CMDA Statement on Recreational Marijuana

The term “recreational marijuana” refers to any form of marijuana, its derivatives, or synthetic derivatives used for recreational, non-medical purposes. Marijuana has been in the news constantly as American states and countries around the world have been asked to make important decisions about the decriminalization, legalization and regulation of recreational marijuana.

The Christian Medical & Dental Associations (CMDA) has developed this policy on “recreational marijuana” with both an inherent belief that the Bible is the Word of God—that it speaks into our time and culture and that God gave us his creation to use to its fullest potential—and with the incorporation of scientific evidence which provides a window into the truths about God’s creation.

Executive Summary

The term “recreational marijuana” refers to any form of marijuana, its derivatives, or synthetic derivatives used for recreational, non-medical purposes. Marijuana has been in the news constantly as American states and countries around the world have been asked to make important decisions about the decriminalization, legalization and regulation of recreational marijuana.

The Bible is our final authority for faith and practice which speaks to the creation mandate, promotion of the good, the role of authority and being good stewards of the environment. The Bible does not solve every question of policy or ethics, but we do feel it provides insights into the use of recreational marijuana.

The two main cannabinoids, or active ingredients, in marijuana are tetrahydrocannabinol, also called THC, and cannabidiol, or CBD. Cannabis-derived products (dried flowers, resin, oil, sprays, creams, foods, capsules) may be delivered via smoking, inhaling, vaporizing, eating or drinking food products or beverages, topical applications, and suppositories. These products may contain THC alone, CBD alone, or some combination of both. These products are neither FDA-approved nor regulated.

Social issues abound with disadvantaged minorities and the poor being affected at a higher incidence than others. Increase in accidents and death, access to marijuana for teens and minors, false advertising, increase in crime, environmental problems and the cost to society are wide-ranging.

Because of unreliable research and developing evidence of the health hazards of “recreational marijuana” use, CMDA does not support the legalization of recreational use of marijuana even where it is legally allowed. CMDA maintains that healthcare professionals should abstain and strongly advise against the use of recreational marijuana.

A. Biological 1. Cannabinoids : The two main cannabinoids, or active ingredients, in marijuana are

tetrahydrocannabinol, also called THC, and cannabidiol, or CBD. THC is the

“psychoactive” ingredient; it is what produces the euphoria or “high” that comes from marijuana. CBD is not psychoactive, but it does appear to have a mild anti-anxiety effect.1

2. Marijuana products : Cannabis-derived products (dried flowers, resin, oil, sprays, creams, foods, capsules) may be delivered via smoking, inhaling, vaporizing, eating or drinking food products or beverages, topical applications, and suppositories. These products may contain THC alone, CBD alone, or some combination of both.2 Often the products produced for “medical” use are the same as those used recreationally, with the exception that recreational products always contain THC, which produces the “high.” These products are neither FDA-approved nor regulated for consistency in the amount of active compounds or safe processing; they may contain potentially hazardous contaminants or adulterants such as degradation products, microbes, heavy metals, pesticides, fertilizers, glass beads, lead, tobacco, cholinergic compounds, and solvents.3

3. Rising THC Levels : The natural levels of THC and CBD in Cannabis are under 1%.4 Using powerful lights, selective breeding, hydration, chemical fertilizers and special soils, the industry has created a new and more potent marijuana plant than the one of the 1960s and 1970s. The average THC content in the “new” marijuana leapt to over 12% nationwide in 2014.5 And, in Colorado today, levels of THC are much higher, as there are plants pushing past 40%.6 It is not clear which, if any, studies have been done with anything stronger than 16% THC, although it is likely that higher THC content is detrimental to the brain.7 Marijuana concentrates contain 80 to 95% THC8 with reports of addictive highs, psychosis, and effects deserving of a label of a “hard drug,”9 like heroin and LSD. Although not yet implemented, recommendations have been made to revise the Netherlands Opium Act to place cannabis containing more than 15% THC in List 1 (hard drugs).10

B. Biblical1. Bible our final authority for faith and practice : We believe the Bible speaks directly into

every social, cultural, and political issue. But that does not mean we as Christians are empowered to speak to every social or political question or every area of personal morality; the Bible does not solve every question of policy or ethics, but we do feel it provides insights into the use of recreational marijuana.

2. The Creation mandate : Genesis relates that God gave humans dominion over all the earth with instructions to subdue it.11 We have a mandate to use everything our Creator has given us to its fullest potential and greatest good—to God’s glory. But the fall12 caused mankind to begin using creation for selfish and sinful purposes. The marijuana plant has potential good medicinal use for humanity. However, it also has the potential to harm individuals, society, and the environment.

