Welcome to the CAPT Northeast Regional Team Marijuana Webinar Series!

1. Welcome to the CAPT Northeast Regional Team Marijuana Webinar Series! We will be starting shortly

2. Short- and Long-Term Consequences of Non-Medical Marijuana Use:A Review of the Literature Kristen Quinlan, Ph.D., Regional Evaluator, NE Regional Team May Yamate, Regional Epidemiologist, NE Northeast Regional Team Linda Barovier, Associate Coordinator, NE Regional Team

3. Introduction to Connect Pro Welcome to this Connect Pro Virtual Meeting. We will be using the following windows: • PowerPoint Window • Attendee List • Chat • Note We will also use the “Raise your Hand” feature

4. Introduction to Connect Pro Two Ways to Ask Questions 1. In Writing: • Write question in Chat window • Press “Enter” • Only the “Presenters” and moderator will see your question;

5. 2. By Raising Your Hand: Raise your hand by clicking You will see your status change in attendees list Un-mute your phone (press * #) when called upon Remember to mute your phone again once you have finished speaking Lower your hand by again clicking Introduction to Connect Pro

6. Welcome & Introductions We will use the hand raise feature for a virtual roll call Raise your hand to signal your presence when your state is called ME VT NH NY MA CT RI PA NJ MD DE

7. Purpose of the Series This three-part series is designed to increase the capacity of communities to understand: • Short- and long-term consequences of non-medical marijuana use • Risk and protective factors strongly associated with non-medical use of marijuana • Effective strategies to reduce non-medical marijuana use and its consequences

8. Consequence Take-Aways & the Big Picture

9. Who Cares and Why? • Six States within the Northeast Region (mostly in New England) are among the top ten nationally for marijuana use. • These same States rank among the lowest in perception of risk of harm for marijuana use. • States throughout the region report erosion of norms at the societal, community, and family levels that seriously impede their efforts to prevent onset or reduce use.

10. Past-Month Marijuana Use Among Persons Aged 12 to 20 WA ME MT ND MN VT OR NH WI ID NY SD MA RI CT MI WY PA IA NE NE NJ NV IN IN OH IL UT DE WV CO MD CA VA KS MO KY NC TN TN AZ OK OK SC NM AR SC AR Percentages of Persons AL GA MS 7.82 – 10.86 TX LA TX AK 7.18 – 7.81 HI FL FL 6.30 – 7.17 5.72 – 6.29 4.47 – 5.71 Source: 2007 and 2008 SAMHSA National Surveys on Drug Use and Health (NSDUHs).

11. Perception of Great Risk Among Persons Aged 12 to 17 Highlights Adolescents who perceived great risk from smoking marijuana once a month were much less likely to have used marijuana in the past month than those who perceived moderate to no risk. Adults who first used marijuana before age 12 were twice as likely as adults who first used marijuana at age 18 or older to be classified as having significant mental illness in the past year ME VT NH NY MA CT RI PA NJ MD DE Percentages of Persons 38.70 - 44.50 29.61 – 32.58 36.05 – 38.69 24.08 – 29.60 32.59 – 36.04 Source: 2007 and 2008 SAMHSA National Surveys on Drug Use and Health (NSDUHs).

12. Background • CAPT Associates Kristen Quinlan, Ph.D., Renee Boothroyd, Ph.D., and Karen Friend, Ph.D. reviewed a body of literature containing approximately 200 articles, including numerous meta-analyses and summarized relevant findings. • Regional Epidemiologist May Yamate reviewed numerous data sources concerning consequences and consumption patterns associated with marijuana. • CAPT staff collaborated with National Institute on Drug Abuse epidemiologists to identify current data or research gaps.

13. Myths About Harm from Marijuana

14. Marijuana Consequences • There are both short- and long-term effects of use, including: • Acute psychiatric symptoms or mental health effects • Cognitive impairment • Risk of injury or harm • Dependence • More research is needed because existing research is mixed and often includes other variables that confound the findings.

15. Short-Term Consequences of Marijuana Use

16. Short-Term Consequences • Acute psychiatric reactions (especially in new users) • Driving impairment and potential for injury • Risk of other injury

17. Acute Psychiatric Reactions • Anxiety and psychotic symptoms—most commonly in new users (Hall & Degenhart, 2009) • 22% of new users reported acute anxiety or panic attacks immediately following use • Acute marijuana intoxication may also be associated with impaired judgment and risky behavior (Jacobus, Bava, Cohen-Zion, Mahmood & Tappert, 2009) • Examples: Unprotected sexual intercourse, driving while impaired or intoxicated

18. Driving Impairment and Risk of Injury • Use impacts many of the processes required for safe driving, including tracking, reaction time, and attention (as cited in MacDonald, 2003; Kalant, 2004) • Marijuana’s effect on driving skills seems to indicate that THC concentrations of 7-10ng/ml may produce similar impairment to blood alcohol concentrations of .05% (Groternhermen et al., 2007). • See portal for various reports on drugged driving and various federal or state efforts (Per Se laws) to reduce this consequence.

