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MARIJUANA 101 Kendra McLaughlin, MPH Presentation for Garrett College Student and Professional Staff September 1, 2016

9.1 Marijuana 101 GC

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Page 1: 9.1 Marijuana 101 GC

MARIJUANA 101Kendra McLaughlin, MPHPresentation for Garrett College Student and Professional StaffSeptember 1, 2016

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MARIJUANA101

Presentation Outline• Marijuana Defined• Federal Law• Maryland Law• What Do We Need to Know?• Lessons Learned from Legalization

• Take Home Messages

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What is marijuana?

• Marijuana is the most commonly abused illegal drug.• It is a dry, shredded green, brown or gray mix of flowers,

stems, seeds and leaves from the hemp plant, Cannabis sativa.

• The main active chemical in marijuana is delta-9-tetrahydrocannabinor, or THC for short. This is the mind-altering, psychoactive chemical in marijuana.

• Also referred to as pot, weed, Mary Jane, grass

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What is marijuana?• Marijuana is usually smoked

• As a cigarette or “joint”• In a pipe or water pipe (bong)• In “blunts,” which are cigars that are hollowed out and refilled with

a mixture of marijuana and tobacco• Marijuana can also be mixed in food (edibles)• As an extract, marijuana is also available in various other

forms

Photos from: http://kutv.com/news/local/study-teen-pot-use-increasing-in-colorado-after-legalizationhttps://sites.psu.edu/siowfa15/2015/09/17/does-smoking-marijuana-kill-braincells/

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FEDERAL LAW

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Federal Law

• Food and Drug Administration (FDA) and Drug Enforcement Agency (DEA) reviews, analyzes and assesses data from National Institute on Drug Abuse then makes determination

• As of August 11, 2016, DEA maintained marijuana as a schedule I controlled substance

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Federal Law – Schedule 1 Controlled Substance

• Does not meet criteria for accepted medical use in treatment in the U.S.

• Lack of accepted safety for use under medical supervision

• High potential for abuse• To be considered a schedule I controlled substance, must be a specific, branded product with a defined dose.

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Myth: Marijuana that is smoked or eaten is medicine

Science• Marijuana has medical properties, BUT WE DON’T NEED

TO SMOKE OR EAT IT.• There are marijuana-based pills available that are being or

have been scientifically developed and researched – Marinol and Sativex

• Many medical societies have reserved support of medical marijuana pending legitimate approval processes for its medicinal use – American Society of Addiction Medicine, American Cancer Society, American Glaucoma Foundation, National MS Society, American Academy of Pediatrics

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Myth: Marijuana that is smoked or eaten is medicine

1. Administering any medication via drawing hot smoke into the lungs is inherently unhealthy.

2. While vaporizers, sprays and tinctures solve the problems associated with smoking, treatment of an illness without standardized dose or content of the medication remains a safety issue.

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Myth: Marijuana is non-addictive

Science• 1 in 10 adults who try marijuana will become addicted to it

• 1 in 6 teens who try marijuana will become addicted to it

Hall W, Degenhardt L. Adverse health effects of non-medical cannabis use. Lancet. 2009;374:1383-1391. Photo from http://www.bbc.com/news/world-asia-china-30188527

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MARYLAND’S LAW

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Medical Marijuana Law in Maryland

• MD became 21st state to legalize medical marijuana when its first law passed in 2013.

• MD Medical Cannabis Regulations were adopted in September 2015

• Maryland’s law is regulated by the MD Medical Cannabis Commission.

• Regulations allow for 15 licensed growers in MD, no limit on processors, and propose ≤ 2 per Senatorial district, plus one per grower (potential of 109).

