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Dr Sabet Power Point Final Sept 23, 2013

Dr Sabet Power Point Final Sept 23, 2013



This is the power point that Dr Sabet presented on September 23, 2013.

This is the power point that Dr Sabet presented on September 23, 2013.



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  • Corrected data (Oct 2011)NumberRatiopeople using pain relievers non-medically in the past month in 2007. 5,174,000450people with abuse or dependence on pain relievers in 20071,707,000148ED visits related to opioid analgesics in 2007 328,18229treatment admissions with a primary cause of synthetic opioid abuse in 2007 85,4227unintentional overdose deaths due to opioid analgesics in 2007;11,499 
  • Patients get their medications at pharmacies, is logical that they would take them back there tooIf pharmacy take-back becomes the norm, it could have significant impact on public health, medication therapy management, and health outcomes as the reason for not taking your antibiotic, blood pressure medication, etc. can be addressed. Don’t have to reinvent the wheel
  • Move to the ballot initiative. Talk about what a pot shop looks like: deli, pot everywhere, food items, menus, plant cuttings….
  • Our position is, we have compassion for chronically ill in need of relief. This is not the way to get the very few people who find marijuana offers pain relief through their illness. We do not need 35 pot shops, allow people to grow it in their homes, carry a 60 day supply to service the few that truly are in need. This is not the legislation to do that. This is legislation that offers opportunity for extreme exploitation and misuse/abuse. Widespread use and abuse of pot among the masses. We don’t determine medicine through public opinion or legislative initiative in this country. We determine medicine through clinical trial and rigorous, highly controlled reseach/study. Anything less puts the public at risk for fraudulent, unsafe, unhealthy medicine.
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Dr Sabet Power Point Final Sept 23, 2013 Dr Sabet Power Point Final Sept 23, 2013 Presentation Transcript

  • Current Drug Use Trends Kevin A. Sabet, Ph.D. Co-Founder, Project SAM (Smart Approaches to Marijuana) Asst. Professor, UF College of Medicine www.kevinsabet.com www.learnaboutsam.org
  • Overview • Prescription Drug Abuse • Synthetics • Other Drugs • (Cocaine, Heroin, Methamphet amine) • Marijuana
  • Prescription Drug Abuse 1. Depressants: central nervous system include sedatives (calm and drowsy) and tranquilizers (reduce tension or anxiety). Ex. Zyperxa, Seroquel, Haldol 1. Opioids and Morphine Derivatives: Painkillers. Ex. Codeine, Hydrocodone, Oxycodone, Fentanyl 1. Stimulants: Increase energy, alertness but also blood pressure and heart rate. ADD/ADHD Ex. Ritalin, Concerta, Dexedrine, Adderall 2. Antidepressants: Psychiatric drugs supposed to handle depression. Ex. Prozac, Celexa, Zoloft, Paxil
  • Commonly Abused Prescription Drugs
  • Youth: Prescription Drugs (RX) • Every day in the US, 2,500 youth (12-17) abuse a prescription pain relievers for the first time. – The average age for first time users is now 13 to 14. – 8% of American 12th graders used narcotics in the past 12 months (MTF, 2012). • A 2012 study in the US found that 1.7% of 12 and 13-year olds and 2.5% of 14 and 15-year olds had abused a prescription drug in the past month (NSDUH, 2013). • Almost 50% of teens believe that prescription drugs are much safer than illegal street drugs.
  • Youth: Prescription Drugs (RX) • 2.5 million teenagers (12 to 17) in the US have used prescription drugs in their lifetime (NSDUH, 2013). – Over 2 million used pain killers such as OxyContin – Nearly half a million used stimulants such as methamphetamine. • According to the National Center on Addiction and Substance Abuse at Columbia university, teens who abuse prescription drugs are 2x as likely to use alcohol, 5x more likely to use marijuana, and 12-20x more likely to use illegal streets drugs such as heroin, ecstasy, and cocaine.
  • Prescription Drug Abuse (Rx) • Of the 1.4 million drug-related emergency room admissions, 598, 542 were associated with abuse of prescription drugs • Prescription drug abuse causes the largest percentage of deaths from drug overdosing. Of the 22, 400 drug overdose deaths, opioid painkillers were the most commonly found drug, accounting for 38.2% of these deaths.
  • Prescriptions Dispensed for Select Opioids in U.S. Outpatient Retail Pharmacies, 2000-2009 0 20,000,000 40,000,000 60,000,000 80,000,000 100,000,000 120,000,000 140,000,000 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Hydrocodone Oxyocodne methadone buprenorphine tramadol NumberofPrescriptions Source: SDI, Vector One: National. Extracted June 2010.
  • Sources of Nonmedical Prescription Drugs1 9 1 2010; Most recent nonmedical pain reliever use among past year users ≥12 years. 2 The Other category includes the sources: “Wrote Fake Prescription,” “Stole from Doctor’s Office/Clinic/Hospital/Pharmacy,” and “Some Other Way.” Bought/Took from Friend/Relative 16.2% Drug Dealer/ Stranger 4.4% Bought on Internet 0.4% Other 2 4.9% Free from Friend/Relative 7.3% Bought/Took from Friend/Relative 4.9% One Doctor 79.4% Drug Dealer/ Stranger 2.3% Other 2 2.2% Source Where Respondent Obtained: Source Where Friend/Relative Obtained: One Doctor 17.3% More than One Doctor 1.6% Free from Friend/Relative 55.0% More than One Doctor 3.3% SAMHSA 2010, 2011
  • Emergency Department Visits
  • Persons Classified with Substance Abuse/Dependence on Psychotherapeutics Results from the 2009-2013 National Surveys on Drug Use and Health (NSDUH) NSDUH
  • 12 Percent Increase in Admissions for Specific Opioid Analgesics1: 2000-2006 1 Includes admissions where primary, secondary, or tertiary substance was reported as Other opiates/synthetics. Excludes admissions for non- prescription use of methadone. Analysis restricted to 13 States that reported detailed drug codes for 2000 and 2006.
