The Smoke Behind Marijuana

1. The Smoke Behind Marijuana December 12, 2012 Linda M. Keegan Moraine Park Technical College

2. What is Marijuana?

3. America’s most commonly abused illicit drug • Marijuana is a greenish-gray mixture of the dried, shredded leaves, stems, seeds, and flowers of Cannabis sativa, the hemp plant. • Most users smoke marijuana in hand-rolled cigarettes, commonly called “joints.” • Some people use pipes or water pipes, called “bongs.” • Marijuana cigars, or “blunts,” also are popular.

4. America’s most commonly abused illicit drug Street names for marijuana: • Pot • Grass • Reefer • Weed • Herb • Mary Jane (MJ) For more street names, go to: http://botanical.com/botanical/mgmh/h/hemp22b.html

5. America’s most commonly abused illicit drug • The main active chemical in marijuana is delta-9-tetrahydrocannabinol, or THC for short. • As a more concentrated, resinous form, it is called hashish. • As a sticky black liquid, it is called hash oil. • Marijuana smoke has a pungent and distinctive, usually sweet-and-sour, odor.

6. America’s most commonly abused illicit drug • Marijuana is a Schedule I drug. • In 1970, Congress enacted laws against marijuana based in part on its conclusions that the drug has noscientifically provenmedical value. • Likewise, the Food and Drug Administration (FDA) has thus far declined to approve smoked marijuana for any condition or disease.

7. America’s most commonly abused illicit drug • According to the National Survey on Drug Use and Health, in 2009, 16.7 million Americans aged 12 or older used marijuana at least once in the month prior to being surveyed, an increase over the rates reported in all years between 2002 and 2008. • There also was a significant increase among youth aged 12-17 years, with current use up from 6.7 percent in 2008 to 7.3 percent in 2009. • However, this rate is lower than what was reported in 2002 (8.2 percent).

8. America’s most commonly abused illicit drug • Past-month use also increased among those persons ages 18-25 years, from 16.5 percent in 2008 to 18.1 percent in 2009. • Results from the 2009 Monitoring the Future survey show, as in the past few years, a stall in the decline of marijuana use that began in the late 1990s among our nation’s youth. • In 2009, 11.8 percent of 8th-graders, 26.7 percent of 10th-graders, and 32.8 percent of 12th-graders reported past-year use.

9. America’s most commonly abused illicit drug • In addition, perceived risk of marijuana use declined among 8th- and 10th-graders. • And disapproval of marijuana use declined among 10th-graders. This is a concern because changes in attitudes and beliefs often drive changes in drug use.

10. Why is it making the news?

11. Why are some people celebrating?

12. Why are some people worried?

13. Let’s watch and listen http://www.reuters.com/video/2012/12/06/deadly-rare-tornado-hits-new-zealand?videoChannel=2602&videoId=239622174 According to this Reuters’ web site, Washington is the “first state in the nation to legalize pot for adult recreational use.”

14. News Summary • Since Dec. 6, it is legal in Washington state for adults to possess and useup to one ounceof marijuana. • Users must be21 years of age, or older. • They must use the drug in the privacy of their own homes. • The plan is for the state to eventually sell the drug legally instate-licensed stores. • For now, it remains a crimeto sell, cultivate or even share one’s own stash.

15. News Summary Similar to alcohol regulation, driving under the influence of cannabis or imbibing in public places where the consumption of alcohol is already banned remain illegal. A patient challenges the established legal limit of marijuana while driving, saying that the limit is too low, given this patient’s current use of the drug.

