Underwriting Recreational & Medicinal Marijuana Users Wally Taylor, FALU CLU ChFC FLMI

1. Underwriting Recreational & Medicinal Marijuana Users Wally Taylor, FALU CLU ChFC FLMI VP & Chief Underwriter

2. What this presentation is • Known medical facts regarding recreational and medicinal marijuana use. • The mortality risks of recreational and medicinal marijuana use. • Underwriting implications of applicants’ with recreational or medicinal marijuana use.

3. What it isn’t • An argument for or against legalizing marijuana use. • Discussion of the ethics of marijuana use. • Discussion of the legal implications of marijuana use. • Underwriting implications of chronic or heavy use.

4. Introduction • Began with college research project. • Published as two-part article in On The Risk. • AHOU “Point-Counter-Point.” • Advent of legal medicinal use. • Continued research on the topic.

5. “Reefer Madness” • 1936 propaganda film financed by church group. • “Documents” inevitable outcomes of marijuana use: • Hit and run accident • Manslaughter • Suicide • Attempted rape • Descent into madness

6. Definition Recreational marijuana use defined as: “Use of marijuana up to 8 to 10 times per month.”

7. Definition Medicinal use defined as: “Marijuana use in locales where its use medically is legal and where the user has known debilitating symptoms of medical conditions. These may include severe pain, cancer, anorexia weight loss, and/or nausea, as well as glaucoma and seizure disorder.”

8. What the research has shown

9. Usage Facts • Marijuana most commonly used illegal drug in the U.S. and most other countries as well. • More than 70 million Americans have used it. • Some 20 million within the past 12 months. • 35% of Americans aged 26 and over have tried it. • 20% still smoke it, at least occasionally. • Experimental use common, but progression to daily use rare. • Less than 1% of Americans admit using it daily.

10. How it works in the body • Chief hallucinogenic agent tetrahydrocannabinol (THC) delivered to brain. • Less than 1% of THC reaches the brain where it binds to neuroreceptors. • When the amount in the brain exceeds a threshold dose, psychoactive effects occur. • Maximum effects reached within 15 to 30 minutes and last up to 2 to 4 hours.

11. Potency • Popular press touts “highly potent pot.” • Since 1980 researchers at Univ. of Mississippi found no consistent potency trend upward. • More potent MJ not necessarily more dangerous: • No possibility of fatal overdose. • Higher potency has not been shown to pose any greater health hazard than lower potency. • No scientific support for MJ potency greater now than in 1960’s and 1970’s.

12. Research Ambiguities • Ambiguities around medical hazards of MJ caused by: • Most research done with animal subjects using doses many times greater than those used by humans over very short time frame. • MJ typically used by healthy young people underestimating potential health impact. • MJ often combined with alcohol and tobacco use. • Entire field of MJ research HIGHLY emotional.

13. Research Milestones • India Hemp Commission of 1893: “…the moderate use of hemp drugs is practically attended by no evil results at all.” • U.S. Government 1925 study of solders in the Panama Canal Zone found MJ effects: “…greatly exaggerated.” • 1970’s British Wootten Report: “…long term consumption of cannabis in moderate doses has no harmful effect.”

14. Shafer Commission • 1970 formation of the National Commission on Marijuana and Drug Abuse. • To date it’s the largest, most complete review of the effects of MJ. • The Committee found no convincing evidence that MJ caused crime, insanity, sexual promiscuity, “amotivational syndrome,” or was a stepping stone to other drugs.

15. Since Shafer • 1982 committees of the Institute of Medicine and the World Health Organization (WHO) published reviews on MJ. • Neither committee found any evidence of biological harm, psychological impairment, or social dysfunction among moderate users. • Found that long-term heavy users had problems, but no study confirmed that MJ use caused them.

16. A “Gateway Drug”

17. In 1950’s it was said to lead to heroin. • In 1960’s and ‘70’s it was said to lead to LSD. • In 1980’s it was said to lead to cocaine. • Very few MJ users progress to other drugs. • Those that do tend to be: • Poor, live in areas where illicit drug use prevalent. • Less likely to come from stable homes. • Less likely to be successful at school or jobs. • More likely to have psychological problems. • Engage in deviant/criminal behavior PRIOR to using legal or illegal drugs.

18. 1994 report the U.S. Dept. of Health and Human Services followed high school students into their 30’s and found that of those who tried MJ: • 75% had not used it in the past year. • 85% had not used it in the past month. • For vast majority of MJ users, their usage is confined to MJ and no other drug.

19. “Gateway theory” a description of typical sequence of multiple drug use. It doesn’t prove causality. • There are similar statistical relationships among other kinds of commonly and uncommonly related activities.

20. The Nervous System

21. No evidence of brain damage demonstrated by CAT scans (even smoking 9 joints/day). • Brain wave patterns as measured by EEG cannot be distinguished. • In one animal study rhesus monkeys exposed to equivalent of 4 or 5 joints/day for a year. • On autopsy there was no MJ related CNS abnormalities at all.

22. Memory Impairments • Traditional research taken two approaches: • Examine subjects while they are “high” • Examine sober subjects to look for long term or permanent effects of MJ on cognition. • Memory impairments when “high” • Only tests that consistently show adverse effect are tests of short term memory with learned info. • No effects on tests of attention, perception, information processing and problem solving.