  • 13 % Increase in Admissions for Heroin and Opioid Analgesics1: 2001-2011 1 Includes admissions where primary, secondary, or tertiary substance was reported as Other opiates/synthetics. Excludes admissions for non-prescription use of methadone. 47.66% 0.33% 406.92% 0% 50% 100% 150% 200% 250% 300% 350% 400% 450% Total visits Heroin Opioid Analgesics N-SSATS, 2011: TEDS 2001-2011
  • 14 Treatment Admissions Involving Opioid Analgesics1 1 Includes admissions where primary, secondary, or tertiary substance was reported as Other opiates/synthetics. Excludes admissions for non-prescription use of methadone. SAMHSA 2007 300 320 340 360 380 400 420 440 460 480 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Numberofadmissionsx1000 N-SSATS, 2011: TEDS 2001-2011
  • Drug-Induced Deaths vs. Other Injury Deaths, 1999–2009* Source: National Center for Health Statistics, Centers for Disease Control and Prevention. National Vital Statistics Reports Deaths: Final Data for the years 1999 to 2007 (2001 to 2009); Deaths: Preliminary Data for the years 2008 and 2009 (2010 and 2011). *Data for 2008 and 2009 are provisional and subject to change. Causes of death attributable to drugs include accidental or intentional poisonings by drugs and deaths from medical conditions resulting from chronic drug use. Drug-induced causes exclude accidents, homicides, and other causes indirectly related to drug use. Not all injury cause categories are mutually exclusive. 9/2011
  • 0 1 2 3 4 5 6 7 8 9 10 '70 '72 '74 '76 '78 '80 '82 '84 '86 '88 '90 '92 '94 '96 '98 '00 '02 '04 '06 Deathrateper100,000 Heroin Cocaine 27,658 unintentional drug overdose deaths Unintentional Drug Overdose Deaths United States, 1970–2007 National Vital Statistics System, http://wonder.cdc.gov Year Rx Drugs
  • Public Health Impact of Opioid Analgesic Use Mortality figure is for unintentional overdose deaths due to opioid analgesics in 2007, from CDC Treatment admissions are for with a primary cause of synthetic opioid abuse in 2007, from TEDS Emergency department (ED) visits related to opioid analgesics in 2007, from DAWN Abuse/dependence and nonmedical use of pain relievers in the past month are from the 2008 National Survey on Drug Use and Health 450 148 29 7 Nonmedical users People with abuse/dependence ED visits for misuse or abuse Abuse treatment admissions For every 1 overdose death in 2007, there were…
  • Economic Costs • Illicit drug use in the United States is estimated to have cost the U.S. economy more than $193 billion in 20071 • $55.7 billion in costs for prescription drug abuse in 20072 – $24.7 billion in direct healthcare costs • Opioid abusers generate, on average, annual direct health care costs 8.7 times higher than nonabusers3 1. National Drug Intelligence Center. The Economic Impact of Illicit Drug Use on American Society. 2010. http://www.justice.gov/ndic/pubs44/44731/44731p.pdf 2. Birnbaum HG, White, AG, Schiller M, Waldman T, et al. Societal Costs of Prescription Opioid Abuse, Dependence, and Misuse in the United States. Pain Medicine. 2011;12:657-667. 3. White AG, Birnbaum, HG, Mareva MN, et al. Direct Costs of Opioid Abuse in an Insured Population in the United States. J Manag Care Pharm. 11(6):469-479. 2005
  • Prescription Drug Abuse Prevention Plan • Coordinated effort across the Federal government • 4 focus areas – Education – Prescription Drug Monitoring Programs – Proper Medication Disposal – Enforcement
  • Education • Education Goals for youth, parents, and patients • Increase awareness about prescription drug abuse • Patients and parents understand how to use medications safely, and how to store and dispose them properly • Main Actions • Evidence-based public education campaign partnering with local anti-drug coalitions, and other organizations (chain pharmacies, community pharmacies, boards of pharmacies, boards of medicine)
  • Education Gaps • Physicians: • 2000 survey: 56 % of residency programs required substance use disorder training, median number of curricular hours ranged from 3 to 12 hours1 • 2008 follow-up: ―Although the education of physicians on substance use disorders has gained increased attention, and progress has been made to improve medical school, residency, and postresidency substance abuse education since 2000, these efforts have not been uniformly applied.‖2 1. Isaacson JH, Fleming M, Kraus M, Kahn R, Mundt M. A National Survey of Training in Substance Use Disorders in Residency Programs. J Stud Alcohol. 61(6):912-915. 2000. 2. Polydorou S, Gunderson EW, Levin FR. Training Physicians to Treat Substance Use Disorders. Curr Psychiatry Rep. 10(5):399-404. 2008. 3. Lafferty L. Hunter TS, Marsh WA. Knowledge, attitudes and practices of pharmacists concerning prescription drug abuse. J Psychoactive Drugs. 2006 Sep:38(3):229-232.
  • Education Gaps • Pharmacists • 67.5% report receiving two hours or less of addiction or substance abuse education in pharmacy school • 29.2% reported receiving no addiction education Pharmacists with greater amounts of addiction-specific education: • Higher likelihood of correctly answering questions relating to the science of addiction and substance abuse counseling • Counseled patients more frequently and felt more confident about counseling
  • Prescription Drug Monitoring Programs http://www.pmpalliance.org/pdf/pmpstatusmap2010.pdf
  • Prescription Drug Monitoring Programs • Develop and implement ―interoperability‖ system (PMIX, NABP, others) • Link PDMP with State Health Information Exchanges (HIE) • Liberate PDMP data to healthcare providers as part of provider ―work flow‖ operation • Ensure Emergency Departments have ―real- time‖ access to RX data
  • Proper Medication Disposal • Goals: • Easily accessible, environmentally friendly method of drug disposal that reduces the amount of prescription drugs available for diversion and abuse • Main Actions • Publish and implement regulations allowing patients and caregivers to easily dispose of controlled substance medications • DEA will continue holding a take-back day at least every 6 months until a Final Rule is implemented • Once regulations are in place, partner with stakeholders to promote proper medication disposal programs
  • Pharmacy Based Programs • Completes the drug distribution loop – Patient/pharmacist relationship already exists • Potential for clinical intervention – Reasons for unused medication - adverse events, ineffective, cost, etc. – Stronger patient/pharmacist/prescriber relationship – Improved health outcomes • Reverse distribution and disposal mechanisms already in place • Security and diversion safe guards already in place for current drug inventory • Pharmacy based programs have been effectively operating in other countries and in the U.S.