16. Confused? • A Schedule 1 drug at the national level? • Yet, personal use is legal in Washington? • And consider this…

17. Confused? • Popular interest has focused on state initiatives and other legislation decriminalizing the use of smoked cannabis for personal medical use. • Because of this legislation, herbal cannabis in various forms is now being distributed by dispensaries to large numbers of individuals with a wide variety of medical conditions. -- American Society of Addiction Medicine

18. What do you think? Pros and Cons • http://www.balancedpolitics.org/marijuana_legalization.htm • http://marijuanatoday.com/ • http://www.umsl.edu/~keelr/4380_ss08_wiki/ba0e099eb51f95fb9dfc0d6d2f268372.html • http://usliberals.about.com/od/patriotactcivilrights/i/MarijuanaProCon.htm • http://www.ibtimes.com/pros-cons-drug-legalization-us-246712

19. What do you think? • http://www.ibtimes.com/pros-cons-drug-legalization-us-246712 • http://legalizationofmarijuana.com/pros-and-cons-of-marijuana.html • http://www.treatmentsolutions.com/pros-and-cons-of-legalizing-marijuana/ • http://www.buzzle.com/articles/pros-and-cons-of-legalizing-marijuana.html • http://www.huffingtonpost.com/2012/08/28/drug-legalization-pros-cons-drug-war_n_1834417.html

20. Consider this… • The legalization movement is not simply a harmless academic exercise. • The mortal danger of thinking that marijuana is “medicine” was graphically illustrated by a story from California. • In the spring of 2004, Irma Perez was “in the throes of her first experience with the drug Ecstasy…when, after taking one Ecstasy tablet, she became ill and told friends that she felt like she was…’going to die’”…

21. Consider this… • Two teenage acquaintances did not seek medical care and instead tried to get Perez to smoke marijuana. • When that failed due to her seizures, the friends tried to force-feed marijuana leaves to her, “apparently because [they] knew that drug is sometimes used to treat cancer patients.”

22. Consider this… Irma Perez lost consciousness. She died a few days later, when she was taken off life support. She was 14 years old.

23. Marijuana as Medicine • The potential medicinal properties of marijuana have been the subject of substantive research and heated debate. • And while marijuana is not an FDA-approved medicine, 16 states and the District of Columbia have currently legalized its medical use. • Scientists have confirmed that the cannabis plant contains active ingredients with therapeutic potential for relieving pain, controlling nausea, stimulating appetite, and decreasing ocular pressure.

24. Marijuana as Medicine As a result, a 1999 Institute of Medicine report concluded that further research on cannabinoid drugs and safe delivery systems was warranted. -- National Institutes of Health

25. Marijuana as Medicine However, the Food and Drug Administration has “recognized and approved the medicinal use of isolated components of the marijuana plant and related synthetic compounds.” According to the FDA: • “Dronabinol is one such synthetically produced compound, used in the FDA-approved medicine Marinol, which is already legally available for prescription by physicians whose patients suffer from nausea and vomiting related to cancer chemotherapy and wasting (severe weight loss) associated with AIDS.

26. Marijuana as Medicine • Another FDA-approved medicine, Cesamet, contains the active ingredient Nabilone, which has a chemical structure similar to THC, the active ingredient of marijuana. • And Sativex, an oromucosal spray approved in Canada, the UK, and other parts of Europe for the treatment of multiple sclerosis spasticity and cancer pain, is currently in late-stage clinical trials with the FDA. It combines THC and another active ingredient in marijuana, cannabidiol (CBD), and provides therapeutic benefits without the ‘high’ from the drug.”

27. Marijuana as Medicine Marijuana itself is an unlikely medication candidate for several reasons: • It is an unpurified plant containing numerous chemicals with unknown health effects; • It is typically consumed by smoking, further contributing to potential adverse effects; and • Its cognitive impairing effects may limit its utility.

28. Marijuana as Medicine • The promise lies instead in designing tailored medications, developed from marijuana’s active components, for specific conditions or symptoms with improved risk/benefit profiles. • Scientists are actively engaged in this pursuit and hope to bring to market a new generation of safe and effective medications that avoid the adverse effects of smoked marijuana.

29. How Does Marijuana Affect the Brain? • When marijuana is smoked, its effects begin almost immediately. • THC rapidly passes from the lungs into the bloodstream, which carries the chemical to organs throughout the body, including the brain. • The effects of smoked marijuana can last from 1 to 3 hours. • Smoking marijuana delivers significantly more THC into the bloodstream than eating or drinking the drug.

