Marijuana use among youth poses significant risks to brain development and mental health. Regular marijuana use is associated with cognitive decline across all domains even after years of abstinence. It can also increase the likelihood of developing psychiatric disorders like depression and psychosis. Prenatal marijuana exposure has been linked to lower birth weight, abnormal development and long term cognitive impairments in offspring. Overall, the evidence shows that marijuana jeopardizes the healthy development of youth.

1. Marijuana Jeopardizing Youth
Eric A. Voth, M.D., F.A.C.P-Eric A. Voth, M.D., F.A.C.P-
ChairmanChairman
The Institute onThe Institute on
Global Drug PolicyGlobal Drug Policy

3. Brain Development
Motivation
Emotion
Judgment
Cerebellu
m
Amygdala
Nucleus
Accumbens
Prefrontal
Cortex
Judgement is last to develop!
Physical
coordination
Sensory
processing
Maturation starts at the back of the brain
and moves to the front

4. 30-day Marijuana Use

5. Friends Who Use

6. Perception of Harm –
% reporting NO RISK with regular use

7. CESAR FAX
U n i v e r s i t y o f M a r y l a n d , C o l l e g e P a r k
A Weekly FAX from the Center for Substance Abuse Research
January 18, 2010
Vol. 19, Issue 2
U.S. High School Seniors’ Perception of Harm from Regular Marijuana Use Decreasing
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
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
0%
10%
20%
30%
40%
50%
60%
70%
80%
Perceived Risk of Harm
from Regular Use
Used in Past Month
Percentage of U.S. Twelfth Grade Students Reporting Past Month
Marijuana Use and Perceived Risk of Harm from Regular Marijuana Use, 1975-2009
SOURCE: Adapted by CESAR from University of Michigan, “Teen Marijuana Use Tilts Up, While Some
Drugs Decline in Use,” Press Release, 12/14/09. Available online at
http://www.monitoringthefuture.org/data/09data.html#2009data-drugs.

10. Marijuana
 Impurity-488 substances, 66 cannabinoidsImpurity-488 substances, 66 cannabinoids
 Resembles tobacco in constituents.Resembles tobacco in constituents.
 High THC concentrations 2-30%High THC concentrations 2-30%
 1/2 life 5-7 days1/2 life 5-7 days

11. Ave %THC potency (seizures)
 19751975 0.74%0.74%
 19771977 0.900.90
 19801980 2.062.06
 19831983 3.233.23
 19851985 2.822.82
 19901990 3.353.35
 19921992 3.103.10
 19951995 3.753.75
 19961996 4.074.07
 19971997 4.534.53
 19981998 4.434.43
 19991999 4.554.55
 20002000 4.874.87
 20012001 5.325.32
 20022002 6.346.34
 20032003 6.126.12
 20062006 8.758.75
 20072007 9.69.6
 20082008 8.88.8
University of MississippiUniversity of Mississippi
Potency monitoring reportPotency monitoring report

12. Neuro-Behavioral Effects

13. Cognitive Changes
 AttentionAttention
 ConcentrationConcentration
 Decision-makingDecision-making
 InhibitionInhibition
 ImpulsivityImpulsivity
 Working memoryWorking memory
 Verbal fluencyVerbal fluency
 Concept formation and planningConcept formation and planning
J Addict Med 2011;5:1-8J Addict Med 2011;5:1-8

14. Memory
Difficulty sorting information andDifficulty sorting information and
inhibition of memory even after ainhibition of memory even after a
mean two year abstinence.mean two year abstinence.
SOLOWIJ- LIFE SCIENCESSOLOWIJ- LIFE SCIENCES
1995;5:2119-261995;5:2119-26

15. Structural Damage to Brain
 59 users 33 controls59 users 33 controls
 Ave age 33, Ave use 15 yrs, started 16.7 yoAve age 33, Ave use 15 yrs, started 16.7 yo
 Ave joints /mo=147Ave joints /mo=147
 Ave life joints 25922Ave life joints 25922
 Demonstrated axonal connectivityDemonstrated axonal connectivity
impairment in hippocampus, splenium ofimpairment in hippocampus, splenium of
corpus callosum, commissural fiberscorpus callosum, commissural fibers
Brain 2012:135;2245-2255Brain 2012:135;2245-2255

