WAR ON DRUGS or is it a WAR ON US???

roots69

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BGOL Investor
Is Cannabis The New Wonder Drug?


Israeli scientists are exploring cannabis as a treatment, or even cure, for conditions ranging from cancer to Parkinson’s, asthma, insomnia, PTSD, epilepsy and IBS.

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Cancer, chronic pain, epilepsy, asthma, insomnia, autism, PTSD, inflammatory bowel disease, Parkinson’s – the list of conditions that can be improved, and possibly cured, by medical cannabis keeps growing longer.

The powerful plant used to make cannabis and hashish may prove to be the wonder drug of the century. Israeli researchers have long been at the forefront of discovering which of its many components — and in what quantity and form of delivery –- are effective for which ailments.

Already since the 1990s, medical cannabis has been permitted in Israel and currently is dispensed by prescription to about 33,000 people for relief of pain associated with diseases such as cancer, multiple sclerosis, Parkinson’s and Crohn’s, as well as post-traumatic stress disorder (PTSD).

Now, academic and corporate research is more intensive than ever. The Israeli government is formulating rules for exporting medical cannabis products such as capsules and oils, and the first government-sponsored international conference on medical cannabis will take place April 23-26 near Tel Aviv.

We spoke to conference organizer Hinanit Koltai, PhD, senior research scientist at the government’s Agricultural Research Organization – Volcani Institute. She works with the Agriculture and Health ministries to promote medicalization of cannabis by determining proper growth conditions and building a national cannabis gene bank for the use of authorized growers, scientists and breeders.
“With cancer, we’re starting to talk about curing. This is revolutionary in relation to medical cannabis.”
Individual strains or cultivars could be optimized for certain medical indications, Koltai explains.

“We can grow cannabis plants for research purposes and manipulate the growth conditions in a way that forms whatever composition we prefer and then we can give future guidelines to growers,” Koltai tells ISRAEL21c.

Her lab developed new extraction methods and bio-assays, and collaborates with physicians, scientists and commercial companies to develop cannabis-based treatments for specific conditions.

IBD and cancer
For research on inflammatory bowel diseases (IBD) including Crohn’s and ulcerative colitis, Koltai’s lab partnered with Israeli-Canadian PlantEXT, a subsidiary of Israel Plant Sciences.

They’re examining the effect of cannabis extracts and compounds on tissue from colon biopsies provided by Meir Medical Center in Kfar Saba and will soon start clinical trials. Next they’ll turn their attention to colon cancer.

“Until now, even with IBD we talked about treating symptoms rather than curing. With cancer, we’re starting to talk about curing. This is revolutionary in relation to medical cannabis,” Koltai reveals.

“I do not want to raise false hopes but we see it as a mission to try and establish cannabis as an anti-cancer treatment. We have exciting results that have to be verified in clinical trials and that can take years,” she adds.

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From left, PlantEXT Chairman Joe Oliver with Dr. Hinanit Koltai and Prof. Eli Finerman of the Volcani Institute. Photo by Shlomo Pazner

Cannabis will one day be an important tool in curing cancer, agrees Prof. David “Dedi” Meiri, head of the Laboratory of Cancer Biology and Cannabanoid Research at the Technion-Israeli Institute of Technology.

However, a one-size-fits-all approach won’t work. Each type of cancer has unique characteristics and cannabis contains 142 known cannabinoids (active components).

Matching the most effective cannabis compounds (possibly a cocktail of them) to specific cancers is a complex process that Meiri’s lab is mapping out on mice, Meiri told ISRAEL21c at the fourth annual CannaTech conference in Tel Aviv earlier this year.

Even the compound extraction method makes a difference, Meiri said, “but we don’t know yet which is better, just that there’s a difference.”

Parkinson’s, insomnia
Nearly 70 Israeli companies are actively focusing on medical cannabis in sectors such as agriculture, life-sciences and medical devices, according to a 2018 report from Tel Aviv-based IVC Research Center.

Some of the life-sciences companies developing medicines or treatments are ICD Pharma, Intec Pharma, Talent Biotechs (acquired in 2017 by Kalytera Therapeutics), Therapix Biosciences, Bazelet and Izun Pharma subsidiary CannRx.

“Cannabis is very different from traditional pharma because the initial evidence for relevant indications is coming from patients themselves rather than from basic research,” says Shimon Lecht, PhD, the R&D manager for CannRx.

The medical indications in the CannRx pipeline are insomnia, neurodegenerative disorders such as Parkinson’s disease; and pain (with a delivery system suitable for the elderly and other populations having difficulty with administration).

“The most advanced formulas are for insomnia and pain. We expect during this year to have some announcements of clinical trial results,” says Lecht.

CannRx also develops unique drug-delivery products for the cannabis molecule such as a novel vapor capture technology (VCT) method to extract the oil of the plant for the most beneficial medical effects.

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CannRx’s VCT vapor capture technology device. Photo: courtesy

Autism, epilepsy, fractures, diabetes
Dr. Adi Aran, director of neuropediatrics at Shaare Zedek Medical Center in Jerusalem and a consultant to the Health Ministry for medical cannabis, explores the effects of medical cannabis on epilepsy and autism spectrum disorder (ASD).

“The dramatic clinical effect seen in some cases has led me to further explore the potential benefits, and possible risks, of cannabinoids, particularly in children,” said Aran.

In 2016, he led the world’s first open-label trial studying the effect of cannabidiol (CBD) oil on symptoms in 60 subjects aged 5 to 21.

Nearly half the subjects’ parents said their children’s core ASD symptoms were reduced by the treatment. Almost one-third said their previously uncommunicative children started speaking or communicating nonverbally – including one who said “I love you” to his mother for the first time.

Encouraged by those results, Aran led a large-scale double-blind controlled trial on the efficacy and safety of cannabis for autism, involving 150 severely autistic children and adults aged 5 to 29.

“The follow-up will continue till November,” he tells ISRAEL21c, “and then the publication process will take several months.”

Tikun Olam, the first grower and supplier of medical cannabis to be licensed by the Israeli Health Ministry, in 2005, recently tested its oral CBD oil drops to lessen symptoms associated with severe ASD.

In the study at Assaf Harofeh Medical Center involving 53 children and young adults aged 4 to 22, the Tikun Olam drops caused a significant improvement in social communication skills and decrease in self-injury and rage attacks, hyperactivity, sleep disturbances and anxiety. The overall rate of improvement in symptoms was 74.5 percent, although in some participants the symptoms stayed the same or worsened.
“Cannabidiol appears to be effective in improving ASD symptoms; however, long-term effects should be evaluated in large-scale studies,” the study authors concluded.
Regarding other medical conditions, scientists from Tel Aviv University and the Hebrew University of Jerusalem showed that CBD significantly enhanced healing in lab rats with thigh bone fractures; and Ananda Scientific is investigating how CBD may control and even prevent diabetes.

Pain, PTSD, asthma
The opioid addiction crisis is driving increased interest in medical cannabis as an alternative to other pain-relief medications.

Israeli research published in the March 2018 issue of European Journal of Internal Medicine showed the effectiveness and safety of a six-month regimen of cannabis treatment for pain in 2,736 patients aged 65 and older.

Overall improvement was noted by 93.7% of respondents. They reported significantly fewer falls and less use of prescription pain medicines including opioids.
“Gathering more evidence-based data, including data from double-blind randomized-controlled trials, in this special population is imperative,” concluded the authors, who include Ran Abuhasira, Victor Novack and Lihi Bar-Lev Schleider of the Cannabis Clinical Research Institute at Soroka University Medical Center and Ben-Gurion University in Beersheva (Schleider also heads research at Tikun Olam) and Prof. Raphael Mechoulam from the Hebrew University of Jerusalem.
Mechoulam, the first to successfully isolate the THC (psychoactive) component of cannabis back in 1964, is leading a team at the Hebrew University’s Multidisciplinary Center on Cannabis Research investigating the benefits of non-psychoactive cannabis components for treating asthma and other respiratory conditions, a study commissioned by UK-Israeli biotech startup CiiTech.

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Bazelet’s booth at the 2017 CannaTech event in Tel Aviv. Photo by Miriam Alster/FLASH90

Bazelet, the largest medical cannabis company in Israel,has developed proprietary technology to isolate and utilize specific cannabis components to treat chronic pain, post-traumatic stress disorder (PTSD), neurodegenerative diseases, epilepsy and autism. Clinical trials are in progress for pain relief and PTSD.

Therapix Biosciences of Tel Aviv recently received US Food and Drug Administration (FDA) clearance for its investigational synthetic cannabinoid drug THX-110, paving the way for a Phase IIa clinical trial of THX-110 for chronic low back pain.

Tourette and sleep apnea
Therapix also has a clinical development program for THX-110 in the treatment of Tourette syndrome (TS) and obstructive sleep apnea.

A Phase IIa study at Yale University for TS suggests that THX-110 significantly improved symptoms over time in adult subjects. Complete results will be presented at the 2018 European Society for the Study of Tourette Syndrome meeting in Copenhagen this June.

“These results are of particular interest as the pharmacology of THX-110 appears to be distinct from existing medications for TS and may offer a unique option for treating these patients,” said Therapix CTO Adi Zuloff-Shani.

“Based on these study results, we intend to initiate a randomized, double-blind, placebo controlled study to evaluate the safety, tolerability and efficacy of daily oral THX-110 in treating adults with Tourette syndrome.”

There is more on the horizon: Therapix is testing a different cannabis compound, THX-130, for the treatment of mild cognitive impairment and traumatic brain injury; THX-150 for the treatment of infectious diseases; and THX-ULD01 for treating mild cognitive impairment.
 

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BGOL Investor
Is Vaping Cannabis Safe?

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Credit: B. Breneman
Some vape pens may not be vaporizing at all.
Of all the methods of ingesting cannabis, vaping (short for "vaporizing") has grown the most in popularity in recent years. It involves heating — but not burning — cannabis and then inhaling the vapor. It's generally thought to be safer than smoking, and it's more discreet and convenient. But is it actually safe?
Well, it depends on your vaping device, and there are a few factors to consider.
Vaping is commonly done via a portable vape pen, and while you can use raw cannabis in some vape pens, most require cartridges of concentrates. These concentrates are created through the use of solvents, such as butane, CO2, or ethanol, which extract compounds from the plant and leave behind a more potent substance.
Hydrocarbon extraction, such as using butane or propane, is more likely than CO2 extraction to result in residual solvents ending up in the concentrate. A 2015 study published in The Journal of Toxicological Sciences found that more than 80 percent of the concentrate samples were contaminated by residual solvents.
There can also be issues with the raw cannabis itself. In the same 2015 study, pesticides were detected in one-third of the concentrate samples. While there are new requirements for testing cannabis (in all its forms) before it goes to market, they won't be enforced until July 1.
Of particular concern with vaping is propylene glycol (PG), a chemical that's added to cannabis oil products as a thinner. (It's also used in everything from shampoo to ice cream.) Although the FDA classifies it as "generally recognized as safe," there are concerns about propylene glycol when it's heated to high temperatures, according to a 2015 report by Jahan Marcu, chief scientific officer for Americans for Safe Access. That's because it transforms into carbonyls, "a group of cancer-causing chemicals that includes formaldehyde, which has been linked to spontaneous abortions and low birth weight," Marcu wrote. In the same report, Project CBDresearch associate Eric Geisterfer looked at hemp-derived CBD vape oil and found that nearly every one contained PG or polyethylene glycol (PEG), another toxic additive.



A more recent study, published in November 2017, tested four common thinning agents — PG, PEG 400, vegetable glycerin (VG), and medium chain triglycerides (MCT) — used by the cannabis industry, heating them to 230-degrees Celsius (or 446-degrees Fahrenheit), the temperature appropriate for cannabis oil vaporization. The results showed that PG and PEG 400, in particular, produced high levels of acetaldehyde and formaldehyde when heated. With PEG 400, formaldehyde production was nearly the equivalent of smoking one cigarette, the researchers found.
Marcu said another issue of concern are added terpenes, which give cannabis its distinctive odor. "They're generally regarded as safe," he said in an interview. "But not all are safe to be inhaled at a high concentration."
While cannabis oil only needs to be heated between 160- and 190-degrees Celsius to begin to aerosolize, vaping devices do not heat evenly or consistently. People also use the products differently.
Jeremy Green, COO of vape pen company Dosist, noted that almost all vape pens are made in Shenzhen, China, which bills itself as the headquarters of the e-cig industry. (Vape pens are made from the same device as e-cigarettes.) The actual heating element can vary, from ceramic to glass to metal. Green said the nichrome (or nickel-chromium) wire — the same type of heating mechanism you'll find in a toaster — is the most common heating element found in vape pens.
"A lot of people say they have a ceramic heating element, but really that's not true," said Green. "The nichrome [wire] is wrapped around the ceramic or embedded in the ceramic." (Green said Dosist pens use a custom blended alloy.)
The problem? In a peer-reviewed study published in 2013, a researcher at UC Riverside found a high concentration of heavy metals and silicates in the vapor of e-cigarettes, which came from the device's heating element — nickel-chromium wire coated in silver.
Just how much heat is being generated depends on the device's battery and how long the user engages it. Some vape pens are activated by pushing a button, while others are powered when the user sucks on it.
Green said many vape pens also have silver tips (the part you suck on), which are nickel or chrome plating. "You don't see those on medical devices because they aren't safe," he said. (He said Dosist uses medical-grade plastic for its exterior.)

There are no regulations for these devices in the e-cig or cannabis industry, so there are no standards, Green noted. While some vape brands, such as Brass Knuckles and Stiiizy, test their concentrates for pesticides and residual solvents and list the results on their websites, others may only tout potency.
So how can consumers stay safe? Marcu recommends looking for a third-party seal of approval on products (such as PFC, or Patient Focused Certification, of which he is the director), critically reviewing the label (beware of propylene glycol), and not being afraid to ask the company questions about its ingredients and testing. Also, don't buy any product that doesn't come with storage and usage guidelines. And when it comes to using the device, don't inhale or hold down the button for too long because you may be smoking the concentrate. All that said, "true vaporizers are absolutely safe," he noted.
What Is Patient Focused Certification?
But with cannabis testing regulations going into effect July 1 (for California), Green believes many vape brands will go under due to a lack of compliant product and increased costs related to compliance. "So, you're going to start to see some consolidation among the brands," he said. "There won't be 45 vape pens on the shelf."
 

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BGOL Investor
Medical Cannabis Benefits: Treating Fibromyalgia



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Although fibromyalgia is often considered an arthritis-related condition, it is not truly a form of arthritis (a disease of the joints) because it does not cause inflammation or damage to the joints, muscles, or other tissues. Like arthritis, however, fibromyalgia can cause significant pain and fatigue, and it can interfere with a person’s ability to carry on daily activities. Also like arthritis, fibromyalgia is considered a rheumatic condition, a medical condition that impairs the joints and/or soft tissues and causes chronic pain.

Fibromyalgia is a disorder characterized by intense musculoskeletal pain that affects 5 million Americans. Studies have shown marijuana effectively lowers pain levels and improves quality of sleep in patients.

About Fibromyalgia:

Fibromyalgia is a common disorder characterized by widespread pain and fatigue that primarily affects women. The disorder can greatly affect a person’s abilities to perform daily activities and causes sleep problems. According to Mayo Clinic, having fibromyalgia affects the way the brain processes pain signals and makes painful sensations feel amplified.

In addition to pain, fatigue and sleep problems, those with fibromyalgia may also experience cognitive and memory problems, headaches, morning stiffness, painful menstrual periods, numbness or tingling, restless legs syndrome, temperature to sensitivity, irritable bowel syndrome, and depression.

The causes of fibromyalgia remain unknown, but the National Institute of Arthritis and Musculoskeletal and Skin Diseases notes that many people associate their fibromyalgia to a physically or emotionally stressful or traumatic event. Repetitive injuries or illnesses are also commonly associated to fibromyalgia by patients. Others claim the disorder developed spontaneously.

There is no cure of fibromyalgia, so treatment focus is on controlling symptoms with pain relievers, antidepressants, exercise and therapy.

Most common symptoms of fibromyalgia are:
Diffuse tenderness – sensitive to touch or pressure
Sleep disturbances and unrefreshed sleep
Exhaustion and fatigue
Brain fog – problems with thinking or memory
Mood problems like depression / anxiety
Headaches


Additionally, many fibro patients also suffer with:
Digestive problems like IBS and GERD
Irritable or overactive bladder
Pelvic pain
Temporomandibular joint disorder (TMJ)

Fibromyalgia can occur in men or women, but is most common in women. Symptoms most often appear as a young adult, but onset can happen at any age.

FINDINGS: EFFECTS OF CANNABIS ON FIBROMYALGIA

The cannabinoids contained in cannabis have both analgesic and sleep-promoting effects to help fibromyalgia patients manage symptoms. Studies have found that cannabis is effective at improving sleep disruption, pain, depression, joint stiffness, anxiety, physical function and quality of life in individuals with fibromyalgia (de Souza Nascimento, et al., 2013) (Russo, 2004).

While fibromyalgia is known for causing intense and unrelenting musculoskeletal pain, cannabis has proven effective at offering fibromyalgia patients relief. Fibromyalgia patients treated with cannabis and assessed over a seven-month period experienced significant pain intensity improvements and were able to reduce their doses of opioids (Weber, et al., 2009). One study discovered that after four weeks of cannabis treatment, fibromyalgia patients experienced significantly less pain and anxiety whereas a placebo group saw no improvements (Skrabek, Galimova, Ethans & Perry, 2008). Another study reported significant reductions in pain and stiffness, an enhancement of relaxation and an increase in somnolence and feeling of well being in fibromyalgia patients two hours after they smoked or orally consumed cannabis (Fiz, et al., 2011).

Cannabis has also been found to be effective at improving sleep quality in patients with fibromyalgia (Ware, Fitzcharles, Joseph & Shir, 2010).

STATES THAT HAVE APPROVED MEDICAL CANNABIS FOR FIBROMYALGIA

Only the states of Arkansas, Illinois, North Dakota and Ohio have approved medical marijuana specifically for the treatment of fibromyalgia.

However, several states have approved medical cannabis specifically to treat “chronic pain,” a symptom commonly associated with fibromyalgia. These states include: Alaska, Arizona, California, Colorado, Delaware, Hawaii, Maine, Maryland, Michigan, Montana, New Mexico, Ohio, Oregon, Pennsylvania, Rhode Island and Vermont. The states of Nevada, New Hampshire, North Dakota, Montana, Ohio, Vermont, and West Virginia allow medical marijuana to treat “severe pain.” The states of Arkansas, Minnesota, Ohio, Pennsylvania, Washington, and West Virginia have approved cannabis for the treatment of “intractable pain.”

Sixteen states have approved medical cannabis for the treatment of spasms. These states include: Arizona, Arkansas, California, Colorado, Delaware, Florida, Hawaii, Maryland, Michigan, Minnesota, Montana, Nevada, New Hampshire, Oregon, Rhode Island and Washington.

A number of other states will consider allowing medical cannabis to be used for the treatment of fibromyalgia with the recommendation by a physician. These states include: California (any debilitating illness where the medical use of cannabis has been recommended by a physician), Connecticut (other medical conditions may be approved by the Department of Consumer Protection), Massachusetts (other conditions as determined in writing by a qualifying patient’s physician), Nevada (other conditions subject to approval), Oregon (other conditions subject to approval), Rhode Island (other conditions subject to approval), and Washington (any “terminal or debilitating condition”).

In Washington D.C., any condition can be approved for medical cannabis as long as a DC-licensed physician recommends the treatment.

RECENT STUDIES ON CANNABIS’ EFFECT ON FIBROMYALGIA

Fibromyalgia patients experienced significant reductions in pain and stiffness, an enhancement of relaxation, and an increase in somnolence and feeling of well being, two hours after smoking or orally consuming cannabis.
Cannabis use in patients with fibromyalgia: effect on symptoms relief and health-related quality of life.
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3080871/)

Cannabis medication found effective at improving sleep quality and was well tolerated by fibromyalgia patients.
The effects of nabilone on sleep in fibromyalgia: results of a randomized controlled trial.
(http://journals.lww.com/anesthesia-...=2010&issue=02000&article=00056&type=abstract)

Four weeks of cannabis treatment caused significant decreases in pain and anxiety in patients with fibromyalgia.
Nabilone for the treatment of pain in fibromyalgia.
(http://www.jpain.org/article/S1526-5900(07)00873-5/fulltext)



Beneficial Cannabinoids and Terpenoids Useful for Treating Fibromyalgia

The cannabis plant offers a plethora of therapeutic benefits and contains cannabinoids and terpenoid compounds that are useful for treating the symptoms of Fibromyalgia. While most of the ongoing research focuses on CBD and THC, the following list also denotes which cannabinoids and terpenoids work synergistically with each other for possible therapeutic benefit. It may be beneficial to seek out strains that contain these cannabinoids and terpenoids.



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"Marijuana Rated Most Effective for Treating Fibromyalgia"
Posted on April 21, 2014 in Fibromyalgia, Pain Medication

http://nationalpainreport.com/marijuana-rated-most-effective-for-treating-fibromyalgia-8823638.html


Medical marijuana is far more effective at treating symptoms of fibromyalgia than any of the three prescription drugs approved by the Food and Drug Administration to treat the disorder.

That is one of the surprise findings in an online survey of over 1,300 fibromyalgia patients conducted by the National Pain Foundation and National Pain Report.


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The FDA has approved only three drugs – Cymbalta, Lyrica and Savella — for the treatment of fibromyalgia. Although they generate billions of dollars in annual sales for Pfizer, Eli Lilly, Forest Laboratories and other drug makers, most who have tried the medications say they don’t work.

The National Institutes of Health estimates that 5 million Americans suffer from fibromyalgia, a poorly understood disorder characterized by deep tissue pain, fatigue, headaches, depression, and lack of sleep. There is no known cure and the disorder is difficult to treat.

“Fibromyalgia is devastating for those who must live in its grip. There is much we do not understand. We need innovative ‘out of the box’ solutions that change the face of this disease,” said Dan Bennett, MD, an interventional spine and pain surgical physician in Denver, Colorado, who is chairman of the National Pain Foundation.


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Many who responded to the survey said they had tried all three FDA approved drugs.

“The prescriptions that are available for treatment have more negative side effects than positive aspects,” said one fibromyalgia sufferer.

“I haven’t found anything! Please find a cure or at least a medicine that will take our pain away,” said another.

Asked to rate the effectiveness of Eli Lilly’s Cymbalta (Duloxetine), 60% of those who tried the drug said it did not work for them. Only 8% said it was very effective and 32% said it helps a little.

Among those who tried Pfizer’s Lyrica (Pregabalin), 61% said it did not work at all. Only 10% said it was very effective and 29% said it helps a little.


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Asked to rate the effectiveness of Forest Laboratories’ Savella (Milnacipran), 68% of those who said they tried the drug said it didn’t work. Only 10% said it was very effective and 22% said it helps a little.

About 70% of the people who responded to the survey said they had not tried medical marijuana – which is not surprising given that it is still illegal in most states and many countries. But those who have tried marijuana said it was far more effective than any of the FDA-approved drugs.

Sixty-two percent who have tried cannabis said it was very effective at treating their fibromyalgia symptoms. Another 33% said it helped a little and only 5% said it did not help at all.

“I’ve found nothing that has worked for me, apart from marijuana,” said one survey respondent.


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“Nothing but medical marijuana has made the greatest dent in the pain and mental problems,” said another.

“Marijuana does help a LOT it numbs the pain. But it doesn’t last long and it makes your brain foggy,” wrote another fibromyalgia sufferer.

Survey respondents said massage, swimming, acupuncture, muscle relaxers and other alternative treatments also helped relieve their symptoms. Many said they take opioids to relieve their pain – although narcotic painkillers are generally not prescribed to treat fibromyalgia.

Other survey findings:

Four out of ten (43%) fibromyalgia sufferers feel their physician is not knowledgeable about the disorder.

Over a third (35%) feel their physician does not take their fibromyalgia seriously.

45% feel their family and friends do not take their fibromyalgia seriously.

Nearly half (49%) said their fibromyalgia symptoms began at a relatively young age (18-34).

Only 11% were diagnosed with fibromyalgia within the first year of symptoms.

44% said it took five or more years before they were diagnosed with fibromyalgia.

Many survey respondents lamented that the disorder had taken over their lives, leaving them socially isolated, fatigued and in constant pain.

“I was once an active person and have now virtually become a hermit due to this disease,” said one.

“The worst thing about having fibromyalgia is disappointing loved ones when I can’t do things with them,” wrote one fibromyalgia sufferer.

“Having fibromyalgia is a life sentence. One simply cannot have a productive life living with this disease,” said another.

The 1,339 people who participated in the survey were self-selected as fibromyalgia sufferers. Ninety-six percent of them were female.

This was the second online survey of pain patients conducted by the National Pain Foundation and National Pain Report. The first survey found that over half of patients worry that they are perceived as “drug addicts” by pharmacists. Eight out of ten said they had stopped seeing a doctor because they felt they were treated poorly.
 

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BGOL Investor
New Patient Guide To Medical Cannabis

UNITE - NETWORK - GROW - INFORM - KNOW - EDUCATE - ACTIVISM - VOTE - HEALTH - WELLNESS

Know Your Medicine...Cannabis News Journal believes that all patients should receive the highest quality medicine to fit their specific needs. This section provides the medical cannabis patient a complete overview of all aspects of using medical cannabis and types of cannabis medicine.

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Key Terms Defined

Medical cannabis: or medical marijuana can refer to the use of cannabis and its cannabinoids to treat disease or improve symptoms; however, there is no single agreed upon definition

Cannabis Strain: a genetic variety or varieties of medical cannabis; Indica, Sativa, Hybrid, & Ruderalis.

Indica Strains: are sedatives/relaxants and are effective for treating the symptoms of medical conditions such as anxiety, chronic pain, insomnia, muscle spasms and tremors. Indicas have a higher level of cannabinoids than sativas, which results in a sedated body-type stone. Because indica strains may cause feelings of sleepiness and heaviness, many patients prefer to medicate with this type of cannabis at night. And many dispensaries will color code its strains on menus & list all Indica Strains in Purple or Blue.

Sativa Strains: are more of a stimulant, and are effective in appetite stimulation, relieving depression, migraines, chronic pain and nausea. Sativas have a higher level of THC than indicas, which results in a psychoactive and energetic mind-high. Because sativa strains may cause feelings of alertness and optimism, many patients prefer to medicate with this type of cannabis during the day. Typically Sativa will be color coded in a Red Color.

Hybrid Strains: hybrids and cross-breeding of Indica and Sativa strains produce varieties that carry some characteristics of each parent. For example, adding sativa to indica strains adds mental clarity and decreases sedation effects. And adding indica to sativa strains can decrease or even eliminate the sativa tendency to stimulate anxiety. Hybrids are often referred to based upon the dominant subspecies inherited from their lineage, eg: pure indica, mostly indica, mostly sativa, or pure sativa. Instead of using pure indica or pure sativa, many patients can benefit from the use of hybrid strains. Hybrid Strains are color coded in Green.

Ruderalis: Cannabis ruderalis is native to areas in Asia, Central/Eastern Europe, and specifically Russia, where botanists used the term "ruderalis" to classify the breeds of hemp plant that had escaped from human and cultivation, adapting to the extreme environments found in these climates. The effects of cannabis ruderalis alone are minimized by its naturally low concentrations of THC. However, the stability and short lifecycle make ruderalis versatile and attractive to breeders who want to take advantage of its autoflowering trait. Ruderalis genes offer the ability for breeders to create an autoflowering hybrid with the advanced potency and flavor profile from its genetic partner. Ruderalis is comparative to to being a potential sub-species of Indica, identified with a similar color code of Purple or Blue.

Hash Plant Strain: This Indica Dominant Strain type of the precious Afghani (Indica), is descended from one of the finest hash-making cultivars ever brought from the Hindu Kush (Indica) to the west. Cannabis strains known generally as hash plants are found throughout the countries that border these mountains, but very few have the pedigree of this Hash Plant - a living definition of the stocky, chunky, beautifully sticky Afghanica genotype. The direct ancestor of Hash Plant was developed in the Northwest USA and came to Holland.

Cannabinoids and Glossary of Basic Cannabinoid Terms:



There are at least 113 different cannabinoids isolated from cannabis and roughly 500 compounds found within the plant. While these cannabinoids do present medical benefits on their own, they seem to work together to promote even greater health. This is known as the “Net Effect” or the “Entourage Effect”.

Probably the most known cannabinoid found in cannabis is THC. This psychoactive cannabinoid is responsible for producing the sense of euphoria associated with cannabis consumption. However, more recently CBD has also been gaining in popularity particularly for medical applications. And a lot of dispensaries will color code strains dominant in CBD with Orange.

CBD: has a wide potential for treating many conditions including:

Schizophrenia – due to the anti-psychotic nature of CBD, this compound could pave the way for new schizophrenia drugs. This is might be because CBD may stabilize disrupted or disabled NMDA receptor pathways in the brain.

Seizures – CBD has shown to be very effective in treating epilepsy. While there aren’t currently “accepted” treatments as of yet, for some patients such as Charlotte Figi, this compound has been the difference between life and death.

Nausea – CBD is an antiemetic, meaning it reduces nausea and vomiting.

Inflammation – CBD is also an anti-inflammatory agent.

Cancer – As well as THC, CBD is an anti-tumoral agent and can be used to treat certain types of cancer. For other cancers, THC works better such as Prostate Cancer.

Depression – CBD is also an anxiolytic and an antidepressant meaning it can help for a wide range of anxiety disorders and depressive conditions.

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THC:

Apart from the euphoric sensation induced by THC, there are plenty of other medical properties of this compound. Below is a short list of some of the medical benefits of THC.

Pain Relief – 60% of patients use cannabis for pain relief. This is due to the fact that THC activates pathways in the central nervous system and in turn blocks pain signals being sent to the brain. Particularly useful for neuropathic pain, THC has provided relief for thousands of patients around the world.

PTSD – ‘Short Term Memory Loss’ was considered a ‘bad thing’ for quite some time, that was until a deeper understanding of Post-Traumatic Stress Syndrome was unveiled. To simplify what happens with PTSD, the patient is ‘stuck’ in a looped memory of a past trauma. THC helps interrupt these loops allowing the patient to deal with the trauma.

Nausea – THC has been available for nausea in pill form since 1980+. This has been used to treat nausea induced by chemotherapy and is one of the few pills containing THC that is legally available on the market.

Appetite Stimulation – Another benefit of THC is stimulating appetite. Patients undergoing chemotherapy have found that THC helps stimulate their appetite regardless of the nauseating effects of chemo. Studies have also suggested that it could be a potential treatment for anorexia.

Asthma – Since the 1970’s, researchers have known that THC improves the breathing of asthmatics. While attempts to make a suitable inhaler has been largely ignored due to the staunch rules against cannabis, people believe that modern day vaporizers could suffice in providing relief to medical patients suffering with asthma.

Glaucoma – Similar to Asthma, the beneficial effects of THC on Glaucoma has been documented since the 1970’s, many Americans have been using THC to treat their glaucoma.

Insomnia – Another medical benefit of THC relates to sleep. While preferably Cannabis indica is used in this treatment, many Americans have found relief in cannabis for cases of insomnia. These studies date back to the 1970’s.

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There are plenty more effects of THC on the human body, however this shows that THC should not be demonized as it has been over the past few decades. The medical efficacy of this compound is yet to reveal the totality of the benefits to the human condition.




A must read for any person interested in Cannabis:
Understanding Medical Cannabis (PDF) by Rev. Dr. Kymron deCesare (with video)




Americans For Safe Access Condition-based Booklets
These booklets summarize the history of medical cannabis and the recent research used to treat a variety of conditions, including Cancer, Multiple Sclerosis, Chronic Pain, Arthritis, GastroIntestinal Disorders, Movement Disorders, HIV/AIDS, and conditions related to Aging. (About Americans For Safe Access)

A Patient's Guide to Medical Cannabis



This guide for patients who use medical cannabis (cannabis) covers everything you need to know. Created by Americans for Safe Access (ASA), a non-profit advocacy organization, this publication will help individuals who are using or considering cannabis treatments to better educate themselves, their families and their physicians. ASA has been developing information resources about medical cannabis (cannabis) for patients, their families, doctors, and elected officials for over a decade.

Arthritis



Cannabis can ease the pain and reduce the swelling of arthritis without the side effects caused by frequent NSAID or opiate use.

Cancer



Cannabis has been found to help cancer patients with the symptoms that usually accompany cancer such as pain, nausea, wasting, and loss of appetite.

Chronic Pain



Cannabis can serve at least two important roles in safe, effective pain management. It can provide relief from the pain itself (either alone or in combination with other analgesics), and it can control the nausea associated with taking opioid drugs, as well as the nausea, vomiting and dizziness that often accompany severe, prolonged pain.

Gastrointestinal Disorders



The effectiveness of cannabis and its derivatives for treating gastrointestinal disorders has been known for centuries. Recently, its value as an anti-emetic and analgesic has been proven in numerous studies.

HIV/AIDS



The effectiveness of cannabis for treating symptoms related to HIV/AIDS is widely recognized. Its value as an antiemetic and analgesic has been proven in numerous studies.

Movement Disorders



The therapeutic use of cannabis for treating muscle problems and movement disorders has been known to western medicine for nearly two centuries.

Multiple Sclerosis



Many of the symptoms of multiple sclerosis (MS) - such as spasticity, pain, fatigue, bladder problems and depression - respond positively to medical cannabis.

Aging



Cannabis has been found to help many patients suffering from conditions that afflict older patients, including arthritis, chronic pain, cancer, Alzheimer’s disease, diabetes, and spasticity associated with such diseases as Parkinson’s.

Veterans



Veterans of military service have a disproportionately high rate of certain debilitating medical conditions as compared to the general population. Some of those conditions may result from injury or exposures to toxins, but not all.
 

roots69

Rising Star
BGOL Investor
Isnt it odd, once this corporation got control of afghan and those heroin fields!! We started having this so called opioid issue??




Prescription Nation 2018: Facing America's Opioid Epidemic

Improving Medical Cannabis Programs Will Help Combat The Opioid Crisis


Credit: NSC


In a report released this month by the National Safety Council, which provides research showing just 13 states and Washington, D.C., have implemented comprehensive, proven actions to eliminate opioid overdoses and help protect their residents. Despite widespread acknowledgement of the severity of the opioid crisis, most states have been slow to respond, according to this recent report from the National Safety Council.

The 2018 report did not conduct research into states with medical cannabis programs and the impact there on reducing use of opioids and other painkillers but the National Safety Council has plans to do so in the 2019 Prescription Nation Report. Despite this years report not taking medical cannabis programs into consideration, there are some strong correlations revealed in the NSC Prescription Nation White Paper.

Only 13 states and the District of Columbia have implemented comprehensive, proven measures to address what NSC calls “the worst drug crisis in recorded U.S. history” in Prescription Nation 2018. The report, which analyzes how states are battling the opioid crisis, has been released annually since 2013.
“While we see some states improving, we still have too many that need to wake up to this crisis,” said Deborah A.P. Hersman, president and CEO of the National Safety Council. “For the last five years, the Council has released Prescription Nation reports to provide a roadmap for saving lives across the country. We hope states adopt the recommended actions laid out here so we can eliminate preventable opioid deaths and stop an everyday killer.”


NSC identifies six actions that “could have immediate and sustained impact” in combating the opioid epidemic – which claimed more than 42,000 American lives in 2016 – as well as the number of states employing them:

  • Mandatory prescriber education (34 states and D.C.)
  • Implementing opioid prescribing guidelines (33 states and D.C.)
  • Integrating prescription drug monitoring programs into clinical settings (39 states and D.C.)
  • Improving data collection and sharing (seven states)
  • Treating opioid overdose (37 states and D.C.)
  • Increasing availability of opioid use disorder treatment (36 states and D.C.)
In Prescription Nation, a digest analyzing how states are tackling the worst drug crisis in recorded U.S. history, the Council assigned its highest mark of “Improving” to Arizona, Connecticut, Delaware, Washington, D.C., Georgia, Michigan, Nevada, New Hampshire, New Mexico, North Carolina, Ohio, Rhode Island, Virginia and West Virginia.
All of these states, except three; Georgia, North Carolina, and Virginia - the rest are all states with a comprehensive medical cannabis program that allow treatment of ‘chronic pain’ or ‘severe pain’.

The eight states receiving a “Failing” mark – Arkansas, Iowa, Kansas, Missouri, Montana, North Dakota, Oregon and Wyoming – are taking just one or two of the six key actions identified in the report as critical and life-saving.
All of the states receiving failing grade, except Oregon, are all states with no medical cannabis programs or states that allow use of "low THC, high cannabidiol (CBD)" products for medical reasons in limited situations or as a legal defense. Those programs are not counted as comprehensive medical cannabis programs.
[Related Article: ‘Improving Medical Cannabis Programs Will Combat Opioid Crisis’]
Medical cannabis is a proven alternative to treat chronic pain. Medical professionals and researchers have released studies demonstrating its positive effects and overall benefits to public health. However, medical cannabis programs are serving just 2 percent of the population in most of the thirty states, Washington, D.C., Puerto Rico and Guam that have so far passed laws (another sixteen have passed more limited laws). One-third of the U.S. population is living with chronic pain, and they all deserve access to medical cannabis. The blueprint lays out the specific barriers to access contributing to this disparity and provides lawmakers with the legislative means to reduce those barriers.

Americans for Safe Access released “Medical Cannabis as a Tool to Combat Pain and the Opioid Crisis: A Blueprint for State Policy.” The blueprint outlines legislative and regulatory solutions related to medical cannabis that states can utilize to combat the opioid epidemic.

Using medical cannabis to treat chronic pain is an approach that is supported by research and medical professionals, and has demonstrated positive public health outcomes. Thirty states in the US have passed medical cannabis laws and another sixteen have passed more limited laws. Medical cannabis programs on average are serving 2% of the population despite a potential addressable market of 1/3 of the population that are living with chronic pain.

Americans for Safe Access and their advisors have examined current medical cannabis programs and have identified many barriers for medical professionals, patients, and their caregivers that prevents them from utilizing medical cannabis as a tool to combat pain and opioid use disorder. The following report takes a public health approach to defining enrollment issues and offers a blueprint for legislative and regulatory bodies to resolve these issues. We have concluded that improvements in state medical cannabis legislation and regulations could increase program enrollment and save lives.

DOWNLOAD THE REPORT

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http://www.safeaccessnow.org/opioidblueprint

The report features model legislation, an emergency proclamation, and flow charts that help lawmakers identify barriers to access that medical cannabis patients in their states are facing.

New Mexico and Nevada are the only two states to meet all six indicators, giving those two states the highest marks in the NSC Prescription Nation White Paper. This is great news for those states and for New Mexico this shows how further expansion of the states medical cannabis program with result in a continued decline in opioid & painkiller drug abuse, overdose, and even death.

Despite having a 10 year old comprehensive medical cannabis program and a medical cannabis law on the books for over 40 years- the New Mexico Department of Health mentions nothing of how medical cannabis contributed to the reduction seen in the state.

“We are working hard to reduce drug overdose deaths in New Mexico, including from prescription opioids,” said Lynn Gallagher, NMDOH Cabinet Secretary. “It is clear that we still have work to do, and we are committed to reducing the loss of life to opioid overdose and ending the tragic impact that these drugs have on our families and communities.”

The New Mexico Department of Health reports that, Governor Susana Martinez has made drug overdose prevention a major priority of her administration and has implemented comprehensive solutions to fight drug abuse in New Mexico. Under her administration, New Mexico:
  • strengthened Prescription Monitoring Program (PMP) laws to require health care providers to check the database when prescribing opioids, leading to fewer opportunities for someone addicted to opioids to go from doctor to doctor for drugs;
  • became the first state to require all local and state law enforcement agencies to provide officers with naloxone, a medication that reverses opioid overdoses;
  • expanded legislation allowing both pharmacists and law enforcement to dispense naloxone without a prescription -- expanding access to the life-saving drug;
  • and removed prior authorization for Suboxone, expanded the number of methadone clinics, and the number of these clinics accepting Medicaid.
As a result of these measures, prescriptions of opioids are down across New Mexico:
  • The total volume of opioids (measured in morphine milligram equivalents or MME), dispensed in New Mexico fell by 11% between the 4th quarter of 2016 and the 4th quarter of 2017.
  • The number of patients receiving high-dose prescriptions fell by 15% over the same period.
  • The number of patients receiving concurrent benzodiazepines and opioid prescriptions for 10 days or more in the quarter (making them at higher risk of overdose) fell by 17%.
  • Approximately half of all drug overdose deaths in New Mexico involve prescription opioids.
The National Safety Council released their report last week at the National Rx Drug and Heroin Summit in Atlanta, where NMDOH officials participated in a national discussion about effective prevention and treatment tools and resources.

Additionally, the NMDOH site has more information on Prescription Opioid Safety, Harm Reduction, and Substance Abuse Epidemiology.




The New Mexico Department of Health makes no mention of how the medical cannabis program has rapidly grown over the last two years. Nor does NMDOH mention how treatment of severe Chronic Pain in the medical cannabis program is benefiting over 17,000 New Mexicans and is the second most used qualifying condition into the program. Patient enrollment has been accelerating over the past 24 months. Enrollment increased by
more than 14,400 patients between the end of January 2017 and the end December 2017. Each day, the Medical Cannabis Program receives between 150 and 600 patient applications.
[Related Article: ‘Study Finds Medical Cannabis Is Effective At Reducing Opioid Addiction’]
Then in the late fall of 2017, we saw a new study conducted by researchers at The University of New Mexico, involving medical cannabis and prescription opioid use among chronic pain patients, found a distinct connection between having the legal ability to use cannabis and significant reductions in opioid use.

The study titled, “Associations between Medical Cannabis and Prescription Opioid Use in Chronic Pain Patients: A Preliminary Cohort Study,” and published in the open access journal PLOS ONE, was conducted by Drs. Jacob Miguel Vigil, associate professor, Department of Psychology and Sarah See Stith, assistant professor, Department of Economics. The results from this preliminary study showed a strong correlation between enrollment in the New Mexico Medical Cannabis Program (MCP) and cessation or reduction of opioid use, and that whole, natural Cannabis sativa and extracts made from the plant may serve as an alternative to opioid-based medications for treating chronic pain.

The UNM researchers used Prescription Monitoring Program opioid records over a 21-month observation period (first three months prior to enrollment for the MCP patients) to more objectively measure opioid cessation – defined as the absence of opioid prescriptions activity during the last three months of observation, with use calculated in average daily intravenous [IV] morphine dosages. MCP patient-reported benefits and side effects of using cannabis one year after enrollment were also collected.

By the end of the observation period, the data showed MCP enrollment was associated with a 17 times higher age- and gender-adjusted odds of ceasing opioid prescriptions, a 5 times higher odds of reducing daily prescription opioid dosages, and a 47 percentage point reduction in daily opioid dosages relative to a mean change of positive 10 percentage points in the non-enrolled patient group.




