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By Janis Russell

October 11, 2016 (La Mesa) - Yesterday, the Live Well San Diego East Leadership Team Substance Abuse Prevention Subcommittee put together a community forum (#UThinkUKnowWeed) to educate the public on adolescents using marijuana. The event was held in the Grossmont Healthcare District conference center. There was a panel of five individuals who had stories to share and statistics to give regarding adolescents using marijuana.

Dana Stevens from Communities Against Substance Abuse (CASA) and one of the chair people of the Live Well subcommittee gave a welcome. They hope to spread their concerns about marijuana through social media. “Marijuana is of great concern to all of us,” Stevens added. She introduced Dr. Michael Emerson, Vice President of the Grossmont Healthcare District Board of Directors, and the forum moderator, JW August, Director of Investigative Reporting for NBC News San Diego.

Dr. Emerson began. “We’re delighted to host this important discussion...data is what we need to separate fact from emotion…I’ve tried to learn more on marijuana.” He noted that in Oregon and Colorado, where recreational marijuana is legal, there has been a “tremendous increase in emergency room visits.”  He said that from 2005 (before marijuana was legalized) to 2015 (after legalization) hospital admissions related to marijuana increased 170%, there was a 513% increase in marijuana related exposure, and among children ages 6-19 years, a 139% increase in Emergency Department visits.  However, during that time, overall traffic fatalities decreased by 29%. “Adverse health effects continue to increase,” Emerson stated, adding that marijuana “impacts the ability to provide consistent quality of care to patients.”

Stevens then introduced the keynote speaker on the panel, Dr. Roneet Lev, Director of the Scripps Mercy Emergency Department, San Diego Campus. Dr. Lev gave a PowerPoint presentation titled “Marijuana, Good Medicine, Bad Medicine.” Marijuana is a plant-cannabis actively made up of THC, which is a psychoactive substance and CBT, which blocks psychoactive effects. The effects of CBD receptors in the brain include stimulant symptoms (fast heart rate and chest pain) and immune/gastrointestinal effects. It has gotten medical approval, and is used in Dronabinol and Nabilone (THC medications). “[These are] available to any licensed physician in the United States,” Dr. Lev added.

She noted, “Drug testing is tricky,” Dr. Lev said, because cannabis meta bouts persist in body fluids for an extended time. There are harmful effects to pregnant women and children, like a permanent drop in IQ points, lower GPA, problem with memory, effects on work performance and attendance, and drugged drivers (marijuana is the #1 drug detected in impaired drivers, fatally injured and motor vehicle crash victims), 10% of adults develop an addiction if it’s used chronically, and 17% if you start in adolescence. There are also cannabis withdrawal symptoms. Sometimes people develop Cyclical Vomiting Syndrome, which is “chronic marijuana use on the GI tract.” Though there is some evidence it helps with diseases like AIDS, spinal injury, seizures and cancer, it is not a proven treatment for glaucoma. Only 17% of medications are accurately labeled for marijuana, but there is no warning label. For more information, visit: http://www.mpisdcounty.net/.

August introduced the rest of the speakers starting with Dr. Susan Writer. She is the Community Outreach Liaison for Aurora Behavioral Health Care. She has her doctorate of philosophy in clinical psychology from Alliant International University in San Diego. She currently works for HELP as a contracted therapist and in private practice as a psychological assistant to Dr. Annette Conway at Aurora. Dr. Writer works with adolescents, transitional age youth, adults and seniors, as well as couples and families.  She gave a PowerPoint presentation on Marijuana and Mental Health.

Smoking marijuana causes impaired driving. It’s addictive, and is possible to overdose, according to her presentation. Marijuana hacks the brain’s messaging system. “It does it in a variety of ways.” The person can be psychoactive and hallucinogenic. The brain doesn’t fully develop until age 26 with the frontal lobe developing last. The frontal lobe deals with critical thinking, which gets impaired when marijuana is used in adolescence; there can be permanent brain damage.

Marijuana use disorder affects how people think (they’re unable to say when they’ve had too much), how people feel emotionally and physically, how people behave, what people perceive, how people relate to and interact with others, and how people function on a daily basis. “I have teens I work with….they tell me tobacco is bad for you…they also say marijuana is a plant and is not bad for you,” Dr. Writer observed, then explained three myths on marijuana- 1) ‘I’ll know when things get out of control.’ The person won’t know. 2) ‘I’ll be able to stop whenever I want.’ A person can get addicted, and it’s difficult to treat because it has dopamine, which feels good. 3) ‘Getting sober is quick and easy, and there are no long-term side effects.’ Dr. Writer mentioned she has seen long term brain damage and permanent GI tract damage. “No addict will ever tell you it’s easy to get sober,” she added. She then emphasized the importance of people getting treatment.

Tim Glover, PhD, spoke next. He is the current Superintendent of the Grossmont Union High School District. Prior to that, he was the Assistant Superintendent of the Student Services and Program Division at the San Diego County Office of Education. He thanked Grossmont Union High School District board members, Priscilla Schreiber and Jim Stieringer, for being in attendance. He asked people to consider if marijuana helped teens achieve 21st century learning skills to be college ready, to be in a 21st century learning environment, and for kids to be better off than their parents’ generation. “We are here to build a better future… If we truly care about the wellness of the future.. .and kids, take stock of what you’ve heard today,” he urged.

