http://publichealthconsulting.org/ Get the facts about the pros and cons of marijuana. Karina Villalba from ARAK Public Health Consulting makes a presentation at the Florida Department of Health's Health Fair.

1. Marijuana Legalization Trends and
Consequences: Impact on Public Health
KARINA VILLALBA PhD

2. So You Think You Know Marijuana?
QUESTIONS

3. What
legislation
method is
most
effective?
Would legalization
alleviate some of the
society’s problem
including violence of
drug cartels and our
economic woes?
Should
marijuana be
legalized or
decriminalized?
Is marijuana
worse than
alcohol, tobacco,
caffeine or
prescription
medications?
Is marijuana
addictive?
Is cannabis
effective to
treat chronic
diseases?Is marijuana
a gateway
drug?

4. Objectives
FL PolicyTrends
Public Health
Introduction
Medical
Benefits
Adverse
Effects

5. What is marijuana?
Schedule 1 drug
Contains over 400 chemicals
Delta-9-tetrahydrocannabinol (THC)
Delta-8-tetrahydrocannabinol
Cannabidiol (CBD)
Cannabinol
Cannabichromene
Cannabigerol
Etc.
It is also called weed, herb, pot, grass, bud,
ganja, and Mary Jane.
Refers to leaves, flowers, stems, and seeds from
the hemp plant, Cannabis sativa.

6. joints
pipes (bowls)
water pipes
(bongs, hookahs)
dabbing
cream
suppositories
Beverages
Beauty products

7. Economy & tax benefits
Cost of the war on drugs
Ineffective ban
Government regulation
Natural
Victimless crime
Not physically addictive
Public support
Public safety an driving danger
Health risks Exposure to children
Gateway drug Scientific research
Marijuana Legalization
Opening doors to
legalization of other drugs
Neurological effects
Increased use

8. Current Policy

9. Objectives
FL PolicyTrends
Public Health
Introduction
Medical
Benefits
Adverse
Effects

11. NIDA, 2017

14. Use of Marijuana in Relation to Perceived Risk and Daily
Use of Tobacco Cigarettes or Marijuana among U.S.
Students in Grade 12, 1975–2013
Data from Johnston et al, 2016

15. Increases over Time in the Potency of
Tetrahydrocannabinol (THC) in
Marijuana and the Number of
Emergency Department Visits
Involving Marijuana, Cocaine, or
Heroin
Volkow et al, 2014

16. Objectives
FL PolicyTrends
Public Health
Introduction
Medical
Benefits
Adverse
Effects

17. Challenges and barriers
Challenges and barriers in conducting cannabis research,
including regulatory barriers, classification of cannabis as a
Schedule I substance.
Conclusive evidence regarding the short- and long-term
health effects of cannabis use remains elusive.
To develop conclusive evidence for the effects of cannabis
use improvements and standardization in research
methodology is needed.

18. The Health Effects Of Cannabis And Cannabinoids
Percentage of medical
cannabis patients reported
by condition in
Colorado and Oregon, July
2016.

19. Health Condition Sufficient
Evidence
Moderate
evidence
Limited
Evidence
Insufficient
Evidence
Chemotherapy-induced nausea/vomiting X
Chronic pain X
Multiple Sclerosis X
Cancers X
Appetite and wasting in HIV X
Cancer associated anorexia X
Epilepsy X
Parkinson’s disease X
Abstinence in the use of addictive drugs X
Anxiety X
Schizophrenia X
Sleep Disorders X
Tourette syndrome X
Huntington’s disease X
Dementia X
Glaucoma X
PTSD X

20. Objectives
FL PolicyTrends
Public Health
Introduction
Medical
Benefits
Adverse
Effects

21. Marijuana effects
IF smoked: THC pass from the lungs into the bloodstream, rapidly going into the brain.
Euphoria Sense of relaxation Heightened sensory perception Laughter
Altered perception of time Increase appetite
IF consumed in food: effect are delayed to 30 min to 1 hr.
The feeling lasts between 1 to 3 hrs.

22. The effects on the brain
THC able to attach to cannabinoids receptors and influence pleasure,
memory, thinking, concentration movement, coordination, sensory and
time perception.
THC is able to alter the function of the hippocampus and orbitofrontal
cortex.
THC also disrupts functioning of the cerebellum and basal ganglia,
areas that regulate balance, posture, coordination and reaction time.
THC activates the brain’s reward system, governs healthy pleasurable
behaviors.
Similar to most drugs THC stimulates the release of dopamine at levels
higher that typical observed.
NIDA, 2016

23. Is marijuana addictive
Short term risk associated with Cannabis use
 Impaired short-term memory, making it difficult to learn and to retain information
 Impaired motor coordination, interfering with driving skills and increasing the risk of injuries
 Altered judgment, increasing the risk of sexual behaviors that facilitate the transmission of
sexually transmitted diseases
 In high doses, paranoia and psychosis
Long term risk associated with Cannabis use
 Addiction (in about 9% of users overall, 17% of those who begin use in adolescence, and 25
to 50% of those who are daily users)
 Altered brain development
 Poor educational outcome, with increased likelihood of dropping out of school
 Cognitive impairment, with lower IQ among those who were frequent users during
adolescence
 Symptoms of chronic bronchitis
 Increased risk of chronic psychosis disorders (including schizophrenia) in persons with a
predisposition to such disorders

24. Is marijuana a gateway drug
Research suggests that marijuana use is likely to precede use of other licit and illicit
substances and the development of addiction to other substances.
Animal research suggests cross-sensitization and early exposure to cannabinoids
showed decrease reactivity of brain dopamine reward center later in adulthood.
An alternative to the gateway-drug hypothesis is that people who are more
vulnerable to drug-taking are more likely to start with marijuana, tobacco, or
alcohol, and their social interactions increases their chances of trying other drugs.