Survey responses in the UNM study indicated improvements in pain reduction, quality of life, social life, activity levels, and concentration, and few negative side effects from using cannabis one year after enrollment in the MCP.

The researchers’ findings, which provide clinically and statistically significant evidence of an association between MCP enrollment and opioid prescription cessation and reductions and improved quality of life warrant further investigations on cannabis as a potential alternative to prescription opioids for treating chronic pain.

As a result of those measures by the NM Health Department, how the state’s comprehensive medical cannabis program has more than three-fourths (83%) of the program participants listing Post-Traumatic Stress Disorder (49.1%) or Severe Chronic Pain (33.3%) as a qualifying condition and rapid growth of the program for over two years- all resulted in prescriptions of opioids being down across New Mexico resulting in:

The total volume of opioids (measured in morphine milligram equivalents or MME), dispensed in New Mexico fell by 11% between the 4th quarter of 2016 and the 4th quarter of 2017.

The number of patients receiving high-dose prescriptions fell by 15% over the same period.

The number of patients receiving concurrent benzodiazepines and opioid prescriptions for 10 days or more in the quarter (making them at higher risk of overdose) fell by 17%.

Approximately half of all drug overdose deaths in New Mexico involve prescription opioids.

New Mexico did not pass any legislative or regulatory improvements to the medical cannabis program in 2017. However, research from the University of New Mexico showed a strong correlation between use of medical cannabis and reduction of opioid use, making the state more poised to adopt opioid use disorder in 2018, despite a veto from Governor Martinez on this condition in 2017. New Mexico remains a strong program for patients; however, the state still needs to add civil protections for patients including housing, employment, parental rights, and organ transplants.

“Medically Necessary” is defined as “health-care services or supplies needed to prevent, diagnose, or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine.” Medical necessity is a United States legal doctrine, related to activities which may be justified as reasonable, necessary, and/or appropriate, based on evidence-based clinical standards of care.

At the November 2017 medical cannabis Advisory Board Hearing, Doctors recommended to add Substance Abuse Disorders into the New Mexico Medical Cannabis Program with 5-0 Vote. The final decision rest with Secretary Lynn Gallagher at the Department of Health and is expected at the next hearing on May 11th 2018. View the Petition Here: http://lecuanmmcpmcabpetitions.blogspot.com/2017/09/petition-substance-abuse-disorder.html

Lawmakers in the Roundhouse and the Governor need to address the neglected medical cannabis program and follow the recommendations by the Doctors on the advisory board. The State’s Medical Cannabis Program expansion is now “Medically Necessary” and the State needs to allow the Department of Health to open the application process, the State needs to increase the Licensed Non Profit Producer plant count, add more licensed non-profit producers, in conjunction with other measures to ensure safe access to medicine.

 

roots69

Rising Star
BGOL Investor
The Drug War’s Impact on the American Economy


America’s and the world’s appetite for drugs is insatiable. Billions upon billions of dollars have been spent on both the consumption of illicit drugs and fighting the war on drugs.

At first glance as an investor, you probably don’t think this affects you (that is, if you don’t use or sell drugs). But a closer look will reveal the enormous economic impact that the war on drugs has on America. Prepare yourself for some very alarming numbers.

Since 1971, the United States has spent $1,000,000,000,000 on the war on drugs. If you have a hard time reading that enormous number, it’s 1 TRILLION dollars! There are an estimated 500,000 inmates incarcerated for drug related charges. At an annual cost of $25,000 per inmate, that equates to $12.6 billion a year. America spends 58% less money to educate a child than it does to keep an inmate behind bars. The next generation (who will be future consumers) is suffering and is being heavily disadvantaged.

On the consumption side, the numbers are just as incredible. The estimated annual value of the cocaine market is $88 billion. For Heroin, it is $55 billion. The average cocaine addict will spend $25,000 per year to fuel their habit and the average heroin addict will spend $18,000.

These massive sums of money could be spent on much more productive things. The USA has been struggling financially for years now, to the point where a major city like Detroit had to declare bankruptcy. The enormous amount of money that is spent untaxed on drugs is mind boggling, and the large majority of it goes out of the country. Can you imagine if these wasted dollars could be used to fuel its growth or pay back its astronomical debt?

The first step of rehab is to admit there is a problem. Spending over a trillion dollars and incarcerating hundreds of thousands is definitely that. The next step is finding a way to solve it – we’re open to ideas.
 

roots69

Rising Star
BGOL Investor
America's Shameful War in Afghanistan: The US Involvement in the Drug Trade
Afghanistan_Helmand_province_f3aef.jpg


An ancient Hindu prayer says, ‘Lord Shiva, save us from the claw of the tiger, the fang of the cobra, and the vengeance of the Afghan.’

The United States, champion of freedom and self-determination, is now in its 18th year of colonial war in Afghanistan. This miserable, stalemated conflict is America’s longest and most shameful war. So far it has cost over $1 trillion and killed no one knows how many Afghans.

This conflict began in 2001 on a lie: namely that Afghanistan was somehow responsible for the 9/11 attacks on the US. These attacks were planned in Europe and the US, not Afghanistan, and apparently conducted (official version) by anti-American Saudi extremists. This writer remains unconvinced by the official versions.

We still don’t know if Osama bin Laden instigated the attacks. He was murdered rather than brought to trial. Dead men tell no tales. However, Mullah Omar, leader of Afghanistan’s Taliban movement, told my late friend journalist Arnaud de Borchgrave that bin Laden was not involved in 9/11. Who benefited? Certainly not the Afghans. They have been at war for the past 40 years.


As I wrote in my first book, ‘War at the Top of the World,’ Afghanistan’s Pashtun tribal majority were fierce fighters and were incredibly brave. Their Taliban movement was a tribal-nationalist-Islamist force devoted to fighting communism, drug dealing, and foreign influence. Taliban stamped out the Afghan opium trade and had just about crushed the drug-dealing Russian-backed Tajik northern alliance – until the US invaded in 2001. The Afghan drug lords quickly became US allies and remain so today.

MORE...
Taliban was not a ‘terrorist movement,’ as western war propaganda falsely claimed. Twenty years earlier their fathers were hailed ‘freedom fighters’ by President Ronald Reagan when they were fighting Soviet occupation. Taliban’s Pashtun warriors wanted all foreigners out of their nation and the right to run their own affairs according to Islamic principles.

The US has savaged Afghanistan, one of the world’s poorest countries. US B-52 and B-1 heavy bombers are razing tribal villages, predator killer drones attack most road movement, US-paid Afghan puppet forces, many former Communists, routinely torture and murder. All this while the US-installed yes-man regime in Kabul does nothing to halt massive drug dealing and human rights abuses.

In fact, dealing in opium and morphine is the primary business of Afghanistan. This cash crop could not be exported to Pakistan, India, Iran and Russia without the connivance of the Kabul regime and its US military protectors. When the full truth about the war is finally written, the US will be in the deepest shame over involvement in the drug trade.

Washington, which has done as much as the former Soviet invaders to ravage Afghanistan, has no clear idea what to do next. President Trump announced withdrawal of some of the 14,000 US troops (and large numbers of mercenaries) from Afghanistan. But then the pro-war neocons at State and the Pentagon sought to veto the president’s statement. Meanwhile, desultory talks are droning on in Doha, Qatar, between the US and Taliban, led by the US ‘special envoy’ (read proconsul) Zalmay Khalilzad, a neocon who played an important role in promoting the invasion of Iraq.

Why is the US still at war in Afghanistan after 18 years? First, because the politicians and generals involved won’t accept responsibility for a defeat and its huge cost. There is nothing more wasteful than a lost war. Second, because imperial-minded circles want to keep bases in Afghanistan to menace China, Iran and Pakistan. There are huge profits to be made from this endless war with its $400 per gallon gasoline trucked in from Karachi and 24-hour on-call air support. Plus the bases and fleet that support the war and promotion for the senior officers involved.

To keep this useless war against lightly armed Pashtun tribesmen going, the US must massively bribe Pakistan to maintain the military’s supply routes into that isolated nation. The absurd waste of US money in Afghanistan and Pakistan has been fully documented by the US government’s audit agencies.

President Trump is right to talk about ending this ignoble conflict. But the neocon fifth column he has foolishly helped install keeps thwarting his aspirations.

Trump should order the fighting ended and all US troops out of Afghanistan within 90 days. End US involvement in the drug trade. Tell India to butt out of Afghanistan. That would be statesmanship. Afghanistan must be allowed to return to its former obscurity.
 

roots69

Rising Star
BGOL Investor
Technotyranny: The Iron-Fisted Authoritarianism of the Surveillance State
“There will come a time when it isn’t ‘They’re spying on me through my phone’ anymore. Eventually, it will be ‘My phone is spying on me.’” ― Philip K. Dick
big-brother_4bf71.jpg


Red pill or blue pill? You decide.

Twenty years after the Wachowskis’ iconic 1999 film, The Matrix, introduced us to a futuristic world in which humans exist in a computer-simulated non-reality powered by authoritarian machines—a world where the choice between existing in a denial-ridden virtual dream-state or facing up to the harsh, difficult realities of life comes down to a red pill or a blue pill—we stand at the precipice of a technologically-dominated matrix of our own making.

We are living the prequel to The Matrix with each passing day, falling further under the spell of technologically-driven virtual communities, virtual realities and virtual conveniences managed by artificially intelligent machines that are on a fast track to replacing us and eventually dominating every aspect of our lives.

Science fiction has become fact.


In The Matrix, computer programmer Thomas Anderson a.k.a. hacker Neo is wakened from a virtual slumber by Morpheus, a freedom fighter seeking to liberate humanity from a lifelong hibernation state imposed by hyper-advanced artificial intelligence machines that rely on humans as an organic power source. With their minds plugged into a perfectly crafted virtual reality, few humans ever realize they are living in a dream world.

Neo is given a choice: to wake up and join the resistance, or remain asleep and serve as fodder for the powers-that-be. “You take the blue pill and the story ends. You wake in your bed and believe whatever you want to believe,” Morpheus says to Neo in The Matrix. “You take the red pill and you stay in Wonderland, and I show you how deep the rabbit hole goes.

Most people opt for the red pill.

In our case, the red pill—a one-way ticket to a life sentence in an electronic concentration camp—has been honey-coated to hide the bitter aftertaste, sold to us in the name of expediency and delivered by way of blazingly fast Internet, cell phone signals that never drop a call, thermostats that keep us at the perfect temperature without our having to raise a finger, and entertainment that can be simultaneously streamed to our TVs, tablets and cell phones.

Yet we are not merely in thrall with these technologies that were intended to make our lives easier. We have become enslaved by them.

Look around you. Everywhere you turn, people are so addicted to their internet-connected screen devices—smart phones, tablets, computers, televisions—that they can go for hours at a time submerged in a virtual world where human interaction is filtered through the medium of technology.

This is not freedom.

This is not even progress.

This is technological tyranny and iron-fisted control delivered by way of the surveillance state, corporate giants such as Google and Facebook, and government spy agencies such as the National Security Agency.

We are living in a virtual world carefully crafted to resemble a representative government, while in reality we are little more than slaves in thrall to an authoritarian regime, with its constant surveillance, manufactured media spectacles, secret courts, inverted justice, and violent repression of dissent.

So consumed are we with availing ourselves of all the latest technologies that we have spared barely a thought for the ramifications of our heedless, headlong stumble towards a world in which our abject reliance on internet-connected gadgets and gizmos is grooming us for a future in which freedom is an illusion.

It’s not just freedom that hangs in the balance. Humanity itself is on the line.

Indeed, while most people are busily taking selfies, Google has been busily partnering with the NSA, the Pentagon, and other governmental agencies to develop a new “human” species.

Essentially, Google—a neural network that approximates a global brain—is fusing with the human mind in a phenomenon that is called “singularity.” Google will know the answer to your question before you have asked it, said transhumanist scientist Ray Kurzweil. “It will have read every email you will ever have written, every document, every idle thought you’ve ever tapped into a search-engine box. It will know you better than your intimate partner does. Better, perhaps, than even yourself.”

But here’s the catch: the NSA and all other government agencies will also know you better than yourself. As William Binney, one of the highest-level whistleblowers to ever emerge from the NSA said, “The ultimate goal of the NSA is total population control.”

Cue the dawning of the Age of the Internet of Things, in which internet-connected “things” will monitor your home, your health and your habits in order to keep your pantry stocked, your utilities regulated and your life under control and relatively worry-free.

The key word here is control.

In the not-too-distant future, “just about every device you have — and even products like chairs, that you don’t normally expect to see technology in — will be connected and talking to each other.”

By 2020, there will be 152 million cars connected to the Internet and 100 million Internet-connected bulbs and lamps. By 2021, it is estimated there will be 240 million wearable devices such as smartwatches, keeping users connected it real time to their phones, emails, text messages and the Internet. By 2022, there will be 1.1 billion smart meters installed in homes, reporting real-time usage to utility companies and other interested parties.

This “connected” industry—estimated to add more than $14 trillion to the economy by 2020—is about to be the next big thing in terms of societal transformations, right up there with the Industrial Revolution, a watershed moment in technology and culture.

Between driverless cars that completely lacking a steering wheel, accelerator, or brake pedal and smart pills embedded with computer chips, sensors, cameras and robots, we are poised to outpace the imaginations of science fiction writers such as Philip K. Dick and Isaac Asimov. (By the way, there is no such thing as a driverless car. Someone or something will be driving, but it won’t be you.)

The aim of these internet-connected devices, as Nest proclaims, is to make “your house a more thoughtful and conscious home.” For example, your car can signal ahead that you’re on your way home, while Hue lights can flash on and off to get your attention if Nest Protect senses something’s wrong. Your coffeemaker, relying on data from fitness and sleep sensors, will brew a stronger pot of coffee for you if you’ve had a restless night.

Internet-connected techno gadgets as smart light bulbs can discourage burglars by making your house look occupied, smart thermostats will regulate the temperature of your home based on your activities, and smart doorbells will let you see who is at your front door without leaving the comfort of your couch.

Nest, Google’s $3 billion acquisition, has been at the forefront of the “connected” industry, with such technologically savvy conveniences as a smart lock that tells your thermostat who is home, what temperatures they like, and when your home is unoccupied; a home phone service system that interacts with your connected devices to “learn when you come and go” and alert you if your kids don’t come home; and a sleep system that will monitor when you fall asleep, when you wake up, and keep the house noises and temperature in a sleep-conducive state.

It’s not just our homes that are being reordered and reimagined in this connected age: it’s our workplaces, our health systems, our government and our very bodies that are being plugged into a matrix over which we have no real control.

Moreover, given the speed and trajectory at which these technologies are developing, it won’t be long before these devices are operating entirely independent of their human creators, which poses a whole new set of worries.

As technology expert Nicholas Carr notes, “As soon as you allow robots, or software programs, to act freely in the world, they’re going to run up against ethically fraught situations and face hard choices that can’t be resolved through statistical models. That will be true of self-driving cars, self-flying drones, and battlefield robots, just as it’s already true, on a lesser scale, with automated vacuum cleaners and lawnmowers.”

For instance, just as the robotic vacuum, Roomba, “makes no distinction between a dust bunny and an insect,” weaponized drones will be incapable of distinguishing between a fleeing criminal and someone merely jogging down a street.

For that matter, how do you defend yourself against a robotic cop—such as the Atlas android being developed by the Pentagon—that has been programmed to respond to any perceived threat with violence?

Unfortunately, in our race to the future, we have failed to consider what such dependence on technology might mean for our humanity, not to mention our freedoms.

Ingestible or implantable chips are a good example of how unprepared we are, morally and otherwise, to navigate this uncharted terrain. Hailed as revolutionary for their ability to access, analyze and manipulate your body from the inside, these smart pills can remind you to take your medication, search for cancer, and even send an alert to your doctor warning of an impending heart attack.

Sure, the technology could save lives, but is that all we need to know? Have we done our due diligence in dealing with the ramifications of giving the government and its cronies access to such intrusive programs? For example, asks reporter Ariana Eunjung Cha, “How will patients be assured that the technology won’t be used to compel them to take medications they don’t really want to take? Could what started as a voluntary experiment be turned into a compulsory government identification program that could erode civil liberties?

Let me put it another way.

If you were shocked by Edward Snowden’s revelations about how NSA agents have used surveillance to spy on Americans’ phone calls, emails and text messages, can you imagine what unscrupulous government agents could do with access to your internet-connected car, home and medications?

All of those internet-connected gadgets we just have to have (Forbes refers to them as “(data) pipelines to our intimate bodily processes”)—the smart watches that can monitor our blood pressure and the smart phones that let us pay for purchases with our fingerprints and iris scans—are setting us up for a brave new world where there is nowhere to run and nowhere to hide.

Imagine what a SWAT team could do with the ability to access, monitor and control your internet-connected home: locking you in, turning off the lights, activating alarms, etc.

Thus far, the public response to concerns about government surveillance has amounted to a collective shrug.

After all, who cares if the government can track your whereabouts on your GPS-enabled device so long as it helps you find the fastest route from Point A to Point B? Who cares if the NSA is listening in on your phone calls and downloading your emails so long as you can get your phone calls and emails on the go and get lightning fast Internet on the fly? Who cares if the government can monitor your activities in your home by tapping into your internet-connected devices—thermostat, water, lights—so long as you can control those things with the flick of a finger, whether you’re across the house or across the country?

It’s hard to truly appreciate the intangible menace of technology-enabled government surveillance in the face of the all-too-tangible menace of police shootings of unarmed citizens, SWAT team raids, and government violence and corruption.

However, both dangers are just as lethal to our freedoms if left unchecked.

Consider that on any given day, the average American going about his daily business is monitored, surveilled, spied on and tracked in virtually every way by both government and corporate eyes and ears.

Whether you’re walking through a store, driving your car, checking email, or talking to friends and family on the phone, you can be sure that some government agency, whether the NSA or some other entity, will be listening in and tracking your behavior.

This doesn’t even begin to touch on the corporate trackers that monitor your purchases, web browsing, Facebook posts and other activities taking place in the cyber sphere.

In other words, there is no form of digital communication that the government cannot and does not monitor: phone calls, emails, text messages, tweets, Facebook posts, internet video chats, etc., are all accessible, trackable and downloadable by federal agents.

The government and its corporate partners-in-crime have been bypassing the Fourth Amendment’s prohibitions for so long that this constitutional bulwark against warrantless searches and seizures has largely been rendered antiquated and irrelevant.

We are now in the final stage of the transition from a police state to a surveillance state.

Having already transformed local police into extensions of the military, the Department of Homeland Security, the Justice Department and the FBI are in the process of turning the nation’s police officers into techno-warriors, complete with iris scanners, body scanners, thermal imaging Doppler radar devices, facial recognition programs, license plate readers, cell phone Stingray devices and so much more.

Add in the fusion centers and real-time crime centers, city-wide surveillance networks, data clouds conveniently hosted overseas by Amazon and Microsoft, drones equipped with thermal imaging cameras, and biometric databases, and you’ve got the makings of a world in which “privacy” is reserved exclusively for government agencies.

In other words, the surveillance state that came into being with the 9/11 attacks is alive and well and kicking privacy to shreds in America. Having been persuaded to trade freedom for a phantom promise of security, Americans now find themselves imprisoned in a virtual cage of cameras, wiretaps, sensors and watchful government eyes.

Just about every branch of the government—from the Postal Service to the Treasury Department and every agency in between—now has its own surveillance sector, authorized to spy on the American people.

And of course that doesn’t even begin to touch on the complicity of the corporate sector, which buys and sells us from cradle to grave, until we have no more data left to mine. Indeed, Facebook, Amazon and Google are among the government’s closest competitors when it comes to carrying out surveillance on Americans, monitoring the content of your emails, tracking your purchases and exploiting your social media posts.

“Few consumers understand what data are being shared, with whom, or how the information is being used,” reports the Los Angeles Times. “Most Americans emit a stream of personal digital exhaust — what they search for, what they buy, who they communicate with, where they are — that is captured and exploited in a largely unregulated fashion.”

It’s not just what we say, where we go and what we buy that is being tracked.

We’re being surveilled right down to our genes, thanks to a potent combination of hardware, software and data collection that scans our biometrics—our faces, irises, voices, genetics, even our gait—runs them through computer programs that can break the data down into unique “identifiers,” and then offers them up to the government and its corporate allies for their respective uses.

For instance, imagine what the NSA could do (and is likely already doing) with voiceprint technology, which has been likened to a fingerprint. Described as “the next frontline in the battle against overweening public surveillance,” the collection of voiceprints is a booming industry for governments and businesses alike. As The Guardian reports, “voice biometrics could be used to pinpoint the location of individuals. There is already discussion about placing voice sensors in public spaces, and … multiple sensors could be triangulated to identify individuals and specify their location within very small areas.”

The NSA is merely one small part of a shadowy permanent government comprised of unelected bureaucrats who march in lockstep with profit-driven corporations that actually runs Washington, DC, and works to keep us under surveillance and, thus, under control. For example, Google openly works with the NSA, Amazon has built a massive $600 million intelligence database for CIA, and the telecommunications industry is making a fat profit by spying on us for the government.

In other words, Corporate America is making a hefty profit by aiding and abetting the government in its domestic surveillance efforts.

Control is the key here.

Total control over every aspect of our lives, right down to our inner thoughts, is the objective of any totalitarian regime.

George Orwell understood this. His masterpiece, 1984, portrays a global society of total control in which people are not allowed to have thoughts that in any way disagree with the corporate state. There is no personal freedom, and advanced technology has become the driving force behind a surveillance-driven society. Snitches and cameras are everywhere. And people are subject to the Thought Police, who deal with anyone guilty of thought crimes. The government, or “Party,” is headed by Big Brother, who appears on posters everywhere with the words: “Big Brother is watching you.”

Make no mistake: the Internet of Things is just Big Brother in a more appealing disguise.

Now there are still those who insist that they have nothing to hide from the surveillance state and nothing to fear from the police state because they have done nothing wrong. To those sanctimonious few, secure in their delusions, let this be a warning: the danger posed by the American police state applies equally to all of us, lawbreaker and law-abider alike.

In an age of too many laws, too many prisons, too many government spies, and too many corporations eager to make a fast buck at the expense of the American taxpayer, there is no safe place and no watertight alibi.

We are all guilty of some transgression or other.

Eventually, as I make clear in my book Battlefield America: The War on the American People, we will all be made to suffer the same consequences in the electronic concentration camp that surrounds us.
 

roots69

Rising Star
BGOL Investor
Excerpts from the book...
Cocaine Politics
by Peter Dale Scott and Jonathan Marshall
University of California Press, 1991, paper

page vii
In country after country, from Mexico and Honduras to Panama and Peru, the CIA helped set up or consolidate intelligence agencies that became forces of repression, and whose intelligence connections to other countries greased the way for illicit drug shipments.
page ix
It has ... become more clear just how cynical were the government' claims that the apprehension of Noriega would help constrain the hemispheric drug traffic. Within a year of Noriega's ouster, U.S. drug agents admitted that the Cali cartel had turned Panama into a financial and logistics base for flooding North America and Europe with cocaine. And U.S. Ambassador Deane Hinton complained in 1993 that Panamanian authorities had not arrested a single person for the crime of money laundering in the three and a half years after Noriega's capture in a bloody U.S. invasion.
These problems are of more than historical interest, given that the problem of a U.S.-protected drug traffic endures. Today the United States, in the name of fighting drugs, has entered into alliances with the police, armed forces, and intelligence agencies of Colombia and Peru, forces conspicuous by their own alliances with drug traffickers in counterinsurgency operations.
One of the most glaring and dangerous examples is in Peru. Behind Peru's president, Alberto Fujimori, is his chief adviser Vladimiro Montesinos, the effective head of the National Intelligence Service, or SIN, an agency created and trained by the CIA in the 1960s.'4 Through the SIN, Montesinos played a central role in Fujimori's "auto-coup," or suspension of the constitution, in April 1992, an event which (according to Knight-Ridder correspondent Sam Dillon) raised "the specter of drug cartels exercising powerful influence at the top of Peru's government." Recently Montesinos has been accused of arranging for an opposition television station to be bombed, and in August 1996 an accused drug trafficker claimed that Montesinos had accepted tens of thousands of dollars in payoffs.
According to an opinion column in the New York Times by Gustavo Gorriti, a leader among the Peruvian intellectuals forced into exile, "Mr. Montesinos built a power base and fortune mainly as a legal strategist for drug traffickers. He has had a close relationship with the CIA, and controls the intelligence services, and, through them, the military."
In the New York Review of Books, Mr. Gorriti spelled out this CIA-drug collaboration more fully:
In late 1990, Montesinos also began close cooperation with the CIA, and in 1991 the National Intelligence Service began to organize a secret anti-drug outfit with funding, training, and equipment provided by the CIA. This, by the way, made the DEA. . . furious. Montesinos apparently suspected that the DEA had been investigating his connection to the most important Peruvian drug cartel in the 1980s, the Rodriguez-Lopez organization, and also links to some Colombian traffickers. Perhaps not coincidentally, Fujimori made a point of denouncing the DEA as corrupt at least twice, once in Peru in 1991, and the second time at the Presidential summit in San Antonio, Texas, in February [1992]. As far as I know, the secret intelligence outfit never carried out anti-drug operations. It was used for other things, such as my arrest.
The San Francisco Chronicle also reported from Mexican officials that "Vladimiro Montesinos .. and Santiago Fujimori, the president's brother, were responsible for covering up connections between the Mexican and Peruvian drug mafias."
Others have pointed to the drug corruption of Peru's military establishment, which also receives U.S. anti-drug funding. Charges that the Peruvian army and security forces were continuing to take payoffs, to protect the cocaine traffickers that they were supposed to be fighting, have led at times to a withholding of U.S. aid. Such charges against Fujimori, Montesinos, and the Peruvian military are completely in line with what we have written in this book about Peru over the last two decades
The ongoing situation in Peru shows that Washington's proclivity to tolerate, protect, and reinforce the influence of Third World drug traffickers didn't die with the end of the Reagan-Bush years. Indeed, the Clinton Administration, guided by White House drug czar General Barry McCaffrey, has consistently asked for large increases in counternarcotics aid to compromised Latin American police and military forces. As a critical New York Times editorial observed, "Until taking the drug czar job, General McCaffrey was head of the United States army Southern Command, which worked with Latin militaries and police to fight cocaine. He knows that the overseas programs have succeeded largely in pushing cocaine from country to country."
Such funding priorities must be repudiated. The misnamed "War on Drugs," a pernicious and misleading military metaphor, should be replaced by a medically and scientifically oriented campaign geared toward healing this country's drug sickness. The billions that have been wasted in military anti-drug campaigns, efforts which have ranged from the futile to the counterproductive, should be rechanneled into a public health paradigm, emphasizing prevention, maintenance, and rehabilitation programs. The experiments in controlled decriminalization that have been initiated in Europe should be closely studied and emulated here.
A root cause of the governmental drug problem in this country (as distinguished from a broader social drug problem) is the National Security Act of 1947, and subsequent orders based on it. These, in effect, have exempted intelligence agencies and their personnel from the rule of law, an exemption that in the course of time has been extended from the agencies themselves to their drug trafficking clients. This must cease. Either the president or Congress must proclaim that national security cannot be invoked to protect drug traffickers. This must be accompanied by clarifying orders or legislation that discourages the conscious collaboration with, or protection of, criminal drug traffickers by making it clear that such acts will constitute grounds for prosecution.
Clearly a campaign to restore sanity to our prevailing drug policies will remain utopian if it does not contemplate a struggle to realign the power priorities of our political system. Such a struggle will be difficult I and painful. For those who believe in an open and decent America, the results will also be rewarding.
page xv
The drug traffic should be visualized, not as a horizontal line between producers and consumers, but as a triangle. At its apex sit governments whose civilian and military intelligence agencies recurringly afford defacto protection to drug kingpins beneath them. In the United States as elsewhere, this vertical dimension of protected trafficking has created windows of opportunity for importing narcotics by the ton.
Our conclusion remains that the first target of an effective drug strategy should be Washington itself, and specifically its own connections with corrupt, drug-linked forces in other parts of the world. We argued that Washington's covert operations overseas had been a major factor in generating changes in the overall pattern of drug flows into the United States, and cited the Vietnam-generated heroin epidemic of the 1960s and the Afghan-generated heroin epidemic of the 1980s as analogues of the central concern of this book: the explosion of cocaine trafficking through Central America in the Reagan years, made possible by the administration's covert operation to overthrow the Nicaraguan Sandinistas.
Recent indictments, congressional hearings, and news investigations into the shadowy Bank of Credit and Commerce International indicate that the parallel we drew between Afghanistan and Central America is even tighter than we dared suggest. In both regions, BCCI appears to have gone out of its way to attract drug money, facilitate arms transactions, and cater to the CIA, all the while enjoying an extraordinary, if still unexplained, degree of immunity from prosecution.
Thus the head of BCCI's Panama branch, which as noted in Chapter 4 was a conduit of CIA funds to General Manuel Noriega, was the son of a former director of intelligence in Pakistan. Numerous sources confirm that the CIA (and Arab states) used BCCI to move funds into the Afghan pipeline, and that the bank was used in turn by corrupt Pakistani officials to launder drug profits from the burgeoning heroin trade.
To be sure, denials have come from many quarters. Acting CIA Director Richard Kerr, admitting that his agency knew by the early 1980s that the bank "was involved in illegal activities such as money-laundering, narcotics and terrorism," insisted that the CIA used BCCI merely as a "transfer point" for the routine movement of funds. And Pakistan's finance minister, Sarti Asis, told the Financial Times of London that although the bank did launder CIA contributions to the Afghan rebels, "it was not even handling 1 percent of total drug money."
In Latin America, however, evidence is indisputable that the bank moved aggressively to boost its share of that region's total drug money. BCCI officers met with and opened accounts for such major Colombian cartel leaders as Pablo Escobar, Jorge Luis Ochoa and Jose Gonzalo Rodriguez Gacha. The bank established branches in such notorious drug centers as Medellin, Cali and even Pablo Escobar's home town, Envigado. In Peru, it opened an office in the Huallaga Valley, the center of that country's coca production. In Florida, it handled accounts for some 200 drug traffickers and tax evaders. In all, according to estimates by some U.S. sources, the bank laundered nearly $1 billion in Colombian drug profits.'
At BCCI's Panama City branch, Noriega deposited at least $33 million. Some of that money, as noted in Chapter 4, came from the CIA and other U.S. intelligence agencies. As part of the discovery process preceding the Noriega trial, the CIA and U.S. Army admitted paying him $322,226 in cash and gifts between 1955 (when, at the age of 19, he joined the Socialist Party and began informing on its operations) and 1986.5 Much more money apparently flowed through Noriega's hands and into BCCI on behalf of the Panamanian Defense Forces.
Such connections may go far to explain the otherwise baffling failure of law enforcement authorities to crack down on the bank, despite indications as early as 1984 that it was laundering drug money. Informant tapes were mysteriously "lost," leads were buried in the files, and when an indictment finally came down in 1988, prosecutors accepted a plea bargain that struck many critics as far too easy on the bank. As Congressman Charles Rangel of New York put it, in releasing a report on this record by the staff of the Crime and Criminal Justice Subcommittee, "It wasn't just that BCCI was rumored to be bad. It was that professional investigators in the agencies had hard evidence that they were bad, and bad in a big way, and nobody did anything about it "
Expressions of outrage at this failure-and at outright stonewalling from such government departments as Justice and Treasury-have come from as ideologically diverse sources as President Reagan's Customs Commissioner, William Von Raab, and Manhattan District Attorney Robert Morgenthau. Former Customs agent Robert Mazur, whose undercover work led to the bank's indictment for money-laundering crimes in 1988, quit Customs in disgust at its investigatory lapses and decried the Justice Department's failure to follow up witnesses and records from that case. And Senator John Kerry, whose subcommittee on narcotics and terrorism is investigating BCCI as we write, has complained of Justice Department obstruction in the provision of witnesses, conduct he is only too familiar with from his earlier investigation of U.S. complicity in the Central American drug trade of the 1980s.
Bureaucratic jealousy, bungling, and incompetence and political interference from the bank's influential allies no doubt explain some of this record of official misbehavior. But it is hard to write off the claim of one U.S. intelligence officer, quoted in Time magazine, that "if BCCI is such an embarrassment to the U.S. that forthright investigations are not being pursued, it has a lot to do with the blind eye the U.S. turned to heroin trafficking in Pakistan." It is similarly hard to write off the assertion of one senior bank executive, Abdur Sakhia, that some kind of deal-perhaps related to the Iran-Contra affair-was struck with the bank's founder, Aga Hassan Abedi, in 1985 to allow him entry to the United States after being blacklisted. And, finally, it is hard to write off the suspicion that the sea change in Washington's approach to BCCI, so closely parallel to its change in relations with Noriega, was less a product of new information than of shifting regional priorities, in particular the abandonment in 1987 of the commitment to a military victory by the Contras.
The political inspiration of Washington's zigs and zags on matters of law enforcement is evident. from the ongoing trial of Noriega in Miami for drug offenses, many of which he is no doubt guilty of. Far from demonstrating the renewed commitment of U.S. officials to waging a nonpartisan "war on drugs," however, the trial demonstrates the total subordination of that war to politics. In order to justify the demonization of Noriega and the 1989 invasion of Panama, the authorities have slashed prison terms and restored millions of dollars of drug profits to witnesses willing to take the stand against the man deprecated by former cartel kingpin Carlos Lehder as "just another criminally corrupt police officer."
The trial, eagerly awaited by some government critics as a source of revelations about Reagan administration complicity with Noriega, has been narrowly contained by prosecutorial objections and judicial rulings barring most questions about the Contras, George Bush, and related matters. Even so, one key government witness, Floyd Carlton, testified that his associate in the cocaine trade, Alfredo Caballero, organized arms shipments to the Contras in 1983 and 1984." And Lehder, who also testified to the complicity of Cuban and Nicaraguan leaders in the drug trade, admitted (over the intense objection of prosecutors) that the Medellin Cartel contributed some $10 million to the Contra cause.
Meanwhile, evidence is mounting that even with Noriega removed from Panama, cocaine continues to pour through that country. One Drug Enforcement Administration agent told the General Accounting Office that the volume of cocaine transiting Panama "may have doubled since Operation Just Cause." The price of cocaine reached record lows there in mid-1991. Panamanian reporters have had a field day exposing the links of President Guillermo Endara (whose 1989 election campaign was financed in part by the CIA) to notorious money-laundering banks. Costa Rican authorities say that two-thirds of the cocaine transshipped through their own country goes through Panama's Chiriqui Province and is often protected by former Nicaraguan Contras.
Now that the Nicaraguan civil war is over, more will surely emerge in years to come of the Contra-drug connection. In November 1991, for instance, the chief of Nicaragua's National Police Criminal Division announced the arrest of that country's leading narcotics trafficker, Norwin Meneses, known as "El Rey" (The King). Police seized 738 kilos of cocaine from the ring, which intended to smuggle it to the United States through El Salvador. The Meneses group reportedly had plans to export 4,000 kilos to the North American market. As discussed in Chapter 6, Meneses was at the center of one of the most sensitive U.S. drug busts of the 1980s, the so-called Frogman seizure, which (through a press leak) exposed his role in financing elements of the Contras.
Whether new revelations will make any more difference than the old ones to Congress, public opinion or administration policy remains to be seen. Many law enforcement professionals need no persuading to accept our thesis; Dennis Dayle, former chief of an elite DEA enforcement unit, has said for the record that "in my 30-year history in the Drug Enforcement Administration and related agencies, the major targets of my investigations almost invariably turned out to be working for the CIA." Yet the notion that Washington is a big part of the problem continues to meet with strong resistance in the major media, where evidence of government complicity with international narcotics traffickers is variously dismissed as unthinkable or as a mere "sideshow" to more important factors in the drug market.
Signs of any new thinking about drug issues in Congress are hard to find. The U.S. Senate confirmed the nomination of Robert Gates as CIA director by a vote of 64 to 31 on November 5, 1991, despite voluminous testimony suggesting that he lied as to his ignorance of key matters in the Iran-Contra affair and that he distorted the production of intelligence estimates to serve the political ends of his boss, former Reagan campaign director William Casey. In this respect, one critic testified that Gates pushed the administration line on "narcoterrorism," which blamed drug trafficking on leftwing states and insurgent movements (see Chapter 2). Accusing Gates of shopping for analysts to make that case, Mel Goodman testified that "a senior analyst was called in by Bob Gates and told that Bill Casey wanted a memo that would link drug dealers to international terrorists. This senior analyst looked at the evidence and couldn't make those conclusions. The evidence wasn't there. He was told to go back and look again. He did that. Said the evidence wasn't there. Gates took the project away from him and gave it to another analyst. I believe there is an ethical issue here." Gates admitted asking analysts to look into accusations of a linkage between traffickers and terrorists but said in his defense that three separate agency analyses concluded any such linkage was weak.
Congress also shows few signs of challenging the "war on drugs," in particular, President Bush's "Andean Initiative" to send millions of dollars in aid to the militaries of Bolivia, Colombia, and Peru. Assistance to these drug-corrupted forces often goes to fight not traffickers but leftist guerrillas and their civilian sympathizers. The program has been seriously challenged only in the case of Peru, which the human rights group Americas Watch accused of having one of the worst records in the world for "disappearances." (The organization admits that the human rights record of the guerrilla group Shining Path, which finances its struggle in part from cocaine taxes, is at least as grisly as that of government forces.) Congress showed enough concern over official abuses in late 1991 to hold up $10 million in military aid earmarked for two army battalions combating the Shining Path.
This limited dissent is not enough. The administration's disastrous drug policies must be challenged, both for traditional considerations of national security and basic considerations of humanity. The United States cannot afford to become enmeshed in counterinsurgency campaigns abroad, in Third World jungles, nor at home in the streets of our cities. The social cost of trying to reproduce for illicit drugs the conditions of Prohibition is too high.
page 1
For half a century, starting with the challenge of fascism, America's national security establishment has enjoyed the most important guarantee of its influence, prestige, and claim on the national treasury: a credible international threat. When Germany, Japan, and Italy became America's allies, international communism took their place as an enemy for almost four decades. Yet that menace too has faded with the opening to China, détente, and now the revolutionary political changes in Eastern Europe. And even state-sponsored terrorism, once nominated by the Reagan administration as a successor threat, today arouses little sustained indignation.
In the 1990s, the national security community has finally found a new threat: narcoterrorism. The nation's enemy number one today is drug abuse. Before the crisis with Iraq, nearly two-thirds of the American people viewed it as "the most important problem facing this country."' More Americans ranked drugs an "extremely serious threat" to national security than they did any other issue-including terrorism, the Persian Gulf or Middle East conflicts, and the spread of communism in Central America. Now that Mikhail Gorbachev has put a benign face on America's traditional foe, the United States is beginning to turn the weight of its power against this new evil, represented above all by Colombia's cocaine cartels and their corrupt allies, like former Panama dictator Manuel Noriega.
Drugs have played a role in American foreign policy since the early part of the twentieth century. During the Cold War, American leaders played the theme of the "Red dope menace" in their propaganda against communist China, Castro's Cuba, and, most recently, Nicaragua under the Sandinistas. During the past two decades, drug issues have also strained U.S. relations with such noncommunist regimes as France, Turkey, Mexico, and the Bahamas.
Today, however, the national panic over crack has turned foreign drug enforcement into a new American crusade. The popular frustration with America's failure to stop the drug trade at home, despite government expenditures of more than $10 billion a year, has prompted national leaders to demand a dramatic escalation of enforcement abroad, up to and including military intervention against foreign drug lords and peasant 7 cultivators. The "War on Drugs" is fast turning from an overworked metaphor into a dangerous reality.
As early as 1982, Vice President Bush and his aides began pushing to involve the CIA and U.S. armed forces in the drug interdiction effort. In 1986, President Reagan signed a directive acknowledging drugs as a national security threat. In the summer of 1989, only a few months after taking office as president, Bush built on that precedent with a secret National Security Decision Directive (NSDD) expanding the role of U.S. military forces in fighting the drug trade in Latin America. In addition to increased financial aid, equipment, and training for the military and police of the Andean countries, Bush authorized wide-ranging missions by U.S. military special operations forces in the drug-producing regions.
Defense Secretary Richard Cheney, branding drugs a "direct threat to the sovereignty and security of our country," ordered commanders to develop specific plans for "operational support" of antidrug missions in Latin America and vowed to ensure a "more aggressive and robust" U.S. military presence in the Andes. And with the invasion of Panama in December 1989, justified in part as an effort to capture an indicted drug suspect (General Noriega), the Bush administration dramatically demonstrated the terms on which it is willing to fight the new drug war.
A few years ago, such a policy would have stirred dire warnings from politicians, the press, and the public of the danger of another Vietnam-style entanglement. Indeed, the prospects of victory are no better in the Andes, where unforgiving terrain, hostile peasants, and well-financed traffickers mistake a deadly mix. But memories today are short and passions are high.
page 4
... the long and sordid history of CIA involvement with the Sicilian Mafia, the French Corsican underworld, the heroin producers of Southeast Asia's Golden Triangle, the marijuana- and cocaine-trafficking Cuban exiles of Miami, and the opium smuggling mujaheddin of Afghanistan simply reinforces the lesson of the Contra period: far from considering drug networks their enemy, U.S. intelligence organizations have made them an essential ally in the covert expansion of American influence abroad.
page 5
New York Times reported in 1988
"The Reagan administration has done little to press the guerrillas to curb the drug trade, according to se or State Department and intelligence analysts."
page 5
a Reagan administration official who follows Afghanistan closely, emphasizing that narcotics are relatively a minor issue in the context of policy toward the Afghan guerrillas
"We're not going to let a little thing like drugs get in the way of the political situation... And when the Soviets leave and there's no money in the country, it's not going to be a priority to disrupt the drug trade.''
page 5
For the CIA to target international drug networks, it would have to dismantle prime sources of intelligence, political leverage, and indirect financing for its Third World operations.
page 9
On April 13, 1989 ... the Senate Subcommittee on Terrorism, Narcotics, and International Operations finally confirmed what the administration, Congress, and much of the media had attempted to dismiss: the Contra-drug connection was real.
The subcommittee's 144-page report covered drug corruption in the Bahamas, Colombia, Cuba, Nicaragua, Haiti, and Panama, but it focused on the Contras and related drug-trafficking in Honduras and Costa Rica. In several hundred pages of appendices, the report supplemented the subcommittee's four-volume hearing record with FBI and Customs Service documents, news stories, witness depositions, and a chronology of the investigation and attempts to interfere with it.
The subcommittee, led by Sen. John Kerry of Massachusetts, found that drug trafficking had pervaded the entire Contra war effort. "There was substantial evidence of drug smuggling through the war zones on the part of individual Contras, Contra suppliers, Contra pilots, mercenaries who worked with the Contras, and Contra supporters throughout the region," the subcommittee concluded. Far from taking steps to combat those drug flows, "U.S. officials involved in Central America failed to address the drug issue for fear of jeopardizing the war efforts against Nicaragua," the investigation showed. "In each case," the report added, "one or another agency of the U.S. government had information regarding the involvement either while it was occurring, or immediately thereafter." Moreover, "senior U.S. policy makers were not immune to the idea that drug money was a perfect solution to the Contras' funding problems."
page 23
Narcoterrorism as Propaganda
President Reagan came to office with a mission: to roll back the frontiers of world communism, especially in the Third World. Almost from the start he singled out Nicaragua as a dangerous base of Soviet bloc operations in the Western Hemisphere. But with the American public's anticommunist sentiments dulled by a decade of détente and memories of Vietnam, how could his administration revive support for combating the Nicaraguan challenge to U.S. power and credibility?
One answer was to invent a new threat, closely associated with communism and even more frightening to the public: narcoterrorism. The term, rarely well defined by its users, encompasses a variety of phenomena: guerrilla movements that finance themselves by drugs or taxes on drug traffickers, drug syndicates that use terrorist methods to counter the state's law enforcement apparatus, and state-sponsored terrorism associated with drug crimes.' But in the hands of administration officials, the epithet served a more political than analytical purpose: to capitalize on popular fear of terrorists and drug traffickers in order to mobilize support for foreign interventions against leftist regimes. As two private colleagues of Oliver North noted in a prospectus for a propaganda campaign to link the Sandinistas and drugs, "the chance to have a single issue which no one can publicly disagree with is irresistible."
Administration spokesmen drove the lesson home through sheer repetition. In January 1986, President Reagan said, "The link between the governments of such Soviet allies as Cuba and Nicaragua and international narcotics trafficking and terrorism is becoming increasingly clear. These twin evils-narcotics trafficking and terrorism-represent the most insidious and dangerous threats to the hemisphere today." A year and a half earlier, Secretary of State George Shultz decried the "complicity of communist governments in the drug trade," which he called "part of a larger pattern of international lawlessness by communist nations that, as we have seen, also includes support for international terrorism, and other forms of organized violence against legitimate governments." Elliott Abrams, assistant secretary of state for Inter-American Affairs, told a meeting of the Council on Foreign Relations in 1986 that "sustaining democracy and combating the 'narcoterrorist' threat are inextricably linked."
The term "narcoterrorism" also soon became an essential adjunct to the doctrine of national security developed by right-wing Latin American military forces to rationalize their repressive domestic activities and seizures of power. At the Fourteenth Bilateral Intelligence Conference of the general staffs of the Argentine and Bolivian armies, held in Buenos Aires in late August 1988, military leaders concluded that "the relationship between drugs and subversion, which generates narcoterrorism, has become part of the East-West confrontation, with a real impact on the national-international security of the West." They declared that "narcoterrorism now constitutes a means of Revolutionary War" and that "the MCI [International Communist Movement] uses narcoterrorism as a socio-ideological procedure for provoking social imbalances, eroding community morale, and corrupting and disintegrating Western society, as part of the strategic objective of promoting the new Marxist order." Combating narcoterrorism would justify repressing a whole range of familiar enemies: "trade unions, religious, student groups, etc." Above all, it would require granting more resources and political power to military elites: "The intervention of the armed forces in this context has been considered necessary, given that the increase in drug trafficking surpasses individual action."
The Reagan administration's calculated use of the term was often challenged by leftist critics, academics, and even the Drug Enforcement Administration, which cautiously demurred from the most inflammatory accusations against Nicaragua, Cuba, and Latin American guerrilla movements. But White House officials went beyond exaggerating the truth to make their case against Marxist movements and regimes: they sponsored narcoterrorists of their own within the Contras in the course of waging ,"covert" war against Nicaragua.
The distortion of the Contras' ostensibly democratic cause by drugs and terrorism owed much to the practices of three important influences on the anti-Sandinista rebels: militant CIA-trained Cuban exiles, the Mexican drug Mafia, and Argentine military intelligence agents. Their methods, both in war and in crime, indelibly tainted the Contras' own cause. In short, the Contra-drug link, supported by Washington, exemplified the very narcoterrorist threat that Assistant Secretary Abrams called an enemy of democracy.
page 172
One symptom of something deeply wrong with U.S. drug enforcement is that since World War II it has been promoted with the aid of blatant lies. In the 1950s Harry Anslinger, the head of the U.S. Federal Bureau of Narcotics, wrung his annual appropriations from Congress with the accusation, which he knew to be groundless, that the U.S. was being flooded with a tide of "Yunnan opium" from Communist China, "the uncontrolled reservoir supplying the worldwide narcotics traffic." Only in the 1970s, as the United States moved towards normalization of relations with Beijing, did a U.S. narcotics agent admit that "there was no evidence for Anslinger's accusations."' Thus the U.S. media have faced a special problem when reporting on the international drug trade. They are accustomed to drawing their stories from government sources; what should they do when they suspect these sources are Iying?
In the 1980s the Eisenhower-Anslinger propaganda about Red Chinese heroin was replaced by the Reagan-North propaganda about Red Sandinista cocaine. The climax of this campaign was Reagan's charge in a nationally televised broadcast "that top Nicaraguan government officials are deeply involved in drug trafficking." Reagan made this charge on March 16, 1986, only a few hours after the San Francisco Examiner, in a frontpage story, had revealed the involvement of Contra leaders and supporters in the Frogman cocaine bust three years earlier. Reagan's charges reached a national audience; the Examiner's story remained a local one.
It was a sign of improvement in U.S. narcotics enforcement that Reagan's charge was almost immediately undercut by the Drug Enforcement Administration:
Reporters who called the DEA public affairs office after Reagan's speech were read a brief statement, which said: "DEA receives sporadic allegations concerning drug trafficking by Nicaraguan nationals. One DEA investigation resulted in the indictment of the Nicaraguan aide to the minister of the interior [i.e., Federico Vaughan]; no evidence was developed to implicate the minister of the interior or other Nicaraguan officials." The statement earned the DEA an unwelcome headline in The New York Times: "Drug Agency Rebuts Reagan Charge." DEA's stock sank at the White House. The Washington Times attacked [DEA Administrator] Lawn's senior spokesman, a respected former journalist, Robert Feldkamp, for failing to support the president.
At the same time, Vice President Bush was helping spread the administration story, also discounted by DEA Chief Lawn, that Nicaragua, as well as the Medellin cartel, had inspired the 1985 attack by M-19 guerrillas against the Colombian Supreme Court.
Despite the lessons of Watergate, the methods and protocol of United States journalism are not well equipped to handle government spokesmen who are out to peddle lies. It is true that establishment media, which have longer-lived reputations to worry about than do politicians, do not connive willingly at these lies; but as the government is the usual source for political journalism in Washington, the establishment media are reluctant to find themselves at odds with it.
page 174
... the media do not set their own investigative agendas independently, but operate as part ... of the political establishment.
page 174
As a journalist with a good Iran-Contra reporting record told us, "I had the Oliver North story for two years before it broke, but never ran it. Ollie was my best Washington source."
page 174
... it is the journals with the highest national reputations, such as the New York Times and the Washington Post, that find it hardest to undermine their government sources, at least when the story concerns drugs and the U.S. intelligence community.
page 179
The timidity of Congress in challenging administration big lies on the Contra drug issue rises in no small part from the fear of contradiction and criticism from the powerful establishment media, whose interests all too frequently parallel those of the administration.
page 181
The Kerry report, although cautious, had come up with significant and disturbing facts, such as that "the State Department selected four companies owned and operated by narcotics traffickers to supply humanitarian assistance to the Contras," that when one of these companies in Honduras (SETCO) came under suspicion, along with its allies in the Honduran military, "the DEA office in Honduras was closed in June of 1983," or that "Five witnesses testified that [John] Hull ['a central figure in Contra operations on the Southern Front'] was involved in cocaine trafficking."
Both the drug traffic and the CIA's relationship to it were prominent public issues when the report was released in April 1989. Yet the New York Times story on the Kerry report was buried on page 8; the Washington Post's on page 20. Neither John Hull nor the closure of the DEA office was mentioned at all; the State Department story was mentioned only briefly. Thus stories that the Times and Post had never told continued to be excluded from their columns.
The Post in particular devoted far less space to the accounts of Contra involvement ("The report concluded that there was 'substantial' evidence of drug smuggling through the Nicaraguan war zone and that combatants on both sides were involved") than to the subcommittee report's own disclaimers: "The report acknowledges that widely publicized allegations that high-level contras were directly involved in the drug trade could not be substantiated. The report also states that one of the Contras' chief accusers, convicted money launderer Ramon Milian Rodriguez, failed a lie detector test and was found to be 'not truthful.' Another widely quoted contra accuser, Richard Brenneke, never had the Central Intelligence Agency connections he claimed and was found to be otherwise unreliable as well, the report said." Thus the report's twenty-five pages of documentation on the Contras were reduced to a tepid half sentence, while three pages of disclaimers about minor, irrelevant witnesses were given three full sentences.
The Times and the Post, like the Iran-Contra Committees, were also circumspect in investigating the recurring deals of Oliver North and Richard Secord with drug-linked international arms brokers, such as Manucher Ghorbanifar, Sadeg Tabatabai, and Manzer al-Kassar. Here the press and Congress, so shrill in their demands for a "real war" against drugs, were not covering up for the CIA (which had recommended against dealing with Ghorbanifar); they were covering up for these drug traffickers themselves.
In the same way, Jack Terrell's revelations about the drug aspects of North's illegal Contra support activities, as they slowly found their way into the mainstream U.S. press, were never fully covered. The Washington Post ran one story about how more than $100,000 from Secord's IranContra bank accounts had been spent on Robinette efforts against Terrell and others involved in the Christic Institute lawsuit against Secord, a story based largely on Terrell's allegations. But the more such stories proliferated, the more obvious it became that the establishment press was avoiding three central facts: (1) Terrell had told the FBI and other government agencies about major drug smuggling by Contra supporters; (2) the FBI was engaged by North to harass and silence Terrell, an FBI source, along with his political allies; and (3) North's ability to engage the FBI in silencing one of its own witnesses depended on the secret counterterrorism powers of the Operations Sub-Group. (When the Democrats of the Iran-Contra Committees came to issue their report, they too, in their extended treatments of the Terrell story, suppressed these three facts.)
Intrinsic and Exotic Pressures for Media Conformity on Drugs
Undoubtedly this reluctance to publish arises in part from the phenomenon of pack journalism we have already described, which the press itself has recognized. As the Los Angeles Times once observed in a front-page story,
Former Sen. Eugene McCarthy once likened reporters to blackbirds on a telephone wire-when one lands, they all land, he said; when one takes off, they all take off. Nowhere is this phenomenon more pervasive than in Washington.... "Washington is more susceptible to pack journalism than any place I've been," says John Balzar, a political writer for the Los Angeles Times. "I've watched reporters go through the agonies of hell because their stories differed slightly from their colleagues'." . . . "It seems paradoxical to say that competition produces uniformity, rather than diversity," says Howell Raines, Washington bureau chief of the New York Times, but that's exactly what often happens in Washington. One explanation: Washington journalists have many of the same sources, sources who have their own vested interests. They are government aides and spokesmen who function much as political aides and consultants do in a campaign; they are "spin doctors," ready to tell the reporters and commentators just what each event "really means. "
In defense of the media, one can point to the unique propaganda campaign mounted by the Reagan administration on behalf of the Contras, with the help of U.S. tax dollars. This campaign itself has been effectively covered up:
Congressional investigators [for the Iran-Contra Committees] did draft a chapter about the domestic side of the scandal for the Iran-contra report, but it was blocked by House and Senate Republicans. Kept from the public domain, therefore, was the draft chapter's explosive conclusion: that, according to one congressional investigator, senior CIA covert operatives were assigned to the White House to establish and manage a covert domestic operation designed to manipulate the Congress and the American public.... The Administration was indeed running a set of domestic political operations comparable to what the CIA conducts against hostile forces abroad. Only this time they were turned against the three key institutions of American democracy: Congress, the press, and an informed electorate.
page 184
... author Mark Hertsgaard that the aberrations and excesses of the Reagan years are unfortunately outgrowths of a more fundamental problem: "that the press was part of, and beholden to, the structure of power and privilege in the United States." Former Newsweek reporter Bob Parry concurs that when any administration defines its policy priorities so clearly, most media executives are happy to play ball: "In Washington, there is a correspondence between people who run news organizations and people in government. There is this sense of wanting to be respected.... [Drug] stories raise too many questions and don't serve the 'national interest.' That is more important to these executives than selling magazines or newspapers. Many news editors and executives are more interested in being respected at cocktail parties than selling newspapers."
Others have pointed to economic as well as psychological bonds that link media chiefs to others with power.
As ABC's Sam Donaldson acknowledged in his autobiography: "The press, myself included, traditionally sides with authority and the establishment." It is hard to see how it could do otherwise; the press was itself a central part of the American establishment. According to Ben Bagdikian's The Media Monopoly, a mere fifty large corporations owned or controlled the majority of media outlets in the United States . . . when Ronald Reagan came to power in 1981. By the time Bagdikian published a new edition of his book in 1987, mergers and acquisitions had shrunk the previous fifty down to twenty-nine. Half of these media moguls ranked among the Fortune 500-itself an elite club whose members, while numbering less than 1 percent of all industrial corporations in the United States, nevertheless accounted for 87 percent of total sales.
Herman and Chomsky also focus on the wealth of the mass media, and the ways in which they "are closely interlocked, and have important common interests, with other major corporations, banks, and government." This corporate analysis of media oligopoly can easily be oversimplified. Although the media as a whole have been affected by their growing concentration of ownership, the behavior of particular institutions cannot be predicted by their size. Large newspaper chains like Hearst and KnightRidder, with relatively independent Washington bureaus, have collectively a far better record on the drug issue than the New York Times and the Washington Post, which by the yardstick of corporate wealth are smaller. But Hearst and Knight-Ridder newspapers have little circulation among the elites of Washington and New York.
It is true that during Vietnam and Watergate the press had begun to criticize (even if for establishment reasons) the political performance of the U.S. power structure it represented. But this brief drama had led to a prompt backlash for which the academic as well as financial establishments must share responsibility.
"The most important new source of national power in 1970, as compared to 1950, was the national media," Samuel Huntington, a Harvard professor of political science and frequent government consultant, wrote in 1975. Huntington was one of dozens of scholars hired to explore the theme of "the governability of democracy" for the Trilateral Commission, a private group founded by banker David Rockefeller and composed of highly influential business, political and academic figures from the United States, Western Europe and Japan. It was the Trilateral Commission's view that the United States suffered from an "excess of democracy" which prevented the country from making the difficult and painful choices needed to set things right again. On the specific topic of the press, Huntington asserted, "There is . . . considerable evidence that the development of television journalism contributed to the undermining of governmental authority." Backed by large corporate foundations, right-wing think tanks and other representatives of the American power structure, the attack on the press seemed aimed at convincing both the press itself and the public at large that journalists were out of step with the rest of the country.
In the 1980s, the United States press was open to voices of dissent on policy, but not to questions about the fundamental legitimacy of institutions accused of systematically breaking the law. It is chilling to recognize the extent to which this defense of the status quo entailed, time after time, a protective cover-up of the United States security system's involvement with international drug traffickers, its supposed enemies.
page 186
The history of official toleration for or complicity with drug traffickers in Central America in the 1980s suggests the inadequacy of traditional "supply-side" or "demand-side" drug strategies whose targets are remote from Washington. Chief among these targets have been the ethnic ghettos of America's inner cities (the demand side) and foreign peasants who grow coca plants or opium poppies (the supply side). Experience suggests instead that one of the first targets for an effective drug strategy should be Washington itself, and specifically its own support for corrupt, drug-linked forces in the name of anticommunism.
Since the 1940s these government intelligence connections have opened up unsupervised shipping and plane communications between the United States and drug-growing areas and conferred protection on drug traffickers willing to ally themselves in the war against communism- a process the Kerry subcommittee referred to as "ticket punching."' These conditions in turn have created windows of opportunity for drug smugglers to flood America's domestic market with their products.
Such a window was opened wide to cocaine smugglers in Honduras by Washington's support of the Nicaraguan Contras in the 1980s. The resulting "Honduran connection" was built around trafficker allies in the Honduran military, who provided essential support to the Reagan administration's Contra program. Honduras in these years accounted for 20 percent or more of all the cocaine smuggled into the United States. Costa Rica, another center of Contra activity and official corruption, accounted for another 10 percent or more. And Panama, with the CIA-protected Noriega at its helm, supplied drugs, pilots, and banks to service these networks.
The Contra drug connection arose in the context of other drug-related covert operations conducted since the passage of the National Security Act in 1947, which created the legal justification for a national security bureaucracy that evaded normal constraints of law and congressional review. The cumulative history of such connections suggests that changes in politics, as much as changes in either demand or supply, have driven shifts in the overall pattern of drug flows into the United States.
One clear example is the so-called heroin epidemic of the late 1960s, which followed a decade and a half of CIA collaboration with opium-smuggling gangs and drug-corrupted regimes in the Golden Triangle of Burma, Laos, and Thailand. Historian Alfred McCoy noted that this relationship sparked a "takeoff" in the Southeast Asian opium trade in the 1950s, with Burma's production growing tenfold and Thailand's even more. The addition of American troops and the disruption of the French Connection supplied the conditions for an explosion in heroin shipments across the Pacific.
The revival of covert operations under Reagan was accompanied by the dramatic expansion of another traditional opium region: Southwest Asia's "Golden Crescent." In 1979, the region was not a major heroin supplier to the U.S. market; the drug was virtually unknown in Pakistan. The Afghan war changed all that. By 1984, the year Vice President Bush (Reagan's drug czar) graced Pakistan with an official visit, the border area with Afghanistan supplied roughly 50 percent of the heroin consumed in the United States, and 70 percent of the world's high-grade heroin; and there were 650,000 addicts in Pakistan itself. Heroin was shipped out in the same Pakistani army trucks that brought in covert U.S. aid to the Afghan guerrillas. The only high-level heroin bust in Pakistan was made at the insistence of a Norwegian prosecutor; none was made at the instigation of narcotics officers in the U.S. Embassy.
The Central America drug experience in the 1980s, in short, was not an anomaly but part of a long-standing pattern of intelligence alliances, military intervention, and official corruption. It is a pattern that shows no sign of abating.
page 192
Under these conditions, the strategy of further militarizing the societies of Latin America promises to be utterly counterproductive, not only for controlling drugs but also for fostering democracy. Surely the latter objective should stand higher in the priorities of both North and South America. It will be achieved not through wholesale destruction of peasant economies and drug wars but rather through strengthening civilian polities and economies.
Washington could better help Latin America by looking more at home than abroad for ways to reduce drug abuse. Rather than export its crime problem, America should start exporting the example of dealing more humanely with the social, psychological, and medical issues of drug use. As Colombian President-elect Cesar Gaviria said in July 1990, "The demand for drugs is the engine of the trafficking problem. If the United States and the industrial countries don't get a way to reduce consumption, we will not solve the problem. It doesn't matter how much we work against the trafficking of drugs, how many lives we lose. It doesn't matter how great our effort, the problem will be there. The United States and industrialized countries need a way to reduce the consumption of drugs."
Instead of addressing the root causes of America's drug demand, however, during the 1980s about 70 percent of federal drug spending went to law enforcement, which even enthusiasts admit can interdict only a small fraction of total drug supplies. Spending priorities must be reversed if any progress toward social healing is to begin. Drug education and support for expanded treatment are essential. So too are broader (if more challenging) programs to rebuild broken communities that breed despair, escapism, and crime. Ultimately, the United States must begin to consider, and experiment with, proposals to take the crime out of drug markets through controlled legalization.
No approach will succeed, however, without urgent political action to end Washington's own complicity with drug traffic. Both Congress and the media, institutions that have served executive power more than they have challenged it, must show more courage. They must simultaneously judge administration foreign policies more critically and exercise more restraint in milking the drug issue for votes and sales. Neither institution is likely to reform entirely from within; only an informed and demanding public can push them to respond as the nation needs and deserves.
 

