The Good, The Bad, The Ugly and The Impact of Making Marijuana LegalMARTHA L. THOMPSON PSYD., LPC., CAADC

EMPOWER THE MIND LLC © 2015

Objectives

Gain knowledge of research related information supporting the impact of marijuana legalization.

Be able to identify pros and cons as it relates to how other states are seeing with the changes and impact to treatment / probation.

Objectives Explore at least three ways to address these changes in the work they do.

Gain an increased awareness of the world of E-Cigs, Vaporization and Other THC related Food / Beverage products on the market.

History of Marijuana in the US

1906 Pure food and drug act - intended targets being who mislabeled or polluted drugs with undisclosed narcotics. This resulted in labeling non-medical cannabis as a "poison“

1910 Mexican Revolution – immigrants introduced marijuana's recreational use. Interestingly, it was only referred to as "marihuana" and "because anti-cannabis factions wanted to underscore the drug's "Mexican-ness”

1929 Great Depression

History Continued 1931 Government research linked marijuana to heinous criminal activity "primarily

committed by 'racially inferior' or underclass communities”

1920-1933 Alcohol Prohibition

1932 Uniform State Narcotic Act gave legislative control of marijuana from the federal

government to the states

1937 Marijuana Tax Act, Formation of NORML

1972 Marijuana becomes a Schedule 1 drug

After the elections….November 5, 2014

23 states and the District of Columbia currently have laws legalizing marijuana in some form

4 states legalized marijuana for medical / recreational use

◦ Colorado & Washington – legal since 2012

◦ Oregon & Alaska – votes will determine measures to be set in 2015

◦ District of Columbia - voters overwhelmingly approved a ballot

initiative legalizing recreational purpose marijuana *Subject to

Congressional review

After the elections…. 19 states allow medical marijuana use

◦ States have various restrictions around medical marijuana cards

◦ California – so loose it is almost like legalizing it

◦ Illinois – only have 30 medical diagnosis eligible for marijuana

treatment

After the elections 14 states have decriminalized marijuana use / possession

◦ Softening the penalties associated with possessing the drug

◦ Limiting or eliminating prison time and opting for fines instead

◦ Does not do away with harsh penalties for possessing or trafficking

large amounts of the plant

Chaos did not follow legalization – did it?

States have not fallen to pieces after making the various legal changes

Some states report not having enough product on hand… the shelves ran dry! (but they have restocked)

Colorado says recreational sales have surpassed medical sales … does this change the black market for marijuana?

Majority Rules1990 appx 16% of US

voters support pot

2014 appx 55% of US

voters support pot

85% of PA voters pro-pot◦ voters in PA

PA Compassionate Use of Marijuana Act

The state Senate voted 43-7 on Sept. 24 to pass its medical marijuana legislation (SB 1182)

Under the Senate proposal, state residents would need an access card from the state Health Department after proving they have a practitioner-patient relationship and written confirmation of a qualifying medical condition

◦ A handful of drug delivery methods that do not involve smoking it would be permitted, including extracted oil, edible products, ointments and tinctures

Possible qualifying medical conditions in PA

Cancer Epilepsy and seizures Lou Gehrig's disease Post-traumatic stress disorder Traumatic brain injury and post-concussion syndrome.

Spinocerebellar ataxia Severe fibromyalgia Wasting syndrome Parkinson's disease Multiple Sclerosis What Else??????

What’s up in the city of brotherly love

On October 1, Philadelphia Mayor Michael Nutter signed an ordinance decriminalizing marijuana in the City of Brotherly Love, making it the largest U.S. city to have done so.

Beginning on October 20, the ordinance will remove criminal penalties for the possession of up to an ounce of marijuana and replace them with a civil fine of $25, similar to a traffic ticket.

Does PA have a weed and race issue?

Under state law, an individual arrested for possession of up to an ounce of marijuana in Pennsylvania can be sentenced to a maximum of 30 days in jail and fined up to $500

A 2013 study by the American Civil Liberties Union found that although blacks and whites use marijuana at nearly identical rates, blacks in Pennsylvania are 5.2 times more likely than whites to be arrested for marijuana possession

Pot in Prison A 2004, survey by the U.S. Department of Justice (DOJ) estimated that about 70% of State and 64% of Federal prisoners regularly used drugs prior to incarceration◦ The study also showed that 1 in 4 violent offenders in State prisons

committed their offenses under the influence of drugs.

