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Marijuana

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Eric Wang

on 31 December 2013

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Transcript of Marijuana

Marijuana Prescription
Effects on developing fetus:
What are the physiological effects of marijuana?
Two important things to keep in mind!
- Marijuana is currently illegal, and this directly affects the productivity of potential social or clinical research
- In existing studies,
correlation =/= causation !
No. It can be recommended by a physician.

A physician must write a letter explaining the patient's diagnosis and the physician’s choice of cannabis as treatment. 



Is Marijuana Prescribed?
Medical Marijuana Card (MMIC)
Psychoactive Drugs
Substances that alter mental functioning
MARIJUANA

What are the health effects of marijuana?
Alcohol
Tobacco
Caffeine
Prescription
Morphine
Benzodiazepines
Adderall
Legalization of Marijuana
Legal
Illegal
Cocaine
Heroin
MDMA
Changing tides in legislation
Over the past 20 years, 18 states + DC have legalized medical marijuana
In the past year, Colorado and Washington have legalized marijuana for recreational use
California, Arizona, Oregon, Alaska, and other states are currently seeking voter approval of ballots to approve legalization of marijuana
Trends in Public Opinion
Reasons for Drug Use
Why are more people supporting legalization
of marijuana?
Perceived personal benefits to mood
Escape/Relieve psychic distress
Dependency
Religious or Cultural ceremonial practice
Treatment of illness and disease
New Age thinking -- a steady progression
towards legalization
Attempts at Legalization in California
Drug Use Can Be Harmful
Legal History of Cannabis
the regulation of marijuana for recreational or medical purposes in the US
1910-1911
1915
1906
1600s-1890s
1910: States Outlaw Marijuana First
1910: The Mexican Revolution caused an influx of Mexican immigrants. Officials feared they would introduce the habit of recreational use into American society.

Bolstered by Progressive Era faith in big government, the 1910s marked a high tide of prohibitionist sentiment in America.

1915-1927 - 10 States Pass Marijuana Prohibition Laws

"[In 1915] Utah passes state anti-marijuana law...
Other states quickly followed suit with marijuana prohibition laws, including Wyoming (1915), Texas (1919), Iowa (1923), Nevada (1923), Oregon (1923), Washington (1923), Arkansas (1923), and Nebraska (1927)." The state of New York outlaws cannabis in 1927.


1915: Foundation for Federal Drug Regulation
1915 - President Wilson Signs Harrison Act, the Model for Future Drug Regulation Legislation


Representative Francis B. Harrison wanted to regulate the opium trade, and therefore introduced three bills in 1913 to remedy the [drug] problem



Although it does not apply to marijuana, the Harrison Act becomes the model for drug regulation on the federal level and is considered the basis for the Marihuana Tax Act of 1937.

Hemp Production Encouraged
1600s-1890s:

Marijuana vs. Hemp vs. Cannabis

American production of hemp was encouraged by the government in the 17th century for the production of rope, sails, and clothing.

In 1619 the Virginia Assembly passed legislation requiring every farmer to grow hemp. Hemp was allowed to be exchanged as legal tender in Pennsylvania, Virginia, and Maryland.


1906: Strengthening of Poison Laws








The Pure Food and Drug Act:
-passed by the United States Congress in 1906
-required that certain special drugs, including those with cannabis, be accurately labeled with contents.

Further regulation of cannabis followed in:
Massachusetts (1911)
New York (1914)
Maine (1914)

In New York, reform legislation began under the Towns-Boylan Act, which targeted all "habit-forming drugs", restricted their sale, prohibited refills in order to prevent habituation, prohibited sale to people with a habit, and prohibited doctors who were themselves habituated from selling them.


1936 - Reefer Madness Film Cautions Against Marijuana

"Reefer Madness is a morality tale of how Reefer Addiction ruins
the life of its young protagonist and gets a lot of other people
killed, sexually compromised and committed to lunatic asylums..."