roots69

Rising Star
BGOL Investor
Welcome to the Police State

“This is not a new world: It is simply an extension of what began in the
old one. It has patterned itself after every dictator who has ever
planted the ripping imprint of a boot on the pages of history since the
beginning of time. It has refinements, technological advancements,
and a more sophisticated approach to the destruction of human
freedom. But like every one of the super states that preceded it, it has
one iron rule: Logic is an enemy, and truth is a menace.”

ROD SERLING, The Twilight Zone

How do you get a nation to docilely accept a police state? How do
you persuade a populace to accept metal detectors and pat downs
in their schools, bag searches in their train stations, tanks and military
weaponry used by their small town police forces, surveillance cameras
on their traffic lights, police strip searches on their public roads,
unwarranted and forced blood draws at drunk driving checkpoints, whole
body scanners in their airports, and government agents monitoring their
communications?

Try to ram such a state of affairs down their throats, and you might
find yourself with a rebellion on your hands. Instead, you bombard the
citizenry with constant color-coded alerts, terrorize them with reports of
shootings and bomb threats in malls, schools, and sports arenas,
desensitize them with a steady diet of police violence, and mesmerize
them with entertainment spectacles (what the Romans used to refer to as
“bread and circus” distractions) and electronic devices, while selling the
whole package to them as being in their best interests.
And when leaders like John F. Kennedy,
Martin Luther King Jr., John Lennon,
and others rise up who dare to challenge the government
elite, what happens to them? Government agents carry out surveillance
on them, intimidate them, threaten them, and in some cases cause them
to “disappear,” knowing full well that few will rise up to take their place.

Likewise, when government whistleblowers, lacking followers or
name recognition, rise up and shine a spotlight on the government’s
misdeeds, they are labeled traitors, isolated from their friends and loved
ones, and made examples of: this is what happens to those who dare to
challenge the police state.

Fixing the Unfixable

What is most striking about the American police state is not the
megacorporations running amok in the halls of Congress, the militarized
police crashing through doors and shooting unarmed citizens, or the
invasive surveillance regime which has come to dominate every aspect of
our lives. No, what has been most disconcerting about the emergence of
the American police state is the extent to which the citizenry appears
content to passively wait for someone else to solve the nation’s many
problems.

Yet if we don’t act soon, all that is in need of fixing will soon be
unfixable, especially as it relates to the police state that becomes more
entrenched with each passing day. By “police state,” I am referring to
more than a society overrun by the long arm of the police—federal, state,
and local. I am referring to a society in which all aspects of a person’s life
are policed by government agents, one in which all citizens are suspects,
their activities monitored and regulated, their movements tracked, their
communications spied upon, and their lives, liberties, and pursuit of
happiness dependent on the government’s say-so.

That said, how can anyone be expected to “fix” what is broken
without first understanding the lengths to which the government will go in
order to accustom the American people to life in a police state? Why are
millions of innocent Americans being spied on by government agents, as
well as by their partners in the corporate world, when they’ve done
nothing wrong? As noted by the Brookings Institution, “For the first time
ever, it will become technologically and financially feasible for
authoritarian governments to record nearly everything that is said or done
within their borders—every phone conversation, electronic message,
social media interaction, the movements of nearly every person and
vehicle, and video from every street corner.”

Indeed, as the trend towards overcriminalization makes clear, it won’t
be long before average law-abiding Americans are breaking laws they
didn’t even know existed during the course of a routine day. The point, of
course, is that while you may be oblivious to your so-called law-breaking
—whether it was collecting rainwater to water your lawn, lighting a
cigarette in the privacy of your home, or gathering with friends in your
backyard for a Sunday evening Bible study—the government will know
each and every transgression and use them against you when
convenient.

We Are the Enemy

The outlook for civil liberties grows bleaker by the day, from the
government’s embrace of indefinite detention for U.S. citizens and armed
surveillance drones flying overhead to warrantless surveillance of phone,
email, and Internet communications and prosecutions of government
whistleblowers. Meanwhile, the homeland is ruled by a police-industrial
complex, an extension of the America military empire. Everything that our
founding fathers warned against—a standing army that would see
American citizens as enemy combatants—is now the new norm. The
government—local law enforcement now being extensions of the federal
government—has trained its sights on the American people. We have
become the enemy. And if it is true, as the military asserts, that the key to
defeating an enemy is having the technological advantage, then “we the
people” are at a severe disadvantage.

These troubling developments are the outward manifestations of an
inner philosophical shift underway in how the government views not only
the Constitution and the Bill of Rights but “we the people,” as well. What
this reflects is a move away from a government bound by the rule of law
to one that seeks total control through the imposition of its own selfserving laws on the populace.

All the while, the American people remain largely oblivious to the
looming threats to their freedoms, eager to be persuaded that the
government can solve the problems that plague us, whether it is
terrorism, an economic depression, an environmental disaster, or even a
viral epidemic.
 

roots69

Rising Star
BGOL Investor
Some States do things right!!



New Mexico - It’s Time to Regulate Alcohol like Cannabis


The regulatory regime that has been applied to medical cannabis programs and legal cannabis states is far more severe than anything alcohol has been subjected to.
If there’s any doubt on this point, try this thought experiment: Think what obtaining alcohol would be like if instead of cannabis being regulated like alcohol, alcohol were regulated like cannabis.
A visit to a liquor store would begin with a clerk or sometimes a security person asking to see your ID, which isn’t too different from what happens today, but the ID would be subjected to much closer scrutiny than the check it receives today as one will need two forms of ID. Oh wait, you have a hole punch in that ID but they gave you a piece of paper from the DMV saying it’s ok - nope. No sale. And every year, you need to provide proof to the State of New Mexico that you are still over the age of 21, and this process could take any where from 30-90 days.
If you’re wearing sun-glasses, chances are you will be asked to take them off so that the clerk can compare your photo with your face. Oh and if you are seen taking cash from someone else out front of the alcohol store then you will not get to purchase alcohol. If you are driving home with your alcohol and get pulled over for a simple traffic ticket, the Police will have to call a special number to a person from the state to verify that you are indeed over 21 and can have alcohol.
Your license may also be swiped through some sort of a scanner, which presumably will check it against a state database.
Instead of going directly into the store and choosing among thousands of kinds of beer, wine and distilled spirits displayed on supermarket-style shelves, you would be asked to take a seat in a waiting room until a alcohol tender. In a separate room, where the alcoholic beverages were actually sold, was available to wait on you. The experience would be more like waiting to see a doctor than making a quick beer run.
When a alcohol tender became available and you were allowed to enter the holy of holies where the alcoholic beverages were kept, the first thing your personal alcohol tender would do is check your ID a second time.
The shopping experience would not be like going into a store and grabbing a bottle of scotch off a shelf or a couple of six-packs out of a cooler. The alcohol tender would be behind a counter and most of the merchandise would be behind the alcohol tender. In some stores the alcohol tender would bottle your purchase from a store barrel or vat instead of selling you pre-bottled beverages.
Instead of being able to choose among thousands of beers, wines and liquors, your selection would be limited to a few dozen choices.

There would be a strict limit on the amount of alcohol you could buy in a single trip to the store — liquid ounces are now called units, now these units equal the same as the ounces but we count them differently. (?) And maybe a couple of six-packs of beer or a bottle of scotch. There would be a legal limit on how much booze you could possess at any one time.
You would not be able to put your purchase on your credit card — alcohol selling would be a cash only business, although some stores would take debit cards. Most stores would have an ATM machine available so you could get the cash to make your purchase.
Your beer would come in a child-proof container. If you have someone else who lives with you and they drink alcohol too, then both of you are limited to what is allowed in your refrigerator. Nor are you allowed to share what you bought from the alcohol tender or gift this alcohol to another drinker. Making homemade craft beer, wine or even mixing your favorite alcoholic drink, is now considered home manufacturing and is illegal.
Alcohol consumers wouldn’t put up with this sort of over-regulation for a nano-second. Yet alcohol demonstrably causes much more violence and antisocial behavior than cannabis does. And alcohol kills people in a number of ways.
Two New Mexico retail liquor licenses have sold for $975,000 each, the highest ever in the state. Other businesses and investors have routinely paid between $300,000 and $600,000 for a liquor license in 2013.

By comparison, in neighboring Colorado, the most expensive liquor license costs under $2,500. It’s even cheaper in Texas: A two-year “package store permit” (a license to run a liquor store) is less than $1,500. These two neighboring states have a far less of a problem with alcohol and alcohol related deaths as well.


But unlike those states, New Mexico has a quota system for liquor licenses, with the cap currently at 1,411. The quota is supposedly restricted to one liquor license (either a bar or liquor store) for every 2,000 people, though there are some exemptions. Thats 35 total medical cannabis dispensaries selling medicine and 1,411 alcohol stores profiting off New Mexicans while excessive-use of alcohol cost the state 2.2 Billion in one year in dealing with those problems.

Medical cannabis consumers and producers put up with it because that was what it took to overcome 70 years of reefer-madness lying by pot prohibitionists inside and outside of the government.
Yet there is no question that the result of cannabis over-regulation is that a visit to a medical cannabis dispensary is only slightly more exciting than a visit to a drug store.
 

roots69

Rising Star
BGOL Investor
The Second Amendment and Medical Cannabis Patients


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In a 1755 letter to the Pennsylvania General Assembly Ben Franklin wrote “those who would give up essential liberty to purchase a little temporary safety, deserve neither liberty nor safety." However, while its original context, which related to tax policy, may not apply, the words lend themselves to a conversation that lawmakers should be having. How should our country address liberty, but also safety, when it comes to firearms and cannabis?

Recently, the House of Representatives passed H.R. 38, the Concealed Carry Reciprocity Act of 2017 allowing for individuals to receive reciprocity for state issued concealed carry permits allowing them to carry a concealed weapon in another state that permits the concealed carrying of firearms. To be eligible for a universal carry permit, the individual must be able to possess, transport or receive a firearm under federal law. For over 2 million medical cannabis patients, this creates an unworkable impasse.

A short time before the voting on H.R. 38, the Honolulu Police Department issued 30 letters to gun owners that they had to turn in their firearms in 30 days, indicating that the use of medical cannabis disqualifies and individual from the ownership of firearms and ammunition. This policy was reversed only a short time as it was initiated, as possession of a medical cannabis card doesn't automatically equate to using cannabis. Hawaiian officials expressed confusion over the original decision to go after medical cannabis patients, including Retired Supreme Court Justice Steven Levinson who states “I’m a little puzzled as to why the distinction between medical marijuana and medical opioids.”

Currently, medical cannabis patients (and caregivers) are forced to choose to follow a doctor's recommendation or retain their Second Amendment rights. For some this is an easy choice. But for others giving up the liberty of gun ownership means also giving up their livelihood or means of defending their families. The Gun Control Act of 1968 (18 U.S.C. § 922) prohibits the sale of firearms from federally licensed dealers, to among other categories, any “unlawful user of or addicted to any controlled substance.”

In a 2011 letter the Bureau of Alcohol, Tobacco and Firearms (“ATF”) wrote that “Any person who uses or is addicted to marijuana, regardless of whether his or her State has passed legislation authorizing marijuana use for medicinal purposes, is an unlawful user of or addicted to a controlled substance, and is prohibited by Federal law from possessing firearms or ammunition.” It is worth noting that since 2011, thirteen states have passed comprehensive medical cannabis programs.

On forms, including Form 4473, the ATF warns that “the use or possession of marijuana remains unlawful under Federal lax regardless of whether it has been legalized or decriminalized for medicinal or recreational purposes in the state where you reside.” The 2011 ATF letter warns that if gun dealers are aware that a potential buyer simply possesses a medical cannabis card, then this is “reasonable cause to believe” that the person is an unlawful user of a controlled substance.



Controlled substances as defined by federal law include cannabis, but do not include distilled spirits, wine, beer or other alcohol. A federal firearms law only restricts firearm ownership to those who are using controlled substances “unlawfully”, but aside from a medical cannabis card, this metric is nearly impossible to detect, and severely under reported for other substances. Users of alcohol and opioids will typically have no problem obtaining a firearm, unless they are visibly intoxicated at the time of purchase. Additionally, while some states have passed laws preventing alcohol abusers from obtaining firearms, alcoholism and alcohol abuse is not something that is widely looked into during the federal background check process.

There is an undeniable safety component that comes into play when any firearm user is under the influence of a substance, even if the substance is doctor recommended. In providing supposed justification for denying medical cannabis patients firearms, the Ninth Circuit Court of Appeals held that while “t may be argued that medical marijuana users are less likely to commit violent crimes, as they often suffer from debilitating illnesses, for which marijuana may be an effective palliative… those hypotheses are not sufficient to overcome Congress’s reasonable conclusion that the use of such drugs raises the risk of irrational or unpredictable behavior with which gun use should not be associated.”

Despite the statements of Attorney General Sessions and other opponents, cannabis does not lead to violence in the same way alcohol and other substances do. A January 2016 Studypublished in the Journal of Drug Issues, found that “There is no evidence of negative spillover effects from medical marijuana laws on violent or property crime. Instead, we find significant drops in rates of violent crime associated with state medical marijuana laws” For comparison, in an average month, an estimated 8.9 to 11.7 million firearm owners binge drink, and among men, deaths from alcohol-related firearm violence equal those from all alcohol-related motor vehicle crashes.

The Founding Fathers envisioned a country that would be based on limited government, individual liberty, and the principle that the right to bear shall not be in arms infringed. Forty-six states have passed some form of medical cannabis program, and it is a certainty that each of these programs has gun owners who participate as patients or caregivers. We must reconcile the ability of a doctor, under the First Amendment to recommend medical cannabis for a debilitating condition with an individual's right to bear arms under the Second Amendment. Is there some form of safety risk when a gun owner is under the influence of any substance whether it be alcohol or opioids or cannabis? Without question. But is this safety risk worth the price of individual medical choice and liberty? Unlikely.
 

roots69

Rising Star
BGOL Investor
Two More New Studies Show How Medical Cannabis Could Be Helping Curb The Opioid Epidemic



Rates of opioid prescriptions went down in states that implemented laws allowing access to medical cannabis, according to two studies published on April 2nd 2018 in the journal JAMA Internal Medicine.

The findings suggest that access to medical cannabis may have cut patients' need for opioids to manage their pain, the researchers said.

"There has been substantive evidence that medical cannabis can relieve pain at a lower risk of addiction than opioids and with virtually no risk of overdose," said lead study author Hefei Wen, an assistant professor of health management and policy at the University of Kentucky College of Public Health in Lexington, Kentucky. "The potential for cannabis policies to reduce the use of addictive opioids deserves consideration, especially in states that have been hit hard by the opioid epidemic."

In one of the studies, Wen and her colleague Jason M. Hockenberry, associate professor of health policy at Emory University in Atlanta, analyzed rates of opioids prescriptions during 2011 and 2016 for Medicaid enrollees — a population that has a relative high risk for chronic pain and opioid addiction, Wen said. They found that the rates of opioid prescribing in states that had legalized medical cannabis dropped by 5.9 percent annually, on average. What's more, states that widened access further, by legalizing the recreational use of cannabis, saw a 6.4-percent annual decrease, on average.

In the second study, another team of researchers looked at the number of opioid prescriptions filled under Medicare in all U.S. states from 2010 through 2015. Studies suggest medical cannabis use is rising fastest among older Americans—a group that's also most likely to have the type of pain conditions that respond best to cannabis, the researchers said. Opioid prescriptions fell by 2.21 million daily doses per year, on average, in states that legalized medical cannabis — an 8.5-percent decrease — compared with opioid prescriptions in states that didn't legalize the drug.

Medical Cannabis vs. Opioids
Studies show that cannabinoids — chemical components in Cannabis plants — can be effective in alleviating some kinds of pain, and "a mountain of anecdotal evidence from patients" suggests that some who turn to medical cannabis for chronic pain end up needing fewer opioids, said Dr. Kevin Hill, an associate professor of psychiatry at Harvard Medical School who was not involved with the studies.

"And now, with these two papers, plus a handful of previous studies, we've got pretty compelling evidence that shows that we need to really to think about cannabis as a potential way to curb the opioid crisis," said Hill, who co-authored an editorial that was published alongside the two studies in the same journal.

Using medical cannabis to treat chronic pain is an approach that is supported by research and medical professionals, and has demonstrated positive public health outcomes. Thirty states in the US have passed medical cannabis laws and another sixteen have passed more limited laws. Medical cannabis programs on average are serving 2% of the population despite a potential addressable market of 1/3 of the population that are living with chronic pain.
(Click to View Report)

Opioids are a class of strong pain medications, including drugs such as OxyContin (oxycodone) and Vicodin(a combination of hydrocodone and acetaminophen). Opioids bind to opioid receptors in the body and cause feelings of euphoria. They are highly addictive, and can lead to drug abuse, severe complications and overdose deaths. The number of Americans dying from opioid overdoses continues to rise; there were more than 42,000 U.S. deaths from this cause in 2016, up from 33,000 deaths in 2015, according to a March 30 report from the Centers for Disease Control and Prevention.

Most people, including teenagers, with an opioid-use disorder start out with a legitimate prescription for the drugs from health care providers for pain management. Medical Cannabis may be an alternative to consider for some of these patients, experts say; the cannabinoids in the drug bind to the body's cannabinoid receptors, which are part of an internal pain-relieving system.
Related Article: “Study Finds Medical Cannabis Is Effective At Reducing Opioid Addiction”. “A new study conducted by researchers at The University of New Mexico, involving medical cannabis and prescription opioid use among chronic pain patients, found a distinct connection between having the legal ability to use cannabis and significant reductions in opioid use.”
Still, it may not be possible to replace all kinds of pain medications with cannabis. So far, clinical studies suggest that cannabis is effective in easing chronic pain, neuropathic pain (pain caused by damage to the nervous system), and involuntary and continuous muscle contractions associated with multiple sclerosis, Hill told Live Science. But to know whether cannabis is as effective for other types of pain, more research needs to be done, he added.

What's more, studying prescription data from states can only reveal a correlation between medical-cannabis laws and a reduction in opioid use; it can't show a cause-and-effect relationship, Hill said. Future studies should take a closer look at the link by performing randomized clinical trials to see the effects of taking cannabis for pain or following patients to see if cannabis helped them avoid opioids altogether or only lower their use.

Medical Cannabis alone cannot fix the country's opioid problem. "It is but one aspect of a comprehensive package to tackle the epidemic," Wen told Live Science. Other essential strategies include providing appropriate pain management and various nonopioid and nonmedical alternatives, as well as improving access to addiction treatment, she said.

At the November 2017 medical cannabis Advisory Board Hearing, Doctors recommended to add Substance Abuse Disorders into the New Mexico Medical Cannabis Program with 5-0 Vote. The final decision rest with Secretary Lynn Gallagher at the Department of Health and is expected at the next hearing on May 11th 2018.
 

roots69

Rising Star
BGOL Investor
But as usual, aint nobody listening, until the bullshit is knocking at their front door!!!


The CIA's Drug-Trafficking Activities


The CIA's operational directorate, in other words that's their covert operations, para-military, dirty tricks — call it whatever you want — has for at least 40 years that we can document paid for a significant amount of its work through the sales of heroin and cocaine. — Guerrilla News Network's Interview with Christopher Simpson


ClA-supported Mujahedeen rebels [who in 2001 were part of the "Northern Alliance" fighting the Taleban which became the core of the new Afghani government following the U.S. attack on Afghanistan in late 2001] engaged heavily in drug trafficking while fighting against the Soviet-supported government and its plans to reform the very backward Afghan society. The Agency's principal client was Gulbuddin Hekmatyar, one of the leading druglords and a leading heroin refiner. CIA-supplied trucks and mules, which had carried arms into Afghanistan, were used to transport opium to laboratories along the Afghan/Pakistan border. The output provided up to one half of the heroin used annually in the United States and three-quarters of that used in Western Europe. U.S. officials admitted in 1990 that they had failed to investigate or take action against the drug operation because of a desire not to offend their Pakistani and Afghan allies. — The Real Drug Lords
The U.S. Central Intelligence Agency, as is by now well-known by anyone who has cared to be informed, has long been deeply involved in the international trafficking of the addictive drugs heroin and (since the early 1980s, if not earlier) cocaine, the enormous profits from which have financed, and continue to finance, both U.S. covert operations and the U.S. military (via payments to Pentagon contractors).

The main reason why this is not more widely known is that the main players in the U.S. media have always worked to protect the Agency and to keep the American public in the dark as to the nature of its activities (as documented in great detail in Carl Bernstein's article in the October 20, 1977, issue of Rolling Stone: "The CIA and the Media: How America's Most Powerful News Media Worked Hand in Glove with the Central Intelligence Agency and Why the Church Committee Covered It Up"). The information you will find on this web page, and the web pages it links to, is not considered by the editors of the New York Times and other mainstream U.S. "news" media as proper for the public to know.





By the end of the 1980's it was calculated that the illegal use of drugs in the United States now netted its controllers over $110 billion a year. — Modern Times, p.782.


Covert government by defense contractor means corrupt wars of conquest, government by dope dealer. When the world's traditional inebriative herbs become illegal commodities, they become worth as much as precious metal, precious metal that can be farmed. ... Illegal drugs, solely because of the artificial value given them by Prohibition, have become the basis of military power anywhere they can be grown and delivered in quantity. ... To this day American defense contractors are the biggest drug-money launderers in the world.— Drug War: Covert Money, Power and Policy, p.318.
Most of this page concerns the CIA's involvement in drug trafficking, but we should first note that this is only one part of its activities, the means by which it finances its operations in addition to the billions of dollars it gets from U.S. taxpayers courtesy of the U.S. federal government (the exact amount, of course, being kept secret from U.S. taxpayers). In addition to being the principal source of U.S. propaganda for domestic and foreign consumption the CIA is the covert operations division of the U.S. goverment and as such has engaged in many terrorist activities. In fact the CIA is a terrorist organization, funded by the profits of international drug smuggling.





Kennedy's intended change in Vietnam policy — his plan to unilaterally withdraw from the imbroglio — infuriated not only the CIA but elements in the Pentagon and their allies in the military-industrial-complex. By this time, of course, the Lansky Syndicate had already set-up international heroin running from Southeast Asia through the CIA-linked Corsican Mafia in the Mediterranean. The joint Lansky-CIA operations in the international drug racket were a lucrative venture that thrived as a consequence of deep U.S. involvement in Southeast Asia as a cover for drug smuggling activities. — Michael Collins Piper, The Final Judgment, quoted at Vietnam, the CIA's Illegal Drug Trafficking, and JFK's Assassination
From the days of the Vietnam War the CIA has been at the forefront of heroin trafficking. When the Reagan administration needed to finance its war against Nicaragua the CIA applied what it had learned in Vietnam to importing vast quantities of cocaine (sometimes 20 tons at a time) from Latin America, selling it to the Mafia, and using the profits to finance its "covert activities", activities so contrary to America's professed values that they must be concealed at all costs from the American people.



