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Kevin A. Sabet, Ph.D. Director, Drug Policy Institute, University of Florida
Co-Founder, Project SAM (Smart Approaches to Marijuana)
www.learnaboutsam.org www.kevinsabet.com
1
New Challenges in the
Anti-Drug Scene:
Cannabis
2
The false dichotomy:
“Legalization OR
Incarceration?”
Legalization =
Big Marijuana
4
5
Why should we
care about
marijuana?
6
Myth
Marijuana Is
Harmless and
Non-addictive
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Cannabinoid Receptors Are Located Throughout the Brain and Regulate:
• Brain Development
• Memory & Cognition
• Motivational Systems & Reward • Appetite
• Immunological Function
• Reproduction
• Movement Coordination
• Pain Regulation & Analgesia
1 in 6 teens become addicted
• The adolescent brain is especially susceptible to marijuana use.
• When kids use, they have a greater chance of addiction since their brains are being primed.
Wagner, F.A. & Anthony, J.C. , 2002; Giedd. J. N., 2004
1 in 11 adults and 1 in 6 adolescents who try marijuana will become
addicted to it.
8
Long Term Effects of Marijuana Addiction: About 9% of adult users may become dependent,
1 in 6 who start use in adolescence
32
15
9
17
118
5
23
0
5
10
15
20
25
30
35
Percen
t
Source: Anthony JC et al.,
1994
Estimated Prevalence of Dependence Among Users
* *
1960
1965
1970
1974
1978
1980
1983
1984
1985
1986
1990
1992
1993
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
THC 0 0 0 0 1 1 2 3 3 4 4 3 3 4 5 5 5 5 5 6 7 7 8 8 9 10 10 10 11 11
CBD 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0
0
2
4
6
8
10
12
14
MA
RIJ
UA
NA
PO
TE
NC
Y
CBD: NON-
Psychoactive Ingredient
Average THC and CBD Levels in the US: 1960 - 2011
Mehmedic et al., 2010
THC: Psychoactive
Ingredient
10 Copyright SAM and the Slides' Authors.
Use with permission.
98% Pure Marijuana: “Just a Plant” ?
“Budder”
“Shatter”
“Ear Wax” “Green Crack” wax
Hash Oil Capsules
Butane Hash Oil (BHO)
Copyright SAM and the Slides' Authors. Use with permission.
11
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.
12
Early Marijuana Use and Intensity of Use are
Associated with Educational Attainment
High School Completion
-12%**
-1%
-
28%***
-
11%***
< Age 14 > Age 14
Low Intensity Med/High Intensity
*** p<0.01, ** p<0.05
Source: Cobb-Clark et al. http://ftp.iza.org/dp7790.pdf
Young people who begin
marijuana use at a young
age and use it intensively
have a higher probability
of dropping out of high
school.
University Entrance Score
-2.4%
0.4%
-
10.1%*
**
-1.9%
For those that do
successfully complete
high school and obtain a
university entrance score,
med-high intensity use is
associated with scores on
average 10 percentiles
lower than their peers.
< Age 14 > Age 14
Source: Meier MH et al., PNAS Early Edition 2012.
Reductions in IQ
Adolescent Vulnerability
Ch
an
ge
in
Fu
ll-S
ca
le I
Q
(in
sta
nd
ar
d d
ev
iati
on
un
its
)
0.4
0.2
0
-0.2
-0.4
-0.6
-0.8 p=.44 p=.09 p=.02
Cannabis Dependent
Before Age 18 (n=17)
Cannabis Dependent
Before Age 18 (n=12)
Cannabis Dependent
Before Age 18 (n=23)
Not Cannabis Dependent
Before Age 18 (n=57)
Not Cannabis Dependent
Before Age 18 (n=21)
Not Cannabis Dependent
Before Age 18 (n=14)
1 Diagnosis 2 Diagnoses 3 Diagnoses Dunedin prospective study of 1037 Ss born 1972/73, Tested for IQ at age 13 and 38y. Tested THC use ages 18, 21, 26, 32 and 38y
More Use of Cannabis Associated with Worse Social Outcomes at Age 25 (New Zealand Study)
Source: Fergusson and Boden. Addiction, 103, pp. 969-976, 2008.
Number of occasions using Cannabis between ages 14-21
% welfare dependent
(ages 21-25)
% Unemployed (ages 21-25)
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 14-
21
Ad
jus
ted
Od
ds
Ra
tio
s
0 2 4 6 8
10 12 14 16 18 20
Less than Monthly
Monthly or More
Weekly or More
Daily
Maximum Frequency Of Cannabis Use Before Age 17 Years, And Each Young Adult Outcome
clear and consistent associations and dose-response relations were found between the frequency of adolescent cannabis use and all adverse young
adult outcomes
Silins E et al., The Lancet September 2014.
