1. Marijuana Trends November 13, 2014 MAPPA Members Presenter: Cynthia Shifler, ATOD Prevention Coordinator, Wicomico County Health Department

2. Marijuana Facts It is addictive 1 in 6 teens and 1 in 10 adults who try marijuana become addicted to it. 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. Source: Anthony, J.C. Warner, L.A., & Kessler,R.C. (1994); Giedd, J. N., 2004

3. Dependence on or Abuse of Specific Illicit Drugs Persons 12 or Older, 2008 Drugs: 126 Sedatives 175 Inhalants 282 Heroin 351 Stimulants 358 Hallucinogens 451 Tranquilizers 1,411 Cocaine 1,716 Pain Relievers 4,199 Marijuana Source: Substance Abuse and Mental Health Services Administration. (2009), Office of Applied Studies, Treatment Episode Data Set (TEDS): 2009 Discharges from Substance Abuse Treatment Services Copyright Kevin Sabet and SAM. Use with permission

4. Increased Potency Today’s marijuana is not the marijuana of the 1960’s. In the past 15 years, marijuana potency has tripled and since 1960 it’s grown 5 times stronger. Source: Mehmedic.et.al., (2010) Copyright Kevin Sabet and SAM. Use with permission.

5. ER Admission Rates Rising Cannabis-related emergency hospital admission rates have been rising sharply in the U.S. From an estimated 16,251 in 1991 to over 374,000 in 2008 Source: SAMHSA, 2011

6. Marijuana Facts Marijuana is unsafe if you are behind the wheel of a car Most common illegal drug involved in auto fatalities Found in the blood of around 14% of drivers who die in accidents, often in combination with alcohol and other drugs Copyright Kevin Sabet and SAM. Use with permission. www.drugabuse.gov/

7. Marijuana Facts Marijuana affects a number of skills required for safe driving Alertness Concentration Coordination Reaction Time Hard to judge distances and react to signals and sounds on the road Combining with alcohol (even a small amount) greatly increases driving danger State law sets 5 nanograms of active THC in the blood as the legal limit for driving. www.drugabuse.gov/

8. Marijuana Facts Marijuana is linked to school failure Negative effects on attention, memory, and learning can last for days and sometimes weeks – especially if you use it often Students who smoke marijuana tend to get lower grades and are more likely to drop out of high school Linked with unemployment, social welfare dependence Lower self-reported quality of life Source: Fergusson, D.M. and Boden, J.M., 2008 Copyright Kevin Sabet and SAM. Use with permission.

9. Marijuana Facts It can lower your IQ if you smoke it regularly in your teen years Persistent and heavy use among adolescents reduces IQ by 6-8 points According to a government survey, youth with poor academic results are more than four times likely to have used marijuana in the past year than youth with an average of higher grades. Source: Meier, M.H. et al., 2012; MacLeod, J., et al., 2004. Copyright Kevin Sabet and SAM. Use with permission.

10. Marijuana use is linked to low productivity and job performance Employee marijuana use is linked with increased: Absences Tardiness Accidents Worker’s Compensation Claims Job Turnover Source: NIDA, 2011 Copyright Kevin Sabet and SAM. Use with permission.

11. Marijuana Facts High doses of marijuana can cause psychosis or panic when you’re high Increased risk of mental illness Schizophrenia (6 fold) Psychosis Depression Anxiety www.drugabuse.gov/ Source: AndreassonS., Allebeck P., Engstrom A., Rydberg U., 1987; Areseneault, L., 2002 Copyright Kevin Sabet and SAM. Use with permission.

12. Health Related Effects Increased heart rate Our heart beats 70 to 80 beats per minute May increase by 20-50 beats per minute or may even double in some cases Rapid or Irregular heart beat Heart Failure Some evidence that a person’ s risk of a heart attack during the first hour after smoking marijuana is four times his or her usual risk. This is explained by marijuana raising blood pressure and heart rate and reducing the blood’s capacity to carry oxygen Source: Tetrault, J.M., 2007 Copyright Kevin Sabet and SAM. Use with permission

13. Other Health Related Effects Chest pain Respiratory failure Harmful effects on the lungs Marijuana smoke is an irritant to the lungs Results in greater prevalence of: Bronchitis Cough Phlegym Production Nausea Abdominal pain Strokes Source: Tetrault, J.M., 2007 Copyright Kevin Sabet and SAM. Use with permission

14. Other Health Related Effects Seizures Headaches Cancer It contains 50-70 percent more carcinogens and irritants than tobacco smoke Evidence linking marijuana and cancer is mixed This is due to the way it is smoked which exposes the lungs longer to carcinogenic smoke (over 400 chemicals/with 60 cannabinoides) However, marijuana smoke contains an enzyme that converts hydrocarbons into a cancer-causing form. Source: Hoffman, D., et al., 1975; Brambilla, C., & Colonna, M., 2008; Bello, D., 2006; Tashkin, D.P., 1999 Copyright Kevin Sabet and SAM. Use with permission.

