinical, Research, and Legal Update”

March 2015

The Academy reaffirms its position against the legalization of marijuana, states its opposition to “medical marijuana” outside the FDA regulatory process, and presents recommendations to protect children in states that have legalized marijuana for medical or recreational purposes.

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General Overview

•Marijuana use nearly doubled between 2001‐2002 and 2012‐2013.

• Marijuana use now surpasses tobacco use for many young people.

University of Michigan's Monitoring the Future

JAMA Psychiatry October 2015

Lancet Psychiatry, August 2016

NIH October 2015

Marijuana Basics

Contains hundreds of chemicalsCannabinoids (@ 100)THC & CBD

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Marijuana Basics


Smoked, Vaped, Dabbed, or Eaten

Marijuana Basics



Impacts multiple organ systems

Marijuana Basics



Impacts multiple organ systems

Stays in body extended period of time Implications for school, work, &driving

Update on Cannabis and its Medical Use, B. Madras

NEJM, N. Volkow

NIDA

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Marijuana is Addictive

Addiction

Recent data shows that 30% of marijuana users may have some degree of marijuana use disorder

9% of adults and 17% of young adults who try marijuana will become addicted

NIDA: Rate increases to 25‐50% for those who use on a daily or near daily basis

NIH, October 2015NIDA

The younger a kid is when they start using pot, the more likely they will become addicted.

Source: Anthony, J.C., Warner, L.A., & Kessler, R.C. (1994): Giedd J. N., 2004

SAM Resources

The adolescent brain is especially to susceptible to marijuana use

When kids use pot, they have a greater chance of addiction since their brains are still developing.

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Marijuana is not Harmless

Marijuana related ER visits & Hospitalizations

American Public Health Association Meeting, 2015

Inpatient admissions related to marijuana 82%2007 to 2011

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Potency ‐ last 5 years in CO

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2010 2011 2012 2013 2014 2015

THC in CO

THC in CO

SAM Summit, 2016

No Longer “just a plant”(40‐90 % THC Concentrates)

Butane Hash Oil (BHO)

“Budder”

“Green Crack” wax

“Ear Wax”

“Shatter”SAM Resources

“710”

Pulmonary

• Marijuana smoke contains the same if not greater number of carcinogens and toxins that are present in tobacco smoke

• Pot smoke deposits more tar than cigarettes

• Chronic cough, wheezing, frequent respiratory infections, persistent phlegm production

American Lung Association

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http://www.cadca.org/resources/study‐finds‐one‐six‐children‐hospitalized‐lung‐inflammation‐test‐positive‐marijuana

1 in 6 Children Hospitalized for Lung Inflammation

Test Positive for Marijuana Exposure in Colorado

16% of children exposed to marijuana smokers had positive drug tests for (THC)

More of the children were THC positive after legalization (21 % vs 10%)

Secondhand marijuana smoke contains carcinogenic and psychoactive chemicals and is a “rising child health concern.”

“Marijuana should never be smoked in the presence of children."

Cardiovascular

Temporal links:

Stroke

Arrhythmias

Sudden Cardiac Death

Second hand marijuana smoke as dangerous on blood vessels as second hand tobacco smoke

Heartwire, 2014

Journal of the AHA, 2016

Cannabinoid Hyperemesis Syndrome

• Typically affects heavy users

• Event can last from hours to several days and can reoccur over period of weeks to months.

• Other complaints include abdominal pain, polydipsia and resultant fluid/electrolyte disturbances

• Minimal response to antiemetic medicines. Hallmark of attacks is need for repetitive hot showers.

• No formal diagnostic testJAOA, March 2011

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Brain

Medscape Medical News

March 17, 2016

Legalized Cannabis and the Brain: NIDA Sounds the Alarm

Neuropsychological Decline

Cannabis and Psychosis

Contributor to Mental Illness

Journal of Neuroscience, 2014

“BRAIN CHANGES ARE ASSOCIATED WITH CASUAL MARIJUANA USE IN YOUNG ADULTS”

Society for Neuroscience

• Young people identified as light users (1 or 2x per week) had significant differences in the size and shape of two brain structures.