0
0.2
0.4
0.6
0.8
1
1.2
1.4
High School Completion
Degee Attainment
Depression Welfare Dependence
Cannabis-Associated Psychosis
Andréasson et al Lancet, 1987.
0 1 2 10 <50 >50
30
20
10
0
No of times cannabis taken
Cases of Sz per 1,000
4.5
1.6
0
1
2
3
4
5
6
7
8
9
Cannabis users by age 15 years
Cannabis users by age 18 years
Arseneault et al BMJ 2002
Risk of schizophrenia-like psychosis at age 26 years
Od
ds
rati
o
CANNABIS AND SCHIZOPHRENIA Study of Swedish Conscripts (n=45570)
CANNABIS AND SCHIZOPHRENIA-Like Longitudinal prospective Dunedin study (n=1037)
Increased use can lead to increased
drugged driving
• “Drivers who test
positive for marijuana or
self-report using
marijuana are more than
twice as likely as other
drivers to be involved in
motor vehicle crashes.”
18 Mu-Chen Li, J.E., et al., 2011
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. 19
20
Myth
Smoked
Marijuana is
Medicine
“We will use [medical marijuana] as a red-herring to give marijuana a
good name.” —Keith Stroup, head of NORML to the Emory Wheel, 1979
• Advocates have pushed their agenda through
“medicine by popular vote” rather than the rigorous scientific testing system devised by the FDA.
Legalization behind the smokescreen
Emory Wheel Entertainment Staff, 6 February 1979 21
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
Compassionate care or increased
access to marijuana?
<5%
• Less than 5% of card holders are cancer, HIV/AIDS, or glaucoma patients
• Average user: 32
WM, no illness
Bottom Line
We don’t smoke opium to get the
effects of morphine.
So why would we smoke
marijuana to get its potential
medical effects?
Cannabis-Based Medicines Research on the efficacy of
cannabinoids is not focused on raw/crude marijuana, but in the individual components that may have medical use.
Sativex is in the process of being studied (phase III trials)
Approved in Canada and
across Europe
Administered via an oral spray
25
Epidiolex™
98% pure CBD
Some effectiveness for
seizures Many versions on market
which are not purified or standardized
26
27
Myth
The Legality of
Alcohol and Tobacco
Strengthen the Case
for Marijuana
Legalization
Alcohol and Tobacco: A Model?
• Use levels for alcohol and tobacco are much higher than marijuana
• Industries promote addiction and target kids
28
Schiller JS, Lucas JW, Peregoy JA. Summary health statistics for U.S. adults: National Health Interview Survey, 2011. National Center for Health Statistics. Vital Health Stat 10(256). 2012. Centers for Disease Control and Prevention. Vital Signs: Current Cigarette Smoking Among Adults Aged ≥ 18 Years—United States, 2005–2010. Morbidity and Mortality Weekly Report 2011;60(33):1207–12
Will legalization diminish the power of cartels and the black market?
• In a legal market, where drugs are taxed and regulated (for instance to keep THC potency below a certain level or to prevent sale to minors), the black market has every incentive to remain
• Would legalizing marijuana would not deter these groups from continuing to operate?
Kilmer, B., et al., 2010 29
‘Big Marijuana’
Can we trust companies and Big
Corporations not to target youth and the
vulnerable?
30
Copyright SAM and the Slides' Authors. Use with permission.
31
Privateer Holdings: The first equity company
dedicated to the marijuana industry.
Early Days of Big Tobacco Messaging
33
Alcohol & Tobacco:
Money Makers or Dollar Drainers?
35
Alcohol
Costs T obacco
Costs
$14 billion
Costs
Revenues
$25 billion
$200 billion
$185 billion
Revenues
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,” on p.2.
36
Myth
Portugal and Holland Provide
Successful Examples of Legalization
Neither Holland nor Portugal
have legalized ANY drug
37
No modern nation has tried legalization, though most Western countries do not imprison people for simple marijuana
possession. • Use rates in the Netherlands, Portugal, and Italy in the
last 10 years are lower for some drugs and higher for others.
• The Dutch experienced a three-fold increase in marijuana use among young adults after commercialization expanded.
Legalization: Experience elsewhere?
38
In 2001, Portugal changed policy to send users with small amounts of drugs to “dissuasion panels”
– social worker panels who refer individuals to treatment, administer fine, etc.
Portugal also implemented robust treatment plan
Portuguese policy
39
• Youth use has increased since 2001
• Deaths have gone down
• The impact of the policy unclear, despite extreme rhetoric
Results are mixed
40
The Dutch established the Non-enforcement Policy in 1976 and saw the birth of “Coffee Shops”
Dutch policy
41
• Experienced a three-fold increase in marijuana use among young adults
• Before Non-Enforcement, the Dutch always had lower rates of drug use than the US.
