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Is Marijuana the New Tobacco?

Kevin Sabet, Ph.D

Is Marijuana the New Tobacco?
Presented by Kevin Sabet, PhD

Earn 1 free CE credit for this program from the RiverMend Health Institute

Transcript of Presentation:

It’s really wonderful to see PSI and to have met many of you working here and others involved in the treatment community here in Chicago, and the life-saving work you’re doing, which is really just so important. You know, this is just a very difficult issue, actually. I mean, I think it’s the elephant in the room in drug policy today.

We’re in the middle of probably the biggest drug epidemic in our nation’s history, obviously, with the opiate epidemic, which is important to talk about, but what gets lost in that discussion is actually the drugs that are often what I call the ‘pathways’ to addiction.

The opiate epidemic is not driven by 14-year-olds who use heroin for the first time and that was their first drug of choice. As we know, the death and destruction is really driven by folks who have taken a long and windy road down multiple addictions and have been in-and-out of treatment and have been resuscitated back and forth.

About 52,000 people a year are incredibly and disturbingly losing their lives. I tell folks in Washington, that’s almost everyone on the Vietnam wall every year. And that is an incredible statistic. But we, in talking about this horrible opiate epidemic, I think sometimes we forget to talk about some of the, I believe, early contributing factors to that epidemic and, really, to addiction and mental health issues today. And that’s marijuana.

When you actually look at the opiate epidemic again, to use the example, it’s an epidemic driven by for-profit companies that said that their product was medicine, not addictive, and could be very helpful to society. They then marketed it, advertised it, worked with politicians to spread its use. That sounds a little familiar today with the marijuana issue, in terms of the way that folks are approaching that.

And I have no confidence that we as a country with a very, very disturbing background of the tobacco industry, of the pharmaceutical industry, and of course the alcohol industry, why we would think we would be able to, responsibly and in a public health lens, regulate or legalize marijuana. And we’re moving at 100 miles per hour on a freight train, without having a discussion, at least a discussion, about the pros and cons of such a policy.

And so, when I left the White House I started this group called SAM with Patrick Kennedy, Congressman, very well known. His recovery is also very well known. It’s kind of hard if you’re a Kennedy and, you know, drive at 3 o’clock in the morning to bust into the capital while you’re high on prescription medication – it’s kind of hard to slip away from that unharmed. But he’s just been an incredible advocate, as you all know, for mental health and addiction and reminding lawmakers this really incredible thing that it only took our lawmakers 100 years to realize, which is that the brain is an actual part of the body in terms of our healthcare. And so, doing that and working with him, and also Republicans, making sure it’s bipartisan, but really getting the science out there on this issue is why we started SAM.

I wish the average American read the Journal of the American Medical Association as bedside reading, but it doesn’t happen. And the average kid getting information about marijuana is getting it from websites lead by the industry or by 50 marijuana users who started a reddit subgroup. That is what’s informing our country on marijuana. They’re not- you know, I told Nora Volkow, like it’s still a fat sieve, but they are not reading the National Academy of Science’s 450-page report on the harms of pot. It’s just not happening. We are having this discussion so fast that I worry that we are opening up the door, again, to another tobacco-like industry.

We knew that tobacco was addictive. I don’t know if—do you all know, can anyone make a guess, about when the first peer reviewed research on tobacco on lung cancer was published? Sixties is the educated guess, because that’s when Joe Califano and the government released a surgeon general’s report. The twenties. It was actually the twenties, and our government caught up 40 years later. We have lived with 80 years of deceit from that industry that said that their product was safe, it was only for adults, it’s only about using it the privacy of your own home. And we, thankfully, have reversed course, are trying to reverse course, and we’re having some success. But I just don’t know why we want to go through that again.

So, we’re not going to have time to go through every slide here because there’s a lot of data. We’re going to make sure you all get a copy of it, because I do want to have some time for questions.

Just to give an overall landscape, in over the last 10 years, 12th grade drug use has fallen in this country. It’s kind of hard to think about that, because we’re like, “Wait a minute. The opiate epidemic?” But again, when it comes to young people using, we’ve seen a reduction in alcohol by 16%, according to Monitoring the Future. We’ve actually seen a reduction in every drug, including heroin, cocaine etc., except marijuana, by 23%. We’ve seen about a 60% reduction in tobacco. This is use among 12th graders.

But the only drug that has been stubborn . . . has been marijuana. We’ve seen about a 12% increase. And you might say, “12%? That’s nothing.” When every other drug has been falling significantly, and there’s one that isn’t, we have to look at that and say, “Why is that?”

I think it’s because this drug is getting free advertising and getting very good press, as they would say in PR. And it’s getting good press by an industry that needs to make money and the only reason this whole thing, that we’re even talking about legalization, in Illinois or other states, I think is for one reason and one reason only, and that is money. That is for a small number of people to get rich again. They see this as the end of alcohol prohibition, etc.

Alcohol, obviously, is legal. It’s a harmful drug, but I talk to people who say, “Kevin, alcohol’s legal, shouldn’t marijuana be, too? Because alcohol’s worse, but it’s legal!” There are a couple of problems with that. I sort of see that as . . . that’s like saying, “My headlights are broken in my car, so I should bash my taillights too. Just to be consistent, right?”

