MARIJUANA: CLEARING THE SMOKE

May 15, 2013 Christian Thurstone, M.D. Associate Professor University of Colorado

PAST MONTH PREVALENCE OF USE - NC

National Survey on Drug Use and Health

GREAT RISK WITH USING MJ ONCE PER MONTH - NC

National Survey on Drug Use and Health

The Developing Brain

MARIJUANA USE IN PREGNANCY

13-16 year olds exposed to 6 joints per day (n=25) have poorer processing speed, visual analysis and attention than those exposed to 0-6 joints per day in utero (n=120) (Fried et al., 1992; Fried et al., 1998; Fried et al., 2003)

Among 16-21 year olds, those exposed to marijuana (n=49) were 3 times more likely to use marijuana as a teen than those not exposed (103) even after controlling for other in utero substance exposure (Fried et al., 2005)

GATEWAY HYPOTHESIS

Adolescent MJ use increases the odds of other illicit substance use by 2-3 times by young adulthood

Agrawal et al., 2004; Fergusson et al., 2000; Fergusson et al., 2005; Grau et al., 2007; Kandel et al., 1986; Lessem et al., 2006; Lynskey et al., 2003; Mayet et al., 2011; van Ours et al., 2003; Yamaguchi and Kandel, 1984

Past month marijuana use by age - United States

Source: National Survey on Drug Use and Health

Age

DUNEDIN STUDY
N = 1,037
0 years 7-13 years WISC-R 18-38 years MJ Use WAIS-IV Attention/memory 38 years

Up to an 8 point drop in IQ from 13-38 years

Meier et al., 2012

ADOLESCENT EXPOSURE TO MJ: PSYCHOSIS

8 cohorts confirm adolescent exposure to MJ predicts psychosis (OR = 0.72 3.0) The risk is dose-dependent

Risk is not accounted for by intoxication effect, revere-causation or other confounds

Andreasson et al., 1987; Arsenault et al., 2002; Fergusson et al., 2003; Henquet et al., 2005; Tien et al., 1990; van Os et al., 2002; Wiles at al., 2006

DEVELOPING BRAIN IN ANIMALS

Domain
Motivation Social interaction

Outcome

anxiety

Memory
Attention Hippocampus

short-term recognition
filtering neurons synaptic density

Jager and Ramsey, 2008; Rubino et al., 2009

LESS SCHOOL ACHIEVEMENT

Teens using MJ for the first time after 18 years (or never) compared to those using by age 15 are: 3.6 times more likely to get a HS degree

2.3 times more likely to enroll in college

3.7 times more likely to get a college degree
Fergusson et al., 2010

MARIJUANA AND DRIVING

If THC > 1 ng/ml, 3.3 times more likely to be involved in fatal traffic accident If THC > 5 ng/ml, 4.72 to 6.6 times more likely to be involved in fatal traffic accident

Laumon et al., 2005; Mura et al., 2003; Drummer et al., 2003

MJ AND AGGRESSION
Low dose THC (0.1 mg/kg) aggression High dose THC (0.25-0.4 mg/kg) aggression Marijuana withdrawal aggression on days 3 and 7 but baseline by 28 days
Kouri et al., 1999; Salzman et al., 1976; Taylor et al., 1976

 Among adolescents in substance treatment, age onset MJ use predicts development of IDU within 8 years (decreased by 19% for every year MJ use is delayed)

MJ USE AND HIV RISK

Among adolescents on probation, frequency of MJ use predicts STD diagnosis at 12-month follow-up
Among adolescents on probation, number of cannabis dependence sxs predicts non-condom use in the past 6 months Among adolescents on probation, using marijuana before sex associated with less likelihood of using a condom
Hendershot et al., 2010; Thurstone et al., (in press)

HOW MJ LEGALIZATION HAS FAILED IN CO

BIG TOBACCO PLAYBOOK

Overstate +/-

Lobby/PR

Market to youth

Profits

Develop heavy users

Commercialization Hypothesis
1976-1983
Depenalization Little change in teen use

1984-1996
Rise in Coffee Shops Past month use among 18-20 year olds goes from 8.5% to 18.5%

1997-2005
# coffee shops decreases from 1179 to 729 Legal age for coffee shops goes from 16 to 18 years Past month use among 15-24 year olds goes from 14.3% to 11.4%

Source: MacCoun (2011), Addiction 106:1899-1910

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PAST MONTH MJ USE AMONG CO TEENS - YRBS

PAST MONTH MJ USE COLORADO, DENVER,

BOULDER -- YRBS

Location
Colorado

Past Month Use (%) 2011

22.0

Denver

29.0

Boulder

26.1

Past month prevalence of marijuana use - 12+ yrs

12.2 9.62

7.88
6.1 6.0 6.6

Source: National Survey on Drug Use and Health

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ADAMS COUNTY YOUTH INITIATIVE

MIDDLE SCHOOL PAST MONTH MJ USE 8.7%

8.3%

5.3%

6.0%

School year

NATIONAL SURVEY ON DRUG USE AND HEALTH

PAST MO MJ USE AMONG 12-17 YOS IN CO
10.72% 7.44%

Year

NATIONAL SURVEY ON DRUG USE AND HEALTH

GREAT RISK IN USING MJ 1X/MO
30 25

28.42 21.09

% 15
10 5 0 2000/2001 2010/2011

20

Year

ADAMS COUNTY YOUTH INITIATIVE 2013

IF YOU WANTED TO GET ALCOHOL/MJ, HOW EASY WOULD IT BE TO GET?

27.0% %

27.7%

63.0%

62.3%

MONITORING THE FUTURE, 2012

IF YOU WANTED TO GET ALCOHOL/MJ, HOW EASY WOULD IT BE TO GET? 8TH GRADERS

36.9% 63.1%

42.5%

57.5%

Number substance treatment admissions for marijuana Denver metro

8000 7000 6000 5303 4000 3000 2000 1000 0 2004 2005 2006 2007 2008 2009 2010 2011
26

Colorado

6800 6017

6866

6684

# 5000

5569

5670

6272

Denver

2703

2694

2903

2928

3297

3284

3223

2852

Source: Drug/Alcohol Coordinated Data System

Blood tests for DUID positive for THC - Colorado

Source: Colorado Department of Public Health and the Environment

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Use of regulated marijuana by Denver teens

26 % 18.2 %

74 %
Substance treatment

% 71.8 Primary care

Source: Salomonse-Sautel et al. (2012), JAACAP 51:694-702; Thurstone et al., under review
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Average urine drug screen results

Ng/ml

Source: Thurstone et al., in preparation

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TRAFFIC FATALITIES WITH A THC+ DRIVER

Drug-Related Suspensions/Expulsions - Colorado

Source: Colorado Department of Education

31

ED visits by substance - Denver Metro 2010

Heroin - 7.9% MDMA - 1.6% Other - 2.8%

Stimulants - 9.7%

Alcohol - 40%

Cocaine - 18%

Source: Drug Abuse Warning Network

Marijuana - 20%, n= 2031

32

Hospital Discharge Diagnoses - Denver Metro

Source: CDPHE, Colorado Hosp Assoc Discharge Data Program

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CONCLUSIONS
Evidence supports commercialization hypothesis

Significant increases in many indicators of use

Significant increases in social costs related to use Some social costs may be offset by decrease in number of arrests

QUESTIONS?

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