• Changes in motivation, decision making, attention, functional memory, and processing of emotions.

• More marijuana users reported using, greater the abnormalities.

Effects occurred even in those who were not addicted

The “Dumbing Down Effect”

Marijuana affects regions of the brain responsible for

MemoryReaction Time

AttentionLearning

Effects can last for days

Source: Giedd, J N, 2004

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Proceedings of the National Academy of Sciences (PNAS), 2012

“PERSISTENT CANNABIS USERS SHOW NEUROPSYCHOLOGICAL DECLINE FROM CHILDHOOD TO MIDLIFE”

Meier et al

• “Persistent, heavy cannabis use from adolescence into adulthood associated with significant neuropsychological decline”

• Dose dependent affect

• Impact showed potential IQ decrease of up to 6‐8 points

• Data suggested non‐reversible/permanent change

JAMA Internal Medicine

“ASSOCIATION BETWEEN LIFETIME MARIJUANA USE AND COGNITIVE FUNCTION IN MIDDLE AGE; THE CORONARY ARTERY RISK

DEVELOPMENT IN YOUNG ADULTS STUDY”

Auer, et al

• Exposure to marijuana is associated with worse verbal memory

• Degree of impact on verbal memory was dose dependent; the longer one reported smoking, the more the effect

Lancet Psychiatry, 2015

“Proportion of patients in south London with first‐episode psychosis attributable to use of high potency cannabis: a case‐control study”

DiForti et al

• Daily to Weekend use of high potency marijuana (16%) increases risk 3‐5x

• High potency marijuana responsible for 24% of adults with first‐episode of psychosis in southern area of London.

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American Journal of Psychiatry, 2016

“Concurrent and Sustained Cumulative Effects of Adolescent Marijuana Use on Subclinical Psychotic Symptoms”

Betchtold et al

• Adolescents are more likely to have psychotic symptoms such as paranoia during and after years of regular marijuana use.

• For each year of regular use, “projected level” of such symptoms increased 21%

• Effect persisted even after use stopped for 1 year.

Marijuana use affects life outcomes

Research shows that regular marijuana users have:

• Poorer educational outcomes

• Lower income

• Greater welfare dependence and unemployment

• Lower life satisfaction

Journal of the American Medical Association

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Medical Associations & opposition to state‐based, non‐FDA approved marijuana as medicine

• Medical Association of the state of Alabama (AMA)

• Alabama Chapter of the American Academy of Pediatrics (AAP)

• Alabama Chapter of the American College of Cardiology

• American Society of Addiction Medicine(ASAM)

• American Cancer Society

• American Glaucoma Foundation

• National Multiple Sclerosis Society

• American Psychiatric Association

Journal of the American Medical Association (JAMA), 2015

• Scientific review of literature (79 studies and 6,000 patients)

• “Evidence does not support “medical” marijuana for most of the diseases and conditions states are permitting.”

• “For most qualifying conditions, approval has relied on low quality scientific evidence, anecdotal reports, individual testimonies, legislative initiatives, and public opinion.”

Scientific Process

‘Provides essential protection for patients by promoting safe and effective medications”

• Assures standardization: purity, potency, and consistency• Pre‐clinical and clinical studies give data to insure adequate prescribing information

• Efficacy and risk/benefits clearly delineated and defined through clinical trials

FDA’s Drug Review Process. Retrieved from www.FDA.gov/Drugs/ResourcesForYou/Consumers/ucm289601.htt

Facts About the Current Good Manufacturing Practice. Retrieved from: www.fda.gov/Drugs/DevelopmentApprovalProcess/Manufacturing/UCM169105.htm

B. Madras, Marijuana Schedule 1

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Marijuana as “medicine”

•We don’t smoke medicine

Marijuana as a Medicine, B MadrasJAMA 2015IOM report


• We don’t smoke medicine

•Contains hundreds of chemicals most unknown, untested, and highly variable




• Hundreds of chemicals

• Efficacy and short and long term side effects are not clearly elucidated


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• Hundreds of chemicals

• Efficacy and short and long term side effects not elucidated

• Impacts multiple organ systems with increasing amount of data showing significant adverse effects


Residents of states with medical marijuana laws have abuse/dependence rates almost twice as high

as state with no such laws.