I ask Dennis [Dayle, former head of DEA's Centac], "If the following statement were made to American citizens would you agree with it? 'Enormously powerful criminal organizations are controlling many countries, and to a certain degree controlling the world, and controlling our lives. Your own [U.S.] government to some extent supports them, and is concealing this fact from you.'"
"I know that to be true. That is not conjecture. Experience, over the better part of my adult life, tells me that that is so. And there is a great deal of persuasive evidence. But I also believe that what you just said can be dealt with very effectively. You can contain drug trafficking by the immobilization of the few cartels who truly control it. There must be conscious decisions, based on fact rather than propaganda, at the grass-roots level of the global community, that the global drug-trafficking situation should not be tolerated."— The Underground Empire, p.1161.

Because (some) drugs are illegal, there are huge profits to be made in supplying them to those who want or need them. Legalization would eliminate the enormous profits now being made and would provide a social context in which education concerning the use of drugs was not only respectable but also a social obligation. In the meantime the "War on Drugs" works only to keep (some) drugs illegal and to maintain the profits of the traffickers.

Much information about the CIA is already available (see Audiotapes, Videos, CD-ROMs, Books and Articles), but the mainstream media has deliberately ignored this information, and as others have said, if it's not on TV then for many Americans it isn't real. But this is real, and it affects everyone.

Mind Control and the CIA's Use of LSD

The CIA's interest in drugs goes beyond heroin and cocaine. They have always been very interested in LSD and other drugs for use in interrogation and brainwashing.


  • G. J. Krupey: The High and the Mighty: JFK, MPM, LSD and the CIA


    Could it have been possible that some faction of CIA agents, their typical cold war super-patriot minds blown by acid, indeed flooded the country with LSD, not as part of some plot to forestall change or stifle rebellion, but to encourage it, especially in the aftermath of Kennedy's assassination by their dark counterparts within the agency?


    cia_lsd.jpg
    This shows part of the front page of The Washington Post, 1975-06-11. The report is the Rockefeller Commission investigation into the CIA's domestic activities, in which it was revealed that a U.S. Army scientist had died a week after having been given LSD. This is the "Suicide Revealed". The "suicide" was actually a murder. For further details see The Frank Olson Murder.


  • THE OLSON FILE: A secret that could destroy the CIAGordon Thomas has his own idea of what it [the vital clue to the murder of CIA researcher Dr Frank Olson in 1953] was. "The CIA was using German SS prisoners and Norwegian Quislings [collaborators] taken from jails and detention centres as guinea pigs to test Cameron's theories about mind control. The Agency preferred to conduct such clinical trials outside the United States because sometimes they were terminal — the human guinea pig ended up dead. ... I believe that he [Olson] wanted out." ...
    The CIA has always maintained as a matter of historical record that it has never murdered an American citizen on American soil. If ... this turns out to be a lie, it could well be the beginning of the end of the Agency.



  • The Sleep Room's Missing Memories


    How mental patients in Montreal were subjected to CIA-sponsored brainwashing, including the use of LSD and PCP.


  • In fact a book has been written on this subject — Father, Son and CIA, by Harvey Weinstein. Here is Chapter 9 from that book, Supply and Demand, concerning the origins of the CIA and its interest in brainwashing techniques.


  • Project MKUltra at Wikipedia
For more on these topics see The CIA, MKULTRA and Timothy Leary and Project Monarch.
 

roots69

Rising Star
BGOL Investor
BANKS, THE MAFIA AND DRUGS!


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Exactly the same people who run the Global Financial System run the Global Drug Trade. InEIR's blockbuster expose first published in 1978, revealed that the international narcotics trade is run by the International financial oligarchy as a political weapon against sovereign nations, and that a large section of the international banking system was devoted specifically to the laundering of the revenues from this illicit trade.



Consider for a moment the volume of cash - not just the dollar amount, but also the volume of the actual bills themselves, taken in by drug dealers each day in any major metropolitan area. Just handling the money is a major logistical problem and without a sophisticated money laundering apparatus, the drug trade would quickly choke on its own cash, so the key to laundering drug money is to get it into the banking system as quickly as possible at the local level. One method of doing this is to set up a number of fronts - restaurants, parking lots, sports concessions and the like which take in large amounts of irregular cash, mix in the dope money with the business revenue and deposit it all in the company's bank account. Once it gets into the banking system, it can be transferred through a maze of banks and accounts around the world.



The Federal Reserve's own figures showed how the cash piled up in the Federal Reserve Bank in Miami and then, when law enforcement operations in the Southeast United States caused the drug trafficking to shift to the Southwest, the surplus shifted to the Fed's branches in Los Angeles and San Antonio. It was obvious to all that it was drug money.



The overlords of Dope, Inc., would have us believe that the cocaine trade is run by the Colombians, and the trade in crack cocaine is run by inner city gangs, a myth akin to believing that the oil cartel is run by gas station operators. Those who handle the dope, are mostly low-level employees, and expendable; to find out who runs the drug trade, follow the money, through the banks to the boardrooms. They don't ever touch the stuff, but they always take the money. Many of the figures who seemed so powerful in their day, from Meyer Lansky - to Bernie Cornfield and Robert Vesco of Investors Overseas Services, to junk bond king Michael Milken, were nothing more than front men for the financial oligarchy's dirty money apparatus, dangled like puppets on a string for public consumption. The same holds true for today's titans such as hedge fund operator and drug legalizer and avid Talmudist George Soros.



The American people have also been led to believe that the (Mafia) crime syndicate in America is strictly an Italian affair. Our Jewish entertainment media has produced countless films and Television shows, (like the award winning “Sopranos”) depicting Italo-Americans as the masters of the syndicate. But a closer look reveals that Jews, NOT Italians, founded and financed “the syndicate” in the early days before prohibition. From the late 1940s to the present, the upper structure of the syndicate has remained pretty much the same - Jewish Meyer Lansky dispatched his right-hand man, Bugsy Siegel, to Las Vegas in 1946 to start the gambling and prostitution rackets in that area. Lansky ordered Siegel's death when he learned that Siegel was embezzling from him. Siegel was then replaced by Morris Rosen, Gus Greenbaum, and Morris Sidwirts. In Los Angeles, Lansky's men were Jack Dragna and Mickey Cohen - all strictly "kosher."


The banks on the rare occasions when they are caught laundering drug money, shed rivers of crocodile tears, rub their eyes and whine how they were victimized by devious ole’ dope dealers and when the evidence is too damning, they simply point the finger at the lowest level employee plausible. The fact is, that not only do the banks knowingly handle drug money, they compete avidly for the business. Whole sections of financial institutions, law firms, accounting firms, and consulting firms, have been specifically set up to run money-laundering operations; it is a huge, lucrative business and yet again, principally run by Jews.



In a recent article in the OBSERVER, London - Sunday, November 10, 2002, entitled “Ultra Orthodox US Jews accused of 'cleaning' Colombian coke cartel cash,” reporter Ed Vulliamy, not only proves the point of covert Jewish involvement in CRIMINALenterprises including drugs, but the article clearly illustrates how the belief system of the oh-so-pious Hassidic Jews, are a complete and utter sham! “British and American drug-busting authorities claim to have smashed one of the most bizarre money-laundering services ever operated for Colombian cocaine cartels: a circle of ultra-religious Hassidic Jews in New York. The ring is said to be one of the biggest to be 'cleaning' profits amassed by the Colombian coke barons, with the strange twist that it is run by a group from the Jewish community that acts as moral and spiritual guardian of the Orthodox faith. This is not the first time the Hassidim have been exposed as involved in the big-time drug trade. Last year, the trial ended of a circle run by Sean Erez, a Hassidic who oversaw a massive ecstasy smuggling operation, drawing recruits from the young Orthodox community . . . Sometimes, the evidence had a tragicomic edge. Wiretaps showed smugglers reluctant to take flights on the Sabbath and one of Erez's agents was picked up in Montreal with a suitcase full of ecstasy because she had refused to take the bus to New York on a Saturday. “

MURDER INC

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The American People are Funding Global Terrorism and the Bush Family's International Criminal Enterprises and Mass Murder Programs and they don't even know it. The satanic Bush Crime Family and the CIA/FBI/MOSSAD/Mafia are murdering whole planeloads of people just to bump off their political enemies so that they can further destroy incriminating evidence at the American Tax Payer Funded Expense.



Remember all of the Federal documents that had been shipped to the Federal Murrah Building just prior to its planned bombing? Where witnesses had also disclosed that large teams of trucks were ready and waiting a block away just prior to the bombing and went in immediately to remove the stored documents that had to be ”destroyed.” These documents contained incriminating details that revealed in detail the Bush Crime Family, the CIA, the FBI, the International Banking Community’s huge criminal enterprises and massive ripping off of the American people and is THE real reason for the Federal Murrah Building bombing. And it was done without any concern whatsoever for the murder of more than 170 innocent people including many children, using their CIA Mind Controlled slave Timothy McVeigh, who openly admitted to being a CIA experimental Mind Control Robot.



Thousands upon thousands of innocents die every day so that the Elites can continue with their Global Crimes. TWA 800 was deliberately SHOT DOWN with a ground-to-air missile, simply to murder the author Sally Denton, who wrote the book: “The Blue Grass Conspiracy,” dealing with High Treason in the American Government. Sally was on board that fateful last flight of TWA 800on her way to Europe to deliver her evidence to the European Publishing Houses on the Bush International Crime Family's Global CIA/Mafia Drugs, Money Laundering, Illegal Weapons Trades, Mind Control Operations, Experimental Disease programs, and Mass Murder Operations. They then had James Sanders, the author of the book, "The Downing of TWA Flight 800," arrested along with his wife, without any proper substantive reason other then to silence them and to cover up the proof that TWA 800 had indeed been blown out of the sky under the orders of the out of control criminal elements who are now controlling the U.S. Government.



The list is very long as to those that have been continually targeted for murder, but what about the thousands of others who were also slaughtered, just so the Bush Crime Family and their Elitist Associates could kill perhaps one or two of their political enemies. Innocent people who by their tragic misfortune, happened also to be on the same flights, or in the very buildings that the Bush/CIA murderers had targeted for destruction. This is how far these Judeo/Masonic Elites now firmly control the entire United States Infrastructure for their own sordid criminal enterprises. Under the auspices of “Global Terror,” the Bush Family's three-ring-circus of International Criminal Enterprises and Mass Murder Programs, merrily rolls along and the dumbed-downLEMMINGS STILL have absolutely no idea.

The link below gives access to a list of bodies, directly or indirectly, involving the hand of the Bush family - a roster of the silent dead, who might have been called as witnesses had they not met their untimely ends. Some of the names on this list will give you pause. Some are rumor, some you may find incredible, and some downright frightening. Again, do your own RESEARCH, and then draw your own conclusions.



OPIUM LORDS AND THE KILLING OF A PRESIDENT


After President John F. Kennedy was murdered in 1963, America became deeply involved in the Vietnam War. Within a few short years, heroin addiction in America reached epidemic proportions. In the background, Israel aggressively expanded its borders by force and became a colonial empire ruling a nation of angry Palestinians. A new BOOK“Opium Lords” by Salvador Astucia - reveals how Israel exploited the Western powers’ long history of opium trafficking as a means of toppling the young American president. The following points summarize the well-documented information presented:


Opium was the glue that held together the rivalling factions that conspired to kill JFK. The main factions in the conspiracy were Zionist instigators, the American Mafia (headed by Jewish mobster Meyer Lansky and his lieutenant, Santo Trafficante), French-Corsican crime syndicates in Marseilles, France and Southeast Asia, and the US military. Heroin smuggling was first introduced in the United States in the 1920s by Jewish gangsters such as Meyer Lansky, "Legs" Diamond, and "Dutch" Schultz. One of the reasons President Johnson escalated US involvement in Southeast Asia was because the American Mafia and French-Corsican heroin traffickers needed a new source of opium for their heroin factories. Turkey had been the main source, but its government was about to eradicate opium production.


Joseph Kennedy, Sr’s three sons were viewed as a new American dynasty that threatened Israel’s plans to expand its borders. The Kennedy Dynasty would last until 1985 if each son served two terms in the White House. It is widely known that Joseph Kennedy Sr developed a strong loathing of Jews from his business dealings with them in finance, Hollywood, and politics.



A decree was issued to kill JFK by Nahum Goldmann, founder of the World Jewish Congress and its president in 1963. Louis Bloomfield of Montreal was then assigned to set up the hit. He was an influential international lawyer with an extensive espionage background - including, British intelligence, Haganah, OSS and the CIA. Martin Agronsky and other Jewish journalists and media moguls collaborated in the plot by pushing a false cover story that Lee Harvey Oswald and he alone killed JFK. Right-wing extremists joined the coup initially but broke ranks and declared a holy war against Jews immediately after JFK was killed. The assassins were the lieutenants of French-Corsican heroin trafficker and convicted Nazi collaborator, Auguste Joseph Ricord. He was living in Argentina at the time of the assassination.


Later he moved to Paraguay, which became a major hub for smuggling heroin into the United States. The actual assassins were Lucien Sarti, François Chiappe, and Jean-Paul Angeletti—all French-Corsicans. Nixon, (no friend of the Jews) was driven from office because he destroyed Ricord’s heroin cartel, established détente with the Soviet Union, withdrew forces from Vietnam, and ended the draft. Under Nixon’s orders, police in Mexico City tried to arrest Lucien Sarti - the man who actually shot JFK in the head. When Sarti fled, Mexican police opened fire and he conveniently died in a hail of bullets on April 27, 1972.


JFK made powerful enemies within the military/Industrial establishment including Israel, when he attempted to establish détente with the Soviet Union in the summer of 1963. He also wanted to put an end to the evil of the Federal Reserve System and to prevent Israel from acquiring ”the Bomb.” Abolishing the Fed would have been a crucial blow to the establishment elite’s dream of a New World Order, so it was decided that JFK simply had to go, by those that had the most to loose. It also sent a powerful message throughout the Washington establishment that has not been lost on potential “buckers” of the ZOG system.
 

roots69

Rising Star
BGOL Investor
We have to put everything on the table and start putting this puzzle together!!!



The Government's DIRTY LITTLE SECRETS

by Alexander Cockburn
LOS ANGELES TIMES, COMMENTARY


The dirtiest secrets of South Africa's apartheid regime are now spilling out in the Truth and Reconciliation Commission hearings in Cape Town. It's a pity that the chilling stories haven't made much of a commotion in the United States, whose own intelligence agencies have traveled along the same path. In 1997, press reports detailed a South African agent's description of drug smuggling to raise money for terrorist schemes, including chemical experimentation on blacks. He said he had done this on behalf of the Directorate of Covert Collections, a super-secret unit within South Africa's military intelligence apparatus. The drugs - ecstasy and mandrax - were manufactured in labs run by Wouter Basson, one of the chieftains of South Africa's chemical and biological weapons program. Basson was arrested in 1997.

Hearings this month (June, 1998) at the Truth and Reconciliation Commission offered vivid insights of what went on at Roodeplaat Research Laboratories, a military installation where Basson oversaw production of infamous materials. Dr. Schalk van Rensburg testified that "the most frequent instruction" from Basson was for development of a compound that would kill but make the cause of death seemingly natural. "That was the chief aim of the Roodeplaat Research Laboratory."

The laboratory manufactured cholera organisms, anthrax to be deposited on the gummed flaps of envelopes and in cigarettes and chocolate, walking sticks firing fatal darts that would feel like bee stings. Van Rensburg took his riveted audience painstakingly through what he called "the murder lists" of toxins and delivery systems. These included 32 bottles of cholera that, one of the lab's technicians testified, would be most effectively used in the water supply. There were plans to slip the still imprisoned Nelson Mandela covert doses of the heavy metal poison, thallium, designed to make his brain function become "impaired, progressively," as Van Rensburg put it. In one case, lethal toxins went from Roodeplaat to a death squad detailed by the apartheid regime to kill one of its opponents, the Rev. Frank Chikane. The killers planted lethal chemicals in his clothing, expecting him to travel to Namibia, where they reckoned there would be "very little forensic capability." Instead, Chikane went to the U.S., where doctors identified the toxins and saved his life.

The big dream at Roodeplaat was to develop race-specific biochemical weapons, targeting blacks. Van Rensburg was ordered by Basson to develop a vaccine to make blacks infertile. Van Rensburg told the truth commission that was his major project. There also were plans to distribute infected T-shirts in the black townships to spread disease and infertility. Americans need not entertain feelings of moral superiority. In 1960, in one of the CIA's frequent attempts to assassinate Fidel Castro, the agency planned to put thallium salts in Castro's shoes before he addressed the United Nations. Years later, the Nicaraguan government reported that a CIA-supplied team tried to assassinate its foreign minister by giving him a bottle of Benedictine laced with thallium.

U.S. military researchers of biochemical warfare in the 1950s conducted race-specific experimentation. In 1980, the U.S. Army admitted that Norfolk Naval Supply Center was contaminated with infectious bacteria in 1951 to test the Navy's vulnerability to biological warfare attack. The Army disclosed that one of the bacteria types was chosen because blacks were known to be more susceptible to it than whites. One of the investigators for the truth commission, Zhensile Kholsan, has been reported as saying that there is a strong suggestion that "drugs were fed into communities that were political centers, to cause socioeconomic chaos." Black communities in the U.S. have expressed similar suspicions, particularly about the arrival of crack cocaine in South-Central Los Angeles in the early 1980s, allegedly imported by CIA-sponsored Nicaraguans raising money for arms.

In March, CIA Inspector General Frederick Hitz finally conceded to a U.S. congressional committee that the agency had worked with drug traffickers and had obtained a waiver from the Justice Department in 1982 (the beginning of the Contra funding crisis) allowing it not to report drug trafficking by agency contractors. Was the lethal arsenal deployed at Roodeplaat assembled with the advice from the CIA and other U.S. agencies? There were certainly close contacts over the years. It was a CIA tip that led the South African secret police to arrest Nelson Mandela.

A truth commission here wouldn't do any harm.

END
 

roots69

Rising Star
BGOL Investor
How the Drug Money Works

The Editor of www.DrugWar.com discusses Drugs, terrorists, illegal money and official complicity in all with researcher Daniel Hopsicker at the Venice Beach by the Venice Airport in Florida, which Hopsicker suspects is the Mena, Arkansas airport of today.

January 8, 2003- Why does the War on Some Drugs and Users continue despite the obvious failure of every tactic tried by prohibitionists? Could it be that the illegal drug trade engenders such massive untraceable black market profits and forms of social control that the Warriors really do not want the War to end?

drug_meeting.jpg
When one takes the endless tales of corruption, greed and lies on the part of so many Drug Warriors into consideration, it isn't such a stretch of the imagination. Some researchers insist that the Warriors in positions of influence and power are making too much money waging the War on Some Drugs itself to ever allow honest Drug Policy Reform to happen, that these Warriors will stoop to any levels to make sure their profits and control never end, including enabling and even engaging in illicit drug trafficking themselves. This deadly sort of greed is by no means limited to Drug Warriors alone, but extends throughout government, military and corporate cultures around the world, lead by the US military/industrial/law enforcement complex, as evidenced by the numerous reports compiled at the websites linked below.

All wars pay if one is in the business of supplying the weapons to all sides, controlling the means of spreading public information and spending tax dollars. It's a symbiotic relationship. Drug Crime certainly does pay if one is in the lucrative business of drug crime fighting, or shipping large amounts of pricey illegal drugs, made so expensive and profitable by prohibition itself. - Preston Peet
 

roots69

Rising Star
BGOL Investor
The Real Drug Lords
A brief history of CIA involvement in the Drug Trade
by William Blum

1947 to 1951, FRANCE
According to Alfred W. McCoy in The Politics of Heroin in Southeast Asia, CIA arms, money, and disinformation enabled Corsican criminal syndicates in Marseille to wrestle control of labor unions from the Communist Party. The Corsicans gained political influence and control over the docks — ideal conditions for cementing a long-term partnership with mafia drug distributors, which turned Marseille into the postwar heroin capital of the Western world. Marseille's first heroin laboratories were opened in 1951, only months after the Corsicans took over the waterfront.



Early 1950s, SOUTHEAST ASIA
The Nationalist Chinese army, organized by the CIA to wage war against Communist China, became the opium barons of The Golden Triangle (parts of Burma, Thailand and Laos), the world's largest source of opium and heroin. Air America, the ClA's principal airline proprietary, flew the drugs all over Southeast Asia. (See Christopher Robbins, Air America,Avon Books, 1985, chapter 9.)



1950s to early 1970s, INDOCHINA
During U.S. military involvement in Laos and other parts of Indochina, Air America flew opium and heroin throughout the area. Many GI's in Vietnam became addicts. A laboratory built at CIA headquarters in northern Laos was used to refine heroin. After a decade of American military intervention, Southeast Asia had become the source of 70 percent of the world's illicit opium and the major supplier of raw materials for America's booming heroin market.



1973-80, AUSTRALIA
The Nugan Hand Bank of Sydney was a CIA bank in all but name. Among its officers were a network of US generals, admirals and CIA men, including fommer CIA Director William Colby, who was also one of its lawyers. With branches in Saudi Arabia, Europe, Southeast Asia, South America and the U.S., Nugan Hand Bank financed drug trafficking, money laundering and international arms dealings. In 1980, amidst several mysterious deaths, the bank collapsed, $50 million in debt. (See Jonathan Kwitny, The Crimes of Patriots: A True Tale of Dope, Dirty Money and the CIA, W.W. Norton & Co., 1987.)



1970s and 1980s, PANAMA
For more than a decade, Panamanian strongman Manuel Noriega was a highly paid CIA asset and collaborator, despite knowledge by U.S. drug authorities as early as 1971 that the general was heavily involved in drug trafficking and money laundering. Noriega facilitated "guns-for-drugs" flights for the contras, providing protection and pilots, as well as safe havens for drug cartel officials, and discreet banking facilities. U.S. officials, including then-ClA Director William Webster and several DEA officers, sent Noriega letters of praise for efforts to thwart drug trafficking (albeit only against competitors of his Medellin Cartel patrons). The U.S. government only turned against Noriega, invading Panama in December 1989 and kidnapping the general, once they discovered he was providing intelligence and services to the Cubans and Sandinistas. Ironically drug trafficking through Panama increased after the US invasion. (John Dinges, Our Man in Panama, Random House, 1991; National Security Archive Documentation Packet The Contras, Cocaine, and Covert Operations.)



1980s, CENTRAL AMERICA
The San Jose Mercury News series documents just one thread of the interwoven operations linking the CIA, the contras and the cocaine cartels. Obsessed with overthrowing the leftist Sandinista government in Nicaragua, Reagan administration officials tolerated drug trafficking as long as the traffickers gave support to the contras. In 1989, the Senate Subcommittee on Terrorism, Narcotics, and International Operations (the Kerry committee) concluded a three-year investigation by stating:

"There was substantial evidence of drug smuggling through the war zones on the part of individual Contras, Contra suppliers, Contra pilots mercenaries who worked with the Contras, and Contra supporters throughout the region.... U.S. officials involved in Central America failed to address the drug issue for fear of jeopardizing the war efforts against Nicaragua.... In each case, one or another agency of the U.S. govemment had information regarding the involvement either while it was occurring, or immediately thereafter.... Senior U.S. policy makers were not immune to the idea that drug money was a perfect solution to the Contras' funding problems." (Drugs, Law Enforcement and Foreign Policy, a Report of the Senate Committee on Foreign Relations, Subcommittee on Terrorism, Narcotics and Intemational Operations, 1989)
In Costa Rica, which served as the "Southern Front" for the contras (Honduras being the Northern Front), there were several different ClA-contra networks involved in drug trafficking. In addition to those servicing the Meneses-Blandon operation detailed by the Mercury News, and Noriega's operation, there was CIA operative John Hull, whose farms along Costa Rica's border with Nicaragua were the main staging area for the contras. Hull and other ClA-connected contra supporters and pilots teamed up with George Morales, a major Miami-based Colombian drug trafficker who later admitted to giving $3 million in cash and several planes to contra leaders. In 1989, after the Costa Rica government indicted Hull for drug trafficking, a DEA-hired plane clandestinely and illegally flew the CIA operative to Miami, via Haiti. The U.S. repeatedly thwarted Costa Rican efforts to extradite Hull back to Costa Rica to stand trial.

Another Costa Rican-based drug ring involved a group of Cuban Americans whom the CIA had hired as military trainers for the contras. Many had long been involved with the CIA and drug trafficking They used contra planes and a Costa Rican-based shrimp company, which laundered money for the CIA, to move cocaine to the U.S.

Costa Rica was not the only route. Guatemala, whose military intelligence service — closely associated with the CIA — harbored many drug traffickers, according to the DEA, was another way station along the cocaine highway. Additionally, the Medellin Cartel's Miami accountant, Ramon Milian Rodriguez, testified that he funneled nearly $10 million to Nicaraguan contras through long-time CIA operative Felix Rodriguez, who was based at Ilopango Air Force Base in El Salvador.

The contras provided both protection and infrastructure (planes, pilots, airstrips, warehouses, front companies and banks) to these ClA-linked drug networks. At least four transport companies under investigation for drug trafficking received US government contracts to carry non-lethal supplies to the contras. Southern Air Transport, "formerly" ClA-owned, and later under Pentagon contract, was involved in the drug running as well. Cocaine-laden planes flew to Florida, Texas, Louisiana and other locations, including several military bases. Designated as 'Contra Craft,' these shipments were not to be inspected. When some authority wasn't clued in, and made an arrest, powerful strings were pulled on behalf of dropping the case, acquittal, reduced sentence, or deportation.



1980s to early 1990s, AFGHANISTAN
ClA-supported Mujahedeen rebels [now, 2001, part of the "Northern Alliance"] engaged heavily in drug trafficking while fighting against the Soviet-supported government and its plans to reform the very backward Afghan society. The Agency's principal client was Gulbuddin Hekmatyar, one of the leading druglords and a leading heroin refiner. CIA-supplied trucks and mules, which had carried arms into Afghanistan, were used to transport opium to laboratories along the Afghan/Pakistan border. The output provided up to one half of the heroin used annually in the United States and three-quarters of that used in Western Europe. U.S. officials admitted in 1990 that they had failed to investigate or take action against the drug operation because of a desire not to offend their Pakistani and Afghan allies. In 1993, an official of the DEA called Afghanistan the new Colombia of the drug world.



Mid-1980s to early 199Os, HAITI
While working to keep key Haitian military and political leaders in power, the CIA turned a blind eye to their clients' drug trafficking. In 1986, the Agency added some more names to its payroll by creating a new Haitian organization, the National Intelligence Service (SIN). SIN was purportedly created to fight the cocaine trade, though SIN officers themselves engaged in the trafficking, a trade aided and abetted by some of the Haitian military and political leaders.
 

roots69

Rising Star
BGOL Investor
Why the "War on Drugs" Persists

Clearly the unstated aim of the federal government of the United States of America is the attainment of total control of the Earth, including all its material resources and peoples, by economic, political and military means. The achievement of this requires the expenditure of vast amounts of money over several decades. A major part of this money comes from covert U.S. government trafficking in illegal drugs, primarily the addictive drugs cocaine and heroin. (Actually not so covert now — 2015 — since everyone who is not asleep has long been aware of this.) U.S.-sponsored world-wide drug prohibition, a.k.a. the "War on Drugs", is primarily a tactic to keep street prices high and profits astronomical, regardless of the huge social and personal damage done. U.S.-sponsored drug prohibition will continue until either the U.S. attains its aim of complete military and political domination of the Earth (which is still some time away, if it ever happens) or the junta which rules the U.S. and which aims at total control is removed from power. Only an alliance of anti-fascist nations, and sustained resistance by people who value their freedom, can prevent the subjugation of the Earth to those intent on controlling and exploiting it. Repeal of the laws, and of the U.S.-imposed international treaties, prohibiting possession and sale of drugs which are presently illegal would remove the enormous profits derived from wholesale illegal drug trafficking and cut off a major source of the money required by the U.S. for the achievement of its aim of total world domination. Obviously the U.S. will never repeal these laws and treaties, so it is up to the other countries of the world to do so, if they value their sovereignty, freedom and cultural tradition.





Covert government by defense contractor means corrupt wars of conquest, government by dope dealer. When the world's traditional inebriative herbs become illegal commodities, they become worth as much as precious metal, precious metal that can be farmed. ... Illegal drugs, solely because of the artificial value given them by Prohibition, have become the basis of military power anywhere they can be grown and delivered in quantity. ... To this day American defense contractors are the biggest drug-money launderers in the world. — Drug War: Covert Money, Power and Policy, p.318.


And, of course, the tactics used by one player in the game can be used by others. Not all the poppy fields are funded by the CIA. To some it will seem that with enough money one can buy control of the entire planet. This is no doubt an idea which occurred to some people long ago. But it takes time to achieve such an ambitious goal. Ethical considerations, of course, do not enter into the calculations. Any means may be used to attain the end. One useful means is the exploitation of the urge humans have to modify their consciousness by eating, drinking, smoking or snorting substances found to produce desirable effects. Humans have done it for ages. Bring in a capitalist socio-economic system and you have a sure way to make a lot of money. Especially if consumer prices can be jacked way up. And the way to do that is to make the possession and use of these substances illegal. Then suppliers become criminals and run the risk of punishment, and so must be financially compensated for the risks they take. The higher the risk, the higher the street price. So make it all very illegal and (try to) corner the market in mind-altering substances, especially the addictive ones (a captive market, so to speak) and voila! the greatest money-making scam in the entire history of the planet! Sufficiently lucrative that with the profits one can buy everyone who needs to be bought: police, judges, customs officers and politicians. Total control!The wet-dream of every fascist dictator — now within the grasp of any sufficiently large, sufficiently well-run, sufficiently immoral organization, such as a government of a country whose wealth has been acquired by war and ruthless exploitation of natural resources and which maintains a military-industrial economy larger and more threatening than that of any other.



award_dr.jpg
How long has there been a "War on Drugs"? Seems forever. (It was announced by Richard Nixon in 1971, but goes back millennia, as we saw above.) And year after year, it just gets crazier and crazier, ruins more and more lives, and drives the U.S. further into the pit of social disaster. How is it possible that this insanity persists (even though intelligent and rational people have been pointing out for many years how crazy and evil it is)? Read this page (and page two) for an understanding of what lies behind this monstrosity.

Human Rights Watch World Report 2001: United States


The United States incarcerates more people than any other country in the world and for the first time in the nation's history, more than one in every 100 American adults is confined in a prison or jail, according to a report released on Thursday. The report by the Pew Center on the States said the American penal system held more than 2.3 million adults at the start of the year [2008]. ... "Beyond the sheer number of inmates, America also is the global leader in the rate at which it incarcerates its citizenry, outpacing nations like South Africa and Iran," according to the report. Tough sentencing laws, record numbers of drug offenders and high crime rates have contributed to the United States having the largest prison population and the highest rate of incarceration in the world, criminal justice experts say. The latest report tracked similar findings on the U.S. prison population by the Justice Department and various private groups. A report in November [2007] by a criminal justice research group found the number of people in U.S. prison had risen eight-fold since 1970. The new report said that the national prison population has nearly tripled between 1987 and 2007. — U.S. incarcerates more than any other nation, Reuters, 2008-02-28
At this time the Gulag Archipelago, the scattered islands of prisons in which hundreds of thousands of non-violent people are locked away for half their lives for their opposition to the disgraceful and immoral policies of a tyrannical and dictatorial state, is not in Russia, rather it is in the United States of America. This is a crime against humanity by which the government of the United States, which trumpets itself as a defender of liberty and democracy, makes itself into an object of contempt in the eyes of the world.

The real problem with drugs in the modern world is that they are illegal. Put simply, the Drug War exists primarily to support — financially and otherwise — the maintenance of the criminal status of the possession of (certain) drugs so that those (mostly on the payroll of the U.S. federal government) who profit big — directly or indirectly — from the supply of prohibited drugs can continue to do so, at the expense of everyone else, and especially at the expense of the hundreds of thousands of people imprisoned for victimless "crimes". This is a scandal and a disgrace of the first magnitude. It will become for the United States of America a source of enduring shame and infamy just as the Third Reich became for Germany.


We demand:



    • An immediate amnesty for victims of the "war on drugs".
    • The reformulation of national and international agreements
      that hinder decriminalization.
    • An end to the "war on drugs".




Prohibition (1920-1933 R.I.P.) was known as The Noble Experiment. The results of the experiment are clear: innocent people suffered; organized crime grew into an empire; the police, courts, and politicians became corrupt; disrespect for the law grew; and the per capita consumption of the prohibited substance — alcohol — increased dramatically, year by year, for the next thirteen years of this Noble Experiment, never to return to the pre-1920 levels.
You would think that an experiment with such clear results would not need to be repeated; but the experiment is being repeated; it's going on today. Only the prohibited substances have changed. The results remain the same. They are clearer now than they were then. — Peter McWilliams, Ain't Nobody's Business If You Do, p.61.



But the current prohibition is not really an experiment — it is U.S. government policy imposed upon all peoples of the world (by threat of sanctions against their countries) in order to keep the prices of illegal drugs sky-high, thereby ensuring huge profits for the drug lords both within and without the governments of the world (including the U.S. government).
Drug Hysteria: U.S.A.
The Drug War cannot stand the light of day. It will collapse as quickly as the Vietnam War, as soon as people find out what's really going on. — Joseph McNamara, former Police Chief, Kansas City and San Jose, and Fellow, Hoover Institution

I'm for truth, no matter who tells it. I'm for justice, no matter who it is for or against. I'm a human being first and foremost, and as such I am for whoever and whatever benefits humanity as a whole. — Malcolm X





Unquestionably, police power and resources can never eliminate drug use. Such a goal is impossible.
Nonetheless, drug warriors have established and maintained a national consensus that American must become free of drug use. By accepting an impossible goal and by accepting the idea that it must be achieved through police power, citizens relinquish more and more rights and revenue to police upon demand by Drug War leaders. Continued acquiescence to these escalating demands should create a police state.

I believe authoritarians are manufacturing and manipulating public fears about drug use in order to create a police state where a much broader agenda of social control can be implemented, using government power to determine what movies we may watch, determine who we may love and how we may love them, determine whether we may or must pray to a deity. I believe the war on drug users masks a war on democracy.

After all, what is the vision of a Drug-Free America? Millions in prison or slave labor, and only enthusiastic supporters of government policy allowed to hold jobs, attend school, have children, drive cars, own property. This is the combined vision of utopia held forth by Nancy Reagan, Ronald Reagan, George Bush, William Bennett, Daryl Gates and thousands of other drug warriors. News media and "public interest" advertising tell us this is the America for which all good citizens yearn.

— Richard Lawrence Miller, Drug Warriors and Their Prey: From Police Power to Police State, p.191.

In his review of this book Peter Webster writes:



There is a certain difficulty in writing a review of [this book] ... but not because it is a difficult book in any usual sense. On the contrary, it is disarmingly easy to understand the author's every implication. Yet the theme of Mr. Miller's essay, a point by point comparison of the reality of Drug Prohibition in the United States today with exactly analogous situations leading up to Hitler's Third Reich and the attempted destruction of the Jewish people, is certain to repulse the very readers who need most to understand that, indeed, it can happen again.
 

roots69

Rising Star
BGOL Investor
Occupied America:
A Chronology of Nazi Infiltration
and the War On Some Drugs

by Neal Smith, 2000-03-12

FOREWORD

What you are about to read is a compilation of history. R. William Davis and I had been independently asking the question: "Why is Marijuana illegal?" Every time we found an answer, it led to several more questions. Randy had been looking into other political activities, mainly concerning the Nazis of Germany. He soon drew a connection between the general attitudes of the Nazis and members of the government and industries of The United States.

Much of politics of the first half of the 20th century centered around oil and the great amount of wealth available to those who transformed decayed plant material into gasoline for the burgeoning automobile industry, home heating, lubrication and the new idea of synthetics ... plastics. Of the big oil families, the Rockefellers were, and still are, at the top of the heap. Those who supported the Rockefellers, specifically the Mellon banking family, also profited greatly. Andrew Mellon, who had invested a great amount of money in Rockefeller, wasn't going to lose the chance of becoming fabulously wealthy. Another client of Mellon's, the duPont family, in addition to building companies like General Motors, was developing synthetic fibers and plastics from petroleum. Law firms like Brown Brothers Harriman handled the legal work for these and others. Media giants like the Hearsts were more than happy to join the ranks of the filthy rich by putting out whatever their cronies said was news. These people had absolutely no concern for the health and well-being of society at large. Indeed, the less the average man knew, the better for the rich man. Strangely enough, it was many of these same people who were responsible for the illegalization of Hemp/Marijuana.

Hemp, the plant that humans have used for several millenia, and the industry that provided the best in cloth, rope and oil, was on hard times. Hemp, though growing luxuriously throughout America's farmland, was extremely labor-intensive. Until the availability of the Decorticator, Hemp had to be harvested in large part by hand. American industry needed more than Hemp could produce in this way.

The Decorticator came on the scene in 1935. Hemp was on its way once again. That is, until those in the petroleum industry saw a problem: Fuel could be made from Hemp that would burn cleaner, much more effieciently, and with a greater supply than crude petroleum oil. Rudolph Diesel had built his famous engine intending it to burn vegetable oil, mainly Hemp. Hemp was already well known for its lubricating ability, which was of importance to the young aviation industry. Hemp oil in an aircraft engine doesn't break apart chemically at high altitudes like petroleum did. Now with the Decorticator a reality, Hemp was on its way ... again.

Hemp, as I'm sure you know, is in the same family as Marijuana ... the flower tops and leaves of other species of Cannabis Savita L. It was smoked freely, in the form of Hashish, in many fairs. Hash dens were popular in America's bigger cities. But Blacks and Hispanics were known to smoke the dried flowers and leaves. Jazz musicians of the period were known smokers of "Reefer." The Big Oil folks and their cronies found an excuse to drive Hemp away: Claim all sorts of bad things about Marijuana; don't make a distinction between Hemp and Marijuana so the average person won't know what they had grown up with would be taken away. Do this by playing on White America's racism. Scare them by claiming Marijuana would drive you insane or lead you to more insidious drugs like Heroin and Cocaine. By 1936, "Reefer Madness" was well played. Well played enough to cause Congress to pass the Marihuana Tax Act of 1937. Hemp was crippled. Big oil was safe.

Meanwhile, Adolph Hitler was building Germany into a war machine with the same American industrialists that wanted to ban Hemp! Hitler had no oil. Rockefeller did. With the help of the greedy, Hitler got his oil. We know the rest of the Hitler story.

After World War II, our intelligence community turned its attention to the Soviet Union. They sought to use former Nazi intelligence agents as well as other Nazis against the Russians. By 1955, over ten thousand former Nazis, many of them war criminals, were brought into the United States and put into our Central Intelligence Agency. They brought their hatred, their inhuman experiments and their willingness to subjugate all for the greater good of National Socialism. With the help of America's right wing, they became entrenched. Their policies still rule America today.

The prohibition of Hemp/Marijuana was fallout-part of a much bigger picture of control of the American citizen. Total control over what we read, see, hear, eat, and smoke. The policies that led to Marijuana prohibition are the same policies that have taken away rights that true Americans hold dear.

This piece is a chronology of the events of the 20th century, into the first days of the 21st century. Because of the "War On (Some) Drugs" Americans now stand to lose all of our freedoms. It is a very complex concept. When you look at the inter-related elements in their historical context, you begin to see how and why the government we have now is bogus.

This is far from complete. It may never be finished. In some instances, only those involved in the government shenanigans have the actual proof, and they certainly aren't going to share it with us. In other cases, the proof is available. I use it where I can. In still other instances, to quote Bob Dylan, "You don't need a weatherman to know which way the wind blows." For instance, the full Warren Commission report into the assassination of President Kennedy won't be released for 100 years. If some serious crimes weren't being covered up, why wait so long?

I didn't start out to rewrite history. I started this project as a simple time line to keep Randy's and my research straight, because there was so much material! The timeline took on a life of its own. It is a companion-piece to Randy's excellent "Shadow of the Swastika".

If you wish to replicate or further investigate any of this, and I urge you to do so, I provide the bibliography. Over the past seven years, I have checked and cross checked, and researched and confirmed any and all available sources on this information. As I said earlier, some of the proof is too well protected for anyone to get at right now. Which in and of itself speaks ill for a supposedly free society.
 

roots69

Rising Star
BGOL Investor
Medical Cannabis Benefits: Treating Cancer


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Medical cannabis offers many benefits for patients facing cancer.
Relief From Cancer Symptoms and Treatment Side Effects

When used properly, cannabis can be a safe and effective treatment for nausea and vomiting caused by chemotherapy1, chronic pain2, and insomnia3. Animal studies have shown that cannabinoids can prevent the development of neuropathic pain, a common side effect of chemotherapy.4,5,6,

Patients can often achieve significant improvements in quality of life with minimal side effects using very low doses of cannabinoids, in the range of 10-60mg per day (less than half a gram of herbal cannabis). A combination of THC, CBD, and other cannabinoids in various ratios can be used to fine-tune the benefits and minimize the side effects of cannabinoid treatment. Medical cannabis can help patients tolerate conventional cancer treatment, such as chemotherapy and radiation, and can be used as an adjunct to these treatments with low likelihood of drug interaction7. For patients with terminal cancer, cannabis offers numerous benefits in palliative care at the end of life8.
Use Cannabis to Fight Cancer and Promote Healing

In addition to the symptom relief and improvement in quality of life for cancer patients, cannabinoids have also demonstrated anti-cancer oncologic effects in numerous animal models.9 A large body of anecdotal evidence suggests that human cancers also respond to treatment with cannabinoids.10,11 Several patients have reported slowing or arresting the growth of tumors, while others have experienced full remission of aggressive cancers while using cannabis extracts.12

To achieve these powerful anti-cancer effects, most patients require a higher dose than what is needed for symptomatic relief, often 200mg – 2,000mg cannabinoids per day, the equivalent of up to 1-2 ounces of herbal cannabis per week. While this level of treatment may be cost effective, especially if the cannabis is grown outdoors, acquiring this amount of medicine from a medical cannabis retailer could incur significant costs (see below). At these high doses, a knowledgeable medical provider must monitor the treatment to prevent side effects and interactions with conventional cancer treatment. While any medical treatment carries certain risks, even high-dose cannabis is non-lethal and much safer than conventional chemotherapy, though the efficacy of high-dose cannabis for cancer has not been studied in humans.

If you have cancer, and are interested in learning more about the use of cannabis, please make an appointment with a doctor or nurse practitioner that specializes in cannabinoid medicine.

I recommend reflecting on the following questions before your visit:
What is your prognosis? How likely is success with conventional treatment?
Are you interested in cannabis-based symptomatic treatment or a more aggressive anti-cancer approach?
Are you willing to follow up with your oncologist to monitor the changes in your condition?
How comfortable are you with mortality and death? Are you making fully informed medical decisions based on your personal preferences, or based on fear?
If you decide to pursue a high-dose cancer treatment protocol, be prepared for the costs:
Medical costs: initial and follow-up visits with your oncologist, your cannabinoid medicine specialist, and perhaps other complementary providers such as an acupuncturist or Reiki practitioner.