  • Enforcement • Goals: • Assist states in addressing ―pill mills‖ and doctor shopping • Main Actions • Provide technical assistance to states on model regulations/laws for pain clinics • Encourage High-Intensity Drug Trafficking Areas (HIDTAs) to work on prescription drug abuse issues • Support prescription drug abuse-related training programs for law enforcement
  • Conclusions • This is a critical time for the ―marriage‖ merging of Public Health and Public Safety Strategies… • Striking the right balance of strategies will ensure the critical availability of these medications while preventing/reduce diversion and abuse .
  • What Can The Rx Problem Teach Us About Illicit Drug Use?
  • • Rx Drugs Are ―Highly‖ Controlled • Available and Abused at Extremely High Rates • Medical Properties • Cause Billions in Societal Costs
  • First Choice Drugs: Youth(Grades 8, 10, 12 Combined) Substance Past Month Use Past Year Alcohol 25.5% 45.3% Cigarettes 18.2% 23.7% Marijuana 15.2% 25% Monitoring the Future: Johnston, L. D., O’Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2012). Monitoring the Future national results on adolescent drug use: Overview of key findings, 2011. Ann Arbor: Institute for Social Research, The University of Michigan.
  • Alcohol • Alcoholic beverages have been and are the most widely used psychoactive substances by American young people. • Binge drinking (5 > drinks in a row during the prior two-week interval at least once) is probably of greatest concern from a public health perspective. • In 2011, all measures of alcohol use— lifetime, annual, 30-day, and binge drinking in the prior two weeks—reached historic lows.
  • Alcohol Trends • In 2011, all measures of alcohol use—lifetime, annual, 30- day, and binge drinking in the prior two weeks—reached historic lows. • In 2011, 40% of 12th graders and 27% of 10th graders reported drinking alcohol in the past month. • Since 2003, perceived risk as well as disapproval of weekend binge drinking has risen in all grades including in 2011. – Accredited to public service advertising campaigns.
  • Tobacco • In 2011, 18.7% of 12th graders and 11.8% of 10th graders reported using cigarettes in the past month. • Perception: 77% of 12th graders perceive smoking one or more packs of cigarettes a day as harmful. • For all three grades, the 2011 levels of perceived risk are the highest ever observed.
  • Synthetic Marijuana (K2, Spice) • Synthetic marijuana is a new and major concern – it refers to herbal mixtures laced with synthetic cannabinoids, chemicals that act in the brain similarly to THC, the primary psychoactive active ingredient in marijuana. • These mixtures can be obtained legally as ―herbal incense‖ and are perceived as a safe alternative to marijuana. • Marketed as a ―legal‖ high.
  • Synthetic Marijuana • Synthetic marijuana (K2, Spice) was added to Monitoring the Future, University of Michigan study in 2o11. • In that year, 11.4% of 12th graders or 1 in 9 reported using the substance in the past year. • According to data from the American Association of Poison Control Centers, 2,915 calls were received related to synthetic marijuana in 2010, and 5,471 calls were received in 2011.
  • Synthetic Marijuana • Health warnings have been issued in numerous State and local health departments describing the adverse health affects associated with its use. • Hallucinations, Withdrawal, Anxiety, Nausea • The DEA and state drug control agencies have recognized the need to monitor and, when necessary, control these substances. In March 2011, five synthetic cannabinoids were categorized as Schedule 1 substances.
  • Cocaine • According to the 2013 National Survey on Drug Use and Health, the estimated percentage of persons 12 or older who use cocaine in the past month was 0.6%, which were similar to the 2011 and 2008 rates. • Over the last decade, annual prevalence among 12th graders has been declining and stands at a historical low in 2012 at 2.7%
  • Heroin • According to the 2013 National Survey on Drug Use and Health, the number of current (past month) heroin users 12 or older increased from 281,000 in 2011 to 335,000 in 2012. • In 2012, there were 156,000 persons aged 12 or older who used heroin for the first time within the past year. • The annual prevalence of heroin users among 12th graders have fluctuated between 0.7% and 0.9% from 2005 through 2011. Use has declined in the past two years.
  • Methamphetamine • According to the 2013 National Survey on Drug Use and Health, the number of past-month methamphetamine users aged 12 or older decreased by over 20% between 2010 and 2012 (and even more since 2008). • 530,000 – 2010 • 439,000 – 2011 • 440,000 – 2012 • From 2002 to 2008, past-month use of methamphetamine declined significantly among youth aged 12-17, from 0.3 percent to 0.1 percent, and young adults 18-25 also reported a decline from 0.6 percent to 0.2 percent in 2008.
  • Past Year Methamphetamine Initiates among Persons Aged 12 or Older and Mean Age at First Use of Methamphetamine among Past Year Methamphetamine Initiates Aged 12 to 49: 2002-2012
  • Marijuana
  • Marijuana • The number and percentage of persons aged 12 or older who were current marijuana users in 2012 were 18.9 million or 7.3% - similar to 2010 and 2011 rates, but higher than those in 2002 through 2009. • After a decline in marijuana use among 12th graders from 2006-08, an upturn occurred until 2011. • In 2012, 22.9% of 12th graders used marijuana in the past month – an increase from 18.8% in 2007. – Only 22% of 12th graders perceive smoking marijuana occasionally as harmful.
