Side event: Lessons learned from marijuana legalization

Organised by Smart Approaches to Marijuana

Community Alliances for Drug Free Youth: This is supported by Kevin Sabet and Sam. You may not know it, but I’m not Kevin Sabet – and neither is she. Kevin asked if I’d do a small, seven minute presentation at his event. The morning I got on the plane he said he isn’t coming. So I’ve always wanted to be here presenting a Kevin Sabet presentation and then answer questions from the audience. My dream at the UN has been fulfilled today.

Kevin was gracious enough to send me a 17 minute video on his perspective, so we’re gonna play that for 17 minutes. Then, I’m gonna show the marijuana impact report. Then, Amy is going to talk about the marijuana legalisation for medical purposes in Canada and what’s happened there. Then we’ll take your questions.

Kevin Sabet: It’s a privilege even to be with you by the internet. If it wasn’t for a very special occasion I would definitely be there. I want to encourage all of you to talk about marijuana with your friends and neighbours. I also want you to validate everything that I say – don’t take my word for what I’m saying, you should realise that everything I talk about is fully vetted and peer reviewed.

I want to talk about the causes of concern. Many of you know that SAM has affiliates all over the country. With the help of many of you here today, we collaborate with multiple groups around the country. We feel like we’re marching forward in this country in the absence of evidence, public awareness and total understanding of the implications. Teen and young adult use is happening with many things in the background: the marijuana industry is combined with the tobacco industry and big pharma. This is about big business and big money. Coming along with big business is this major lobbying class of folks who get paid to spin and pass laws for the marijuana industry. We have not seen a decline in the prison population that was promised – one of the main justifications that was promised. I’m very concerned about all of the exemptions to thing like clean indoor air acts, and outdoor public smoking restrictions, that the anti-tobacco movement fought for for decades. These are being peeled back by industry. I’m very concerned – vaping should be the number one thing that everyone is talking about. Marijuana is using supply mechanisms related to juul and e-cigarette vaping.

I’m very concerned about how we are targeting minorities and low-income communities – the marijuana industry is doing this by clustering stores in poor areas with people of colour. The revenue is 1% of what was promised. It’s important that we don’t conflate three issues: decriminalisation; medicinal use; legalisation for non-medical use. Medical marijuana can just be a synonym for legalisation, but in many respects – because there are medical components of marijuana – we have to look at that separately. The marijuana industry wants to join all these issues together. I think we need to think about these issues separately. We also need to recognise that we’re not talking about joints any more – we’re talking about cookies, sodas, dabs, waxes – up to 99% THC – if you haven’t used marijuana in the past year, I don’t think you know what THC is. The problems are changing so fast.

The marijuana of today is different from a year ago to 10/20 years ago, which politicians base their views on. The potency has significantly increased – in legal states the potency is increasing even faster. One of my concerns here is that daily or near daily consumption is rising dramatically. There’s been a huge divergence since 1990, whereas with alcohol it’s stayed the same – never been more than 10 or 12%. That’s a massive difference, this gap here today. It shows us the problems with commercialisation. That’s about ten times as many daily users now versus 1992 (900,000 versus 9 million). Why does this matter? I really like the calculation that John Caulkins did, where he looked at THC consumed today versus 2000 – it’s about 65 times as much. This is the difference between the caffeine in one 20-ounce bottle of diet coke versus 33 grande Starbucks cappucinos. That is a huge difference in the amount of THC being consumed each day. Legalisation has really brought on massive daily use that is threatening the safety of everybody.

According to SAMHSA, marijuana is associated with opioid use, heavy alcohol use. Big big differences from 20 years ago. When we did research and looked at youth use in legal and non-legal states – 8.9% versus 9.1% in legal states and 6.75% to 6.46% in legal states. Living near a pot shop increases the change of marijuana use. Almost 80% of California stores have rejected marijuana municipalities. There are a lot of studies now mounting about harms in legal states. We’ve seen emergency room transmissions increasing 147.5%. Of course, the vaping issue – we’ve seen the biggest year-to-year increase of vaping than we have any other drug year to year. We never saw a doubling like we did now with other epidemics. The 12 month prevalence of having a cannabis use disorder is increasing in a way that it hasn’t before. Emergency room admissions: we’re seeing this top off now close to 300,000. Past month use in a legal state like Alaska going up.