Financed by a small church group

Purchased for exploitation by Dwain Esper who changed the title
and added salacious insert shots


Other films included:
Esper's own Marihuana (1936)
Elmer Clifton's Assassin of Youth (1937)

1936: Reefer Madness
What are the social effects of marijuana?
Legal History of Cannabis
the regulation of marijuana for recreational or medical purposes in the US
A Brief Outline Below:
Legal History of Cannabis
the regulation of marijuana for recreational or medical purposes in the US
Topics of Discussion
Appropriate with recommendation by a physician in treatment of cancer, anorexia, AIDS, chronic pain, spasticity, glaucoma, arthritis, migraine…

Patients and their primary caregivers with recommendation who obtain and use marijuana for medical purposes are not subject to criminal prosecution or sanction.

No physician punished or denied any right or privilege for having recommended marijuana to a patient for medical purposes.

Compassionate Use Act of 1996 (Prop 215)
The cardholder is protected under the provisions of Prop 215 and SB 420

February 2009
Legalizes the cultivation, possession, sale, and use of marijuana by adults equal or greater than 21 years old
Aims to use the tax revenue to fund programs that discourage substance abuse
Bill was delayed until January 2010
Approved by the Assembly Public Safety Committee
Denied by the Health Committee
The Marijuana Control, Regulation,
and Education Act
Side note: Legislative Terminology
Prohibition
: criminalization of marijuana through strong legal sanctions
Decriminalization
: elimination, reduction, or non-enforcement of penalties for the sale, purchase, or possession of marijuana although it still remains illegal
Legalization
: regulation of the sale, distribution, use, and advertisement of marijuana
Is marijuana prescribed? If so, under what conditions?

private residencies and public storefronts

Different types of herbal marijuana, marijuana-based products and prepared foods

Patients must regulate their own intake of the marijuana.

Dispensaries
Law enforcement identify the cardholder as being able to legally possess certain amounts of medical marijuana under specific conditions.

Valid for one year

50% Medi-cal fee reduction

Tied to Driver's License No.
(patient privacy protected under HIPAA)

not a license to possess or cultivate with intent to sell.





California Proposition 19-
Regulate, Control, and Tax Cannabis Act
March 2010
Similar to the Marijuana Control, Regulation, and Education Act
Treats marijuana similarly to alcohol
Defeated by a small percentage (53% voted no) during the November 2010 Election
California Cannabis Hemp Initiative/
Marijuana Control, Legalization, and Revenue Act
Similar aims as the 2 previous acts
Need to collect 504,000 signatures in 150 days in order to make it onto the ballot
California Cannabis Hemp Initiative
- by February 24th
Requires that 50% of excise tax from recreational use be used for the creation of industrial, nutritional, and medicinal cannabis hemp industries
Caps the excise tax to 10% of retail price
Marijuana Control, Legalization, and Revenue Act
- starting December 23rd
All tax revenue from marijuana will go towards the Public Benefit Fund, which will be annually appropriated to education, health care, police, sheriff, and fire services, and drug abuse education and treatment
Legalization in Colorado and Washington
Tax and heavily regulate legal markets for marijuana
Require rigid security and 3rd party lab testing
Limit sale to adults 21 years of age or older and the amount an adult can carry
Prohibit out-of-state investment
Track marijuana closely from “seed-to-sale”

Physical Harm
Psychological Harm
Social Harm
Status of Dispensaries in CA
July 2012 - 762 registered dispensaries in Los Angeles

May 2013 - Proposition D of LA country: Medical Marijuana Regulation and Taxation
Passed (63%)

-limit the number of "medical marijuana businesses" to 135 that operated before September 2007
-Pass annual background tests
-Limits location and hours
-Increase city taxes on dispensaries

Spectrum of Psychoactive Substance Use
Marijuana Awareness Programs
No current medication for marijuana addiction


Court- mandated educational class as part of the fulfillment for marijuana-related misdemeanor



Goal: preventing future offenses

2004
1937
1951
1970
Marijuana Tax Act (1937)
The Marijuana Tax Act created a tax equaling roughly one dollar for anyone who dealt commercially in cannabis, hemp, or marijuana.
The Act did not itself criminalize the possession or usage of hemp, marijuana, or cannabis.
It did include penalty and enforcement provisions to which marijuana, cannabis, or hemp handlers were subject.



