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Cannabinoids pseudoscience vs science

Smoked or vaporized dried cannabis -oral processed Cannabis- Cannabinoids: Synonyms? Illness? Personal Health? Public Health?

By Arnaldo Cruz Igartua MD, 2020; update September 2021

Ref. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research, 2017

Ref. Persistency of Cannabis Use Predicts Violence following Acute

Psychiatric Discharge, Front. Psychiatry; Jules R. Dugre et al 2017

Ref. Patterns of marijuana use among psychiatry patients with depression and its impact on recovery Journal of affective disorders; Published Online: February 13, 2017

Ref. Cannabis use and risk of psychiatric disorders; Prospective Evidence

From a US National Longitudinal Study; Carlos Blanco, MD, Ph.D. et al.

JAMA Psychiatry. 2016. “

Ref. Other references are summarized bellow

We are presenting the recent evidence with downable references from the internet. The purpose is to help to clarify many ethical issues; irrational ideas and wrong definitions that are presented in an unethical way as science but are really not.

Pseudoscience definitions/ methods in propaganda and PR “Medical Cannabis” laws:

The dangerous impact of this poly-drug (contain 4 known addictive drugs) has been potentiated by the misinformation in media and the incorporation of pseudoscientific terminology in legalization laws. These actions are provoking wrong communication, and pseudoscience like publications by nonscientific people and even by some health professionals. The impact in patients and in adolescents is even a greater magnitude and level of confusion than in health professionals. The use of terms “medical “ and “recreational” are both a creation of the marijuana industry and should not be used in scientific studies. No “recreational use” should be attributed to any psychoactive substance (legal or illegal) and less if it represents evidence of damage to personal or public health. Reaction in science is related to sport or to art or other healthy pleasures that are done in a safe and moderate way. What is described in science is the use of substances in terms of quantity and frequency to assess a possible relation to adverse consequences.

The actual use of smoked dried cannabis or vaporized or THC derivatives in a patient with depression, anxiety, or psychosis complicates a lot the possibility of treatment if the patient does not accept to stop smoking, inhaling, or eating its unstandardized cannabis derivates. The doctor has to educate the patient about the active effect of the four THC-like psychoactive cannabinoids that have smoked dried cannabis and the worsening of prognosis if not discontinued before starting a psychiatric treatment. The use of smoked dried cannabis, cannabinoids as synonyms is confusing and damaging the serious study in this field that tries to find the benefits of standardized cannabinoids in medicine (not of cannabis nor of smoked dried cannabis). The purified CBD (cannabidiol) with less than 0.3mg of THC may be less interfere to psychiatric treatment in theory but in practice; the lack of standardization of products makes it almost impossible to know what the patient is really using nor the dose either. The lack of standardization and the hundreds of psychoactive components of these substances had resulted in the fact that no hospital in the USA is allowing the use of any non-FDA-approved cannabinoid product during hospitalization.

The propaganda increases the distortion of definitions augmenting the communication problems. Education on the contrary is based on evidence provided by science, history, logic, and social values. The propaganda has the immediate goal of power or sale. Education and medical treatment have the goal of increasing wellness and health that eventually result in economic prosperity. Government in democratic countries have the responsibility of fomenting industry but at the same time balancing and protecting the health of populations (public health). This balance is lost if the gourmet does not follow Public Health recommendations and worse when legalizing pseudoscientific terms and procedures. The propaganda of addictive substances (and polysubstance like smoked or processed dried cannabis) and legalization of the wrong definition of terms is a growing barrier in doing good scientific research and making propaganda and more accessible the smoked dried cannabis. The result is making research, prevention, and treatment less effective and less available to poor people in need of professional services and making free propaganda to the growing legal and illegal industry of addictive substances. This is clearly against what recommends Public Health and has negative consequences.

In the past 3 decades, the PR government had not given enough funding to treat mental illness as to treat other physical illnesses. About 9 out of ten people in need of specialized addiction treatment o do not have access to it. The situation is getting worse when in last 10 years some states of USA

(and last years in PR) government enters actively into the reality distortion propaganda using pseudoscientific terms to normalize smoked dried cannabis as saying that is “a medicine”. This is having a negative impact on Public Health.

The government has promoted smoked dried cannabis legislating the legalization of industrial (invented by the industry) - pseudoscientific (false science that present as true science) information classifying it as a medicine; “medical” cannabis. This misinformation propaganda and liberalization is having negative Public Health consequences like increased smoking, emergency rooms visit, and accidental intoxication of children and others. If governments follow Public Health guidelines, they will use scientific terms like Medical use of cannabinoids (not of cannabis nor of smoked dried cannabis). The problem increases when they legalize these pseudoscientific terms and a pseudoscientific use of any cannabis compound nonstandardized no doses and in several dangerous ways of intake (like inhalation, smoking, eating, and “artisanal use”). The response of several medical institutions has been not consistent and several medical professionals are incorporating these pseudoscientific terms and methods as “a new way of doing science research”. There are many publications that present a lot of confounding factors and could not be conclusive nor replicated. This is becoming a real barrier to the finding of genuine medical use of cannabinoids (not cannabis nor smoked dried cannabis).