• Types of marijuana included in law are the dried form and cannabis-infused products

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Cannabis Concentrates and Cannabis-Infused Products

Photos from: http://forhighschoolcounselors.blogspot.com/2015/01/national-drug-fact-awareness-week.htmlhttps://www.pinterest.com/pin/325174035572891485/https://www.pinterest.com/heatherpadgett7/cannabis/https://www.google.com/search?tbs=sbi:AMhZZitB_11HOEPHpQ8eueJU9gw1VadUe6iCDOPJsPk7oMFw-pE1Vx_1mcIXTGAr3cBccnejOat2HYF0vws_1qIzQTpajSWomoDX37GZYOQOQyU4Q-OxS4UX4ybmf30DbO7Inr_1noBMU4-OM96ZqzDeJbpgoNvsY5Bc22r96OD7ovudUiL69lVCrIbzKlKHc_13HGe6Wkinmm-g20ras3BFqeg6pMBaa524aB-nUPZ6PO6SPCB5F9sozZRL8noSh_1P-IdRBWMIane6rQzlOlEjqsBTklOdQcLYIvspE_1iULXg1va9SCSSkTdFvfK3qMcZXczbwH5HMPrlcU39seSwBKU52fZ5KFCrWc5WJIdF_11QuHxmQ505ZrLpGg9hwQ7d1fnDYQRwGHXLzZWWl8O6Q5iK0gz4TMZ-DVs4piyoH3oUo826KeXXstDrvaBFv91Ncv6HSrK7sx8SRA3v2xH3FYCMWyn_1wbaoMU9RAaB0fZqRgR3IQ5wKzGNF5nBD7JQhozAg1MPEjtFaeTcED73uY91Fk-Q--HR8giNihVHOzmLmvjRGSW3N2HASAe5FqKkehGjR5aZK4Gc8_1sKFTnAmXnd7jHlTrsRH_1txmkxV-d_1QpMWzKyb_1Hb0ymogEgQ8yUA63M8UDngUQZvge95neWD8Zn7JdnD_1sq9B_1zPOUOFUHoDx4uHEvIs3pF-6dcbpHsPSdQLZvwbMV7oyNWtP_1s74LMxBPKX4yay_1I-V3QbuRpPlL4666y2eTtqXQHId6zYo8hPUFJq8q-DJo9RFPINH8uQEIcxlV8My16d-wbasFntpAqHy8idxoc70jTEMcLyZb2vnIktOeiJkAVVkzOXG8FiWUvxNs5UuEopLbCVJVKvQARb8z_1oY8J1xYqnUaUJWZk-SMKoI-owyAPBQ0vTQIJ2DtTreV7lFoflzwEQk3Fyg7XWaMN_1YOIW2u_1-aYBFxCmcsBXGP4c5TYvQy4-SOiiCM9be3hkbs-LSR6gEPlmK-bche1hxsyBTG_1iaV4cqknzR1JoezqVm_1vPjzjJ0G87RmqJxdBOrBy-YB3OKUOqgXq4d8nEdPDRFqrYpJ8ciK7Q_1b1OYbBqgcPk7ng6AFt1i0lZsIJhWk4uAf3fnnRaNI2b3nU2mW2uDUwEUBiTNUuE82M8R5dPbiOYopoWnlYrZ5m7AnGGGeEaQjQ&btnG=Search%20by%20image&hl=enhttps://www.google.com/search?tbs=sbi:AMhZZitSTiNG4ihIoFFJDfzfXY_14BfQACoFUMvlUJHzsEYrePvuRbVyyW54xaqBbPpvldCqZiogs43RSprnTt53_1Z-lMyZVtDcqYUAW49FnI0Bs6EiwweWuAk8544XfRi0hKelFg6EfvSlOmOdvUFMkU1RfcaW8ta0kBp9kR4YdOabUd8BY2EorY4OcgloNAUYZFcKGV-gL8u9bSVlqfdNQfx9MGfguYQvh5hlQE4TzIYAmYNU6nqt7FQGBz5ce9cqFgDg9qG3EeWTGrFrjOD_1P5hHxMDV0ErhDEbBTT0DuA_1ft77sGlT1E8ojkLHxljALL1UYmZjcfqHQGJvJu2SPCpscevkf0X8BmFSVFbkHe-uOjX3TXQQlnv2QjRucLhDo38xxD5nR7ltG3KKL0tDtA6scPnq8Fo8rjKqzyIhhKvnYhwUYK85H-VsWtk2cFT4BOx-0fMyQ-2y1zA1VUcmN2_1_11UU2UZgBI7VBd-sPgVBkokAd2cmufxx0NEx6Cez4-0LHY_14wq_1jY40aAfudpGgS8sn-xdgMddwU-Qq7Kfh17Bk2ObTpBOLbbGVi-jxp7EZrS_1YExf9Gy_1hoLxTXU9_1yzganK6_1TSb8pdDHP6SeP-UB5GXAi5xPhUawZNHnWdJfc-Sdi_1xf6Dt9kZTLfGlXDVZ1Vk4gZuElGBR-eDfxbtU1ZDpaZshQpC6SRD_1s2wOJ389v9rZyCHL8U99oKFttW8yIbZBWOLUKEjzO99P2fmZQe3AGhLh42veACzvh5i8elrgdyhZxQLH4KX62LaHaM3UmpHbwiBzBasvVN_1wzFflE-_1HJvsxazjiMFJuahqYEM2C602UiqGJbcjlddQvj0NxvJeJH7c-KIyS-6Q8TaSK6lo0CYdhukeD8OTmEYN1zrqovF4dVZyyo_1h6YxwftUrA5j9w7CRhqIUU4kVaO4aeEwf8y9VHql22As5CdrZsCbARDhQzTORNeBGuGY5yKZARd1AgQJJzrRw8TS-pxV1P3P0b2zKiCvbdyeYPsqSF2h4nZP8LxSVsP_1NIgFBK2TP_1z1zgkV08Pl1yVR-8LycEia0C02X-l0tbWFBER-QP_1mRuwvk1x2zFYpj6nNhoAOoXCXHsVFz8rEiiIFjVq4T3l408J8yrgQ9UR3fVTyiGfCRu8X8LPop77LsgWF2MKQCGu-hl2il7qVppDMRo4NRVGqDfejaCdE8KBp54Oe77Fy2BwvmhAGtn-I9Xnneml9Znea_1jUKvowux07PV2nqSkYOsNIcFmGHINXk4XTK89xlf4fkBAuZN2eHXtDj3qZeSAUB0acPwY1rQtwiSSSndgaBYkhhPZucO-EWwAReM0xY0emNZNQyBAXggY1OUNzRW9Nf6aEsmEe8u1pZE-2d5cZRtPpqhIJphnVQZMtg4RdXDd8RS9fyIBnejaeKoZb-ShhR46RWUvNfo4QAM4yFERRIwN7UhKJIANmY_1AqsT3sE-shxeFKJ&btnG=Search%20by%20image&hl=enhttps://www.google.com/search?tbs=sbi:AMhZZitn6_1MeHKZisQYigKYqGDRDyQLrnM21GVt3YvaC5iK8ePyU-nb9hBpBSoUKbO1WZY4EGKTEZca0SCFDh_1-DgOWgbTH7wEhFSGI94bply9yaB4kbdQs2tUe5VOpCWQzTee9R0MIHCfBVH_1KK1f8a98G7-iyGHkL3rkpGjdH3yl_1lFzJt_1Ao1k9JbaqckrbuTPVmRBlb6Xwcri0MrRjMjPUxQz4QkQ--6ab-OHFQMEKKRRihQ0bDq3JSDlb2BTzaeIKxNlwAkIZJQqw42apBGqgXXtt3vhQmkEkCUjRLKqVDZ7hhH1DZbMQsj469awVYhRDAbFNk8S8KzBtZDU54mMXtOlzy8siO8Owa3ya7btxA6lwnkUKpaBO5Ao50baKVPkTsWxAE-JySphzJXaSmcyQVn7Dayu5fPMS1hbpAoYFkl6XTmkUtvIvbDCXu-z1xACqNgAU4AzzpmYXCbvLgLuzeAx4UwLhqyocw50qz_1Cs0WJu6ISsh-o8Nf9E4nlpUrWCbr2luEUQvyXOpprPyIHI1qcJXPRDNlUNkNM74xy5p5TvRt56Pv-4U9u0npb3FYIF7NXc1zxjlOLFhvRHrfJMiTSTwMmwaOSrcIqOkayHrKVum0HDuBCnNZPbwvB9kzNGQoi-1khDo3CwmdhYxz1BZjQZvMl4kQS7T3jaudrnUEj06f66U9FtL0EM6-dCacO7v2cYHsUmAJH5OEhQAbGwKoKkdK9t9Mw2SvACJY6uPyr_1Z1XadqdsXRf2pb_1h3sfB7FbVsnNIuqlE59o8Amm2OUAC6JzDmWQLDwHhA1zdH0bLPHHlI7SCNKc5wtVsnc4rspdJtQrWqe8ow20mlLmrDU6JmrPpioTnZaGBI4dYRiYQAEJ1H0eblali_1xqUJfNuoLyzeYZRQosNWR8bUzdmdJ2Z4SISPqkE1q7-vPymfBBmTLqUd_15awjfxjAUdVAndpiKhp5XPdYsKaRRa8BKtEWUSL0mBfj5E4pQZLlMgLizUO094xmodmxeY2ey27sUFbHi9BBmKTlVtks09Jta9R0Oxe5zDAqBZljP4uW-yLRwAXegiEk6G0Wi48LuOeERqLIpaRXGAKEE_1FmIt9Mk17j_12mSB7Not88lwCUUCVNiJhwKXjePK2EQgwB7EMOPDZ9nfdFnXMahSbaRZ2JA8YWtPzMA9FnsXJmwI8sKQPFpS9mzRpMUD65mczL9hiLJdLs6pBgbFYbyAhW-AGreawzVCNTYF0GDvuUdW1v4stjLbjabJurXUKRgaAn5kRHt7mdLDWoHGZ6uN_1xFfadSOZN3jHzXvG7osqLNNuydtdvV9IL16Ke7yJMA9HYiYDzcDPmB4cLvz0GtAqZbpJgDYNl4LvmDRbdbQ4da47X_1ioq8KivJiO1EmpwyrtNL0Ljn0IPTJVX7-Tsp032Qq3Rc6MbDkarDRg&btnG=Search%20by%20image&hl=en