16. Neuropsychological Decline
 1037 individuals1037 individuals
 Pot use at 18,21,26,32,38 y/oPot use at 18,21,26,32,38 y/o
 Neuropsych testing at 13 before pot and 38Neuropsych testing at 13 before pot and 38
 Broad Neuropsychological decline acrossBroad Neuropsychological decline across
all domains even controlling for educationall domains even controlling for education
 Greatest decline was adolescent andGreatest decline was adolescent and
persistent use.persistent use.
Proc Natl Acad Sci U S A. 2012 Aug 27Proc Natl Acad Sci U S A. 2012 Aug 27

17. From the horse’s mouth
 ““I used to smoke this stuff regulerly I quit because II used to smoke this stuff regulerly I quit because I
needed to pass a test to get a job. The reason I am writingneeded to pass a test to get a job. The reason I am writing
is because I never had any of thougs side effects you talkis because I never had any of thougs side effects you talk
about don’t get me wrong its not for every body. But youabout don’t get me wrong its not for every body. But you
don’t need to say untrue things about it coordinationdon’t need to say untrue things about it coordination
imparment that’s bs it allows you to focus better on singleimparment that’s bs it allows you to focus better on single
things its perfect for kids like I was that cant concetrate onthings its perfect for kids like I was that cant concetrate on
ting well you don’t have to reply to this email I am justting well you don’t have to reply to this email I am just
bored and looking at stuff on the net and emailing peoplebored and looking at stuff on the net and emailing people
and going on and on cause I cant sleep well you have aand going on and on cause I cant sleep well you have a
nice day.nice day.

18. Driving effects

19. Driving Effects
 Combining EtOH and Marijuana in FirstCombining EtOH and Marijuana in First
Study Reduced Driving SkillsStudy Reduced Driving Skills
 .07 + 100ug = Plain EtOH of 0.09.07 + 100ug = Plain EtOH of 0.09
 .07 + 200 ug = Plain EtOH of .14 g/dl.07 + 200 ug = Plain EtOH of .14 g/dl
 NHTSA Notes Annals of Emergency MedicineNHTSA Notes Annals of Emergency Medicine
 2000;35:3992000;35:399

20. Colorado Pot

21. Marijuana & Pilots

22. Psychiatric and
Behavioral Disorders

23. Marijuana and depression
 1920 subjects1920 subjects
 15 year follow up15 year follow up
 Likelyhood of major depression 4 timesLikelyhood of major depression 4 times
greater among users.greater among users.
Am J. Psychiatry
2001;158:2033-2037

24. Depression
 Depressive responses measuredDepressive responses measured
 Lower doses= Serotonin agonistLower doses= Serotonin agonist
 Higher doses= Serotonin suppressantHigher doses= Serotonin suppressant
 Effect was the Medial Prefrontal CortexEffect was the Medial Prefrontal Cortex
J Neuroscience 2007;27:11700-11711J Neuroscience 2007;27:11700-11711

25. Marijuana and Psychosis
 40454045 psychosis-freepsychosis-free and 59 individualsand 59 individuals
exhibiting psychosis at baseline assessment.exhibiting psychosis at baseline assessment.
 Marijuana predictedMarijuana predicted 2.762.76 times greatertimes greater
likelihood oflikelihood of any psychotic symptomsany psychotic symptoms,,
predictedpredicted 24.1724.17 times higher incidence oftimes higher incidence of
severe psychotic symptomssevere psychotic symptoms, and predicted, and predicted
12 times higher need for clinical assessment12 times higher need for clinical assessment
and care for psychotic symptoms.and care for psychotic symptoms.
American Journal of EpidemiologyAmerican Journal of Epidemiology
2002;156:319-272002;156:319-27

26. Persistence of Psychosis
 Risk of psychosis -no prior psychosis whoRisk of psychosis -no prior psychosis who
used pot, 1.9 times greater that non-users inused pot, 1.9 times greater that non-users in
ave 3.5 years.ave 3.5 years.
 Continued pot use risk of future psychosisContinued pot use risk of future psychosis
was 31% vs 20% in those who did not usewas 31% vs 20% in those who did not use
out to approx 8.5 years.out to approx 8.5 years.
 BMJ 2011;342: d738BMJ 2011;342: d738