15. Smoked/Eaten Marijuana is Medicine Marijuana has medical properties, but we don’t need to smoke or eat it! We don’t smoke opium to derive the benefits of morphine. So we don’t need to smoke marijuana to receive its potential benefits. A distinction must be made between raw, crude marijuana and marijuana’s components. Copyright Kevin Sabet and SAM. Use with permission.

16. Is Marijuana Medicine? No: smoked or inhaled raw marijuana is not medicine Yes: there are marijuana based pills available and other medications coming soon. Research is ongoing. Copyright Kevin Sabet and SAM. Use with permission.

17. Marijuana has medicinal properties Studies show that components or constituents within marijuana have medical value. For instance, dronabinol (also known as Marinol) contains lab-made THC and is widely available at pharmacies as capsules to treat nausea/vomiting from cancer chemotherapy. Copyright Kevin Sabet and SAM. Use with permission.

18. Marijuana-based medicines Sativex is in the process of being studied in the USA. THC:CBD = 1.1 Cannabidiol (CBD) is one of at least 85 active cannabinoids identified in cannabis. [4] It is a major phytocannabinoid, accounting for up to 40% of the plant's extract. [5] CBD is considered to have a wider scope of medical applications than tetrahydrocannabinol (THC). [5] An orally-administered liquid containing CBD has received orphan drug status in the US, for use as a treatment for dravet syndrome, under the brand name Epidiolex. [6]activecannabinoidscannabis [4]phytocannabinoid [5]tetrahydrocannabinol [5]orphan drugdravet syndrome [6] Copyright Kevin Sabet and SAM. Use with permission.

19. Marijuana-based medicines It is administered via an oral mouth spray Already approved in Canada and Europe Also, Epidiolex, pure CBD, no THC Copyright Kevin Sabet and SAM. Use with permission.

20. Average medical marijuana patients Profile: 32-year old white male History of alcohol and substance abuse No history of life-threatening illnesses 87.9% had tried marijuana before age 19 75% of Caucasian patients had used cocaine and 50% had used methamphetamine in their lifetime. Source: O”Connell, T.J. & Bou-Matar, C.B., 2007 Copyright Kevin Sabet and SAM. Use with permission.

21. Dabbing BHO (Butane Hash Oil) is produced by one of two methods: “open” or “closed." The open method involves packing a stainless steel tube with marijuana and "blasting" the tube with butane (an extraction solvent). The resulting extract—a thick, yellow-orange oil—trickles out onto a pan. This method can be dangerous: FEMA reports increasing incidents of explosions across the US caused by clumsy hash oil production attempts.FEMA reports Copyright Kevin Sabet and SAM. Use with permission.

22. Dabbing The closed system, a safer method, uses a machine called abutane oil extractor—which is also used to perform oil extraction from botanical herbs like lavender and mint to produce aromatics, infusions, and tinctures. Consuming BHO is known as "dabbing," and usually involves the user touching the concentrate onto a heated surface (like a nail) and inhaling its vapors. abutane oil extractor Copyright Kevin Sabet and SAM. Use with permission.

23. Dabbing Dabbing comes with potential health dangers, including inhalation of "dirty" butane. Another risk is ingesting harmful contaminants that may have been infused into the concentrate during the extraction process, like pesticides, herbicides and fungi. Copyright Kevin Sabet and SAM. Use with permission.

24. Vaping Marijuana

25. A way to use marijuana without anyone smelling it Some E-Cigarettes can be used for liquid hash oil, etc. Dangerous if children obtain access to it

26. What has occurred to change how society views Marijuana?

27. What have been the results? Medical Marijuana Decriminalization Legalization

28. National Organization for the Reform of Marijuana Laws Formation of the National Organization for the Reform of Marijuana Laws (NORML) The mission of the NORML Business Network [NBN] is to encourage the development of responsible, sustainable enterprises that seek to serve their community and set a positive example for the growing cannabis industry. The NBN highlights new and growing marijuana-related business partners that have shown a commitment to responsible consumer engagement, environmental protection, and to using their business as a platform for social change.

