9.1 Marijuana 101 GC

1. MARIJUANA 101
Kendra McLaughlin, MPH
Presentation for Garrett College Student and
Professional Staff
September 1, 2016

2. MARIJUANA
101
Presentation Outline
• Marijuana Defined
• Federal Law
• Maryland Law
• What Do We Need to Know?
• Lessons Learned from
Legalization
• Take Home Messages

3. What is marijuana?
• Marijuana is the most commonly abused illegal drug.
• It is a dry, shredded green, brown or gray mix of flowers,
stems, seeds and leaves from the hemp plant, Cannabis
sativa.
• The main active chemical in marijuana is delta-9-
tetrahydrocannabinor, or THC for short. This is the mind-
altering, psychoactive chemical in marijuana.
• Also referred to as pot, weed, Mary Jane, grass

4. What is marijuana?
• Marijuana is usually smoked
• As a cigarette or “joint”
• In a pipe or water pipe (bong)
• In “blunts,” which are cigars that are hollowed out and refilled with a
mixture of marijuana and tobacco
• Marijuana can also be mixed in food (edibles)
• As an extract, marijuana is also available in various other
forms
Photos from:
http://kutv.com/news/local/study-teen-pot-use-increasing-in-colorado-after-legalization
https://sites.psu.edu/siowfa15/2015/09/17/does-smoking-marijuana-kill-braincells/

5. FEDERAL LAW

6. Federal Law
• Food and Drug Administration (FDA) and
Drug Enforcement Agency (DEA) reviews,
analyzes and assesses data from National
Institute on Drug Abuse then makes
determination
• As of August 11, 2016, DEA maintained
marijuana as a schedule I controlled
substance

7. Federal Law – Schedule 1 Controlled
Substance
• Does not meet criteria for accepted medical
use in treatment in the U.S.
• Lack of accepted safety for use under
medical supervision
• High potential for abuse
• To be considered a schedule I controlled
substance, must be a specific, branded
product with a defined dose.

8. Myth: Marijuana that is smoked or eaten
is medicine
Science
• Marijuana has medical properties, BUT WE DON’T NEED
TO SMOKE OR EAT IT.
• There are marijuana-based pills available that are being
or have been scientifically developed and researched –
Marinol and Sativex
• Many medical societies have reserved support of medical
marijuana pending legitimate approval processes for its
medicinal use – American Society of Addiction Medicine,
American Cancer Society, American Glaucoma
Foundation, National MS Society, American Academy of
Pediatrics

9. Myth: Marijuana that is smoked or eaten
is medicine
1. Administering any medication via drawing hot
smoke into the lungs is inherently unhealthy.
2. While vaporizers, sprays and tinctures solve the
problems associated with smoking, treatment of
an illness without standardized dose or content
of the medication remains a safety issue.

10. Myth: Marijuana is non-addictive
Science
• 1 in 10 adults who try marijuana will become addicted to it
• 1 in 6 teens who try marijuana will become addicted to it
Hall W, Degenhardt L. Adverse health effects of non-medical cannabis use. Lancet. 2009;374:1383-1391. Photo from
http://www.bbc.com/news/world-asia-china-30188527

11. MARYLAND’S LAW

12. Medical Marijuana Law in Maryland
• MD became 21st state to legalize medical marijuana when
its first law passed in 2013.
• MD Medical Cannabis Regulations were adopted in
September 2015
• Maryland’s law is regulated by the MD Medical Cannabis
Commission.
• Regulations allow for 15 licensed growers in MD, no limit
on processors, and propose ≤ 2 per Senatorial district,
plus one per grower (potential of 109).
• Types of marijuana included in law are the dried form and
cannabis-infused products

13. Cannabis Concentrates and Cannabis-
Infused Products
Photos from:
http://forhighschoolcounselors.blogspot.com/2015/01/national-drug-fact-awareness-week.html
https://www.pinterest.com/pin/325174035572891485/
https://www.pinterest.com/heatherpadgett7/cannabis/
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14. Medical Marijuana Law in Maryland
• Qualifying patient can possess up to 4 ounces of dried
flower at one time or 36 grams of THC as an extract.
• MD patient can only get medical cannabis from MD
licensed dispensaries.
• MD dispensaries can only get their cannabis from MD
licensed growers and processors.
• MD dispensaries will not, at this time, recognize other
state medical cannabis ID cards.
• Every batch of marijuana is to be inspected by
independent lab.

15. Medical Marijuana Law in Maryland
• 269 grower or processor applications were submitted in
November 2015
• 15 growers and 15 processors granted license pre-
approvals in August 2016
• Pre-approvals span 16 counties and Baltimore City,
including a grower license in Garrett County.
• 811 dispensary applications were submitted; approvals
should be granted in January 2017
• Medical cannabis could become available to patients in
the summer of 2017.

