Sheila Polk, Yavapai County AttorneyMerilee Fowler, Executive Director

MATFORCE, Yavapai County Substance Abuse Coalition

Notice of Copyright Usage

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Presentation Overview

• To examine the changing attitudes and other changes with Marijuana in thelast 20 years.

• To look at youth marijuana use trends and what youth are telling us inArizona.

• To review the science on the harms of marijuana.

• To answer questions from the audience.

Changing Attitudes toward Marijuana

How has marijuana changed from 1990 to 2015?

What is:

A Grassroots Movement

A movement with a focus on the facts and the facts only

The prevention community united with one message

Over 25 organizations working together

A vehicle to share the message of what current trends in marijuana will mean to our kids future and the future of our country

Components of the Movement

Website and Social Media

MarijuanaHarmlessThinkAgain.org

What do youth tell us?

Insights on youth marijuana use in Arizona

2014 Arizona Youth Survey

Arizona Criminal Justice Commission

1. Consumption

2. Consequences

3. Contextual Factors

CONSUMPTION

Identifying the severity of the problem and who is most affected

Percentage of Arizona Youth Reporting Past 30 Day Substance Use (2014)

24.1

13.69.4

6.6 6.33.4 2.0 1.4 1.2 1.0 0.8 0.6 0.3 0.3

0

10

20

30

40

50

60

70

80

90

100 A

lco

ho

l

Mar

ijuan

a

Cig

are

tte

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Ch

ewin

g To

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co

Pre

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on

Dru

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OTC

Inh

alan

ts

Hal

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s

Ecst

asy

Co

cain

e

Syn

thet

ics

Ste

roid

s

Her

oin

Met

h

Pe

rcen

t (%

) R

ep

ort

ing

Use

Percentage of Arizona Youth Reporting Past 30 Day Use of the Most Common Substance Types

0

5

10

15

20

25

30

35

40

2006 2008 2010 2012 2014

Per

cen

t (%

) R

epo

rtin

g U

se

Alcohol Marijuana Cigarettes Rx Drugs

Cumulative Percent Change in Arizona Youth Substance Use Rates (2006-2014)

-33.61

3.82

-38.56-41.12

-45

-40

-35

-30

-25

-20

-15

-10

-5

0

5

10

Alcohol Marijuana Cigarettes *Rx Drugs

Pe

rce

nt

(%)

Ch

ange

*Rx Drug Cumulative Change is from 2008-2012

Percentage of Arizona Youth Reporting Past 30 Day Marijuana Use (2014)By County

19.3 18.3 16.7 16.6 15.5 15.3 15.3 14.4 13.3 12.9 12.7 11.2 9.4 8.6 5.20

10

20

30

40

50

60

70

80

90

100

Pe

rce

nt

(%)

Re

po

rtin

g U

se

State Average = 13.6%

CONSEQUENCES

Identifying the Costs of Substance Use and Markers of Return on Investment

for Prevention

Percentage of Arizona Youth Reporting Delinquent Behavior

0

2

4

6

8

10

12

14

16

18

20

2006 2008 2010 2012 2014

Pe

rcen

t (%

) R

ep

ort

ing

Use

Assault Drunk or High at School Suspended from School Sold Illegal Drugs Been Arrested

