1. 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

2. National Drug Policy Overview Seven Great Myths About Marijuana Where Can We Go? International Perspectives 2 Outline

3. Kevin A. Sabet, Ph.D., www.kevinsabet.com

9. 9 Myth 1: Marijuana Is Harmless and Nonaddictive

10. 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. 10 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).

11. 11 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.

12. 12 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).

13. 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.http://home.olemiss.edu/~suman/potancy%20paper%202010.pdf

14. Addiction Chances After One Time Use Tobacco 32 23 17 15 11 9 8 5 AlcoholMarijuanaCocaineStimulantAnalgesicsPsychedelics 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

15. Addictive Risk from One Time Use Is Different If One Starts Drug Use in Adolescence Tobacco 24% 15% 8%8% 9% AlcoholMarijuanaCocaineStimulantAnalgesicsPsychedelics 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%

16. Relation to Mental Health Increased risk of psychosis Risk 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. 17 Myth 2: Smoked/Eaten Marijuana is Medicine

18. 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

19. This doesn’t mean that components in marijuana do not have medical properties. These are being scientifically developed. However, this process should be improved. 19

20. 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

21. 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 kevinsabet@gmail.com May Only Be Used With Author's Permission

22. Distinction must be made between raw, crude marijuana and marijuana’s components So we should research marijuana’s components (C) Kevin Sabet kevinsabet@gmail.com May Only Be Used With Author's Permission

23. 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 implementation Started 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

24. 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. http://www.columbia.edu/~dsh2/pdf/MedicalMarijuana.pdf

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 25 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. 26

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 27

28. Compassionate care or increased 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 28

29. 29 Myth 3: Countless People Are Behind Bars for Smoking Marijuana

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32. 32 Myth 4: The Legality of Alcohol and Tobacco Strengthen the Case for Marijuana Legalization

33. 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):1207–12Vital Signs: Current Cigarette Smoking Among Adults Aged ≥ 18 Years—United States, 2005–2010

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) 34 Cook, P. J. (2007). Paying the tab: The economics of alcohol policy. Princeton, NJ: Princeton University Press.

35. Can we trust companies and Big Corporations not to target youth and the vulnerable? Copyright 2013 Kevin A. Sabet and Project SAM www.learnaboutsam.org 35

36. http://legacy.library.ucsf.edu/tid/eyn18c00 RJ Reynolds (1984 est.)

37. http://legacy.library.ucsf.edu/tid/pvt37b00 Tobacco Institute (1989)

38. http://legacy.library.ucsf.edu/tid/mqu46b00 RJ Reynolds (1973)

39. http://legacy.library.ucsf.edu/tid/wwq54a99 Brown & Williamson (1972)

40. http://legacy.library.ucsf.edu/tid/sdw88c00 Lorillard (1979)

41. Copyright 2013 Kevin A. Sabet and Project SAM www.learnaboutsa m.org 41 “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.

42. 42 Will Big Marijuana become the new Big Tobacco?

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44. Marketing to Children 44

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47. Galvanized by Marijuana Legalization, Investors and Entrepreneurs Flocking to a New Industry Steve DeAngeloTroy Dayton

48. ArcView DeAngelo with investors at the Washington Athletic Club

49. 49 Alcohol and Tobacco legalization teach us there is no money in this for anyone other than Big Marijuana

50. 50 Myth 5: Legal Marijuana Will Solve the Government’s Budgetary Problems

51. Alcohol & Tobacco Money Makers or Dollar Drainers Alcohol Costs T obacco Costs $14 billion Costs Revenues $25 billion $200 billion $185 billion 51 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 847,000 Yearly ( Does NOT include violence; Includes violations of liquor laws and driving under the influence) “If Only We Treated It Like Alcohol…” 52 ALCOHOL ARRESTS MARIJUANA ARRESTS Federal Bureau of Investigation (2008) UniformCrime Reports, Washington,DC. http://www.fbi.gov/ucr/ucr.htm

53. 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 54

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. 55

56. 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

57. 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. 58 Myth 7: Prevention, Intervention and Treatment Are Futile – So Why Try?

59. 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.

60. So what are our choices for marijuana policy? 60

61. All or Nothing? Legalization vs. Incarceration-Only 61

64. We Need A “SMART APPROACH” Not about legalization vs. incarceration We can be against legalization but also for health, education, and common-sense

65. Chair, Patrick J. Kennedy Launched January 10 th, Denver Over 5,000 press mentions Public Health Board of Trustees 10 state-wide affiliates

66. 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. 66

67. 67 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

68. International Policy: What can we learn? International policy guided by 3 UN treaties No movement to legalize drugs worldwide, with the exception of Uruguay and (perhaps) Guatemala

69. Support for Legalization is Weak Worldwide Despite well-financed international legalization movement Confusion between “reform” and “change” equating to “legalization”

71. 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

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73. Brazil Polling Data In 2008, 4044 Brazilian adults were asked if they think smoking marijuana should remain a crime:

74. Chile Polling Data In 2009, Ipsos asked 1522 Chileans the following question: Do you support or oppose legalizing marijuana?

75. 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

76. Thank You! Questions? www.learnaboutsam.org Email info@learnaboutsam.org kevin@learnaboutsam.org 76