19. Risk of Other Injury • Examinations of the relationship between marijuana use and unintentional, non-traffic-related injury have generated mixed results, likely because of the many confounding variables associated with use. • In one study of 60,000 patients, marijuana users were more likely to be admitted to the hospital due to injury from all causes than non- or former users (Gerberich, Sidney, Braun, Tekawa, Tolan, Quesenberry, 2003)

20. Long-Term Consequences of Marijuana Use

21. Long-Term Consequences • Cognitive impairment • Psychosocial adjustment • Violence/delinquency/crime • Mental health effects • Respiratory system effects • Birth defects • Dependence

22. Cognitive Impairment - Adults • Chronic users have shown impairments in visual search skills, which are necessary for everyday tasks like reading or safely driving a vehicle (Huestegge, Radach, & Kunert, 2009). • Experimental studies have shown that chronic adult users experience problems with attention, learning, and memory following brief periods of abstinence (as cited in Jacobus et al., 2009).

23. Cognitive Impairment - Adolescents Although more longitudinal studies are needed to elucidate the relationship between marijuana use and adolescent brain development, experimental studies have consistently shown that heavy adolescent users experience problems with attention, learning, memory, and processing speeds, and that these deficits continue beyond one month of abstinence (as cited in Jacobus et al., 2009).

24. Psychosocial Adjustment Heavy use of marijuana prior to age 21 may lead to psychosocial difficulties such as lower levels of income, lower levels of educational attainment, higher unemployment, lower levels of relationship satisfaction, and lower levels of life satisfaction at age 25 (Fergusson & Boden, 2008).

25. Psychosocial Adjustment Research has pointed to a dose-response relationship, which means that as marijuana use increases, so do problems in psychosocial adjustment (Fergusson & Boden, 2008).

26. Crime and Violence Generally, links between marijuana and violence are recognized, but studies attempting to make causal connections have met with mixed results (MacDonald, 2003; Macdonald et al, 2008; Pedersen & Skardhamar, 2009).  

27. Mental Health Effects - Schizophrenia Longitudinal studies have clearly demonstrated that marijuana use increases the likelihood that schizophrenia will develop in at-risk individuals, with more frequent use linked to increased risk of diagnosis (as cited in Degenhardt & Hall, 2006).

28. Mental Health Effects – Depression & Suicide • There are links between depression and marijuana use, but the evidence is not as strong as that seen between marijuana use and psychosis (as cited in Moore et al., 2007). • A link between suicide and marijuana use exists as well, but causation remains unclear (as cited in Moore et al., 2007).

29. Mental Health Effects – Panic Disorder Research has also suggested links between marijuana and panic disorder. In a large community survey, lifetime marijuana use was found to be associated with a panic disorder history, even after controlling for confounds like alcohol or nicotine dependence (Zvolensky, Johnson, Cougle, & Bonn-Miller, 2010).

30. Effects on the Respiratory System - Bronchitis • Regular, heavy smokers of marijuana report chronic cough, throat irritation, and other symptoms of chronic bronchitis (as cited in Kalant, 2004). • Damages to the respiratory system may occur after only a short period of heavy cannabis use (Kalant, 2004; Taylor, Poulton, Moffitt, Ramankutty, & Sears, 2000).

31. Effects on the Respiratory System – Cancer Related • Marijuana smoke and tobacco smoke contain many of the same carcinogens (Tetrault, Crothers, Moore, Mehra, Concato,& Fiellin, 2007). • Most researchers agree that chronic, heavy use of marijuana increases cancer risk (as cited in Kalant, 2004).

32. Birth Defects • Use of marijuana during pregnancy has been associated with low birth weight, mild developmental abnormalities, and future hyperactivity and impulsivity. (as cited in Hall & Degenhardt, 2009). • Epidemiological studies have been unable to find evidence that marijuana causes birth defects, largely because those using marijuana during pregnancy are also more likely to use alcohol, tobacco, and other illicit drugs and are less likely to seek or receive appropriate prenatal care (as cited in Hall & Degenhardt, 2009).

33. Dependence • It is estimated that 8.5% of the U.S. population will experience a marijuana-use disorder during their lifetime (Stinson, Ruan, Pickering, & Grant, 2006). • Longitudinal studies have indicated that initiating use during adolescence leads to an increased risk of future dependence—it is estimated that of those who initiate use during adolescence, one in six will go on to become marijuana dependent.

34. Dependence • Daily or weekly use also strongly predicts future dependence (as cited in Hall & Degenhardt, 2009; Kalant, 2004). • Withdrawal symptoms can include anxiety, restlessness, insomnia, appetite disruptions, stomach pain, and mood disturbance. Withdrawal symptoms can appear after only two weeks of daily use (as cited in Ashton, 2001).

35. How Will You Use this Information?

36. Summary • Use of marijuana does have significant consequences. • Areas where more research is needed include: • The extent to which marijuana use actually causes … • Violence, crime and delinquency • Levels of depression elevated enough to lead to suicide • Actual risk of birth defects for children born to women who otherwise had prenatal care but used marijuana

37. Closing • Next webinar dates: • Risk & Protective Factors/February 22, 2011 from 10:00am-11:30am • Strategies/March 8, 2011 from 10:00am-11:30am • Questions or comments?