Hemprove | Marijuana Legalization is good or not for us

1. Marijuana Legalization is good or not for us Hemprove

2. No presenter has an actual or potential conflict of interest in relation to this activity or presentation.

3. Objectives Pros and cons of marijuana legalization Effects of legalization on use of marijuana, especially in adolescents and young adults Brief discussion of endocannabinoid system in the brain and how marijuana effects it Adverse effects of marijuana especially for those who start early and use frequently Marijuana addiction How do we address these issues in the Health Center?

4. Why do people use marijuana?

5. Marijuana contains many chemicalsincluding cannabinoids • THC – tetrahydrocannabinol • Psychoactive component • Active in the brain • Induces the “high” • CBD – cannabidiol • Nonpsychoactive • Active in the periphery • Acts on immune system, anti-inflammatory

6. Marijuana Today

7. Marijuana Legalization Medical 1996 CA is first state to legalize medical marijuana Recreational 2012 CO and WA pass ballot initiatives to legalize recreational marijuana 2014  OR and AK legalize marijuana 2016  CA, ME, MA, NE also legalize marijuana 2018 VT is first state to legislate legalization

8. 24 million people in the US used marijuana in the last month (8%) 19.8% among college students 200 million people in the world use marijuana

10. Marijuana LegalizationPRO CON • Industry can be regulated – potency, labeling, safety of product • Majority of users are not harmed • No lethal overdose • Does not cause violence • New industry – will increase jobs and tax $ • Black Market will decrease • Use will increase, especially among adolescents and young adults • With increased use, there will an increase in negative consequences of use – effect on brain devel, addiction, ER visits, traffic accidents – all which will cost $ • More research is needed re risks and benefits before it’s on the market • Black market will increase

11. Marijuana Legalization is coming to your state (if it's not there already!) This is a multi-billion dollar industry including sales, tax revenues, jobs – hard for states to resist Growing acceptance of marijuana legalization 1972 16% approve legalization 2016 60% approve legalization

12. Medical marijuana has normalized use “We will use medical marijuana as a red herring to give marijuana a good name.”

14. Impact of Legalization in Colorado • 2000 Medical Marijuana • 2009 Commercialization of MMJ • 2012 Recreational marijuana • Jan 2014 Retail sales

15. Number of Marijuana Dispensaries, Starbucks and McDonalds

16. Percentage of monthly users ages12-17 CO compared to US average

17. States with Medical and Recreational Marijuana Have Highest Rates of Use Among 18-25 year olds

20. Impact of Legalization in CO Rocky Mountain HIDTA 2017 Traffic fatalities when driver tested positive for marijuana up 225% 2013-16 ER visits rates related to marijuana per 1000 visits up 35% 2011-2015 Pounds of illegal marijuana seized up 700% 2015-2016 2016 tax revenue $180 million (0.8% of budget) Price of marijuana per lb fell 25% 2015-2016

21. Marijuana Legalization Is Coming Our population – adolescents and young adults- are vulnerable to the negative effects of marijuana. As college health professionals, what are the issues we need to be aware of and concerned about?

22. What are the effects of marijuana we should be concerned about? Cognitive Effects Anxiety and depression Increased risk of psychotic disorders (schizophrenia) Potential for Addiction/Cannabis Use Disorder

23. Cognitive Effects “There’s growing literature, and it’s all pointing in the same direction: Starting young and using frequently disrupts brain development.” Susan Weiss, Director of Research NIDA

24. Endocannabinoids and THC Anandamide was discovered in 1992 and named after the Sanskrit word “ananda” meaning “bliss, joy, delight.”

25. Endocannabinoids and THC Anandmide is a natural endocannabinoid. THC is 4 times as likely to attach to cannabinoid receptors so the brain slows down production of the endocannabinoids.

27. Brain development and neural connections pruning continues until age 26

28. Short Term Cognitive Effects Problems with learning and memory Executive functioning (attention, planning, abstract reasoning, decision making) Altered time and spatial perception Poor coordination and balance Effects academic performance Effects judgment Effects driving skills

29. Driving Under the Influence THC Effects Decreases muscle coordination Increases reaction time Decreases ability to judge distance Decreases peripheral vision

30. Long Term Effects on Brain Meier, Prac. Natl. Sci.,2012 Decrease in IQ – study in NZ of a cohort of 1000 followed for 25 years found that early, regular long term use resulted in an 8 point drop in IQ.

31. Anxiety and Depression Hill, 2015 Marijuana decreases anxiety in the short term but as its effect wears off, there often is rebound anxiety which is often at a greater level, so more marijuana is used to decrease the anxiety. Panic attacks – often related to high concentrations of THC. Heavy marijuana use associated with depression.

