what drugs do we use? · 2016-09-27 · co-founder, project sam (smart approaches to marijuana) 1...
TRANSCRIPT
4/6/2015
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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.orgwww.kevinsabet.com
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Reefer Sanity: Seven Great Myths About Marijuana You
Need to Know
What drugs do we use?
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52%
26%
7.5%
0%
10%
20%
30%
40%
50%
60%Current use among persons 12 and older: 2012
NSDUH, 2013
TobaccoAlcohol Marijuana
Perceived Risk is Correlated with Use of Marijuana:
12th Graders’ Use vs. Perceived Risk of Occasional MJ Use
0
20
40
60
80
100
Past Year Use Perceived Risk
SOURCE: University of Michigan, 2013 Monitoring the Future Study
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Copyright SAM and the Slides' Authors. Use with permission.
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• Number of people who use 21+ days has increased by a factor of 7 since 1992
• Since 2007, the use of marijuana measured by days of use has increased 57%
• One arrest for every 5,800 days of use.
• That means someone who smokes marijuana 2x week for their whole life has a chance of being arrested once every 50 years.
• Potency has grown 10-20 fold
• Marijuana is now 2nd leading cause of impaired driving
• Marijuana use now surpasses tobacco for most young people
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Why should we care about
marijuana?
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Myth 1:
Marijuana Is Harmless and
Non-addictive
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Cannabinoid Receptors Are Located Throughout the Brain and Regulate:
• Brain Development• Memory and Cognition• Motivational Systems
& Reward• Appetite• Immunological Function• Reproduction• Movement Coordination• Pain Regulation
& Analgesia
Addiction: About 9% of users may become dependent,
1 in 6 who start in adolescence and 25-50% of daily users
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15
9
17
118
5
23
05
101520253035
Per
cent
* Nonmedical Use Source: Anthony JC et al.,
1994
Estimated Prevalence of Dependence Among Users
**
American Psychiatric Association’s Diagnostic Manual (DSM) has American Psychiatric Association’s Diagnostic Manual (DSM) has included marijuana included marijuana uuse se ddisorders since 1980. isorders since 1980.
DSMDSM--5 added Marijuana Withdrawal as a diagnosis. 5 added Marijuana Withdrawal as a diagnosis. 2014 Mass. General Hospital study confirms withdrawal syndrome.2014 Mass. General Hospital study confirms withdrawal syndrome.
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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
10Copyright SAM and the Slides' Authors.
Use with permission.
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.
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“But it’s just a plant…”(80-90% THC) Concentrates
“Budder”
“Shatter”
“Ear Wax”“Green Crack”
wax
Hash Oil Capsules
Butane Hash Oil (BHO)
Copyright SAM and the Slides' Authors. Use with permission.
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Slide 10
1 Also can you get rid of the gray shaded box behind these data?Kevin Sabet, 4/30/2013
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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.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
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 Szper 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
oO
dd
s ra
tio
CANNABIS AND SCHIZOPHRENIA Study of Swedish Conscripts (n=45570)
CANNABIS AND SCHIZOPHRENIA-Like Longitudinal prospective Dunedin study (n=1037)
Non-usersused 1 Dx
used 2 Dx
used 3 Dx
-8
-6
-4
-2
0
2
Ave
rag
e P
oin
t D
iffe
ren
ce i
n IQ
sco
re
(IQ
at
ag
e 1
3 –
IQ a
t a
ge
38
)
Persistent Marijuana Users Show A Significant IQ Drop between Childhood and Midlife
Source: Meier MH et al., PNAS Early Edition 2012
Followed 1,037 individuals from birth to age 38. Tested marijuana use at 18, 21, 26, 32 and 38. Tested for IQ at ages 13 and 38
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The Gulf Has Never Been Greater Between
The Scientific Understanding of Marijuana’s Harms
and
The Public’s MisunderstandingCopyright SAM and the Slides' Authors.
Use with permission. 16
How Did We Get Here?
Copyright SAM and the Slides' Authors. Use with permission.
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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 increasedaccess to marijuana?
<5%• Less than 5% of card
holders are cancer,HIV/AIDS, or glaucomapatients
• Average user: 32 WM, no illness
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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
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Marijuana policy and adolescents
• Restriction of legalized medical or recreational marijuana within state/district borders and to those ≥21 years old does not sufficiently safeguard against widespread adverse effects on youth– Youth access legalized marijuana obtained by
adults, via diversion (Salomonsen-Sautel et al., 2012) and accidental ingestion (Wang et al., 2013)
– Policy changes and marketing efforts have effects across ages and across state lines, with particular impact on youth (Berg et al., 2015; Richter & Levy, 2014)
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‘Big marijuana’
Can we trust companies and Big Corporations not to target youth and the vulnerable?
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Copyright SAM and the Slides' Authors. Use with permission.
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Privateer Holdings:The first equity company
dedicated to the marijuana industry.
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Early Days of Big Tobacco Messaging
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Colorado and
Washington
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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 openMedical
Marijuana
in
Colorado
2001 2005
Denver
legalizes
possession
Colorado Didn’t Legalize Overnight
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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.
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Marijuana Edible Displays
Copyright SAM and the Slides' Authors. Use with permission.
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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
Cerda M et al. Drug and Alcohol Dependence 2012; 120: 22 – 27.