Oct. 2, 1937 - First Marijuana Seller Convicted under US Federal Law Is Arrested
The same day the Marijuana Tax Stamp Act was enacted,
Samuel R. Caldwell was arrested for a quarter ounce of marijuana:

-18 month prison sentence
-4 years of hard labour in Leavenworth Penitentiary
-$1,000 fine

Judge:
"I consider marijuana the worst of all narcotics, far worse than the use of morphine or cocaine. Under its influence men become beasts. Marijuana destroys life itself. I have no sympathy with those who sell this weed. The government is going to enforce this new law to the letter." Samuel Caldwell was given four years hard labor in Leavenworth and fined $1,000.

1951 - Boggs Act Establishes Minimum Prison Sentences for Simple Possession
Mandatory sentencing and further punishment were mandated after the Boggs Act of 1952 and the Narcotics

Control Act of 1956
-first-time cannabis possession offense a minimum of two to ten years with a fine up to $20,000

-however in 1970 the United States Congress repealed mandatory penalties for cannabis offenses.

1970 - Controlled Substances Act Classifies Marijuana as a Drug with "No Accepted Medical Use"
Physiological signs of using marijuana include:
- Rapid heart rate
- Increased blood pressure
- Increased rate of breathing
- Red eyes
- Dry mouth

Psychological effects:
- Distorted sense of time
- Slowed reaction time
- Paranoia, fear, distrust, panic
- Short-term memory loss

** Large doses may lead to symptoms such as: acute psychosis, hallucinations, delusions


LEGALIZATION: Pros and Cons

Marijuana is not FDA -approved!
Danger To Oneself and Others
Others:
-Stoned driving and other dangers would be increased.

-More widespread use would increase the dangers of secondhand smoke-damage to bystanders
Decreased Perception Of Risk
In Youths

"According to the 2009 National Survey on Drug Use and Health, past‐month marijuana use among 12‐ to 17‐year‐olds climbed 9 percent from 2008 (6.7%) to 2009 (7.3%)"
Self:
-Marijuana is associated with dependence and the smoke causes respiratory illnesses

-Marijuana has been associated with schizophrenia and depression.
Little Effect on Drug Cartels/ Violence
With such high taxes on marijuana and the increase in demand after legalization, drug cartels could simply lower their prices to keep their market share.

Marijuana is only a portion of the profit made from black markets. Organizations would continue to operate from other drug distribution, human trafficking, and other crimes.
High Social Costs
Alcohol and tobacco (substances that are legal and taxes) create a larger social cost for the United States than the revenue they generate.

Tobacco (2007)
Excise taxes Generated: $25 billion
Social Cost: $200 billion

Alcohol (2007)
Taxes Generated: $9 billion
Social Cost: $185 billion


-374,000 people entering an emergency room annually with a primary marijuana problem.

*"in alcohol‐related costs to health care, criminal justice, and the workplace in lost productivity."
CONS
Comparison of the harms of various drugs
Legalization in Colorado
15% excise tax and 10% sales tax
No cap on total amount of marijuana produced per year by state
Requires vertical integration
2-year minimum residency requirement for any owner or investor
Cultivation for personal use is allowed

Legalization in Washington
25% tax on all pot production
Cap on the total amount of marijuana that can be produced per year in the state
Prohibits "vertical integration"
3-month minimum-residency requirement for any owner or investor
Prohibit out-of-state investment in the growth and production of marijuana
Limit on the number of sellers' licenses available
Prohibits keeping plants for personal use

