Marijuana Update: Facts, Research and Marijuana as Medicine Kevin A. Sabet, Ph.D. Director, Drug...
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Transcript of Marijuana Update: Facts, Research and Marijuana as Medicine Kevin A. Sabet, Ph.D. Director, Drug...
Marijuana Update: Facts, Research and
Marijuana as Medicine
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
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National Drug Policy Overview
Seven Great Myths About Marijuana
Where Can We Go?
International Perspectives
Outline
Kevin A. Sabet, Ph.D., www.kevinsabet.com
Kevin A. Sabet, Ph.D., www.kevinsabet.com
Kevin A. Sabet, Ph.D., www.kevinsabet.com
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Myth 1:
Marijuana Is
Harmless and
Nonaddictive
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Marijuana’s Health Effects
Most people who use marijuana once will stop, and not become addicted.
1 in 6 kids who try marijuana will become addicted. (1 in 11 adults)
For people who keep smoking marijuana, the health harms are underappreciated and costly.
Wagner, F.A. & Anthony, J.C. From first drug use to drug dependence; developmental periods of risk for
dependence upon cannabis, cocaine, and alcohol. Neuropsychopharmacology 26, 479-488 (2002).
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Marijuana and Kids
The adolescent brain is especially susceptible to marijuana use.
That means that when kids use, they have a greater chance of addiction since their brains are being primed.
Giedd. J. N. (2004). Structural magnetic resonance imaging of the adolescent brain. Annals of the New York Academy of Sciences, 1021, 77-85.
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This isn’t your Woodstock Weed – potency 5x stronger than in 1970s
Connected to changes in adolescent brain resulting in learning and memory problems, IQ loss, less life satisfaction
Doubles risk of car crash
Bronchitis/lung complications - Lung cancer link mixed; still learning
Marijuana’s Potential for Harm
Mehmedic, Z., et, al. A. (2010), Potency Trends of Δ9-THC and Other Cannabinoids in Confiscated Cannabis Preparations from 1993 to 2008. Journal of Forensic Sciences, 55: 1209–1217
Giedd. J. N. (2004). Structural magnetic resonance imaging of the adolescent brain. Annals of the New York Academy of Sciences, 1021, 77-85.
M. Asbridge, J. A. Hayden, J. L. Cartwright. Acute cannabis consumption and motor vehicle collision risk: systematic review of observational studies and meta-analysis. BMJ, 2012; 344 (feb09 2): e536 DOI:
Tetrault, J.M., et al. Effects of cannabis smoking on pulmonary function and respiratory complications: a systematic review. Arch Intern Med 167, 221-228 (2007).
1960
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THC
0.2 0.24 0.39 0.47 1 1 1.5 3.3 3.3 3.5 3.5 3.1 3.1 4 4.54 5.16 4.96 4.67 5.4 6.18 7.26 7.18 8.33 8.09 9.08 10.27
10.25
9.91 10.96
11.42
CBD
NaN NaN NaN NaN NaN NaN NaN NaN 0.28 0.31 0.38 0.36 0.33 0.31 0.42 0.4 0.41 0.43 0.45 0.47 0.42 0.46 0.46 0.46 0.53 0.48 0.41 NaN NaN NaN
1
3
5
7
9
11
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Average THC and CBD Levels in the US: 1960 - 2011
MA
RIJ
UA
NA
PO
TEN
CY
NON-Psychoactive
Ingredient
Psychoactive Ingredient
Mehmedic et al., Potency Trends of D-9 THC and Other Cannabinoids in Confiscated Cannabis Preparations from 1993 to 2008, J Forensic Sci, September 2010, Vol. 55, No. 5. Seehttp://home.olemiss.edu/~suman/potancy%20paper%202010.pdf.
Addiction Chances After One Time Use
Tobacco
32
23
1715
119
8
5
Alcohol Marijuana Cocaine Stimulant Analgesics Psychedelics
Source: Wagner, F.A. & Anthony, J.C. From first drug use to drug dependence; developmental periods of risk for dependence upon cannabis, cocaine, and alcohol. Neuropsychopharmacology 26, 479-488 (2002).
Heroin
ESTIMATED PREVALENCE OF DEPENDENCE AMONG USERS
Addictive Risk from One Time Use Is Different If One Starts Drug
Use in Adolescence
Tobacco
24%
15%
8% 9%
Alcohol Marijuana Cocaine Stimulant Analgesics Psychedelics
Source: Anthony JC, Warner LA, Kessler RC (1994): Comparative epidemiology of dependence on tobacco, alcohol, controlled substances, and inhalants: Basic findings from the National Comorbidity Survey. Experimental and Clinical Psychopharmacology 2: 244 - 268
Heroin
25%
20%17%
14%
Relation to Mental Health
Increased risk of psychosisRisk of schizophrenia
increased six-fold
More treatment resistant 16
Cannabis use in adolescence and risk for adult psychosis: longitudinal prospective study Louise Arseneault, BMJ 2002;325:1212-1213 ( 23 November ) Andréasson S, Allebeck P, Engström A, Rydberg U. Cannabis and schizophrenia: a longitudinal study of Swedish conscripts. Lancet 1987; ii: 1483-1485.