Officer Emilio Ramirez and Drug Recognition Expert (DRE) from the San Diego Police Department then shared his thoughts. “Being out on the road every weekend.. you come in contact with people” who have used drugs. With young adults and teens, they think marijuana is okay. Teens have always been taught that alcohol and tobacco are bad. They claim to have a medical card to use marijuana. “We see people on the roadway and I don’t see how they drive their cars,” Ramirez said, adding that symptoms include bloodshot eyes looking as if they’ll fall asleep. There’s a rise/increase in the use of marijuana and alcohol on the roads. Now, more officers are being trained to become DREs, so more impaired people can get off the roads.

Jessica Sanchez, recent San Diego State college graduate with a Bachelors in public health and minor in psychology, was the last to speak. During her time as a student she learned plenty about nonprofit organizations, epidemiology, health policy and community health. Her PowerPoint Presentation was on a young adult’s view on marijuana. In her senior year of college, she interned at Casa neighborhoods. “In elementary school, we had red ribbon week” to show harmful effects of smoking. Now that there has been a decreased risk in smoking tobacco, she has heard people on the SDSU campus say that marijuana is good. There’s a high number of people who smoke marijuana. “Marijuana is openly talked about on college campuses” with hope that it’ll be legalized this November. There’s been a person dressed in a mascot/costume with a petition at SDSU and CSU San Marcos who wants Prop 64 to pass.

“Today marijuana is readily available,” Sanchez said, bringing up the Weedmaps on the computer. (https://weedmaps.com).  It is similar to Yelp, where people can have marijuana delivered to their house or they can find shops that sell marijuana. There’s also been advertising in magazines issued for the public, like the 420 book and the Reader. August asked Sanchez where the 420 book is sold. Sanchez said in the same location as the Reader, in places like 7-Eleven. Marijuana also comes in edible form, like gummy bears and chocolate.

Then it was time for questions and answers.

One person wanted to know if vaping has increased with marijuana and tobacco. Dr. Writer said that it has increased, and people have used vaping machines. Sanchez added, “More people my age are smoking vape.” Dr. Glover said that marketing is used to entice people to buy the products with marijuana, like cherries on a little kid’s bottle and rainbows.

Someone asked Dr. Lev if the emergency department is ready for an increase in marijuana, like in Colorado. Dr. Lev replied, “The emergency department is a safety net… We’ve [dealt] with marijuana poisoning… We’re used to it… Yes, we always can do better. I always ask people around the country” for tips. Dr. Emerson mentioned, “We do need to get more studies and research now before November… We’re ready for it, but we’d rather not have the measure passed.” The Grossmont Healthcare District Board has taken a formal position against the measure.

Someone asked Ramirez how to conduct a field sobriety test. Ramirez responded, “You conduct it in the same way as alcohol, but a few more steps are involved. It simply shows the ability to multitask and the ability to follow instructions.” There is equipment out there for the test. Dr. Lev wanted to know if Ramirez has prosecuted someone who had marijuana in their system. Ramirez said he had when he was a regular patrol officer.

Another person asked Dr. Writer if there are any drug treatment programs specializing in marijuana addiction. Dr. Writer explained that all addiction treatment programs treat marijuana as a substance abuse without the poly-substance abuse. But with this way, the person isn’t eligible for in-patient detox. Marijuana dependency has now become the primary diagnosis.

Someone asked Sanchez how apathetic parents are about marijuana and how to teach parents about its harmful effects. Sanchez mentioned she had a conversation with her mom, and her mom said she had a bad experience with it when she was her daughter’s age. “It takes a millennial to be open about it. It’s already out there.” Dr. Lev mentioned that if parents used marijuana when they were teens, they don’t see the harm in their kids doing it.

Someone wanted to know more about edibles. Ramirez answered, “Edible gummy bears look the same as regular gummy bears, but the packaging is different.” Someone wouldn’t be able to know if the food has marijuana in it if the packaging is around it. Dr. Writer added,  “Imagine going to a party if Prop 64 passes. You can’t really tell” if it has marijuana in it. “We’ve seen pets dying of marijuana.”

Someone asked Dr. Lev about the effects of marijuana on the reproductive system. Dr. Lev wasn’t sure about it. Dr. Writer said, “It causes limited motility and decreases sperm count in men. It causes utero problems.. and malformed ovaries.” There are also stillbirths and higher risk of miscarriages among marijuana users.

A question was asked about the DRE certification, and if there are enough DREs in San Diego County. Ramirez explained that to get the certification, you go through a two week program where you learn about everything. Then you go to live testing. “It’s not a walk in the park,” he warned. There aren’t enough DREs. “The average trained officer won’t know the effects or if people are impaired.”