27. Marijuana and Bipolar Illness
 166 first-episode bipolar I disorder patients.166 first-episode bipolar I disorder patients.
 Cannabis and alcohol associated with theCannabis and alcohol associated with the
first episode of maniafirst episode of mania
Bipolar Disorder 2008;10:738-741Bipolar Disorder 2008;10:738-741

28. Marijuana and Behavior
 Marijuana had a greater effect on degree ofMarijuana had a greater effect on degree of
violent behavior in non-delinquentviolent behavior in non-delinquent
individuals than in delinquent individuals.individuals than in delinquent individuals.
This effect is even more prominent than theThis effect is even more prominent than the
effect of cocaine, amphetamine, oreffect of cocaine, amphetamine, or
tranquilizer/sedative use.tranquilizer/sedative use.
Friedman AS, J Addict Dis. 2003;22:63-78Friedman AS, J Addict Dis. 2003;22:63-78

29. Gateway Effects
&Addiction

30. Gateway Effect
 Risk spans entire course of adolescent
development.
 Young people exposed to other users are at
higher risk for early initiation.
 Clear family standards and proactive
family management are important in
delaying alcohol and marijuana use.
 Kosterman R, Hawkins JD, Guo J, Catalano RF, Abbott RD.
 . American Journal of Public Health 2000;90:360-366.

31. Gateway effects
 Risk of other drug use with weekly
marijuana vs nonusers:
14-15 y/o 66.7%
17-18y/o 28.5%
20-21y/o 12.2%
24-25y/o 3.9%
Fergusson DM, et al.
Addiction 2006;101:556-569

32. Marijuana Dependence
 Most patients claimed serious problems withMost patients claimed serious problems with
cannabis, and 78.6% met criteria for cannabiscannabis, and 78.6% met criteria for cannabis
dependence.dependence.
 Two thirds reported withdrawal. Cannabis is aTwo thirds reported withdrawal. Cannabis is a
reinforcer. produces both dependence andreinforcer. produces both dependence and
withdrawal and reinforces cannabis use.withdrawal and reinforces cannabis use.
 Regular cannabis use rapid as tobaccoRegular cannabis use rapid as tobacco
progression, and more rapid than alcoholprogression, and more rapid than alcohol
CrowleyDrug and Alcohol Dependence 1998;50:27-37CrowleyDrug and Alcohol Dependence 1998;50:27-37

33. Marijuana Dependence
 20% used before age 16 (20% used before age 16 (New Zealand)New Zealand)
 21.7% demonstrated dependence by age 2121.7% demonstrated dependence by age 21
 If 5 positive experiences with pot, 28 xIf 5 positive experiences with pot, 28 x
increase risk of dependence.increase risk of dependence.
Fergusson DM, Horwood LJ, Lynskey MT, Madden PAF.
Early reactions to cannabis predict later dependence.
Arch Gen Psychiatry 2003;60:1033-1039

34. Fetal/Newborn Effects

35. Effect on Conception
 Women smoking> 90 times in their lifetimeWomen smoking> 90 times in their lifetime
had 27% fewer oocytes retrieved (P=.03)had 27% fewer oocytes retrieved (P=.03)
and 1 fewer embryo transferred (P!.05).and 1 fewer embryo transferred (P!.05).
Women smoking marijuana >10 times inWomen smoking marijuana >10 times in
lifetime infants 17% (P=.01) smallerlifetime infants 17% (P=.01) smaller
Women smoking marijuana 1 year beforeWomen smoking marijuana 1 year before
IVF/ GIFT had25% fewer oocytes retrievedIVF/ GIFT had25% fewer oocytes retrieved
(P=.03)(P=.03)
 Am J Ob-Gyn (2006) 194, 369–76Am J Ob-Gyn (2006) 194, 369–76..