  • 0 5 10 15 20 25 30 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Percentreportingpastmonthuse 8th graders 10th graders 12th graders Trends in current use of any illicit drugs – Past 30 days
  • What drugs do we use? 52.10% 26.70% 7.30% 0% 10% 20% 30% 40% 50% 60% Current use among persons 12 and older: 2012 NSDUH, 2013 47 TobaccoAlcohol Marijuana
  • 48 Myth 1: Marijuana Is Harmless and Non-addictive
  • 1 in 6 teens become addicted • The adolescent brain is especially susceptible to marijuana use. • When kids use, they have a greater chance of addiction since their brains are being primed. Wagner, F.A. & Anthony, J.C. , 2002; Giedd. J. N., 2004 1 in 10 adults and 1 in 6 adolescents who try marijuana will become addicted to it. 49
  • Addictive Nature of Drugs When Different Drug Use Starts in Adolescence Tobacco 24% 15% 8% 9% Alcohol Marijuana Cocaine Stimulant Analgesics Psychedelics Source:Anthony JC, Warner LA, Kessler RC (1994): Comparative epidemiology of dependence on tobacco, alcohol, controlled substances, and inhalants: Basic findings from the National Comorbidity Survey. Experimental and Clinical Psychopharmacology 2: 244 - 268 Heroin 25% 20% 17% 14% 50
  • Primary Substance: Admissions (Aged 12 -17) 1993 (Orange) and 2008(Purple)AdmissionNumbersinThousands Substance(s) Marijuana Alcohol Stimulants Opiates Cocaine Other Drugs
  • Dependence on or Abuse of Specific Illicit Drugs Persons 12 or Older, 2008 Substance Abuse and Mental Health Services Administration. (2009). O$ ce of Applied Studies. Treatment Episode Data Set (TEDS):2009 Discharges from Substance Abuse Treatment Services, DASIS. 1,411 Cocaine 4,199 Marijuana 1,716 Pain Relievers 126 Sedatives 175 Inhalants 282 Heroin 351 Stimulants 358 Hallucinogens 451 Tranquilizers 52
  • Today‘s marijuana is not the marijuana of the 1960s. • In the past 15 years, marijuana potency has tripled and since 1960 it grown 5 times stronger. Increased Potency 53
  • 196 0 196 5 197 0 197 4 197 8 198 0 198 3 198 4 198 5 198 6 199 0 199 2 199 3 199 5 199 6 199 7 199 8 199 9 200 0 200 1 200 2 200 3 200 4 200 5 200 6 200 7 200 8 200 9 201 0 201 1 THC 0. 0. 0. 0. 1 1 1. 3. 3. 3. 3. 3. 3. 4 4. 5. 5 4. 5. 6. 7. 7. 8. 8. 9. 10 10 9. 11 11 CBD 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0 2 4 6 8 10 12 14 MARIJUANAPOTENCY CBD: NON- Psychoactive Ingredient Average THC and CBD Levels in the US: 1960 - 2011 Mehmedic et al., 2010 THC: Psychoactive Ingredient 54
  • Cannabis-related emergency hospital admission rates have been rising sharply in the US • From an estimated 16,251 in 1991 to over 374,000 in 2008 ER admission rates rising SAMHSA, 2011 55
  • Harmful effects on the brain Marijuana use directly affects the brain • It affects parts of the brain responsible for: • memory, • learning attention, • and reaction time. • These affects can last up to 28 days after abstinence from the drug Giedd. J.N., 2004 56
  • • Increased risk of mental illness • Schizophrenia (6 fold) • Psychosis • Depression • Anxiety Harmful effects on mental health Andréasson S, Allebeck P, Engström A, Rydberg U. , 1987; Arseneault, L., 2002 57
  • Research shows that marijuana smoke is an irritant to the lungs. • Results in greater prevalence of: • bronchitis, • cough, • and phlegm production. Harmful effects on the lungs Tetrault, J.M, 2007 58
  • • It contains 50-70 percent more carcinogenic hydrocarbons than tobacco smoke. • Evidence linking marijuana and cancer is mixed. However, marijuana smoke contains an enzyme that converts hydrocarbons into a cancer-causing form. • Evidence on cancer is mixed. Marijuana smoke is carcinogenic. Hoffman, D., et al., 1975; Brambilla, C., & Colonna, M., 2008; Bello, D., 2006; Tashkin, D. P., 1999 59
  • • Persistent and heavy use among adolescents reduces IQ by 6-8 points • Dunedin study; vigorously defended • According to a government survey, youth with poor academic results are more than four times likely to have used marijuana in the past year than youth with an average of higher grades. Marijuana use has significant effects on IQ and learning Meier, M.H., et al., 2012; MacLeod, J., et al., 2004. 60
  • • Linked with: • dropping out of school, • unemployment, • social welfare dependence, • and lower self-reported quality of life Marijuana use is linked to low productivity and job performance Fergusson, D. M. and Boden, J.M., 2008 61
  • • Employee marijuana use is linked with increased: • absences, • tardiness, • accidents, • worker‘s compensation claims, • and job turnover Marijuana use is linked to low productivity and job performance NIDA, 2011 62
  • Increased use can lead to increased drugged driving • ―Drivers who test positive for marijuana or self-report using marijuana are more than twice as likely as other drivers to be involved in motor vehicle crashes.‖ 63 Mu-Chen Li, J.E., et al., 2011
  • 64 Myth 2: Smoked/Eaten Marijuana is Medicine
  • Marijuana has medical properties, BUT we don‘t need to smoke or eat it! We don’t smoke opium to derive the benefits of morphine. So we don’t need to smoke marijuana to receive it’s potential benefits. • A distinction must be made between raw, crude marijuana and marijuana‘s components Is marijuana medicine? 65
  • Is marijuana medicine? 66 No: smoked or inhaled raw marijuana is not medicine Yes: there are marijuana-based pills available and other medications coming soon Maybe: research is ongoing
  • Kevin A. Sabet, Ph.D., www.kevinsabet.com Marijuana is NOT approved as medicine by: • The FDA • The American Medical Association • The National Multiple Sclerosis Society • The American Psychiatric Association • The American Glaucoma Society • The American Academy of Ophthalmology • The American Cancer Society • The American Academy of Pediatrics
  • Studies show that components or constituents within marijuana have medical value. • For instance, dronabinol (also known as Marinol®) contains lab-made THC and is widely available at pharmacies as capsules to treat nausea/vomiting from cancer chemotherapy Marijuana has medicinal properties 68
  • Marijuana-based medicines are being scientifically developed. • However this process needs improvement • Research must be done on marijuana‘s components, not the raw, crude plant Marijuana-based medicines 69