Modern medicine could not recommend any smoked substance nor any non-standardized substance (and less a polysubstance) because of the unpredictable positive and negative or dangerous effects that may have on each person. There may be the exception of palliative use in terminally ill cancer patients. Only a few standardized decarboxylated cannabinoids and synthetic cannabinoids have been standardized and have shown medical use and are FDA approved (Epidiolex, Marinol, and Cesamet).

To improve studies and finding of possible other medical uses the researchers need to start using again the correct scientific terms and methods and stop using pseudoscientific ones that make “free propaganda” to the smoked or inhaled cannabis industry.

Science evidence shows that Cannabis (cannabis flower or leaves) is not a substance not a medicine but a plant; if processed by heat suffers an artificially induced chemical change. It does not become a substance but an addictive polysubstance with an unknown concentration of each of the more than 200 psychotropic components (4 addictive decarboxylated phytocannabinoids plus about 100 other decarboxylated phytocannabinoids and 150 terpenes). The actual cannabis flower content of addictive THC available in dispensaries had increased from 0.03% to 30% by the action of cannabis industry manipulation.

Cannabis is a raw plant with about 500 compounds and has no medical use. The dry form is known in the street as marihuana (smoked dried cannabis) and has no phycological addictive or mental effect in its natural form. So that it has to be changed its natural form chemically by heating it to transform it into a polydrug; activating (by decarboxylation) four addictive drugs (9THC, 8THC, CVN, THCV) and about 100 other cannabinoids that it contains. If smoked has been shown to be an irritant and toxic as smoked tobacco. Both Tobacco and smoked marihuana has about 4K substances (like hydrogen cyanide, tar, ammonia, and 20 known carcinogenic substances. In terms of cancer risk, there are not many studies yet but one reveals that smoking 1 cigarette of marihuana a day is equivalent to 20 cigarettes of tobacco a day in terms of cancer risk.

The scientific terminology for “marijuana addiction” and other related disorders is cannabis use disorder. Really most of these disorders are related to the THC like adverse and neurotoxic effects of dried smoked cannabis or of synthetic cannabinoids. There is a wrong idea that this addiction to smoked dried cannabis is easier to treat than other addictions to other substances. What makes it more difficult to treat a patient is not the substance or substances that use but the sum of several factors: a. the severity of his illness and/or possible use of other substances b. the complexity (possible other concurrent mental/physical disorders) and the severity of these disorders. c. the family support d. the age of beginning the use the patient (the younger the more damage)

In Dr. C Igartua experience there are some patients with a severe addiction to marijuana (and this also apply to patients with a severe addiction to any other substance) that could not be treated with success in intensive ambulatory programs and need an inpatient specialized therapeutic community for their treatment for several months of their long term treatment and maintenance.

There is an ethical need for informed consent for the experimental use of non-FDA substances.

The “Informed Consent” should explain the terminology and specific composition, possible indications, contraindications, and side or toxic possible (short and long terms) effects of any of the derivates that are recommended or dispensed to the people. There is a need for clear science terminology and explain that the law uses nonscientific ones as synonyms for many different compounds. In the following evidence, you will see a brief summary of the most common positive effects of standardized (in doses) decarboxylated cannabinoids and synthetic

cannabinoids and side-toxic effects of dried-smoked- vaporized inhaled or processed swallowed cannabis.

The International Statistical Classification of Diseases and Related Problems (ICD-10) is published by the World Health Organization and classified near 50 different codes of cannabis-related disorders depending on the symptoms associated with intoxication (F12.2 is for cannabis dependence including newborns affected by maternal use of cannabis, poisoning by cannabis derivatives, anxiety, psychosis, delusions, withdrawal, intoxication, and others).

The Diagnostic and Statistical Manual of Mental disorders (DSM -5) present the following definitions of the multiple mental symptoms and disorders associated to smoked/ inhaled/ eaten processed cannabis plant:

Cannabis-Related Disorders: Cannabis Use Disorder: Cannabis Intoxication: Cannabis Withdrawal; Other Cannabis-Induced Disorders; Unspecified Cannabis-Related Disorder Cannabis Use Disorder Diagnostic Criteria A. A problematic pattern of cannabis use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:

1. Cannabis is often taken in larger amounts or over a longer period than was intended.

2. There is a persistent desire or unsuccessful efforts to cut down or control cannabis use.

3. A great deal of time is spent in activities necessary to obtain cannabis, use cannabis, or recover from its effects.

4. Craving, or a strong desire or urge to use cannabis.

5. Recurrent cannabis use resulting in a failure to fulfill major role obligations at work, school, or home.

6. Continued cannabis use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of cannabis.

7. Important social, occupational, or recreational activities are given up or reduced because of cannabis use.

8. Recurrent cannabis use in situations in which it is physically hazardous.

9. Cannabis use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by cannabis.

10. Tolerance, as defined by either of the following: a. A need for markedly increased amounts of cannabis to achieve intoxication or desired effect. b. Markedly diminished effect with continued use of the same amount of cannabis.