NESARC: National Epidemiologic Survey on Alcohol and Related Conditions
1.811.92
1.03
0
0.5
1
1.5
2
2.5
Past Year MJ Abuse/Dependence
Past Year MJ Use Past Year MJ Abuse/Dependence
Among Current Users
Map of States that Legalized Medical Marijuana by 2004
passed laws legalizingmedical MJ
Od
ds
Ra
tio
States that Legalized Marijuana Use For Medical Purposes Have Significantly Higher Rates Of Marijuana Use and of Marijuana Abuse and
Dependence
Projected vs. Actual Tax Revenue
(in millions)
0 50 100 150
January
February
Jan-June
July '14-July '15
Actual
Projected
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Alcohol & Tobacco:Money Makers or Dollar Drainers?
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AlcoholCosts
TobaccoCosts
$14billion
Costs
Revenues
$25billion
$200billion
$185billion
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.
2014 Marijuana Developments
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• Associated Press: “Two Denver Deaths Linked to Recreational Marijuana Use”. One includes the under-aged college student who jumped to his death after ingesting marijuana cookie.
• The number of parents calling the poison-control hotline to report their kids had consumed marijuana has risen significantly in Colorado.
• Marijuana edibles and marijuana vaporizers have been found in middle and high schools.
Marijuana Use in CO, WA, and US
• Past-year and past-month marijuana use by all ages exceeds the national average in both Washington State and Colorado. Marijuana use in both these states has risen significantly* between 2011-2012 and 2012-2013.
*Significant at the 0.05 levels.
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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
Accidental Ingestions by Children
• Between 2008 and 2011, an average of 4 children (between the ages of 3 and 7) were sent to the ER for unintentional marijuana ingestion.
• In 2013, 8 children went to the CO children’s hospital.
• As of the first half of 2014, at least 14 children had already been sent to the ER for accidentally ingesting marijuana products.
More than doubling from the year before.
Source: Children’s Hospital of Colorado Emergency Department
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
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Marijuana-Related Poisonings
• According to the Washington Poison Center,
“the selling of cannabis for recreational purposes became legalized in the state of Washington on July 7th, 2014. As a direct
result, the Washington Poison Center (WAPC) has encountered an increase in the number of
human exposures related to accidental or excessive consumption/inhalation of marijuana
and marijuana edibles, particularly among pediatrics.”
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 Arrests
• Arrests for marijuana use in Denver public schools increased by 6% between 2013 and 2014.
Source: Denver Police Department Versadex and OSI database
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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
Colorado Marijuana is Regularly Diverted to Other States
• In 2013, there were 288 highway interdictions resulting in seizures of Colorado marijuana destined to over 40 states.
• A 397% from 2008.
Source: El Paso Intelligence Center National Seizure System
Nº US Mail Package Interceptions Containing CO Marijuana
0
15
107
0
20
40
60
80
100
120
2009 2010 2013
Source: El Paso Intelligence Center National Seizure System
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Unexpected Consequences: Burns
• The University of Colorado’s Burn Center observed an increase in the number of marijuana-related burns since legalization in 2012.
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11
1
1
1
0 5 10 15 20
2014*
2013
2012
2011
2010
Self-admitted burn victims
*As of Dec 17, 2014Source: University Hospital Burn Unit – University of Colorado Hospital
WA and CO Observe an Increase in the Share of Marijuana Driving Cases
16.9%
17.3%
18.2%18.3%
23.8%
0%
5%
10%
15%
20%
25%
30%
2009 2010 2011 2012 2013
Percentage of total DUI/DRE cases tested positive for THC* in WA
Source: Adapted from data provided by the WA State Patrol and WA State Toxicologist
Colorado’s underground market
A Colorado drug dealer says that if anything, legalization has helped his business because “it’s over priced, it’s being taxed way too high.”
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Colorado Springs Lieutenant stated that“[Legalization] has done nothing more
than enhance the opportunity for the black market. If you can get it tax-free
on the corner, you’re going to get it on the corner.”
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Colorado’s underground market
2014 Marijuana Vote
• Legalization passed in AK, OR, DC
• Medical Marijuana Failed in FL
• Legalization failed in several cities in Colorado, Maine, California, Michigan
• Several anti-marijuana officials elected
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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 recreation
al sales (16%)
Banned recreationa
l sales (84%)*
Source: Colorado Municipalities League
2016
• Looking ahead to California
• Maine, Massachusetts, Arizona, Nevada
• Gallup Poll 2014: Support for legalization falls from 58% to 51%
Evidence-based treatment
• Psychosocial treatment approaches for adolescent cannabis use disorders with the most evidence include– Motivational enhancement therapy– Cognitive-behavioral therapy– Family therapy– Contingency management
• Long-term abstinence outcomes are remarkably poor, even with evidence-based treatments (Compton & Pringle, 2004; Dennis et al., 2004; Waldron & Turner, 2008)
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Bipartisan Co-Chairs (Kennedy + Frum)
Launch 2013
Over 50,000 press mentions
Public Health Scientific Advisory Board
24 state-wide affiliates
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Project SAM1. To inform public policy with the science of today’s
marijuana.
2. To have honest conversations about reducing the unintended consequences of current marijuana policies, such as lifelong stigma due to arrest.
3. To prevent the establishment of Big Marijuana that would market marijuana to children — and to prevent Big Tobacco from taking over Big Marijuana. Those are the very likely results of legalization.
4. To promote research of marijuana’s medical properties and produce pharmacy-attainable medications.
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Thank you – for listening!
www.learnaboutsam.org
www.kevinsabet.com
www.dpi.psychiatry.ufl.edu