  • • Sativex® is in the process of being studied in the USA. • THC:CBD = 1:1 • It is administered via an oral mouth spray • Already approved in Canada and Europe Marijuana-based medicines 70
  • • 87.9% had tried marijuana before age 19 • 75% of Caucasian patients had used cocaine and 50% had used methamphetamine in their lifetime. Average medical marijuana patients O‘Connell, T.J. & Bou-Matar, C.B., 2007 Profile: 32-year old white male history of alcohol and substance abuse no history of life-threatening illnesses 72
  • • In Colorado, 2% reported cancer, less than 1% reported HIV/AIDS, and 1% reported glaucoma as their reason for using medical marijuana. • In Oregon, these numbers are less than 4%, less than 2%, and 1%, respectively. Only a small proportion of medical marijuana users report any serious illness Colorado Department of Public Health and Environment, 2011; Oregon Public Health Authority, 2011 73
  • Majority of medical marijuana users report using marijuana to treat ‗chronic or severe pain‘ • 96% in Colorado • 91% in Oregon • 93% in Montana Chronic pain Colorado Department of Public Health and Environment, 2011; Oregon Public Health Authority, 2011; Montana Department of Public Health and Human Services, 2011 74
  • ―We will use [medical marijuana] as a red-herring to give marijuana a good name.‖ —Keith Stroup, head of NORML to the Emory Wheel, 1979 • Advocates have pushed their agenda through ―medicine by popular vote‖ rather than the rigorous scientific testing system devised by the FDA. Legalization behind the smokescreen Emory Wheel Entertainment Staff, 6 February 1979 75
  • After the Compassionate Use Act passed in California in 1996, Allen St. Pierre, the director of NORML admitted in a TV interview that ―in California, marijuana has also been de facto legalized under the guise of medical marijuana‖ Behind the smokescreen CNN Newsroom 9 May 2009 76
  • Residents of states with medical marijuana laws have abuse/dependence rates almost twice as high as states with no such laws. Pacula et al (RAND) found that two characteristics of medical marijuana states – (1) Dispensaries and (2) Home Cultivation – were positively associated with marijuana use Medical marijuana has led to increased use Cerda, M., et al., 2012; Wall, M., et al., 2011; Pacula et al. 2013. 77
  • • Dispensaries – Are these serving the sick and dying??
  • Bypassing the FDA Process Before FDAapproves a drug as medicine, testing is done to: Determine the benefits and risks of the drug Determine how it may interact with other drugs Assure standardization of the drug Determine the appropriate dosage levels Identify and monitor side effects Identify safe drug administration 79
  • Marijuana-Based Medications • NIH is responsible for research into marijuana-derived medications. • 288 NIH-supported projects on cannabinoids. • Scheduling less relevant – Cocaine is Schedule II, no ―Dispensaries‖ allowed – But it Would Be A Symbolic Victory for Advocates – Need an individual FDA-approved product for medical use
  • A Compassionate Access Proposal • Before marijuana-based medications become more widely available, offer non-smoked marijuana components, regulated in strength, purity, and composition, to: • Cancer patients • Terminally ill • Those with MS, ALS, and AIDS whose bona fide physicians have recommended marijuana because other medications have not worked
  • Bottom Line We don‘t smoke opium to get the effects of morphine. So why would we smoke marijuana to get its potential medical effects?
  • 83 Myth 3: Countless People Are Behind Bars for Smoking Marijuana
  • 6% 1.40% 0.40% 0.30% 0.10% 0% 1% 2% 3% 4% 5% 6% 7% Drug possession Crimes involving only MJ MJ-only drug offenders; no prior sentences MJ-only possession MJ-only possession; no prior sentences Offense Drug Possession Offenders in State Prisons Percent of State Prisoners, 2004 Bureau of Justice Statistics, 2004 84
  • • Only 0.4% of prisoners with no prior offenses are in prison for marijuana possession • 99.8% of Federal prisoners sentenced for drug offenses were incarcerated for drug trafficking • The risk of arrest for each join smoked is 1 for every 12,000 joints Countless people are NOT behind bars for smoking marijuana Bureau of Justice Statistics, 2004 and 2012; Kilmer, B., et al., 2010 85
  • NumberofSentencedPrisoners 38,900 148,600 224,900 263,800 251,400 0 200,000 400,000 600,000 800,000 1,000,000 1,200,000 1,400,000 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Estimated Number of Sentenced Prisoners and Drug Offenders Under State Jurisdiction, 1985 to 2009 Source: Bureau of Justice Statistics, Prisoners in 2009 (December 2010); Prisoners in 1996 (June 1997). 6/2011 All Offenses Drug Offenses 86
  • Bureau of Justice Statistics, 2010 18% 82% 99.80% 0.20% Among sentenced prisoners under state jurisdiction in 2008, 18% were sentenced for drug offenses. Of those 18%, 99.8% were sentenced for drug trafficking Only 0.2% are for drug possession 87
  • 88 Myth 4: The Legality of Alcohol and Tobacco Strengthen the Case for Marijuana Legalization
  • Alcohol and Tobacco: A Model? • Use levels for alcohol and tobacco are much higher than marijuana • Industries promote addiction and target kids 89 Schiller JS, Lucas JW, Peregoy JA. Summary health statistics for U.S. adults: National Health Interview Survey, 2011. National Center for Health Statistics. Vital Health Stat 10(256). 2012. Centers for Disease Control and Prevention. Vital Signs: Current Cigarette Smoking Among Adults Aged ≥ 18 Years—United States, 2005–2010. Morbidity and Mortality Weekly Report 2011;60(33):1207–12
  • Alcohol and tobacco use among teens • 50% and 44% of youth report that they can obtain alcohol and cigarettes, respectively, within a day. • Youth are least likely to report that they can get marijuana within a day (31%); 45% report that they would be unable to get marijuana at all The National Center on Addiction and Substance Abuse at Columbia University (CASA), 2012 90
  • What incentives do legal corporations have to keep price low and consumption high? • ―Enjoy Responsibly‖ • Taxes today for alcohol are 1/5 of what they were during the Korean War (adjusted for inflation) 91 Cook, P. J. (2007). Paying the tab: The economics of alcohol policy. Princeton, NJ: Princeton University Press.