11. Withdrawal, as manifested by either of the following:

a. The characteristic withdrawal syndrome for cannabis (refer to Criteria A and B of the criteria set for cannabis withdrawal, pp. 517-518).

b. Cannabis (or a closely related substance) is taken to relieve or avoid withdrawal symptoms.

Specify if: In early remission: After full criteria for cannabis use disorder were previously met, none of the criteria for cannabis use disorder have been met for at least 3 months but for less than 12 months (with the exception that Criterion A4, “Craving, or a strong desire or urge to use cannabis,” maybe met). In sustained remission; After full criteria for cannabis use disorder were previously met, none of the criteria for cannabis use disorder have been met at any time during a period of 12 months or longer (with the exception that Criterion A4, “Craving, or a strong desire or urge to use cannabis,” may be present).

Specify if: In a controlled environment: This additional specifier is used if the individual is in an environment where access to cannabis is restricted.

Specify current severity: 305.20 (F12.10) Mild: Presence of 2-3 symptoms. 304.30 (F12.20) Moderate: Presence of 4-5 symptoms. 304.30 (F12.20) Severe: Presence of 6 or more symptoms.

Decarboxylated Cannabis and cannabinoids; recent scientific and epidemiological evidence

Ref. Cannabis or experimental cannabinoids? Arnaldo Cruz Igartua MD, Galenus, PR medical college of Surgeons, 2015


1. Decarboxylated cannabis, cannabinoids, and dried smoked/ vaporized cannabis are not synonyms and should not be used as such by scientific or health professionals. “Medical Cannabis” is not a scientific term; is pseudo-science (appears to be science but does not follow scientific definition nor a scientific methodology). This term was invented by the marihuana industry serving its commercial purposes and was adopted in the legalization process and laws as pseudoscience wording (that confound many people as if it is science or medicine without being). This terminology or methods to use marihuana in artisanal nonscientific standardized ways in the legalization is not real science.

2. Cannabis in scientific language is the green plant that is this natural raw state has no medical use and no psychoactive effect. Only after activated by a man artificially induced chemical reaction named decarboxylation produced by 200 degrees F, half-hour or more of heating. So that the “natural plant is not psychoactive” until there is this chemical change induced artificially by the user or by the laboratory.

-The cannabis definition in science is the green alive plant. In its natural form is not psychoactive and has no medical use. - The THCA in cannabis begins to decarboxylate at approximately 220 degrees Fahrenheit after around 30-45 minutes of exposure. Marihuana is a street name to the dried plant (flowers or leaves) that also has to be artificially decarboxylated by burning or by 30 minutes enough heat to activate it. 3. Cannabis decarboxylated extractions are not a drug or a substance but a complex polydrug with 4 known addictive substances of the about 110 known phytocannabinoids and the about 150 known terpenes. Is impossible to do any valid scientific study in medicine without standardizing and /or isolating the multiple components of the polysubstance. There are hundreds of known inbreeding of different industry-made strains. In a single plant, no single leaf or flower has the same combinations of cannabinoids and in different ages of the plant, these compositions also change. There is no way of making science or medicine using these materials without processing the raw plant and without standardization. 4. If heated and inhaled, vapors it generates more than a hundred chemicals, many of which are proven irritants to the respiratory system. If smoked it generates about 4K chemicals, about 20 identified cancer generating ones, hydrogen cyanide, tar, and ammonia very similar to smoked tobacco but in higher concentration by volume of a burned substance. Modern medicine could not use or recommend smoke contaminated substances as medicine nor unstandardized substances with no precise knowledge of its components nor a precise dose of each of them. Palliative use of smoked marihuana or other substances in terminal cancer persons is validated by medicine as a humanitarian “harm reduction approach” but not as a scientific use of medicines.

5. There is a lot of studies ongoing but many uses nonscientific language (industry language) and nonscientific methodology (use anecdotic cases or unstandardized products with no dose). These pseudoscience studies are confounding and delay the serious ones becoming a barrier to science.

We summarized below a collection of serious studies and include in quotation their results. We encourage you to read the direct references given. The great majority of references mentioned are readily available for download at www. We recommend reading original papers for important details.