Or they say, “Kevin, don’t we want to give kids the safer choice?” Now arguing about which is safer aside, even if I were to accept that premise, which I actually don’t, but even if I were to accept that premise of a safer choice, that is like telling someone, a kid, “Why don’t you jump out of the 4th floor window, instead of the 6th floor window?” It’s a bad choice! Both are bad choices!

And alcohol is not legal because it’s “safe.” It’s not legal because it’s so good for everybody to use. That’s not why it’s legal. It’s legal because it’s been around and used by 70% of the West for, well, probably before the Old Testament, we think. And it is used by 60-70% of Americans, and it’s hard to prohibit something that’s used by that many people. Our alcohol policy is abysmal. We tax it 80% less than we did 40 years ago, if you look at inflation.

The use, the death and destruction coming from it, it’s no example! I don’t want to look at that and say, that’s what I want to aim for. And yet that narrative has kind of been out there, “Hey, alcohol! So why not marijuana?” That’s not a thinking person’s narrative on this, if we really think about how that’s been.

And let’s talk about social justice while we’re at it. I don’t know Chicago very well, but you tell me where the liquor stores are in this city. I have a feeling that they’re not in the upper-class neighborhoods, if it follows every other place in this country.

If you want to talk about social justice, these industries target the most vulnerable, because as you all know, addiction is not only your genetics, it’s not only your parents – it’s also your environment. And if you have access to healthcare, housing and other things that stop you sliding from use to dependence, etc., and that help buffer you from going down that path, then you’re less likely to go down that path. And those buffers are a lot of things: economic well-being, housing, stable healthcare, checkups. And the industry knows that.

I see the same thing happening with marijuana in this country. Because let me tell you something, if you’re a rich kid from Beverly Hills, you may not need to get a job at Walmart at 16 where you’ve got to get a drug test. You may be able to afford the good attorney if things go wrong in college and you’re caught with marijuana. But if you’re not that, you’re going to have a lot more problems. And I think the industry knows that. That’s why liquor stores are where they are, and that’s why pot shops are where they are. So, we started SAM.

There’s this false dichotomy that says there are two choices for pot, that you have two choices for policy: you can either lock people up in prison, the War on Drugs, or legalize. Which one do you want? And I think that’s a false dichotomy. I don’t think those are our only choices.

When I look at things that we can do: early intervention. When I look at fines, community services, those kinds of things for early use. We don’t want to give a 16-year-old a criminal record if he has a joint in his pocket. But that argument is used too often as the reason for legalization. “Well, we don’t want kids to get criminal records, Kevin, so that’s why we need to sell pot gummy bears and have advertising and promotion.” That doesn’t make any sense.

So, let’s reform the laws that we don’t like, let’s change some of the . . . no one’s saying the history of drug policy has been anything that we want to glorify. Let’s fix those things. But we can fix them without creating more problems. Too often we’re sort of in this dichotomy that there are only two choices.

The only way to do legalization, unfortunately, in this country, the only way it would actually happen is it would be widely commercialized and promoted. I have not seen any counter example: alcohol, tobacco, gambling, pharmaceuticals, sugar. They don’t give me comfort that we’re going to do this in a public health-oriented way.

I’ve worked for Republicans and Democrats in Washington, I don’t care who, what party you’re from, the revolving door of special interests penetrates both parties, and let me tell you, if you’re in an addictive industry, you have even more incentive to make sure that prices are cheap, regulations are . . . I mean I love it when folks say, “We want to regulate.” They don’t want to regulate. They want as little regulation as possible, because that’s how they make money. It’s a buzzword. So I worry.

When I ask people, “What does the fastest growing drug dealer in this country look like?” They don’t usually think these guys. They have another image in their head about what this person looks like. Some people kind of think I look like this guy. I get kind of offended when they say that. But anyway, just saying it to get off my mind.

But the reality is, and I don’t want to place this so much in race, but this is really about young, rich, white guys getting richer. That’s right! That’s just the reality of the industry right now, Maybe that’ll change, I don’t know, I mean look at the other industries, it’s the same thing, but . . . the issue is, this is about money. And I worry, and I get excited because people are like, “Well, Kevin, opiates, and there’s cocaine, why aren’t you more alcohol focusing?” This excites me and worries me, because these guys aren’t the stoners living in their mom’s basement doing nothing with their lives. I mean, if that was the case, you could just say, “Well, they just need help. They’re not even going to come into work on time, let alone put together a million-dollar plan.”

These guys are putting together billion-dollar business plans. I mean these guys are the ones with the Yale MBAs. They are working in Silicon Valley. Look at who’s funding– you can do your own research after this—to see who funded the California initiative, to see who funds all legalization. These are people who know business.

Folks coming into medical marijuana in this state, they weren’t exactly the head of the Illinois Medical Association, or the scientists. They were the guy that was a real estate developer and then he saw money in this and decided to get into it. That’s what worries me, it’s that they know about business, and they know about addictive industries by doing their homework. The billboards, the events sponsorships, the coupons, all of these things—for example, these all come from Colorado– we’re starting to see in these legalized states. So, Newsweek said big tobacco is back, and I agree with them.