Cannabis costs: most adult patients will have to spend $100-$1,000 per week for a potent cannabis concentrate. Each batch will require laboratory testing for cannabinoid content ($25-$75 in most cannabis analytic labs). While many cannabis producers are working hard to create appropriate formulas, some patients may have to purchase herbal cannabis in bulk and prepare their own concentrates.

Supplements and natural medicines: Most integrative oncologists and many cannabinoid medicine specialists will recommend natural medicines that are not covered by health insuranceto promote health, fight cancer, reduce side effects, and enhance the benefits of cannabis. Average cost $25-$100 per week.

The use of cannabis in the treatment of cancer is an emerging field in medicine, and your cannabinoid medicine specialist should admit to knowing very little about the optimal dosage of the various cannabinoids. By staying up to date on the research and collaborating with other leaders in the field, providers like my colleagues and myself can continue to meet the needs of real patients who choose not to wait for the federal government to stop obstructing human research on cannabis and cancer. Medical cannabis can be a part of an integrative plan that addresses your mind, body, spirit, family, and community.

For a comprehensive review of the anticancer effects of cannabinoids, with numerous personal success stories, I suggest Justin Kander’s book “Cannabis for the Treatment of Cancer: The Anticancer Activity of Phytocannabinoids and Endocannabinoids,” available online. By Dustin Sulak DO


Beneficial Cannabinoids and Terpenoids Useful for Treating Cancer
The following chart denotes which cannabinoids and terpenoids also work synergistically with each other for possible therapeutic benefit. It may be beneficial to seek out strains that contain these cannabinoids and terpenoids.


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Rick Simpson Oil (RSO) - Nature’s Answer For Cancer


The term “Rick Simpson Oil – RSO” refers to extremely potent decarboxylated extracts produced from strong sedative Indica strains, which have THC levels in the 90% range. This harmless non addictive natural medication can be used with great success, to cure or control cancer, MS, pain, diabetes, arthritis, asthma, infections, inflammations, blood pressure, depression, sleeping problems and just about any other medical issues that one can imagine.

Learn About RSO from Rick Simpson (FAQ ABOUT RSO)
The description of The Rick Simpson Process of Producing RSO you can find here. *Before you are making your own oil, please read carefully everything that has been written on his website.* We advise you to watch the process in the documentary Run From The Cure.


Americans For Safe Access Condition-based Booklets
These booklets summarize the history of medical cannabis and the recent research used to treat a variety of conditions, including Cancer, Multiple Sclerosis, Chronic Pain, Arthritis, Gastro-Intestinal Disorders, Movement Disorders, HIV/AIDS, and conditions related to Aging. (About Americans For Safe Access)

Cancer



Cannabis has been found to help cancer patients with the symptoms that usually accompany cancer such as pain, nausea, wasting, and loss of appetite.



A Patient's Guide to Medical Cannabis




This guide for patients who use medical marijuana (cannabis) covers everything you need to know. Created by Americans for Safe Access (ASA), a non-profit advocacy organization, this publication will help individuals who are using or considering cannabis treatments to better educate themselves, their families and their physicians. ASA has been developing information resources about medical marijuana (cannabis) for patients, their families, doctors, and elected officials for over a decade.


Resources:

Roni Stephenson, a Health and Cannabis Educator has a great website on cannabis and cancer. Roni is a stage 4 cancer survivor and she has helped guide people with their cannabis medicine for over 7 years. She teaches and consults from personal experience with medical professionals and clients about pain, cancer, nausea, anxiety and more. With cannabis, whole food and natural herbs as medicine we can help improve on your quality of life.

Her website is Health Cannabis Cancer at https://www.healthcannabiscancer.com/
 

roots69

Rising Star
BGOL Investor
Medical Cannabis Benefits: Treating Depression



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While most individuals experience sadness and even depression from time to time given life events and circumstances, Clinical or Major Depression is a form of developed mental illness that severely affects individuals. The symptoms of the ailment include significant loss of energy, feelings of worthlessness and guilt on a daily basis, difficulties in making decisions, lack of interest in personal responsibilities, chronic restlessness, insomnia and/or excessive sleep, persistent feelings of sorrow or loss, significant gain or loss of weight, and chronic thoughts of suicide and death.
Major/Clinical Depression can last for years, even the lifespan of the sufferer; Dysthymia, a type of chronic long lasting depression often accompanies Major Depression. The illness makes living a normal life for the individual very difficult and unfortunately there is no set cure or therapy that will remedy the ailment. There are, however, a wide variety of psychological therapies and medications that may help the sufferer cope with and ultimately get past the ailment and it’s debilitating symptoms.

Using Cannabis to Treat Depression

Cannabis is a complex medicinal plant that may actually be used to treat a variety of debilitating symptoms caused by a surprisingly large number of ailments. It’s usefulness as a non-lethal medicine (you cannot die from an overdose of cannabis) cannot be overstated and it’s versatility in terms of how it can be consumed and as to how it can be useful for so many illnesses is something to be excited about. However, it is important to remember that consulting with your primary care physician should be your first priority when considering incorporating cannabis into one’s medical regiment and that cannabis is to be used as an adjunct therapy and not a replacement. It is also your responsibility to communicate with your doctor as to how your use of cannabis has affected your health and of your progress with utilizing medical cannabis.
With that said, exciting studies have shown that cannabis and the non-psychoactive compound Cannabidiol (CBD) may be quite useful for treating individuals suffering from Depression for the following reasons: elevating mood levels to combat depression; reducing anxiety; and aiding with sleep to battle insomnia.
FINDINGS: EFFECTS OF CANNABIS ON DEPRESSION
Research has found that the endocannabinoid system is associated with the management of mood. A dysfunction in the system, which causes a reduction in cannabinoid concentrations, has been found to cause mood disorders and depression (Hill & Gorzalka, 2009) (Gorzalka & Hill, 2011) (Smaga, et al., 2014). This dysfunction is likely caused by chronic stress, as one study found that an exposure to stress significantly reduced endocannabinoid concentrations in women diagnosed with major depression (Hill, et al., 2009). These findings suggest that cannabinoids, like tetrahydrocannabinol (THC), which are found in cannabis and influence the endocannabinoid system, could assist in the regulation of the endocannabinoid system and therefore offer therapeutic potential (Hill, et al., 2009) (Smaga, et al., 2014). Cannabinoids have been shown to promote new cell growth in the hippocampus, suggesting they could produce anxiolytic and antidepressant-like effects (Jiang, et al., 2005).
An animal trial found that the administration of cannabinoids was able to restore normal endocannabinoid function, which in turn stabilized mood and eased depression (Haj-Dahmane & Shen, 2014).
Cannabis could also assist in managing the health risks associated with depression. Depression has been linked to a higher risk of cardiovascular disease and a higher resting systolic blood pressure. However, one study found that the administering of cannabinoids in women diagnosed with depression was effective at regulating their high blood pressure (Ho, et al., 2012).
It’s important to note that cannabis use has previously been associated with a greater risk of depressive symptoms (Bricker, et al., 2007). However, a survey found that adults that regularly use cannabis are not at a greater risk of depression than non-using adults (Denson & Earleywine, 2006). In addition, a 2012 study found that suicide rates decreased by an overall of 5% in states with medical cannabis approximately after legislation was adopted. Changes in cannabis laws caused an 11 percent decrease in the suicide rate of 20 through 29-year-old males and a 9% decrease in the suicide rate of 30 to 39-year-old males, with a sharp decrease shown in 15 to 19-year old males (Anderson, Rees & Sabia, 2012).

Beneficial Cannabinoids and Terpenoids Useful for Treating Depression

The cannabis plant offers a plethora of therapeutic benefits and contains cannabinoids and terpenoid compounds that are useful for tackling the symptoms of Clinical Depression.
The following chart denotes which cannabinoids and terpenoids work synergistically with each other for possible therapeutic benefit. It may be beneficial to seek out strains that contain these cannabinoids and terpenoids.
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Americans For Safe Access Condition-based Booklets

These booklets summarize the history of medical cannabis and the recent research used to treat a variety of conditions, including Cancer, Multiple Sclerosis, Chronic Pain, Arthritis, Gastro-Intestinal Disorders, Movement Disorders, HIV/AIDS, and conditions related to Aging. (About Americans For Safe Access)
A Patient's Guide to Medical Cannabis

This guide for patients who use medical marijuana (cannabis) covers everything you need to know. Created by Americans for Safe Access (ASA), a non-profit advocacy organization, this publication will help individuals who are using or considering cannabis treatments to better educate themselves, their families and their physicians. ASA has been developing information resources about medical marijuana (cannabis) for patients, their families, doctors, and elected officials for over a decade.
 

roots69

Rising Star
BGOL Investor
Medical Cannabis Benefits: Treating Rheumatoid Arthritis (RA)


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While arthritis involves the painful inflammation of one’s joints, Rheumatoid Arthritis is an autoimmune disease (a condition in which the individual’s own immune system attacks itself) characterized by chronic and systemic inflammation throughout several parts of the sufferer’s skeletal system and body. It is a severely disabling ailment that often comes with chronic pain. The ailment is not restricted to just one’s joints, but may also affect one’s skin, eyes, lungs, heart, blood, and or nerves.

There are more than 100 different forms of arthritis and related diseases. The most common types include osteoarthritis (OA), rheumatoid arthritis (RA), psoriatic arthritis (PsA), fibromyalgia and gout.

The exact cause of Rheumatoid Arthritis is unknown, although genetics, diet, hormonal, and environmental factors are all believed to contribute to its development in sufferers. The disease affects everyone differently and it may develop gradually or quickly. Current medical advances do, however, offer a number of treatments and therapies aimed at tackling the symptoms of RA as well as with helping the disease go into remission.

Using Cannabis to Treat Rheumatoid Arthritis

Cannabis is a complex medicinal plant that may actually be used to treat a variety of debilitating symptoms caused by a surprisingly large number of ailments. Its usefulness as a non-lethal medicine (you cannot die from an overdose of cannabis) cannot be overstated and its versatility in terms of how it can be consumed and as to how it can be useful for so many illnesses is something to be excited about. However, it is important to remember that consulting with your primary care physician should be your first priority when considering incorporating cannabis into one’s medical regiment and that cannabis is to be used as an adjunct therapy and not a replacement. It is also your responsibility to communicate with your doctor as to how your use of cannabis has affected your health and of your progress with utilizing medical cannabis.

With that said, studies have shown that cannabis may be quite useful for treating individuals suffering from Rheumatoid Arthritis for the following reasons: reducing joint pain and swelling; suppression of joint destruction; and with helping to prevent progression/worsening of the disease.

FINDINGS: EFFECTS OF CANNABIS ON ARTHRITIS
Preclinical trials suggest that cannabis can help limit the damage of different types of arthritis. In an animal trial, cannabidiol (CBD), a major cannabinoid found in cannabis, effectively blocked the progression of arthritis. Researchers found that CBD protected joints against severe damage and concluded that CBD offers a potent anti-arthritic effect.

Other studies have found that synthetic cannabinoids offer strong anti-inflammatory and immunosuppressive properties and reduce joint damage in mice with osteoarthritis. Most recently, cannabinoid treatments were found effective for reducing osteoarthritis-related cartilage breakdown.

Research has also shown that cannabis can help manage the pain and inflammation associated with arthritis. CBD, and another major cannabinoid found in cannabis — tetrahydrocannabinol (THC) — activate the two main cannabinoid receptors (CB1 and CB2) of the endocannabinoid system within the body. Studies have shown the cannabinoid receptor system present in the synovium of joints could be a therapeutic target for addressing the pain and inflammation associated with osteoarthritis and rheumatoid arthritis. These two receptors regulate neurotransmitter release and central nervous system immune cells to reduce pain. Activating the CB1 receptor has been specifically found to reduce pain sensitivity in the osteoarthritic knee joints of rats. One study found that cannabis-based medicine significantly improved pain during joint movement, pain while at rest, and quality of sleep in patients with rheumatoid arthritis. Numerous preclinical studies have confirmed cannabis’ anti-inflammatory and pain-relieving effects and they support the idea that the endocannabinoid system is involved in alleviating pain associated with arthritis.

STATES THAT HAVE APPROVED MEDICAL CANNABIS FOR ARTHRITIS
Currently, Arkansas, California, Illinois (osteoarthritis, rheumatoid arthritis), and New Mexico have approved medical cannabis for the treatment of arthritis. However, in Washington D.C., any condition can be approved for medical cannabis as long as a DC-licensed physician recommends the treatment. In addition, various other states will consider allowing medical cannabis to be used for the treatment of arthritis with the recommendation from a physician. These states include: Connecticut (other medical conditions may be approved by the Department of Consumer Protection), Massachusetts (other conditions as determined in writing by a qualifying patient’s physician), Nevada (other conditions subject to approval), Oregon (other conditions subject to approval), Rhode Island (other conditions subject to approval), and Washington (any “terminal or debilitating condition”).

Several states have approved medical cannabis specifically to treat “chronic pain,” a symptom commonly associated with arthritis. These states include: Alaska, Arizona, California, Colorado, Delaware, Hawaii, Maine, Maryland, Michigan, Montana, New Mexico, Ohio, Oregon, Pennsylvania, Rhode Island, Vermont, and West Virginia. The states of Nevada, New Hampshire, North Dakota, Montana, Ohio and Vermont allow medical cannabis to treat “severe pain.” The states of Arkansas, Minnesota, Ohio, Pennsylvania, Washington, and West Virginia have approved cannabis for the treatment of “intractable pain.”

RECENT STUDIES ON CANNABIS’ EFFECT ON ARTHRITIS
Activating CB2 receptors reduces osteoarthritic knee pain.
Cannabinoid CB2 Receptors Regulate Central Sensitization and Pain Responses Associated with Osteoarthritis of the Knee Joint.
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3840025/)


CBD found to have anti-inflammatory and immunosuppressive effects, and therefore shown to be a potent anti-arthritic.
The nonpsychoactive cannabis constituent cannabidiol is an oral anti-arthritic therapeutic in murine collagen-induced arthritis.
(http://www.pnas.org/content/97/17/9561.full)


Beneficial Cannabinoids and Terpenoids Useful for Treating Rheumatoid Arthritis


The cannabis plant offers a plethora of therapeutic benefits and contains cannabinoids and terpenoid compounds that are useful for treating the painful symptoms of RA. Many of the current studies and research surrounding cannabis as a treatment for Rheumatoid Arthritis are focused on the anti-inflammatory properties of Cannabidiol (CBD) and on the usefulness of Tetrahydrocannabinol (THC) as an effective pain-reliever.

In one study by Malfait et al., published in March of 2000

it was stated that, “Taken together, these data show that CBD, through its combined immunosuppressive and anti-inflammatory actions, has a potent anti-arthritic effect in CIA (collagen-induced arthritis).”

With that said, the following list also denotes which cannabinoids and terpenoids work synergistically with each other for possible therapeutic benefit. It may be beneficial to seek out strains that contain these cannabinoids and terpenoids.





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Americans For Safe Access Condition-based Booklets
These booklets summarize the history of medical cannabis and the recent research used to treat a variety of conditions, including Cancer, Multiple Sclerosis, Chronic Pain, Arthritis, Gastrointestinal Disorders, Movement Disorders, HIV/AIDS, and conditions related to Aging. (About Americans For Safe Access)

Arthritis



Cannabis can ease the pain and reduce the swelling of arthritis without the side effects caused by frequent NSAID or opiate use.
 

roots69

Rising Star
BGOL Investor
Medical Cannabis Benefits: Treating Anxiety Disorder


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While all human beings experience anxiety throughout their lives, Anxiety Disorders are a set of mental illnesses characterized by chronic and overwhelming emotions of fear, anxiousness, restlessness, and crippling worrying. Examples of Anxiety Disorders include: Panic Disorder (which may cause complications of the heart); Social Anxiety Disorder; Selective Mutism (an inability to speak during specific but otherwise normal situations); various Phobias; Agoraphobia; Anxiety associated with Post Traumatic Stress Disorder (PTSD); Substance Induced Anxiety (alcohol abuse; drug abuse; opiate abuse; and even medication induced); and Generalized Anxiety Disorders which run the gamut of social hangups; disproportionate thinking; unhealthy obsessions; and so on.

These ailments are very debilitating and they are a major obstacle that sufferers face preventing them from leading a normal life. Resulting symptoms of these disorders include: problems with sleeping (insomnia); excessive sweating; irrational panicking; physical numbness; dizziness and nausea; heart palpitations; an inability to stay still and stay calm; painful muscle tensions and cramps; shortness of breath; and an inability to act or perform simple tasks.

Anxiety Disorders may either be developed through significant stressful incidents or situations in a sufferer’s life, or they may be hereditary. Thankfully, there are numerous therapies and medications that may help an individual treat and possibly rid themselves of their disorder.


Using Cannabis to Treat Anxiety Disorders

Cannabis is a complex medicinal plant that may actually be used to treat a variety of debilitating symptoms caused by a surprisingly large number of ailments. It’s usefulness as a non-lethal medicine (you cannot die from an overdose of cannabis) cannot be overstated and it’s versatility in terms of how it can be consumed and as to how it can be useful for so many illnesses is something to be excited about. However, it is important to remember that consulting with your primary care physician should be your first priority when considering incorporating cannabis into one’s medical regiment and that cannabis is to be used as an adjunct therapy and not a replacement. It is also your responsibility to communicate with your doctor as to how your use of cannabis has affected your health and of your progress with utilizing medical cannabis.

Currently, much of the ongoing research regarding cannabis’ ability to help with reducing anxiety has been focused on the powerful anxiolytic (anti-anxiety and anti-panic) properties of Cannabidiol (CBD). Overall, exciting studies have shown that cannabis may be quite useful for treating individuals suffering from Anxiety Disorders for the following reasons: significantly reducing anxiety itself; helping to manage possible depression associated with the anxiety disorder; helping to reduce nausea during a panic attack; assisting with sleep should the anxiety disorder cause insomnia; and with preventing possible psychosis.

FINDINGS: EFFECTS OF CANNABIS ON ANXIETY DISORDERS
While tetrahydrocannabinol (THC) has shown to increase anxiety, both animal and human studies have shown that another major cannabinoid found in cannabis — cannabidiol (CBD) — possesses anxiolytic-like effects .

One study found that CBD significantly reduced anxiety, cognitive impairment and discomfort in social phobia patients before they were subjected to simulated public speaking. A similar study also found CBD to have an anxiolytic effect on individuals submitted to a simulated public speaking test. Another found CBD to significantly decrease subjective anxiety in individuals diagnosed with social anxiety disorder.

Cannabinoids have shown they can reverse stress-induced anxiety by inhibiting fatty acid amide hydrolase, the anandamide-degrading enzyme. This is likely due to cannabinoid interaction with cannabinoid receptors, particularly the CB2 receptor, as they have shown to inhibit the fatty acid amide hydrolase and reduce vulnerability to anxiety. One study found that it was through CBD’s activation of the cannabinoid receptors that provided an anxiolytic effect in stressed mice. Another study, however, showed that it was through CBD’s activation of 5-HT1A receptors that caused an anxiolytic-like effect in rats exposed to tests. In another, CBD’s action on limbic and paralimbic brain areas were shown to be responsible for its anxiolytic properties.

STATES THAT HAVE APPROVED MEDICAL CANNABIS FOR ANXIETY DISORDERS
Currently, no states have approved medical cannabis for the treatment of anxiety disorders.

However, in Washington D.C., any condition can be approved for medical Cannabis as long as a DC-licensed physician recommends the treatment. In addition, various other states will consider allowing medical cannabis to be used for the treatment of anxiety disorders with the recommendation from a physician. These states include: California (any debilitating illness where the medical use of cannabis has been recommended by a physician), Connecticut (other medical conditions may be approved by the Department of Consumer Protection), Massachusetts (other conditions as determined in writing by a qualifying patient’s physician), New Mexico (other conditions subject to approval), Nevada (other conditions subject to approval), Oregon (other conditions subject to approval), Rhode Island (other conditions subject to approval), and Washington (any “terminal or debilitating condition”).


Beneficial Cannabinoids and Terpenoids Useful for Treating Anxiety Disorders

The cannabis plant offers a plethora of therapeutic benefits and contains cannabinoids and terpenoid compounds that are useful for treating some of the symptoms caused by an Anxiety Disorder. While much of the interest in treating an Anxiety Disorder with cannabis involves CBD, the following chart denotes which cannabinoids and terpenoids also work synergistically with each other for possible therapeutic benefit.

German Chamomile, tea, also has beneficial terpenes for treating Anxiety.

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Americans For Safe Access Condition-based Booklets
These booklets summarize the history of medical cannabis and the recent research used to treat a variety of conditions, including Cancer, Multiple Sclerosis, Chronic Pain, Arthritis, Gastro-Intestinal Disorders, Movement Disorders, HIV/AIDS, and conditions related to Aging. (About Americans For Safe Access)

A Patient's Guide to Medical Cannabis



This guide for patients who use medical marijuana (cannabis) covers everything you need to know. Created by Americans for Safe Access (ASA), a non-profit advocacy organization, this publication will help individuals who are using or considering cannabis treatments to better educate themselves, their families and their physicians. ASA has been developing information resources about medical marijuana (cannabis) for patients, their families, doctors, and elected officials for over a decade.
 

roots69

Rising Star
BGOL Investor
Drugs and the Correctional System (Prisons, Jails, Probation and Parole)


1. Number Of People Serving Time For Drug, Violent, Property, and Other Offenses In US Prisons
Federal Prisons:
"• Almost half of sentenced federal prisoners on September 30, 2017 (the most recent date for which federal offense data are available) were serving time for drug trafficking (tables 14 and 15).

"• More than a third (38%, or 64,300) of federal prisoners were imprisoned for a public-order offense, including 17% (28,300) for a weapons offense and 7% (11,100) for an adjudicated immigration offense.

"• More than half of female federal prisoners were serving a sentence for drug trafficking, compared to less than half of males."

State Prisons:
"• More than half (55%, or 710,900) of all state prisoners sentenced to more than one year were serving a sentence for a violent offense on their current term of imprisonment at year-end 2016 (the most recent year for which state prison offense-data are available) (tables 12 and 13).

"• At year-end 2016, an estimated 14% of sentenced prisoners (182,400) were serving time in state prison for murder or non-negligent manslaughter, and an additional 13% of state prisoners (164,800) had been sentenced for rape or sexual assault.

"• Among sentenced prisoners under the jurisdiction of state correctional authorities on December 31, 2016, about 15% (190,100 prisoners) had been convicted of a drug offense as their most serious crime."

Jennifer Bronson, PhD, and E. Ann Carson, PhD. Prisoners In 2017. Washington, DC: US Dept of Justice Bureau of Justice Statistics, April 2019, NCJ252156, p. 15 (state) and p. 16 (federal).
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2. 45,300 People At Year-End 2016 Serving Sentences in State Prisons in the US Whose Most Serious Offense Was Possession
The US Dept. of Justice's Bureau of Justice Statistics reports that at yearend 2016, 1,288,466 people were serving sentences in state prisons in the US, of whom 190,100 (14.75% of the total) had as their most serious offence a drug charge: 45,300 for drug possession (3.51% of the total), and 144,800 for "other" drug offenses, including manufacturing and sale (11.24% of the total).

Jennifer Bronson, PhD, and E. Ann Carson, PhD. Prisoners In 2017. Washington, DC: US Dept of Justice Bureau of Justice Statistics, April 2019, NCJ252156, p. 22, Table 13.
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3. People Serving Time in Federal Prisons in the US For Whom Drug Possession is the Most Serious Offense
The US Dept. of Justice's Bureau of Justice Statistics reported that on Sept. 30, 2012, there were a total of 187,773 people sentenced and serving time in US federal prison for any offense. Of those, 97,214 people (51.8% of the total) had as their most serious charge a drug offense: 96,907 of them for drug trafficking or manufacture (51.6% of the total), 296 for drug possession (0.16% of the total), and 11 for "other"* drug offenses.

(* "Other" includes investing illegal drug profits, operating a commercial carrier under the influence, and drug offenses that involve using the U.S. Postal Service.)

Sam Taxy, Julie Samuels, and William Adams, Urban Institute. “Drug Offenders in Federal Prison: Estimates of Characteristics Based on Linked Data.” NCJ248648. US Dept. of Justice Bureau of Justice Statistics: Washington, DC, Oct. 2015, p. 8, Table 8.
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4. Total Number of People On Probation For Drug Offenses In The US
Of the 3,789,800 adults on probation in the US at the end of 2015, 25% (approximately 947,450 people) had a drug charge as their most serious offense.

Danielle Kaeble and Thomas P. Bonczar, "Probation and Parole in the United States, 2015" (Washington, DC: US Dept of Justice Bureau of Justice Statistics, Dec. 2016), NCJ250230, Table 1, p. 3, and Table 4, p. 5.
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5. Total Number of People On Parole For Drug Offenses In The US, 2015
Of the 870,500 people on parole in the US at the end of 2015, 31% (approximately 269,855 people) had a drug charge as their most serious offense.

Danielle Kaeble and Thomas P. Bonczar, "Probation and Parole in the United States, 2015" (Washington, DC: US Dept of Justice Bureau of Justice Statistics, Dec. 2016), NCJ250230, Table 1, p. 3, and Table 6, p. 7.
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6. Past-Month Drug Use By Adults On Parole In The US, 2015
The Bureau of Justice Statistics reported that there were 870,500 people in the US aged 18 and over on parole at yearend 2015. According to the National Survey on Drug Use and Health, an estimated 31.1 percent of people on parole had used an illicit drug in the past month. An estimated 21.2 percent of those on probation were past-month users of marijuana. An estimated 20.4 percent of people on parole in 2015 were reportedly past-month users of any illicit drug other than marijuana. An estimated 10.7 percent of people on parole in 2015 were past-month users of illegal pain relievers.

Center for Behavioral Health Statistics and Quality. (2016). 2015 National Survey on Drug Use and Health: Detailed Tables. Substance Abuse and Mental Health Services Administration, Rockville, MD, p. 1967, Table 6.103B.
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Danielle Kaeble and Thomas P. Bonczar, "Probation and Parole in the United States, 2015" (Washington, DC: US Dept of Justice Bureau of Justice Statistics, Dec. 2016), NCJ250230, p. 1.
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7. Number of People in Jail or State Prisons Who Report Committing Crime to Get Money for Drugs
"About 21% each of state prisoners and sentenced jail inmates said their most serious current offense was committed to get money for drugs or to obtain drugs (table 7). A larger percentage of prisoners (39%) and jail inmates (37%) held for property offenses said they committed the crime for money for drugs or drugs than other offense types. Nearly a third of drug offenders (30% of state prisoners and 29% of jail inmates) said they committed the offense to get drugs or money for drugs. Approximately 1 in 6 state prisoners (15%) and jail inmates (14%) who committed violent offenses said they did so to get money for drugs or to obtain drugs."

Jennifer Bronson, PhD, Jessica Stroop, Stephanie Zimmer, and Marcus Berzofsky, PhD, "Drug Use, Dependence, and Abuse Among State Prisoners and Jail Inmates, 2007-2009" (Washington, DC: US Dept of Justice Bureau of Justice Statistics, June 2017), NCJ250546, p. 1.
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8. Number of People Serving Time in Federal Prison in the US, by Offense
"• Forty-seven percent (81,900) of sentenced federal prisoners on September 30, 2016 (the most recent date for which federal offense data are available) were serving time for a drug offense (table 14; table 15).
"• More than a third (38% or 65,900 prisoners) of federal prisoners were imprisoned for a public order offense, including 17% (28,800 federal prisoners) for a weapons offense and 8% (13,300) for an adjudicated immigration offense.
"• More than half (56% or 6,300) of female federal prisoners were serving sentences for a drug offense, compared to 47% of males (75,600).
"• A larger proportion of white offenders in federal prison (45%) were serving time for a public order offense on September 30, 2016, than blacks (34%) or Hispanics (38%).
"• More than half (57%) of Hispanic federal prisoners in 2016 were convicted of a drug offense, and nearly a quarter (23%) were serving time for an adjudicated immigration offense."

E. Ann Carson, PhD. Prisoners In 2016. Washington, DC: US Dept of Justice Bureau of Justice Statistics, January 2018, NCJ251149, p. 13.
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9. Forty Percent of People in Prison and Jail Report Using Drugs at the Time of Their Offense
"During 2007-09, about 4 in 10 state prisoners (42%) and sentenced jail inmates (37%) said they used drugs at the time of the offense for which they were currently incarcerated (table 6). Among prisoners, 22% reported marijuana/hashish use at time of the offense, 16% reported cocaine/crack use, 11% reported stimulant use, and 7% reported heroin/opiate use. Among sentenced jail inmates, 19% reported using marijuana/hashish at time of the offense, 13% reported cocaine/crack use, and 8% reported stimulant and heroin/opiate use."

Jennifer Bronson, PhD, Jessica Stroop, Stephanie Zimmer, and Marcus Berzofsky, PhD, "Drug Use, Dependence, and Abuse Among State Prisoners and Jail Inmates, 2007-2009" (Washington, DC: US Dept of Justice Bureau of Justice Statistics, June 2017), NCJ250546, p. 1.
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10. Drug Use by Adults on Probation in the US, 2015
According to the Bureau of Justice Statistics, there were a total of 3,789,800 people aged 18 and over in the US who were on probation at yearend 2015. According to the National Survey on Drug Use and Health, 31.6 percent of that population were past-month users of any illicit drug. Past-month use of marijuana was reported by 23.8 percent of people on probation. Past-month use of illicit drugs other than marijuana was reported by an estimated 16.9 percent of people on probation. Past-month illegal use of pain relievers was reported by an estimated 8.3 percent of people on probation in 2015.

Center for Behavioral Health Statistics and Quality. (2016). 2015 National Survey on Drug Use and Health: Detailed Tables. Substance Abuse and Mental Health Services Administration, Rockville, MD, p. 1957, Table 6.98B.
https://www.samhsa.gov/data/po...
https://www.samhsa.gov/data/si...
https://www.samhsa.gov/data/si...
Danielle Kaeble and Thomas P. Bonczar, "Probation and Parole in the United States, 2015" (Washington, DC: US Dept of Justice Bureau of Justice Statistics, Dec. 2016), NCJ250230, p. 1.
https://www.bjs.gov/index.cfm?...
https://www.bjs.gov/content/pu...

11. Offense Distribution of People Serving Time In State Prisons in the US, by Race/Ethnicity and Gender
"• More than half (54% or 707,900 prisoners) of all state prisoners sentenced to more than 1 year at year-end 2015 (the most recent year for which state prison offense data are available) were serving sentences for violent offenses on their current term of imprisonment (table 12; table 13).

"• At year-end 2015, an estimated 14% of sentenced prisoners (177,600 prisoners) were serving time in state prison for murder or nonnegligent manslaughter, and an additional 12% of state prisoners (161,900) had been sentenced for rape or sexual assault.

"• Among sentenced prisoners under the jurisdiction of state correctional authorities on December 31, 2015, 15% (197,200 prisoners) had been convicted of a drug offense as their most serious crime.

"• At year-end 2015, 60% of all Hispanic prisoners sentenced to more than 1 year in state prison were sentenced for a violent offense, compared to 59% of black and 47% of white prisoners.

"• A quarter (25%) of females serving time in state prison on December 31, 2015, had been convicted of a drug offense, compared to 14% of males."

E. Ann Carson, PhD. Prisoners In 2016. Washington, DC: US Dept of Justice Bureau of Justice Statistics, January 2018, NCJ251149, p. 13.
https://www.bjs.gov/index.cfm?...
https://www.bjs.gov/content/pu...

12. No Relationship Between Drug Imprisonment Rates and States' Drug Problems
"One primary reason for sentencing an offender to prison is deterrence—conveying the message that losing one’s freedom is not worth whatever one gains from committing a crime. If imprisonment were an effective deterrent to drug use and crime, then, all other things being equal, the extent to which a state sends drug offenders to prison should be correlated with certain drug-related problems in that state. The theory of deterrence would suggest, for instance, that states with higher rates of drug imprisonment would experience lower rates of drug use among their residents.

"To test this, Pew compared state drug imprisonment rates with three important measures of drug problems — self-reported drug use (excluding marijuana), drug arrest, and overdose death — and found no statistically significant relationship between drug imprisonment and these indicators. In other words, higher rates of drug imprisonment did not translate into lower rates of drug use, arrests, or overdose deaths.

"State pairings offer illustrative examples. For instance, Tennessee imprisons drug offenders at more than three times the rate of New Jersey, but the states’ rates of self-reported drug use are virtually the same. (See Figure 3.) Conversely, Indiana and Iowa have nearly identical rates of drug imprisonment, but Indiana ranks 27th among states in self-reported drug use and 18th in overdose deaths compared with 44th and 47th, respectively, for Iowa.

"The results hold even when controlling for standard demographic variables, including the percentage of the population with bachelor’s degrees, the unemployment rate, the percentage of the population that is nonwhite, and median household income."

More Imprisonment Does Not Reduce State Drug Problems: Data show no relationship between prison terms and drug misuse. The Pew Charitable Trusts. March 2018, pp. 5-6.
http://www.pewtrusts.org/en/re...
http://www.pewtrusts.org/~/med...

13. Incarceration Not Effective At Reducing Drug Use Or Related Problems
"Although no amount of policy analysis can resolve disagreements about how much punishment drug offenses deserve, research does make clear that some strategies for reducing drug use and crime are more effective than others and that imprisonment ranks near the bottom of that list. And surveys have found strong public support for changing how states and the federal government respond to drug crimes.

"Putting more drug-law violators behind bars for longer periods of time has generated enormous costs for taxpayers, but it has not yielded a convincing public safety return on those investments. Instead, more imprisonment for drug offenders has meant limited funds are siphoned away from programs, practices, and policies that have been proved to reduce drug use and crime."

More Imprisonment Does Not Reduce State Drug Problems: Data show no relationship between prison terms and drug misuse. The Pew Charitable Trusts. March 2018, p. 11.
http://www.pewtrusts.org/en/re...
http://www.pewtrusts.org/~/med...

14. Cost Effectiveness of Prison Compared With Treatment
"Substance-involved people have come to compose a large portion of the prison population. Substance use may play a role in the commission of certain crimes: approximately 16 percent of people in state prison and 18 percent of people in federal prison reported committing their crimes to obtain money for drugs.21Treatment delivered in the community is one of the most cost-effective ways to prevent such crimes and costs approximately $20,000 less than incarceration per person per year.22 A study by the Washington State Institute for Public Policy found that every dollar spent on drug treatment in the community yields over $18 in cost savings related to crime.23 In comparison, prisons only yield $.37 in public safety benefit per dollar spent. Releasing people to supervision and making treatment accessible is an effective way of reducing problematic drug use, reducing crime associated with drug use and reducing the number of people in prison."

Justice Policy Institute, "How to safely reduce prison populations and support people returning to their communities," (Washington, DC: June 2010), p. 8.
http://www.justicepolicy.org/i...

15. US Prisons and Drug Offenses
"The United States leads the world in the number of people incarcerated in federal and state correctional facilities. There are currently more than 2 million people in American prisons or jails. Approximately one-quarter of those people held in U.S. prisons or jails have been convicted of a drug offense. The United States incarcerates more people for drug offenses than any other country. With an estimated 6.8 million Americans struggling with drug abuse or dependence, the growth of the prison population continues to be driven largely by incarceration for drug offenses."

Justice Policy Institute, "Substance Abuse Treatment and Public Safety," (Washington, DC: January 2008), p. 1.
http://www.justicepolicy.org/i...

16. People in Prison with Drug Addiction or Dependence
"Violent offenders (47%) were the only offender group in State prisons with less than half meeting the DSM-IV criteria for drug dependence or abuse. Property and drug offenders (63% of each) were the most likely to be drug dependent or abusing.
"Drug offenders (52%) were the only group of Federal inmates with at least half meeting the drug dependence or abuse criteria. Property offenders (27%) reported the lowest percentage of drug dependence or abuse."

Mumola, Christopher J., and Karberg, Jennifer C., "Drug Use and Dependence, State and Federal Prisoners, 2004," (Washington, DC: US Dept. of Justice, Oct. 2006) (NCJ213530), p. 7.
http://www.bjs.gov/content/pub...

17. Parents in Prison, by Offense
"Among male state prisoners, violent (47%) and property (48%) offenders were less likely to report having children than public-order (60%) and drug (59%) offenders (table 6). For women held in state prison, violent (57%) offenders were less likely than drug (63%), property (65%), and public-order (65%) offenders to be a mother.
"The prevalence of being a parent differed by gender and offense for inmates held in state and federal prisons. For state inmates, female (65%) property offenders were more likely to be a parent than male (48%) property offenders. In federal prison, male (69%) drug offenders were more likely than female (55%) drug offenders to report having children.
"Among men held in federal prison, drug offenders (69%) were more likely than property (54%) and violent (50%) offenders to report having children (appendix table 5). Public-order offenders (62%) were also more likely than violent offenders to report having children. For women in federal prison, the likelihood of being a mother did not differ by offense."

Glaze, Lauren E. and Maruschak, Laura M., "Parents in Prison and Their Minor Children" (Washington, DC: USDOJ, Bureau of Justice Statistics, Jan. 2009), NCJ222984, p. 4.
http://www.bjs.gov/content/pub...

18. Parents in Prison
"Mothers in state prison (58%) were more likely than fathers (49%) to report having a family member who had also been incarcerated (table 11). Parents in state prison most commonly reported a brother (34%), followed by a father (19%). Among mothers in state prison, 13% reported a sister and 8% reported a spouse. Six percent of fathers reported having a sister who had also been incarcerated; 2%, a spouse.
"While growing up, 40% of parents in state prison reported living in a household that received public assistance, 14% reported living in a foster home, agency, or institution at some time during their youth, and 43% reported living with both parents most of the time (appendix table 11). Mothers (17%) held in state prison were more likely than fathers (14%) to report living in a foster home, agency, or institution at some time during their youth. Parents in federal prison reported lower percentages of growing up in a household that received public assistance (31%) or living in a foster home, agency, or institution (7%). These characteristics varied little by gender for parents held in federal prison.
"More than a third (34%) of parents in state prison reported that during their youth, their parents or guardians had abused alcohol or drugs. Mothers in state prison (43%) were more likely than fathers (33%) to have had this experience. Fewer parents (27%) in federal prison reported having a parent or a guardian who had abused alcohol or drugs."

Glaze, Lauren E. and Maruschak, Laura M., "Parents in Prison and Their Minor Children" (Washington, DC: USDOJ, Bureau of Justice Statistics, Jan. 2009), NCJ222984, p. 7.
http://www.bjs.gov/content/pub...

19. Number of Prisoners Who Report Having Committing Crime to Get Money for Drugs
"17% of State and 18% of Federal prisoners committed their crime to obtain money for drugs."

Mumola, Christopher J., and Karberg, Jennifer C., "Drug Use and Dependence, State and Federal Prisoners, 2004," (Washington, DC: US Dept. of Justice, Oct. 2006) (NCJ213530), p. 1.
http://www.bjs.gov/content/pub...

20. Increasing Costs of Overcrowding
"The increases in drug imprisonment, the decrease in releases from prison, and the re-incarceration for technical parole violations are leading to significant overcrowding and contribute to the growing costs of prisons. Prisons are stretched beyond capacity, creating dangerous and unconstitutional conditions which often result in costly lawsuits. In 2006, 40 out of 50 states were at 90 percent capacity or more, with 23 of those states operating at over 100 percent capacity."

Justice Policy Institute, "Pruning Prisons: How Cutting Corrections Can Save Money and Protect Public Safety," (Washington, DC: May 2009), pp. 7-8.
http://www.justicepolicy.org/i...

21. Estimated Number Of People In The US Sentenced To State and Federal Prison For Marijuana Offenses
Total Federal Prisoners 2004 = 170,535
Total State Prisoners 2004 = 1,244,311

Percent of federal prisoners held for drug law violations = 55%
Percent of state prisoners held for drug law violations = 21%

Marijuana/hashish, Percent of federal drug offenders, 2004 = 12.4%
Marijuana/hashish, Percent of state drug offenders, 2004 = 12.7%

(Total prisoners x percent drug law) x percent marijuana = "marijuana prisoners"

Federal marijuana prisoners in 2004 = 11,630
State marijuana prisoners in 2004 = 33,186
Total federal and state marijuana prisoners in 2004 = 44,816

Note: These data only address people in prisons and thus exclude the 700,000+ offenders who may be in local jails because of a marijuana conviction.

Mumola , Christopher J. and Karberg, Jennifer C., "Drug Use and Dependence, State and Federal Prisoners, 2004," Bureau of Justice Statistics (Washington, DC: U.S. Department of Justice, January 2007) NCJ 213530, p. 4.
http://www.bjs.gov...
Harrison, Paige M. and Beck, Allan J., "Prisoners in 2004," Bureau of Justice Statistics, (Washington, DC: US Department of Justice, October 2005), NCJ 210677, Table 1, page 2.
http://www.bjs.gov...

22. Estimated Number of People Sentenced To Federal Prison For Drug Offenses
Federal-Specific Datahttp://www.bjs.gov/index.cfm?t...
http://www.bjs.gov/content/pub...

23. Federal Drug Prisoners by Offense, 2004
According to the Justice Department, 5.3% of drug offenders in federal prisons are serving time for possession; 91.4% are serving time for trafficking offenses; and 3.3% are in for "other."

Mumola, Christopher J., and Karberg, Jennifer C., "Drug Use and Dependence, State and Federal Prisoners, 2004," (Washington, DC: US Dept. of Justice, Oct. 2006) (NCJ213530), p. 4.
http://www.bjs.gov/content/pub...

24. Incarceration Growth 1995-2003
"Violent offenders under Federal jurisdiction increased 46% from 1995 to 2003, and accounted for almost 8% of the total growth during the period. Homicide offenders increased 146%, from 1,068 in 1995 to 2,632 in 2003.
"While the number of offenders in each major offense category increased [from 1995 to 2003], the number incarcerated for a drug offense accounted for the largest percentage of the total growth (49%), followed by public-order offenders (38%)."

Harrison, Paige M. & Allen J. Beck, Allen J., PhD, US Department of Justice, Bureau of Justice Statistics, Prisoners in 2005 (Washington DC: US Department of Justice, Nov. 2006) NCJ 215092, p. 10.
http://www.bjs.gov/content/pub...

25. Prisons - Data - Number of People Serving Time in State Prisons for Drug Offenses
State- and Local-Specific Datahttps://www.bjs.gov/index.cfm?...
https://www.bjs.gov/content/pu...

26. Drug Treatment Admissions and Incarceration Rates
"Increased admissions to drug treatment are associated with reduced incarceration rates. States with a higher drug treatment admission rate than the national average send, on average, 100 fewer people to prison per 100,000 in the population than states that have lower than average drug treatment admissions. Of the 20 states that admit the most people to treatment per 100,000, 19 had incarceration rates below the national average. Of the 20 states that admitted the fewest people to treatment per 100,000, eight had incarceration rates above the national average."