A. Cannabinoids Studies: (decarboxylated phytocannabinoids extractions or synthetic cannabinoids standardized and dose delivered)

4 Proven Benefits of Standardized processed in dose (for example drops, pills, or spray) Cannabinoids (is not cannabis nor marihuana)

Ref. The Health Effects of Cannabis and Cannabinoids:

The Current State of Evidence and Recommendations for Research, 2017

Today there is only 4 proven “modest effects” (not strong effects) of standardized and specific doses of cannabinoids (not of cannabis nor marihuana nor smoked nor inhaled):

1. Antiemetic In adults with chemotherapy-induced nausea and vomiting, oral cannabinoids are effective. FDA standardized Marinol/Dronabinol; Nabilone/Cesamet

2. Analgesic In adults with chronic pain, patients who were treated with cannabis or cannabinoids are more likely to experience a clinically significant reduction in pain symptoms. More studies using cannabidiol (CBD).

3. Patient-Reported Spasticity In adults with multiple sclerosis (MS) related spasticities, short-term use of oral cannabinoids (not clinically measured) spasticity symptoms. (standardized Sativex- Namiximol)

4. Dravet’s Syndrome Epilepsy; (not in other epilepsy) FDA approved Epidiolex that is a standardized CBD tincture.

These proven benefits in these particular areas are not at all free of possible risks of adverse and side effects:

Ref. The PDR, The GW Pharma on Sativex 1. THC- Marinol: can worsen certain mental illnesses, such as mania, depression, bipolar disorder, or schizophrenia. Increased heart rate, decreased blood pressure, and fainting. Marinol could alter mood or cause feelings of being "high".

2. CBD/ Epidiolex: drowsiness, decreased appetite, diarrhea, transaminase elevations (enzymes elevation due to liver irritation), fatigue, feeling unwell (malaise), weakness/lethargy, rash, difficulty sleeping (insomnia, disordered sleep, and poor quality sleep), and infections (immune suppression effect).

3. CBD/ THC -Sativex: lack of energy or feeling weak or generally unwell; problems with your memory or having trouble concentrating; feeling abnormal or drunk; feeling sleepy or drowsy; blurred vision; constipation or diarrhea; feeling or being sick; loss of balance or falling over; changed sense of taste or a dry mouth; mouth problems, including burning, pain or mouth ulcers.

B. Evidence of Medical Health Adverse effects of Smoked- Inhaled, Processed-Eaten Marihuana

There are several studies that show dangerous effects of smoked or inhaled or eaten processed marihuana (not of prescribed standardized cannabinoids) on humans

1. Ref. The Health Effects of Cannabis and Cannabinoids:

The Current State of Evidence and Recommendations for Research, 2017

Substantial evidence that: Initiating cannabis use at an EARLIER AGE is a RISK FACTOR for the development of problem cannabis use Increases in cannabis use FREQUENCY and the PROGRESSION to developing problem cannabis use. MAYOR DEPRESSION disorder is a RISK FACTOR for the development of problem cannabis use. The use of illicit drugs and alcohol. Moderate evidence of a statistical association between cannabis use and Development of Substance Dependence and /or Substance Abuse disorder for substances, including ALCOHOL, TOBACCO, and other ILICIT DRUGS.

2. Ref. Pattern of marijuana use during adolescence may impact psychosocial outcomes in adulthood Journal of Addiction, Erika Forbes, Ph.D. Et al 2017

This study shows how an adolescent uses marijuana, in particular, a pattern of escalating use, which may make an adolescent more prone to higher rates of Depression and Lower Educational Accomplishments by the time they reach adulthood.

3. Ref. Persistency of Cannabis Use Predicts Violence following

Acute Psychiatric Discharge, Front. Psychiatry; Jules R. Dugre et al 2017

The longer individuals reported using cannabis after psychiatric discharge, the more likely they are of being violent in the following time waves. Of 1136 studied patients, the ones that reported using cannabis were 2.44 more likely to display Violent Behaviors

4. Ref. "Drug Facts: Marijuana," NIH and National Institute on Drug Abuse (NIDA), Revised September 2015

Raw and smoked marijuana is toxic, not medicinal. The amount of THC in marijuana has steadily increased, creating more harmful effects for users. The National Institute of Health USA summarizes a number of possible harm, both physical and mental, from the use of marijuana such as: “Marijuana can be addictive, dulls the senses, produce mood swings, altered body movement, difficulty thinking, decrease in problem-solving, impaired memory and learning, respiratory illnesses, damage to the brain of a fetus in pregnant clients, hallucinations and paranoia. The treatment for marijuana addiction includes various forms of behavioral therapy. Currently, there are no medications for the treatment of marihuana addiction.

5. Ref. "Can marijuana use affect driving ability?"; National Institute of Drug Abuse (NIDA and NIH), in September 2015.

"Among the drivers who have been involved in a car accident, which have had positive results on tests of THC in the blood, and especially those who have higher levels in their blood are three to seven times more likely to be responsible for the accident than those who have not used drugs or alcohol. The risk related to marijuana and alcohol combined seems to be higher than that of having used any of these substances by themselves"

6. Ref. “The association between cannabis use and depression: A systemic review and meta-analysis of longitudinal Studies The association between cannabis use and depression: A systematic review and metanalysis of longitudinal studies. Article in Psychological Medicine · Syahran Ran et al. June 2013

Conclusions. Cannabis use, and particularly heavy cannabis use, may be associated with an increased risk for developing depressive disorders. There is a need for further longitudinal exploration of the

association between cannabis use and developing depression, particularly taking into account cumulative exposure to cannabis and potentially significant confounding factors.