Someone asked about employment issues and if drug testing would change if Prop 64 passes. Dr. Writer mentioned she’s worked with Human Resources companies. From what she’s heard, it’s difficult to determine an on-site write up because they don’t know if the person ingested marijuana that day on the job or a few days ago. So HR then works with labs to determine if the employee is high on the job. They’re struggling; they wouldn’t want to be sued by the employee.

Someone asked Dr. Lev what the links are between marijuana and crime. She’s had experience with high mellow marijuana patients in the ER, but stated, “The majority of patients are agitated…” She’s seen people come back again with the same issue to the ER.

Another person asked Sanchez what messages would have most influence on peers regarding marijuana. Sanchez believes just educating them would work. She took a course at SDSU on drugs, where she learned about a different drug each day.

The last question was from August. He wanted to know what the worst is of Prop 64. Dr. Lev said, “We see what’s happened at Colorado. They believe they’ll lose an entire generation because of this… [It’s] more of what we’re doing to the next generation.” Colorado legalized marijuana in 2012. Dr. Writer answered, “It normalizes that marijuana is not harmful…” Dr. Glover said that it would be a detriment to everyone. Ramirez responded, “You’ll open Pandora’s box..” Then it’ll be what else people can legalize.” Sanchez replied, “It’s illegal currently. People my age are able to get it…it opens up more opportunities…”

A flyer from the Marijuana Prevention Initiative gives a warning on marijuana/cannabis food products. It says that marijuana food products are an alternative to smoking marijuana. Packages are often designed to appeal to youth, and may closely resemble familiar brands. Marijuana food and snack products tend to be more potent and container higher levels of THC. The safety, potency and quality of these products are often unknown to the user. Edibles can look similar to popular food products. Marijuana oils can be added into baked goods, candies and drinks. The psychoactive effects or “high” from eating marijuana-laced food may not appear for 30-60 minutes depending upon an individual’s metabolism and last meal. The high felt from eating marijuana may last 4 to 8 hours. Side effects from eating marijuana food products include anxiety, hallucinations, paranoia, and panic. Unlike other food, there is no local or federal oversight on these products. When packaged as a single serving, they may be intended for multiple “doses” over time. If eaten all at once, effects may be severe. Once the packaging is removed, there is no way of determining whether the product contains marijuana.

Other statistics listed on a paper from the event include: In 2014, 2.4 million youth ages 12-25 had a marijuana use disorder (Center for Behavioral Health Statistics and Quality, 2015). Those studies suggest that 9% of people who use marijuana will become dependent on it (at age 23 or 24) rising to about 17% in those who start using young (in their teens) (from National Institute of Drug Abuse). A long term study found that youth ages 14-25 who used marijuana continuously had cognitive memory problems and an average IQ loss of 8-10 points (from Meier et.al., 2012). In 2015, more 8th, 9th, and 12th graders used marijuana than cigarettes (also from National Institute of Drug Abuse). According to the California Healthy Kids survey, past 30 day use for students’ grades 7,9, and 11 has continued to increase since 2005.

A flyer shows that a resource available is the McAlister Institute Teen Recovery Centers at 550 Fesler Street in El Cajon; the phone number is (619) 588-5361. They offer individualized outpatient treatment and recovery services, specifically designed for adolescents between the ages of 12 and 17. The programs accommodate school schedules, and offer after-school treatment, individual and group counseling, and structured recovery activities to help teens develop the tools they need to stay alcohol –and-drug-free. They also provide free initial drug testing for teens. For more information, go to: http://www.mcalisterinc.org/freetest/.

That same flyer offers advice for parents to talk to their kids about drugs. They can: 1) base alcohol related messages on facts, not fear. Kids love to learn facts. 2) Talk to your pediatrician or the school’s student counselor. They are a great resource for current information on how to start the conversation about drugs. 3) Stay calm. If the conversation isn’t going well, suggest talking about it at a later time. 4) Encourage healthy, creative activities. Look for ways to get your child involved in sports, hobbies, school clubs, and other activities that reduce boredom and excess free time. 5) Keep your conversations in “present tense.” Teens are concerned about the present.

Another community forum about marijuana use in adolescents will take place October 20, 6:30-8:00 p.m. at the Madison Middle School Gym. The address is 4930 Lake Blvd, Oceanside. Parents and students in 6th-12th grade are encouraged to attend. This event will feature Joe Eberstein, Program Manager for the Marijuana Program Initiative. For more information, contact Colleen Hervey, PTSA president at info@rbvptsa.org or Erica Leary, NCPC Program Manager at eleary@vcc.clinic. This event is sponsored by the RBV and Madison PTSA with the North Coastal Prevention Coalition and Vista Community Clinic.

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Stoned maybe

I am not sure if anyone or a pet has actually died from marijuana?

Marijuana deaths

I've heard of overdoses in people but no deaths directly from consumption of marijuana, though of course there have been driving related deaths where drivers were impaired, often on multiple substances such as alcohol and pot or pot and other drugs.  I'd be interested to know how many involved drivers impaired by marijuana alone.

I don't have data on marijuana and pets,  but would be interested to hear from any experts or veterinarians with first-hand experience in this.