more restrictive than Colorado
Current Issues in Colorado
and Washington
Regulating the price of taxation
"What if we gave a pot legalization and nobody came?" -Advisor to Washington's marijuana regulators, Mark Kleinman
Legalization Trends
Increase in Accessibility to children
Colorado looking to require child-resistant packaging for edible marijuana products
*
Vertical integration
: Permitting businesses to get licensed in more than 1 stage of production: growing, processing, or selling
PROS
Financial Profits
Ability to Regulate Usage
Free up legal resources
Medical Research
Tax revenues
Industrial/ Commercial Use
Oversee production and regulate sales
Promote safe usage
Of the billions of tax dollars we spent fighting the war on drugs, 2/3rds is spent on police, courts, and prisons. If marijuana is no longer a legal issue, these resources can be used to prevent more pressing safety concerns
Drive the black market out of business
Substance abuse of any kind can cause problems:
- in relationships
- at work
- at school

Less teenagers going to jail for possession/ sale of marijuana
Less pressure from black market dealers to purchase harder, more addictive drugs
Drug disputes on the streets would be significantly reduced
How do the social effects of marijuana differ from those of other commonly abused substances?
The social effects of marijuana are closely linked to the physiological effects that it produces:
- Marijuana use adversely affects cognitive function: (during use as well as a sustained period after consumption)
o problems in sustaining attention
o impaired memory
o affects ability to learn, register, and use information
- Deficits in these abilities make it less likely to develop the proper interpersonal/social skills to do well in school or get a job

Short-term cognitive effects:
- impairs attention and judgment
- causes trouble focusing
- impairs memory and learning

Long term effects
(from chronic abuse):
- can lead to addiction (and subsequent withdrawal symptoms)
- sleep impairment
- may increase risk of anxiety, depression, personality disorders

More research can be conducted on the long-term effects of marijuana
Possibly find more medicinal uses
Substance Abuse and Related Statistics
The Health, Physiological, and Social Effects
Prescription of Medical Marijuana
Awareness Programs
History-in-context
Legalization and Legislation
The Pros and Cons
Some parties have argued that the aim of the Act was enacted to reduce the hemp industry

Separating Fact from Myth

Because drug use is very sensitive to price and illegality causes the prices of drugs to be higher, the use is lower while marijuana is illegal.
Effects on the heart:
- Increased heart rate and blood pressure (normally 70 to 80 bpm, may increase by 20 to 50 bpm, or may even double in some cases
o These conditions increase risk for heart attack while smoking marijuana

Legalization
: regulation of the sale, distribution, use, and advertisement of marijuana
Increased Availability
- smoking of any kind can obstruct the supply of oxygen and nutrients to a fetus
- exposure to marijuana prenatally is associated with negative effects on fetal growth and body weight

Statistics on Marijuana Use
United States
California
Effects on the brain:
Los Angeles
- Impairs cognitive function
o Biochemical basis of marijuana:
The active ingredient, THC, or delta-9-tetrahydrocannabinol, can be absorbed within minutes of smoking/ingesting. THC “disrupts coordination and balance by binding to cannabinoid receptors in the cerebellum and basal ganglia—parts of the brain that regulate balance, posture, coordination and reaction time.
- cognitive deficits detectable at least a week after heavy cannabis use but appear reversible

Medical Marijuana
- the smoke of marijuana, like that of tobacco, consists of a toxic mixture of gases and particulates, many of which are known to be harmful to the lungs
- same respiratory problems
as tobacco smoke:
o daily cough
o phlegm production
o more frequent acute chest illnesses
o greater risk of lung infections and bronchitis

**Although there have been many extensive studies on whether smoking marijuana leads to lung cancer, no definitive link has been established

1936
Medical cannabis is defined as:

1)parts of the herb cannabis used as medicine

2)synthetic forms of cannabinoids
Benefits of Medical Marijuana
A current case: "Parents Fight For Zander Welton, 5, To Access Medical Marijuana"
Effects on the lungs:
Resources
Eric
Cannabis use and later life outcomes:
http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2008.02221.x/full
The effects of adolescent cannabis use on educational attainment: a review.
http://www.ncbi.nlm.nih.gov/pubmed/11219366