Reefer Sanity, K Sabet

R

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University of Pittsburgh School of the Health Sciences August 2015

•Places with more “medical” marijuana dispensaries, have more marijuana‐related hospitalizations

• Marijuana codes ↑ overall2001: 17,469

2012: 68,408

• “Each additional dispensary per square mile in a zip code associated with 6.8% ↑ in hospitalizations linked to marijuana abuse and dependence.”

Legitimate medicines made from marijuana components

Nabilone, Dronabinol, SyndrosFDA approved/available by RX

SativexClinical trials

EpidiolexFDA expanded access program(Carly’s Law ‐ UAB study) “Orphan” drug status

$185BILLLION

$200BILLION

$14 Billion

Tobacco Costs

Source: State estimates found at http://www.nytimes.com/2008/08/31/weekinreview/31saul.html?em; Federal estimates found at https://www.policyarchive.org/bitstream/handle/10207/3314/RS20343_20020110.pdf; Also see http:// www.tobaccofreekids.org/research/factsheets/pdf/0072.pdf; Campaign for Tobacco Free Kids, see “Smoking-caused costs,” Sam resources

ALCOHOL & TOBACCO: MONEY MAKERS OR DOLLAR DRAINERS?

$25Billion

REVENUE

REVENUE

Alcohol Costs

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DrugUse

Perceived Harm

Availability

Social Norms

Clearing the Haze, C. Thurstone, MD

Colorado now for youth usage

Age 12‐17: 12.6%Age 18‐25: 31.2%

Up from #4 in 2011/2012 and #14 in 2005/2006. RMHIDTA Report, 2016

The Legalization of Marijuana in Colorado: The Impact

RMHIDTA

Impaired Driving

Youth Marijuana Use

Adult Marijuana Use College age and up

Emergency Department and Hospital Marijuana‐Related Admissions

Marijuana‐Related Exposure

Diversion of Colorado Marijuana

Crime

•2006 – 2008: Medical marijuana pre-commercialization era•2009 – Present: Medical marijuana commercialization and expansion era •2013 – Present: Recreational marijuana era

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Marijuana‐related ER visits & Hospitalizations Colorado

Data looking at two‐year average since legalization (2013‐2014) compared to two‐year average before (2011‐2012)

• Hospitalization rates likely related to marijuana showed 32% increase

• ER rates likely related to marijuana showed 49% increase

RMHIDTA IMPACT DATA

RMHIDTA, 2016

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Impact Data (Northwest HIDTA)

• Children:• Last‐year use (ages 12+) 23% from (2011‐12 to 2013‐14)• Marijuana poisoning calls to the Washington State Poison Center 54% from 2012‐2014.

• Road Safety:• Marijuana related Driving DUI’s 19% • Marijuana related Fatal accidents 120% (2010‐2014).

Educate

• Begin educating early & talk frequently. • Risk taking behavior often starts young. • Prioritize marijuana education.• Look for “teaching” moments.• Include parents and family members.

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Parents strongdisapproval

Parents not strongdisapproval

Parental Attitudes toward Marijuana Use

Source: NSDUH Data 2013

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Educate

• Educate early & often.

• Empower kids with knowledge

• Base all conversations on facts. • Be critical of media messaging and talk about these drug‐related messages in the media.

• Use reliable sources of information and seek outhigh‐quality peer reviewed studies.

Educate



• Role play real life situations so child can respond appropriately when offered drugs or when friends are using around them.

Educate



• Role play real life situations

• Make sure child knows parental rules related to drug use and the consequences if broken.

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get the facts on

medicat ion abuse

KNOWLEDGE IS THE KEY

Steps to Prevent Medicat ion Abuse at Home:

• Most young people obtain these mediat ions from homemedicine cabinets. Secure, monitor, and dispose of medicat ionsproperly.

