1. Medical Marijuana Legalization Issues: An Appeal for Reefer Sanity Kevin A. Sabet, Ph.D. Director, Drug Policy Institute and Assistant Professor, University of Florida President, Policy Solutions Lab, Cambridge, MA www.kevinsabet.com Kevin A. Sabet, Ph.D., www.kevinsabet.com

2. All or nothing? Legalization vs. Prohibition Kevin A. Sabet, Ph.D., www.kevinsabet.com

4. Ultimately the Question is: “Is the right to get high and buy legal marijuana in a store worth the risk to kids, society, and the economy in the form of: greater addiction and learning deficits a new, legal industry relying on addiction for profits increased safety and health costs (like car crashes or the costs to health care and the costs of a newly regulated system) compromising our scientific system in the name of politics and medicine a la public opinion”?

5. 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 IN LOOKING AT MJ’s COMPONENTS

6. 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?

7. Bypassing the FDA Process Before FDA approves a drug as medicine, testing is done to: Determine theDetermine how itAssure benefits and risks may interact withstandardization of the drug other drugsof the drug Determine theIdentify andIdentify appropriate monitorsafe drug dosage levels side effectsadministration Kevin A. Sabet, Ph.D., www.kevinsabet.com

8. FDA Determines Medicine “No sound scientific studies supported medical use of marijuana for treatment in the United States, and no animal or human data supported the safety or efficacy of marijuana for general medical use. There are alternative FDA-approved medications in existence for treatment of many of the proposed uses of smoked marijuana.”

9. Distinction must be made between raw, crude marijuana and marijuana’s components So we should research marijuana’s components

10. Snapshot of Promising Research: Sativex Sativex is a drug, approved in Canada, the UK, and other parts of Europe for the treatment of MS Spasticity and Cancer Pain. It combines THC and CBD to eliminate the “high” from marijuana

11. Current Medical Marijuana Laws 17 States and D.C. 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 Rely not on the FDA, but unregulated businesses

12. 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 12 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

13. Increased access and availability lead to decreased perceptions of harm and increased use 13

14. Effects of “Medical” Marijuana California Oregon Colorado

15. Compassionate care increased access to marijuana? <5% ■ Less than 5% of card holders have cancer, HIV/AIDS, or life-threatening diseases ■ 90% are registered for ailments such as general pain or headaches Kevin A. Sabet, Ph.D., www.kevinsabet.com

16. Compassionate care or increased access to marijuana? >80% ■ 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 Kevin A. Sabet, Ph.D., www.kevinsabet.com

17. California Profile Average user: 32 y/o WM – No history of chronic illness – History of cocaine and alcohol use Recent study by legalization advocates report : 44% of users received marijuana for “headaches”, similar number for “exhaustion” Fridays at 2:00 PM – Sundays at noon: – Primary foot traffic

18. Oregon 2011: Currently 49,337 registered individuals. 10 physicians made 46% of all recommendations. There are 40 Patients under age 18. – 19 are age 17 – 12 are age 16 – 9 are under the age of 15

19. Total Conditions Severe pain 118,133 Muscle spasms 28,304 Severe nausea 15,972 Seizures 1,787 Cancer 2,646 Cachexia 1,653 HIV/AIDS 664 Glaucoma 1,116 Colorado

20. Listing conditions for which marijuana can be obtained, including “other conditions as determined in writing...” Typical Medical Marijuana Legislation

21. Two tier system: Marijuana Stores Home-Grown Cultivation Typical Medical Marijuana Legislation

22. In MA: can possess a 60-day supply of marijuana 60-day supply is not defined in proposed law 1 ounce = 60-120 joints At 3 joints/day, 1 oz. = 20 days So 60-day supply = 3 oz. 3 oz = 180-360 joints Three times more than what is currently allowed in MA without arrest But it could be more – as a day’s supply could be 5 joints…. Or more….. How Much Marijuana is Medicine?

23. People could legally grow marijuana their homes. Typical Medical Marijuana Legislation

24. Pot based products such as foods, oils, ointments, aerosols, may be legally sold as “medicine”. Typical Medical Marijuana Legislation

25. No expiration date or limit on renewals for “recommendations” No age restrictions State Government would be charged to regulate marijuana dispensaries, card registration and statewide (users/growers free to start before DPH steps in) Federally Illegal System (state employees at risk of arrest) Other outstanding issues

26. That doesn’t mean that components in marijuana do not have medical properties. These are being scientifically developed. Kevin A. Sabet, Ph.D., www.kevinsabet.com

27. Let’s do medical marijuana the right way Determine all of the medicinal compounds in the marijuana plant. Determine which compounds are most effective for cancer patients, which are more effective for pain management, which are most effective for treating other diseases. Make them available to doctors and patients legitimately, at pharmacies.

28. Kevin A. Sabet, Ph.D., www.kevinsabet.com The Government Is Doing Research Robust marijuana research program conducted by the US Government – Not much interest from Pharma 209 active researchers registered with DEA to perform bona fide research with marijuana, marijuana extracts, and THC. – Every researcher who has put forth a valid research proposal has received permission to study marijuana. – Studies include evaluation of abuse potential, physical/psychological effects, adverse effects, therapeutic potential, and detection. 14 use smoked marijuana with humans

29. Marijuana-Based Medications NIH is responsible for research into marijuana-derived medications. 288 NIH-supported projects on cannabinoids. Scheduling less relevant – Cocaine is Schedule II, no “Dispensaries” allowed – But it Would Be A Symbolic Victory for Advocates – Need an individual FDA-approved product for medical use

30. A Compassionate Access Proposal Before marijuana-based medications become more widely available, offer marijuana, regulated in strength, purity, and composition, to: Cancer patients Terminally ill Those with MS, ALS, and AIDS whose bona fide physicians have recommended marijuana because other medications have not worked

31. 1978: Keith Stroup “We are trying to get marijuana reclassified medically. If we do that, (we'll do it in at least 20 states this year for chemotherapy patients) we'll be using the issue as a red herring to give marijuana a good name.” 2012: MASSCANN/NORML spokesman: “Stepping stone to legalization? I hope so. That’s the plan. Decrim 2008, Medical 2012, Legal 2016. Yes we want to legalize! We will completely legalize for everybody in 2016.” What is this really about?

32. Kevin A. Sabet, Ph.D., www.kevinsabet.com Marijuana is NOT approved as medicine by: The FDA The American Medical Association The National Multiple Sclerosis Society The American Glaucoma Society The American Academy of Ophthalmology The American Cancer Society The American Pediatric Society The Massachusetts Medical Society

33. T HANK YOU ! Kevin A. Sabet, Ph.D., www.kevinsabet.com KEVINSABET @ GMAIL. COM WWW. KEVINSABET. COM