3. Promotion of the Good : We believe Scriptures clearly communicate God’s will that people everywhere--in all circumstances--be treated with love, humility, kindness, compassion, and self-control. This means doing good and promoting the good to our neighbors – not evil.13 CMDA believes society should not condone harmful behaviors including the promotion of hallucinogenic, potentially addicting drugs, like marijuana. Scripture cautions us to not be mastered by anything,14 for when any thing or person other

than God is master, we are guilty of idolatry15 in not loving God with all of our heart, mind, body, and soul.16

4. Biblical admonitions against an altered state of mind : Multiple passages label drunkenness as sin and an undesirable behavior.17 When Paul tells us “to not be drunk with wine,” he is not arguing against wine, he is arguing against using it to create an altered state of mind.18 Because such an altered state of mind is intrinsic to marijuana use, it should not be used for recreational purposes.19 Marijuana and alcohol differ in this respect, in that alcohol can be consumed without impairment in faculties, whereas a “high” is inherent to marijuana use. In other words, the one thing we are forbidden by Scripture to do with alcohol is the only thing we can do with marijuana recreationally.

5. Role of authority : We believe Scripture calls Christians to be submissive to governments and authorities.20 Since no government or authority is perfect or flawless, there clearly are limits to this submissiveness when the authorities and Biblical commands are in conflict.21 Leaders and teachers must give an account and are judged more strictly;22 physicians fill both roles and must be careful never to abuse that authority. Christians, in general, are to “set an example for the believers in speech, in conduct, in love, in faith and in purity.”23 Whether or not recreational marijuana is legal in a particular jurisdiction, its use is a poor Christian witness.

6. Good stewards of the environment according to the creation mandate:24 The widespread growth of the marijuana industry, according to scientists, will have a deleterious impact on the environment due to deforestation (when grown on natural land) and excessive demands of water and power and the use of pesticides and fertilizers.25

C. Social1. General : We believe all citizens of a country should consider the known and potential

harmful and beneficial effects of marijuana on individuals and society. It is not hard to extrapolate from our challenging experiences with prescription opioids, alcohol, and cigarettes when considering marijuana.

2. The disadvantaged minorities and the poor may suffer disproportionately when marijuana becomes more available. Recreational marijuana became available in Colorado in 2014. As reported in the Denver Post, the vast majority of marijuana businesses in Denver service low-income minority neighborhoods.26 In Colorado, 20 percent of people with incomes under $25,000 consumed marijuana/THC products in the last year, while only 11 percent of those earning over $50,000 consumed the same products.27

3. Increased accidents and deaths : Between 2013 and 2016 in Colorado, the number of drivers involved in fatal crashes increased 40 percent, and the number of drivers who tested positive for marijuana use increased 145 percent. The prevalence of testing drivers for marijuana use did not change significantly during that time.28 According to the Colorado Department of Transportation, the number of fatalities with drivers testing positive for 5ng or greater THC decreased from 2016 to 2017.29 However, state law does not require coroners to test deceased drivers for THC (not all do the test). In addition,

many police agencies do not test surviving drivers for THC if he or she has already failed a simpler alcohol breath test, thus failing to document drivers who are impaired by both THC and alcohol.30 Marijuana deaths and injuries have increased in Colorado as marijuana was named as the culprit in fatal fires, explosions, and suicides.31

4. Increased access to teens and minors : Experience with opioid prescription drugs indicates unequivocally that overall accessibility and availability leads to an increase in teen usage. Marijuana use among those aged 18 to 25 is increasing in states where marijuana is legal.32 In Anchorage, where marijuana was legalized in 2015, school suspensions for cannabis use and possession have increased more than 141 percent from 2015 to 2017.33 In both Washington and Oregon, recreational marijuana retailers have been cited for selling marijuana to minors.34 States with legal medical marijuana have youth use rates that surpass those states that do not; Colorado’s youth marijuana use leads the nation at more than twice the national average.35 There is some evidence that 11th graders, but not 8th graders, in Oregon have a higher marijuana use rate in communities without retail bans than in communities with bans.36

5. Commercialization and social media : Individuals, small businesses, and corporations who profit from marijuana sales are looking to increase marijuana usage and find new customers. To this end, they are using social media platforms to promote usage and commercial advertising distortions are common. Physicians should warn their patients about false advertising and the hype on social media.37 False advertising gives recreational users the idea that marijuana is not harmful.

