Marijuana: What We Should All Know Elinore F. McCance-Katz, MD, PhD - PowerPoint PPT Presentation

Marijuana: What We Should All Know Elinore F. McCance-Katz, MD, PhD Assistant Secretary for Mental Health and Substance Use Substance Abuse and Mental Health Services Administration U.S. Department of Health and Human Services Smart Approaches to Marijuana April 25, 2019 1

The Issue Marijuana is rapidly becoming more widely available in the U.S.: 33 states: allow medical marijuana use; 10 states plus DC have legalized recreational use Huge and profitable industry that markets heavily with health claims that have little to no basis and which have had virtually no counter arguments put forward until the present time Numerous forms: smoked, edibles, oil for vaping, lotions, transdermal patches 2

Marijuana: The Issue • Increase in THC content over time led to higher potency intoxicant: • THC content: 4% (1990s) increased to 12% (2014) • Current average MJ extract has THC levels at > 50% • THC: component responsible for euphoria/intoxication • Can also produce anxiety, agitation, paranoia, and psychosis • Addiction liability: 10-20% of users will develop use disorder (Volkow et al. 2016) • Declining CBD content in currently available MJ • Not thought to be addictive; May reduce psychosis • Medical value: FDA approved for certain seizure disorders • CBD content in marijuana dropped by approx. 50% from 1990s to 2014 • THC content increased • THC/CBD ratio 1995: 14; 2014: 80 (Ehsoly MA et al. 2016) 3

Risks and Adverse Outcomes • Downplayed by industry; ignored by states • Low birth weight • Pulmonary symptoms • MVAs • Cognitive impairment • Poor performance in school and at work • Addiction • Risk of adverse outcomes to our children and young adults 4

What Happens as State Laws Liberalize? Past Year Marijuana Use among Persons Aged 12 or Older Residing in States with No Legalization of Marijuana Range: 9-13% State Effective Date 2012-13 2012-13 2013-14 2013-14 2014-15 2014-15 2015-16 2015-16 Percentages Numbers Percentages Numbers Percentages Numbers Percentages Numbers N/A 389 404 389 386 Alabama 9.69% 9.98% 9.60% 9.50% N/A 925 963 1,052 1,048 Georgia 11.44% 11.75% 12.67% 12.46% Percentages and N/A 127 152 152 158 Idaho 9.82% 11.58% 11.40% 11.62% Estimated Numbers N/A 598 700 760 733 Indiana 11.05% 12.86% 13.88% 13.35% N/A 266 251 235 254 (in Thousands), Iowa 10.40% 9.74% 9.05% 9.75% N/A 192 259 292 265 Kansas 8.21% 11.01% 12.38% 11.17% Annual Averages N/A 334 398 449 470 Kentucky 9.22% 10.93% 12.28% 12.79% Based on 2012-2013, N/A 405 425 427 429 Louisiana 10.76% 11.23% 11.22% 11.22% N/A 213 229 212 231 Mississippi 8.78% 9.40% 8.67% 9.46% 2013-2014, N/A 581 639 683 668 Missouri 11.64% 12.73% 13.53% 13.19% 2014-2015, and N/A 152 158 166 176 Nebraska 9.98% 10.35% 10.75% 11.33% N/A 877 986 975 996 2015-2016 NSDUHs North Carolina 10.88% 12.07% 11.79% 11.90% N/A 58 62 61 61 North Dakota 9.92% 10.25% 9.90% 9.80% N/A 310 338 358 357 Oklahoma 9.97% 10.75% 11.28% 11.18% N/A 460 460 507 448 South Carolina 11.72% 11.55% 12.56% 10.92% N/A 66 62 75 83 South Dakota 9.64% 8.97% 10.77% 11.85% N/A 535 560 606 709 Tennessee 9.93% 10.29% 11.05% 12.82% N/A 1,972 2,043 2,213 2,264 Texas 9.38% 9.52% 10.10% 10.14% N/A 196 224 211 229 Utah 8.76% 9.84% 9.07% 9.62% N/A 839 891 796 768 Virginia 12.39% 13.04% 11.54% 11.06% N/A 159 172 174 179 West Virginia 10.12% 10.93% 11.07% 11.45% N/A 534 572 584 592 Wisconsin 11.12% 11.86% 12.05% 12.18% N/A 48 51 52 51 5 Wyoming 10.11% 10.72% 10.87% 10.62%

What Happens as State Laws Liberalize? Past Year Marijuana Use among Persons Aged 12 or Older Residing in States with Legal Medical Marijuana Use Only Range: 11-21.8% State Effective Date 2012-13 2012-13 2013-14 2013-14 2014-15 2014-15 2015-16 2015-16 Percentages Numbers Percentages Numbers Percentages Numbers Percentages Numbers Nov 2, 2010 699 752 734 696 Percentages and Arizona 12.94% 13.69% 13.12% 12.22% Nov 9, 2016 235 277 284 274 Estimated Numbers Arkansas 9.69% 11.37% 11.59% 11.14% Oct 1, 2012 425 427 479 461 Connecticut 14.00% 14.00% 15.67% 15.08% (in Thousands), Jul 1, 2011 108 109 103 105 Delaware 13.97% 13.98% 13.06% 13.18% Annual Averages Jan 3, 2017 1,885 1,990 2,152 2,275 Florida 11.43% 11.87% 12.59% 13.07% Based on 2012-2013, Dec 28, 2000 151 144 147 151 Hawaii 13.37% 12.58% 12.72% 13.05% 2013-2014, Jan 1, 2014 1,247 1,305 1,339 1,320 Illinois 11.66% 12.16% 12.47% 12.31% Jun 1, 2014 565 670 757 779 2014-2015, and Maryland 11.47% 13.48% 15.13% 15.50% Dec 4, 2008 1,268 1,304 1,266 1,317 2015-2016 NSDUHs Michigan 15.22% 15.60% 15.10% 15.68% May 30, 2014 536 553 579 592 Minnesota 11.93% 12.22% 12.69% 12.91% Nov 2, 2004 134 120 133 160 Montana 15.78% 14.07% 15.38% 18.41% Jul 23, 2013 175 194 199 202 New Hampshire 15.39% 16.95% 17.35% 17.58% Jul 1, 2010 759 844 894 907 New Jersey 10.18% 11.25% 11.86% 12.01% Jul 1, 2007 257 267 253 272 New Mexico 15.09% 15.61% 14.72% 15.83% Jul 5, 2014 2,342 2,372 2,519 2,491 New York 14.13% 14.24% 15.04% 14.86% Sep 8, 2016 1,237 1,122 1,179 1,344 Ohio 12.81% 11.57% 12.13% 13.81% May 17, 2016 1,223 1,265 1,339 1,415 Pennsylvania 11.33% 11.70% 12.35% 13.05% Jan 3, 2006 181 170 170 184 Rhode Island 20.22% 18.95% 18.81% 20.31% Jul 1, 2004 104 108 111 118 6 Vermont 19.10% 19.97% 20.50% 21.79%