32. Marijuana Use and Risk of Schizophrenia

33. Is Marijuana Addictive? VolkowND, N Engl J Med, 370, 23 2219-27 Definition of addiction: Repeated use of a substance despite negative consequences. Marijuana withdrawal syndrome: Anxiety Insomnia Irritability

34. Is Marijuana Addictive? 1/6 (17%) of adolescents who try marijuana will develop an addiction 25 - 50% of daily users will develop an addiction 1/11 (9%) of adults who try marijuana will develop an addiction VolkowND, N Engl J Med, 370, 23 2219-27 2.7 million Americans meet DSM-5 criteria for marijuana addiction

35. Long Term Effects Multiple long term studies suggest that early-onset cannabis use especially when combined with alcohol use, is predictive of lower educational attainment, diminished life satisfaction, increased likelihood of addiction, and other health problems. Marijuana is a Performance Degrading Drug

36. Assessment of Students Regarding Marijuana Use Ask about use, especially if they are being seen for respiratory symptoms, sleep problems, anxiety, depression, vomiting, abdominal pain, if they indicate academic, family or social problems Determine extent of use Identify if symptoms may be related to use Ask why they use – important to get their perspective! If appropriate, discuss marijuana addiction

37. Assessment of Students in Health Center, cont’d Employ harm reduction strategy Discuss importance of avoiding DUI, either as driver or passenger, especially avoiding combining alcohol and marijuana Interactions with prescribed medications unknown Medical marijuana card? Document this discussion in the medical record

38. Acute Marijuana Intoxication Incidences increases with easier access to marijuana, stronger THC potency, edibles Tachycardia, elevated BP (sometimes orthostatic BP) Anxiety, panic, paranoia, agitation, psychosis Treatment – reassurance, fluids prn, rest in a quiet room, sometimes benzodiazipines needed Can last a few hours if smoked or vaped, longer if ingested

39. Marijuana Hyperemesis Syndrome • Seen in heavy chronic users, incidence has increased in legalized states • Frequent daily vomiting relieved by hot showers • Can lead to “scromiting” - screaming and vomiting • Screaming due to psychosis and/or abd pain • Treatment – rest, fluid replacement • Occasionally benzodiazapines or haloperidol needed • Capsaicin has been studied for abd pain

40. Legality of Marijuana in the US 2018 Who’s next? AZ AR CT DE FL IL MD MI MN MT NH NJ NY OH RI States with legal marijuana CO WA AK OR CA ME MA NV VT

41. In Summary There is a good chance that marijuana legalization is coming to your state Legalization increases use especially in adolescents and young adults Marijuana has short tem and long term effects on the brain especially for those who start young and use frequently Marijuana is addictive, greater risk for those that start as adolescents Important to assess use and give accurate information nonjudgmentally to students Stay up to date with what’s happening in your state

42. Other Physiological Effects Adrenergic symptoms Tachycardia Hypertension (also orthostatic hypotension) Tachypnea Dry mouth Conjunctival injection Coronary artery constriction Increased appetite

43. National Survey on Drug Use and Health CaulkinsJ, Nat Affairs 2016 Population based survey asking questions about past month drug and alcohol use and diagnostic criteria for abuse and dependence conducted annually 70,000 respondents annually 20 million marijuana users; 137 million alcohol users 21% of current marijuana users met diagnostic criteria for abuse/dependence 13% of alcohol users met criteria 20% of marijuana users use 80% of marijuana consumed

44. Psychosis Several studies have shown that using marijuana increases the risk of developing psychosis by a factor of 2 to 6. Another study concluded that using marijuana could hasten the development of psychotic symptoms by 3 years – significant because the earlier the onset of psychosis, the worse the long term outcome. Robin Murray of London’s Institute of Psychiatry estimated that 25,000 schizophrenic diagnoses could have been avoided if no cannabis use.

45. 1840s to 1930s widely prescribed in US and Europe for a variety of ailments Listed in US Pharmacopeia as treatment for: Neuralgia Gout Rheumatism Tetanus Cholera Convulsions Chorea Hysteria Depression DTs Insanity Uterine hemorrhage

46. History of Marijuana Prohibition 1913 – 1970’s state and federal laws prohibiting marijuana 1936 Reefer Madness

47. History of Prohibition cont’d • 1970 Controlled Substance Act classifying marijuana as Schedule I (no medicinal value and potential for harm) • 1980’s President Ronald Reagan’s War on Drugs

49. THANK YOU!