17
Myth 2:
Smoked/Eaten
Marijuana is
Medicine
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
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This doesn’t mean that components in marijuana do not have medical properties.
These are being scientifically developed.
However, this process should be improved.
Marijuana and Scheduling
Congress placed marijuana into Schedule I – meaning it has no medical use, and high potential for abuse.
This is separate and distinct to its legal status
Cocaine is Schedule II (as is Marinol, the THC pill)Not because it is “safer”Because in limited settings it has
medical value
The FDA Process is needed to:
• Determine the benefits and risks
• Determine drug interactions
• Assure standardization of the drug
• Determine the appropriate dosage levels
• Identify and monitor side effects
• Identify the safe means of administering the drug
(C) Kevin Sabet [email protected] May Only Be Used With Author's Permission
Distinction must be made between raw, crude marijuana and marijuana’s components
So we should research marijuana’s components
(C) Kevin Sabet [email protected] May Only Be Used With Author's Permission
Current Medical Marijuana Laws
Since 1996, 17 states and DC have passed laws allowing marijuana to be used as “medicine”
They vary in degree and implementationStarted as “affirmative defense” for
marijuana use for medicinal purposes; or removal of criminal penalties if “medical” use is claimed
Evolved into state-based production and distribution
None of the state laws rely upon FDA determination of what is a medicine
State Medical Marijuana Programs Increase Drug Use
• Two independent, peer-reviewed studies looking at medical marijuana states in the 2000s concluded that:
States with medical marijuana programs had an increased in marijuana use not seen in other
states
Cerda, M. et al. (2011). Medical marijuana laws in 50 states: investigating the relationship between state legalization of medical marijuana and marijuana use, abuse and dependence. Drug and Alcohol Dependence. Found at http://www.columbia.edu/~dsh2/pdf/MedicalMarijuana.pdf. Wall, M. et al (2011). Adolescent Marijuana Use from 2002 to 2008: Higher in States with Medical Marijuana Laws, Cause Still Unclear, Annals of epidemiology, Vol 21 issue 9 Pages 714-716.
25
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
• Approved in Canada and across Europe
• Administered via an oral mouth spray, THC:CBD - 1:1
Bayer Health. Fact Sheet – Sativex. April 13, 2005.http://www.hc-sc.gc.ca/dhp-mps/prodpharma/notices-avis/conditions/sativex_fs_fd_091289-eng.php
26
We don’t smoke opium to benefit from morphine.
So we don’t need to smoke marijuana to receive its potential benefits.
27
Compassionate care or increased access to marijuana?
< 5%• Less than 5% of card
holders are cancer, HIV/AIDS, or glaucoma patients
• 90% are registered for ailments such as ”pain,” headaches and athlete’s foot
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Compassionate care orincreased access to marijuana?
Profile: 32 y/o WM
• Most card holders in CA and CO are white men between the ages of 17 and 35
• No history of chronic illness
• History of Alcohol and Drug Use
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Myth 3:
Countless People Are
Behind Bars for Smoking
Marijuana
30
Num
ber o
f Sen
tenc
ed P
rison
ers
38,900148,600
224,900 263,800 251,400
0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
1,400,000
1985
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2001
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Estimated Number of Sentenced Prisoners and Drug Offenders Under State Jurisdiction, 1985 to 2009
Source: Bureau of Justice Statistics, Prisoners in 2009 (December 2010); Prisoners in 1996 (June 1997).
6/2011
All Offenses
Drug Offenses
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Myth 4:
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
33
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
34
What incentives do legal corporations have to keep price low and consumption
high?
• “Enjoy Responsibly”
• Taxes today for alcohol are 1/5 of what they were during the Korean War (adj for inflation)
Cook, P. J. (2007). Paying the tab: The economics of alcohol policy. Princeton, NJ: Princeton University Press.
Copyright 2013 Kevin A. Sabet and Project SAM www.learnaboutsam.org 35
Can we trust companies andBig Corporations not to target youth and the vulnerable?
http://legacy.library.ucsf.edu/tid/eyn18c00RJ Reynolds (1984 est.)
http://legacy.library.ucsf.edu/tid/pvt37b00 Tobacco Institute (1989)
http://legacy.library.ucsf.edu/tid/mqu46b00RJ Reynolds (1973)
http://legacy.library.ucsf.edu/tid/wwq54a99Brown & Williamson (1972)
http://legacy.library.ucsf.edu/tid/sdw88c00Lorillard (1979)
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Copyright 2013 Kevin A. Sabet and Project SAM www.learnaboutsam.org“The use of marijuana ... has important
implications for the tobacco industry in terms of an alternative product line. (We) have the land to grow it, the machines to roll it and package it, the distribution to market it. In fact, some firms have registered trademarks, which are taken directly from marijuana street jargon. These trade names are used currently on little-known legal products, but could be switched if and when marijuana is legalized. Estimates indicate that the market in legalized marijuana might be as high as $10 billion annually.” From a report commissioned by cigarette manufacturer Brown and Williamson (now merged with R.J. Reynolds) in the 1970s.