7. Ref. “Association of Cannabis with Long-term Clinical Symptoms in Anxiety and Mood Disorders: A Systematic Review of Prospective Studies George Mammen et al Clin Psychiatry 79:4, July/August 2018 Conclusions: Recent cannabis use was associated with negative long-term symptomatic and treatment outcomes across AMD. The findings should be interpreted with caution, considering the observational designs across studies and the biases associated with the samples (e.g., inpatients) and sources of cannabis consumed (i.e., unregulated sources). Nonetheless, clinicians can use the insight gained to inform their own and their patients' knowledge concerning potential risks of cannabis with regard to symptoms of AMD.

8. Ref. Textbook: Cannabis and Cannabinoids, Pharmacology, Toxicology, and Therapeutic Potential, Franjo Crotenhermen, MD Ethan Russo, MD, 2002

"The cannabis plant and the products of the crude drug (marijuana, hashish, and hashish oil) are complex natural products

with a wide variety of chemical components. As shown in this chapter, there are 483 different identifiable chemical compounds are known to exist in cannabis. The suggestion that crude marijuana drugs should be approved as a medicine, particularly in smoked form, goes against the scientific judgment when considering the huge number of components that ingested a product of this kind.

Smoked-Inhaled Marihuana possible adverse effects:

---Poorer psychological adjustment, more persistent (4 to six weeks after abstinence) or permanent impairments

---Damage is gradual and cumulative may become permanent

---Affects executive prefrontal brain ability to:

Shift and sustain attention; Selective and divided attention

Reduced working memory, Complex tasks, Short term memory

---Addiction with rapid withdrawal symptoms (depression and anxiety after few days of smoked or oral use)

---Mental Symptoms such as anxiety, interpersonal sensitivity, panic, and agitation

---High doses may produce transient psychosis with Hallucinations (Visual-Auditory), Delusions, Hypomania

--- Immunosuppressive; increase risk of infection in immunosuppressed patients

---Reproductive- Endocrine: Decrease LH, FSH, Testosterone and

spermiogenesis (also affect the morphology of sperm) in smokers with possible oligospermia in heavy users, may lower libido and potency

---Transient inhibit prolactin, estrogen, and progesterone release could lead to anovulatory and shortened menstrual cycles

--- Acute activation (with tolerance development) of hypothalamus-pituitary-adrenal axis increasing heart rate and anxiety

--- Care with diabetics: Decrease plasma GH, TSH,

changes in glucose tolerance and insulin secretion

9. Ref. A Comparison of Mainstream and Sidestream Marijuana and

Tobacco Cigarette Smoke Produced under Two Machine Smoking

Conditions David Moir et al

Tobacco smoke contains over 4000 identified chemicals, including

more than 50 that are known to cause cancer. Most of

the chemicals, including carbon monoxide, benzene, formaldehyde,

and hydrogen cyanide, are formed during the combustion

of the tobacco. Tobacco and marijuana smoke have been found to qualitatively contain many of the same carcinogenic chemicals. It is worth noting that the effort to prove the causal links between tobacco smoke inhalation and disease, including lung cancer, even though smokers, nonsmokers, and former smokers could be readily identified and tracked, required decades of case-control and prospective epidemiological studies and reviews.

In this study, ammonia was found in mainstream marijuana smoke at levels up to 20-fold greater than that found in tobacco. Hydrogen cyanide, NO (nitrous oxide), and some aromatic amines were found in marijuana smoke at concentrations 3–5 times those found in tobacco smoke. Many of the analytes detected in the smoke condensates are known to be cytotoxic, mutagenic, and/or carcinogenic. Marijuana smoking is associated with long-term pulmonary inflammation and injury.


STUDY Sarah Aldington et al.; Eur Respir J. 2008 February;

Results: There were 79 cases of lung cancer and 324 controls. The risk of lung cancer increased 8% (95% CI 2% to 15%) for each joint-year of cannabis smoking, after adjustment for confounding variables including cigarette smoking, and 7% (95% CI 5% to 9%) for each packyear

of cigarette smoking, after adjustment for confounding variables including cannabis smoking. The highest textile of cannabis use was associated with an increased risk of lung cancer RR=5.7 (95% CI 1.5 to 21.6), after adjustment for confounding variables including cigarette smoking.

Conclusions: Long term cannabis use increases the risk of lung cancer in young adults.

The following SPECT images show the cumulative brain damage to the pre- frontal cortex. A decreased metabolic activity is the result of years of use of smoked or inhaled marihuana. The frontal lobes executive functioning is impaired specially in adolescents and young adults that has not developed the myelinization/ maturation of them.