  • Will legalization diminish the power of cartels and the black market? • Marijuana accounts for 15-25% of revenues gained from drug trafficking groups • More money is found in human trafficking, kidnapping, and other illicit drugs Kilmer, B., et al., 2010 92
  • Will legalization diminish the power of cartels and the black market? • In a legal market, where drugs are taxed and regulated (for instance to keep THC potency below a certain level or to prevent sale to minors), the black market has every incentive to remain • Legalizing marijuana would not deter these groups from continuing to operate Kilmer, B., et al., 2010 93
  • Can we trust companies and Big Corporations not to target youth and the vulnerable? ‗Big marijuana‘ 94
  • 95
  • The ―Yale MBAs Are Here‖ Steve DeAngelo Troy Dayton 96
  • ArcView with investors at the Washington Athletic Club 97
  • ―Business is driving the change. Business is the most powerful platform for political change that‘s existed, when there is money for government, money for investors, money for entrepreneurs, and benefits to communities, that‘s a powerful incentive for change‖ ArcView Co-Founder Troy Dayton
  • ―The use of marijuana ... has important implications for the tobacco industry in terms of an alternative product line. [We] have the land to grow it, the machines to roll it and package it, the distribution to market it. In fact, some firms have registered trademarks, which are taken directly from marijuana street jargon. These trade names are used currently on little-known legal products, but could be switched if and when marijuana is legalized. Estimates indicate that the market in legalized marijuana might be as high as $10 billion annually.‖ From a report commissioned by cigarette manufacturer Brown and Williamson (now merged with R.J. Reynolds) in the 1970s. ‗Big marijuana‘ 99
  • R.J.Reynolds, 1984 est.: http://legacy.library.ucsf.edu/tid/eyn18c00 100
  • Tobacco Institute, 1989: http://legacy.library.ucsf.edu/tid/pvt37b00 101
  • Brown and Williamson, 1972: http://legacy.library.ucsf.edu/tid /wwq54a99 102
  • ‗The 2nd Annual National Marijuana Business Conference And Expo‘ – Nov. 6- 8, 2013 in Seattle • Expecting nearly 600 people including: • Dispensary owners and license holders • Professional cultivators • Edibles and infused product makers • Ancillary goods and services firms, from attorneys to security technology • Investors and angel investing group leaders • Conference registration costs $600 ‗Big marijuana‘ 103
  • 104 Will Big Marijuana become the new Big Tobacco?
  • Several vending machines and billboards have already emerged throughout the country 105
  • A variety of medical marijuana products and ‗edibles‘ can be found at dispensaries: • Brownies, cake, cookies, peanut butter, granola bars, ice cream • Many such as ‗Ring Pots‘ and ‗Pot Tarts‘ are marketed with cartoons and characters appealing to children: 106
  • 107 Alcohol and Tobacco legalization teach us there is no money in this for anyone other than Big Marijuana
  • 108 Myth 5: Legal Marijuana Will Solve the Government‘s Budgetary Problems
  • Will legalization solve budgetary problems? • Few people are currently in jail for smoking marijuana • Arrests and regulatory costs will increase with legal marijuana 109
  • 2.7million Arrests for alcohol-related crimes in 2008 847,000 Marijuana-related arrests in 2008 (Does NOT include violence; Includes violations of liquor laws and driving under the influence) ―If Only We Treated It Like Alcohol…‖ 110
  • Alcohol & Tobacco: Money Makers or Dollar Drainers? • For every $1 gained from alcohol and tobacco tax revenues, $10 is lost in legal, health, social, and regulatory costs $$$$$$$$$$$ Urban Institute and Brookings Institute, 2012; Tax Policy Center, 2008 111
  • Alcohol & Tobacco: Money Makers or Dollar Drainers? 112 Alcohol Costs Tobacco Costs $14 billion Costs Revenues $25 billion $200 billion $185 billion Revenues State estimates found at http://www.nytimes.com/2008/08/31/weekinreview/31saul.html?em; Federal estimates found at https://www.policyarchive.org/bitstream/handle/10207/3314/RS20343_20020110.pdf; Also see http://www.tobaccofreekids.org/research/factsheets/pdf/0072.pdf; Campaign for Tobacco Free Kids, see ―Smoking-caused costs,‖ on p.2.
  • There are 8x as many alcohol outlets in poorer, communities of color than in upper-class white communities.
  • New Message A new Big Marijuana industry will target the most vulnerable, just like Big Tobacco and the Liquor Lobby have. We don’t need more arrests in these communities, BUT we also don’t need more drugs -- we need job opportunities, health screening, and proper education – all things that are compromised when more people smoke marijuana.
  • 115 Myth 6: Portugal and Holland Provide Successful Examples of Legalization
  • Neither Holland nor Portugal have legalized ANY drug 116
  • In 2001, Portugal changed policy to send users with small amounts of drugs to “dissuasion panels” – social worker panels who refer individuals to treatment, administer fine, etc. Portugal also implemented robust treatment plan Portuguese policy 117
  • • Youth use has increased since 2001 • Deaths have gone down • The impact of is policy unclear, despite extreme rhetoric Results are mixed 118
  • The Dutch established the Non- enforcement Policy in 1976 and saw the birth of ―Coffee Shops‖ Dutch policy 119
  • • Experienced a three-fold increase in marijuana use among young adults • Before Non-Enforcement, the Dutch always had lower rates of drug use than the US. • Holland is now #1 country in Europe with marijuana treatment need • Scaling back policy • Coffee Shops Closing • Cannot sell to non-residents Results 120
  • What about Jolly Ole‘ England?
  • 122 Myth 7: Prevention, Interventi on, and Treatment are Doomed to Fail – So Why Try?
  • 123 Policy Implications
  • The groups pushing for marijuana legalization have found a way to make their issue resonate with everyday people. 124
  • They have reframed the issue so it is about: • Voting for compassion for the sick and dying • Reducing our prison population • Stimulating the economy 125
  • Advocates have organized across US states and around the world to push their initiatives. 126
  • They have major donors who fund their work and messages. 127
  • Spent over $250 Million on Legalization
  • The National Organization for the Reform of Marijuana Laws estimates that Peter Lewis has spent between $40 million and $60 million funding legalization of marijuana campaigns since the 1980s.