Justice Policy Institute, "Substance Abuse Treatment and Public Safety," (Washington, DC: January 2008), p. 2.
http://www.justicepolicy.org/i...

27. Drug Offenses of State Inmates in the US, 2004
According to the US Justice Department, in 2004, 27.9% of people serving time for drug offenses in state prisons had a possession charge as their most serious offense; 69.4% were serving time on trafficking offenses; and 2.7% were in for "other."

Mumola, Christopher J., and Karberg, Jennifer C., "Drug Use and Dependence, State and Federal Prisoners, 2004," (Washington, DC: US Dept. of Justice, Oct. 2006) (NCJ213530), p. 4.
http://www.bjs.gov/content/pub...

28. Drug Use by People in Prison for Other Types of Offenses
"Violent offenders in State prison (50%) were less likely than drug (72%) and property (64%) offenders to have used drugs in the month prior to their offense."

Mumola, Christopher J., and Karberg, Jennifer C., "Drug Use and Dependence, State and Federal Prisoners, 2004," (Washington, DC: US Dept. of Justice, Oct. 2006) (NCJ213530), p. 1.
http://www.bjs.gov/content/pub...

29. Local Jail Inmates
According to a federal survey of jail inmates, of the total 440,670 jail inmates in the US in 2002, 112,447 (25.5%) were drug offenders: 48,823 (11.1%) for possession and 56,574 (12.8%) for trafficking.

Karberg, Jennifer C. and Doris J. James, US Dept. of Justice, Bureau of Justice Statistics, "Substance Dependence, Abuse, and Treatment of Jail Inmates, 2002" (Washington, DC: US Dept. of Justice, July 2005), Table 7, p. 6.
http://www.bjs.gov/content/pub...

30. Alcohol and Other Drug Use by Jail Inmates, by Offense
According to a federal survey of jail inmates, in 2002, of the 96,359 violent offenders in jail, 37.6% used alcohol at the time of their offense, 21.8% used drugs, and 47.2% used alcohol or drugs; of the 112,895 property offenders in jail that year, 28.5% used alcohol at the time of their offense, 32.5% used drugs, and 46.8% used alcohol or drugs; of the 112,447 drug offenders in jail that year, 22.4% used alcohol at the time of their offense, 43.2% used drugs, and 51.7% used drugs or alcohol at the time of their offense.

Karberg, Jennifer C. and Doris J. James, US Dept. of Justice, Bureau of Justice Statistics, "Substance Dependence, Abuse, and Treatment of Jail Inmates, 2002" (Washington, DC: US Dept. of Justice, July 2005), Table 7, p. 6.
http://www.bjs.gov/content/pub...

31. Drug Offenders Sentenced to Treatment
"In 2006 an estimated 38% of persons sentenced for a felony in state courts were ordered to pay a fine as part of their sentence (table 1.5). Approximately 1 in 4 property offenders was ordered to make restitution and 23% of offenders convicted of drug possession were sentenced to treatment."

Sean Rosenmerkel, Matthew Durose and Donald Farole, Jr., "Felony Sentences in State Courts, 2006 –Statistical Tables," Bureau of Justice Statistics (Washington, DC: US Department of Justice, December 2009), p. 2.
http://www.bjs.gov/content/pub...

32. State Felony Drug Convictions
"State courts sentenced an estimated 1,132,290 persons for a felony in 2006, including 206,140 (or 18% of all felony convictions) for a violent felony (table 1.1). A drug crime was the most serious conviction offense for about a third of felons sentenced in state courts that year."

Sean Rosenmerkel, Matthew Durose and Donald Farole, Jr., "Felony Sentences in State Courts, 2006 – Statistical Tables," Bureau of Justice Statistics (Washington, DC: US Department of Justice, December 2009). p. 2.
http://www.bjs.gov/content/pub...

33. Incarceration for Drug Crimes Both Ineffective and Counterproductive
http://www.pewtrusts.org/en/re...
http://www.pewtrusts.org/-/med...

34. People of Color in State Prison for Drug Offenses
"The number of people in state prisons for drug offenses has increased 550 percent over the last 20 years. A recent JPI report found that the amount spent on 'cops and courts' – not rates of drug use -- is correlated to admissions to prison for drug offenses. Counties that spend more on law enforcement and the judiciary admit more people to prison for drug offenses than counties that spend less. And increases in federal funding through the Edward Byrne Memorial State and Local Law Enforcement Assistance Grant Program have promoted increases in resources dedicated to drug enforcement. As crime continues to fall in many communities, law enforcement will have more time to focus on aggressive policing of drug offenses; this can be expected to lead to even higher drug imprisonment rates and crowded jails and prisons. According to FBI reports, 83 percent of drug arrests are for possession of illegal drugs alone.16 And regardless of crime in a particular jurisdiction, police often target the same neighborhoods to make drug arrests, which can increase the disproportionate incarceration of people of color."

Justice Policy Institute, "Pruning Prisons: How Cutting Corrections Can Save Money and Protect Public Safety," (Washington, DC: May 2009), p. 6.
http://www.justicepolicy.org/i...

35. The American Gulag - Former Drug Czar Gen. Barry R. McCaffrey
"We must have law enforcement authorities address the issue because if we do not, prevention, education, and treatment messages will not work very well. But having said that, I also believe that we have created an American gulag."

Gen. Barry R. McCaffrey (USA, Ret.), Director, ONDCP, Keynote Address, Opening Plenary Session, National Conference on Drug Abuse Prevention Research, National Institute on Drug Abuse, September 19, 1996, Washington, DC.
http://archives.drugabuse.gov/...

36. Drug Free Policies and Growing Underclass
"But while drug-free schools remain a fantasy, their policies are contributing to an uneducated underclass that just gets larger, more despairing, and more entrenched. This underclass now includes five million young adults between sixteen and twenty-four who are both out of school and out of work, with few skills and fewer prospects. It includes most ex-prisoners, half of whom lack a high school education, and most of whom are jobless one year after release. And it includes Black Americans and other racial minorities who have never remotely attained the standard of well-being common throughout the developed world."

Eric Blumenson, Eva S. Nilsen, "How to Construct an Underclass, or How the War on Drugs Became a War on Education," The Journal of Gender, Race & Justice, (May 2002), p. 76.
http://lsr.nellco.org/cgi/view...
 

roots69

Rising Star
BGOL Investor
Race & Prisons
Datatables:
Number of People in the US Serving Time in State and Federal Prisons, by age, sex, race, and Latinx ethnicity

1. Imprisonment Rates In The US By Age And Gender
"There were 440 prisoners sentenced to more than one year in state or federal prison per 100,000 U.S. residents on December 31, 2017, the lowest rate since 1997 (444 per 100,000) (table 5; see figure 1). Among U.S. residents age 18 or older, 568 in 100,000 were imprisoned on a sentence of more than one year at year-end 2017. At that time, 1.1% of adult males living in the United States (1,082 in 100,000) were serving a sentence of more than one year, representing a 2% decrease from year-end 2016 (1,108 in 100,000). The imprisonment rate for females also declined during that period, from 64 to 63 per 100,000 female U.S. residents of all ages and from 82 to 81 per 100,000 female U.S. residents age 18 or older.

"Broken down by state and federal rates, the imprisonment rate for sentenced prisoners per 100,000 U.S. residents was 390 under state jurisdiction and 51 under federal jurisdiction. At year-end 2017, a total of 22 states had imprisonment rates that were higher than the nationwide average for all states. Louisiana had the highest rate (719 per 100,000 state residents), followed by Oklahoma (704 per 100,000) and Mississippi (619 per 100,000) (table 6).

"The imprisonment rate for females was highest in Oklahoma (157 per 100,000 female state residents), followed by Kentucky (133 per 100,000), South Dakota (124 per 100,000), and Idaho (114 per 100,000). More than 1% of all male residents in six states were in prison on December 31, 2017: Louisiana (1,387 per 100,000 male state residents), Oklahoma (1,262 per 100,000), Mississippi (1,189 per 100,000), Arkansas (1,122 per 100,000), Arizona (1,039 per 100,000), and Texas (1,022 per 100,000)."

Jennifer Bronson, PhD, and E. Ann Carson, PhD. Prisoners In 2017. Washington, DC: US Dept of Justice Bureau of Justice Statistics, April 2019, NCJ252156, pp. 9-10.
https://www.bjs.gov/index.cfm...
https://www.bjs.gov/content/pu...

2. Number of People in the US Serving Time in State and Federal Prisons, by age, sex, race, and Latinx ethnicity
Click here for complete datatable of Number of People in the US Serving Time in State and Federal Prisons, by age, sex, race, and Latinx ethnicity, on December 31, 2015

Carson, E. Ann, and Mulako-Wangota, Joseph. Bureau of Justice Statistics. Estimated sentenced state and federal prisoners per 100,000 U.S. residents, by sex, race, Hispanic origin, and age, December 31, 2015. Generated using the Corrections Statistical Analysis Tool (CSAT) - Prisoners at www.bjs.gov on December 31, 2016.
https://www.bjs.gov/...
https://www.bjs.gov/nps/...

3. US Imprisonment Rates by Race
"Between year-end 2015 and year-end 2016, the rate of imprisonment for black adults decreased 4% (from 1,670 per 100,000 in 2015 to 1,608 per 100,000 in 2016) (figure 2). The imprisonment rate declined 29% since 2006 (2,261 per 100,000). The rate for white adults decreased 2% between 2015 (281 per 100,000) and 2016 (274 per 100,000), and it declined 15% during the past decade (324 per 100,000 in 2006). The imprisonment rate for Hispanic adults decreased 1%, from 862 per 100,000 in 2015 to 856 in 2016. Since 2006, the imprisonment rate for Hispanics declined 20% (1,073 per 100,000 in 2006)."

E. Ann Carson, PhD. Prisoners In 2016. Washington, DC: US Dept of Justice Bureau of Justice Statistics, January 2018, NCJ251149, p. 10.
https://www.bjs.gov/index.cfm...
https://www.bjs.gov/content/pu...

4. Jail Inmate Population in the US by Gender and Race/Ethnicity at Yearend 2016
"Non-Hispanic blacks (599 per 100,000 black U.S. residents) had the highest jail incarceration rate at year-end 2016, followed by American Indian or Alaska Natives (359 per 100,000 AIAN residents). Non-Hispanic whites (171 per 100,000 white residents) and Hispanics (185 per 100,000 Hispanic residents) were incarcerated at a similar rate at year-end 2016. Among non-Hispanics in 2016, blacks were incarcerated in jail at a rate 3.5 times that of whites, down from 5.6 times the rate in 2000.

"At year-end 2016, an estimated 85% of the jail population were male (table 3). Juveniles (those age 17 or younger) made up of 0.5% of the inmates held in local jails, down from 1.2% in 2000.

"White non-Hispanic inmates accounted for 48% of the jail population in 2016, up from 42% in 2000. In comparison, the percentage of black non-Hispanic inmates declined from 41% in 2000 to 34% in 2016. Hispanics represented 15% of the jail population in both 2000 and 2016. American Indian or Alaska Native inmates and Asian, Native Hawaiian, or Other Pacific Islander inmates each represented about 1% of the jail population."

There were 704,500 people confined in local jails on December 31, 2016, of whom 602,200 were male and 102,300 were female. Juveniles held as adults numbered 3,000, plus an additional 700 juveniles who were held as juveniles. Racial demographics were as follows: white, 338,700; black/African-American, 242,200; Latinx, 107,200; American Indian/Alaska native: 8,600; Asian/native Hawaiian/other Pacific islander: 5,600; two or more races: 2,100. Only 245,900 people confined to a local jail had been convicted of any crimes and had either already been sentenced or were awaiting sentencing. The remaining 458,600 people confined to local jails were unconvicted and awaiting court action on a current charge.

Zhen Zeng, PhD, "Jail Inmates in 2016," Bureau of Justice Statistics (Washington, DC: Department of Justice, Feb. 2018), NCJ251210, pp. 3-4 and p. 8, Appendix Table 1.
https://www.bjs.gov/index.cfm...
https://www.bjs.gov/content/pu...

5. State and Federal Prison Populations in the US, by Race, Gender, and Latinx Ethnicity
"• At year-end 2016, an estimated 7% of non-Hispanic white males in state and federal prison were ages 18 to 24, compared to 13% of non-Hispanic black males and 12% of Hispanic males.

"• Sixteen percent of while male prisoners were age 55 or older, compared to 10% of black male and 8% of Hispanic male prisoners.

"• Eight percent each of white and black female prisoners in 2015 were age 55 or older, compared to 5% of Hispanic female prisoners.

"•More than twice as many white females (48,900 prisoners) as black (20,300) or Hispanic (19,300) females were in state and federal prison at year-end 2016.

"• About 2.5% of black male U.S. residents were in state or federal prison on December 31, 2016 (2,415 per 100,000 black residents) (table 10).

"• Black males ages 18 to 19 were 11.8 times more likely to be imprisoned than white males of the same age. This age group had the highest black-to-white racial disparity in 2016.

"• Black males age 65 or older were 4.4 times more likely to be imprisoned than white males age 65 or older. This age group had the lowest black-to-white racial disparity in 2016.

"• The imprisonment rate for black females (96 per 100,000 black female residents) was almost double that for white females (49 per 100,000 white female residents).

"• Among females ages 18 to 19, black females were 3.1 times more likely than white females and 2.2 times more likely than Hispanic females to be imprisoned in 2016."

E. Ann Carson, PhD. Prisoners In 2016. Washington, DC: US Dept of Justice Bureau of Justice Statistics, January 2018, NCJ251149, p. 13.
https://www.bjs.gov/index.cfm...
https://www.bjs.gov/content/pu...

6. African American Males in Prison in the US
"On December 31, 2014, black males had higher imprisonment rates than prisoners of other races or Hispanic origin within every age group. Imprisonment rates for black males were 3.8 to 10.5 times greater at each age group than white males and 1.4 to 3.1 times greater than rates for Hispanic males. The largest disparity between white and black male prisoners occurred among inmates ages 18 to 19. Black males (1,072 prisoners per 100,000 black male residents ages 18 to 19) were more than 10 times more likely to be in state or federal prison than whites (102 per 100,000)."

Carson, E. Ann. Prisoners In 2014. Washington, DC: US Dept of Justice Bureau of Justice Statistics, Sept. 2015, NCJ248955, p. 15.
http://www.bjs.gov/index.cfm?t...
http://www.bjs.gov/content/pub...

7. Number of People In The US Serving Time In State Prison For Drug Offenses, by Race
An illegal drug conviction was the most serious offense for 206,300 out of the 1,316,409 people in the US sentenced to state prison facilities at the end of 2014. That represents 15.7% of all sentenced prisoners under state jurisdiction. Of this total: 67,800 (32.9%) were non-Latinx white, 68,000 (33.0%) were non-Latinx African American, and 28,800 (7.2%) were Latinx. No race/ethnicity was reported for the remaining 41,700 people (20.2%) serving time in state prison for a drug offense.
(Note: The Bureau of Justice Statistics annual report on prisoners does not provide separate counts for inmates who identify as two or more races, nor of American Indians, Alaska Natives, Asians, Native Hawaiians, or other Pacific Islanders.)

E. Ann Carson, PhD, and Elizabeth Anderson. Prisoners In 2015. Washington, DC: US Dept of Justice Bureau of Justice Statistics, Dec. 2016, NCJ250229, p. 30, Appendix Table 5.
https://www.bjs.gov/index.cfm?...
https://www.bjs.gov/content/pu...

8. Adults on Community Correctional Supervision in the US in 2015, by Race/Ethnicity, Gender, and Most Serious Offense
According to the federal Bureau of Justice Statistics:
Of the 3,789,800 adults in the US on probation as of 12/31/2015:
• 75% were male and 25% were female.
• 55% were non-Latinx Whites, 30% were non-Latinx African-American, 13% were Latinx, 1% were American Indian/Alaska Native, and 1% were Asian/Native Hawaiian/other Pacific Islander. The number of multi-racial/other was too low to be reported.
• Drug offenses were the most serious offenses for 25% of all probationers in 2015.

Of the 870,500 adults in the US on parole as of 12/31/2015:
• 87% were male and 13% were female.
• 44% were non-Latinx Whites, 38% were non-Latinx Blacks, 16% were Latinx, 1% were American Indian/Alaska Native, and 1% were Asian/Native Hawaiian/Other Pacific Islander. The number of multi-racial/other was too low to be reported.
• Drug offenses were the most serious offense for 31% of all parolees in 2015.

Danielle Kaeble and Thomas P. Bonczar, "Probation and Parole in the United States, 2015" (Washington, DC: US Dept of Justice Bureau of Justice Statistics, Dec. 2016), NCJ250230, Table 1, p. 3, Table 4, p. 5, and Table 6, p. 7.
https://www.bjs.gov/index.cfm?...
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9. Estimated Population of Young Adults in the US With a Parent Who Has Ever Spent Time in Jail or Prison
http://pediatrics.aappublicati...
http://pediatrics.aappublicati...

10. Offense Distribution of People Serving Time In State Prisons in the US, by Race/Ethnicity and Gender
"• More than half (54% or 707,900 prisoners) of all state prisoners sentenced to more than 1 year at year-end 2015 (the most recent year for which state prison offense data are available) were serving sentences for violent offenses on their current term of imprisonment (table 12; table 13).

"• At year-end 2015, an estimated 14% of sentenced prisoners (177,600 prisoners) were serving time in state prison for murder or nonnegligent manslaughter, and an additional 12% of state prisoners (161,900) had been sentenced for rape or sexual assault.

"• Among sentenced prisoners under the jurisdiction of state correctional authorities on December 31, 2015, 15% (197,200 prisoners) had been convicted of a drug offense as their most serious crime.

"• At year-end 2015, 60% of all Hispanic prisoners sentenced to more than 1 year in state prison were sentenced for a violent offense, compared to 59% of black and 47% of white prisoners.

"• A quarter (25%) of females serving time in state prison on December 31, 2015, had been convicted of a drug offense, compared to 14% of males."

E. Ann Carson, PhD. Prisoners In 2016. Washington, DC: US Dept of Justice Bureau of Justice Statistics, January 2018, NCJ251149, p. 13.
https://www.bjs.gov/index.cfm?...
https://www.bjs.gov/content/pu...

11. Children with Parents Behind Bars
"Among white children in 1980, only 0.4 of 1 percent had an incarcerated parent; by 2008 this figure had increased to 1.75 percent. Rates of parental incarceration are roughly double among Latino children, with 3.5 percent of children having a parent locked up by 2008. Among African American children, 1.2 million, or about 11 percent, had a parent incarcerated by 2008."

Western , Bruce; Pettit, Becky, "Incarceration & social inequality," Dædalus (Cambridge, MA: American Academy of Arts and Sciences, Summer 2010), p. 16.
http://www.mitpressjournals.or...

12. Parents Behind Bars
"The growth of incarceration in America has intergenerational impacts that policy makers will have to confront. According to this analysis, more than 1.2 million inmates — over half of the 2.3 million people behind bars — are parents of children under age 18. This includes more than 120,000 mothers and more than 1.1 million fathers. The racial concentration that characterizes incarceration rates also extends to incarcerated parents. Nearly half a million black fathers, for example, are behind bars, a number that represents 40 percent of all incarcerated parents.
"The most alarming news lurking within these figures is that there are now 2.7 million minor children (under age 18) with a parent behind bars. (See Figure 9.) Put more starkly, 1 in every 28 children in the United States — more than 3.6 percent — now has a parent in jail or prison. Just 25 years ago, the figure was only 1 in 125.
"For black children, incarceration is an especially common family circumstance. More than 1 in 9 black children has a parent in prison or jail, a rate that has more than quadrupled in the past 25 years. (See Figure 10.)
"Because far more men than women are behind bars, most children with an incarcerated parent are missing their father.37 For example, more than 10 percent of African American children have an incarcerated father, and 1 percent have an incarcerated mother."

The Pew Charitable Trusts, 2010. Collateral Costs: Incarceration’s Effect on Economic Mobility. Washington, DC: The Pew Charitable Trusts, p. 18.
http://www.pewtrusts.org/en/re...

13. Parents in Prison
"Similar to men in the general prison population (93%), parents held in the nation's prisons at midyear 2007 were mostly male (92%) (not shown in table). More than 4 in 10 fathers were black, about 3 in 10 were white, and about 2 in 10 were Hispanic (appendix table 2). An estimated 1,559,200 children had a father in prison at midyear 2007; nearly half (46%) were children of black fathers.

"Almost half (48%) of all mothers held in the nation's prisons at midyear 2007 were white, 28% were black, and 17% were Hispanic. Of the estimated 147,400 children with a mother in prison, about 45% had a white mother. A smaller percentage of the children had a black (30%) or Hispanic (19%) mother."

Glaze, Lauren E. and Maruschak, Laura M., "Parents in Prison and Their Minor Children" (Washington, DC: USDOJ, Bureau of Justice Statistics, August 2008, Revised March 30, 2010), NCJ222984, p. 2.
http://www.bjs.gov/content/pub...

14. Incarceration of People of Color
"Mass arrests and incarceration of people of color – largely due to drug law violations46 – have hobbled families and communities by stigmatizing and removing substantial numbers of men and women. In the late 1990s, nearly one in three African-American men aged 20-29 were under criminal justice supervision, 47while more than two out of five had been incarcerated – substantially more than had been incarcerated a decade earlier and orders of magnitudes higher than that for the general population.48 Today, 1 in 15 African-American children and 1 in 42 Latino children have a parent in prison, compared to 1 in 111 white children.49In some areas, a large majority of African-American men – 55 percent in Chicago, for example50 – are labeled felons for life, and, as a result, may be prevented from voting and accessing public housing, student loans and other public assistance."

"Drug Courts Are Not the Answer: Toward a Health-Centered Approach to Drug Use" Drug Policy Alliance (New York, NY: March 2011), p. 9.
http://www.drugpolicy.org/site...

15. Odds of Arrest and Incarceration for Marijuana Offenses in California
"Compared to Non-blacks, California’s African-American population are 4 times more likely to be arrested for marijuana, 12 times more likely to be imprisoned for a marijuana felony arrest, and 3 times more likely to be imprisoned per marijuana possession arrest. Overall, as Figure 3 illustrates, these disparities accumulate to 10 times’ greater odds of an African-American being imprisoned for marijuana than other racial/ethnic groups."

Males, Mike, "Misdemeanor marijuana arrests are skyrocketing and other California marijuana enforcement disparities," Center on Juvenile and Criminal Justice (San Francisco, CA: November 2011), p. 6.
http://www.cjcj.org/uploads/cj...

16. Female Incarceration Rates in the US in 2010 by Race/Ethnicity
According to the Bureau of Justice Statistics, at midyear 2010, the incarceration rate for women was 126 per 100,000 population. The rate for non-Hispanic white females was 91, for non-Hispanic black females the rate was 260, and for Hispanic women the rate was 133.

Glaze, Lauren E., "Correctional Population in the United States, 2010," Bureau of Justice Statistics (Washington, DC: Department of Justice, December 2011), NCJ 236319, Appendix Table 3, p. 8.
http://www.bjs.gov/content/pub...

17. Problems of Systemic Racial Biases Within Drug Courts
"Importantly, representation of African-Americans in jails and prisons was nearly twice that of both Drug Courts and probation, and was also substantially higher among all arrestees for drug-related offenses. On one hand, these discrepancies might be explained by relevant differences in the populations. For example, minority arrestees might be more likely to have the types of prior convictions that could exclude them from eligibility for Drug Courts or probation. On the other hand, systemic differences in plea-bargaining, charging or sentencing practices might be having the practical effect of denying Drug Court and other community-based dispositions to otherwise needy and eligible minority citizens. Further research is needed to determine whether racial or ethnic minority citizens are being denied the opportunity for Drug Court for reasons that may be unrelated to their legitimate clinical needs or legal eligibility."

West Huddleston and Douglas B. Marlowe, "Painting the Current Picture: A National Report on Drug Courts and Other Problem Solving Court Programs in the United States" (Alexandria, VA: National Drug Court Institute, July 2011), NCJ 235776, p. 29.
http://www.ndci.org/...

18. Racism and the War on Drugs
"The main obstacle to getting black America past the illusion that racism is still a defining factor in America is the strained relationship between young black men and police forces. The massive number of black men in prison stands as an ongoing and graphically resonant rebuke to all calls to 'get past racism,' exhibit initiative, or stress optimism. And the primary reason for this massive number of black men in jail is the War on Drugs. Therefore, if the War on Drugs were terminated, the main factor keeping race-based resentment a core element in the American social fabric would no longer exist. America would be a better place for all."

McWhorter, John, "How the War on Drugs Is Destroying Black America," Cato's Letter (Washington, DC: The Cato Institute, Winter 2011), p. 1.
http://www.cato.org/sites/cato...

19. Incarceration Rates by Race and Gender in the US in 2007
"Changes in the incarceration rates for men and women by race were associated with changes to the overall composition of the custody population at midyear 2007. Black men had an incarceration rate of 4,618 per 100,000 U.S. residents at midyear 2007, down from 4,777 at midyear 2000. For white men, the midyear 2007 incarceration rate was 773 per 100,000 U.S. residents, up from 683 at midyear 2000. The ratio of the incarceration rates of black men to white men declined from 7 to 6 during this period.

"Changes in the incarceration rates for women were more distinct. At midyear 2000, black women were incarcerated at a rate 6 times that of white women (or 380 per 100,000 U.S. residents versus 63 per 100,000 U.S. residents). By June 30, 2007, the incarceration rate for black women declined to 3.7 times that of white women (or 348 versus 95). An 8.4% decline in the incarceration rate for black women and a 51% increase in the rate for white women accounted for the overall decrease in the incarceration rate of black women relative to white women at midyear 2007."

Sabol, William J., PhD, and Couture, Heather, Bureau of Justice Statistics, Prison Inmates at Midyear 2007 (Washington, DC: US Department of Justice, June 2008), NCJ221944, p. 8.
http://www.bjs.gov/content/pub...

20. Racial Disparities in Enforcement and Incarceration
"The racial disparities in the rates of drug arrests culminate in dramatic racial disproportions among incarcerated drug offenders. At least two-thirds of drug arrests result in a criminal conviction.18 Many convicted drug offenders are sentenced to incarceration: an estimated 67 percent of convicted felony drug defendants are sentenced to jail or prison.19 The likelihood of incarceration increases if the defendant has a prior conviction.20 Since blacks are more likely to be arrested than whites on drug charges, they are more likely to acquire the convictions that ultimately lead to higher rates of incarceration. Although the data in this backgrounder indicate that blacks represent about one-third of drug arrests, they constitute 46 percent of persons convicted of drug felonies in state courts.21 Among black defendants convicted of drug offenses, 71 percent received sentences to incarceration in contrast to 63 percent of convicted white drug offenders.22Human Rights Watch’s analysis of prison admission data for 2003 revealed that relative to population, blacks are 10.1 times more likely than whites to be sent to prison for drug offenses.23"

Fellner, Jamie, "Decades of Disparity: Drug Arrests and Race in the United States," Human Rights Watch (New York, NY: March 2009), p. 16.
http://www.hrw.org/sites/defau...

21. Male Incarceration Rate In The US 2007, By Race/Ethnicity
"The custody incarceration rate for black males was 4,618 per 100,000. Hispanic males were incarcerated at a rate of 1,747 per 100,000. Compared to the estimated numbers of black, white, and Hispanic males in the U.S. resident population, black males (6 times) and Hispanic males (a little more than 2 times) were more likely to be held in custody than white males. At midyear 2007 the estimated incarceration rate of white males was 773 per 100,000.

"Across all age categories, black males were incarcerated at higher rates than white or Hispanic males. Black males ages 30 to 34 had the highest custody incarceration rate of any race, age, or gender group at midyear 2007."

Sabol, William J., PhD, and Couture, Heather, Bureau of Justice Statistics, Prison Inmates at Midyear 2007 (Washington, DC: US Department of Justice, June 2008), NCJ221944, p. 7.
http://www.bjs.gov/content/pub...

22. People Held in Prisons in 2007, by Race/Ethnicity, Gender, and Age
"Of the 2.3 million inmates in custody, 2.1 million were men and 208,300 were women (table 9). Black males represented the largest percentage (35.4%) of inmates held in custody, followed by white males (32.9%) and Hispanic males (17.9%).

"Over a third (33.8%) of the total male custody population was ages 20 to 29 (appendix table 10). The largest percentage of black (35.5%) and Hispanic (39.9%) males held in custody were ages 20 to 29. White males ages 35 to 44 accounted for the largest percentage (30.1%) of the white male custody population.

"The largest percentage (35.9%) of the female custody population was ages 30 to 39. Over a third of white females (35.9%) were ages 30 and 39. The largest percentage (36.8%) of Hispanic females in custody was ages 20 to 29."

Sabol, William J., PhD, and Couture, Heather, "Prison Inmates at Midyear 2007," (Washington, DC: US Dept. of Justice, Bureau of Justice Statistics, June 2008), NCJ221944, p. 7.
http://www.bjs.gov/content/pub...

23. Racial and Gender Disparities
"Looking at the numbers through the lenses of race and gender reveals stark differences. Black adults are four times as likely as whites and nearly 2.5 times as likely as Hispanics to be under correctional control. One in 11 black adults—9.2 percent—was under correctional supervision at year end 2007. And although the number of female offenders continues to grow, men of all races are under correctional control at a rate five times that of women."

Pew Center on the States, "One in 31: The Long Reach of American Coorections," (Washington, DC: The Pew Charitable Trusts, March 2009), p. 5.
http://www.pewcenteronthestate...

24. Incarceration Rates Compared
"When incarceration rates by State (excluding Federal inmates) are estimated separately by gender, race, and Hispanic origin, male rates are found to be 10 times higher than female rates; black rates 5-1/2 times higher than white rates; and Hispanic rates nearly 2 times higher than white rates."

Harrison, Paige M., & Beck, Allen J., PhD, Bureau of Justice Statistics, "Prison and Jail Inmates at Midyear 2005" (Washington, DC: US Dept. of Justice, May 2006) (NCJ213133), p. 10.
http://www.bjs.gov/content/pub...

25. Chance of Imprisonment, 2001
"In 2001, the chances of going to prison were highest among black males (32.2%) and Hispanic males (17.2%) and lowest among white males (5.9%). The lifetime chances of going to prison among black females (5.6%) were nearly as high as for white males. Hispanic females (2.2%) and white females (0.9%) had much lower chances of going to prison."

Bonczar, Thomas P., US Department of Justice, Bureau of Justice Statistics, "Prevalence of Imprisonment in the US Population, 1974-2001," NCJ197976 (Washington DC: US Department of Justice, August 2003), p. 8.
http://www.bjs.gov/content/pub...

26. Changing Racial and Ethnic Statistical Classifications in the US Correctional System Over Time
Click here for complete datatable of Estimated number of adults on probation, in jail, in prison, or on parole and their percent of the adult population, by sex and race, 1990.

Click here for complete datatable of Imprisonment rate of sentenced state and federal prisoners per 100,000 U.S. residents, by demographic characteristics, December 31, 2014

Click here for the complete datatable of Number of sentenced prisoners under jurisdiction of state or federal correctional authorities, by age, sex, race, and Hispanic origin, December 31, 2014

Click here for the complete datatable of Number of sentenced prisoners under State or Federal jurisdiction, by gender, race, Hispanic origin, and age, 2000

Click here for complete datatable of Sentenced prisoners under State or Federal jurisdiction per 100,000 residents, by gender, race, Hispanic origin, and age, 2000

Click here for complete datatable of Characteristics of adults on probation in the US, 2000, 2013, and 2014

Click here for complete datatable of Characteristics of adults on parole in the US, 2000, 2013, and 2014

William J. Sabol, PhD, Heather Couture, and Paige M. Harrison, "Prisoners in 2006" (Washington, DC: US Dept of Justice Bureau of Justice Statistics, Dec. 2007), NCJ219416, p. 7.
http://bjs.gov/content/pub/pdf...
Carson, E. Ann. Prisoners In 2014. Washington, DC: US Dept of Justice Bureau of Justice Statistics, Sept. 2015, NCJ248955, Table 10, p. 15, and Appendix Table 3, p. 29.
http://www.bjs.gov/index.cfm?t... http://www.bjs.gov/content/pub...
Kaeble, Danielle, Maruschak, Laura M., and Bonczar, Thomas P. Probation and Parole in the United States, 2014. Washington, DC: US Dept of Justice Bureau of Justice Statistics, Nov. 2015. NCJ249057, Table 4, p. 5, Table 6, p. 7, and Table 1, p. 2.
http://bjs.gov/content/pub/pdf...
Beck, Allen J., PhD, and Harrison, Paige M. Prisoners in 2000. Washington, DC: US Dept of Justice Statistics, Aug. 2001, NCJ188207, Table 14, p. 10, and Table 15, p. 11
http://www.bjs.gov/content/pub...
Jankowski, Louis W. Correctional Populations in the United States, 1990. Washington, DC: US Dept of Justice Bureau of Justice Statistics, July 1992, NCJ134946, Table 1.2, P. 6.
https://www.ncjrs.gov/pdffiles...

27. Parents in Prison, 1999
"Of the Nation's 72.3 million minor children in 1999, 2.1% had a parent in State or Federal prison. Black children (7.0%) were nearly 9 times more likely to have a parent in prison than white children (0.8%). Hispanic children (2.6%) were 3 times as likely as white children to have an inmate parent."

Mumola, Christopher J., US Department of Justice Bureau of Justice Statistics, Incarcerated Parents and Their Children (Washington, DC: US Department of Justice, August 2000), p. 2.
http://www.bjs.gov/content/pub...

28. Effects of "Three-Strikes" Laws
Due to harsh new sentencing guidelines, such as 'three-strikes, you're out,' "a disproportionate number of young Black and Hispanic men are likely to be imprisoned for life under scenarios in which they are guilty of little more than a history of untreated addiction and several prior drug-related offenses... States will absorb the staggering cost of not only constructing additional prisons to accommodate increasing numbers of prisoners who will never be released but also warehousing them into old age."

Craig Haney, Ph.D., and Philip Zimbardo, Ph.D., "The Past and Future of U.S. Prison Policy: Twenty-five Years After the Stanford Prison Experiment," American Psychologist, Vol. 53, No. 7 (July 1998), p. 718.
http://www.prisonexp.org/pdf/a...
http://www.ncbi.nlm.nih.gov/pu...

29. Injustice of Racial Disparities
"The racially disproportionate nature of the war on drugs is not just devastating to black Americans. It contradicts faith in the principles of justice and equal protection of the laws that should be the bedrock of any constitutional democracy; it exposes and deepens the racial fault lines that continue to weaken the country and belies its promise as a land of equal opportunity; and it undermines faith among all races in the fairness and efficacy of the criminal justice system. Urgent action is needed, at both the state and federal level, to address this crisis for the American nation."

Summary and Recommendations from "Punishment and Prejudice: Racial Disparities in the War on Drugs" (Washington, DC: Human Rights Watch, June 2000)
http://www.hrw.org/legacy/camp...
http://www.hrw.org/legacy/repo...

30. Impact of the Over-Incarceration of Young Black Males in the US
http://www.mitpressjournals.or...

31. Impact of Racial Disparities
At the start of the 1990s, the U.S. had more Black men (between the ages of 20 and 29) under the control of the nation's criminal justice system than the total number in college. This and other factors have led some scholars to conclude that, "crime control policies are a major contributor to the disruption of the family, the prevalence of single parent families, and children raised without a father in the ghetto, and the 'inability of people to get the jobs still available.'"

Craig Haney, Ph.D., and Philip Zimbardo, Ph.D., "The Past and Future of U.S. Prison Policy: Twenty-five Years After the Stanford Prison Experiment," American Psychologist, Vol. 53, No. 7 (July 1998), p. 716.
http://www.csdp.org/research/h...

32. Strip Searches of Arrestees, England
"One study on the role of closed circuit television in a London police station emphasizes the potential for abuse and discrimination when police officers have discretion to strip search detainees.174 From May 1999 to September 2000, officers in the station processed over 7000 arrests.175 The station’s policy allowed officers of the same sex to conduct strip searches only if they felt it was necessary to remove drugs or a harmful object.176
"For each arrest, the researchers documented the detainee’s age, sex, ethnicity, and offense.177 A statistical analysis of these factors revealed that, as expected, people arrested for drug offenses were the most likely to be strip searched.178 The results also showed that while all other variables (age, sex, and offense) were controlled, females were less likely to be strip searched than males, and arrestees who were seventeen to twenty-three years old were more likely to be strip searched than other age groups.179 In addition, ethnicity influenced whether a strip search was conducted even when all other variables were taken into account. Specifically, compared to white Europeans, African-Caribbeans were twice as likely to be searched while Arabics and Orientals were half as likely.180 The researchers in the study concluded that the data at least 'raise . . . the spectre of police racism' and reveal that 'policing is unequally experienced,' though it is impossible to determine whether the disproportionate number of strip searches of African-Caribbeans is due to institutional racism or unintentional discrimination.181"
 

roots69

Rising Star
BGOL Investor
Women & Drug War

1. Imprisonment Rates In The US By Age And Gender
"There were 440 prisoners sentenced to more than one year in state or federal prison per 100,000 U.S. residents on December 31, 2017, the lowest rate since 1997 (444 per 100,000) (table 5; see figure 1). Among U.S. residents age 18 or older, 568 in 100,000 were imprisoned on a sentence of more than one year at year-end 2017. At that time, 1.1% of adult males living in the United States (1,082 in 100,000) were serving a sentence of more than one year, representing a 2% decrease from year-end 2016 (1,108 in 100,000). The imprisonment rate for females also declined during that period, from 64 to 63 per 100,000 female U.S. residents of all ages and from 82 to 81 per 100,000 female U.S. residents age 18 or older.

"Broken down by state and federal rates, the imprisonment rate for sentenced prisoners per 100,000 U.S. residents was 390 under state jurisdiction and 51 under federal jurisdiction. At year-end 2017, a total of 22 states had imprisonment rates that were higher than the nationwide average for all states. Louisiana had the highest rate (719 per 100,000 state residents), followed by Oklahoma (704 per 100,000) and Mississippi (619 per 100,000) (table 6).

"The imprisonment rate for females was highest in Oklahoma (157 per 100,000 female state residents), followed by Kentucky (133 per 100,000), South Dakota (124 per 100,000), and Idaho (114 per 100,000). More than 1% of all male residents in six states were in prison on December 31, 2017: Louisiana (1,387 per 100,000 male state residents), Oklahoma (1,262 per 100,000), Mississippi (1,189 per 100,000), Arkansas (1,122 per 100,000), Arizona (1,039 per 100,000), and Texas (1,022 per 100,000)."

Jennifer Bronson, PhD, and E. Ann Carson, PhD. Prisoners In 2017. Washington, DC: US Dept of Justice Bureau of Justice Statistics, April 2019, NCJ252156, pp. 9-10.
https://www.bjs.gov/index.cfm...
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2. Number of People in Jails in the US, 2015, by Gender
"The juvenile population (those age 17 or younger) in local jails continued to decline in 2015, to fewer than 4,000 inmates (tables 3 and 4). This was down from a peak of about 7,600 juveniles in 2010. Since 2000, at least 8 in 10 juveniles held in local jails were on trial or awaiting trial in adult court.
"While males accounted for at least 85% of the jail population each year since 2000, the female jail population grew from 11% of the total jail population in 2000 to more than 14% in 2013 and 2014. As a result, the female jail incarceration rate increased from about 50 per 100,000 female U.S. residents in 2000 to nearly 70 per 100,000 in 2014. The male incarceration rate remained relatively stable since 2000 (about 400 per 100,000 male U.S. residents) (not shown)."

Todd D. Minton and Zhen Zeng, PhD, "Jail Inmates in 2015," Bureau of Justice Statistics (Washington, DC: Department of Justice, Dec. 2016), NCJ250394, p. 4.
https://www.bjs.gov/index.cfm...
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3. Women in the US Sentenced and Serving Time in Either State or Federal Prisons, 2000 and 2010-2015
Click here for complete datatable for Women in the US Sentenced and Serving Time in Either State or Federal Jurisdiction: 2000 and 2010-2015

Note: The Bureau of Justice Statistics defines Imprisonment Rate as "the number of prisoners under state or federal jurisdiction sentenced to more than 1 year per 100,000 U.S. residents."
a: Includes American Indians and Alaska Natives; Asians, Native Hawaiians, and Other Pacific Islanders; and persons of two or more races.
b: Excludes persons of Hispanic or Latino origin.
*: Number of women identifying as "other" not provided separately until 2012, so for 2000 and 2010-2011, this figure was derived by subtracting the number of non-Latina whites, non-Latina blacks, and Latinas from the total. As a result, the imprisonment rate is not available.

Carson, E. Ann, and Anderson, Elizabeth, "Prisoners in 2015" (Washington, DC: US Dept of Justice Bureau of Justice Statistics, Dec. 2016), NCJ250229, p.13 and Appendix Table 4, p. 30.
https://www.bjs.gov/index.cfm?...
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Carson, E. Ann, "Prisoners in 2014" (Washington, DC: US Dept of Justice Bureau of Justice Statistics, Sept. 2015), NCJ248955, Table 10, p. 15.
https://www.bjs.gov/index.cfm?...
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Carson, E. Ann, "Prisoners in 2013" (Washington, DC: US Dept of Justice Bureau of Justice Statistics, Sept. 2014, Revised Sept. 30, 2014), NCJ247282, Table 8, p. 9.
https://www.bjs.gov/index.cfm?...
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Carson, E. Ann, and Golinelli, Daniela, "Prisoners in 2012: Trends in Admissions and Releases, 1991-2012" (Washington, DC: US Dept of Justice Bureau of Justice Statistics, Dec. 2013, Revised Sept. 2, 2014), NCJ243920, Table 18, p. 25, and Appendix Table 4, p. 37.
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Carson, E. Ann, and Sabol, William J., "Prisoners in 2011" (Washington, DC: US Dept. of Justice Bureau of Justice Statistics, Dec. 2012), NCJ239808, p. 8; Table 7, p. 7; and Table 8, p. 8.
http://www.bjs.gov/content/pub...
Guerino, Paul; Harrison, Paige M.; and Sabol, William J., "Prisoners in 2010," Bureau of Justice Statistics, (Washington, DC: US Department of Justice, December 2011), NCJ 236096, Table 12, p. 26; Table 14, p. 27; and p. 12.
http://www.bjs.gov/content/pub...

4. State Policies Regarding Substance Use by Pregnant Women
"24 states and the District of Columbia consider substance use during pregnancy to be child abuse under civil child-welfare statutes, and 3 consider it grounds for civil commitment.

"23 states and the District of Columbia require health care professionals to report suspected prenatal drug use, and 7 states require them to test for prenatal drug exposure if they suspect drug use.

"19 states have either created or funded drug treatment programs specifically targeted to pregnant women, and 17 states and the District of Columbia provide pregnant women with priority access to state-funded drug treatment programs.