Figure 33 Comparison between a normal Single Photon Emission Tomography (SPECT) and smoked marihuana users.

See what appears as holes in the upper part of the brain of smokers is the low metabolic activity of these areas affecting the frontal lobe executive functions. This increases the risk of developing SUD to cannabis and to other substances or to develop other mental disorders. Also, decrease the beneficial effect and prognosis to psychiatric treatment.

Normal SPECT (nonsmoker)

Evidence of Public Health Damages after legalizing pseudoscientific terms, procedures, and smoked/ artisanal use of marihuana. (These are only briefly summarized data. Please read the original reference for important details; al is easily found to download at www).

1. Ref. Centennial Institute epidemiologic study; Colorado 2017

Executive summary

•For every dollar gained in tax revenue, Coloradans spent approximately $4.50 to mitigate the effects of legalization

• Costs related to the healthcare system and from high school drop-outs are the largest cost contributors

• While people who attended college and use marijuana has grown since legalization, marijuana use remains more prevalent in the population with less education

• Research shows a connection between marijuana use and the use of alcohol and other substances

• Calls to Poison Control related to marijuana increased dramatically since the legalization of medical marijuana and legalization of recreational marijuana

• About 15 people are severely burned as a result of marijuana use per year

• People who use marijuana more frequently tend to be less physically active, and a sedentary or inactive lifestyle is associated with increased medical costs

• Adult marijuana users generally have lower educational attainment than non-users

• Research does suggest that long-term marijuana use may lead to reduced cognitive ability, particularly in people who begin using it before they turn 18

• Yearly cost-estimates for marijuana users: $2,200 for heavy users, $1,250 for moderate users, $650 for light users

•69% of marijuana users say they have driven under the influence of marijuana at least once, and 27% admit to driving under the influence on a daily basis

• The estimated costs of DUIs for people who tested positive for marijuana only in 2016 approaches $25 million

• The marijuana industry used enough electricity to power 32,355 homes in 2016

• In 2016, the marijuana industry was responsible for approximately 393,053 pounds of CO2 emissions

• Marijuana packaging yielded over 18.78 million pieces of plastic

Figure 34 Calls to Marijuana poison

2. Ref. Lessons Learned from Marijuana Legalization in Four U.S. States and D.C. March 2018, Smart Approach to Marijuana (SAM), Reviewed by researchers from University of Colorado at Denver Johns Hopkins University Harvard Medical School Children’s Hospital Boston University of Kansas.

-Since Colorado, Washington, Oregon, Alaska, and the District of Columbia (Washington, DC) legalized marijuana, past-month use of the drug has continued to rise above the national average among youth aged 12–17 in all five jurisdictions (National Survey on Drug Use and Health [NSDUH], 2006-2017).

-Alaska and Oregon are leading the nation in past-year marijuana use among youth aged 12–17 (NSDUH, 2006-2017).

-Colorado currently holds the top ranking for first-time marijuana use among youth, representing a 65% increase in the years since legalization (NSDUH, 2006-2017).

-Young adult use (youth aged 18–25) in legalized states is increasing (NSDUH, 2006-2017).

-Colorado toxicology reports show the percentage of adolescent suicide victims testing positive for marijuana has increased (Colorado Department of Public Health & Environment [CDPHE], 2017).

-In Colorado, the annual rate of marijuana-related emergency room visits increased 35% between the years 2011 and 2015 (CDPHE, 2017).

- Narcotics officers in Colorado have been busy responding to the 50% increase in illegal growth operations across rural areas in the state (Stewart, 2017).

-The false idea that marijuana will reduce the opioid use that was published in most of the public media is now deflated with the new facts:

Figure 35.

Since 2012 in Colorado

• Higher rates of marijuana-related driving fatalities.

• More marijuana-related emergency room visits,

hospitalizations, and accidental exposures.

• Expansion of a lucrative criminal market.

• Increases in marijuana-related crimes and juvenile offenses.

• Increases in workplace problems, including labor shortages

and accidents.

Figure 36.

3. Ref. Association between medical cannabis laws and opioid overdose mortality has reversed over time PNAS vol 116, Chelsea L. Shovera et al. 2019

The association between state medical cannabis laws and opioid

overdose mortality reversed direction from −21% to +23%

and remained positive after accounting for recreational cannabis

laws. The claim that enacting medical cannabis laws will reduce opioid overdose death should be met with skepticism.

4. Ref. "Prevalence of Marijuana Use Among US Adults Doubles Over Past Decade"; National Institute of Health (NIH); October 21, 2015.

"Based on the results of our survey, marijuana use in the United States has increased rapidly in the last decade, with about 3 in 10 people who use marijuana meet the criteria for addiction. Given these increases, it is important that the scientific community provide information to the public about the potential harms of marijuana use, "said George Koob,

Ph.D., director of the NIAAA, (part of the National Institute of Health).