Attributes of long-term heavy cannabis users: a case-control study
http://ukcia.org/research/AttributesOfLongTermHeavyUsers.pdf

http://www.drugabuse.gov/publications/marijuana-abuse/how-does-marijuana-use-affect-school-work-social-life

The efficacy of preemployment drug screening for marijuana and cocaine in predicting employment outcome.
http://www.ncbi.nlm.nih.gov/pubmed/2232039
http://www.drugabuse.gov/publications/marijuana-abuse/how-does-marijuana-use-affect-your-brain-body

http://www.webmd.com/mental-health/marijuana-use-and-its-effects

http://www.medicinenet.com/marijuana/page5.htm

Marijuana Neurobiology and Treatment
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2597384/

An Evidence Based Review of Acute and Long-Term Effects of Cannabis Use on Executive Cognitive Functions: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3037578/

Trajectory of adolescent cannabis use on addiction vulnerability http://www.ncbi.nlm.nih.gov/pubmed/23954491

The Residual Cognitive Effects of Heavy Marijuana Use on College Students:
http://jama.jamanetwork.com/article.aspx?articleid=396766

Neuropsychological performance in long-term cannabis users.
http://www.ncbi.nlm.nih.gov/pubmed/11576028

Health care use by frequent marijuana smokers who do not smoke tobacco
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1311782/

Association Between Marijuana Exposure and Pulmonary Function Over 20 Years: http://jama.jamanetwork.com/article.aspx?articleid=1104848

The association between marijuana smoking and lung cancer: a systematic review.
http://www.ncbi.nlm.nih.gov/pubmed/16832000

Effects of perinatal exposure to delta-9-tetrahydrocannabinol on the emotional reactivity of the offspring: a longitudinal behavioral study in Wistar rats.
http://www.ncbi.nlm.nih.gov/pubmed/18452035

http://adai.uw.edu/marijuana/factsheets/reproduction.htm
Grace


http://www.cfdp.ca/bchoc.pdf

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(07)60464-4/abstract

http://www.cdc.gov/nchs/data/hus/2012/058.pdf

http://www.samhsa.gov/data/NSDUH/2012SummNatFindDetTables/NationalFindings/NSDUHresults2012.htm#ch8.3

http://www.drugscience.org/States/CA/CA.pdf

http://file.lacounty.gov/bc/q4_2010/cms1_152904.pdf

Kari
Nikko
Amy
Cognitive Behavioral Therapy (CBT)
Learn skills that help you maintain abstinence: refusal skills, coping with cravings, minimizing exposure to dangerous situations

Motivational Enhancement Therapy (MET)
Generate your own personally relevant reasons to seek change

Contingency Management (CM)
Programs that offer contingency management motivational incentives
Types of Awareness Programs
Effectiveness of Programs
http://www.rmhidta.org/html/FINAL%20Legalization%20of%20MJ%20in%20Colorado%20The%20Impact.pdf

http://nation.time.com/2013/10/19/new-laws-chart-course-for-marijuana-legalization/

http://www.forbes.com/sites/jacobsullum/2013/10/17/high-marijuana-taxes-could-derail-legalization-legislation/

http://www.gallup.com/poll/165539/first-time-americans-favor-legalizing-marijuana.aspx

http://www.latimes.com/local/lanow/la-me-ln-medical-marijuana-gay-marriage-abcarian-20131023,0,3509931.story#axzz2ikqHWXg1

http://medicalmarijuana.procon.org/view.resource.php?resourceID=000881

http://healthland.time.com/2013/05/28/more-kids-accidentally-ingesting-marijuana-following-new-drug-policies/

http://www.whitehouse.gov/sites/default/files/ondcp/Fact_Sheets/marijuana_legalization_fact_sheet_3-3-11.pdf

http://heinonline.org/HOL/Page?handle=hein.journals/cjtl10&div=26&g_sent=1&collection=journals#419

http://books.google.com/books?hl=en&lr=&id=xlmD7orlKlsC&oi=fnd&pg=PA1&dq=legalization+of+marijuana&ots=qbZM347Jgz&sig=U3hOziDdYPVJb0dvyMVqed3SLAg#v=onepage&q=legalization%20of%20marijuana&f=false