2012, nearly 7 million adults were involved with the criminal justice system (State or Federal prisons, local jails), ◦ including nearly 5 million who were under probation or parole

supervision

And Justice for All 2008, 18% were sentenced for drug offenses and only 6% were incarcerated for drug possession alone

4.4% were drug offenders with no prior sentences

2009, 51 %of Federal prisoners, who represent 13% of the total prison population, had a drug offense as the most serious offense

99.8% of Federal prisoners sentenced for drug offenses were incarcerated for drug trafficking

One-tenth of 1% (0.1 percent) of State prisoners were marijuana possession offenders with no prior sentences

Medical Pros and Cons Medical Marijuana Pros and Cons Research has show it to be an effective treatment for pain and nausea Benefits of this as a treatment option need to be weighed against the risks i.e. are there less harmful alternatives

Controversy around smoking it – are there better ways to regulate it therefore make it less harmful

Medical Pros / Cons Needs more research to determine addictability despite history of high rates of abusing this substance

Need more research to determine impact on the brain, memory, learning, impulsivity, problem solving ability etc.

Marijuana Assisted Therapy Marijuana treatment research Restrictions on research with hallucinogens are easing, a new generation of investigators are studying

◦ MDMA for PTSD◦ LSD for Anxiety ◦ Psilocybin for OCD◦ Marijuana for MS, chronic pain, PTSD and other conditions

Pot Practice Contemporary research on positive effects of psychedelics and marijuana needs to be carefully designed

Medical use for teens and children

- Marijuana does cause changes in the same areas of the brain as other addictive drugs (in particular the nucleus accumbens)

-There is compelling evidence that marijuana is neurotoxic to children and adolescents. The American Academy of Pediatrics opposes 'medical marijuana' for children

Our little darlings + Charlottes Web (low dose THC) 99% seizure reduction when used for treatment of Dravet Syndrome

? Research for short / long term use is still inconclusive even in cases of severe seizure disorders and chemo therapy patients

But they won’t they smoke more!?!

2013, 7% of 8th graders, 18% of 10th graders, and 22.7% of 12th graders used marijuana in the past month

Up from 5.8%, 13.8%, and 19.4% in 2008.

Daily use has also increased; 6.5% of 12th graders now use marijuana every day, compared to 5% in the mid-2000s

Other reports state no known increase in states with legalization

Less is more for minors If the legal market replaces the black market – will it make it more difficult for minors to access?

Shady shops will be more easily detected and busted…Right?

Delayed first use of marijuana lessens the impact of THC on the developing brain

Regulations for Safer Use Regulation and public safety is a common sense principle born in the history in countless industries

◦ Manufacturing regulations

◦ Production inspections

◦ Quality product without impurities

◦ New pharmaceutical product applications would go to the FDA

What are the Feds doing Still Schedule I drug with NO Medical Benefits according to the DEA

◦ Marinol schedule II (special consideration made in 1999)

Researchers get DEA approval to explore medical value

◦ Need to explore carcinogen impact

◦ Need to explore impact on brain development

Obama administration’s memo“the Department of Justice wouldn't challenge state laws on marijuana legalization as long as they adhere to a set of strict rules regarding the sale and distribution of the drug, such as ensuring minors don't have access to it.”

the "memo"

The debate just got closer to home with the District of Columbia’s move to legalize marijuana in the backyard of the White House

Show me the money! How much money could be made?????

◦ 3x the NFL (appx 10 billion / year)

Colorado – ◦ 30 million dollars taxable revenue per month ◦ = Appx 7.5 million dollars tax revenue

California - ◦ Appx 1.4 billion dollars of extra tax revenue per year

$$$$$$$$$$$$Money$$$$$$$$$$$$$$$

The power of a for-profit industry to stoke more demand for a already popular drug cannot be overestimated.

◦ Exhibit A: tobacco.

◦ Yet – around 50,000 people die each year from alcohol poisoning

◦ Exhibit B: alcohol.◦ Yet - more than 400,000 deaths each year are attributed to

tobacco smoking

Delectable Delicacies

Edible Marijuana products

Poor dosing instructions, information and production regulation

The Future of Marijuana Treats

2 -12 fatalities in Colorado????? 26 overdoses just this year?????

Increased ER visits Minors taking it and not knowing

Vape Life Is it safer than smoking….no one knows yet!

2011-2012 Billion dollar industry – set to out sell tobacco

Poor regulations with minors

Difficult to detect if cartridge contains illicit substances

Marijuana Intoxication Most commonly used illegal drug in the US

◦ Appx 1 in every 10 adults in the US have tried marijuana

Sometimes use results in complicated and undesirable side effects

Intoxicating effects of marijuana include relaxation, sleepiness, and mild euphoria

◦ Smoking marijuana leads to fast and predictable signs and symptoms. ◦ Eating marijuana can cause slower, and sometimes less predictable

effects.