This is the head of the largest marijuana lobbying organization. He goes to the tobacco industry in the different states, and essentially says—he admitted this, that’s why we can quote him– “What do you want?” to the tobacco industry, “How do we get you?”

So, now we not only have the marijuana industry acting like the tobacco industry, they’re actually working together. That very much worries me as well. We put out an ad saying, “Let’s not be fooled by big tobacco again.”

We also have to separate different issues. People conflate decriminalization, legalization, and medicalization, and within medical, they conflate marijuana and other components of marijuana.

Marijuana’s a very complex plant with hundreds of components. The component that gets you high is a cannabinoid called THC, that is one of probably hundreds of them. We’ve identified some of them, we don’t know about a lot of them. Another one is called, have you all heard of Cannabidiol, CBD oil, the oils that they use for the seizures? That’s another one.

Even within the medical thing, the headlines are . . . Yesterday there was a piece that came out, and it said that Cannabidiol oil could help seizure medication, that it could help seizures, which is great! We should promote that research. The headline was, ‘Cannabis Could Help Treat Seizures.’ That’s not cannabis. Cannabis is a plant mixture of hundreds of components, active, inactive, terpenes, flavonoids, etc. That thing in the study was one of those hundreds of cannabidiol, so it’s a constant struggle.

The terminology is a constant struggle. When Colorado legalized marijuana, the headline was “Colorado First State to Decriminalize Marijuana.” I said, “Wait a minute. California decriminalized the possession of marijuana in 1976 or something.” They use these things interchangeably. We need to distinguish between them.

In the medical argument, just very quickly, first of all: we don’t smoke any medicine. We also don’t take a raw plant material and say, “Yeah, this is medicine. I don’t know the dosage cause it’s just crude plant material. There’s no dosage. Don’t ask me about side-effects. You can’t get it from your pharmacy, forget about it being prescribed by your doctor. But if you go down to the store by the pizza shop down there, this kid who didn’t graduate high school is going to sell you something called, well, someone today called it blue cheese and super silver haze, and that’s going to treat your whatever. Oh, and it didn’t go through the FDA, but we had legislators vote on it. And none of the legislators have PhDs in biochemistry or pharmaceuticals or anything, by the way. So, anyway, there you go.” That’s not medicine. That’s something we vote on and politicize.

But there are components of marijuana that are used, and right now there are pills available at pharmacies. One is Marinol, it’s a synthetic of THC, but there are others that are in the works. And frankly, there’s a lot more interesting research going on, which I think we should promote. Look, if there are medical components, great! Let’s help people. Let’s get them in pharmacies, understand the risks and go from there. It’s not that hard. We don’t need to set up medical marijuana “dispensaries.” When I first heard the word dispensary, I thought someone was reading a history book from like 1820, about what they used be called before we had the FDA, like, what?

And it’s literally going back to pre-FDA. You know, pre-FDA we had all kinds of cool things, you should look at the snake oils. I’ll tell you, you could get anything to cure baldness, sadness, like, anything. And none of it was validated. Why are we doing that? I don’t understand. I do understand, it’s money. Again, it’s people that want to make money. But it’s unfortunate.

Not all medical marijuana programs are the same, actually. The one in Illinois, thankfully, I don’t think it’s great but it’s certainly not California with the bikini woman on Venice Beach. If you’ve been on Venice Beach and come in for your evaluation . . . A guy went in there with his dog, he was an undercover agent, he said, “My dog is sick, so can I get medical marijuana?” And they said, “Well, I don’t think the law allows dog . . . Let us check.” And then they did and he said, “Well, no, I have anxiety from the dog being sick.” He got his card in under 10 minutes. He had to give $200 cash, and it was done. That’s not medicine. If it is medicine, we should treat it that way.

There’s a whole issue about scheduling, and I just want to say, has anyone heard that marijuana’s a Schedule 1 drug? I’ve heard that a lot. There’s a lot of confusion about what scheduling means.

There are actually hundreds of researchers researching marijuana today even though it is a Schedule 1 drug. People are all like, “You have to legalize it to research it!” No. There are a lot of drugs that get researched out of schedule. It’s harder, but it’s possible to do. Scheduling, the best way I can describe it, it’s really confusing – scheduling is not a harm index. In other words, heroin is a Schedule 1 drug, too, as is PCP. The fact that marijuana’s in Schedule 1 does not mean that we think marijuana is as dangerous as heroin or PCP. It means that they both fulfill the definition of a Schedule 1 drug.

It’s like the snack aisle at 7-Eleven has bananas and Doritos. They’re both classified as snacks to 7-Eleven. I wish they were more precise, but they’re not. It’s not ‘fruit’ and whatever, no, it’s snacks. And we would not take the banana and the Doritos and say, “Oh my God, society is saying that these two things are equal!” No. It’s just the stupid way 7-Eleven classifies a snack.

Well, this is an old way of classifying drugs from 1970, and it’s a Schedule 1 drug. People are like, “Schedule 1! If only we had it at Schedule 2, it could be . . . !” There’s so much confusion about it. Schedule 1 simply means there’s no accepted medical use. And it’s correct. Raw marijuana does not have accepted medical use in terms of it being in its raw, plant material form. Marinol does, that’s Schedule 3. It’s a component that’s available at a pharmacy. And others as well. But I think it’s a very, very confusing point.