30. How Does Marijuana Affect the Brain? • THC binds to specific sites called cannabinoid receptors (CBRs) located on the surface of nerve cells. • These receptors are found in high-density in areas of the brain that influence pleasure, memory, thinking, concentration, movement, coordination, and sensory and time perception. • CBRs are part of a vast communication network known as the endocannabinoid system, which plays a critical role in normal brain development and function.

31. How Does Marijuana Affect the Brain? • When someone smokes marijuana, THC stimulates the CBRs artificially, disrupting function of the natural, or endogenous, cannabinoids. • An overstimulation of these receptors in key brain areas produces the marijuana “high,” as well as other effects on mental processes. • Over time, this overstimulation can alter the function of CBRs, which can lead to addiction and to withdrawal symptoms when drug use stops.

32. How Does Marijuana Affect the Brain? • As THC enters the brain, it causes the user to feel euphoric (high), by acting on the brain’s reward system. • The reward system is made up of regions that govern the response to pleasurable things, like sex and chocolate, as well as to most drugs of abuse. • THC activates the reward system by stimulating brain cells to release the chemical dopamine.

33. How Does Marijuana Affect the User? Effects vary dramatically by user • Euphoria • Relaxation • Heightened sensory perception • Laughter • Altered perception of time • Increased appetite • After a while, the euphoria subsides, and the user may feel sleepy or depressed. • Occasionally, marijuana use may produce anxiety, fear, distrust or panic.

34. How Does Marijuana Affect the User? • Impairs a person’s ability to form new memories, and to shift focus. • Disrupts coordination and balance by binding to receptors in the cerebellum and basal ganglia (parts of the brain that regulate balance, posture, coordination, and reaction time). • Therefore, learning, doing complicated tasks, participating in athletics, and driving are also affected.

35. How Does Marijuana Affect the User? • Marijuana users who have taken large doses of the drug may experience an acute psychosis, which includes hallucinations, delusions, and a loss of the sense of personal identity. • Short-term psychotic reactions to high concentrations of THC are distinct from longer-lasting, schizophrenia-like disorders that have been associated with the use of cannabis in vulnerable individuals.

36. Consequences of Marijuana Abuse Acute (present during intoxication) • Impairs short-term memory • Impairs attention, judgment, and other cognitive functions • Impairs coordination and balance • Increases heart rate • Psychotic episodes

37. Consequences of Marijuana Abuse Persistent (lasting longer than intoxication, but may not be permanent) • Impairs memory and learning skills • Sleep impairment

38. Consequences of Marijuana Abuse Long-term (cumulative effects of chronic abuse) • Can lead to addiction • Increases risk of chronic cough, bronchitis • Increases risk of schizophrenia in vulnerable individuals • May increase risk of anxiety, depression, and amotivational syndrome • Other health consequences

39. Marijuana Addiction • Long-term marijuana use can lead to addiction. • That is, people have difficulty controlling their drug use and cannot stop even though it interferes with many aspects of their lives. • It is estimated that 9 percent of people who use marijuana will become dependent on it. • The number goes up to about 1 in 6 in those who start using young (in their teens) and to 25-50 percent among daily users.

40. Marijuana Addiction • Marijuana addiction also is linked to a withdrawal syndrome similar to that of nicotine withdrawal, which can make it hard to quit. • People trying to quit report irritability, sleeping difficulties, craving, and anxiety. • They also show increased aggression on psychological tests, peaking approximately 1 week after they last used the drug.

41. Did You Know? • Marijuana and driving do not mix. • It is the most common illegal drug found in drivers who die in accidents (around 14 percent of drivers), sometimes in combination with alcohol or other drugs.