5. Ref. "Marijuana and Medicine: Assessing the science base; Institute of Medicine Preface ix in Joy JE, JA Benson, SJ Watson, eds, Washington, DC: Institute of Medicine, National Academy Press, 1999.

The National Institute of Medicine of the United States clarifies that purified cannabinoids are not cannabis (marihuana) and raw and smoked marijuana should not be classified as a medicine. Cannabinoids are not marijuana and some are studied in experimental protocols to assess their potential medical uses.

"If there is any future for marijuana as medicine is in its isolated components, the cannabinoids, and their synthetic derivatives. Isolated cannabinoids provide more reliable effects than mixtures of raw vegetables. Therefore, the purpose of clinical trials smoked marijuana would not be to develop marijuana as a licensed drug but rather to serve as a first step towards the development of non-smoked cannabinoids and rapid effect.

6. "Adolescent Substance Use: America's # 1 Public Health Problem"; June 2011 Funded by: Legacy Conrad N. Hilton

Foundation Carnegie Corporation of New York Michael Alan Rosen Foundation Increase in marijuana use by teenagers in PR in recent years.

"The substance most commonly used by teenagers, after alcohol and tobacco, is marijuana (12.4%). The use of marijuana showed the sharpest rise to double its prevalence of 6.1% in 2005-07 to 12.4% in 2010-12. Approximately 30,348 students on the island have smoked marijuana or hashish once in life and 30,222 (12.4%) have used it in the past year. It is estimated that 21.745 (9.0%) of our youth have recently used marijuana (last month). A 16.0% of youth who have tried marijuana said that during the past year have smoked this substance daily and almost half (46.5%) has done it occasionally, but not regularly. In addition, 14.8 % of students reported smoking marijuana daily in the month before the survey. "

7. "The effect of medical cannabis laws on juvenile cannabis use"; Lisa Stolzenberg Etal; Florida International University,

The United States; International Journal of Drug Policy, 2015

Study links legalizing and normalizing marijuana as "medicine" to the increase in the use of smoked marijuana in teenagers. This study explains that it is more sensitive than previous longitudinal ones. The calibration results every two years (2002-2012) allows us to consider other factors specific to each state that can explain the variation in drug and can not be assessed in studies with a single time series. "Based on our results, it seems reasonable to speculate that medical cannabis laws amplify the use of cannabis among young dispel the social stigma associated with the recreational use of cannabis and to allay fears that cannabis could

potentially result in a negative health outcome. "

8. "The use of substances in Puerto Rican schools"; Youth Consultation 2010-2012 VIII, UCC

Increase in marijuana use by teenagers in PR in recent years.

"The substance most commonly used by teenagers, after alcohol and tobacco, is marijuana (12.4%). The use of marijuana showed the sharpest rise to double its prevalence of 6.1% in 2005-07 to 12.4% in 2010-12. Approximately 30.348 students on the island have smoked marijuana or hashish once in life and 30.222 (12.4%) have used it in the past year. It is estimated that 21.745 (9.0%) of our youth have recently used marijuana (last month). A 16.0% of youth who have tried marijuana said that during the past year have smoked this substance daily and almost half (46.5%) has done it occasionally, but not regularly. In addition, 14.8 % of students reported smoking marijuana daily in the month before the survey. "

Youth Consultation-PR-2018-2020:

1. Prevalence of substance use seventh to twelfth public and private schools.

2. 80 schools

3. 8,603 (77.7%) of 11,134

4. Female (50.0%) / Male (50.0%)

5. 13-17 years (81.9%) median of 15

6. They lived with their mother (91.4%) and father (46.5%)

• Most commonly used substances in the previous year: Now marihuana is more used than tobacco.

1. Alcohol (33.0%) / 38.4%- (2015-2016 in red)

1. 42.9% before 14 / 38.0%

2. 38.1% between 14-15 years old

3. 61.2% (5 or more runs in the past month) / 65.1%

2. Marijuana (9.4%) / 9.5% / synthetic cannabinoids: 4.4%

1. 36.7% before the age of 14

2. 39.0% between 14-15 years

3. Tobacco (6.1%) / 7.3%

1. 43.4% before the age of 14 / 35.7%

2. 15.9% before 12

Illicit Substances (Youth Consultation PR 2018-2019)

1. Marijuana (excludes synthetic cannabinoids and also "medical cannabis"*)

*Not defining the pseudoscientific term "medical cannabis" is a confounding factor in this consultation; because it can include smoked cannabis (which is prohibited by law in PR but is also used) or vaporized high THC content (>5%) which is addictive and harmful to health and was not asked about it (see reference #12).