Note: scale reduced for visibility; accurate depiction is out of 100%

Percentage of Arizona Youth Reporting Delinquent Behavior

8.8 6.8 3.2 5.6 2.0

23.918.8 18.1

60.0

29.5

0

10

20

30

40

50

60

70

80

90

100

Suspended from School Assault Been Arrested Drunk or High at School Sold Drugs

Pe

rcen

t (%

) R

ep

ort

ing

Use

No Past 30 Day Marijuana Use Past 30 Day Marijuana Use

2.7x Higher Rate

10.7x Higher Rate

5.7x Higher Rate

14.8x Higher Rate

2.8x Higher Rate

Percentage of Arizona Youth Reporting Delinquent Behavior

23.918.8 18.1

60.0

29.522.2 23.9

18.0

50.7

27.2

18.5 16.4 13.2

39.0

18.4

0

10

20

30

40

50

60

70

80

90

100

Suspended from School Assault Been Arrested Drunk or High at School Sold Drugs

Pe

rcen

t (%

) R

ep

ort

ing

Use

Past 30 Day Marijuana Users Past 30 Day Rx Drug Users Past 30 Day Alcohol Users

CONTEXTUAL FACTORS

Identifying What Can Be Changed

Where Arizona Youth Obtained Marijuana*

78.6

28.6

14.8 11.6 13.46.1

75.7

27.1

14.3 14.3 11.35.7

0

10

20

30

40

50

60

70

80

90

100

Friends Parties Family/Relative Someone with amedical mj card

School Home

Pe

rce

nt

(%)

Yo

uth

Re

po

rtin

g Ea

ch S

ou

rce

2012 2014

*Students could pick more than one source; will not sum to 100%

Risk Factors of Note in Arizona Past 30 Day Youth Marijuana Users (2014)

14.018.5

24.0 23.029.0 28.3

35.0

54.1

65.169.0

78.1

56.1

65.1

54.760.7

91.8

0

10

20

30

40

50

60

70

80

90

100

Early Initiationof

Drug Use

AttitudesFavorable

to Drug Use

Friend's Use ofDrugs

ParentAttitudes

Favor Drug Use

PerceivedAvailability

of Drugs

Laws & NormsFavor Drug Use

Poor FamilyManagement

No/SlightPerceived Risk

ofDrug Use

Pe

rce

nt

(%)

Yo

uth

at

Ris

k

Non Users Users

Users had 1.5-4.7x the rate of risk as non-users

Age of First Use by Substance Type in Arizona

12.8

12.9

13.1

12.8

12.9

12.5

12.7

12.9

12.7

12.9

13.2

13.5

13.6 13.613.7

13.5

13.4

12.00

12.50

13.00

13.50

14.00

2006 2008 2010 2012 2014

Ave

rage

Age

in Y

ear

s

Alcohol Cigarettes Marijuana Rx Drugs

Age of First Use for Arizona Youth Marijuana Users

13.61

13.81

13.99 13.96

14.08

13.05

13.31 13.31

13.53

13.64

12.83

12.97 12.97

13.3113.27

12.28

12.57 12.57

12.78 12.78

12

12.5

13

13.5

14

14.5

2006 2008 2010 2012 2014

Ave

rage

Age

in Y

ear

s

Experimental Use (1-2x past 30 days)

Weekend Use (3-9x past 30 days)

Weekend+Some Weekday Use (10-19x past 30 days)

Habitual Use(20+ x past 30 days)

Percentage of Arizona Youth Reporting No/Slight Risk of Marijuana Use

0

10

20

30

40

50

60

70

80

90

100

2006 2008 2010 2012 2014

Pe

rcen

t (%

) R

ep

ort

ing

Use

Try Marijuana Regular use of marijuana

25.8%% Increase

116.6% Increase

Factors Contributing to Arizona Youth Attitudes About Marijuana (2014

21.117.9

29.0

38.6

28.4

38.7

55.0

85.288.7

78.1

68.7

96.1

0

10

20

30

40

50

60

70

80

90

100

Cool to use marijuana

Not wrong to usemarijuana

Peer approval ofmarijuana use

Know adults whouse marijuana

Siblings usemarijuana

Best friends usemarijuana

Pe

rce

nt

(%)

Yo

uth

at

Ris

k

No Past 30 Day Marijuana Use Past 30 Day Marijuana Use

Over HALF of Arizona youth have never talked to their

parents about alcohol or drugs!