23. Long-term Cognition • Findings of past 30 years worth of research… • There are, at most, minor cognitive differences between MJ users and nonusers. • It doesn’t appear that long term MJ use causes significant permanent damage to cognitive ability. • Even animal studies which have shown short term memory impairments with high dose THC have failed to provide evidence of permanent damage.

24. Psychological Effects

25. Most studies show MJ use more likely to follow rather than precede onset of psych symptoms. • MJ has been shown to exacerbate symptoms in users with existing psych disorders. • Personality traits in MJ users of non-conformity, thrill seeking and unconventionality. • These traits precede rather than follow MJ use.

26. The Immune System

27. World Health Organization Conference on Marijuana: “…there is no conclusive evidence that cannabis predisposes man to immune dysfunction.” • When FDA approved oral THC for use medicinally it found no evidence that it caused immune impairment. • In 1992 FDA approved THC for use as appetite stimulant for AIDS patients.

28. Results of San Francisco Men’s Health Study showed no negative association between MJ use and development of AIDS among HIV infected men. • MJ use associated with decreased rate of progression to AIDS.

29. Respiratory System

30. Tobacco smoke and MJ smoke similar, except for active ingredients (nicotine and THC). • MJ users inhale more deeply depositing more dangerous material in the lungs. • Still, it’s the volume of inhaled toxic material over time that matters—not the amount inhaled per cigarette. • Even heavy MJ users never reach smoke consumption of heavy tobacco smokers.

31. Recent published study analyzed association between MJ use and pulmonary function. “Occasional and low cumulative marijuana use was not associated with adverse effects on pulmonary function.” “Association Between Marijuana Exposure and Pulmonary Function Over 20 Years” JAMA, 2012

32. Kaiser Permanente Medical Center Study • Daily MJ smokers who don’t also smoke tobacco only slightly more likely than nonsmokers to make outpatient visits for respiratory illness. • 36% of MJ users sought treatment for respiratory diseases • Rate for nonsmokers was 33%. • Australian researchers followed weekly MJ users over 19 years. • Cannabis users had lower rate of emphysema and asthma than the general population.

33. Over time tobacco smokers have increasing obstructions of lungs and small airways… • …MJ users do not. • No study has shown association between MJ smoking and development of COPD. • Canadian Medical Association Journal, April 14,2009. • MJ smoking conferred no COPD risk.

34. After evaluating subjects who smoked average of 3 to 4 joints/day for about 15 years, UCLA researchers concluded: “…marijuana smokers probably will not develop emphysema.” L. Gagnon et al. “Marijuana less Harmful to Lungs than Cigarettes.” Med Post, Sept. 6, 1994.

35. No epidemiological or clinical data showing higher rates of lung cancer in people who smoke only MJ. • Studies indicate that THC is not carcinogenic. • It is possible that people who smoke both MJ and tobacco heavily have increased risk of lung cancer.

36. Kaiser Permanente Medical Center study of 64,855 patients aged 15 to 49 years. • Most comprehensive study of risk of lung cancer in MJ users. • When compared with nonusers MJ users not associated with increased risk of lung cancer.

37. So why do we continue to consider MJ only users on a smoker/tobacco basis?

38. Medicinal Use

39. Research has demonstrated medicinal uses of MJ in a number of areas: • Shown to stimulate appetite and promote weight gain. • Useful in reducing nausea and vomiting. • Aids in diminishing intra-ocular pressure due to glaucoma. • Reduces muscle spasticity from spinal cord injuries and multiple sclerosis.

40. Diminishes tremors in multiple sclerosis patients. • Shown to provide benefits to patients suffering from migraine headaches, depression, seizures, insomnia, and chronic pain. • Provides relief from nausea and vomiting due to AIDS or cancer chemotherapy.

43. The federal prohibition of medical marijuana is “corrupting the intent of state laws and depriving thousands of glaucoma and cancer patients of the medical care promised by their legislatures.” Newt Gingrich “Legal Status of Marijuana” JAMA, Vol. 247: 1563, 1982.

44. Marijuana & Mortality

45. Cannabis does not profoundly alter cardiovascular and respiratory functions. • It appears that no dose is fatal to humans. • There have been no confirmed published cases worldwide of human deaths from cannabis poisoning. • In the Swedish Conscript Study subjects followed for 15 years. • Relative risk for mortality statistically insignificant when compared to nonuser control group.

46. Kaiser Permanente Hospital study of 65,171 HMO enrollees aged 15 to 49. • Researchers conducted mortality follow-ups on all subjects. • When compared with nonusers current MJ use was not associated with increased mortality.

47. “…there is no risk of death from smoking marijuana.” J.P. Kassirer, MD New England Journal of Medicine

48. Underwriting Implications

49. Based on all the empirical data, MJ use (even daily) does not result in increased mortality provided that: • No underlying psychiatric or personality disorder. • No poly-drug abuse—including alcohol. • No significant history of risk taking behaviors—such as driving criticisms or hazardous avocations.

50. Based on all the empirical data, MJ use (even daily) does not result in increased mortality provided that: • No occupational or financial criticism. • No criminal record. • Most reinsurance manuals not as liberal. • Review shows most offer standard SMOKER rates with use up to 8 to 10 times per month.