36. Effect on Conception (cont)
 If men smoked marijuana 11 to 90 times inIf men smoked marijuana 11 to 90 times in
their lifetime, there was a 15% decrease intheir lifetime, there was a 15% decrease in
infant birth weight (P = .03)infant birth weight (P = .03)
 more than 90 times, there was a 23%more than 90 times, there was a 23%
decrease (P=.01).decrease (P=.01).
 Women and men who smoked in the past 15Women and men who smoked in the past 15
years, had 12%(P=.04) and 16% (P=.03)years, had 12%(P=.04) and 16% (P=.03)
smaller infants, respectively.smaller infants, respectively.

37. Pre-Term Birth
 3234 births from healthy women3234 births from healthy women
 Use of marijuana (particularly pre-Use of marijuana (particularly pre-
pregnancy) is a strong environment risk forpregnancy) is a strong environment risk for
pre-term birth.pre-term birth.
Dekker GA, Lee SY, North RA, McCowan LM, Simpson NAB, et al.Dekker GA, Lee SY, North RA, McCowan LM, Simpson NAB, et al.
(2012PLoS ONE 7(7): e39154. doi:10.1371/journal.pone.0039154)(2012PLoS ONE 7(7): e39154. doi:10.1371/journal.pone.0039154)

38. Newborn Effects
BirthweightBirthweight
LengthLength
Head CircumferenceHead Circumference
Abnormal DevelopmentAbnormal Development
Neurological IrritabilityNeurological Irritability

39. Fetal/Infant Effects
Prenatal exposure to marijuana is associated withPrenatal exposure to marijuana is associated with
reduction in birth weight, length, and headreduction in birth weight, length, and head
circumference even when tobacco use factoredcircumference even when tobacco use factored
out.out.
Clinical Chemisty 2010;56:1442-1450Clinical Chemisty 2010;56:1442-1450

40. Fetal Effects: 14 y/o
 524 subjects524 subjects
 Confounding variables controlledConfounding variables controlled
 Greatest effect first Trimester >1joint /dayGreatest effect first Trimester >1joint /day
 Fetal exposure= 14 y/o Wechsler compositeFetal exposure= 14 y/o Wechsler composite
 Poor Intelligence age 6Poor Intelligence age 6
 Attention and Depression age 10Attention and Depression age 10
Neurotoxicology and TeratologyNeurotoxicology and Teratology
Goldschmidt and DayGoldschmidt and Day
34 (2012) 161–16734 (2012) 161–167

41. Respiratory Effects
 CoHb 5x TOBACCOCoHb 5x TOBACCO
 TAR 3x TOBACCOTAR 3x TOBACCO
 Decreased DiffusionDecreased Diffusion
 Cellular InflammationCellular Inflammation
 Precancerous ChangesPrecancerous Changes
 Diminished Lung ImmunityDiminished Lung Immunity

42. Respiratory Effects
 Cannabis associated with dose-relatedCannabis associated with dose-related
impairment of large airways resulting inimpairment of large airways resulting in
obstruction, wheezing, mucous, andobstruction, wheezing, mucous, and
hyperinflation.hyperinflation.
 Dose equivalence 1: 2.5-5 vs tobaccoDose equivalence 1: 2.5-5 vs tobacco
Thorax 2007;0: 1-7Thorax 2007;0: 1-7

43. Lung Damage
 Marijuana smoking leads to bullous lungMarijuana smoking leads to bullous lung
disease in normal CXR and lung functiondisease in normal CXR and lung function
20 years earlier than seen with tobacco20 years earlier than seen with tobacco
Respirology 2008;13:122-127Respirology 2008;13:122-127

44. Marijuana and Lung Cancer
 The risk of lung cancer increased 8% (95%The risk of lung cancer increased 8% (95%
confidence interval (CI) 2–15) for eachconfidence interval (CI) 2–15) for each
joint-yr of cannabis smoking, 7% (95% CIjoint-yr of cannabis smoking, 7% (95% CI
5–9) for each pack-yr of cigarette smoking,5–9) for each pack-yr of cigarette smoking,
 The highest tertile of cannabis use wasThe highest tertile of cannabis use was
associated with an increased risk of lungassociated with an increased risk of lung
cancer relative risk 5.7 (95% CI 1.5–21.6)),cancer relative risk 5.7 (95% CI 1.5–21.6)),
Eur Respir J 2008; 31: 280–286Eur Respir J 2008; 31: 280–286

46. Marijuana Lobby & “Medical”
Pot

47. Medical Excuse Marijuana
No compelling evidence that there
is a significant group of untreated
or inadequately treated patients.
Pro-marijuana lobby getting its
“nose under the tent”

48. Marijuana Policy Project
 "This is the next step in the evolution of medical
marijuana as a political issue," "We have informed
elected officials about the widespread public
support for the issue, we have lobbied members
of Congress and their staffs directly, and we
have activated our grassroots. Now it is time to
provide financial support to those who are willing
to support medical marijuana.”
Steve Fox
Marijuana Policy Project (MPP) Washington, D.C.