We’re not seeing the revenues we were promised. One driving fatality alone costs $1.4 million per person. But we’re not seeing the budgets showing big portions coming from marijuana revenue. I think we’re reliving our history – we’re in 1919. Unlimited potency, unlimited advertising. All of the things that we’re seeing are showing major major increases. Big tobacco like Altria has made a big investment. The former CEO of Purdue is apparently now selling medical marijuana. Why should we care because the brain is rapidly in development up until age 30 – there are numerous changes now that we didn’t see 20 years ago. The biggest changes are a mental illness: psychosis risk of fivefold compared to non-users, we’re seeing schizophrenia, we’re seeing suicide and depression issues causally related to marijuana, we’re seeing a lot of this happen. We’re also seeing large uses in workplaces. We’re repeating history, and the reality is that science shows ‘a 23% increase’ in opioid deaths in medical marijuana states. The opioid crisis appears to be worsening where marijuana has been legalised (JAMA). We need to get this information out there. Part of the reason marijuana has become so harmful is because it’s more available: more promoted, more commercialised.

Mark Kleiman said: “The people now being hired by the guys in suits doing cannabis-business stock promotions play by different rules…”, “I think commercial sale…is going to end in tears”

We have to educate before it gets out of hand. We need more and more people speaking the truth so that fewer people are hurt and lives are saved.

Community Alliances for Drug Free Youth: We can look at this nationally, but also state-to-state and see what’s happening in individual states. They’re not all the same, because states are different. What’s important is, as we look at this, that we realise that we have to look at these issues as a group, and start to come together, rather than debate these extreme cases, and start to look about how this is going to work.

This is Dr Nora Volkow, Director of the National Institute on Drug Abuse. She said “The United States has a marijuana epidemic and it has a youth crisis”. For her that was the issue. As Kevin said, in these brain formative years, that is where children have sometimes irreversible brain damage. So when she said this, this is what changed my perspective and what my focus was all about. Can we change the levels of substance abuse? Absolutely, the question is – how? Are we gonna do it the right way? How are we gonna get this one right?

In 1978 there were focused, targeted campaigns on drug abuse, and use reduced by 50%. Now we’re back in the time of these peak numbers. One of the issues that we need to understand is that, in general, the potency of marijuana is increasing. The National Potency Project have been looking at the potency of marijuana since the 1970s. There has bee a steady increase from 4% to 14-15%. In the 1960s this was 1% THC. That’s changed. Now, when we talk about extracts, the extracts can be between 60 and 98%. We’ve had other concentrates before, but in terms of the concentrates that we’ve seen today, that can get really really high. With that increase obviously comes other challenges.

In terms of California history, prop 215 was one of the first states to decriminalise possession for medical purposes. Clinton actually challenged this and the Supreme Court said no. I don’t think what they meant was that doctors would start writing letters of recommendation, seemingly prescriptions, to give doses of cannabis and move it forward. This did go to the Supreme Court but in the way it was written they didn’t accept it. This is when a number of things started to happen in California. Then there was State Assembly Bill 420: can a senator put his own number on a bill in California? The answer is yes. This bill was looking at how the law was written. In California, before SB420 we had around 80,000 arrests a year due to simple possession. but what did this mean? Did this mean someone was put in a squad car and taken to jail. For the vast majority this didn’t happen. What happened was, it was a low-level class C special misdemeanour, meaning that if you smoked a joint for whatever reason, law enforcement could arrest you – he would say ‘do you wanna give up your fourth amendment rights, want to go to jail, or do you just want me to write you this ticket?’ If they said they wanted their full rights they would be arrested, but if they didn’t, they wouldn’t be handcuffed. The ticket wasn’t for an infraction though. They would take it back to the office, this would be looked at a clerk would attach it to a public defender and then they would take the DA and attach that DA to the case, the case was settled without anybody ever doing anything, and then they would issue the fine. But it went on your record as an arrest.