The studies about medical marijuana, by the way, it’s not exactly granny with a terminal illness. It’s a 32-year-old white male with a history of drug abuse who got a pot card because his back hurt or he had a headache. That’s what it was in California. Now, I think they’re looking at what it is here, but all the states I’ve looked at, fewer than 5% are cancer, HIV, glaucoma patients. I’m not demeaning the fact that components of marijuana can be helpful for some people. We should do research. But the studies in terms of looking at who’s using it, I have to tell you, the majority of people with terminal illnesses, their doctors are not saying, “If only you could use marijuana! Please go to a dispensary!” It’s not happening. But there’s a kind of misperception that it is.

There are medications out there. Many of you might have seen Sanjay Gupta talk about the kid with seizures. That was a whole thing called weed. It was called weed. Okay? That was the name of it. What do you think when you think of weed? Do you think of this? Does the average American, when they think of weed, do they think of a blue bottle with an oil in it? No. Someone back there made their hand like this [holds an imaginary roll], yes, exactly, that’s what I think about too. And again, it’s just this sensationalized, lowest common denominator stuff. And the reality– and oh, these are the heroes, the brothers who are making oil for the poor child. That is great TV. It’s not great science.

And Dr. Gupta heard from myself, Patrick Kennedy, and a bunch of other physicians as well that weren’t very happy. But it’s ratings, folks. It’s ratings. And the reality is, sure, there might be a component that’s helpful, but first of all it’s not called weed, and secondly, if it’s so great, will you please put it through the FDA? We’d like to know more about it. The answer’s like, “No, no, no, we don’t need the FDA. No, no, we’re good. We have, you know, five kids that are getting help, that’s good enough for us.” I have to be somewhat suspicious of that.

There is a need for it, you know. There are all kinds of seizures, I’m not going to talk– but there is a need for them, for new medications. But here’s one of them actually going through the FDA right now. If there are others, good, we should get them through the FDA and see what happens with them. And we should accelerate research, we should absolutely do that.

But let’s get to what this really is about. And the whole thing about marijuana is about capturing the adolescent brain. Your brain is under construction until age 25 or 30. The analogy today, it’s sort of like when your house is under construction. It’s really exciting cause you can pick a new floor, what kind of wallpaper you want, you can fight with your spouse about the color of the room. It’s exciting, and which is what, and you’re picking your appliances.

I’m originally from California, so I have to use this example. If there’s an earthquake during the construction, it’s bad news because that house is vulnerable. It really kind of sucks that there’s an earthquake during the construction. I wish the earthquake would’ve happened when it was well-established, when it was good, when the house was on a firm foundation.
Your brain is the same way. There are great things that happen when it’s developing. It’s so exciting, you’re learning languages, you’re swimming, you’re learning how to ride a bike. You’re taking things in, you’re figuring out what you like, what you dislike. That’s all very exciting. The flipside, of course, is your brain is a sponge for bad things too. And whether it’s trauma or abuse or drugs or adverse events, these things can stay with you longer than if you had those things happen to you when you were 40 or 50. Just like if you learned a language when you were 40 or 50, it’s a lot harder than when you’re 4 or 5. It’s a flipside to that, right?

So, what does that –I’m going to go back to marijuana on the brain– but what does that means to the industry? I’m going to bring it back to the industry and the economics. It means that if you’re an industry like alcohol or marijuana, you really need young brains, because that’s when your preferences are being formed. And the reason why you need young brains is that you need addicts to survive. I mean, the opiate epidemic, for all the talk about OxyContin, the majority of people on pain medications never got addicted to them. It was a small minority that drove this huge problem. And, what did that also mean? Line the pockets of the industry. The small minority of heavy users.

Same thing with alcohol. In this country, 10% of us drink 75% of the alcohol consumed. One in ten of us, that means, drinks seven and a half out of ten drinks. The nine of us are then fighting over two and a half drinks. That means if you’re in this industry, you need alcoholics to survive. That’s who your customers are. You don’t care about the person that enjoys a glass of wine once a month with dinner, or a couple of beers in the weekend. That’s not lining your pockets.

There’s no reason to think marijuana would be any different. I worry because THC, the active ingredient, really specifically affects parts of the brain that are important if you want to be a good student and get a job and wake up on time and not forget that you have a test tomorrow, and be able to socialize with peers and drive a car when you’re 16 without being impaired. These are actually things that are not impaired with tobacco, which is very interesting. Now I don’t really say that when I talk to students, because I don’t want a student to say, “Great! I’m going to go smoke. It’s not bad for me.” Of course it is. You start smoking young, you’re liable to be addicted, and it kills 410,000 people a year. We don’t want kids to smoke.

But the cigarettes are not producing car crashes, they’re not producing you coming late to school, they’re not making you forget about the test, and they’re not lowering your IQ, or causing mental illness. That’s a critical difference. And yet we have stigmatized smoking so much. I mean, I don’t even know where you can smoke these days. And you can’t, it’s totally stigmatized. That’s very interesting. The act of smoking is shunned upon, frowned upon. We’re doing that as a society, and yet we’re saying, “You know, go with this pot thing, let’s try it out!” It doesn’t make any sense to me.