49. Important points to remember
 Safe, effective reliable medicines are bestSafe, effective reliable medicines are best
for patients, and they are availablefor patients, and they are available
 Marijuana is impure, unreliable, full ofMarijuana is impure, unreliable, full of
contaminants, high side effect rate.contaminants, high side effect rate.
 Defense to possession bypasses FDA andDefense to possession bypasses FDA and
jeopardizes consumer protectionjeopardizes consumer protection
 Medical excuse marijuana createsMedical excuse marijuana creates
“medicine by popular vote.”“medicine by popular vote.”

50. Proposed Medicinal Uses of
Marijuana
Nausea of ChemotherapyNausea of Chemotherapy
GlaucomaGlaucoma
Appetite StimulationAppetite Stimulation
Multiple SclerosisMultiple Sclerosis
Pain/ MigrainePain/ Migraine
Misc- Cramps, Sleep, DepressionMisc- Cramps, Sleep, Depression

51. Who is Actually Using
Medical Excuse Marijuana?
 Under 34 -- 45.4%Under 34 -- 45.4%
 Under 54 (most pain age older) 84%Under 54 (most pain age older) 84%
 For Pain 82%For Pain 82%
 For Anxiety 37%For Anxiety 37%
 For Depression 26%For Depression 26%
 For Nausea 27%For Nausea 27%
 For Appetite 37.7%For Appetite 37.7%
Journal of psychoactive drugsJournal of psychoactive drugs
2011;43:128-1352011;43:128-135

52. Colorado Medical Excuse Pot
 Sept 2011 127,444 usersSept 2011 127,444 users
 94% pain94% pain
 Ave Age 40Ave Age 40
 Denver has 400 dispensaries (375 StarbucksDenver has 400 dispensaries (375 Starbucks
state-wide)state-wide)
 Denver Dispensary crime up 69% with 75%Denver Dispensary crime up 69% with 75%
increase in burglaries.increase in burglaries. Denver Police June 4, 2012Denver Police June 4, 2012

53. MarijuanaMarijuana
ForFor
PainPain

54. Pain
 Healthy volunteers doses 0,2,4,8% THCHealthy volunteers doses 0,2,4,8% THC
 Decrease of pain medium dosesDecrease of pain medium doses
 Increase of pain higher dosesIncrease of pain higher doses
 ?Specific substance responsible??Specific substance responsible?
Anesthesiology. 2007;107:785-96Anesthesiology. 2007;107:785-96

55. THC as Opioid Adjunct
 THC alone ineffective for the most partTHC alone ineffective for the most part
 Literature is contradictory. SomeLiterature is contradictory. Some
demonstrated higher morphine dosesdemonstrated higher morphine doses
 May be useful as an adjunct to opiodsMay be useful as an adjunct to opiods
International Review of Psychiatry,International Review of Psychiatry,
April 2009; 21(2): 143–151April 2009; 21(2): 143–151

56. Palliative Care
 Studies largely marginalStudies largely marginal
 Mostly involve oral or SativexMostly involve oral or Sativex
 Not indicated as sole agentNot indicated as sole agent
 May be some add-on benefitMay be some add-on benefit
International Journal of Palliative NursingInternational Journal of Palliative Nursing
2010, Vol 16, No 102010, Vol 16, No 10

57. Sativex as add-on for pain
 Advanced cancer patients on opioid painAdvanced cancer patients on opioid pain
medsmeds
 Low, medium, high dose treatementsLow, medium, high dose treatements
 Add on to the opioid medicationAdd on to the opioid medication
 Low and medium dose had benefit, not highLow and medium dose had benefit, not high
dosedose
 Adverse events dose related and high doseAdverse events dose related and high dose
was unfavorablewas unfavorable