16. Medical Marijuana Law in Maryland
• Dispensaries can sell devices to administer marijuana
• Dispensaries can provide delivery services to patients
• Database will link physician and patient so that each
patient can have only one physician at a time
• Certain conditions are to be present in order for physician
to certify patient for marijuana – end of life care, wasting
syndrome, severe/chronic pain, severe nausea, seizures,
glaucoma, PTSD

17. WHAT DO WE NEED TO
KNOW ?

18. Myth: Marijuana is harmless
Science
• Marijuana negatively affects the parts of the brain that are
responsible for motivation, memory and learning.
• The adolescent brain is especially susceptible to
marijuana use.
• Persistent and heavy use among
adolescents reduces IQ by 6-8 points.
Meier MH, Caspi A, Ambler A, et al. Persistent cannabis users show neuropsychological decline from childhood to midlife. Proc Natl
Acad Sci USA. 2012; 109:E2657-2664.

19. Myth: Marijuana is harmless
Science
• Between 1999 and 2010, the prevalence of drugs other
than alcohol in fatally injured drivers increased from
16.6% to 28.3%.
• The greatest increase was for marijuana which tripled,
from 4.2% in 1999 to 12.2% in 2010.1
Brady JE and Li Gl. Trends in Alcohol and Other Drugs Detected in Fatally Injured Drivers in the U.S., 1999-2010 American Journal of
Epidemiology Advance Access, 1/29/14.
Ronen A, Gershon P, Drobiner H, et al. Effects of THC on driving performance, physiological state and subjective feelings relative to alcohol.
Accid Anal Prev. 2008; 40(3):926-934.

20. Myth: Marijuana is harmless
Science
• Marijuana intoxication doubles your risk of a car crash.1
• THC is associated with poorer driving performance, and
slower response times.2
1M.Asbridge, JA Hayden, JL Cartwright. Acute Cannabis Consumprion and motor vehicle collision risk: systematic
review of observational studies and meta-analysis. BMJ, 2012; 344(Feb 09)
2Hall W, Degenhardt L. Adverse health effects of non-medical cannabis use. Lancet. 2009;374:1383-139

21. In the past 15 years, marijuana potency has tripled and since 1960 it has grown
5 times stronger.
0
2
4
6
8
10
12
Average THC and CBD Levels in the US
THC CBD
CBD:
NON-
Psychoactive
Ingredient
THC:
Psychoactive
Ingredient
Mehmedic et al., 2010

22. LESSONS LEARNED
FROM LEGALIZATION

23. Lessons Learned
• In most states that permit the use of medical marijuana,
less that 2-3% of users report having cancer, HIV/AIDS,
glaucoma, multiple sclerosis, or any other life-threatening
diseases.1
• Majority of medical marijuana users
report using marijuana to treat “chronic
or severe pain.”
• 96% in Colorado
• 91% in Oregon
• 93% in Montana
Colorado Department of Public Health and Environment, 2011; Oregon Public Health Authority, 2011;Montana
Department of Public Health and Human Services, 2011.
Image from:
https://www.pinterest.com/rangerbandy/the-future/

24. Alcohol and Tobacco as Examples
• With legalization, drugs become driven
by industry.
• Industry promotes use and targets kids.
• With legalization comes higher use. Use
levels for alcohol and tobacco are much higher
than marijuana (7x and 2x respectively)
Photos from:
http://www.forbes.com/sites/jacobsullum/2015/11/04/2-reasons-ohio-voters-overwhelmingly-rejected-marijuana-legalization/#310f46f448c6

25. Past 30 day use for people 12 and older
52%
27%
7%
Current (past month) use among persons 12 and older; NSDUH, 2013. Photos from: the AIGA
symbol signs collection which was produced through a collaboration between AIGA and
the U.S. Department of Transportation (DOT) in 1974 and 1979

26. • For every $1 gained from alcohol and tobacco tax
revenues, $10 is lost in legal, health, social and regulatory
costs.
$$$$$$$$$$$
Urban Institute and Brookings Institute, 2012; Tax Policy Center 2008
Alcohol and Tobacco as Examples

27. $14
billion
$25
billion
$185
billion
$200
billion
Alcohol
Costs
Tobacco
Costs
Revenues Revenues
Source: State estimates found at http://www.nytimes.com/2008/08/31/weekinreview/31saul.html?em; Federal estimates
found at https://www.policyarchive.org/bitstream/handle/10207/3314/RS20343_20020110.pdf; Also see
http://www.tobaccofreekids.org/research/factsheets/pdf/0072.pdf; Campaign for Tobacco Free Kids, see “Smoking-
caused costs,” on p.2.
Alcohol and Tobacco as Examples

28. Industry Tactics
1. Pass “medical” marijuana initiatives
• “We are trying to get marijuana reclassified medically…we’ll be
using the issue as a red herring to give marijuana a good name.”
Keith Stroup from Natl. Org. for the Reform of Marijuana Law, 2001
• By using “marijuana as medicine,” a permission structure is built
about the safety and acceptability of marijuana use with the general
public.
2. Full legalization of marijuana – Colorado, Washington,
Oregon, Alaska, Washington, D.C.