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Medical Marijuana Law in Maryland

• Qualifying patient can possess up to 4 ounces of dried flower at one time or 36 grams of THC as an extract.

• MD patient can only get medical cannabis from MD licensed dispensaries.

• MD dispensaries can only get their cannabis from MD licensed growers and processors.

• MD dispensaries will not, at this time, recognize other state medical cannabis ID cards.

• Every batch of marijuana is to be inspected by independent lab.

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Medical Marijuana Law in Maryland

• 269 grower or processor applications were submitted in November 2015

• 15 growers and 15 processors granted license pre-approvals in August 2016

• Pre-approvals span 16 counties and Baltimore City, including a grower license in Garrett County.

• 811 dispensary applications were submitted; approvals should be granted in January 2017

• Medical cannabis could become available to patients in the summer of 2017.

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Medical Marijuana Law in Maryland

• Dispensaries can sell devices to administer marijuana• Dispensaries can provide delivery services to patients• Database will link physician and patient so that each

patient can have only one physician at a time• Certain conditions are to be present in order for physician

to certify patient for marijuana – end of life care, wasting syndrome, severe/chronic pain, severe nausea, seizures, glaucoma, PTSD

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WHAT DO WE NEED TO KNOW ?

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Myth: Marijuana is harmless

Science• Marijuana negatively affects the parts of the brain that are

responsible for motivation, memory and learning.• The adolescent brain is especially susceptible to

marijuana use.

• Persistent and heavy use among adolescents reduces IQ by 6-8 points.

Meier MH, Caspi A, Ambler A, et al. Persistent cannabis users show neuropsychological decline from childhood to midlife. Proc Natl Acad Sci USA. 2012; 109:E2657-2664.