Factors Contributing to the Lack of Parent-Child Conversations (2014)

34.6

22.4

14.3

40.0 38.6

46.8

34.529.9

54.9 53.2

0

10

20

30

40

50

60

70

80

90

100

Can't sharewith parents

Can't go toparents with problems

Honesty withparents not important

Parents never/rarely notice good job

Parents never/rarely say they are proud

Pe

rce

nt

(%)

Yo

uth

at

Ris

k

No Past 30 Day Marijuana Use Past 30 Day Marijuana Use

Reasons Past 30 Day Arizona Youth Marijuana Users Gave for Using Substances (2014)

55.854.0

41.0

32.2

26.622.9

20.5 20.4

11.19.3 8.2

5.0 2.8 2.3 1.6

0

10

20

30

40

50

60H

ave

fun

Get

hig

h

Dea

l wit

h s

tres

s

Kee

p f

rom

feel

ing

sad

Sto

p b

ore

do

m

Oth

er

To f

ocu

s

Try

som

eth

ing

new

Fee

l no

rmal

Bec

au

se I

nee

ded

it

Fit

in

Lose

we

igh

t

Get

bac

k at

my

par

ents

Be

mo

regr

ow

n u

p

Be

like

afa

mo

us

per

son

Pe

rce

nt

(%)

Yo

uth

Re

po

rtin

g R

eas

on

s

*Students could pick more than one reason; will not sum to 100%

Reasons Non-Marijuana Users Gave for Not Using Substances (2014)

77.4

53.1 52.5

44.740.6 40.5 40.4 39.6

33.4

25.8

19.9

6.9 5.9

0

10

20

30

40

50

60

70

80

90

No

t in

tere

sted

Can

hu

rt m

e

Par

ent

dis

app

rova

l

Co

uld

be

arre

ste

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isap

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Mo

rally

wro

ng

Lose

pri

vela

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Mig

ht

get

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Get

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Frie

nd

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ve

Aga

inst

be

liefs

Do

n't

like

Co

uld

n't

fin

d a

ny

Pe

rce

nt

(%)

Yo

uth

Re

po

rtin

g R

eas

on

s

Percentage of Each Age of Marijuana Initiation for Arizona Youth (2014)

12 years, 11.6%

13 years, 19.5%

14 years, 18.9%

15 years, 17.4%

19 or Older, 0.3%

1 out of 8 Arizona youth who use marijuana started

using in elementary school

80% of Arizona youth who use marijuana started

using before they could legally drive a car

1 in 5 Arizona youthwho use marijuanastarted at age 13

Why Does This Matter?

Marijuana and the Brain

THC and Your Brain

• THC stimulates the “reward circuit” of the brain

• Causes intense surges in dopamine to create the “high” or euphoria

EFFECTS Euphoria, laughter Distorted perception of time Impaired coordination Reduced inhibition & risky

behavior Difficulty with thinking and

problem solving Memory loss

Impaired Driving Slower reaction times Impaired judgment Problems responding to signals and

sound

Marijuana Rewires the Brain

Substitutes the high of a drug for the high from a job well done.

Reward without effort

Long-term damage to brain’s natural reward system (brain is re-wired)

Long-term cognitive damage Memory & learning skills impaired

Marijuana Slowly Hijacks Brain’s Natural Reward System

Amotivational Syndrome• Persistent procrastination• Low productivity; low energy• Grandiosity• Low self-confidence• Lack of clear thinking• Bad or guilty feelings• Anxiety; panic attacks; paranoia• Unreliable• Decline in personal relations• Poor academic outcomes

Weekly Teen Use of Marijuana Lowers IQ By 7-8 points by Age 38

IQ Drops in Adults Who Regularly Used Marijuana Before Age 18

• Frequent Use at age 38 = 7-8 point drop

• Infrequent Use at age 38 = 4-5 point drop

• Lost cognitive abilities not fully restored even in adults who quit

Regular Marijuana Use is Harmful to Developing Adolescent Brain

Marijuana’s negative effects on attention, memory and learning can last for days or weeks (even after intoxication is gone)

Impairment, low energy and reduced initiative mean poor academic outcomes

• Users 3.6 times less likely to graduate from high school• Daily users 60% less likely to graduate• Users 2.3 times less likely to enroll in college• Users 3.7 times less likely to get a college degree

Daily Users of Marijuana Before Age 17

Clear and consistent associations between the frequency of adolescent cannabis use and all adverse young adult outcomes.