29. What’s Happening in Colorado?
A Colorado Timeline
• 2000 – 1st conservative medical marijuana bill passed
• 2007-2008 – early medical marijuana era – 1000-4800
cardholders and 0 known dispensaries
• 2009-2013 – medical marijuana commercialization and
expansion era – 108,000 cardholders and 532 licensed
dispensaries
• 2014 – full legalization of marijuana; recreational and
medical
The Legalization of Marijuana in Colorado. Rocky Mountain High Intensity Drug Trafficking Area; Volume 3; September 2015.

30. What’s Happening in Colorado
• More medical marijuana centers than Starbucks and
McDonalds.
• Medical Marijuana Centers = 497
• Recreational Marijuana Stores = 369
• Starbucks Coffee = 405
• McDonald’s = 227
• In Denver, there are 198 medical marijuana centers
and 117 pharmacies.

31. What’s Happening in Colorado?
• There was a 40% increase in drug-related
suspensions and expulsions in Colorado schools
from 2008-09 to 2013-14. (3,736 to 5,259)
• Drug Testing Index showed that in 2013, positive
drug test results in the workforce for marijuana
increased nationwide by 6.2%, but in Colorado by
20%.
• Hospitalizations related to marijuana increased from
4,438 in 2008 to 11,438 in 2014.
The Legalization of Marijuana in Colorado. Rocky Mountain High Intensity Drug Trafficking Area; Volume 3; September 2015.

32. Average Past Month Use of Marijuana,
CO vs U.S., Ages 12-17 Years
6.7
9.9
7.15
8.29
10.32
11.16
0
2
4
6
8
10
12
2006-2008 2009-2012 2013
AveragePercent
U.S.
CO
Pre-Commercialization Post Commercialization Legalization
National Survey on Drug Use and Health

33. Adult Marijuana Use
College Age Adults
(ages 18-25 years)
Current Marijuana Use
2013
National average =
18.9%
Colorado average =
29%
Adults (ages 26+ years)
Current Marijuana Use
2013
National average = 5.5%
Colorado average =
10.1%
National Survey on Drug Use and Health, 2006-2013

34. Past Month Usage by 12-17 Year Olds in
Medical Marijuana States, 2013
0
2
4
6
8
10
12
14
AL
KY
KS
LA
MS
SD
OK
ND
WV
UT
NJ
ID
AR
TX
WY
IN
TN
VA
NE
IA
IL
NC
MN
PA
MO
SC
GA
WI
OH
MD
FL
CA
NY
AZ
NV
CT
MT
AK
MA
MI
DE
NM
ME
HI
OR
NH
WA
CO
VT
RI
Average %
Legalized Recreational/Medical Marijuana States (as of 2013)
Legalized Medical Marijuana State (as of 2013)
Non-Legalized Medical Marijuana State (as of 2013)

35. TAKE HOME MESSAGES

36. Take Home Messages
• Science has proven that marijuana is both addictive and
harmful to the human brain, especially when used as an
adolescent. Your brain knows that it wants more of the feeling
that marijuana offers.
• Marijuana may not cause overdose, but neither does tobacco.
In either case, you cannot deny the harmful effects of the
drug’s use.
• Marijuana contains medical properties, but we don’t have to
smoke it to get the benefits.
• Today’s marijuana is much more potent than the marijuana of
the 1960’s because of the increase in the THC content.
• Marijuana and driving do not mix. Marijuana effects your
reaction time and your judgment.

37. Things to Think About
Marijuana is a cash-only business because of the fact that
it is a schedule I control substance.
• Health insurers not required to cover marijuana; private
insurers may cover if they choose
• Veterans should make sure that using marijuana will not
disqualify them from benefits
• Most banks won’t take marijuana money because they
have to comply with federal regulations.
• Maryland’s law does not prevent an employer from testing
for marijuana use and taking action against an employee
for a positive test.
• Subsidized housing authorities do not have to allow the
use of medical marijuana because of federal regulations

38. Things to Think About
• Medical marijuana legalization is the first
step of marijuana industry tactics.
• Step 2 is the commercialization of
marijuana.
• Step 3 is full legalization of marijuana,
including medical and recreational use.

39. CONTACT INFORMATION
Kendra McLaughlin
Kendra.mclaughlin@maryland.gov
301-334-7730