58. Pain in HIV
 Trial in HIV-associated neuropathyTrial in HIV-associated neuropathy
 No comparison to other medicines norNo comparison to other medicines nor
MarinolMarinol
 Benefit in reducing the neuropathic painBenefit in reducing the neuropathic pain
comparable to existing medicationscomparable to existing medications
 Difficult to discern “high” vs. medicalDifficult to discern “high” vs. medical
effecteffect
 Abrahms Neurology 2007;68 515-521Abrahms Neurology 2007;68 515-521

59. Abrahms
 Table 2 Mean side effect scores by study groupTable 2 Mean side effect scores by study group
 Anxiety* 0.25 (0.14, 0.44) 0.10 (0.05, 0.22)Anxiety* 0.25 (0.14, 0.44) 0.10 (0.05, 0.22)
 Sedation† 0.54 (0.36, 0.81) 0.08 (0.04, 0.17)Sedation† 0.54 (0.36, 0.81) 0.08 (0.04, 0.17)
 Disorientation† 0.16Disorientation† 0.16(0.07, 0.34)(0.07, 0.34) 0.01 (0.00, 0.04)0.01 (0.00, 0.04)
 Paranoia 0.13 (0.03, 0.45) 0.04 (0.01, 0.14)Paranoia 0.13 (0.03, 0.45) 0.04 (0.01, 0.14)
 Confusion† 0.17 (Confusion† 0.17 (0.07, 0.390.07, 0.39) 0.01 (0.00, 0.06)) 0.01 (0.00, 0.06)
 Dizziness† 0.15Dizziness† 0.15 (0.07, 0.31)(0.07, 0.31) 0.02 (0.01, 0.05)0.02 (0.01, 0.05)
 Nausea 0.11 (0.04, 0.30) 0.03 (0.01, 0.14)Nausea 0.11 (0.04, 0.30) 0.03 (0.01, 0.14)
 ** p, 0.05; † p 0.001.p, 0.05; † p 0.001.

60. HIV Cognitive Impairment
 HIV patients vs controlsHIV patients vs controls
 Significantly more depression and anxietySignificantly more depression and anxiety
in marijuana using groupin marijuana using group
 More alcohol use if used marijuanaMore alcohol use if used marijuana
 Memory impaired even after factoring outMemory impaired even after factoring out
depression, anxiety, and alcoholdepression, anxiety, and alcohol
The Journal of Neuropsychiatry andThe Journal of Neuropsychiatry and
Clinical Neurosciences 2004; 16:330–335Clinical Neurosciences 2004; 16:330–335

61. Pain Summary
 Summary of literature on pain/ quality ofSummary of literature on pain/ quality of
studies generally marginalstudies generally marginal
 Mostly discussing oral or syntheticMostly discussing oral or synthetic
cannabinoidscannabinoids
 May be useful as an adjunct particularly forMay be useful as an adjunct particularly for
neuropathic painneuropathic pain
 As solo agent, high doses needed and moreAs solo agent, high doses needed and more
side effectsside effects
Current Opinion in Anaesthesiology 2005, 18:424–427Current Opinion in Anaesthesiology 2005, 18:424–427

62. Cannabinoids in MS
meta-analysis
 All studied were non-smokedAll studied were non-smoked
 Cannabinoids difficult to work withCannabinoids difficult to work with
 Adverse effects not related to doseAdverse effects not related to dose
 Little benefit for spasticity-poss as add-onLittle benefit for spasticity-poss as add-on
 Evidence on tremor weakEvidence on tremor weak
 Evidence on pain moderateEvidence on pain moderate
 Problems with psychoactivityProblems with psychoactivity
CNS Drugs 2011:25 ZajicekCNS Drugs 2011:25 Zajicek

63. MS- Cognitive Effects
 MS patients using smoked or ingested potMS patients using smoked or ingested pot
 Impaired processing speed, memory,Impaired processing speed, memory,
executive function, spatial perceptionexecutive function, spatial perception
 Twice as likely as nonusers to beTwice as likely as nonusers to be
classified as globally cognitivelyclassified as globally cognitively
impaired.impaired.
Neurology 2011;76:1153-1160Neurology 2011;76:1153-1160