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Myth: Marijuana is harmless

Science• Between 1999 and 2010, the prevalence of drugs other

than alcohol in fatally injured drivers increased from 16.6% to 28.3%.

• The greatest increase was for marijuana which tripled, from 4.2% in 1999 to 12.2% in 2010.1

Brady JE and Li Gl. Trends in Alcohol and Other Drugs Detected in Fatally Injured Drivers in the U.S., 1999-2010 American Journal of Epidemiology Advance Access, 1/29/14.Ronen A, Gershon P, Drobiner H, et al. Effects of THC on driving performance, physiological state and subjective feelings relative to alcohol. Accid Anal Prev. 2008; 40(3):926-934.

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Myth: Marijuana is harmless

Science• Marijuana intoxication doubles your risk of a car crash.1

• THC is associated with poorer driving performance, and slower response times.2

1M.Asbridge, JA Hayden, JL Cartwright. Acute Cannabis Consumprion and motor vehicle collision risk: systematic review of observational studies and meta-analysis. BMJ, 2012; 344(Feb 09)2Hall W, Degenhardt L. Adverse health effects of non-medical cannabis use. Lancet. 2009;374:1383-139

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In the past 15 years, marijuana potency has tripled and since 1960 it has grown 5 times stronger.

1960

1970

1978

1983

1985

1990

1993

1996

1998

2000

2002

2004

2006

2008

2010

0

2

4

6

8

10

12

Average THC and CBD Levels in the US

THC CBD

CBD: NON-Psy-

choactive In-gredient

THC: Psychoactive

Ingredient

Mehmedic et al., 2010

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LESSONS LEARNED FROM LEGALIZATION

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Lessons Learned• In most states that permit the use of medical marijuana,

less that 2-3% of users report having cancer, HIV/AIDS, glaucoma, multiple sclerosis, or any other life-threatening diseases.1

• Majority of medical marijuana users report using marijuana to treat “chronic or severe pain.”

• 96% in Colorado• 91% in Oregon• 93% in Montana

Colorado Department of Public Health and Environment, 2011; Oregon Public Health Authority, 2011;Montana Department of Public Health and Human Services, 2011. Image from:https://www.pinterest.com/rangerbandy/the-future/

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Alcohol and Tobacco as Examples

• With legalization, drugs become driven by industry.

• Industry promotes use and targets kids.

• With legalization comes higher use. Uselevels for alcohol and tobacco are much higher than marijuana (7x and 2x respectively)

Photos from: http://www.forbes.com/sites/jacobsullum/2015/11/04/2-reasons-ohio-voters-overwhelmingly-rejected-marijuana-legalization/#310f46f448c6

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Past 30 day use for people 12 and older

52%27%

7%

Current (past month) use among persons 12 and older; NSDUH, 2013. Photos from: the AIGA symbol signs collection which was produced through a collaboration between AIGA and the U.S. Department of Transportation (DOT) in 1974 and 1979

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• For every $1 gained from alcohol and tobacco tax revenues, $10 is lost in legal, health, social and regulatory costs.

$$$$$$$$$$$

Urban Institute and Brookings Institute, 2012; Tax Policy Center 2008

Alcohol and Tobacco as Examples

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$14 billion

$25 billion

$185billion

$200billion

Alcohol Costs

Tobacco Costs

Revenues Revenues

Source: 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.

Alcohol and Tobacco as Examples

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Industry Tactics1. Pass “medical” marijuana initiatives

• “We are trying to get marijuana reclassified medically…we’ll be using the issue as a red herring to give marijuana a good name.” Keith Stroup from Natl. Org. for the Reform of Marijuana Law, 2001

• By using “marijuana as medicine,” a permission structure is built about the safety and acceptability of marijuana use with the general public.