What Happens as State Laws Liberalize? Past Year Marijuana Use among Persons Aged 12 or Older Residing in States with Legal Medical and Recreational Marijuana Use Range: 13-25% State Effective Date 2012-13 2012-13 2013-14 2013-14 2014-15 2014-15 2015-16 2015-16 Percentages Numbers Percentages Numbers Percentages Numbers Percentages Numbers Percentages and Estimated Numbers Alaska Feb 24, 2015 19.69% 114 19.60% 114 21.92% 127 23.00% 134 (in Thousands), Nov 9, 2016 Annual Averages California (revised penalties) 13.89% 4,384 14.49% 4,633 15.25% 4,936 16.23% 5,296 Based on 2012-2013, 2013-2014, Dec 10, 2012 (revised penalties); 2014-2015, and Jan 1, 2014 Colorado (commercial sales) 18.92% 814 20.74% 909 23.09% 1,033 23.12% 1,057 2015-2016 NSDUHs District of Columbia Feb 26, 2015 21.02% 116 21.70% 121 23.51% 134 24.68% 143 Jan 30, 2017 Maine (grow and possess) 16.24% 186 19.55% 224 19.69% 227 19.81% 228 Massachusetts Dec 15, 2016 15.57% 885 17.23% 989 18.26% 1,058 18.64% 1,088 Nevada Jan 1, 2017 14.10% 324 13.01% 304 12.95% 309 13.13% 319 Oregon Mar 29, 2016 19.03% 630 19.39% 649 19.42% 659 22.70% 783 Washington Dec 6, 2012 17.48% 1,008 18.92% 1,105 17.49% 1,037 18.93% 1,140 7

Illicit Drug Use Impacts Millions: Marijuana Most Widely Used Drug PAST YEAR, 2017, 12+ 15.0% Marijuana 40.9 MILLION 6.6% Psychotherapeutic Drugs Prescription opioids, sedatives, tranquilizers, stimulants 18.1 MILLION 2.2% Cocaine 5.9 MILLION 20.1 Hallucinogens 1.9% MILLION 5.1 MILLION People aged 12 or Inhalants 0.6% older had a substance use 1.8 MILLION disorder Methamphetamines 0.6% 1.6 MILLION Heroin 0.3% 886,000 8% 10% 12% 14% 16% 0% 2% 6% 4% 8

How did we get to where we are and what does the data tell us about ongoing risks? 9

Adolescent Perceptions of Great Risk of Harm From Substance Use PAST YEAR, 2015 - 2017, 12-17 + Difference between this estimate and the 2017 See table 3.1 in the 2016 and 2017 NSDUH detailed tables for additional information. estimate is statistically significant at the .05 level. 10

Young Adult Perceptions of Great Risk of Harm From Substance Use PAST YEAR, 2015 - 2017, 18-25 + Difference between this estimate and the 2017 See table 3.1 in the 2016 and 2017 NSDUH detailed tables for additional information. estimate is statistically significant at the .05 level. 11

Past Year Initiates, Age Group & Substance PAST YEAR, 2017, 12+ * Initiation of misuse 12

Marijuana Use Is Increasing in the U.S. 35 • Since 2007, past year marijuana use has 2002 increased 37% 30 2003 • In 2016, 1 in 7 2004 Americans ≥ 12 years 2005 25 2006 used marijuana in the 2007 past year Percent 20 2008 • Frequent marijuana use 2009 (using ≥ 200 days in the 2010 15 past year) increased 2011 37% since 2002 2012 2013 • Nearly 1 in 3 people 10 2014 using marijuana in 2016 2015 reported using ≥ 200 5 2016 days in the past year 0 Past Year Marijuana Use Use of Marijuana 200 Days or More in Past Year Among Those Reporting Past Year Marijauna Use 13 Source: Jones CM Analysis of the NSDUH 2002-2016 Public Use Files

Marijuana Use by Age Group PAST MONTH, 2015 - 2017, 12+ Significant Increases in Use + Difference between this estimate and the 2017 See figure 13 in the 2017 NSDUH Report for additional information. estimate is statistically significant at the .05 level . 14

Marijuana Use among Young Adults PAST MONTH, 2015 - 2017, 18 - 25 + Difference between this estimate and the 2017 estimate is statistically significant at the .05 level. + Difference between this estimate and the 2017 Special analysis of the 2017 NSDUH Report. estimate is statistically significant at the .05 level. 15