"10 states prohibit publicly funded drug treatment programs from discriminating against pregnant women."

Substance Use During Pregnancy. Guttmacher Institute. May 1, 2018. Washington, DC.
https://www.guttmacher.org/pri...
https://www.guttmacher.org/sta...

5. Total Arrests in the US by Gender
"In 2015, 73.1 percent of all arrestees were males. Males accounted for 79.7 percent of persons arrested for violent crimes and for 61.7 percent of persons arrested for property crimes.
• Males comprised 88.5 percent of persons arrested for murder and nonnegligent manslaughter in 2015.
• Of the total number of persons arrested for drug abuse violations, 77.4 percent were males.
• Females accounted for 43.2 percent of all persons arrested for larceny-theft offenses in 2015.
• Of persons arrested for aggravated assault in 2015, 23.1 percent were females.
• Of persons arrested for driving under the influence, 24.9 percent were females.

"Crime in the United States 2015 - Arrests," FBI Uniform Crime Report (Washington, DC: US Dept. of Justice, September 2016), Table 42.
https://ucr.fbi.gov/crime-in-t...
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https://ucr.fbi.gov/crime-in-t...

6. Number of People Serving Time in State Prisons Whose Most Serious Offense Was A Drug Charge, By Gender
robbery, and assault. Whites had a higher percentage of sentenced prisoners serving time in state facilities for rape or sexual assault (16%) than blacks (8%) or Hispanics (13%). Whites also had a higher percentage offenders serving a sentence of more than 1 year in state prison for property crimes (25%) than blacks (16%) and Hispanics (14%) at yearend 2014. The proportion of prisoners sentenced to more than 1 year in state prison for drug offenses was roughly equal between whites, blacks, and Hispanics (15.0% or 67,800 white prisoners, 14.9% or 68,000 black prisoners, and 14.6% or 28,800 Hispanic prisoners)."

Click here for the complete datatable of Number of Sentenced Prisoners Under State Jurisdiction in the US Whose Most Serious Offense Was A Drug Charge, By Gender, 2006-2014.

Carson, E. Ann, and Anderson, Elizabeth, "Prisoners in 2015" (Washington, DC: US Dept of Justice Bureau of Justice Statistics, Dec. 2016), NCJ250229, p. 14 and Appendix Table 5, p. 30.
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Carson, E. Ann, "Prisoners in 2014" (Washington, DC: US Dept of Justice Bureau of Justice Statistics, Sept. 2015), NCJ248955, Appendix Table 4, p. 30.
https://www.bjs.gov/index.cfm?...
https://www.bjs.gov/content/pu...
Carson, E. Ann, "Prisoners in 2013" (Washington, DC: US Dept of Justice Bureau of Justice Statistics, Sept. 2014, Revised Sept. 30, 2014), NCJ247282, Table 14, p. 16.
https://www.bjs.gov/index.cfm?...
https://www.bjs.gov/content/pu...
Carson, E. Ann, and Golinelli, Daniela, "Prisoners in 2012: Advance Counts" (Washington, DC: US Dept of Justice Bureau of Justice Statistics, July 2013), NCJ242467, Appendix Table 10, p. 43.
https://www.bjs.gov/index.cfm?...
https://www.bjs.gov/content/pu...
Carson, E. Ann, and Sabol, William J., "Prisoners in 2011" (Washington, DC: US Dept. of Justice Bureau of Justice Statistics, Dec. 2012), NCJ239808, Table 9, p. 9, Appendix Table 8, p 27, and Appendix Table 7, p. 26.
http://www.bjs.gov/content/pub...
Guerino, Paul; Harrison, Paige M.; and Sabol, William J., "Prisoners in 2010," Bureau of Justice Statistics, (Washington, DC: US Department of Justice, December 2011), NCJ 236096, Appendix Table 16B, p. 28.
http://www.bjs.gov/content/pub...
West, Heather C.; Sabol, William J.; and Greenman, Sarah J., "Prisoners in 2009," Bureau of Justice Statistics, (Washington, DC: US Department of Justice, December 2010), NCJ 231675, Appendix Table 16a, Appendix Table 16b, Appendix Table 16c, pp. 29-30.
http://www.bjs.gov/content/pub...

7. Women in Prison for Drug Offenses
State: "More than half (53% or 696,900 prisoners) of all state prisoners sentenced to more than 1 year on December 31, 2014 (the most recent year for which state prison offense data are available) were serving sentences for violent offenses on their current term of imprisonment (table 9) (appendix table 5). At yearend 2014, 13% of sentenced prisoners (171,700 prisoners) were serving time in state prison for murder or nonnegligent manslaughter. An additional 162,800 state prisoners (12%) had been sentenced for rape or sexual assault. On December 31, 2015, 249,900 state prisoners (19%) were sentenced to at least 1 year for property offenses. Sixteen percent of state prisoners were serving sentences for drug-related offenses (206,300 prisoners).
"Violent offenders represented more than half (54%) of the sentenced male state prisoners. More than a third (36%) of female prisoners were violent offenders. Eighteen percent (223,700) of male state prisoners and 28% (26,000) of females were sentenced for property offenses. Twenty-five percent of female state prisoners (23,500 females) and 15% of male state prisoners (182,700 males) were sentenced for drug offenses."
Federal: "Almost 50% (92,000 prisoners) of sentenced federal prisoners on September 30, 2015 (the most recent date for which federal offense data are available) were serving time for drug offenses (table 10) (appendix table 6). An additional 36% of federal offenders (67,500 prisoners) were imprisoned for public order offenses, including 30,200 (16% of all federal prisoners) for weapons offenses and 14,900 (8%) for adjudicated immigration crimes. While 53% of sentenced state prisoners were serving time for violent offenses, 7% of federal prisoners (13,700 prisoners) were serving sentences for violent crimes.
"Among female federal prisoners, 59% were serving sentences for drug offenses, compared to 49% of males. A larger proportion of white prisoners in federal prison (42%) were serving time for public order offenses on September 30, 2015 than blacks (32%) or Hispanics (37%). More than half of black (51%) and Hispanic (58%) federal prisoners in 2015 were convicted of drug offenses."

Carson, E. Ann, and Anderson, Elizabeth, "Prisoners in 2015" (Washington, DC: US Dept of Justice Bureau of Justice Statistics, Dec. 2016), NCJ250229, p. 14 (state) and p. 15 (federal).
https://www.bjs.gov/index.cfm?...
https://www.bjs.gov/content/pu...

8. Current Alcohol Use by Gender
"In 2011, an estimated 56.8 percent of males aged 12 or older were current drinkers, which was higher than the rate for females (47.1 percent). However, among youths aged 12 to 17, the percentage of males who were current drinkers (13.3 percent) was similar to the rate for females (13.3 percent)."

Substance Abuse and Mental Health Services Administration, Results from the 2011 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-44, HHS Publication No. (SMA) 12-4713. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012, p. 33.
http://www.samhsa.gov/data/NSD...

9. Current Drug Use in the US by People Aged 12 and Older, by Gender
"• In 2013, as in prior years, the rate of current illicit drug use among persons aged 12 or older was higher for males (11.5 percent) than for females (7.3 percent). Males were more likely than females to be current users of several different illicit drugs, including marijuana (9.7 vs. 5.6 percent), cocaine (0.8 vs. 0.4 percent), and hallucinogens (0.7 vs. 0.3 percent).
"• In 2013, the rate of current illicit drug use was higher for males than females aged 12 to 17 (9.6 vs. 8.0 percent). This represents a change from 2012, when the rates of current illicit drug use were similar among males and females aged 12 to 17 (9.6 and 9.5 percent, respectively), and reflects a decrease in the rate of current illicit drug use among females from 2012 to 2013. Likewise, in 2013, the rate of current marijuana use was higher for males than females aged 12 to 17 (7.9 vs. 6.2 percent), which is a change from 2012 when the rates of current marijuana use for males and females were similar (7.5 and 7.0 percent).
"• The rate of current marijuana use among males aged 12 to 17 declined from 9.1 percent in 2002 to 6.9 percent in 2006, then increased between 2006 and 2011 (9.0 percent) (Figure 2.11). The rate decreased from 2011 to 2012 (7.5 percent) and remained stable in 2013 (7.9 percent). Among females aged 12 to 17, the rate of current marijuana use decreased from 7.2 percent in 2002 and 2003 to 6.2 percent in 2013."

Substance Abuse and Mental Health Services Administration, Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-48, HHS Publication No. (SMA) 14-4863. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014, p. 25.
https://www.samhsa.gov/data/si...
https://www.samhsa.gov/data/si...

10. Substance Dependence or Abuse by Gender
"As was the case from 2002 through 2010, the rate of substance dependence or abuse for males aged 12 or older in 2011 was about twice as high as the rate for females. For males in 2011, the rate was 10.4 percent, which decreased from 11.7 percent in 2010 (Figure 7.6). For females, it was 5.7 percent in 2011, which did not differ from the rate of 6.0 percent in 2010. Among youths aged 12 to 17, the rate of substance dependence or abuse among males was not different from the rate among females in 2011 (6.9 percent for each)."

Substance Abuse and Mental Health Services Administration, Results from the 2011 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-44, HHS Publication No. (SMA) 12-4713. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012, p. 78.
http://www.samhsa.gov/data/NSD...

11. Mothers in Prison by Race/Ethnicity
"Almost half (48%) of all mothers held in the nation’s prisons at midyear 2007 were white, 28% were black, and 17% were Hispanic. Of the estimated 147,400 children with a mother in prison, about 45% had a white mother. A smaller percentage of the children had a black (30%) or Hispanic (19%) mother."

Glaze, Lauren E., and Maruschak, Laura M., "Parents in Prison and Their Minor Children" (Washington, DC: US Dept. of Justice Bureau of Justice Statistics, Aug. 2008), NCJ222984, p. 2.
http://www.bjs.gov/content/pub...

12. Growth in Incarceration Rates, 1995-2005
"Since 1995 the total number of male prisoners has grown 34%; the number of female prisoners, 57%. At yearend 2005, 1 in every 1,538 women and 1 in every 108 men were incarcerated in a State or Federal prison."

Harrison, Paige M. & Allen J. Beck, PhD, Bureau of Justice Statistics, Prisoners in 2005 (Washington DC: US Department of Justice, Nov. 2006), p. 4.
http://www.bjs.gov/content/pub...

13. Mothers in Prison
"The nation’s prisons held approximately 744,200 fathers and 65,600 mothers at midyear 2007 (appendix table 1). Fathers in prison reported having 1,559,200 children; mothers reported 147,400."

Glaze, Lauren E., and Maruschak, Laura M., "Parents in Prison and Their Minor Children" (Washington, DC: US Dept. of Justice Bureau of Justice Statistics, Aug. 2008), NCJ222984, p. 2.
http://www.bjs.gov/content/pub...

14. Children with Parents in Prison
"Since 1991, the number of children with a mother in prison has more than doubled, up 131%. The number of children with a father in prison has grown by 77%. This finding reflects a faster rate of growth in the number of mothers held in state and federal prisons (up 122%), compared to the number of fathers (up 76%) between 1991 and midyear 2007.
"Of the estimated 74 million children in the U.S. resident population who were under age 18 on July 1, 2007, 2.3% had a parent in prison (table 2). Black children (6.7%) were seven and a half times more likely than white children (0.9%) to have a parent in prison. Hispanic children (2.4%) were more than two and a half times more likely than white children to have a parent in prison."

Glaze, Lauren E., and Maruschak, Laura M., "Parents in Prison and Their Minor Children" (Washington, DC: US Dept. of Justice Bureau of Justice Statistics, Aug. 2008), NCJ222984, p. 2.
http://www.bjs.gov/content/pub...

15. Rates of Inmate-on-Inmate Sexual Victimization in Prisons and Jails
"• Rates of inmate-on-inmate sexual victimization among prison inmates were higher among females (6.9%) than males (1.7%), higher among whites (2.9%) or inmates of two or more races (4.0%) than among blacks (1.3%), higher among inmates with a college degree (2.7%) than among inmates who had not completed high school (1.9%), and lower among currently married inmates (1.4%) than among inmates who never married (2.1%) (table 7).
??"• Similar patterns of inmate-on-inmate sexual victimization were reported by jail inmates. Female jail inmates (3.6%), whites (2.0%), and inmates with a college degree (3.0%) reported higher rates of victimization than males (1.4%), blacks (1.1%), and inmates who had not completed high school (1.4%).
??"• Rates of inmate-on-inmate sexual victimization were unrelated to age among state and federal prisoners, except for slightly lower rates among inmates age 55 or older.
??"• Rates were lower among jail inmates in the oldest age categories (ages 35 to 44, 45 to 54, and 55 or older) than among jail inmates ages 20 to 24."

Beck, Allen J., PhD, Berzofsky, Marcus, DrPH, and Krebs, Christopher, PhD, "Sexual Victimization in Prisons and Jails Reported by Inmates, 2011-2012" (Washington, DC: US Dept. of Justice Bureau of Justice Statistics, May 2013), NCJ241399, pp. 17-18.
http://www.bjs.gov/content/pub...

16. Patterns of Prison and Jail Staff Sexual Misconduct
"The reported use or threat of physical force to engage in sexual activity with staff was generally low among all prison and jail inmates (0.8%); however, at least 5% of the inmates in three state prisons and one high-rate jail facility reported they had been physically forced or threatened with force. (See appendix tables 3 and 7.) The Clements Unit (Texas) had the highest percentage of inmates reporting sexual victimization involving physical force or threat of force by staff (8.1%), followed by Denver Women’s Correctional Facility (Colorado) (7.3%), and Idaho Maximum Security Institution (6.0%). Wilson County Jail (Kansas) led all surveyed jails, with 5.6% of inmates reporting that staff used physical force or threat of force to have sex or sexual contact.
"While 0.8% of prison and jail inmates reported the use or threat of physical force, an estimated 1.4% of prison inmates and 1.2% of jail inmates reported being coerced by facility staff without any use or threat of force, including being pressured or made to feel they had to have sex or sexual contact. In 8 of the 24 facilities with high rates of staff sexual misconduct, at least 5% of the inmates reported such pressure by staff. Among state prisoners, the highest rates were reported by female inmates in the Denver Women’s Correctional Facility (Colorado) (8.8%) and by male inmates in the Clements Unit (Texas) (8.7%). Among jail inmates, the highest rates were reported by inmates in the Rose M. Singer Center (New York) (5.6%) and the Contra Costa County Martinez Detention Facility (California) (5.2%)."

Beck, Allen J., PhD, Berzofsky, Marcus, DrPH, and Krebs, Christopher, PhD, "Sexual Victimization in Prisons and Jails Reported by Inmates, 2011-2012" (Washington, DC: US Dept. of Justice Bureau of Justice Statistics, May 2013), NCJ241399, p. 14.
http://www.bjs.gov/content/pub...

17. Female Incarceration Rates in the US in 2010 by Race/Ethnicity
According to the Bureau of Justice Statistics, at midyear 2010, the incarceration rate for women was 126 per 100,000 population. The rate for non-Hispanic white females was 91, for non-Hispanic black females the rate was 260, and for Hispanic women the rate was 133.

Glaze, Lauren E., "Correctional Population in the United States, 2010," Bureau of Justice Statistics (Washington, DC: Department of Justice, December 2011), NCJ 236319, Appendix Table 3, p. 8.
http://www.bjs.gov/content/pub...

18. International Standards and US Law Relating to Sexual Abuse in Prisons
"Under international law, rape of an inmate by staff is considered to be torture. Other forms of sexual abuse violate the internationally recognized prohibition on cruel, inhuman or degrading treatment or punishment. Rape and sexual assault violate US federal and state criminal laws. In addition, 36 states, the District of Columbia and the federal government have laws specifically prohibiting sexual relations between staff and inmates. A number of the laws prohibit staff-inmate sexual contact regardless of inmate consent, recognizing that such sexual relations cannot be truly consensual because of the power that staff have over inmates. Fourteen states do not have laws criminalizing sexual relations between staff and inmates.(7)"

Amnesty International, "Not Part of My Sentence: Violations of the Human Rights of Women in Custody" (Washington, DC: Amnesty International, March 1999).
http://www.amnestyusa.org/node...

19. Historic Growth in Female Imprisonment Rate
"During 2005 the number of females under the jurisdiction of State or Federal prison authorities increased by 2.6% (table 5). The number of males in prison rose 1.9%. At yearend 2005, 107,518 females and 1,418,406 males were in prison. Since 1995 the annual rate of growth in female prisoners averaged 4.6%, which was higher than the 3.0% increase in male prisoners. By yearend 2005 females accounted for 7.0% of all prisoners, up from 6.1% in 1995 and 5.7% in 1990."

Harrison, Paige M. & Allen J. Beck, PhD, Bureau of Justice Statistics, Prisoners in 2005 (Washington DC: US Department of Justice, Nov. 2006), p. 4.
http://www.bjs.gov/content/pub...

20. Historic Growth in Female Prison Population
"Female state prison population growth has far outpaced male growth in the past quarter-century. The number of women serving sentences of more than a year grew by 757 percent between 1977 and 2004 – nearly twice the 388 percent increase in the male prison population."

Frost, Natasha A.; Greene, Judith; and Pranis, Kevin, "HARD HIT: The Growth in the Imprisonment of Women, 1977-2004," Institute on Women & Criminal Justice (New York, NY: Women's Prison Association, May 2006), p. 9.
http://www.wpaonline.org/insti...

21. Men Guarding Female Prisoners
"Federal and state laws prohibit rape and sexual assault and the policies of jail and prison authorities generally prohibit sexual conduct that is not part of the duties of staff. However, the duties of male guards include conduct that is not prohibited by law but which greatly distresses female inmates, in particular searches for contraband which require guards to touch their bodies, and guards' surveillance of them when they are undressed.
"Under anti-discrimination employment laws in the USA, prisons and jails cannot refuse to employ men to supervise female inmates (or women to supervise male inmates) and in many states there are few restrictions on their duties. A 1997 survey of prisons in 40 states found that on average 41 percent of the correctional officers working with female inmates are men.(9)
"The employment of men to guard women is inconsistent with international standards set out in the United Nations Standard Minimum Rules for the Treatment of Prisoners. Rules 53(2) and 53(3) state that female prisoners should be attended and supervised only by female officers and that male staff, such as doctors and teachers who provide professional services in female facilities, should always be accompanied by female officers. The United Nations Special Rapporteur on Violence Against Women has called on all countries to "fully implement the Standard Minimum Rules for the Treatment of Prisoners and ensure that protective measures are guaranteed in all situations of custody."(10) Amnesty International agrees: the nature and extent of sexual abuse of female inmates by male staff in jails and prisons in the USA, and the harm that sexual abuse causes, warrants strong and immediate action by authorities to provide the protection to which incarcerated women are entitled under international standards."

Amnesty International, "Not Part of My Sentence: Violations of the Human Rights of Women in Custody" (Washington, DC: Amnesty International, March 1999).
http://www.amnestyusa.org/node...

22. Treatment Facilities in the US Offering Programs or Groups for Women and Other Specific Client Types, 2012
http://www.samhsa.gov/data/DAS...

23. Women Under-Represented in Substance Use Treatment Globally
"To be equally represented in treatment, the ratio of males to females in treatment should be similar to the ratio of males to females in problem drug use. Using past-month prevalence as a proxy for problematic use,24gender-disaggregated data from EMCDDA on past-month prevalence and outpatient clients in treatment suggest that in most countries in Europe females could be underrepresented in treatment for the problematic use of cannabis, cocaine and amphetamines (see figure 5). There are few studies that analyse gender differences in the accessibility of treatment services; however, the ratio of males and females reported in treatment in Europe was 4:1 — higher than the ratio between male and female drug users.25 In many developing countries, there are limited services for the treatment and care of female drug users and the stigma associated with being a female drug user can make accessibility to treatment even more difficult. In Afghanistan, for instance, 10 per cent of all estimated drug users have access to treatment services,26whereas only 4 per cent of female drug users and their partners have access to treatment services and interventions."

UN Office on Drugs and Crime, World Drug Report 2012 (United Nations publication, Sales No. E.12.XI.1), p. 16.
https://www.unodc.org/document...

24. Prevalence of LSD Use Among Young Women
"Our results indicate that this population of sexually active female adolescents and young adults have similar rates of lifetime use of LSD (13%) as reported in other surveys,1,30 and half of these young women report using LSD one or more times in the last year. Prior data suggests that the use of hallucinogens by African Americans is virtually nonexistent across all ages of adolescents and young adults.2,9 In fact, we found that none of our African American young women reported using LSD. However, the proportion of African Americans who reported using marijuana was much greater than either caucasian or Mexican American women."

Rickert, Vaughn I.; Siqueira, Lorena M.; Dale, Travis; and Wiemann, Constance M., "Prevalence and Risk Factors for LSD Use among Young Women," Journal of Pediatric and Adolescent Gynecology (Washington, DC: North American Society for Pediatric and Adolescent Gynecology, April 2003) Volume 16, Issue 2, p. 72.
http://www.ncbi.nlm.nih.gov/pu...

25. Children of Incarcerated Women
"More than 70 percent of women in prison have children. Even before a mother’s arrest and separation from the family unit, many children will have experienced emotional hardship associated with parental substance abuse and economic instability. While she is incarcerated they suffer additional trauma, anxiety, guilt, shame and fear.30
"More than half of mothers in prison have no visits with their children for the duration of their time behind bars.31 Children are generally subject to instability and uncertainly while their mothers are imprisoned."

Frost, Natasha A.; Greene, Judith; and Pranis, Kevin, "HARD HIT: The Growth in the Imprisonment of Women, 1977-2004," Institute on Women & Criminal Justice (New York, NY: Women's Prison Association, May 2006), p. 26.
http://www.wpaonline.org/insti...

26. Mothers in Correctional System, 1997
"Approximately 7 in 10 women under correctional sanction have minor children & children under the age of 18. An estimated 72% of women on probation, 70% of women held in local jails, 65% of women in State prisons, and 59% of women in Federal prisons have young children.
"Women under correctional care, custody, or supervision with minor children reported an average of 2.11 children of this age. Those on probation reported the fewest, 2.07 young children per woman with children while those in State prison reported an average of 2.38 children under age 18.
"These estimates translate into more than 1.3 million minor children who are the offspring of women under correctional sanction; more than a quarter million of these children have mothers who are serving time in prison or jail. About two-thirds of women in State prisons and half of women in Federal prisons who had young children had lived with those children prior to entering prison."

Greenfield, Lawrence A., and Snell, Tracy L., Bureau of Justice Statistics, Women Offenders (Washington, DC: US Department of Justice, December 1999), pp. 7-8.
http://www.bjs.gov/content/pub...

27. Many Women Under Correctional Authority Are Survivors of Sexual Assault
"Forty-four percent of women under correctional authority [including 57% of the women in State prisons], reported that they were physically or sexually assaulted at some time during their lives. Sixty-nine percent of women reporting an assault said that it had occurred before age 18."

Greenfield, Lawrence A., and Snell, Tracy L., Bureau of Justice Statistics, Women Offenders (Washington, DC: US Department of Justice, December 1999), p. 8, Table 20.
http://www.bjs.gov/content/pub...

28. Growth in Drug Offense Convictions of Females 1990-1996
Between 1990 and 1996, the number of women convicted of drug felonies increased by 37% (from 43,000 in 1990 to 59,536 in 1996). The number of convictions for simple possession increased 41% over that period, from 18,438 in 1990 to 26,022 in 1996.

Greenfield, Lawrence A., and Snell, Tracy L., Bureau of Justice Statistics, Women Offenders (Washington, DC: US Department of Justice, December 1999), p. 5, Table 11.
http://www.bjs.gov/content/pub...

29. Reasons for Growth in the Incarceration of Women in the US
http://www.wpaonline.org/insti...

30. Substance Use, Social Support, and Child Protection Services
"The results of this study are important for the child protection field. They show that, rather than severity of substance use being associated with mothers’ involvement with the child protection system, other factors are of greater importance. Of particular interest was the finding that having greater social support, particularly from parents, significantly reduced the likelihood of being involved with the child protection system."

Taplin, Stephanie and Mattick, Richard P., "Child Protection and Mothers in Substance Abuse Treatment," National Drug and Alcohol Research Centre (Sydney, Australia: University of New South Wales, November 2011), p. 9.
http://dl.dropbox.com/u/646635...
 

roots69

Rising Star
BGOL Investor
Corruption

News articles and reports on police corruption in the US, particularly related to drug enforcement, have sadly become ubiquitous. Journalist Phil Smith with the Drug War Chronicle writes a weekly column for the Drug War Chronicle, "This Week's Corrupt Cops Stories," that's an excellent resource on this topic.

1. Nexus of Corruption and Drug Trafficking
"The drug problem and corruption have a mutually reinforcing relationship. Corruption facilitates the production and trafficking of illegal drugs and this, in turn, benefits corruption.76 The wealth and power of some drug trafficking organizations can exceed that of local governments, allowing them to buy protection from law enforcement agents, criminal justice institutions, politicians and the business sector. In doing so, they further reinforce corruption. The rule of law is both an immediate victim and, if it is already weak, an underlying factor that feeds this cycle."

United Nations Office on Drugs and Crime, World Drug Report 2017 (ISBN: 978-92-1-148291-1, eISBN: 978-92-1-060623-3, United Nations publication, Sales No. E.17.XI.6). Booklet Five: The Drug Problem and Organized Crime, Illicit Financial Flows, Corruption and Terrorism, p. 30.
https://www.unodc.org/wdr2017/
https://www.unodc.org/wdr2017/...

2. High-Level Political Corruption, Crime, and Drug Trafficking
"The Cosa Nostra and ‘Ndrangheta have long benefited from high-level political connections in Italy.77 In a similar way, some Mexican drug cartels allegedly benefited from protection from local police and local politicians.78 In Guinea Bissau, international drug traffickers counted on the support of
influential segments within the political and military apparatus for a number of years.79

"This kind of activity is often called high-level corruption. It involves a small number of senior officials in the government, police, customs or the justice system being targeted in a business transaction with bribes in exchange for either passive or active support facilitating illegal activities. In several cases high-level corruption has posed a threat to the State. Organized criminal groups have attempted to influence the outcome of democratic processes; for example, by funding election campaigns in favour of specific candidates or political parties through “vote buying”, intimidation or corrupting participants in the political process. Moreover, a corrupted judicial system and a lack of prison governance results in relative impunity."

United Nations Office on Drugs and Crime, World Drug Report 2017 (ISBN: 978-92-1-148291-1, eISBN: 978-92-1-060623-3, United Nations publication, Sales No. E.17.XI.6). Booklet Five: The Drug Problem and Organized Crime, Illicit Financial Flows, Corruption and Terrorism, p. 30.
https://www.unodc.org/wdr2017/
https://www.unodc.org/wdr2017/...

3. Lower-Level Corruption, Crime, and Drugs
"By contrast, in the European Union much of the corruption reported appears to be on a low level, according to research by Europol.80 Political corruption at the level of elected national representatives or agency heads appears to be rare. However, Europol found that corruption of city councillors, mayors and other local level politicians was more common, especially in cities along the European Union’s eastern land border.81 Overall, Europol concluded that organized crime groups involved in drug trafficking in Europe rely on corruption to facilitate their trafficking activities.82"

United Nations Office on Drugs and Crime, World Drug Report 2017 (ISBN: 978-92-1-148291-1, eISBN: 978-92-1-060623-3, United Nations publication, Sales No. E.17.XI.6). Booklet Five: The Drug Problem and Organized Crime, Illicit Financial Flows, Corruption and Terrorism, pp. 30-31.
https://www.unodc.org/wdr2017/
https://www.unodc.org/wdr2017/...

4. US Border Agents Arrested or Indicted for Corruption
"From fiscal years 2005 through 2012, a total of 144 employees were arrested or indicted for corruption-related activities, including the smuggling of aliens or drugs, and 125 have been convicted. 20 About 65 percent (93 of 144 arrests) were employees stationed along the southwest border. Our review of documentation on these cases indicates that 103 of the 144 cases were for mission-compromising corruption activities, which are the most severe offenses, such as drug or alien smuggling, bribery, and allowing illegal cargo into the United States. Forty-one of the 144 CBP [Customs and Border Patrol] employees arrested or indicted were charged with other corruption-related activities. According to CBP IA [Internal Affairs], this category is less severe than mission-compromising corruption and includes offenses such as the theft of government property and querying personal associates in a government database for purposes other than official business."

"Border Security: Additional Actions Needed to Strengthen CBP Efforts to Mitigate Risk of Employee Corruption and Misconduct (Washington, DC: US Government Accountability Office, Dec. 2012), GAO-13-59, pp. 9-10.
http://www.gao.gov/products/GA...
http://www.gao.gov/assets/660/...

5. Arrests of and Allegations Against Customs and Border Protection (CBP) Employees, 2005-2012
"According to CBP’s data, incidents of arrests of CBP employees from fiscal years 2005 through 2012 represent less than 1 percent of the entire CBP workforce per fiscal year. 18 During this time period, 144 current or former CBP employees were arrested or indicted for corruption—the majority of which were stationed along the southwest border. In addition, there were 2,170 reported incidents of arrests for misconduct.19
"Allegations against CBPOs [CBP Officers] and BPAs [Border Patrol Agents] as a percentage of total on-board personnel remained relatively constant from fiscal years 2006 through 2011 and ranged from serious offenses such as facilitating drug smuggling across the border to administrative delinquencies such as losing an official badge. The majority of allegations made against OFO [Office of Field Operations] and USBP [US Border Patrol] employees during this time period were against officers and agents stationed on the southwest U.S. border."

"Border Security: Additional Actions Needed to Strengthen CBP Efforts to Mitigate Risk of Employee Corruption and Misconduct (Washington, DC: US Government Accountability Office, Dec. 2012), GAO-13-59, p. 8.
http://www.gao.gov/products/GA...
http://www.gao.gov/assets/660/...

6. US Border Agent Corruption
"Since October 1, 2004, 138 CBP employees have been arrested or indicted for acts of corruption including drug smuggling, alien smuggling, money laundering, and conspiracy. During this same period more than 2,000 CBP employees have been charged in other criminal misconduct, including off duty behavior that serves to undermine the confidence of the public that we serve."

Testimony of Thomas Winkowski, Acting Deputy Commissioner, US Customs and Border Protection, US Dept. of Homeland Security, Before US House of Representatives Committee on Homeland Security Subcommittee on Oversight, Investigations and Management, May 17, 2012, pp. 3-4.
https://www.dhs.gov/news/2012/...

7. Dept. of Homeland Security Corruption Cases
"In Fiscal Year (FY) 2009, the Office of Inspector General (OIG) received about 12,458 allegations of fraud and initiated over 1,085 investigations. Our investigations resulted in 313 arrests, 293 indictments, 281 convictions and 59 administrative actions. Additionally, we reported over $85.7 million in fines, restitutions and administrative cost savings and recoveries.
"Specific to employee corruption on the border, since 2003, we have made 129 arrests of corrupt Customs and Border Protection Officers and Border Patrol Agents. In FY 2009, we opened 839 allegations involving DHS employees:
"• 576 CBP;
"• 64 CIS;
"• 35 TSA, and
"• 164 ICE"

Testimony of Thomas M. Frost, Assistant Inspector General for Investigations, US Dept. of Homeland Security, before the Ad Hoc Subcommittee on State, Local, and Private Sector Preparedness and Integration, Senate Committee on Homeland Security and Government Affairs, March 11, 2010, pp. 2-3.
http://www.hsgac.senate.gov/do...

8. Money Laundering and Bulk Cash Smuggling Out of the US
"Mexican drug-trafficking organizations, terrorist organizations, and other groups with malevolent intent finance their operations by moving funds into or out of the United States. For example, a common technique used for taking proceeds from drug sales in the United States to Mexico is a method known as bulk cash smuggling.1 The National Drug Intelligence Center (NDIC) has stated that proceeds from drug trafficking generated in this country are smuggled across the southwest border and it estimates that the proceeds total from $18 billion to $39 billion a year. NDIC also estimates that Canadian drug-trafficking organizations smuggle significant amounts of cash across the northern border from proceeds of drugs sold in the United States."

Statement of Richard M. Stana, Director Homeland and Security Issues, Government Accountability Office, before the Senate Caucus on International Narcotics Control, "Moving Illegal Proceeds: Opportunities Exist for Strengthening the Federal Government's Efforts to Stem Cross-Border Currency Smuggling," March 9, 2011, GAO-11-407T, p. 1.
http://www.gao.gov/products/GA...

9. Public Corruption Along the US Southwest Border
"One particular case highlights the potential national security implications of public corruption along our nation's borders. In that case, an individual gained employment as a border inspector for the specific purpose of trafficking in drugs. Through our collaborative efforts and a year-long investigation, this former public official pled [sic] guilty to one count of conspiracy to import more than 1000 kilograms of marijuana into the United States and received more than $5 Million in bribe payments. This individual has since been sentenced to 22 years in prison.

"In another extensive undercover investigation, the FBI and its partners netted corrupt officials from 12 different federal, state, and local government agencies who allegedly used their positions to traffic in drugs. To date, 84 of those subjects have pled guilty to related charges."

Testimony of Kevin L. Perkins, Assistant Director, Criminal Investigative Division, FBI, before the Ad Hoc Subcommittee on State, Local, and Private Sector Preparedness and Integration, Senate Committee on Homeland Security and Government Affairs, March 11, 2010, p. 2.
http://www.hsgac.senate.gov/do...

10. Infiltration of Customs and Border Protection Agency
"In particular, there have been a number of cases in which individuals, known as infiltrators, pursued employment at CBP solely to engage in mission-compromising activity. For example, in 2007, a CBPO in El Paso, Texas, was arrested at her duty station at the Paso Del Norte Bridge for conspiracy to import marijuana into the United States from June 2003 to July 2007, and was later convicted and sentenced to 20 years in prison. OFO reported that she may have sought employment with CBP to facilitate drug smuggling. CBP officials view this case as an example of the potential impact of corruption—if the officer had succeeded in facilitating the importation of 5,000 pounds of marijuana per month, this would amount to a total of 240,000 pounds over 4 years with a retail value of $288 million dollars. In another case, a former BPA previously stationed in Comstock, Texas, was arrested in 2008 for conspiracy to possess, with intent to distribute, more than 1,000 kilograms of marijuana. The agent was convicted in 2009 and sentenced to 15 years in prison and ordered to pay a $10,000 fine. CBP is also concerned about employees who may not be infiltrators, but began engaging in corruption-related activities after joining the agency. For example, CBP IA officials stated that some employees may have experienced personal hardships after being hired, such as financial challenges, which made them vulnerable to accepting bribes to engage in corrupt activity. In addition, some employees arrested for corruption had no prior disciplinary actions at the time of their arrests."

"Border Security: Additional Actions Needed to Strengthen CBP Efforts to Mitigate Risk of Employee Corruption and Misconduct (Washington, DC: US Government Accountability Office, Dec. 2012), GAO-13-59, p. 11.
http://www.gao.gov/products/GA...
http://www.gao.gov/assets/660/...

11. Corruption Along US-Canada Border
"In July 2008, for example, the FBI and DEA supported Canadian law enforcement in the arrest of eight people, including a customs agent, suspected of smuggling cocaine and marijuana, contraband cigarettes and illegal immigrants over the Quebec-New York border. This underground network reportedly ferried hundreds of kilograms of cocaine from Colombia into Canada via the Saint-Bernard-de-Lacolle border crossing. This is one of many investigations along our northern border.
"In fact, in FY 2009 alone, FBI field offices along the nation’s Canadian border conducted nearly 300 public corruption investigations. A corrupt border official might think that a bribe is sufficient payment for allowing a carload of drugs through the nation’s borders. The ultimate cost, however, might be significantly higher if that carload includes members of a terrorist cell or ingredients for a weapon of mass destruction."

Testimony of Kevin L. Perkins, Assistant Director, Criminal Investigative Division, FBI, before the Ad Hoc Subcommittee on State, Local, and Private Sector Preparedness and Integration, Senate Committee on Homeland Security and Government Affairs, March 11, 2010, pp. 2-3.
http://www.hsgac.senate.gov/do...

12. Corruption Along the US Southwest Border
"Our investigation of an 8-year veteran of U.S. Customs and Border Protection (CBP) revealed that, over a 6-month period, the CBP Officer provided drug traffickers with his work schedule and lane assignments, which they used to coordinate their smuggling efforts through his inspection lane.
"After he pleaded guilty to Conspiracy to Possess and Distribute Cocaine and Bribery, he was sentenced to 110 months in Federal prison. Additionally, he was ordered to serve 36 months of supervised release following his incarceration, and surrender $100,000 in cash pending the forfeiture of his residence. The Officer’s estranged wife has also pleaded guilty to one count of Conspiracy to Possess and Distribute Cocaine and one count of Bribery. She is currently being sought after she failed to appear for sentencing before a judge in the Western District of Texas."

Department of Homeland Security Office of Inspector General, "Special Report: Summary of Significant Investigations January 1, 2011, to December 31, 2011" (Washington, DC: August 2012), Pub. No. OIG-12-108, p. 5.
http://www.oig.dhs.gov/assets/...

13. Drug Enforcement and Police Corruption
"Traditional police corruption usually involved a mutually beneficial arrangement between criminals and police officers (e.g., the former offered the latter bribes in exchange for immunity from arrest). In contrast, several studies and investigations of drug-related police corruption found on-duty police officers engaged in serious criminal activities, such as (1) conducting unconstitutional searches and seizures; (2) stealing money and/or drugs from drug dealers; (3) selling stolen drugs; (4) protecting drug operations; (5) providing false testimony; and (6) submitting false crime reports."

General Accounting Office, Report to the Honorable Charles B. Rangel, House of Representatives, "Law Enforcement: Information on Drug-Related Police Corruption (Washington, DC: USGPO, May 1998), p. 8.
http://www.gao.gov/products/GG...

14. Border Agencies Seizes Only Small Percentage of Illicit Cash Being Smuggled
"In March 2009, CBP reestablished the Outbound Enforcement Program within its Office of Field Operations. 4 As a result of its outbound enforcement activities, CBP seized about $67 million in illicit bulk cash leaving the country at land ports of entry—97 percent of which was seized along the southwest border— from March 2009 through February 22, 2011. Total seizures account for a small percentage of the estimated $18 billion to $39 billion in illicit proceeds being smuggled across the southwest border annually."

Statement of Richard M. Stana, Director Homeland and Security Issues, Government Accountability Office, before the Senate Caucus on International Narcotics Control, "Moving Illegal Proceeds: Opportunities Exist for Strengthening the Federal Government's Efforts to Stem Cross-Border Currency Smuggling," March 9, 2011, GAO-11-407T, p. 3.
http://www.gao.gov/products/GA...

15. Patterns of Drug-Related Police Corruption
"In addition to protecting criminals or ignoring their activities, officers involved in drug-related corruption were more likely to be actively involved in the commission of a variety of crimes, including stealing drugs and/or money from drug dealers, selling drugs, and lying under oath about illegal searches. Although profit was found to be a motive common to traditional and drug-related police corruption, New York City’s Mollen Commission identified power and vigilante justice as two additional motives for drug-related police corruption. The most commonly identified pattern of drug-related police corruption involved small groups of officers who protected and assisted each other in criminal activities, rather than the traditional patterns of non-drug-related police corruption that involved just a few isolated individuals or systemic corruption pervading an entire police department or precinct."

General Accounting Office, Report to the Honorable Charles B. Rangel, House of Representatives, "Law Enforcement: Information on Drug-Related Police Corruption" (Washington, DC: USGPO, May 1998), p. 3.
http://www.gao.gov/products/GG...

16. Official Corruption in Mexico
"To increase transparency and accountability, the Government of Mexico restructured and augmented their Internal Affairs offices through implementing programs/centers in all law enforcement agencies called 'The Center for Evaluation and Control of Trust,' or more commonly known as 'Control de Confianza.' Moreover, new labor laws constrain judges from reinstating police officers fired for corruption. These efforts, combined with leadership changes in the PGR, have had a positive impact; in 2011, over 40 high ranking officials and hundreds more employees were dismissed from service due to allegations of corruption.
"While federal law enforcement standards continue to improve, state and municipal law enforcement officials remain vulnerable to corruption. State and municipal police have been implicated in the press and social media for facilitating the movement of drugs or contraband, as well as impeding federal or military enforcement operations."

United States Department of State Bureau for International Narcotics and Law Enforcement Affairs, "International Narcotics Control Strategy Report: Volume I: Drug and Chemical Control (Washington, DC: March 2012), p. 320.
http://www.state.gov/documents...

17. Historic Drug Related Police Corruption in the US
A 1998 report by the General Accounting Office cited specific examples of publicly disclosed drug-related police corruption in the following cities: Atlanta, Chicago, Cleveland, Detroit, Los Angeles, Miami, New Orleans, New York, Philadelphia, Savannah, and Washington, DC.

General Accounting Office, Report to the Honorable Charles B. Rangel, House of Representatives, "Law Enforcement: Information on Drug-Related Police Corruption" (Washington, DC: USGPO, May 1998), p. 36-37.
http://www.gao.gov/products/GG...

18. The Mollen Commission and NYPD Corruption
The Mollen Commission was appointed to investigate corruption in the New York City Police Department. The Commission "found that police corruption, brutality, and violence were present in every high-crime precinct with an active narcotics trade that it studied, all of which have predominantly minority populations. It found disturbing patterns of police corruption and brutality, including stealing from drug dealers, engaging in unlawful searches, seizures, and car stops, dealing and using drugs, lying in order to justify unlawful searches and arrests and to forestall complaints of abuse, and indiscriminate beating of innocent and guilty alike."

Cole, David, "No Equal Justice: Race and Class in the American Criminal Justice System" (New York: The New Press, 1999), pp. 23-4.
http://www.ncjrs.gov/App/publi...

19. Drug-Related Police Corruption
On average, half of all police officers convicted as a result of FBI-led corruption cases between 1993 and 1997 were convicted for drug-related offenses.

General Accounting Office, Report to the Honorable Charles B. Rangel, House of Representatives, "Law Enforcement: Information on Drug-Related Police Corruption" (Washington, DC: USGPO, May 1998), p. 35.
http://www.gao.gov/products/GG...

20. Drug War Related Corruption Outside the US
The United Nations Drug Control Program noted the inevitable risk of drug-related police corruption in 1998, when it reported that "wherever there is a well-organized, illicit drug industry, there is also the danger of police corruption."

United Nations International Drug Control Program, "Technical Series Report #6: Economic and Social Consequences of Drug Abuse and Illicit Trafficking" (New York, NY: UNDCP, 1998), p. 38.
http://www.unodc.org/pdf/techn...