29. Marijuana in Colorado Impact of Legalization

30. Colorado Youth Marijuana Use In 2012, 10.47 percent of youth ages 12 to 17 were considered current marijuana users compared to 7.55 percent nationally. Colorado, ranked 4 th in the nation, was 39 percent higher than the national average. Drug related suspensions/expulsions increased 32 percent from school years 2008/2009 through 2012/2013. The vast majority were for marijuana violations. Copyright Kevin Sabet and SAM. Use with permission.

31. Impaired Driving in Colorado Traffic fatalities involving operators testing positive for marijuana have increased 100% from 2007 to 2012. The majority of driving-under-the-influence of drugs arrests involve marijuana and 25-40% were marijuana alone. Toxicology reports with positive marijuana results for driving under the influence have increased 16% from 2011 to 2013. Copyright Kevin Sabet and SAM. Use with permission.

32. Colorado’s Emergency Room Marijuana Admissions From 2011 through 2013, there was a 57 percent increase in marijuana related emergency room visits. Hospitalizations related to marijuana have increased 82 percent from 2008 to 2013. In 2012, the City of Denver rate for marijuana-related emergency visits was 45 percent higher than the rate in Colorado. Copyright Kevin Sabet and SAM. Use with permission.

33. Only a small proportion of medical marijuana users report any serious illness In Colorado, 2% reported cancer, less than 1% reported HIV/AIDS, and 1% reported glaucoma as their reason for using medical marijuana. In Oregon, these numbers are less than 4%, 2% and 1% respectively. Source: Colorado Department of Public Health and Environment, 2011; Oregon Public Health Authority, 2011 Copyright Kevin Sabet and SAM. Use with permission.

34. Chronic Pain Majority of medical marijuana users report using marijuana to treat ‘chronic or severe pain.’ 96% in Colorado 91% in Oregon 93% in Montana Source: Colorado Department of Public Health and Environment, 2011; Oregon Public Health Authority, 2011; Montana Department of Public Health and Human Services, 2011 Copyright Kevin Sabet and SAM. Use with permission.

35. Medical Marijuana has led to increased use Residents of states with medical marijuana laws have abuse/dependence rates almost twice as high as states with no such laws. Source: Cerda, M., et al., 2012. Copyright Kevin Sabet and SAM. Use with permission.

36. What have we learned from Colorado and Washington Increased rates of drugging and driving Increased marijuana poisonings of children Increased ER visits due to marijuana edibles Copyright Kevin Sabet and SAM. Use with permission.

37. Edibles Booming business since marijuana has been legalized in Colorado Halloween Edibles were found recently in Prince George’s County, Maryland Philosophy: get them hooked young and you will have them for life

38. Edibles THC amounts have to be written on the item Found that the amounts do not reflect the reality Edibles can have up to 99% THC Copyright Kevin Sabet and SAM. Use with permission.

39. Edibles New York Times Columnist ate candy bar in Colorado and ended up in the ER Nothing on item to say that it was supposed to be eaten in 16 pieces If she had eaten the entire thing, she probably would have died. Copyright Kevin Sabet and SAM. Use with permission.

40. Edibles New proposed rules for edibles Child Proof Packaging Clearly Printed Health Warning Labels Strict THC limits for various serving sizes Copyright Kevin Sabet and SAM. Use with permission.

41. Edibles Many edible shops buy soft or hard candy in bulk Then spray it with viscous hash oil Once it dries there is no way to tell the difference between candy that is infused and candy that’s not infused Best advice to parents: only give candy that comes from a recognized brand like Hershey, Haribo, Mars, etc. Copyright Kevin Sabet and SAM. Use with permission.

42. Edibles Serving Size of 10 milligrams of THC for marijuana edibles A cookie with 65 milligrams is said to contain six and one- half servings Copyright Kevin Sabet and SAM. Use with permission.

43. Two Deaths Due to Edibles 19 year old Wyoming college student who took a deadly leap off a Denver hotel on March 11 not long after eating edible marijuana. There were 7.2 nanograms of active THC per milliliter of blood in the deceased student. He consumed a marijuana cookie but no other drugs or alcohol Copyright Kevin Sabet and SAM. Use with permission.

44. Two Deaths Due to Edibles 44year old Kristine Kirk, allegedly shot dead by her 47 year old husband Richard Kirk while she was reporting his psychotic behavior to a police 911 operator after he consumed marijuana candy. Father of three stands accused of murder. He was also on pain killers at the time for his back. Copyright Kevin Sabet and SAM. Use with permission.

45. Edibles

46. More Edibles