The addiction center of the brain, reward memory, judgment. I had a kid say, “Kevin, this is false. You’re saying this is the addiction center. Marijuana does not affect that. It’s not addictive.” And I said, “Really? Where did you read that? Where are you getting that from?” And he said, “No, I didn’t read it. I know marijuana’s not addictive because I use it every single day.” So, the same kid said, “Driving high makes me a better driver.” Again, “Why is that?” “Cause I go 30 miles an hour on a 65 mile per hour zone.” That doesn’t make you a better driver.

It’s just incredible, the misinformation that’s out there. But the reality is: “Where do you get that information?” “Wikipedia. Reddit.” “Well, are you reading the National Academy of Science?” “Never heard of it.” “How about the World Health Organization report?” “No. That’s too long, 600 pages, who reads that?”

This misinformation is incredible, but I worry about the areas that are critical for young people’s brain development. Now, thankfully we don’t have any receptors here, right? The brain stem, which is why we have opiate overdoses, because we have tons of opiate receptors right here which control breathing, etc. And that leads to another question, “Keven, marijuana’s never killed anybody.” Get that a lot, too. Maybe you get that, too, with clients and others.

That is about as dumb as saying tobacco never killed anybody. Has anyone ever administered naloxone over a tobacco overdose? Has anyone ever overdosed on tobacco that you know of? How about car crashes from tobacco? No. And so, tobacco kills you indirectly, from lung cancer, from other ways that tobacco kills you, but we would never say that tobacco doesn’t kill you just because it doesn’t produce an overdose.

Marijuana, I am very worried about the link between marijuana and mental illness, especially suicide, and also the link with impaired driving car crashes. Thousands of people a year are dying because marijuana hurts your reflexes, your reaction time.
Your brain is doing a thousand things when you drive. You don’t realize it. We’re thinking about where we’re going, what time of day it is. “Can I see well? What am I listening to on the radio? What am I thinking? This guy’s turning in front of me. What street is this? I remember that street.” Your brain is doing a lot of things. And so, marijuana, which hurts your reflexes, your movement, and co-ordination is a huge part of this. So ‘marijuana doesn’t kill you’? I just can never understand that.

Part of the reason I think there’s a lot of misinformation is because today’s parents’ experience with marijuana is a marijuana that is basically a different drug. The THC levels are so much higher today. And people are saying, “Why are they higher?” They’re higher because we’ve become better farmers. We know about agriculture better than we used to.

If you wanted to get good pot back in the day, you really needed some Mexican sinsemilla without seeds. Because the American pot, it was all seeds and twigs and leaves and you’re separating it like a strainer to get the buds. You wanted sinsemilla. There was all this controversy in the late 70s about spraying it with paraquat in Mexico because of American pot users. Now? Forget about it.

We’ve been talking a lot about trade in the news lately, it’s like “Made in the USA” pot really is the best kind of marijuana that’s out there because we have just learned how to increase the THC. We’ve not only learned how to increase the THC for smoking. We now have all these novel ways of ingestion which, I have to tell you, Cheech and Chong couldn’t have dreamed up.

I mean, 98% potent waxes? That doesn’t . . . This research, when I talk about education I’m going to talk about some research later, this is on THC that’s 6% marijuana. We don’t know what 96% does. 6% we know is not good if you’re a regular user. We have no clue what this stuff is doing. But it’s out there on the market.

Again, the average person who votes ‘YES’ when they read a very well-crafted thing that says, ‘Do you approve of adults 21 and over legally possessing marijuana and regulating it like alcohol?’ “Sounds kind of nice. Like, yeah, sure, that seems reasonable.” I don’t think that person realizes that they’re legalizing this. They don’t know what this is. Who’s seen this before?
But that’s what it does and that’s what we’re talking about. And we don’t know the effects of it at all. This is the Butane Hash Oil that many of you know about, probably, in this room. But if I were to ask the average American, “I have a brown, sticky substance at the end of a hot knife, what drug do you think this is?” I don’t think they’re going to say, “It comes from marijuana, that’s THC.”

So, I worry about the sodas, candies, the edibles, the chocolates that look exactly like the chocolates you get at 7-Eleven, the kid-friendly items that the industry says, “No, no, this is not for kids, this is for adults.” It’s like how Philip Morris used to say, “No, cherry gum cigarettes are really for adults who want to take a break from smoking and instead want to use that as chewing gum.” They said that with a straight face. It’s sort of the same thing with the industry today.

The aggressive marketing and the contaminants. People don’t understand the contaminants that are added to get this to be what it is. And the fighting regulations. The special-interest groups in the state capital, fighting every single regulation that you might think is reasonable. You know, we’ve tried to cap the THC potency, that failed. Limit the number of stores, that failed. They’re diverting money to the general fund. And there’s a thriving black market, actually.

People say, “Wait a minute, I thought this was supposed to get rid of the drug dealers, because you legalized it?” You’ve just given the drug dealers more business, folks. You’re taxing it 20-30%. I don’t know about you, but there are a lot of people who don’t want to pay that tax. And they’ll go to the same source that they used to go to. These guys are getting free advertising by the industry, essentially. The demand is increasing.

And there’s a huge grey market now. Like I bought it legally, but I’m selling it, too– you now have the legal market, the illegal market, the gray market. It hasn’t gotten rid of the underground market at all.