6. Opioid addiction : There has been much hype about marijuana legalization providing a safer replacement for opioid use, with the potential to reduce opioid addiction and overdoses. Evidence is conflicting as to whether this is, in fact, the case, and caution must be used in looking at studies in this area because of bias,38 unreliability of self-reported use of drugs, state-level data relating marijuana legislation and opioid death rates “cannot tell us anything about individuals’ substitution behaviors,”39 and other methodological problems. Because societal attitudes may have changed prior to either medical or recreational legalization40 and because opioid addiction is a complex issue with multiple antecedents that might represent events coinciding with marijuana legalization, it is difficult to assign causal blame to associations of legalization of marijuana and opioid use. Samples of research:

a. There are reports that opioid use has increased, rather than decreased, in states legalizing marijuana. In Colorado, for example, opioid use more than doubled among 10 to 19 year-olds after recreational legalization of marijuana.41

b. Legalization of marijuana in Colorado is associated with short-term reductions in opioid-related deaths.42

c. Medical legalization appears to be associated with “reductions in both prescriptions and dosages of Schedule III (but not Schedule II) opioids received by Medicaid enrollees.”43

d. A study that examined opioid use in patients following musculoskeletal trauma, found that self- reported marijuana use during recovery was associated with an increased amount and duration of opioid use. However, many patients in this study had

misperceptions that their marijuana use reduced both their pain and the amount of opioids used.

e. Not only marijuana use, but also use of alcohol, illegal methadone, and other opioids was found to increase in pregnant women after legalization of recreational marijuana in Washington State.44

7. Profits over people : The emphasis on marijuana benefits in the form of excise taxes, job creation, and corporate profits represents a misguided effort to place profits over the well-being of society and individuals. In addition, we believe the cost to society of state regulation, law enforcement, accidents, divorces and addiction programs will be substantial. One report found that “for every dollar gained in tax revenue, Coloradans spend approximately $4.50 to mitigate the effects of legalization.”45

8. Crime : Property crimes have increased in Colorado, Alaska, and Oregon since legalization of recreational marijuana.46 Black market activity has also increased post-legalization, as documented in both Colorado and Oregon; legalization makes illegal marijuana crops easier to conceal. Some of the illegal operations have been found in national forests or other environmentally-protected areas, and damage has resulted in these areas.47

9. Environmental problems : Commercial production of marijuana is fraught with environmental concerns. Marijuana requires a comparatively large amount of water48 and nutrients. Its cultivation is associated with land clearing, erosion, surface water diversion, use of polluting pesticides and fertilizers, and wildlife poaching.49 When grown indoors, marijuana requires large amounts of energy50 with “potentially negative effects on climate.”51 Growing marijuana consumed 1% of the nation’s electricity in 2012, which is six times the amount of power used by the entire U.S. pharmaceutical industry. Since then, marijuana cultivation has increased dramatically.52 A majority of the marijuana consumed in the United States is grown in California, primarily outdoors. There, illegal marijuana production thrives “in sensitive watersheds…which represent habitats for several rare state- and federally listed species,” and resulting environmental damage has been documented.53

D. Medical1. Studies : Most of the studies of marijuana are related to medical uses, but information

about recreational use can still be gleaned from this data. There are a number of concerns with the research in this area:

a. Unreliable : The research itself may be unreliable because of factors such as heterogeneity in the active ingredients and contaminants, lack of standard dosing, inadequate research into effects of highly potent types, and variability in the route of consuming54 marijuana. Conclusive studies can only be done with FDA-approved medications or pharmaceutical-grade compounds. The marijuana that researchers have access to is not the same as that being used recreationally. It is important to note what type of marijuana derivative is used in any studies; for example, self-reported amount of smoking provides poor data compared to use of FDA-approved standard-dose pharmaceuticals.

b. Insufficient data: In a system proven effective over many decades, medicine aims to establish the safety and effectiveness of treatment by requiring vigorous clinical trials before medications are recommended or released to large numbers of people. There are a lack of studies on safety, efficacy, high potency marijuana and its short and long-term effects, and potential drug interactions between cannabis compounds and prescription and non-prescription medications.

c. Impediments : Researcher bias and obtaining properly controlled, adequately-sized, representative samples are among the methodological problems that may be anticipated in this research area. Research is somewhat impeded by the classification of marijuana as a Schedule I drug, making non-FDA-approved products difficult for researchers to obtain.55

d. Ethical issues : Adverse health effects of marijuana, especially use of high potency variants and smoking as the means of consumption, highlight ethical problems in exposing research subjects to harm when trying to document the safety or harm of specific consumer products.

e. Caution : Weak or absent evidence about harmful effects of marijuana does not mean they do not exist; caution should be used when even limited evidence suggests a possibility of harm. A review of the current literature regarding health effects of cannabis can only represent a snapshot into a rapidly changing landscape.