• Contact your local police department or pharmacy for take-back disposal options in y our area.

• If a take-back location is not available and you must disposeof meds at home, crush them up and dispose of t hem in anundesirable substance- like cof ee grounds or kitt y lit ter andthen throw them in the trash. Addit ionally, there are productsyou can purchase that can aid in safe home disposal. http://deterrasystem.com

• Flushing medicine is NOT advised. It contaminates the waterand creates an environmental hazard.

Resource: DrugFacts: Prescript ion and Over-the-Counter Medicat ions ht tps:/ /goo.gl/ 7Km1tI

Over the counter and prescript ion medicat ions ar e powerful. When used correctly, they can be helpful for some patients, but w hen used incor rect ly, they can be deadly.

Someone is abusing medicines if t hey take a medicat ion t hat w as prescribed for someone else or in a w ay not prescr ibed by a doctor.

Commonly abused medicat ions:

PRESCRIPTION PAIN RELIEVERS such as Vicodin, Lortab, and Oxycontin.

STIMULANT MEDICATIONS such as Adderall and Ritalin.

COUGH AND COLD MEDICATIONS that contain dextromethorphan, pseudoephedrine, or codeine.

CAFFEINE MEDICINES AND ENERGY DRINKS

DIET PILLS/LAXATIVES In high doses, diet pills can gi ve a “buzz”. Some teens use t hese and laxatives in an ef ort to lose weight. Often, they can signify an underlying eating disorder.

BROUGHT TO YOU BY: Drug Free Alabama

get the facts on

e-cigaret tesKNOWLEDGE IS THE KEY

What are e-cigarettes?• E-cigarettes are battery operated devices t hat deliver nicotine,

flavorings, and other chemicals.

• Although many look like traditional cigarettes, many can look likepens, highlighters or even flash drives.

E-cigarettes and vape devices are being used to abuse ot her drugsas well (i.e. marijuana). The typical smell associated w ith smokingmarijuana is not pr esent when it is being vaped. This can often make itimpossible to know what is being used in such a device.

• Keep e-cigarettes and liquid nicotine secur ely locked. Thesesolutions are dangerous and can poison bot h adults and children.It takes a very small amount to be deadly t o a child.

• Talk to kids about t he dangers of smoking and e- cigarettes.

• Set clear expectations regarding no tobacco use.

What’s the big deal?• The long term health ef ects of e-cigarettes are currently not

known.

• Many e-cigarettes contain nicotine (a highly addict i ve substance)and the solut ions used with these devices have been found tocontain toxic chemicals.

• Burns, body-scarring blasts, and mini- exp losions have beenassociated w ith their use.

Resources: E-cigarettes and Lung Health http:/ /goo .gl/9zCluOElectronic Nicotine Delivery Systems htt p:/ /goo .gl/608hzy


ALTHOUGH TEEN USE OF TRADITIONAL CIGARETTES HAS BEEN DECREASING, MORE AND MORE TEENS ARE USING E-CIGARETTES OR VAPE DEVICES.


get the facts on

drug paraphernalia


• Stay informed about what is out t here; these trends changeregularly

• Talk openly w it h your kids about dangers and consequences ofusing alcohol and ot her substances

• Lock up all medications (prescript ion and OTC) and alcohol inyour household

• If you see something that causes suspicion, say something

• Trust your gut

• Reach out to community resources for help when needed

Resource: DrugFacts: Prescript ion and Over-the-Counter Medications https://goo.gl/ 7Km1tI

ONE OF THE MOST POPULAR ADOLESCENT TRENDS TODAY INVOLVES HIDING DRUGS AND PARAPHERNALIA IN PLAIN SIGHT.

Often this involves using everyday i tems such as water bott les, deodoran t st icks, soft drink cans, cof ee mugs, mint/ gum containers, etc. as concealment . Adolescen ts know that paren ts see these i tems as harm less and are not aware of t heir alternate uses.