25. Is there link between marijuana and psychiatric disorders?
Source: Di Forti et al. Biol Psychiatry. 2012.
has found that people who use
marijuana and carry a specific variant of
the AKT1 gene, which codes for an
enzyme that affects dopamine signaling
in the striatum, are at increased risk of
developing psychosis.
Source: Caspi et al. Biol Psychiatry. 2005
Individuals with one or two copies of
the Val variant have a higher risk of
developing schizophrenic-type
disorders if they used cannabis during
adolescence

26. Other related effects
Health Effects Sufficient Evidence Limited Evidence Insufficient Evidence
Smoking does not increase lung, head and
neck cancers X
Testicular cancer is associated to cannabis X
Cannabis use during pregnancy is
associated with greater cancer risk to the
offspring
X
Heart attack X
Stroke X
Diabetes X
Lung conditions X
Immune system X

27. Objectives
FL PolicyTrends
Public Health
Introduction
Medical
Benefits
Adverse
Effects

28. Policy: lessons learned from alcohol and tobacco

29. Florida medical marijuana regulations
2014 – Charlotte’s Web: Low THC, high Cannabidiol medication
2016 – Amendment 2: Full-strength medical marijuana with any THC level.
Amendment 2 makes full-strength marijuana legal and broadens the definition of
debilitating medical condition.
“Debilitating medical condition ... for which a physician believes that the medical use of
marijuana would likely outweigh the potential health risks for a patient”
It is now included cancer, epilepsy, glaucoma, HIV, AIDS, Crohn's disease, PTSD, Parkinson's
disease, ALS, multiple sclerosis.

30. Implementation of Amendment 2
Single doses, no more than 15% THC, labeling and packaging requirements, no
commercially recognized products, not appealing to kids
Smoked marijuana Vaping and edibles

31. Decriminalization policies adopted by Miami-Dade County,
Tampa, Key West, and Orlando giving officers the discretion
to replace arrests for possession of under 20 grams of
marijuana with citations.

32. Physicians
Cannot be employed by or have a direct or indirect
economic interest.
Must complete 2 hour course annually to make
recommendations.
Physical exam while physically in same room as patient
If patient is under 18 a second physician must concur with
recommendation of another.
Only low-THC can be recommended to a pregnant patient
Review the patient’s drug history; 70 day supply;
recommendation every 30 weeks
Must be a qualifying medical conditions.
The type of delivery device must be authorized.

33. Dispensaries
Each licensee can operate up to 25 dispensaries. Upon
reaching the 100,000 threshold another 5. Cap expires
in 2020.
Utilize seed to sale tracking system.
Total 425 dispensaries in the state.
Southeast Region- Broward, Miami-Dade, Martin,
Monroe and Palm Beach.
Total population: 6,173,965; 128 to 143 dispensaries.

34. Edibles
No more than 200 milligrams of THC
Single serving may not contain more than 10
milligrams.
Potency limit on edibles at 15%.
Cannot be attractive to kids.
Not in the shape resemblance to commercialized
candy, no color additives.
Each edible has to be individually sealed in plain,
opaque wrapping marked by universal symbol as
determine by DOH.

35. Advertising and Marketing
Cannot be visible to the public from any street,
sidewalk, park or other public place EXCEPT for a sign
on the outside of the building with a DOH approved
logo.
Logo cannot contain words or images associated
with marketing towards youth or that promotes
recreational use.
All internet marketing and ads must be approved by
DOH and may not target those under 18 and cannot
be unsolicited popup ads.

36. Prevention and Education
$500,000 for statewide marijuana
education and illicit use prevention
campaign.
$5 million to implement a statewide
impaired driving education campaign.
$100,000 (recurring funds) to train
additional law enforcement.
$750,000 to the Coalition for Medicinal
Cannabis Research.

37. Objectives
FL PolicyTrends
Public Health
Introduction
Medical
Benefits
Adverse
Effects

38. The Public Health Effects of Legalizing Medical Cannabis
Effects on adolescents: what is the concern about legalization of
medical marijuana
 Increase cannabis use among adolescents
 Increase access to more potent cannabis, at a cheaper
price than the black market
 Increase the social acceptability of using cannabis
 Lower the perceived risks of using cannabis.
 Adolescents have access to cannabis from adults with legal access to medical or
recreational marijuana.
Pacula et al, 2014

39. The Public Health Effects of Legalizing Medical Cannabis in Adults
Car accidents involving individuals who tested positive for marijuana rose
in California, Hawaii, and Washington after medical marijuana use was
legalized.
Alcohol consumption was drastically reduced in states where medical
marijuana was cheaper than the black market. This was reported in
surveys and in beer sales comparing states that had not legalized medical
marijuana.
A decline in suicide rates in males aged 20 to 30 in states that legalized
medical marijuana.

40. Impacts of Changing Marijuana Policies on Alcohol Use
Literature provides some evidence for both substitution (i.e., more liberal
marijuana policies related to less alcohol use as marijuana becomes a
substitute) and complementary (i.e., more liberal marijuana policies
related to increases in both marijuana and alcohol use) relationships in
the context of liberalization of marijuana policies in the United States
Wilkinson et al, 2016

41. Local Efforts

42. So You Think You Know Marijuana?
RESULTS

43. Karina Villalba
kvill012@fiu.edu