2. Medical complications of marijuana use : Despite the lack of research, some of the short-term and long-term effects of marijuana use are being uncovered. In all associations or lack thereof of marijuana use and health complications listed below, the conclusions are often drawn in the face of insufficient good quality and conflicting data and with the knowledge that research may not reflect the current products being used by consumers. Therefore, future research will be needed to provide more definitive answers to questions about effects of marijuana use.

a. Cancer : There is limited evidence of a statistical association between current, frequent, or chronic cannabis smoking and one type of testicular tumor, but not current sufficient evidence of associations between marijuana use and other cancer types in adults. There is minimal evidence that cannabis use during pregnancy is associated with a greater risk of cancer in offspring.56

b. Respiratory diseases : Substantial evidence of an association between chronic marijuana smoking and chronic bronchitis and worsening respiratory symptoms. There is more limited evidence of an association with chronic obstructive pulmonary disease (COPD).57

c. Injury and death : Substantial evidence correlates cannabis use and increased risk of motor vehicle crashes. Among pediatric populations where cannabis use is legal,

there is moderate evidence of increased risk of overdose injuries and respiratory distress.58

d. Pre-and perinatal exposure to maternal cannabis use : Use of marijuana during pregnancy increased in Washington State after legalization.59 According to a recent study, nearly 70 percent of approved marijuana dispensaries in Colorado recommended marijuana to pregnant mothers experiencing morning sickness.60 Marijuana has potentially serious effects on the developing fetus.61 A recent study documented that prenatal THC exposure adversely affects infant neurobehavior and child development up through the teen years,62 but other researchers feel data is lacking to draw conclusions about long-term effects.63 Overall review of current studies suggests a substantial association between maternal smoking of marijuana with lower birth weight babies and more limited evidence of a correlation with pregnancy complications for the mother and admission of the newborn to intensive care.64

e. Teen use : Heavy marijuana use can damage brain development in youth ages 13 to 18. One study confirmed a link between cannabis use and loss of concentration and memory, jumbled thinking, schizophrenia, and early onset paranoid psychosis.65

f. Psychosocial impairment : Moderate evidence correlates acute cannabis use with impaired learning, memory, and attention, and more limited evidence suggests that such impairments may be sustained even after prolonged abstinence from cannabis use. More limited associations exist between cannabis use and impaired academic achievement and outcomes, higher unemployment, lower income, and impaired social functioning.66

g. Mental health : There is substantial evidence of statistical association between cannabis use and the development of schizophrenia and other psychoses,67 with greater risk occurring among more frequent users. Moderate evidence associates cannabis use with increased incidence of developing depression; suicidal ideation, attempts, and completion; and social anxiety disorder. More limited evidence links cannabis use with certain increased symptoms (e.g. hallucinations) in psychotic disorders, development of bipolar disorder, the development and/or increased symptoms of anxiety disorders, and increased symptoms of posttraumatic stress disorder.68

h. High doses or use of some high potency and/or synthetic cannabis derivatives have produced the following effects: psychosis, mood alterations, panic attacks, cognitive impairment, dizziness, cardiovascular effects (tachycardia, hypertension, palpitations), nausea, appetite changes, and others.69 Mental impairment and distressing emotional states, such as paranoia, hallucinations, and psychosis, have caused people to harm themselves and others.

i. Addiction : Use of marijuana can become problematic (marijuana use disorder) which may progress to addiction in some cases. When a person cannot stop using the drug

despite interference with many aspects of daily life, use disorder is classified as addiction.70 A 2015 study suggests that “30 percent of those who use marijuana may have some degree of marijuana use disorder.71 Marijuana use disorder is frequently “associated with dependence—in which a person feels withdrawal symptoms when not taking the drug.”72 A user may be dependent but not be addicted. Studies estimate that 9 percent of adults73 and 17 percent of teens who use marijuana will become dependent on it.74 In 2015 roughly 4 million people in the US were found to have a marijuana use disorder, and 138,000 sought treatment.75 In the same year in the Netherlands, more first-time entrants and more people overall entered treatment programs for cannabis use than for any other drug.76 Although modulation of smoking technique may partially blunt the effect of use of high potency cannabis,77 there is evidence that higher potency marijuana use is associated with increased severity of cannabis dependence.78 There is moderate evidence of an association between cannabis use and the development of substance dependence and/ or a substance abuse disorder for other substances, including tobacco, alcohol, and illegal drugs.79

j. Delivery method : Smoking is a harmful route of consumption of any substance because of carcinogens and other harmful materials which are known to produce adverse effects on the lungs and other tissues.

