Transcript National Drug Control Strategy

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
Outline
 National Drug Policy Overview
 Seven Great Myths About Marijuana
 Where Can We Go?
 International Perspectives
2
Kevin A. Sabet, Ph.D., www.kevinsabet.com
Kevin A. Sabet, Ph.D., www.kevinsabet.com
Kevin A. Sabet, Ph.D., www.kevinsabet.com
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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Marijuana’s Potential for Harm
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
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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14
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MARIJUANA POTENCY
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Average THC and CBD Levels in
the US: 1960 - 2011
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.
Psychoactive
Ingredient
8
6
4
2
NONPsychoactive
Ingredient
0
1960 1965 1970 1974 1978 1980 1983 1984 1985 1986 1990 1992 1993 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
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 10.3 10.3 9.91 11 11.4
CBD
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
Addiction Chances After One Time
Use
ESTIMATED PREVALENCEOFDEPENDENCEAMONG USERS
32
23
17
15
11
9
8
5
Tobacco
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
Addictive Risk from One Time Use Is
Different If One Starts Drug Use in
Adolescence
25%
24%
20%
17%
15%
14%
8%
Tobacco
Alcohol
Marijuana
Cocaine
Stimulant
Analgesics
9%
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
Relation to Mental Health
 Increased risk of psychosis
 Risk of schizophrenia increased
six-fold
 More treatment resistant
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
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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
This doesn’t mean that
components
in marijuana do not have
medical properties.
These are being
scientifically developed.
However, this process
should be improved.
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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 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
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.
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 or
increased access to marijuana?
Profile: 32
y/o WM
• Most card holders
in CAand 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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Estimated Number of Sentenced Prisoners and Drug
Offenders Under State Jurisdiction, 1985 to 2009
Number of Sentenced Prisoners
1,400,000
All Offenses
1,200,000
1,000,000
800,000
600,000
400,000
200,000
38,900
148,600
224,900
263,800
251,400
Drug Offenses
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
0
Source: Bureau of Justice Statistics, Prisoners in 2009 (December 2010); Prisoners in
1996 (June 1997).
6/2011
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Myth 4:
The Legality of Alcohol
and Tobacco
Strengthen the Case
for Marijuana
Legalization
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Alcohol and Tobacco: A
Model?
 Use levels for alcohol and tobacco
are much higher than marijuana
 Industries promote addiction and
target kids
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.
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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
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RJ Reynolds (1984 est.)
http://legacy.library.ucsf.edu/tid/eyn18c00
Tobacco Institute (1989)
http://legacy.library.ucsf.edu/tid/pvt37b00
RJ Reynolds (1973)
http://legacy.library.ucsf.edu/tid/mqu46b00
Brown & Williamson (1972)
http://legacy.library.ucsf.edu/tid/wwq54a99
Lorillard (1979)
http://legacy.library.ucsf.edu/tid/sdw88c00
Copyright 2013
Kevin A. Sabet and
Project SAM
www.learnaboutsa
m.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
ArcView
DeAngelo with investors at the
Washington Athletic Club
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 & Tobacco
Money Makers or Dollar Drainers
Alcohol
Costs
Tobacco
Costs
$185
billion
Costs
$14
billion
Revenues
$200
billion
$25
billion
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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“If Only We Treated It Like Alcohol…”
ALCOHOL ARRESTS
MARIJUANA
ARRESTS
2.7 million
847,000
Yearly
Yearly
(Does NOT include violence;
Includes violations of liquor laws and
driving under the influence)
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.
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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
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.
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So what are our choices
for marijuana policy?
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All or Nothing?
Legalization vs. Incarceration-Only
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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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Fixing Current Policy
•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
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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
Support for Legalization is
Weak Worldwide
Despite well-financed
international legalization
movement
Confusion between “reform” and
“change” equating to “legalization”
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
Attitudes about Marijuana Legalization: Latin America
100%
87% 89%
80%
73%
60%
Argentina
Colombia
Peru
40%
27%
20%
13% 11%
0%
Support
Oppose
100%
:
90%
80%
70%
60%
Bolivia
Chile
40%
30%
20%
10%
0%
Support
Oppose
 Polling Data
In 2008, 4044 Brazilian adults were asked if they think smoking
marijuana should remain a crime:
Do you think smoking marijuana should remain
a crime?
100%
80%
76%
60%
40%
20%
20%
3%
0%
Yes
No
Not Sure
Polling Data
In 2009, Ipsos asked 1522 Chileans the following question:
Do you support or oppose legalizing marijuana?
100.00%
80.00%
60.00%
Oct-09
Jun-09
40.00%
20.00%
0.00%
Support
Oppose
Only for
medical
purposes
Chile
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
[email protected]
[email protected]
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