It’s amazing, the claims for marijuana. It’s like an infomercial. It’s one substance, it solves all your problems, right? It gets rid of drug cartels and the gangs. It cures cancer. It gets rid of state budget holes. It does everything! Oh, and it saves the environment, too, because hemp can save the environment. So what is this miracle drug? And that’s how it’s really being presented.

I’m going to show some studies quickly, because I do want to get into a discussion, we have about 15 minutes left. A lot of this comes from the New England Journal of Medicine from Dr. Volkow, of course there are caveats, a lot of these are observed among heavier, long-term users, there are going to be confounding factors, absolutely, and it’s very hard to establish causality, of course it is. We’re talking about things that are highly, significantly correlated. In other words, the risk is increasing.

And the analogy I like to use with young people or whomever, just everybody, parents, is that it’s like speed limits. We know a lot of people–I know nobody in this room has ever sped on a speedway, but we know some people we’ve heard of who have–and those people are increasing their crash risk by 20 times. But they’re not caught getting into a car accident. Again, that doesn’t mean going 90 is safe. There’s a risk! But you might get away with it. I know a lot of people that smoked cigarettes their whole life and they died of old age. That doesn’t mean that smoking doesn’t cause lung cancer. It means that it’s a risk, and for them, it didn’t.

The same thing really applies to all drugs. Not everyone who tries heroin for the first time is going to be addicted. We all know that in here. That’s not an argument for trying heroin. That’s an argument to say it increases your risk but, you should know what the risk is.

It’s the same thing with marijuana. I’m not saying that if you smoke marijuana when you’re in junior high school, then you’re going to be a deadbeat and you have no future and you’re going to go use heroin the rest of your life. No. We’re saying that when you look at longitudinal studies with thousands of people over time, the risk for these negative things increase.

And you look at psychosis, schizophrenia, which I think is the biggest issue with high potency marijuana, and you look over time about what’s happening if you use marijuana by 15. This is over a thousand people that have done it in a study in New Zealand, controlling for a lot of things. Four and a half times more likely for schizophrenia-like psychosis by age 25. By the way, this is by age 15 here. By age 18, you’re 1.6 times more likely. So, it’s good, you want to delay use. Guess how many people who have a drug problem, the percentage of users, how many are using marijuana by 15 vs 18? This is like 90%, okay? This is always what I try and tell people, parents and others, if you don’t touch drugs by 21, you’re unlikely ever to do so.

When you look at the opiate epidemic, we cannot look at it as someone who just, is a perfect age, everything is working out perfectly except for the fact that one day they woke up at age 45 and decided to inject heroin. No. There are things that are going on for a long time, multiple substances, multiple issues that we have to look at. And if you don’t touch a substance by 21 you are unlikely, ever, to do so. And that is very, very powerful.

When you look at cannabis dependence and other drug use–which I’m going to talk about in a minute in terms of the gateway issue because it’s controversial and complicated–suicide, high school completion, degree attainment, all these things, welfare dependency, the darker these bars get are the more you use. The more you use, the more likely you are for these things to happen. These are studies with thousands of people over many, many years.

Again, it doesn’t mean that there aren’t some heavy users that never used other drugs. There are. Of course, there are. Just like there’re people who don’t wear their seatbelts and don’t die in a car accident. Absolutely. But if you didn’t wear your seat belt and get in a car accident, you’ve increased your chances of dying 15 times. In this case, you’ve increased your chance for other drug use, if you’re a daily user, by 8 times. Okay, doesn’t mean it’s going to happen to you, but you’ve increased the chance.
I always have to remind kids that the plural of anecdote is not data. People love to go, “Oh, but my friend!” “But I knew!” “But there’s this really successful guy!” “I read Steve Job’s autobiography and I mean, Kevin, he created the phones we’re using and he used drugs!” Great. It doesn’t matter. What matters is evidence over time, and this is what I’m concerned with.

Skip over the workplace issue. You know, this whole issue of gateway, the issue is that, yes, most people who use marijuana will not go onto other drugs. That’s true. That’s definitely true. But the vast majority of those who use other drugs, marijuana and alcohol were used in their adolescence and were used before they used those other drugs. So, the question is, why is there the link there? What’s going on? And, actually, that’s difficult to answer. We don’t really know. There’s some animal data talking about how mice who are administered THC are then more likely to be avid heroin seekers. Also in-utero, more likely to be avid heroin seekers if their– there’s a lot of interesting research going on. And we need to find out what that is.

But to only talk about the opiate epidemic in the context of pills and heroin is to forget the role of other drugs and what else is going on. It’s very tempting to do that because marijuana is a political hot potato and it’s like, “I don’t want to get into an argument with somebody who says that it’s great and medical or they used it for their cancer, so let’s just kind of avoid it and talk about, you know, apple pie, baseball and heroin.” No one is saying like, “You’re saying heroin’s harmful? That’s a conspiracy!” No, nobody’s saying that. But they are with marijuana. It’s amazing.

The only question I stumped Nora Volkow on, only one she didn’t have an answer for me was, “Why do we only see marijuana users protesting for their right to use their drug of choice?” I have never seen a heroin protest. I have never seen alcoholics saying, “Why is my alcohol so expensive?” I don’t see smokers with the highest tax rate on smoking in this country’s history. There’s a smoking lobby, but I don’t see smokers saying, “You’re wrong! I’m using it, and I don’t have cancer. Stop making it expensive, you’re wrong!”