E. LegalCurrent status: When recreational marijuana is legally allowed, the state has agreed to decriminalize, legalize and regulate the sale of marijuana. In most states, this means that marijuana can be purchased at a regulated dispensary by anyone who is 21 years or older with a valid government-issued ID. As of late 2018, the District of Columbia and ten states80 have approved medical marijuana although the United States still classifies marijuana in the same category as heroin, as a Schedule I Drug, which has “no currently accepted medical use and a high potential for abuse.”81 Because of the vast increase in marijuana potency and addiction potential, there is a need for limiting access to marijuana. When medical benefits are established for FDA-approved, pharmaceutical-grade derivatives of marijuana, these substances have been classified as Schedule II (e.g. Syndros) or III (Marinol).82, 83 Re-scheduling “medical marijuana,” smoked forms of marijuana, and high potency marijuana is not indicated; such forms deserve a Schedule I rating.

F. CMDA Recommendations for the Christian Community

1. CMDA does not support the legalization of recreational use of marijuana.

2. Christians should abstain from the use of recreational marijuana even if they live in jurisdictions where it is allowed by state or federal laws.

3. Recreational marijuana does not have place in the life of a believer because of the Biblical admonitions against an altered state of mind and the greatest commandment that God, not any other substance, be master of one’s heart, mind, spirit, and body.

G. CMDA Recommendations for the Christian Healthcare Professional

1. CMDA does not support the legalization of recreational use of marijuana.

2. Healthcare professionals should abstain from using recreational marijuana and strongly advise against the use of recreational marijuana to all of their patients, especially minors and pregnant women, due to adverse health ramifications.

3. Christian healthcare professionals should point out to Christian patients how Biblical admonitions against drunkenness apply to recreational marijuana and how devotion of one’s heart, mind, spirit, and body to the Lord precludes its use.

Endnotes

National Institutes of Health. Marijuana, by Abuse, National Institute on Drug, June 2018.

Netherlands Country Drug Report 2017, by Addiction, European Monitoring Centre for Drugs and Drug, 2017.

Blanco, Carlos, Deborah S. Hasin, Melanie M. Wall, Ludwing Flórez-Salamanca, Nicolas Hoertel, Shuai Wang, Bradley T. Kerridge, and Mark Olfson. "Cannabis Use and Risk of Psychiatric Disorders: Prospective Evidence from a Us National Longitudinal Study." JAMA Psychiatry 73, no. 4 (2016): 388-95.

Caputi, Theodore L. and Kevin A. Sabet. "Population-Level Analyses Cannot Tell Us Anything About Individual-Level Marijuana-Opioid Substitution." American Journal of Public Health 108, no. 3 (2018): e12-e12.

Carah, J. K., J. K. Howard, S. E. Thompson, A. G. Short Gianotti, S. D. Bauer, S. M. Carlson, D. N. Dralle, M. W. Gabriel, L. L. Hulette, B. J. Johnson, C. A. Knight, S. J. Kupferberg, S. L. Martin, R. L. Naylor, and M. E. Power. "High Time for Conservation: Adding the Environment to the Debate on Marijuana Liberalization." Bioscience 65, no. 8 (Aug 1 2015): 822-29. https://www.ncbi.nlm.nih.gov/pubmed/26955083.

Cort, Ben. Weed, Inc. : The Truth About Thc, the Pot Lobby, and the Commercial Marijuana Industry. Deerfield Beach, Florida: Health Communications, Inc., 2017.

DEA. "Drug Scheduling." Last modified Accessed Jan. 4, 2019, 2019. https://www.dea.gov/drug-scheduling.

Dickson, B., C. Mansfield, M. Guiahi, A. A. Allshouse, L. M. Borgelt, J. Sheeder, R. M. Silver, and T. D. Metz. "Recommendations from Cannabis Dispensaries About First-Trimester Cannabis Use." Obstet Gynecol 131, no. 6 (Jun 2018): 1031-38. https://www.ncbi.nlm.nih.gov/pubmed/29742676.

Freeman, T. P. and A. R. Winstock. "Examining the Profile of High-Potency Cannabis and Its Association with Severity of Cannabis Dependence." Psychological Medicine 45, no. 15 (2015): 3181-89.

Grant, K. S., R. Petroff, N. Isoherranen, N. Stella, and T. M. Burbacher. "Cannabis Use During Pregnancy: Pharmacokinetics and Effects on Child Development." Pharmacol Ther 182 (Feb 2018): 133-51.

Grant, Therese M., J. Christopher Graham, Beatriz H. Carlini, Cara C. Ernst, and Natalie Novick Brown. "Use of Marijuana and Other Substances among Pregnant and Parenting Women with Substance Use Disorders: Changes in Washington State after Marijuana Legalization." Journal of Studies on Alcohol and Drugs 79, no. 1 (2018): 88-95.