The thought was that people were getting arrested – they weren’t. What Governor Schwarzenegger said: they’re not getting arrested, so let’s just change it to an infraction. But in the beginning of 2010, there was a feeling that the administration was going to allow a relaxation of the rules of marijuana, so without any real conversation, they started to put pot shops in LA. They had a lot of them. In less than one year’s time, they had over 200 – quickly. And without any rules or regulations, and it was the wild west. That got a big pushback and it was: how are we going to deal with this. Around that time there was a vote on the people to legalise marijuana? The proposition failed in 2010. Then we had full legalisation Prop 24 in 2016.

What’s happened? Perception of marijuana among 12th graders is declining. In states that are illegal there’s less use, a little more in medical states, but in states with full legalisation – these have the most. But before we just make this broad generalisation, I think to really look at this every time you have to look at the particular laws in each state, and how are they applied. That study has never been done, that is a massive, costly study, each and every category on what happens in each state. But generally, the more legal it is, the more use there is. Expulsions are declining. This is a good thing: youth marijuana use is increasing, but expulsions are decreasing. I don’t think anybody in this room would think it’s a good thing for kids to be expelled, even for marijuana use. Having said that, the reason for this lower one is that they want to keep them in school. I don’t think that the support services for issues have been dealt with in California. In college use, it’s going up, California marijuana use rate is increasing. There was a strong campaign to reduce car crash fatalities, almost to nothing – this [2010] is where the explosion of marijuana shops comes in, and crashes went back up, even with that campaign. Emergency department visits going drastically up, marijuana-related exposure calls – this is one of the most shocking and horrible.

Those are some general numbers that are happening in California. I think there’s challenges for us all to deal with.

(Florida): What we did, is we looked at all data coming out of states with similar laws to Florida. When interpreting this, we decided what kind of restrictions/guidelines we can put in place to prevent against the same negative impacts. 2014, we passed a low THC law. 2016, medical marijuana ballot measure passed. 2017, implementation of medical marijuana law. So we looked at every other state that had these laws on the books in the US and asked them what they would do differently. Then we tried to guide our law members to prevent against the same things.

With our physicians, we saw in a lot of states there were these criminal physicians – it was not a medical practice. I am not here to debate whether marijuana is a medicine; our state decided it was. We wanted our physicians to have no direct or indirect interest in dispensaries or testing labs. We wanted to avoid pill mills. We also said that only low-THC can be recommended for pregnant patients, that there should be an examination while physically in the same room, and other measures. They have to obtain a consent form – letting the patient know it’s not FDA-approved – they can only recommend a 70 day supply, every 30 weeks. They have to include the amount that you’re allowed to use, and have to record it in a registry in seven days.

We put some restrictions on the way in which our physicians could market in the state. But this is the reality of the implementation in our state. As globally we face an opioid crisis, if you go to music festivals, have you ever seen a pain management doctor giving out free samples and checking patient eligibility while they’re drinking beers at a music festival. If we’ve determined that it’s a medicine, we want to make sure our patients are treated as patients. One of the main issues with advertisement is that there aren’t other doctors who you will go to who will only answer with marijuana – even a pain management doctor might prescribe something else – but if you go to these kind of physicians, no matter what your ailment is, you only have one modality of care. We implemented restrictions on dispensaries – a big difference. Treating it like a medicine, if that’s what we’ve determined it to be. We’ve also put a cap on dispensaries based on our state population and the number of people enrolled in the medical marijuana programme. We’re trying not to have a free-for-all and meeting the needs of patients.

We put laws in place to regulate what our products look like. For us, we’re trying to make sure that we’re reducing access to kids, because our main concern was increased access, and sometimes using and ending up in the hospital. We implemented controls over advertising and marketing. But this is what they’re doing on social media, even though it’s against the law – advertising using Star Wars themes and muppets. So for us, some areas we want to do, is enforcing the laws – and removing some of the automatic expansions in place.

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