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Will Big Marijuana become the new Big
Tobacco?
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Marketing to Children
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Galvanized by Marijuana Legalization,Investors and Entrepreneurs Flocking
to a New Industry
Steve DeAngelo Troy Dayton
ArcViewDeAngelo with investors at the
Washington Athletic Club
49
Alcohol and Tobacco
legalization teach us there is no
money in this for anyone other than
Big Marijuana
50
Myth 5:
Legal Marijuana Will Solve the Government’s
Budgetary Problems
51
Alcohol & TobaccoMoney Makers or Dollar
Drainers
Alcohol Costs
T obacco Costs
$14 billion
Costs
Revenues
$25 billion
$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.
52
2.7 million Yearly
847,000Yearly
(Does NOT include violence;Includes violations of liquor laws
anddriving under the influence)
“If Only We Treated It Like Alcohol…”
ALCOHOL ARRESTS MARIJUANA ARRESTS
Federal Bureau of Investigation (2008) UniformCrime Reports, Washington,DC. http://www.fbi.gov/ucr/ucr.htm
53
Myth 6:
Portland and Holland Provide
Successful Examples of Legalization
54
Europe: Let’s Get The Facts Straight
Portugal and Holland Have Not Legalized
ANY Drug
55
Legalization: Experience Elsewhere?
No modern nation has tried legalization, though most Western
countries do not imprison people for simple marijuana possession.
- The Netherlands, Portugal, Italy use rates lower for some drugs since 10 years ago; higher for others.
- The Dutch experienced a three-fold increase in marijuana use among young adults after commercialization expanded.
Portugal: Mixed Findings
• In 2001, Portugal changed policy to send users with small amounts of drugs to “dissuasion panels” – social worker panels who refer to treatment, administer fine, etc.
• Also implemented robust treatment plan
• Results mixed. Youth use has gone up since 2001, deaths have gone down. Impact of policy unclear despite extreme rhetoric
Dutch Policy
- Non-enforcement Policy Created “Coffee Shops”
- The Dutch experienced a three-fold increase in marijuana use among young adults after commercialization expanded.
- Dutch had always had lower rates of drug use than the US; now on par
- Coffee Shops Closing, Also Cannot Sell to non-residents
- Scaling back policy; Holland is #1 country in Europe for marijuana treatment need
58
Myth 7:
Prevention, Intervention and Treatment Are Futile – So Why
Try?
59
Marijuana use is both preventable and treatable.
That marijuana use persists does not detract from
the fact that significant numbers of people can and
do avoid using the drug because of evidence-based
prevention and treatment.
Despite the evidence for its effectiveness, we have
never engaged in a truly comprehensive prevention
and treatment effort in the United States.
So what are our choices for marijuana
policy?
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All or Nothing?
Legalization vs. Incarceration-Only
We Need
A “SMART APPROACH”
Not about legalization vs. incarceration
We can be against legalization but also for health, education, and
common-sense
Chair, Patrick J. Kennedy
Launched January 10th, Denver
Over 5,000 press mentions
Public Health Board of Trustees
10 state-wide affiliates
1. 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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•People should not be stigmatized for their past use
•No sense in incarcerating users
•People need job and economic opportunities; by being blocked from them they will re-enter the illicit market
Fixing Current Policy
International Policy: What can we learn?
International policy guided by 3 UN treaties
No movement to legalize drugs worldwide, with the exception ofUruguay and (perhaps) Guatemala
Support for Legalization is Weak Worldwide
Despite well-financed international legalization movement
Confusion between “reform” and “change” equating to “legalization”
Support Oppose0%
20%
40%
60%
80%
100%
27%
73%
13%
87%
11%
89%
ArgentinaColombiaPeru
Attitudes about Marijuana Legalization: Latin America
A survey by Ipsos in 2010 asked individuals in Argentina, Bolivia, Chile, Colombia and Peru how they feel about the legalization or
decriminalization of marijuana in Latin America
Support Oppose0%
20%
40%
60%
80%
100%
10%
90%
30%
70%
BoliviaChile
:
Brazil
Polling Data
In 2008, 4044 Brazilian adults were asked if they think smoking marijuana should remain a crime:
Yes No Not Sure0%
20%
40%
60%
80%
100%
76%
20%
3%
Do you think smoking marijuana should remain a crime?
Chile
Polling Data
In 2009, Ipsos asked 1522 Chileans the following question:
Do you support or oppose legalizing marijuana?
0.00%
40.00%
80.00%
Oct-09Jun-09
75
We need to decrease access and availability.
So, a smart approach might look like this:
• Increased community-based prevention through community coalitions to empower schools, parents, physicians and other health care professionals to prevent marijuana use among youth
• Increased screening and brief interventions in health care settings
• Increased access to treatment• Increased access to recovery-oriented services • Greater number of drug treatment courts and
HOPE Probation programs
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Thank You!
Questions?
www.learnaboutsam.org