  • John Sperling Over $50 Million
  • They‘ve secured legislative champions at all levels – local, state, federal, internation al. 131
  • They‘ve gotten the attention of editorial boards and media – including print, television and social media. 132
  • Case of Sanjay Gupta: ―Gupta Changes His Mind On Weed‖ 133
  • They‘ve mobilized major grassroots and student supporters. 134
  • They are present and active in every single academic, think- tank, UN, and other international and domestic discussion on drug policy. 135
  • Most of all: They have captured the “sensible” ground, boxing us in as extremists, old fashioned, and moralistic. 136
  • What has been the result of their framing of this issue? 137
  • 138Sources: Gallup http://bit.ly/olrSEQ and GSS Support for Marijuana Legalization in the United States Has Reached Unprecedented Levels 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Year 1975 1980 1985 1990 1995 2000 2005 2010 Do not support legalization Support Legalization
  • National Policy After 50 years of a movement to legalize marijuana, 2 states have now done it – Colorado and Washington Marijuana Still Illegal Under Federal Law and Laws of 48 states 139
  • DOJ Guidance from Holder Holder did not endorse legalization He said that the government would defer its right to challenge states in court “right now” 140
  • DOJ Guidance from Holder He laid out major areas of importance, including: - youth use increases - drugged driving/health consequences - advertising for youth 141
  • But has this already happened? 142
  • • Passed medical marijuana in 2001 • But no dispensaries until the mid- 2000s • Between 2006 and 2012, medical marijuana cardholders rose from 1,000 to over 108,000 • The number of dispensaries rose from 0 to 532 Colorado post-2009 143
  • Marijuana use among Colorado teens is currently: • Fifth highest in the nation • 50% above national average Increased teen use NSDUH, 2013 10.7% 7.6% Colorado National average 144
  • Average 5.6% of students per year between 2007 and 2009 Distribution to minors Rocky Mountain HIDTA, 2013 2007-2009 2010-2012 Drug-related referrals for high school students testing positive for marijuana increased Average of 17.3% per year between 2010 to 2012 Rose by over 150% 145
  • In 2007, tests positive for marijuana made up 33% of the total drug screenings, by 2012 that number increased to 57% Distribution to Minors Rocky Mountain HIDTA, 2013 146
  • • Teens who know somebody with a medical marijuana license are more like than those who don‘t to report ‗fairly‘ or ‗very‘ easy access to marijuana • 74% of Denver-area teens in treatment said they used somebody else‘s medical marijuana an average of 50 times Medical marijuana is easily diverted to youth Thurstone, 2013; Salomonsen- Sautel et al., 2012 147
  • • 29% of Denver high school students used marijuana in the last month • If Denver were an American state, it would have the HIGHEST public high school current use rates in the country Denver high schools Healthy Kids Colorado, 2012 148
  • Percent difference between national and Colorado past-month teen marijuana usage averages – 2006 and 2011 9.41% 28.73% 0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 35.00% 2006 2011 Rocky Mountain HIDTA, 2013 149
  • In Colorado, fatalities involving drivers testing positive for marijuana rose by 112%. Increased traffic fatalities Mu-Chen Li, J.E., et al., 2011; Colorado Department of Transportation, 2006 150
  • While the total number of car crashes declined from 2007 to 2011, the number of fatal car crashes with drivers testing positive for marijuana rose sharply. Colorado Dept of Transportation 500 550 600 650 700 750 800 850 2007 2008 2009 2010 2011 Total car crashes 15 20 25 30 35 40 45 50 55 2007 2008 2009 2010 2011 Crashes with high drivers 151
  • In 2011, marijuana-related incidents accounted for 26 percent of the total ER visits, compared to 21 percent nationally Increased ER admissions Rocky Mountain HIDTA, 2013 152
  • 200% 60% 92% Under 5 6 to 12 13 to 14 • 200% for kids under 5 • 60% for kids 6- 12 • 92% for kids 13- 14 Increased ER admissions Rise in marijuana-related ER visits from 2006 and 2012: Rocky Mountain HIDTA, 2013 153
  • As the price for marijuana plummets in legalization states, we can expect cheap marijuana to be sold in non- legalization states for a handsome profit. • According to the El Paso Intelligence Center (EPIC) National Seizure System, in 2012, there were 274 Colorado marijuana interdiction seizures destined for other states compared to 54 in 2005. Diversion of marijuana Rocky Mountain HIDTA, 2013 154
  • Two independent reports released in August 2013 document how Colorado‘s supposedly regulated system is not well regulated at all Poor regulation 155
  • The Colorado State Auditor concluded that: • The state had not ―established a process for caregivers to indicate the significant responsibilities they are assuming for managing the well-being of their patients,‖ and that the state ―cash fund‖ was out of compliance. Poor regulation Colorado Office of the State Auditor, 2013 156
  • The Colorado State Auditor concluded that: • 50% of ALL recommendations made by only TWELVE physicians Poor regulation Colorado Office of the State Auditor, 2013 157
  • The city of Denver Office of the Auditor concluded that: • The city of Denver ―does not have a basic control framework in place for effective governance of the…medical marijuana program.‖ • The medical marijuana records are ―incomplete, inaccurate, inaccessible.‖ • And that many dispensaries are operating without licenses. Poor regulation City of Denver Office of the Auditor, 2013 158
  • 4/20 Rally in Denver 159
  • 4/20 Rally in San Francisco 160
  • Responsible Regulations? 161 • Heavily influenced by CO‘s massive medical marijuana industry • Allowing character packaging, edibles, candies • Can grow much more than you sell • Advertising allowed in ―Adult Periodicals‖
  • With the DOJ‘s announcement that it will not enforce the CSA, the reform group, Marijuana Policy Project (MPP), announced its plan to get legalization on the ballot in 10 states by 2017 Legalization on the horizon 162
  • Arizona California Maine Nevada New Hampshi Vermont Maryland Rhode Island Hawaii Alaska These states include: Massachusetts Oregon 163
  • • MPP is currently supporting a petition – the ―Campaign to Regulate Marijuana‖ – to place legalization on the 2014 ballot • If passed: • The manufacture, sale, and possession of up to one ounce of marijuana becomes legal for adults over 21. • Creates establishments such as: marijuana retail stores and marijuana infused- product manufacturers Alaska 164
