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).

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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

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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.

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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 kevinsabet@gmail.com 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 kevinsabet@gmail.com 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.

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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

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We don’t smoke opium to benefit from morphine.

So we don’t need to smoke marijuana to receive its potential benefits.

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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

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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

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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

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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

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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

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Alcohol and Tobacco

legalization teach us there is no

money in this for anyone other than

Big Marijuana

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Myth 5:

Legal Marijuana Will Solve the Government’s

Budgetary Problems

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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.

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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

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Myth 6:

Portland and Holland Provide

Successful Examples of Legalization

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Europe: Let’s Get The Facts Straight

Portugal and Holland Have Not Legalized

ANY Drug

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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

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Myth 7:

Prevention, Intervention and Treatment Are Futile – So Why

Try?

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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

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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

Email

info@learnaboutsam.org

kevin@learnaboutsam.org