Institute, Centennial. Economic and Social Costs of Legalized Marijuana. Colorado Christian University, 2018.

Jansson, Lauren M., Chloe J. Jordan, and Martha L. Velez. "Perinatal Marijuana Use and the Developing Child." JAMA: Journal of the American Medical Association 320, no. 6 (2018): 545-46.

Liang, D., Y. Bao, M. Wallace, I. Grant, and Y. Shi. "Medical Cannabis Legalization and Opioid Prescriptions: Evidence on Us Medicaid Enrollees During 1993-2014." Addiction 113, no. 11 (Nov 2018): 2060-70.

Livingston, Melvin D., Tracey E. Barnett, Chris Delcher, and Alexander C. Wagenaar. "Recreational Cannabis Legalization and Opioid-Related Deaths in Colorado, 2000-2015." American Journal of Public Health 107, no. 11 (2017): 1827-29.

Lopez-Quintero, Catalina, Jose Perez de los Cobos, Deborah S. Hasin, Mayumi Okuda, Shuai Wang, Bridget F. Grant, and Carlos Blanco. "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 and Alcohol Dependence 115, no. 1-2 (2011): 120-30.

Lucas, Philippe. "Rationale for Cannabis-Based Interventions in the Opioid Overdose Crisis." Harm Reduction Journal 14 (2017): 1-6.

Malone, Daniel T., Matthew N. Hill, and Tiziana Rubino. "Adolescent Cannabis Use and Psychosis: Epidemiology and Neurodevelopmental Models." British Journal of Pharmacology 160, no. 3 (2010): 511-22.

Marijuana, Smart Approaches to. Lessons Learned from Marijuana Legalization. 2018.

Medicine, National Academies of Sciences Engineering and. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press, 2017.

Migoya, David. "Exclusive: Traffic Fatalities Linked to Marijuana Are up Sharply in Colorado. Is Legalization to Blame?" The Denver Post. Updated Dec. 28, 2018, Orig. pub. Aug. 25, 2017. Accessed Jan. 9, 2019, https://www.denverpost.com/2017/08/25/colorado-marijuana-traffic-fatalities/.

Migoya, David and Ricardo Baca. "Denver’s Pot Businesses Mostly in Low-Income, Minority Neighborhoods." The Denver Post. updated Jan. 23, 2017, orig. pub. Jan. 2, 2016. Accessed Jan. 9, 2019, https://www.denverpost.com/2016/01/02/denvers-pot-businesses-mostly-in-low-income-minority-neighborhoods/.

Paschall, Mallie J., Joel W. Grube, and Anthony Biglan. "Medical Marijuana Legalization and Marijuana Use among Youth in Oregon." The Journal of Primary Prevention 38, no. 3 (2017): 329-41.

Pol, Peggy, Nienke Liebregts, Tibor Brunt, Jan Amsterdam, Ron Graaf, Dirk J. Korf, Wim Brink, and Margriet Laar. "Cross-Sectional and Prospective Relation of Cannabis Potency, Dosing and Smoking Behaviour with Cannabis Dependence: An Ecological Study." Addiction 109, no. 7 (2014): 1101-09.

Tibbo, Phil, Candice E. Crocker, Raymond W. Lam, Jeff Meyer, Jitender Sareen, and Katherine J. Aitchison. "Implications of Cannabis Legalization on Youth and Young Adults." Canadian Journal of Psychiatry 63, no. 1 (2018): 65-71.

Transportation, Colorado Department of. "Drugged Driving Statistics: Cannabis-Involved Fatalities in Colorado." Last modified Accessed Jan. 9, 2019. https://www.codot.gov/safety/alcohol-and-impaired-driving/druggeddriving/safety/alcohol-and-impaired-driving/druggeddriving/statistics.

Volkow, N. D., W. M. Compton, and E. M. Wargo. "The Risks of Marijuana Use During Pregnancy." JAMA 317, no. 2 (Jan 10 2017): 129-30.