2. Full legalization of marijuana – Colorado, Washington, Oregon, Alaska, Washington, D.C.

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What’s Happening in Colorado?A Colorado Timeline• 2000 – 1st conservative medical marijuana bill passed• 2007-2008 – early medical marijuana era – 1000-4800

cardholders and 0 known dispensaries• 2009-2013 – medical marijuana commercialization and

expansion era – 108,000 cardholders and 532 licensed dispensaries

• 2014 – full legalization of marijuana; recreational and medical

The Legalization of Marijuana in Colorado. Rocky Mountain High Intensity Drug Trafficking Area; Volume 3; September 2015.

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What’s Happening in Colorado

• More medical marijuana centers than Starbucks and McDonalds.• Medical Marijuana Centers = 497• Recreational Marijuana Stores = 369• Starbucks Coffee = 405• McDonald’s = 227

• In Denver, there are 198 medical marijuana centers and 117 pharmacies.

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What’s Happening in Colorado?

• There was a 40% increase in drug-related suspensions and expulsions in Colorado schools from 2008-09 to 2013-14. (3,736 to 5,259)

• Drug Testing Index showed that in 2013, positive drug test results in the workforce for marijuana increased nationwide by 6.2%, but in Colorado by 20%.

• Hospitalizations related to marijuana increased from 4,438 in 2008 to 11,438 in 2014.

The Legalization of Marijuana in Colorado. Rocky Mountain High Intensity Drug Trafficking Area; Volume 3; September 2015.

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Average Past Month Use of Marijuana, CO vs U.S., Ages 12-17 Years

2006-2008 2009-2012 20130

2

4

6

8

10

12

6.7

9.9

7.158.29

10.3211.16

U.S.CO

Ave

rage

Per

cent

Pre-Commercialization Post Commercialization Legalization

National Survey on Drug Use and Health

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Adult Marijuana Use

College Age Adults (ages 18-25 years)

Current Marijuana Use 2013

National average = 18.9%

Colorado average = 29%

Adults (ages 26+ years)Current Marijuana Use

2013

National average = 5.5%

Colorado average = 10.1%

National Survey on Drug Use and Health, 2006-2013

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Past Month Usage by 12-17 Year Olds in Medical Marijuana States, 2013A

LK

YK

S LA MS

SD

OK

ND

WV UT NJ ID AR TX WY IN TN VA

NE IA IL NC

MN

PA

MO SC

GA WI

OH

MD FL CA

NY AZ

NV CT

MT

AK

MA MI

DE

NM

ME HI

OR

NH

WA

CO VT RI0

2

4

6

8

10

12

14

Average %Legalized Recreational/Medical Marijuana States (as of 2013)Legalized Medical Marijuana State (as of 2013)Non-Legalized Medical Marijuana State (as of 2013)

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TAKE HOME MESSAGES

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Take Home Messages• Science has proven that marijuana is both addictive and

harmful to the human brain, especially when used as an adolescent. Your brain knows that it wants more of the feeling that marijuana offers.

• Marijuana may not cause overdose, but neither does tobacco. In either case, you cannot deny the harmful effects of the drug’s use.

• Marijuana contains medical properties, but we don’t have to smoke it to get the benefits.

• Today’s marijuana is much more potent than the marijuana of the 1960’s because of the increase in the THC content.

• Marijuana and driving do not mix. Marijuana effects your reaction time and your judgment.

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Things to Think AboutMarijuana is a cash-only business because of the fact that it is a schedule I control substance.• Health insurers not required to cover marijuana; private

insurers may cover if they choose• Veterans should make sure that using marijuana will not

disqualify them from benefits• Most banks won’t take marijuana money because they have

to comply with federal regulations. • Maryland’s law does not prevent an employer from testing for

marijuana use and taking action against an employee for a positive test.

• Subsidized housing authorities do not have to allow the use of medical marijuana because of federal regulations

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Things to Think About• Medical marijuana legalization is the first step of marijuana industry tactics.

• Step 2 is the commercialization of marijuana.

• Step 3 is full legalization of marijuana, including medical and recreational use.

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CONTACT INFORMATIONKendra [email protected]