1. Once in a Lifetime: 13.0% / 2015-2016 (12.1% / synthetic cannabinoids 5.0%)

2. Last month: 5.6%

3. Higher prevalence in Caguas, Fajardo and Mayagüez

4. Modalities

1. Cigarettes (64.3%)

2. Vaporizers (60.4%)

3. Kripy (43.0%)

4. Cookies or brownies (39.8%)

5. Accept wax (36.0%)

6. Hookah (26.6%)

7. Hashish (9.6%) higher use in Utuado (47.7%)

9. Need Assessment Study of Mental Health and Substance Use Disorders and Service Utilization among Adult Population of Puerto Rico FINAL REPORT Behavioral Sciences Research Institute;

Gloria Canino et al December 2016 rates of last 12-month substance use by the total population of Puerto Rico and by gender.

· Approximately 7 out of 10 adults (69.8%) who met the criteria for alcohol dependence had not received any treatment (i.e., unmet need) in the last 12 months.

· Nearly six in 10 adults (56.4%) who met the criteria for drug dependence had not received any specialty service in the last 12 months of the interview.

· Approximately 7 out of 10 adults (67.4%) who are in need of substance services (since meeting the criteria for a last-year substance dependence disorder) did not receive any treatment during the same period. Males with a substance dependence disorder have the largest percent (48.7%) of individuals who did not receive any treatment.

· Over 7 out of 10 adults with substance dependence and perceived unmet need for treatment identified three commonly held beliefs that represented major barriers: the problem would get better o itself (78.9%), wanted to handle their problems on their own (72.4%) and the belief that treatment would not work (71.7%).

10. Ref: “THC Products May Play a Role in Outbreak of Lung Injury

Associated with E-cigarette Use, or Vaping; CDC September 27, 2019.

-77% reported using THC-containing products, with or without nicotine-containing products; 36% reported exclusive use of THC-containing products, and 16% reported exclusive use of nicotine-containing products

- The CDC and FDA are asking the public to stop using all THC vapes, whether from the black

market or “licensed” pot shops. At least 21 people have died from severe respiratory complications associated with vaping. At least 1,080 cases have been reported across the United States

- Reports link Marijuana vapes to over 70 percent of the lung illnesses being reported in the wake of the vaping epidemic

- Two of the deaths have been connected to marijuana products, one of which was associated with marijuana oil purchased at a legal dispensary in Oregon A recent study showed adolescents who vaped were 3.5 times as likely to smoke marijuana

- In Arizona, a survey of 50,000 10th and 12th graders found that one quarter (25%) of teens were using has used highly potent marijuana concentrates at least once

11. Ref: Cannabis may be associated with suicidality in young adults; NIH study suggests a link between

Cannabis use, and higher levels of suicidal ideation, plan and attempt June 22, 2021

Analysis of survey data from more than 280,000 young adults ages 18-35 showed that cannabis (marihuana) use was associated with increased risk of thoughts of suicide (suicidal ideation), a suicide plan, and suicide attempt. These associations remained regardless of whether someone was also experiencing depression, and the risks were greater for women than for men. The study was published on the JAMA Network by researchers of NIDA, part of the NIH. Causality could not be established by this study; but needs further studies to determine the relationship between depression, suicidality, and cannabis use.

12. Ref: Mapping cannabis potency in medical and recreational programs in the United States, Mary Catherine Cash et al, March 23, 2020. Cannabis has demonstrated some efficacy in neuropathic pain with low tetrahydrocannabinol (THC) concentrations (< 5–10%), in contrast to potent cannabis (>15% THC), which is highly rewarded in the “recreational” realm. The majority of products, regardless of “medicinal or recreation”l programs, were advertised to have >15% THC (70.3% - 91.4% of products). These stated concentrations seem unsuitable for medicinal purposes, particularly for patients with chronic neuropathic pain. Therefore, this information could induce the misconception that high potency cannabis is safe to treat pain. This data is consistent with reports in which THC and CBD in products from legal dispensaries or in nationwide products from the illegal market were actually measured, which indicates that patients consuming these products may be at risk of acute intoxication or long-term side effects. Our study offers grounds to develop policies that help prevent misconceptions toward cannabis and reduce risks in pain patients.

13. Cannabinoid hyperemesis: cyclical hyperemesis in association with chronic cannabis abuse This study explores the association between chronic cannabis abuse and a cyclical vomiting illness that presented in a series of cases in South Australia. J H Allen et al. Gut; 2004;53:1566–1570

Results: In all 10 cases, including the published case, chronic cannabis abuse predated the onset of the

cyclical vomiting illness. Cessation of cannabis abuse led to the cessation of the cyclical vomiting illness in

seven cases. Three cases, including the published case, did not abstain and continued to have recurrent

episodes of vomiting. Three cases rechallenged themselves after a period of abstinence and suffered a

return to illness. Two of these cases abstained again and became and remain well. The third case did not

and remains ill. A novel finding was that nine of the 10 patients, including the previously published case,

displayed abnormal washing behavior during episodes of active illness.

Conclusions: We conclude that chronic cannabis abuse was the cause of the cyclical vomiting illness in all

cases, including the previously described case of psychogenic vomiting

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