64. As Paul Harvey would say--
““And now for the rest of the story.”And now for the rest of the story.”

65. Marijuana and Fatal Crashes
California 2008
 Five years following medical excuseFive years following medical excuse
marijuana dispensaries 1240 fatal crashesmarijuana dispensaries 1240 fatal crashes
compared to 631 for the five years priorcompared to 631 for the five years prior
 8.3% of fatal single vehicle crashes8.3% of fatal single vehicle crashes
 5.5% fatal passenger crashes5.5% fatal passenger crashes
 Use rate estimated at 16-20%Use rate estimated at 16-20%
 Rivals alcohol as top cause of fatalitiesRivals alcohol as top cause of fatalities
Crancer and CrancerCrancer and Crancer
Involvement of marijuana inInvolvement of marijuana in
California Fatal Vehicle CrashesCalifornia Fatal Vehicle Crashes

66. Marijuana treatment episodes
 National increaseNational increase
 1992 92,5001992 92,500
 2008 322,0002008 322,000
 California increaseCalifornia increase
 1992 73001992 7300
 2008 350002008 35000
RAND 2010RAND 2010
Altered State?Altered State?
Assessing How Marijuana LegalizationAssessing How Marijuana Legalization
in California Could Influencein California Could Influence
Marijuana ConsumptionMarijuana Consumption

67. Scientific Status of Medical
Excuse Marijuana
 Cannabinoids may be useful and worthCannabinoids may be useful and worth
studyingstudying
 Smoking is problematicSmoking is problematic
 Legislative processes bypass the FDA andLegislative processes bypass the FDA and
jeopardize the publicjeopardize the public

68. Organizations Voicing Positions

69. IOM Recommendations
 Rec 5-The goal of clinical trials ofRec 5-The goal of clinical trials of
smoked marijuana wouldsmoked marijuana would not be tonot be to
develop marijuana as a licensed drugdevelop marijuana as a licensed drug
 Rec 6-Rec 6- must meet the followingmust meet the following
conditions:conditions: failure of all approvedfailure of all approved
medicationsmedications to provide relief has beento provide relief has been
documenteddocumented

70. Practical Issues/Regulation
 Has user exhausted all other acceptedHas user exhausted all other accepted
medical interventions?medical interventions?
 Is the proposed patient a drug abuser?Is the proposed patient a drug abuser?
 Does law allow for drug screening to assureDoes law allow for drug screening to assure
no use of illegal drugs?no use of illegal drugs?
 Will patient have medical oversite andWill patient have medical oversite and
monitoring of status and adverse Eventsmonitoring of status and adverse Events
 Legal liability and responsibility?Legal liability and responsibility?

71. Practical Issues/ Regulation
 What marijuana will be allowed, whatWhat marijuana will be allowed, what
strengths, and who pays for it?strengths, and who pays for it?
 Who produces the marijuana?Who produces the marijuana?
 Is marijuana purity assured?Is marijuana purity assured?
 Is the caregiver licensed and in goodIs the caregiver licensed and in good
standing with regulatory agencies?standing with regulatory agencies?
 Does the caregiver demonstrate formalDoes the caregiver demonstrate formal
training or experience in addiction and intraining or experience in addiction and in
the administration of dangerous drugs?the administration of dangerous drugs?

72. Practical Social Issues
 Employment drug testsEmployment drug tests
 Health insurance medication ridersHealth insurance medication riders
 DUI statutes/ accidentsDUI statutes/ accidents
 Student/adult athleticsStudent/adult athletics
 Side effectsSide effects
 Work productivityWork productivity

73. Important points to remember
 Safe, effective reliable medicines are bestSafe, effective reliable medicines are best
for patients, and they are availablefor patients, and they are available
 Marijuana is impure, unreliable, full ofMarijuana is impure, unreliable, full of
contaminants, high side effect rate.contaminants, high side effect rate.
 Defense to possession bypasses FDA andDefense to possession bypasses FDA and
jeopardizes consumer protectionjeopardizes consumer protection
 Medical excuse marijuana createsMedical excuse marijuana creates
“medicine by popular vote.”“medicine by popular vote.”