42. Other Ways to Manage ?

43. For specific conditions, check out the CDC website http://www.cdc.gov/arthritis/resources/spotlights/arthritis-video.htm Includes these links: • Arthritis Basics • Data and Statistics • Funded Science • State Programs • Publications • Interventions • Policy/Partnerships • Resources

44. Internet References • http://www.balancedpolitics.org/marijuana_legalization.htm • http://marijuanatoday.com/ • http://www.umsl.edu/~keelr/4380_ss08_wiki/ba0e099eb51f95fb9dfc0d6d2f268372.html • http://usliberals.about.com/od/patriotactcivilrights/i/MarijuanaProCon.htm • http://www.ibtimes.com/pros-cons-drug-legalization-us-246712 • http://www.ibtimes.com/pros-cons-drug-legalization-us-246712

45. Internet References • http://legalizationofmarijuana.com/pros-and-cons-of-marijuana.html • http://www.treatmentsolutions.com/pros-and-cons-of-legalizing-marijuana/ • http://www.buzzle.com/articles/pros-and-cons-of-legalizing-marijuana.html • http://www.huffingtonpost.com/2012/08/28/drug-legalization-pros-cons-drug-war_n_1834417.html • http://www.reuters.com/article/2012/12/07/us-usa-marijuana-washington-idUSBRE8B506L20121207

46. Internet References • http://www.ncadd.org/images/stories/Get-involved/ncaddpositionstatement-oppositiontomedicalmarijuana-10-30-10.pdf • http://www.marketplace.org/topics/life/president-obamas-drug-policy-adviser-medical-marijuana-and-enforcement • http://www.whitehouse.gov/sites/default/files/ondcp/issues-content/marijuana_and_public_health_one_pager_-_final.pdf • https://soundcloud.com/#marketplace-radio/president-obamas-drug-policy • http://blogs.justice.gov/main/archives/192?print=1

47. Internet References • http://www.reuters.com/video/2012/12/06/deadly-rare-tornado-hits-new-zealand?videoChannel=2602&videoId=239622174 • http://www.asam.org/docs/publicy-policy-statements/state-level-proposals-to-legalize-marijuana-finalF82ECCB0BE99.pdf#search="medical marijuana" • http://www.asam.org/docs/publicy-policy-statements/1medical-marijuana-4-10.pdf?sfvrsn=0#search="medical marijuana" • http://www.asam.org/research-treatment/marijuana • http://www.csam-asam.org/sites/default/files/impact_of_marijuana_on_children_and_adolescents.pdf

48. Internet References • http://www.whitehouse.gov/ondcp/marijuanainfo • http://www.whitehouse.gov/ondcp/frequently-asked-questions-and-facts-about-marijuana • http://www.whitehouse.gov/ondcp/marijuana • http://www.whitehouse.gov/ondcp/federal-laws-pertaining-to-marijuana • http://www.whitehouse.gov/ondcp/state-laws-related-to-marijuana • https://ssl3.ama-assn.org/apps/ecomm/PolicyFinderForm.pl?site=www.ama-assn.org&uri=%2fresources%2fdoc%2fPolicyFinder%2fpolicyfiles%2fHnE%2fH-95.998.HTM

49. Internet References • http://clinicaltrials.gov/ct2/results?term=marijuana&recr=Closed&rslt=&type=&cond=&intr=&outc=&lead=&spons=&id=&state1=&cntry1=NA%3AUS&state2=&cntry2=&state3=&cntry3=&locn=&gndr=&rcv_s=&rcv_e=&lup_s=&lup_e= • http://clinicaltrials.gov/ct2/results?term=marijuana&recr=Open&rslt=&type=&cond=&intr=&outc=&lead=&spons=&id=&state1=&cntry1=NA%3AUS&state2=&cntry2=&state3=&cntry3=&locn=&gndr=&rcv_s=&rcv_e=&lup_s=&lup_e= • http://clinicaltrials.gov/ct2/results?term=marijuana+or+cannabis+and+smoked&no_unk=Y&cntry1=NA%3AUS

50. Internet References • http://www.justice.gov/dea/druginfo/ftp_chart2.pdf • http://www.justice.gov/dea/druginfo/ftp3.shtml • http://www.justice.gov/dea/druginfo/ftp_chart1.pdf • http://www.justice.gov/dea/docs/marijuana_position_2011.pdf • http://www.justice.gov/printf/PrintOut2.jsp • http://botanical.com/botanical/mgmh/h/hemp22b.html • www.marijuana-info.org • www.drugabuse.gov