Marijuana Anonymous - 12-step program modeled after Alcoholics Anonymous
More Resources
http://www.drugabuse.gov/publications/marijuana-abuse/available-treatments-marijuana-use-disorders

http://www.latimes.com/nation/nationnow/la-na-nn-ff-arizona-parents-sue-marijuana-20131029,0,5558878.story#axzz2jeGhNIvU

http://www.chrisconrad.com/expert.witness/Prop215.html

http://clerk.lacity.org/stellent/groups/Departments/@CLERK_Elections_Contributor/documents/Contributor_Web_Content/LACITYP_024794.pdf

http://medicalmarijuana.procon.org/view.answers.php?questionID=000628

http://losangeles.cbslocal.com/2013/05/20/california-state-senate-restricts-medical-marijuana-dispensaries/

http://www.nytimes.com/2013/10/27/us/few-problems-with-cannabis-for-california.html?_r=0\

https://www.marijuana-anonymous.org/literature/pamphlets/stories-by-teens

http://www.smartvoter.org/2013/05/21/ca/la/prop/D/

https://www.aamc.org/students/applying/amcas/

http://articles.latimes.com/2013/oct/12/local/la-me-closing-pot-shops-20131012

http://www.projectknow.com/research/marijuana-anonymous/

http://www.drugs.com/pro/marinol.html

http://www.mbc.ca.gov/medical_marijuana_cma-recommend.pdf

http://mymedicalmarijuanacard.files.wordpress.com/2011/12/medical-marijuana-card.jpg

http://medicalmarijuana.procon.org/view.answers.php?questionID=000628

http://dailybruin.com/2009/10/04/cannabis-centers-growing-problem/

https://www.marijuana-anonymous.org/meetings/what-happens-at-ma-meetings

http://medicalmarijuana.procon.org/view.answers.php?questionID=001654

http://abclocal.go.com/kabc/story?id=9111862

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2148500/


Tetrahydrocannabinol (THC)
-produces hallucinatory effects
-drug Marinol
-anorexia (loss of appetite) associated with weight loss in patients with AIDS and chemotherapy patients with severe nausea


Cannabidiol (CBD)
- anti-psychotic
-epilepsy, multiple sclerosis spasms, anxiety disorders, bipolar disorder, schizophrenia, nausea, convulsion, inflammation, cancer cell growth.
Still federally illegal under the CSA
Effects on Students

Daily marijuana use correlated with:
- lower grades
- being less likely to graduate
- poorer educational outcome

Leading to problems further down the line:
- lower income
- greater welfare dependence
- lower relationship and life satisfaction
-All three types of treatments are proven to work, but MET and CBT works better than MET alone, and MET, CBT and CM all together seem to work best of all.

-Overall success rates modest.
-Only 50% of enrollees achieve an initial 2-week period of abstinence
-Across studies, 1-year abstinence rates have ranged between 10 and 30%.

-Chronic care model should be used!

1. Origins of use: Hemp vs. Cannabis vs. Marijuana

2. Beginning of Restrictions and Prohibition:

3. State Widespread Regulation

4. State Allowances

5. Federal Opinion: Classification as Schedule 1 Drug

Medical Marijuana Clinics
Clinics with salaried physicians who specialize in providing medical cannabis recommendations
1970's onwards: Changing Opinions
1976 The U.S. federal government created the Investigational New Drug (IND) Compassionate Use research program to allow patients to receive up to nine pounds of cannabis from the government each year.
Robert Randall: Federal Court rules use of Marijuana as "Medical Necessity"

1986 President Reagan signed the Anti-Drug Abuse Act, reinstating mandatory minimums and raising federal penalties for possession and distribution and officially begins the U.S. international "war on drugs."

1990: Scientists Discover Cannabinoid Receptors

1991: In a survey of 599 respondents from the members of the American Society of Clinical Oncology (ASCO),
53% of Oncologists say cannabis should be available by prescription.
Full transcript