Paraphernalia is very easy for our adolescents to purchase or make themselves. You can purchase many of these items in local head shops (liquor or tobacco stores), vaping shops, from online retailers, and also in local st ores such as Spencer ’s Gifts, Lids, and Hot Topic. Monitor your teen’s mail, and int ercept any packages you see as suspicious (especially ar riving from Colorado, Washington state, or China).


What can parents do?get the facts on

safetyKNOWLEDGE IS THE KEY

Prom and Graduation

Parents: Have a Plan• Talk with your kids about your concern for thei r health and

safety. Make sure they know you expect them to celebrate wi thout alcohol or o ther drugs.

• Know the plan for the evening. Make sure your child know s that you are available at any time to pick them up if necessary.

• Discuss plans for post -prom part ies. Call the host parents and ask questions about super vision. Assure that no alcohol or drugs w ill be allow ed.

• If you are hosting a prom party, call in rein forcem ents. Ask other parents to help chaperone. Set a clear po licy of no alcohol or other drugs.

• If you’re using a limousine service, speak di rect ly to the driver and discuss your expectat ions for a drug and alcohol free ride. Tell the driver you don’t want any extra stops made to and from prom.

• Wait up and greet your teen w hen they return home. Praise them for making good decisions.

A k hild t i th S f P /G d ti Pl d

Prom and Graduation can be a t ime when students p art icipate in r isky behaviors. However, w ith careful planning, open communication , and appr opr iate monitor ing, student s can have fun and m ake last ing m emories w it h fr iends.

Heroin, Tobacco, Marijuana, Medication Abuse, Prom and Graduation Safety, Parenting Tips, Alcohol, Synthetics, Drug Paraphernalia

get the facts on

alcoholKNOWLEDGE IS THE KEY

Teen alcohol use can seriously impact brain development , damaging critical areas in t he brain responsible for learn ing and memory.

Adolescent drinkers do w orse in school and have an increased risk of social issues, depression, suicidal t houghts, and vio lence. Teens that drink are more likely to be sexually acti ve.

When youth drink they tend to drink heavily, often consuming 4 t o 5 drinks in a short amount of time. This is know n as binge drinking.

Binge drinking is danger ous. It hurts decision making, cr eates a loss of control over emot ions, and alt ers heart rate and temperature. It can even alt er consciousness. It can r esult in death from alcohol poison ing.

What can parents do?• Discuss the dangers associated with underage drinking

• Monitor and lock up any alcohol in your home

• Model behavior that you want your kid’s to follow. Kids look at t he adults in their lives to know what’s acceptable. Practice safe driving habits. A designated driver is someone with no alcohol in their system.

• If you have a blood relative with a history of addiction (or any problems with alcohol) consider making your home an alcohol- free zone and w arn your kids that they m ay have a genetic predisposition to alcoholism .

• Set clear expectations of no alcohol use under 21. Research shows that kids really do listen to their parents when deciding to drink or not.

• Help your kids lear n and practice skills so t hey can avoid underage drinking and peer pressure from their friends and others.

• Pay attention to where your kids go and who they’re with. Get to know the parents of your kids’ friends. Just having an adult presen t doesn’t always guarantee a safe environment. Make sure your kids know that you will pick them up anywhere anytime with no questions asked, and praise them for their wise decisions.

Prevention Partnership of AlabamaBROUGHT TO YOU BY:

ALCOHOL IS A DRUG AND UNDERAGE DRINKING IS A LEADING PUBLIC HEALTH PROBLEM IN THE US.

get the facts on

MARIJUANAKNOWLEDGE IS THE KEY

Concentrates and Edibles

• Talk to your chi ldren about the dangers of all forms of marijuana.

• Be aw are that marijuana concentr ates can be hidden in plain sight.

Resources: Mari juana “Edibles” Make Candy Complicated http:/ /goo .gl/GRrvXq DrugFacts: What is Mari juana ht tps://goo .gl /yslKaq


Mari juana is no longer just a p lant. It now comes in a variety of forms such as oils, w axes, and solid and liquid food products.

Concentrates are products wi th high levels of THC (the m ind alter ing part of the plant). Concentrate THC levels can be near 60-90% and they can be smoked, vaped, dabbed, or infused into food products.