• Holland is now #1 country in Europe with marijuana treatment need
• Scaling back policy
• Coffee Shops Closing
• Cannot sell to non-residents
Results
42
43
Colorado and
Washington
Nussbaum et al., Am J Psychiatry 168:778-781
2007-8
1st stores
2009
700 stores 3.5% adults have MMJ license
2012
Legalized
2014
Recreational Stores open Medical
Marijuana in Colorado
2001 2005
Denver legalizes possession
Colorado Didn’t Legalize Overnight
45
Vaporizing industries: Nicotine and Marijuana
Pax by Ploom • Japan Tobacco International (JTI) is
the third largest international tobacco company behind Philip Morris International.
• In 2011, JTI bought a portion of Ploom
– a startup based in Silicon Valley that produces a loose-leaf vaporizer that can be used to inhale heated vapor from marijuana as well as tobacco, called the Pax.
46
47
Marijuana Edible Displays
Copyright SAM and the Slides' Authors. Use with permission.
48
Source of Marijuana* among 12th Graders in 2012 and 2013, by State Policy
0
20
40
60
80
100
Medical Marijuana States Non-Medical Marijuana States
**
**
SOURCE: University of Michigan, 2013 Monitoring the Future Study *Categories not mutually exclusive ** Statistically significant difference
In a report published in the Journal of the American Medical Association last month, Andrew Monte, MD; Richard Zane, MD; and Kennon Heard, MD, pointed to edible marijuana as the culprit behind the most troubling cases
arriving at the UCH and Children’s Hospital Colorado emergency departments, including severe burns and cycling vomiting syndrome.
Past-Year Marijuana Use (ages 12+)
11.8%
16.2% 15.4%
12.3%
18.9%
17.5%
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
US CO WA
2011-2012
2012-2013
Source: NSDUH, 2014
Nº of Children Ages 3-7 Sent to ER for Accidental Marijuana Ingestion
4
8
14
0
2
4
6
8
10
12
14
16
2008-2011 2013 2014
Source: Children’s Hospital of Colorado Emergency Department
Total Human Marijuana Exposures for 2013 and 2014 YTD (11/30/2014)
Jan. Feb. Mar
. Apr. May
June
July Aug. Sep. Oct. Nov. Dec.
2014 13 23 18 24 14 17 21 22 14 34
2013 12 14 25 14 14 8 13 14 11 11 10 12
0
5
10
15
20
25
30
35
40
To
tal
ex
po
su
re
ca
lls
Source: Washington Poison Center
Teen Admissions to Treatment
• Teen admissions to treatment for marijuana use at the Arapahoe House treatment network in CO increased by 66% between 2011 and 2014.
Source: Arapahoe House Treatment Network
http://www.questdiagnostics.com/home/physicians/health-trends/drug-testing
0 5 10 15 20 25
National
CO
WA
Workplace Pos MJ Tests: Increase from 2012-2013
Jim Johnson said his
company has
encountered so many
job candidates who have
failed pre-employment
drug tests because of
their THC use … it is
actively recruiting
construction workers
from other states.
http://gazette.com/drug-use-a-problem-for-employers/article/1548427
” GE Johnson
“In February,” Leona
Willener said, “more than
half the applicants who
came to her company
looking for work failed the
required drug tests
because of THC use … 1 in
3 attempted to cheat the
test.”
“
” http://gazette.com/drug-use-a-problem-for-
employers/article/1548427 Colorado Staffing Agency
Cities Across Colorado are Banning the
Recreational Sales of Marijuana
• Of the 31 cities in Colorado that voted in November to allow the recreational sales of marijuana, 26* voted to ban it.
Cities that banned pot
sales
Approved recreational sales (16%)
Banned recreational sales (84%)*
Source: Colorado Municipalities League Copyright SAM 59
Are your relationships better off
when people use more
marijuana?
Does marijuana make for better
neighbors? Parents? Better
kids? Better employees? Better
drivers?
Drug Policy Alliance “We're at a tipping point where it's starting to feel like marijuana legalization is no longer a question of if -- but when. But what about the other drugs? My colleagues and I at the Drug Policy Alliance are committed to ensuring the decriminalization of all drug use becomes a political priority.” Now he does not just mean to remove arrests for small amounts… he says: “Many of the reasons why marijuana legalization makes sense can be applied to drugs more generally” --which appears to mean that this is about legalization/full retail sales of all drugs. -HuffPost
Bipartisan Co-Chairs (Kennedy + Frum)
Launch 2013
Over 150,000 press mentions
Public Health Scientific Advisory Board
30 state-wide affiliates
62