Marijuana Intoxication Marijuana can cause undesirable side effects, which increase with higher doses. These side effects include:◦ Decreased short-term memory◦ Dry mouth◦ Impaired perception and motor skills◦ Red eyes

More serious side effects include panic, paranoia, or acute psychosis, which may be more common with new users or in those who already have a psychiatric disease.

Marijuana Use Highly correlated with bringing underlying mental illness to the foreground

Correlations with schizophrenia

Interactions in the brain with dopamine are the proposed cause for this correlation

Synthetic Marijuana Mostly illegal (depending on what it is made with)

◦ Can be charged even if legal ingredients but sold as illicit substance

Up to 800x more potent than “regular” marijuana

Increased rates of addiction, complications and reactions for those who use it such as psychosis

DSM 5 Substance use disorder in DSM-5 combines the DSM-IV categories of substance abuse and substance dependence into a single disorder measured on a continuum from mild to severe

Diagnosis of substance abuse previously required only one symptom, mild substance use disorder in DSM-5 requires two to three symptoms from a list of 11

Diagnosis of dependence caused much confusion. Most people link dependence with “addiction” when in fact dependence can be a normal body response to a substance

Treatment in the “new age” Marijuana dependence appears to be very similar to other substance dependence disorders, although the long-term clinical outcomes may be less severe

On average, adults seeking treatment for marijuana abuse or dependence have used marijuana nearly every day for more than 10 years and have attempted to quit more than six times

Marijuana abuse or dependence typically co-occurs with use of other drugs, such as cocaine and alcohol

No worries – you know what to do

Co- occurring patients still need to be treated with mental health counseling and possible medications to reduce self medicating◦ particularly among heavy users and those with more chronic

disorders Behavioral Treatments

◦ motivational enhancement therapy (MET)◦ Group or individual cognitive-behavioral therapy (CBT) ◦ Contingency Management (CM)◦ Family-based treatments

Treatment Outcomes Even effective treatment for adults, shows only about 50% of enrollees achieve an initial 2-week period of abstinence, and among those who do, approximately half will resume use within a year

Studies show 1-year abstinence rates have ranged between 10 and 30 percent for the various behavioral approaches

As with other addictions, these data suggest that a chronic care model should be considered for marijuana addiction with treatment intensity stepped up or down based on need

The Future of Marijuana Treatment

Most of the studies to date have targeted the marijuana withdrawal syndrome

One study showed that a combination of a cannabinoid agonist medication with lofexidine (a medication approved in the UK for the treatment of opioid withdrawal) produced ◦ more robust improvements in sleep ◦ decreased marijuana withdrawal and craving◦ showing relapse in daily marijuana smokers relative to either

medication alone

The End THANK YOU

Enjoy the Conference

Martha L. Thompson PsyD., LPC., CAADC

Empower the Mind LLC

drmartha@empowerthemind.org

717*304*2631

1464 Rt. 61 S. * Pottsville, PA 17901

Web resources and reference pages

www.cadca.org/

www.drugabuse.gov/

www.erowid.org/

www.nih.gov/

www.norml.org/

www.procon.org/

www.samhsa.gov/

www.whitehouse.gov/

Other references Freisthler, B., Kepple, N. J., Sims, R., & Martin, S. E. (2013). Evaluating medical marijuana dispensary policies: Spatial methods for the study of environmentally-based interventions. American Journal Of Community Psychology, 51(1-2), 278-288. doi:10.1007/s10464-012-9542-6

Jaffe, S. L., & Klein, M. (2010). Medical marijuana and adolescent treatment. The American Journal On Addictions, 19(5), 460-461. doi:10.1111/j.1521-0391.2010.00063.x

MacCoun, R. (2011). What can we learn from the Dutch cannabis coffee shop system?. Addiction (Abingdon, England), 106(11), 1899-1910. doi:10.1111/j.1360-0443.2011.03572.x

Uritsky, T. J., McPherson, M., & Pradel, F. (2011). Assessment of Hospice Health Professionals' Knowledge, Views, and Experience with Medical Marijuana. Journal Of Palliative Medicine, 14(12), 1291-1295. doi:10.1089/jpm.2011.0113

Wilkinson, S. T., & D’Souza, D. (2014). Problems with the medicalization of marijuana. JAMA: Journal Of The American Medical Association, 311(23), 2377-2378. doi:10.1001/jama.2014.6175