1 There are many other cannabinoids (such a THC-V, CBN, THC-A and CBG) and some of them may prove to be of value to patients and physicians, but the two key cannabinoids we know the most about today are THC and CBD. When it comes to medical research, some scientists are exploring the individual cannabinoids while others are exploring the effects of the totality of the plant. 2 National Academies of Sciences Engineering and Medicine, The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research (Washington, DC: The National Academies Press, 2017).3 Ibid.4 Ben Cort, Weed, Inc. : The Truth About Thc, the Pot Lobby, and the Commercial Marijuana Industry (Deerfield Beach, Florida: Health Communications, Inc., 2017), 26.5 Ibid.6 Ibid., 24.7 Ibid., 27.8 Ibid., 67.9 Ibid., 74.10 Netherlands Country Drug Report 2017, by European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Publications Office of the European Union, 2017).11 Genesis 1:2812 Genesis 313 Matthew 22:36-4014 1 Corinthians 6:1215 Deut. 20:316 Mark 12:29-3017 Galatians 5:19-21; 1 Timothy 3:3; Titus 1:718 Eph. 5:1819 Opioids also may cause an altered state of mind, but relief of severe pain may still dictate their prescription for short term use. Studies are equivocal on marijuana use and pain; considering its abuse potential and other problems, alternative treatment is currently recommended.20 Romans 1321 Daniel 322 Heb. 13:17 and James 3:123 1 Timothy 4:1224 Genesis 1:2825J. K. Carah et al., "High Time for Conservation: Adding the Environment to the Debate on Marijuana Liberalization," Bioscience 65, no. 8 (Aug 1 2015), https://www.ncbi.nlm.nih.gov/pubmed/26955083.26 David Migoya and Ricardo Baca, "Denver’s Pot Businesses Mostly in Low-Income, Minority Neighborhoods," The Denver Post, updated Jan. 23, 2017, orig. pub. Jan. 2, 2016, accessed Jan. 9, 2019, https://www.denverpost.com/2016/01/02/denvers-pot-businesses-mostly-in-low-income-minority-neighborhoods/.27 Smart Approaches to Smart Approaches to Marijuana, Lessons Learned from Marijuana Legalization (2018), https://learnaboutsam.org/wp-content/uploads/2018/07/SAM-Lessons-Learned-From-Marijuana-Legalization-Digital-1.pdf.28 David Migoya, "Exclusive: Traffic Fatalities Linked to Marijuana Are up Sharply in Colorado. Is Legalization to Blame?," The Denver Post, Updated Dec. 28, 2018, Orig. pub. Aug. 25, 2017, accessed Jan. 9, 2019, https://www.denverpost.com/2017/08/25/colorado-marijuana-traffic-fatalities/.29 Colorado Department of Transportation, "Drugged Driving Statistics: Cannabis-Involved Fatalities in Colorado," accessed Jan. 9, 2019. https://www.codot.gov/safety/alcohol-and-impaired-driving/druggeddriving/safety/alcohol-and-impaired-driving/druggeddriving/statistics.30 Migoya.31 Smart Approaches to Marijuana.32 Ibid.33 Ibid.34 Ibid.35 Ibid.36 https://nursing.wsu.edu/2017/04/14/13255/ 37 For instance, a study came out showing that synthesized CBD (in doses 10,000 times of that found in the plant) reduced the size and growth of some brain tumors. (Cort.) You can guess the headlines: “Weed Cures Brain Cancer.” Also, boutique makeup brands are churning out CBD moisturizers and natural healers are touting its anti-inflammatory benefits.38 Example of bias: An article by Lucas (Philippe Lucas, "Rationale for Cannabis-Based Interventions in the Opioid Overdose Crisis," Harm Reduction Journal 14 (2017).) advocated for medical and recreational legalization of