Clear reductions in the odds of high-school completion Clear reductions in degree attainment Substantially increased odds of later cannabis dependence Substantially increased odds of use of other illicit drugs Substantially increased odds of later suicide attempts

“Young adult sequelae of adolescent cannabis use: an integrative analysis.” The Lancet Psychiatry, Volume 1, Issue 4, Pages 286 - 293, September 2014.

• About 9% (1 in 11) of users may become dependent• 17% (1 in 6) who start use in adolescence• 25-50% of daily users

32

15

9

17

118

5

23

0

5

10

15

20

25

30

35

Percen

t

Addiction

* Nonmedical Use

Source: Anthony JC et al., 1994

ADDICTION IS A DEVELOPMENTAL DISEASEIt starts in adolescence and childhood

NIAAA National Epidemiologic Survey on Alcohol and Related Conditions, 2003

Age at tobacco, at alcohol and at cannabis use dependence as per DSM IV

Prolonged drug use changes the brain in fundamental and long-lasting ways

Brain is “rewired” Adjusts to the drug Drug use becomes necessary simply to feel

normal

Drug use continues despite tremendous negative consequences

Addiction is a disease that affects both the brain and behavior

Cycle of Addiction

Steps in Drug Addiction and Recovery

* Used to get high or change their mood

Teen Users of Marijuana More Likely to Use All Other Substances

Marijuana a “Gateway” Drug

Partnership Attitude Tracking Study (PATS) 2011

THC OF TODAY

Average THC and CBD Levels in the US: 1960 - 2011

1960

1965

1970

1974

1978

1980

1983

1984

1985

1986

1990

1992

1993

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

THC 0.2 0.2 0.4 0.5 1 1 1.5 3.3 3.3 3.5 3.5 3.1 3.1 4 4.5 5.2 5 4.7 5.4 6.2 7.3 7.2 8.3 8.1 9.1 10 10 9.9 11 11

CBD 0.3 0.3 0.4 0.4 0.3 0.3 0.4 0.4 0.4 0.4 0.5 0.5 0.4 0.5 0.5 0.5 0.5 0.5 0.4

0

2

4

6

8

10

12

14

MA

RIJ

UA

NA

PO

TEN

CY

NON-Psychoactive

Ingredient

THC:Psychoactive

Ingredient

Potency of THC – Colorado vs. Nation

THC National Average

1970s = 1%

1995 = 3.5 %

2012 = 15%

COPYRIGHT BY SAM; USED WITH AUTHORS’ PERMISSION

Increases Potency and Emergency Department Visits Involving Marijuana, Cocaine, or Heroin

Effects of THC on Mental Illness

• Since 2002, almost a dozen studies have shown that regular use of marijuana carries a significant increased risk of developing psychotic illnesses like schizophrenia.

• Higher risk for:• Those with a family history of the disorders• Those with a psychosis-prone personality• Those who start using in early adolescence

• Risks increase with potency and frequency of use

Effects of THC on Mental Illness

- Adolescents who use marijuana have a 2-4 fold increase risk of developing psychosis and this risk is dose-dependent (Hall and Degenhardt, 2009)

- Marijuana, especially high potency marijuana, may cause acute anxiety attacks and psychosis (Hall and Degenhardt, 2009). MJ accounted for 461,028 ED visits in 2012 (DAWN, 2013). Symptoms of withdrawal include anxiety and depression (Budney et al., 2002).

- Controlling for other possible confounds, those who use marijuana are twice as likely to have had a suicide attempt requiring hospitalization (Hall and Degenhardt, 2009).

- Marijuana withdrawal causes a doubling in aggressive episodes compared to controls (Kouri et al., 1999; Smith et al., 2013).