But there’s something about marijuana, I don’t know what it is. It becomes this religion; it becomes a crusade. I don’t know if in your clients you’ve seen this. And actually, that’s part of this insidiousness, it doesn’t hit you in the face.

Heroin is hard to deny. Addiction denial is the hallmark of addiction, of course, with everything. But once it’s sort of out in the open, it’s hard for the family, with a meth-use disorder, to say, “Well, actually, that’s not really getting in the way of what they’re doing. They use meth three times a day, but they function.” That’s kind of a hard sell.

But with marijuana, there is this slow kill over time. It’s like, no, you didn’t lose all your teeth with one thing, and have the other meth thing, or the heroin. But, you know, this year you lost those friends that you had because you were more in love with your pot in 8th grade. And then, in 10th grade, you got the Cs and Bs rather than the As and Bs, but we’ll work on it. And then in 12th grade, that job that you wanted, actually you didn’t make it for that one so you have to go to this. And then that school you wanted to go to, didn’t get there, but then you went to the lower one.

And it’s just like, on their own, things happen in life. Not everybody does what they want to do, and you can kind of justify it and whatnot. But when I read these studies and look over time and talk to marijuana users 30 years on, over time, or in recovery, there is this pattern. When you look at this in its totality, it’s a problem. When you look at it on its own, you’re like, “Well, you didn’t get the job. Okay. Not everybody does that.” But in the totality, it’s a problem.

And I worry that if we then start to promote this in such a heavy way, like imagine if we had national legalization in the next five years. I worry that this is in a sense, a dumbing down, that over time it is going to affect society. It may not affect us yet. It’s not, again, like heroin that’s in your face. But that’s part of why I think it’s dangerous and why I think it’s worrisome.
There’s a lot of data in Colorado that I’m not going to go through. The Colorado issue is, we’re still learning, it’s new, but the early picture isn’t good. More kids are using, more kids in criminal justice are using, there are more kids in treatment for marijuana now than there were before, more violations in schools.

Oh, by the way, it’s not exactly a state budget. Now last time I heard, you had a lottery in Illinois, right? So, is the public-school system saved yet? I mean, the lottery money, what happened? What’s going on? I have an alcohol treatment, fully funded, for anyone who needs it. Because that’s what we’re promised with these things. “You’re going to get money! Money’s going to come! Revenue!” That’s the promise. I’ve never seen that materialize.

I always laugh when people say, for example, “We brought in $118 million in taxes! That’s awesome!” And then I say, “Great, that’s really cool. What were the costs of that?” “Oh, we don’t know. We don’t count the costs of it.”

Well, wait a minute? That’s like having a business and saying, “I sold $300,000 worth of T-shirts last years. This is awesome!” And then you say, “Okay, well, but how much did it cost you to make the T-shirts?” “A million dollars.”

That’s a losing proposition! We’re not counting. It’s like we’re not looking at the back of the ledger. We’re looking at the front. “We’ve made all this money!” Wait a minute. How much does it cost us?

Drugged driving. Productivity in the workplace. Colorado workplace positives are skyrocketing. And the largest construction company in that state now has to hire from Wyoming. They’re thrilled, by the way. Because they can’t get someone to pass the drug tests to work in construction. You can’t take that risk. I think over time we’re going to see the cost, but we’re just beginning to see it now.

By the way, on alcohol and tobacco—surprise, surprise—we make zero-zero-zero money. We lose so much money from our appetite for these two legal drugs. For every dollar in revenue, we give back about 15. That’s the reality of addictive substances. And by the way, the costs here are probably 15% of the drinkers. It’s not that we’re all having the same cost.

Emergency room admissions –this is from one hospital— I’m worried about little kids picking up the cookie, the brownie, the candy bar. And rather than just wait and have that discussion and look at the science, the industry moved at 200 miles per hour to get those edibles on the shelf. They wanted new markets.

People don’t like to smoke anymore. Smoking is out of “oke.” So you bring them back by saying: “Well, you don’t have to smoke, but you can have this really good chocolate bar.” “Sounds good, I love chocolate.”

Then you have the chocolate bar and you have a panic attack and you go to the hospital, and then they say, “Oh, well, how much did you eat of the chocolate bar?” “Well, I ate what was in the serving, I ate the bar.” “Oh, no, no, no, the actual serving is you’re supposed to cut it in ten pieces.”

You know? And they say the serving size is a tenth of that. “Well, why don’t you sell it like that?” “No, no, we sell the whole thing.” This is a huge part of the issue. And there’s no dosage or anything like that.

Some more data: the arrest rate for blacks and Hispanics for marijuana possession, among kids, has gone up 58% and 29%. Hah! They said this was a social justice thing. They said pass legalization so we can stop arresting kids, especially minorities. Wait a minute. If there’s disproportionate arrests, then look at your criminal justice system as a whole. Don’t think that you’re solving that by legalizing, because, again, where are the marijuana stores?