marijuana as a way to reduce opioid addiction and overdoses. However, the Methods section did not reveal the mechanism of article selection nor any other methods, no conflicting data was mentioned at all, and the author’s conflict of interest was noted in small print at the end of the article—he is VP and stockholder with a federally authorized medical cannabis production & research company in Canada.39 Theodore L. Caputi and Kevin A. Sabet, "Population-Level Analyses Cannot Tell Us Anything About Individual-Level Marijuana-Opioid Substitution," American Journal of Public Health 108, no. 3 (2018).40 Mallie J. Paschall, Joel W. Grube, and Anthony Biglan, "Medical Marijuana Legalization and Marijuana Use among Youth in Oregon," The Journal of Primary Prevention 38, no. 3 (2017).41 Smart Approaches to Marijuana.42 Melvin D. Livingston et al., "Recreational Cannabis Legalization and Opioid-Related Deaths in Colorado, 2000-2015," American Journal of Public Health 107, no. 11 (2017).43 D. Liang et al., "Medical Cannabis Legalization and Opioid Prescriptions: Evidence on Us Medicaid Enrollees During 1993-2014," Addiction 113, no. 11 (Nov 2018).44 Therese M. Grant et al., "Use of Marijuana and Other Substances among Pregnant and Parenting Women with Substance Use Disorders: Changes in Washington State after Marijuana Legalization," Journal of Studies on Alcohol and Drugs 79, no. 1 (2018).45 “Costs related to the healthcare system and from high school drop-outs are the largest cost contributors, but many other costs were included as well. Costs of marijuana ranged from accidental poisonings and traffic fatalities to increased court costs for impaired drivers, juvenile use, and employer related costs.” Centennial Institute, Economic and Social Costs of Legalized Marijuana (Colorado Christian University, 2018).46 Smart Approaches to Marijuana.47 Ibid.48 Marijuana requires more water for growth than many other plants. It takes about 22 liters of water a day per marijuana plant in northern CA. Carah et al. Another estimate for marijuana is 900 gallons of water per plant per season (https://www.marijuanaventure.com/report-on-water-usage/). Using estimates of 22,000 corn plants/acre, a yield of 130 bushels/acre, water requirements of 3000 gallons per bushel, and a growing season of 60 days (estimates to err on the side of the highest water needs per plant), a corn plant does not require more than18 gallons of water per plant per season, or 1 liter per day. An average adult requires about 2.5 liters of water per day.49 Ibid.50 Smart Approaches to Marijuana.51 Carah et al.52 Smart Approaches to Marijuana.53 Carah et al.54 For example, alterations in the number of puffs or volume inhaled may change with the potency of THC in the marijuana being smoked. Peggy Pol et al., "Cross-Sectional and Prospective Relation of Cannabis Potency, Dosing and Smoking Behaviour with Cannabis Dependence: An Ecological Study," Addiction 109, no. 7 (2014).55 National Academies of Sciences Engineering and Medicine.56 Ibid.57 Ibid.58 Ibid.59 Grant et al.60 B. Dickson et al., "Recommendations from Cannabis Dispensaries About First-Trimester Cannabis Use," Obstet Gynecol 131, no. 6 (Jun 2018), https://www.ncbi.nlm.nih.gov/pubmed/29742676.61 N. D. Volkow, W. M. Compton, and E. M. Wargo, "The Risks of Marijuana Use During Pregnancy," JAMA 317, no. 2 (Jan 10 2017). K. S. Grant et al., "Cannabis Use During Pregnancy: Pharmacokinetics and Effects on Child Development," Pharmacol Ther 182 (Feb 2018).62Lauren M. Jansson, Chloe J. Jordan, and Martha L. Velez, "Perinatal Marijuana Use and the Developing Child," JAMA: Journal of the American Medical Association 320, no. 6 (2018).63 National Academies of Sciences Engineering and Medicine.64 Ibid.65 Dr. Phil Tibbo, one of the leaders in the medical field and initiator of Nova Scotia’s Weed Myths campaign targeting teens, has seen firsthand evidence of what heavy use can do as director of Nova Scotia’s Early Psychosis Program. His brain research shows that regular marijuana use leads to an increased risk of developing psychosis and schizophrenia, effectively exploding popular and rather blasé notions that marijuana is “harmless” to teens and “recreational use” is simply “fun and healthy.” Multiple researchers have all come to the same conclusion: the younger the brain, the worse the effects in both the short-term and long-term. Phil Tibbo et al., "Implications of Cannabis Legalization on Youth and Young Adults," Canadian Journal of Psychiatry 63, no. 1 (2018).66 National Academies of Sciences Engineering and Medicine.67 Daniel T. Malone, Matthew N. Hill, and Tiziana Rubino, "Adolescent Cannabis Use and Psychosis: Epidemiology and Neurodevelopmental Models," British Journal of Pharmacology 160, no. 3 (2010).68 National Academies of Sciences Engineering and Medicine.

69 National Institutes of Health, Marijuana, by National Institute on Drug Abuse (June 2018).70 Ibid.71 Ibid.72 Ibid.73 Catalina Lopez-Quintero 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 and Alcohol Dependence 115, no. 1-2 (2011).74 National Institutes of Health. 2018.75 Ibid.76Netherlands Country Drug Report 2017.77 Pol et al.78 T. P. Freeman and A. R. Winstock, "Examining the Profile of High-Potency Cannabis and Its Association with Severity of Cannabis Dependence," Psychological Medicine 45, no. 15 (2015).79 National Academies of Sciences Engineering andMedicine.; Carlos Blanco et al., "Cannabis Use and Risk of Psychiatric Disorders: Prospective Evidence from a Us National Longitudinal Study," JAMA Psychiatry 73, no. 4 (2016).80 State Marijuana Laws in 2018 Map. Governing the States and Localities. http://www.governing.com/gov-data/safety-justice/state-marijuana-laws-map-medical-recreational.html81 DEA, "Drug Scheduling," accessed Jan. 4, 2019, 2019. https://www.dea.gov/drug-scheduling.82 https://www.deadiversion.usdoj.gov/schedules/orangebook/c_cs_alpha.pdf. Accessed Jan. 10, 201983 https://www.dea.gov/drug-scheduling. Accessed Jan. 15, 2019