Mari juana edibles contain varying amounts of THC. These products include chocolate and hard candy, baked goods, fr uit drinks, and more. They are often indistinguishable from regular food.

Unlike smoking marijuana which produces ef ects almost immediat ely, eat ing marijuana produces its ef ect anyw here betw een 30min to 2hrs. In addition, the high associated with ingestion can last much longer, often up to 12 hours.

These products are harmful to heal th and can cause a variety of ef ects:

• altered senses and changes in mood and behavior

• dif culty with thinking and problem-solving, impaired memory,learning, and att ent ion

• mental health impacts including hallucinat ions and p aranoia

Wax Hash Oil

get the facts on


MYTH Marijuana is not AddictiveMarijuana is addict ive. According to the National Institute on Drug Abuse, 1 in 6 teens who smoke marijuana w ill become addicted. This rate increases to 25-50% for those w ho smoke on a daily or near daily basis.

Teens are more susceptible to marijuana use and addiction because their brains are st ill forming. The younger you are w hen you t ry pot , the more likely you w ill become addict ed.

solut ion Knowledge is KeySIGNS AND SYMPTOMS OF MARIJUANA USE• Confusion and lack of focus

• Bloodshot eyes (use of eye drops)

• Altered mental state and abrupt mood changes

• Fatigue and general lack of motivation

• Dropping studies or usual activities

• Change in eat ing habits

• Paraphernalia (pipes, rolling papers, shreddedleafy debris, small bot t les of oil, vape pens)

• In some cases, adverse mental reactions includinganxiety, fear, dist rust , panic, or psychosis

More In format ion: NIDA—”Available Treatments for Marijuana Use Disorders” http:/ /goo.gl/5GPlcz


get the facts on


MYTH Marijuana is Not HarmfulMarijuana harms the brain Marijuana use im pairs attention, mem ory, and learning. Research has shown that heavy and persistent use of pot from adolescence into adulthood can impact and decrease IQ by up to 8 points.

Pot use is linked to mental health issues, such as anxiety, depression, amotivational syndrome, and psychosis.

Marijuana harms the lungs The Am erican Lung Association has reported that pot smoke has m any of the same toxins, irr itants, and cancer causing agents found in tobacco smoke. It also creates more tar deposits than traditional cigarette smoke.

Marijuana harms the heart Research shows that pot smoke is just as damaging to our cardiovascular system as tobacco smoke. There is a link between using pot and stroke, abnormal heart rhythm s, and sudden cardiac events.

solut ion Knowledge is Key• Communicate to kids that m arijuana use harms

their future. More In formation: NIDA—”What aremari juana’s long-term ef ects on the brain?”http://goo.gl/S6tkun

• Set and enforce clear no m arijuana use rules

• Monitor your kids: Know where they are and whothey are with


get the facts on


MYTH Marijuana is No Big DealToday’s marijuana is 5 t imes stronger than the marijuana of the 80’s and 90’s. Some forms of pot have between 60-90% THC (the active chemical that causes the high).

Pot continues to af ect the body long after the high is gone. Pot stays in the body for hours to days (weeks in regular users) after smoking, eating, dabbing, or vaping. For example, using pot on the weekend can negatively impact schoolwork days later. Pot harms attention, motivation, learning, and school success.

solut ion Knowledge is Key• Stay up-to-date with current marijuana trends.

Visit the National Institute on Drug Abuse atwww.drugabuse.gov

• Talk to your kids about the risks

• Communicate clear no marijuana use rules

• Monitor your kids: Know where they are andwho they are with


Marijuana

https://www.alsde.edu

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NIDA, www.nida.orgMarijuana facts for teens and parents

NEJM, Adverse Health Effects of Marijuana Use Volkow et al, 2014

Edventi, www.edventi.comMarijuana education /Industry marketing

Documents

Gulf Coast Conference 2016 copy - University of South Alabama€¦ · 10/10/2016 2 General Overview •Marijuana use nearly doubled between 2001‐2002 and 2012‐2013. •Marijuana