Well, let’s look at Denver. Denver, green is upper-class Caucasian, purple is African-American, orange is Hispanic. So it’s like Hispanic, African-American, white. Where are the pot shops? They’re all in lower class communities. This was supposed to be a social justice thing. That’s what they said. Again, it’s not materializing.

There’s a lot of data from Los Angeles saying the same thing. Dispensaries are opening in areas with a higher proportion of black residences, closing in commercially zoned land. They’re concealing their presence. This researcher said, “They’re locating in areas that will not advocate against their presence.”

You go to the places where there’s no political power. Because guess what? If someone wants to open a pot shop in your community, with your precious children, you’re going to be saying, “I don’t want one here. I mean, yeah, you can have them if you want, but not here! Do it over there.” That’s what’s happening. And, you know, we’re not really talking about it.

Crime around the areas of these dispensaries is going up. There’s a new study from last week in the Journal of Primary Prevention talking about 84% more property crimes in these small areas they were looking at.

You know, this whole issue about marijuana use, there was this study saying, “Oh, it hasn’t really increased.” We actually are seeing some increases in some grades; some decreases in others. Nationally. But, if you were to look at this chart, this is marijuana use, ‘93 to 2015. Sort of looks like there’s no real change. Kind of flat, went up, and then down, it’s kind of flat. You’ll say, “Well, wait a minute, Kevin, where’s this increase in pot use from legalization?” Well, that’s a good question. This is a CDC study. When you look at that study, guess which states are not included in that study? Permission to distribute, in waiting. Colorado, Oregon, and Washington. And yet an industry publication last week showed this chart, and said, “Look! Pot use ain’t going up. Look at this.” It’s the CDC! I mean it’s incredible.

When you do look at all states together, you look at the annual prevalence of alcohol, which has gone down 2%, the light purple. Every drug except for marijuana, which is dark purple, has gone down. Look at this, 18.5%. This is heroin and cocaine, 14% now among seniors. And you look at marijuana, it’s gone from 31% to 35.6%. Not a huge increase, but that’s an increase where everything else is going down when you look at all states.

When you look at Colorado individually, with another survey where you actually do look at their data, the use is going up. There are a lot of games being played on this, and a lot of this stuff about how marijuana use has not gone up in Colorado when in reality we are seeing increases.

Going to fast-forward through some of this stuff. The National Academy of Sciences is a great reference for a report that has come out on that, there’s a lot of data there. You know, our power is moving from institutions to people in a way, in our politics. So people aren’t listening to the National Academy of Sciences, but they are listening to their 30 people on reddit who created a webpage about how great pot is. This is part of an interesting kind of movement, and I worry about it, because we’re losing the sanctity of science.

Last slide. It wasn’t long ago that we advertised cigarettes like this. We thought we could never turn the clock. We thought that tobacco would be here forever. If you told anybody 30 years ago, no more smoking in planes and no more smoking in restaurants and no more smoking in most movies, they would have thought you were crazy.

When I talk to anybody under 25 today, they think I’m lying when I say you could actually smoke in the air, you could actually smoke at a restaurant. They don’t even understand that concept. It’s amazing how that’s changed in a small period of time. Those messages have been replaced and smoking has fallen.

I think we can do that for marijuana. I don’t think that this is inevitable. I actually think that over time, I hope it’s sooner rather than later, but that the 10% of marijuana users’ interests are not going to be above the 90% of everyone else, which is what they are now. This is not alcohol. This is not something used by 70% of the population for the last 5,000 years. And so, the time’s going to run out. I hope it runs out sooner rather than later so we have fewer problems.

But it might take a hundred years for our grandkids to say, “Wait a minute, they said pot gummy bears were a good idea? What were they thinking?” Colorado, Denver is voting back marijuana in restaurants. Smoking in restaurants. Marijuana. And I think that we’re going to look back at this and say, “What was going on?” I hope, sooner rather than later, we do that.

I have a website with tons of information there, SAM, it’s called www.learnaboutsam.org. This is my personal email address. Illinois is going to be a key place actually to discuss; it’s where these discussions are going on. Dr. Weiner is here. I was with him this morning. Linden Oaks is going to be really helping us on some of the awareness in the state of Illinois and I’m sure he’d appreciate hearing from you, as would I, if you’re interested in sort of being . . . Whether it’s being active in Illinois, giving your testimonial, just being on our newsletter, we’d love to engage with you. We’re not funded by any industry; we don’t have the money that the other side does, but I think that people will realize sooner rather than later that we need to wake up.
I have to tell you, I was at a UN meeting a couple of years ago, when I was representing the US. I was sitting a table with China, Singapore, South Korea and us. While they were talking about how they’re getting ready, creating jobs and technology and paying teachers more and education and youth of the future, they were looking at the headlines in New York and asking me why we’re focusing on what color the pot gummy bear should be.

Their argument was, “You know, Kevin, you want to go ahead and legalize marijuana, please go ahead and do that. Let us know how it goes in 10 years. We’re over here creating jobs and futures for our kids. You’re over there exposing them to something that is going to hurt their chances of success in life.”

That was a very interesting moment in international relations. A moment of embarrassment, I’ll readily admit. We need to wake up and realize that this is a central part of our work in addiction. So, thank you all for what you’re doing, every day, saving lives. I hope you learned something. Thank you for inviting me, PSI. Thank you.

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