- Daily use sees an increase in psychosis of 5x (Lancet Journal 2014)- Weekend use sees an increase 3x- 24% of psychosis cases in the study group caused by weed alone

Effects of THC on Mental Illness

Meta-analysis was conducted by Australian researchers in 2011 for the Archives of General Psychiatry• used 83 studies to assess the impact of marijuana use on

the early onset of psychotic illness.

The findings were clear and consistent: “The results of meta-analysis provide evidence for a relationship between cannabis use and earlier onset of psychotic illness…[The] results suggest the need for renewed warnings about the potentially harmful effects of cannabis.”

Effects of THC on Mental Illness

2013: Researchers analyzed data from interviews with more than 43,000 respondents over the age of 18 from the National Epidemiologic Survey on Alcohol and Related Conditions.

Study published in the journal Comprehensive Psychiatry, researchers at Toronto’s Centre for Addiction and Mental Health (CAMH) found that people with mental illness are seven times more likely to use marijuana weekly than people without a mental illness.

Rates elevators for:• Bipolar disorder• Other substance abuse disorders.

The Connection

Does marijuana use come first, or does mental illness come first?

Regardless of the mechanism, it is clear that marijuana is harmful to mental health.

Use of Marijuana Increasing, Perception of Marijuana’s Risk Decreasing

Percentage of U.S. 12th Grade Students Reporting Past Month Use of Cigarettes, Marijuana and Alcohol

0

10

20

30

40

50

60

919293949596979899000102030405060708091011121314

Legalization = More Teen Users

Number More LikelyTo Use if Legal

% of Arizona’s High School Students

Students Who Have Never Used

~32,000 10%

Students Who Have Used in Lifetime

~76,000 24%

• The Partnership Attitude Tracking Study (PATS): Teens and Parents, 2012• ACJC Arizona Youth Survey, 2012

% of Arizona’s Teens More Likely to Use Marijuana IF IT IS LEGALIZED

Teen Illicit Use Highest in Medical Marijuana States

*23 Medical Marijuana states

ARIZONA #20

Arizona Medical Marjuana Act

Medical Conditions Profile

Age and Gender of Cardholders as of 9/30/14

Quarterly Report 2014

• Report published November 13, 2014 by the Department of Health Services• 615 physicians provided certifications to 51,783 patients during this time

period. • 25 physicians certified approximately 60% of the patients.

FERRELL & REED-KALIHER CASES

SUPREME COURT OF THE STATE OF ARIZONA STATE v. JENNIFER LEE FERRELL,

Filed April 7, 2015

KEENAN REED-KALIHER v. STATE OF ARIZONA, No. CV-14-0226-PR Filed April 7, 2015

Substance Abuse Is Preventable

Marijuana -- Past Year Prevalence – General Population

World Average5.2%

SUGGESTED STRATEGIES

The best treatment is still prevention

Normalizing sobriety is key

Treatment/Prevention

The best treatment is still preventionNormalizing sobriety is key

Pushing back in a way that will resonate with the culture they are in

Family and social groupsMUST BE RELEVANT!

Call to Action: Looking outside the box

Good Behavior Game

Don’t Get Me Started

Teach Coping Skills

Kids at Hope – Be an Ace! Time Travel“Every Kid can Succeed, No Exceptions”

FOR MORE INFORMATION

• Marijuana Harmless? Think Again!, www.marijuanaharmlessthinkagain.org

• ACJC SAC website: http://www.azcjc.gov/ACJC.Web/sac/Default.aspx

• Community Data Project website: http://www.azcjc.gov/cdp_site/default.aspx

• Substance Abuse and Mental Health Services Administration, www.samhsa.org

• National Institute on Drug Abuse, www.nida.nih.gove

• National Institute on Alcohol Abuse and Alcoholism, www.niaaa.nih.gove

• Sheila Polk, sheila.polk@yavapai.us• Merilee Fowler, mfowler@matforceaz.org

Paige Gullikson

Growing Kids Preschool

2014