  • • Arizona • California • Maine • Nevada • Hawaii • Maryland • New Hampshire • Rhode Island • Vermont Initiatives supported by MPP are in place to put legalization on the ballot by 2016 and 2017 in: Also on the horizon… MassachusettsOregon Montana 165
  • In all of these states, if the proposed amendments are passed, the retail sale and production, and possession of marijuana will become legal If passed… 166
  • So What Are Our Choices? All or nothing? Legalization (―Regulation‖) vs. Incarceration (―Prohibition‖) 167
  • Not about legalization vs. incarceration We can be against legalization but also for health, education, and common-sense Smart approach 168
  • Chair, Patrick J. Kennedy Launched January 10th 2013 Over 15,000 press mentions Public Health Board of Trustees 10 state-wide affiliates 169
  • 1. To inform public policy with the science of today‘s marijuana. 2. To have honest conversations about reducing the unintended consequences of current marijuana policies, such as lifelong stigma due to arrest. 3. To prevent the establishment of Big Marijuana that would market marijuana to children — and to prevent Big Tobacco from taking over Big Marijuana. Those are the very likely results of legalization. 4. To promote research of marijuana‘s medical properties and produce pharmacy-attainable medications. Project SAM 170
  • SAM is a national group with state and local partners Kevin A. Sabet, Ph.D., www.kevinsabet.com
  • SAMIA (SAM Interstate Alliance) State partners who work on state/local issues Can be separate 501 (c) (4) or PAC or simply an informal entity
  • 173
  • 174
  • 175
  • Addressing current policy: • People should not be stigmatized for their past use • No sense in incarcerating users • People need job and economic opportunities; by being blocked from them they will re-enter the illicit market Smart Approach 176
  • • Robust community-based prevention programs • community coalitions • Criminal justice intervention programs • Probation reforms • Drug treatment courts • Non-drug interventions • Housing • Education • Healthcare Non-legalization reforms 177
  • Recruit Champions 178
  • • Legislators at every level of government • Executive branch leaders, at every level of government • Media luminaries in every medium • Business leaders • Other key influentials (faith leaders, civic leaders, foundation leaders, other) 179
  • • Figure out how the marijuana legalization issues affect them and their constituents/members. • Discuss these issues in a way that will appeal to them, their mission and their members. 180 How To Interest Grasstops Leaders:
  • Frames Win Debates 181
  • How to Frame Our Messages to Win Back The Public 182
  • Changing the Frame: • From negative to positive • From ―old‖ to ―new‖ 183
  • Old Message Marijuana legalization will increase drug use and workplace related consequences. 184
  • According to the American Council for Drug Education in New York, employees who abuse drugs are: • 10 times more likely to miss work • 3.6 times more likely to be involved in on- the-job incidents • 5 times more likely to file a workers‘ compensation claim. 185 Facts:
  • 6.5% of high school seniors smoke marijuana every day1 , rendering them virtually unemployable. 186 1 Johnston, L. D., O'Malley, P. M., Bachman, J. G., & Schulenberg, J. E. Monitoring the Future national survey results on drug use, 2012. Volume I: Secondary school students. Ann Arbor: Institute for Social Research, The University of Michigan. Available: http://www.monitoringthefuture.org/data/10data.html#2011data-drugs Fact:
  • New Frame: If your community cares about jobs and employability, you need to care about reducing marijuana use. 187
  • Old Message Marijuana use is bad for memory, motivation and learning 188
  • If you care about academic performance, you need to care about youth marijuana use. 189 The New Frame
  • Connecting the dots for elected officials is crucial if we want results! 190
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  • There are alternatives… Smart International Prevention Treatment Recovery Enforcement Efforts Kevin A. Sabet, Ph.D., www.kevinsabet.com
  • Parental Involvement in Preventing Substance Abuse • In 2012, most youths aged 12 to 17 believed that their parents would strongly disapprove of their having: – Alcoholic Beverage (one or two every day) – 90.5% – Smoking Cigarettes (one or more packs a day) – 93.1% – Marijuana or Hashish Use (once of twice) – 89.3% Effect: – In 2012, past month use of illicit drugs, cigarettes, and alcohol use were all lower among youths 12-17 who reported parental involvement. • 7.6% - Rate of past month illicit drug use with parental involvement. • 18.1% - Rate of past month illicit drug use without parental involvement.
  • Kevin A. Sabet, Ph.D., www.kevinsabet.com
  • Prevention: Community-based Planning Multi-Sector approach Reduction in use of … Alcohol Tobacco Marijuana Kevin A. Sabet, Ph.D., www.kevinsabet.com 12% 28% 24%
  • Kevin A. Sabet, Ph.D., www.kevinsabet.com
  • Recovery
  • Enforcement: An untapped opportunity for progress 7 million Americans in the Criminal Justice System Nearly a … and a quarter of Federal third of State prisoners committed their crimes prisoners … under the influence of drugs 5 million On Probation or Parole 2 million Incarcerated 1/3 1/4
  • Enforcement and Treatment Can Work Together For every $1.00 invested in Drug Court, taxpayers save as much as $3.36 in avoided criminal justice costs alone. Kevin A. Sabet, Ph.D., www.kevinsabet.com
  • Project Hope Reduction in missed appointments 85% Reduction in positive urinalyses 91% 47% Arrested Used Drugs Skipped Appointments Probation Revoked 46% 23% 15% 21% 13% 9% 7% Control Project Hope
  • Drug Market Interventions (DMI) In Rockford, Illinois, property crime declined by 24 percent. In Nashville,Tennessee, drug crime declined by 39.5 percent. In High Point, North Carolina, the first site,indicated that the target area experienced a substantial decline in violent (30.6%) and drug-related crime (32.2%). In all three communities, interviews with local residents revealed a perceived decline in crime and disorder,reported improvement in the quality of neighborhood life, and appreciation for the police.
  • Re-entry Kevin A. Sabet, Ph.D., www.kevinsabet.com
  • Thank You! Questions? Email kevin@learnaboutsam.org www.learnaboutsam.org