21. Poverty and Likelihood of Corruption
"The profits generated from the opiate trade have a serious impact on state and society. UNODC estimates that in 2010 drug traffickers in Central Asia made a net profit of US$1.4 billion from the sale of transiting opiates. Such staggering amounts are comparable with and can destabilize the vulnerable economies of Central Asian countries like Kyrgyzstan and Tajikistan. At the micro level, poverty in these countries leaves many -including low-paid local officials- with few viable avenues for economic advancement. At the macro level, struggling economies in the region have limited resources to devote to drug control. However, poverty is but one factor facilitating the illicit opiate trade. For instance, the economic development experienced by Kazakhstan is inversely proportional to its interdiction efficiency, which is the lowest in Central Asia."

United Nations Office on Drugs and Crime, "Opiate Flows Through Northern Afghanistan and Central Asia: A Threat Assessment" (UNODC Afghan Opiate Trade Project of the Studies and Threat Analysis Section (STAS), Division for Policy Analysis and Public Affairs, May 2012), p. 15.
http://www.unodc.org/documents...

22. Profits of Heroin Trade and Vulnerability of Central Asian Nations
"With a net profit of US$ 1.4 billion from the heroin trade alone, in 2010 drug traffickers earned the equivalent of a third of the GDP of Tajikistan (US$ 4.58 billion) or Kyrgyzstan,269 but only 5 per cent that of Uzbekistan (US$ 28 billion) and 1 per cent of that of Kazakhstan. The economies of Kyrgyzstan and Tajikistan appear to be the most vulnerable in Central Asia, while in Kazakhstan the entire amount would constitute a very small part of total economic activity."

United Nations Office on Drugs and Crime, "Opiate Flows Through Northern Afghanistan and Central Asia: A Threat Assessment" (UNODC Afghan Opiate Trade Project of the Studies and Threat Analysis Section (STAS), Division for Policy Analysis and Public Affairs, May 2012), pp. 85-86.
http://www.unodc.org/documents...

23. Dangers of Corruption in Developing Countries
"The magnitude of funds under criminal control poses special threats to governments, particularly in developing countries, where the domestic security markets and capital markets are far too small to absorb such funds without quickly becoming dependent on them.160 It is difficult to have a functioning democratic system when drug cartels have the means to buy protection, political support or votes at every level of government and society.161 In systems where a member of the legislature or judiciary, earning only a modest income, can easily gain the equivalent of some 20 months’ salary from a trafficker by making one "favourable" decision, the dangers of corruption are obvious.162"

United Nations International Drug Control Program, "Technical Series Report #6: Economic and Social Consequences of Drug Abuse and Illicit Trafficking" (New York, NY: UNDCP, 1998), p. 39.
http://www.unodc.org/pdf/techn...

24. Afghan Corruption Problems
"Afghanistan currently ranks in the second lowest percentile on the World Bank’s corruption index.293 A significant component of this index is based on the activities of corruption prone government agencies. Survey after survey reveals the Afghan perception of law enforcement and courts as among the most corrupt institutions in the country.294 A 2006 poll by the Asia Foundation found that 77 per cent of Afghans believed corruption was a problem at the national level.295"

United Nations Office on Drugs and Crime, "Addiction, Crime and Insurgency: The transnational threat of Afghan opium" (Vienna, Austria: October 2009), p. 137.
http://www.unodc.org/documents...

25. Official US Assessment Of Russian Drug-Related Corruption
"Corruption among law enforcement officials in Russia continues to present major challenges. No senior Russian officials were known to engage in, encourage, or facilitate the illicit production or distribution of such drugs or substances, or the laundering of proceeds from illegal drug transactions. However, several long-running cases of arrests of counternarcotics law enforcement officials on corruption or organized crime charges have occurred in the past two years."

United States Department of State Bureau for International Narcotics and Law Enforcement Affairs, "International Narcotics Control Strategy Report: Volume I: Drug and Chemical Control (Washington, DC: March 2012), p. 379.
http://www.state.gov/documents...

26. Official Corruption in Nigeria
"The Government of Nigeria does not encourage or facilitate illicit production or distribution of narcotics, or the laundering of proceeds from illegal drug transactions. However, corruption plays a major role in drug trafficking in Nigeria. Nigeria has anti-corruption laws, but has secured only a few notable convictions, including that of a former NDLEA chief (though this was overturned on appeal). The perception of high levels of corruption and impunity encourages narcotic trafficking in Nigeria."

United States Department of State Bureau for International Narcotics and Law Enforcement Affairs, "International Narcotics Control Strategy Report: Volume I: Drug and Chemical Control (Washington, DC: March 2014), p. 254.
http://www.state.gov/documents...

27. Cases of Official Corruption in Colombia
"In February 2010, the Colombian government arrested Ramiro Anturi Larrahondo, a lawyer in the Attorney General‘s Office assigned to military criminal investigations, for receiving thousands of dollars from the Rastrojos BACRIM in return for intercepting security agencies‘ telephone calls and feeding information back to narcotics traffickers. In January 2011, Anturi was extradited to the United States to face narcotics trafficking charges. The National Anti-Narcotics Agency (DNE) – the body in charge of handling assets seized from drug traffickers – was dismantled amid investigations into 14 high-level politicians including Congressmen and a former president of the Senate for irregularities in administering seized properties. The Attorney General announced in September 2011 that it will bring embezzlement, fraud and conspiracy charges against former DNE Director Omar Figueroa and 10 other former DNE officials for their role in mishandling seized assets.
"Drug-related corruption remains a problem within the public security forces. The CNP Criminal Investigative Chief of Caquetá was arrested in January for transporting over 100 kilograms of cocaine, and in June, 23 police officers were arrested in two separate anti-drug sting operations in Bogota, Bucaramanga, Cali, San Andres, and Villavicencio. Eight of the officers were charged with stealing a cocaine shipment that belonged to a former BACRIM leader. In May, seven police officers, two Navy officers, and two Prosecutor General‘s Corps of Technical investigators (CTI) agents based in Chocó department were arrested for their ties to a BACRIM organization. That same month, another three CNP officers were arrested in Valle de Cauca for collaborating with the Rastrojos BACRIM. In August 2011, seven police officers and three army soldiers were arrested for allegedly being on the payroll of a deceased BACRIM leader in the Lower Cauca region of Antioquia. Former Defense Minister Rodrigo Rivera subsequently announced that 100 policemen were under investigation for their ties to the Rastrojos BACRIM."

United States Department of State Bureau for International Narcotics and Law Enforcement Affairs, "International Narcotics Control Strategy Report: Volume I: Drug and Chemical Control (Washington, DC: March 2012), p. 175.
http://www.state.gov/documents...

28. Official Corruption in Colombia
"The Presidential Programme Against Corruption in Colombia specifically addresses ‘narco-corruption’.36Colombia, with a capacity to produce 580 tonnes of pure cocaine in 2000,37 is particularly poisoned by the interplay of narcotics and violence, with an estimated one million people internally displaced as a result of battles for territorial control by rebel groups and paramilitary forces. ‘The corruptive effect of this kind of profit is devastating, since it has penetrated to perverse levels in the judiciary and the political system,’ the official report of the Presidential Programme concluded, adding that the rapid accumulation of wealth from illegal drugs ‘has fostered codes and behaviours which promote corruption, fast money and the predominance of private welfare over general interest’."

Luzzani, Thelma, Transparency International, "Global Corruption Report 2001: South America" (Berlin, Germany: Transparency International, 2001), p. 176.
http://archive.transparency.or...

29. Official Corruption in Colombia
"Colombia has suffered the tragic consequences of endemic theft by politicians and public officials for decades. Entwined with the production and trafficking of illegal drugs, this behaviour exacerbated underdevelopment and lawlessness in the countryside, where a brutal war continues to claim the lives of some 3,500 civilians a year. A World Bank survey released in February 2002 found that bribes are paid in 50 per cent of all state contracts.27 Another World Bank report estimates the cost of corruption in Colombia at US $2.6 billion annually, the equivalent of 60 per cent of the country’s debt.28"

Herrera, Eduardo Wills, and Cortés, Nubia Urueña, "Global Corruption Report 2003: South America" Transparency International (Berlin, Germany: Transparency International, 2003), p. 108.
http://www.transparency.org...

30. Money Laundering and Mexican Drug Trafficking Organizations
"Mexico is a major drug producing and transit country. Proceeds from the illicit drug trade leaving the United States are the principal source of funds laundered through the Mexican financial system. Other significant sources of illegal proceeds being laundered include corruption, kidnapping, extortion, piracy, human trafficking, and trafficking in firearms. Sophisticated and well-organized drug trafficking organizations based in Mexico take advantage of the extensive U.S.-Mexico border, the large flow of legitimate remittances, Mexico’s proximity to Central American countries, and the high volume of legal commerce to conceal transfers to Mexico. The smuggling of bulk shipments of U.S. currency into Mexico and the repatriation of the funds into the United States via couriers or armored vehicles, trade, and wire transfers remain favored methods for laundering drug proceeds. Though the combination of a sophisticated financial sector and a large cash-based informal sector complicates the problem, the 2010 implementation of U.S. dollar deposit restrictions reduced the amount of bulk cash repatriation back to the United States via the formal financial sector by approximately 70 percent, or $10 billion. According to U.S. authorities, drug trafficking organizations send between $19 and $29 billion annually to Mexico from the United States, though the Government of Mexico disputes this figure. Since 2002, Mexico has seized a total of more than $500 million in bulk currency shipments."

"International Narcotics Control Strategy Report: Volume II, Money Laundering and Financial Crimes" (Washington, DC: US Dept. of State Bureau for International Narcotics and Law Enforcement Affairs, March 2014), pp. 161-162.
http://www.state.gov/documents...

31. Transshipment Through Costa Rica
"Another problem occurs when officials turn a blind eye to a narcotics trade that looms large in the region. 'Central America has become the meat in the sandwich' - as a trans-shipment point, storehouse and money laundering centre - in the drug traffic from Colombia to the US, said Costa Rican parliamentarian Belisario Solano. The Costa Rican Defence Ministry estimates that between 50 and 70 tonnes of cocaine travel through Costa Rica to the US every year."

Gutiérrez, Miren, Transparency International, "Global Corruption Report 2001: Central America, the Caribbean and Mexico" (Berlin, Germany: Transparency International, 2001), p. 160.
http://archive.transparency.or...

32. Taliban Involvement in Opium Trade
"The Taliban’s principal and most lucrative source of income in Afghanistan is its control of the opium trade. The Taliban have long profited off of the ten percent ushr tax levied on opium farmers, an additional tax on the traffickers, and a per-kilogram transit tariff charged to the truckers who transport the product.152 In recent years, however, they have been 'taking a page from the warlords’ playbook,' and regional and local Taliban commanders have been demanding 'protection money from the drug traffickers who smuggle goods through their territory.'153 A 2007 analysis by the Jamestown Foundation described 'arrangements whereby drug traffickers provide money, vehicles and subsistence to Taliban units in return for protection.'154 In addition, at even higher Taliban command levels, 'senior leadership in Quetta are paid regular installments from narcotics kingpins as a general fee for operating in Taliban controlled areas.'155 Through these various forms of taxation and extortion, the Taliban have been estimated to earn nearly $300 million a year from the opium trade.156"

"Warlord, Inc. Extortion and Corruption Along the U.S. Supply Chain in Afghanistan," Report of the Majority Staff, Rep. John F. Tierney, Chair, Subcommittee on National Security and Foreign Affairs, Committee on Oversight and Government Reform, U.S. House of Representatives (Washington, DC: June 2010), p. 39.
http://www.scribd.com/doc/3343...
http://www.cbsnews.com/htdocs/...

33. Money Laundering and the Global Opiate Market
"Of the US$ 65 billion turnover of the global market for opiates, only 5-10 per cent (US$ 3-5 billion) are estimated to be laundered by informal banking systems. The rest is laundered through legal trade activities (including smuggling of legal goods into Afghanistan) and the banking system."

United Nations Office on Drugs and Crime, "Addiction, Crime and Insurgency: The transnational threat of Afghan opium" (Vienna, Austria: October 2009), p. 7.
http://www.unodc.org/documents...
 

roots69

Rising Star
BGOL Investor
Marijuana Policies and Policy Reform


1. States That Legally Regulate Medical and/or Adult Social Use of Marijuana
As of November 7, 2018, a total of 32 states plus the District of Columbia and Guam have what are called "effective" state medical marijuana laws. These states include: Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, Utah, Vermont, Washington state, and West Virginia.

Ten states have legalized adult (aged 21 and older) personal use of marijuana: Alaska, California, Colorado, Maine, Massachusetts, Michigan, Nevada, Oregon, Vermont, and Washington state. In addition, nine of those ten states - Vermont is the exception - legally regulate the production, distribution, and sale of marijuana. The District of Columbia has also legalized limited personal possession and cultivation of marijuana by adults aged 21 and older.

Marijuana Policy Project, "State by State Medical Marijuana Laws 2015 with a December 2016 Supplement - How to Remove the Threat of Arrest," (Washington, DC: MPP, February 2017), p. 1, last accessed September 27, 2017.
https://www.mpp.org...
West Virginia: https://www.mpp.org/states/wes...
Vermont: "Governor Phil Scott Signs H.511," Office of the Governor of Vermont, News Release, Jan. 22, 2018.
http://governor.vermont.gov/pr...
"An act relating to eliminating penalties for possession of limited amounts of marijuana by adults 21 years of age or older"
https://legislature.vermont.go...
Oklahoma: Oklahoma State Question 788, Medical Marijuana Legalization Initiative (June 2018) https://ballotpedia.org/...
Michigan, Missouri, and Utah: http://www.drugpolicy.org/pres...

2. Washington State Data On Marijuana Use Following Enactment of I-502
"In these initial investigations, we found no evidence that I-502 enactment, on the whole, affected cannabisabuse treatment admissions. Further, within Washington State, we found no evidence that the amount of legal cannabis sales affected cannabis abuse treatment admissions.

"The bulk of outcome analyses in this report used the within-state approach to focus on identifying effects of the amount of legal cannabis sales. We found no evidence that the amount of legal cannabis sales affected youth substance use or attitudes about cannabis or drug-related criminal convictions.

"We did find evidence that higher levels of retail cannabis sales affected adult cannabis use in certain subgroups of the population. BRFSS respondents 21 and older who lived in counties with higher levels of retail cannabis sales were more likely to report using cannabis in the past 30 days and heavy use of cannabis in the past 30 days.

"We also found two effects that are difficult to interpret. Among the portion of the population aged 18 to 21, BRFSS respondents living in counties with higher sales were less likely to report using cannabis in the past 30 days, in some analyses. It may be that legal cannabis sales have made cannabis more difficult to access by persons below the legal age, for instance, by reducing black market supply through competition.

"We also found that in the portion of the BRFSS sample who smoked cigarettes, respondents living in counties with higher levels of legal cannabis sales were less likely to report past-month cannabis use. It is particularly difficult to explain why increased sales would lead to lower cannabis use among cigarette smokers."

Darnell, A.J. & Bitney, K. (2017). I-502 evaluation and benefit-cost analysis: Second required report. (Document Number 17-09-3201). Olympia: Washington State Institute for Public Policy, September 2017, p. 34.
http://www.wsipp.wa.gov/Report...

3. Prevalence and Trends in Marijuana Use Rates in Colorado Before and After Amendment 64
Total US
According to the National Survey on Drug Use and Health (NSDUH), in 2008-2009, an estimated 13.37% of young people in the US aged 12 through 17 had used marijuana in the past year, falling to 12.29% in 2015-2016. The NSDUH also estimates that, in 2008-2009, an estimated 7.03% of young people in the US aged 12 through 17 had used marijuana in the past month, dropping to 6.75% in 2015-2016.

Colorado State
According to the NSDUH, in 2008-2009, an estimated 18.55% of young people in Colorado aged 12 through 17 had used marijuana in the past year, falling to 16.21% in 2015-2016. The NSDUH also estimates that, in 2008-2009, an estimated 10.17% of young people in Colorado aged 12 through 17 had used marijuana in the past month, dropping to 9.08% in 2015-2016.

Click for a table comparing estimated prevalence of marijuana use in Colorado before and after passage and implementation of Amendment 64

Substance Abuse and Mental Health Services Administration. (2017). National Survey on Drug Use and Health: Comparison of 2008-2009 and 2015-2016 Population Percentages (50 States and the District of Columbia). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/
https://www.samhsa.gov/data/po...
https://www.samhsa.gov/data/si...
https://www.samhsa.gov/data/si...
Substance Abuse and Mental Health Services Administration. (2017). National Survey on Drug Use and Health: Comparison of 2014-2015 and 2015-2016 Population Percentages (50 States and the District of Columbia). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/
https://www.samhsa.gov/data/si...
https://www.samhsa.gov/data/si...

4. Uruguay Legalizes Marijuana
“President José Mujica has quietly signed into law the government’s plan to create a regulated, legal market for marijuana, the president’s spokesman said Tuesday. The presidential secretary Diego Canepa said Mr. Mujica signed the legislation on Monday night. That was the last formal step for the law to take effect. Officials now have until April 9 to write the fine print for regulating every aspect of the marijuana market, from growing to selling in a network of pharmacies. They hope to have the whole system in place by the middle of next year. But as of Tuesday, growing marijuana at home was legal, up to six plants per family and an annual harvest of 480 grams, or about one pound.”

Source: Associated Press, “Uruguay: Marijuana Becomes Legal,” in the New York Times, December 24, 2013.
http://www.nytimes.com...

5. Limitation on Federal Interference With Implementation of State Medical Marijuana Laws
In December 2014, the federal budget for FY2015 was enacted, containing this provision:
"SEC. 538. None of the funds made available in this Act to the Department of Justice may be used, with respect to the States of Alabama, Alaska, Arizona, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Hawaii, Illinois, Iowa, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, Oregon, Rhode Island, South Carolina, Tennessee, Utah, Vermont, Washington, and Wisconsin, to prevent such States from implementing their own State laws that authorize the use, distribution, possession, or cultivation of medical marijuana."

"Consolidated and Further Continuing Appropriations Act, 2015," US Congress, Enrolled Bill Published December 17, 2014, p. 88.
https://www.congress.gov/113/b...

6. Marijuana Legalization and Arrests in Colorado
"The total number of marijuana arrests decreased by 52% between 2012 and 2017, from 12,709 to 6,153. Marijuana possession arrests, which make up the majority of all marijuana arrests, were cut in half (‐54%). Marijuana sales arrests decreased by 17%. Arrests for marijuana production increased appreciably (+51%%). Marijuana arrests that were unspecified, meaning the specific reason for the arrest was not noted by law enforcement, went down by 45%.

"The number of marijuana arrests decreased by 56% for Whites, 39% for Hispanics, and 51% for Blacks. The marijuana arrest rate for Blacks (233 per 100,000) was nearly double that of Whites (118 per 100,000) in 2017.

"Nine large Colorado counties (Adams, Arapahoe, Boulder, Douglas, El Paso, Jefferson, Larimer, Mesa, and Weld) showed a decrease in marijuana arrests, ranging between ‐8% (Boulder) and ‐67% (Adams). The average decline across these nine counties was ‐46%.

"Separate data provided by the Denver Police Department’s Data Analysis Unit indicates
an 81% decrease in total marijuana arrests, from 1,605 in 2012 to 302 in 2017.

"The most common marijuana industry‐related crime in Denver was burglary,
accounting for 59% of marijuana crime related to the industry in 2017."

Impacts of Marijuana Legalization in Colorado: A Report Pursuant to Senate Bill 13-283. Colorado Department of Public Safety, Division of Criminal Justice, Office of Research and Statistics. October 2018, pp. 1-2.
https://www.colorado.gov/pacif...
http://cdpsdocs.state.co.us/or...

7. Impact of Marijuana Legalization on Traffic and Driving Safety in Colorado
"The increase in law enforcement officers who are trained in recognizing drug use, from 129 in 2012 to 214 in 2018, can increase drug detection rates apart from any changes in driver behavior.

"Traffic safety data were obtained from a number of different sources. Please note that traffic safety data may be incomplete because law enforcement officers may determine that alcohol is impairing the driver, and therefore additional (time consuming and costly) drug testing may not be pursued.

"The total number of DUI citations issued by the Colorado State Patrol (CSP) decreased from 5,705 in 2014 to 4,849 in 2017. The prevalence of marijuana or marijuana‐in‐combination identified by Patrol officers as the impairing substance increased from 12% of all DUIs in 2014 to 15% in 2017.

"In 2016, the most recent data available, 27,244 cases were filed in court that included a charge of driving under the influence; 17,824 of these were matched with either a breath or blood test.1

"Of these, 3,946 had blood samples screened for the presence of marijuana: 2,885 cases (73.2%) had a positive cannabinoid screen and a follow‐up confirmation for other cannabis metabolites, and 47.5% detected Delta‐9 THC at 5.0 ng/mL or above.

"According to CDOT, the number of fatalities in which a driver tested positive for Delta‐9 THC at or above the 5.0 ng/mL level declined from 52 (13% of all fatalities) in 2016 to 35 in 2017 (8% of all fatalities).

"The number of fatalities with cannabinoid‐only or cannabinoid‐in‐combination positive drivers increased 153%, from 55 in 2013 to 139 in 2017.

"However, note that the detection of any cannabinoid in blood is not an indicator of impairment but only indicates presence in the system. Detection of Delta‐9 THC, one of the primary psychoactive metabolites of marijuana, may be an indicator of impairment.

"A 2017 survey conducted by the Colorado Department of Public Health and Environment found that 3.0% of adults reported driving within two‐to‐three hours of using marijuana in the past‐30 days, while 19.7% of recent marijuana users reported this behavior."

Impacts of Marijuana Legalization in Colorado: A Report Pursuant to Senate Bill 13-283. Colorado Department of Public Safety, Division of Criminal Justice, Office of Research and Statistics. October 2018, pp. 2-3.
https://www.colorado.gov/pacif...
http://cdpsdocs.state.co.us/or...

8. Emergency Department Visits and Hospitalizations Related to Marijuana Use Post-Legalization in Colorado
"The Colorado Department of Public Health and Environment (CDPHE) analyzed data from the
Colorado Hospital Administration (CHA) with these findings:

"Hospitalization rates (per 100,000 hospitalizations) with possible marijuana exposures, diagnoses, or billing codes increased from 803 per 100,000 before commercialization (2001‐2009) to 2,696 per 100,000 after commercialization (January 2014‐September 2015). The period from October 2015‐December 2015 indicated another increase, but due to changes in coding systems, variable structures, and policies at CHA, the numbers for 2016 are considered preliminary by CDPHE.

"The period of retail commercialization showed an increase in emergency department visits, from 739 per 100,000 ED visits (2010–2013) to 913 per 100,000 ED visits (January 2014–September 2015). There was no definitive trend during the period October 2015‐December 2015 and, due to changes in coding systems, variable structures, and policies at CHA, these figures for 2016 are considered preliminary by CDPHE.

"The number of calls to poison control mentioning human marijuana exposure increased over the past 10 years. There were 45 calls in 2006 and 222 in 2017. Between 2014 and 2017, the frequency of calls reporting human marijuana exposure stabilized."

Impacts of Marijuana Legalization in Colorado: A Report Pursuant to Senate Bill 13-283. Colorado Department of Public Safety, Division of Criminal Justice, Office of Research and Statistics. October 2018, pp. 4-5.
https://www.colorado.gov/pacif...
http://cdpsdocs.state.co.us/or...

9. Use of Marijuana by Young People in Colorado Since Legalization
"Data on youth marijuana use was available from two sources. The Healthy Kids Colorado Survey (HKCS), with 47,146 high school and 6,704 middle school students responding in 2017, and the National Survey on Drug Use and Health (NSDUH), with about 512 respondents in 2015/16.

"HKCS results indicate no significant change in past 30‐day use of marijuana between 2013 (19.7%) and 2017 (19.4%). Also, in 2017, the use rates were not different from the national 30‐day use rates reported by the Youth Risk Behavior Survey.2 In 2017, 19.4% of Colorado high school students reported using marijuana in the past 30‐days compared to 19.8% of high school students nationally that reported this behavior.

"The 2017 HKCS found that marijuana use increases by grade level, with 11.0% of 9th graders, 17.7% of 10th graders, 23.7% of 11th graders, and 25.7% of 12th reporting use in the past 30‐days.

"The 2015/16 NSDUH, with many fewer respondents compared to HKCS, indicated a gradual increase in youth use from 2006/07 (9.1%) to 2013/14 (12.6%); however, the last two years showed decreased use, with 9.1% reporting use in 2015/16. The NSDUH showed that youth use of marijuana in Colorado (9.1%) was above the national average (6.8%)."

Impacts of Marijuana Legalization in Colorado: A Report Pursuant to Senate Bill 13-283. Colorado Department of Public Safety, Division of Criminal Justice, Office of Research and Statistics. October 2018, p. 5.
https://www.colorado.gov/pacif...
http://cdpsdocs.state.co.us/or...

10. Arrests of Young People on Marijuana Charges in Colorado Since Legalization
"The number of juvenile marijuana arrests decreased 16%, from 3,168 in 2012 to 2,655 in 2017. The rate of juvenile marijuana arrests per 100,000 decreased from 583 in 2012 to 453 in 2017 (‐22%).

"The number of White juvenile arrests decreased from 2,146 in 2012 to 1,703 in 2017 (‐21%).

"The number of Hispanic juvenile arrests decreased from 767 in 2012 to 733 in 2017 (‐4%).

"The number of Black juvenile arrests decreased from 202 in 2012 to 172 in 2017 (‐15%)."

Impacts of Marijuana Legalization in Colorado: A Report Pursuant to Senate Bill 13-283. Colorado Department of Public Safety, Division of Criminal Justice, Office of Research and Statistics. October 2018, p. 5.
https://www.colorado.gov/pacif...
http://cdpsdocs.state.co.us/or...

11. Marijuana Use by Young People in Washington State Following Legalization
"More schools and students are captured in the HYS [Washington Healthy Youth Survey] than MTF [Monitoring The Future Survey] (Table). The MTF included fewer low–socioeconomic status and nonwhite youth in the prelegalization vs postlegalization period.

"Estimates from the MTF show statistically nonsignificant change in the prevalence of cannabis use for 8th graders (from 6.2% [95% CI, 4.4%-8.7%] to 8.2% [95% CI, 6.3%-10.7%];P = .16), and a significant increase for 10th graders (from 16.2% [95% CI, 14.0%-18.6%] to 20.3% [95% CI, 16.9%-24.1%]; P = .02). In contrast, the HYS shows statistically significant declines in prevalence from 2010-2012 to 2014-2016 among both 8th graders (from 9.8% [95% CI, 9.1%-10.5%] to 7.3% [95% CI, 6.6%-8.0%]; P < .001) and 10th graders (from 19.8% [95%CI, 18.6%-21.0%] to 17.8% [95%CI, 16.7%-18.9%]; P = .01). Neither MTF nor HYS analysis showed changes among 12th graders (Figure). Findings from HYS comparisons to 2014 alone were of less magnitude but similar direction."

Dilley JA, Richardson SM, Kilmer B, Pacula RL, Segawa MB, Cerdá M. Prevalence of Cannabis Use in Youths After Legalization in Washington State. JAMA Pediatr. 2019;173(2):192–193. doi:10.1001/jamapediatrics.2018.4458
https://jamanetwork.com/journa...

12. Marijuana Arrests in Washington State Following Legalization
"Preliminary look at racial disparities in select counties of Washington

"The Crime, Cannabis & Police Research Group at Washington State University used preliminary data from a Department of Justice funded study to compare white vs. Black arrests.11 Latinos were not included in the analysis, because of difficulties measuring ethnicity in arrest data. Their main preliminary findings are that after legalization in Washington, African Americans/Blacks continue to be disproportionally arrested for the possession and selling of marijuana when compared to whites. Though the disparity in marijuana possession between African American/Blacks and whites was reduced slightly after legalization, the disparity for selling marijuana has more than doubled since legalization.

"Local trends

"While statewide studies have the ability to control for individual law enforcement agencies or police departments, monitoring trends in marijuana-related crimes within a local police department can provide details of violations that statewide data systems do not. For example, violations for public consumption of marijuana cannot be directly queried from state-derived data; however, local law enforcement agencies and municipal courts maintain details on the nature of the crime that would indicate whether someone was ticketed for public consumption vs. possession or a different drug-related charge. One example of the potential of local data to explore issues of criminal justice can be made using data from the Seattle Police Department (SPD). A 2015 report for the Seattle Community Police Commission showed a disproportionate number of citations for marijuana public consumption issued to African Americans/Blacks in Seattle.12 Using local police department data is key to understanding differences in the implementation and enforcement of polices pertaining to the legalization of marijuana."

Firth C. Marijuana Legalization in Washington State: Monitoring the Impact on Racial Disparities in Criminal Justice. Alcohol & Drug Abuse Institute, University of Washington, June 2018.
http://adai.uw.edu/pubs/pdf/20...

13. Racial Disparities in Marijuana Arrests in Colorado and Oregon Following Legalization
"Compelling evidence in other states suggest racial disparities persist or have become worse after legalization and the opening of a licensed marijuana market, even while total marijuana-related criminal justice incidents have decreased.

"In Colorado, marijuana court filings decreased by 85% from 2010 to 2014 after legalizing marijuana in 2012. During the same time frame the rate of arrests for marijuana possession among African Americans/Blacks remained 2.4 times higher compared to the arrest rate for whites. The disparities for African American/Blacks were even larger for arrests for marijuana cultivation (2.5 times the arrest rate for whites) and distribution of marijuana (5.4 times the arrest rate for whites).13

"Results from Oregon are consistent with findings in Colorado. The Oregon Public Health Division examined changes in the age-adjusted rates of marijuana arrests by racial groups.14 The age adjusted rate of marijuana arrests for African Americans/Blacks was 2 to 3 times the rate of whites during 2010–2014. Oregon legalized marijuana in 2014 and in the following year the disparity between African Americans/Blacks and whites persisted. Specifically, the rate of arrest was 77% higher among African Americans/Blacks in 2015 when compared to whites.

"Preliminary results suggest that legalization of marijuana for adults has greatly reduced the number of people arrested and convicted for marijuana-related crimes, yet racial disparities persist in Washington and in other states. Other factors may contribute to sustaining the racial disparities, such as over-policing in low-income neighborhoods, racial profiling, and other racially biased police practices. 15 These inequitable practices may minimize the potential positive impacts of I-502 and marijuana legalization on all communities."

Firth C. Marijuana Legalization in Washington State: Monitoring the Impact on Racial Disparities in Criminal Justice. Alcohol & Drug Abuse Institute, University of Washington, June 2018.
http://adai.uw.edu/pubs/pdf/20...

14. Impact of Marijuana Legalization on the State of Washington
"In these initial investigations, we found no evidence that I-502 enactment, on the whole, affected cannabis abuse treatment admissions. Further, within Washington State, we found no evidence that the amount of legal cannabis sales affected cannabis abuse treatment admissions.

"The bulk of outcome analyses in this report used the within-state approach to focus on identifying effects of the amount of legal cannabis sales. We found no evidence that the amount of legal cannabis sales affected youth substance use or attitudes about cannabis or drug-related criminal convictions.

"We did find evidence that higher levels of retail cannabis sales affected adult cannabis use in certain subgroups of the population. BRFSS respondents 21 and older who lived in counties with higher levels of retail cannabis sales were more likely to report using cannabis in the past 30 days and heavy use of cannabis in the past 30 days.

"We also found two effects that are difficult to interpret. Among the portion of the population aged 18 to 21, BRFSS respondents living in counties with higher sales were less likely to report using cannabis in the past 30 days, in some analyses. It may be that legal cannabis sales have made cannabis more difficult to access by persons below the legal age, for instance, by reducing black market supply through competition.

"We also found that in the portion of the BRFSS sample who smoked cigarettes, respondents living in counties with higher levels of legal cannabis sales were less likely to report past-month cannabis use. It is particularly difficult to explain why increased sales would lead to lower cannabis use among cigarette smokers."

Darnell, A.J. & Bitney, K. (2017). I-502 evaluation and benefit-cost analysis: Second
required report. (Document Number 17-09-3201). Olympia: Washington State Institute for Public Policy.
https://www.wsipp.wa.gov/Repor...

15. Netherlands Drug Policy
"All recent policy documents state that the Dutch drug policy has two cornerstones - and this was confirmed by the Minister of Health, Welfare and Sport during the major drug debate in the House of Representatives in March 2012: to protect public health and to combat public nuisance and drug-related crime (TK 24077-259; TK Handelingen 69-28 maart 2012). In the current Opium Act Directive the objective of the drug policy is described as: 'The [new] Dutch drugs policy is aimed to discourage and reduce drug use, certainly in so far as it causes damage to health and to society, and to prevent and reduce the damage associated with drug use, drug production and the drugs trade' (Stc 2011-11134)."

Van Laar, M.W., Cruts, A.A.N., Van Ooyen-Houben, M.M.J., Van Gageldonk, A., Croes, E.A., Meijer, R.F., et al. (2013). The Netherlands drug situation 2012: report to the EMCDDA by the Reitox National Focal Point. Trimbos-instituut/WODC, Utrecht/Den Haag, p. 16.

16. Marijuana Tax Act of 1937 and Federal Prohibition
"Marijuana essentially became illegal in 1937 pursuant to the Marijuana Tax Act.39 The use of marijuana required the payment of a tax for usage; failure to pay the tax resulted in a large fine or stiff prison time for tax evasion.40 Drug prohibition was elevated to another level by targeting 'marijuana,' a plant that had never demonstrated any harm to anyone.41
"Anslinger’s [Harry J. Anslinger, the first Commissioner of the Federal Bureau of Narcotics] efforts to eradicate marijuana continued when Anslinger sought similar anti-narcotic laws against marijuana at the state level.42 Guided by Anslinger’s policy direction, states began passing their own laws or adopting more strident versions of federal laws.43 By 1952, nearly all states had anti-narcotic laws in place.44"

Gilmore, Brian, "Again and Again We Suffer: the Poor and the Endurance of the 'War on Drugs,'" University of the District of Columbia Law Review (Washington, DC: The University of the District of Columbia David A. Clarke School of Law, 2011) Volume 15, Number 1, p. 64.
http://www.udclawreview.com...
 

roots69

Rising Star
BGOL Investor
Everything a person need to know about cannabis..


Cannabis/Marijuana
States That Legally Regulate Medical and/or Adult Social Use of Marijuana


Looking for information on synthetic cannabinoids (e.g. "Kush," "spice," "K2," etc.)? Check our chapter on New Psychoactive Substances

Looking for specific, detailed information on cannabidiol (CBD)? In addition to the items below, check out Project CBD.

1. States That Legally Regulate Medical and/or Adult Social Use of Marijuana
As of November 7, 2018, a total of 32 states plus the District of Columbia and Guam have what are called "effective" state medical marijuana laws. These states include: Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, Utah, Vermont, Washington state, and West Virginia.

Ten states have legalized adult (aged 21 and older) personal use of marijuana: Alaska, California, Colorado, Maine, Massachusetts, Michigan, Nevada, Oregon, Vermont, and Washington state. In addition, nine of those ten states - Vermont is the exception - legally regulate the production, distribution, and sale of marijuana. The District of Columbia has also legalized limited personal possession and cultivation of marijuana by adults aged 21 and older.

Marijuana Policy Project, "State by State Medical Marijuana Laws 2015 with a December 2016 Supplement - How to Remove the Threat of Arrest," (Washington, DC: MPP, February 2017), p. 1, last accessed September 27, 2017.
https://www.mpp.org...
West Virginia: https://www.mpp.org/states/wes...
Vermont: "Governor Phil Scott Signs H.511," Office of the Governor of Vermont, News Release, Jan. 22, 2018.
http://governor.vermont.gov/pr...
"An act relating to eliminating penalties for possession of limited amounts of marijuana by adults 21 years of age or older"
https://legislature.vermont.go...
Oklahoma: Oklahoma State Question 788, Medical Marijuana Legalization Initiative (June 2018) https://ballotpedia.org/...
Michigan, Missouri, and Utah: http://www.drugpolicy.org/pres...

2. US States Which Have Legalized Marijuana
Eight states have legalized adult (aged 21 and older) personal use of marijuana and legally regulate the production, distribution, and sale of marijuana: Alaska, California, Colorado, Maine, Massachusetts, Nevada, Oregon, and Washington state. Additionally, the state of Vermont and the District of Columbia have legalized limited personal possession and cultivation of marijuana by adults aged 21 and older.

Marijuana Policy Project, "State by State Medical Marijuana Laws 2015 with a December 2016 Supplement - How to Remove the Threat of Arrest," (Washington, DC: MPP, February 2017), p. 1, last accessed April 28, 2017.
https://www.mpp.org...
Specifically in regard to West Virginia, see https://www.mpp.org/states/wes...
Vermont: "Governor Phil Scott Signs H.511," Office of the Governor of Vermont, News Release, Jan. 22, 2018.
http://governor.vermont.gov/pr...
"An act relating to eliminating penalties for possession of limited amounts of marijuana by adults 21 years of age or older"
https://legislature.vermont.go...

3. Marijuana is not a gateway drug
Health and Social Behavior (Thousand Oaks, CA: American Sociological Association, September 2010), p. 244.

4. Gateway Effect
"The gateway effect, if it exists, has at least two potential and quite different sources (MacCoun, 1998). One interpretation is that it is an effect of the drug use itself (e.g., trying marijuana increases the taste for other drugs or leads users to believe that other substances are more pleasurable or less risky than previously supposed). A second interpretation stresses peer groups and social interactions. Acquiring and using marijuana regularly may lead to differentially associating with peers who have attitudes and behaviors that are prodrug generally, not only with respect to marijuana. One version of this is the possibility that those peers will include people who sell other drugs, reducing the difficulty of locating potential supplies. If the latter is the explanation, then legalization might reduce the likelihood of moving on to harder drugs compared to the current situation."

Kilmer, Beau; Caulkins, Jonathan P.; Pacula, Rosalie Liccardo; MacCoun, Robert J.; Reuter, Peter H., "Altered State? Assessing How Marijuana Legalization in California Could Influence Marijuana Consumption and Public Budgets" Drug Policy Research Center (Santa Monica, CA: RAND Corporation, 2010), p. 42.

5. Marijuana less addictive than many commonly used substances including alcohol
Is Marijuana Addictive? The best scientific data available indicate that marijuana is less potentially addictive than many other substances in common use. This should not be construed as meaning that marijuana has no potential for dependence or that it is entirely safe.

"People who develop problems with marijuana may indeed be different from those who do not, but this phenomenon has been observed with other substances of abuse. A comparison with alcohol use and dependence provides a case in point. The great majority of Americans have tried alcohol and continue to drink alcoholic beverages regularly. However, only an estimated 10 to 15 percent of alcohol drinkers develop problems, and only some of these problem drinkers seek treatment. This is also true of those who have tried cocaine or heroin (Anthony, Warner, and Kessler, 1994).

"That said, the experience of dependence on marijuana tends to be less severe than that observed with cocaine, opiates, and alcohol (Budney, 2006; Budney et al., 1998). On average, individuals with marijuana dependence meet fewer DSM dependence criteria; the withdrawal experience is not as dramatic; and the severity of the associated consequences is not as extreme. However, the apparently less severe nature of marijuana dependence does not necessarily mean that marijuana addiction is easier to overcome. Many factors besides a drug’s physiological effects -- including availability, frequency and pattern of use, perception of harm, and cost -- can contribute to cessation outcomes and the strength of addiction. The low cost of marijuana, the typical pattern of multiple daily use by those addicted, the less dramatic consequences, and ambivalence may increase the difficulty of quitting. Although determining the relative difficulty of quitting various substances of abuse is complex, the treatment literature reviewed here suggests that the experience of marijuana abusers rivals that of those addicted to other substances."

Budney A, Roffman R, Stephens R, Walker D. Marijuana dependence and its treatment. Addiction Science and Clinical Practice. 2007;4(1):4–16.
http://www.ncbi.nlm.nih.gov...
http://www.ncbi.nlm.nih.gov...

6. How Dangerous is Marijuana?
"Tetrahydrocannabinol is a very safe drug. Laboratory animals (rats, mice, dogs, monkeys) can tolerate doses of up to 1,000 mg/kg (milligrams per kilogram). This would be equivalent to a 70 kg person swallowing 70 grams of the drug—about 5,000 times more than is required to produce a high. Despite the widespread illicit use of cannabis there are very few if any instances of people dying from an overdose. In Britain, official government statistics listed five deaths from cannabis in the period 1993-1995 but on closer examination these proved to have been deaths due to inhalation of vomit that could not be directly attributed to cannabis (House of Lords Report, 1998). By comparison with other commonly used recreational drugs these statistics are impressive."

Iversen, Leslie L., PhD, FRS, "The Science of Marijuana" (London, England: Oxford University Press, 2000), p. 178, citing House of Lords, Select Committee on Science and Technology, "Cannabis -- The Scientific and Medical Evidence" (London, England: The Stationery Office, Parliament, 1998).

7. Public Health Impact of Marijuana Compared With Other Drugs
"The public health burden of cannabis use is probably modest compared with that of alcohol, tobacco, and other illicit drugs. A recent Australian study96 estimated that cannabis use caused 0·2% of total disease burden in Australia—a country with one of the highest reported rates of cannabis use. Cannabis accounted for 10% of the burden attributable to all illicit drugs (including heroin, cocaine, and amphetamines). It also accounted for around 10% of the proportion of disease burden attributed to alcohol (2·3%), but only 2·5% of that attributable to tobacco (7·8%)."

Hall, Wayne and Degenhardt, Louise, "Adverse health effects of non-medical cannabis use," The Lancet (London, United Kingdom: October 17, 2009) Vol. 374, p. 1389.

8. When Did Federal Marijuana Prohibition Begin?
"Marijuana essentially became illegal in 1937 pursuant to the Marijuana Tax Act.39 The use of marijuana required the payment of a tax for usage; failure to pay the tax resulted in a large fine or stiff prison time for tax evasion.40 Drug prohibition was elevated to another level by targeting 'marijuana,' a plant that had never demonstrated any harm to anyone.41
"Anslinger’s [Harry J. Anslinger, the first Commissioner of the Federal Bureau of Narcotics] efforts to eradicate marijuana continued when Anslinger sought similar anti-narcotic laws against marijuana at the state level.42 Guided by Anslinger’s policy direction, states began passing their own laws or adopting more strident versions of federal laws.43 By 1952, nearly all states had anti-narcotic laws in place.44"

Gilmore, Brian, "Again and Again We Suffer: the Poor and the Endurance of the 'War on Drugs,'" University of the District of Columbia Law Review (Washington, DC: The University of the District of Columbia David A. Clarke School of Law, 2011) Volume 15, Number 1, p. 64.

9. Hemp
"Industrial hemp can be grown as a fiber, seed, or dual-purpose crop.15 The interior of the stalk has short woody fibers called hurds; the outer portion has long bast fibers. Hemp seed/grains are smooth and about one-eighth to one-fourth of an inch long.16
"Although hemp is not grown in the United States, both finished hemp products and raw material inputs are imported and sold for use in manufacturing for a wide range of product categories (Figure 1). Hemp fibers are used in a wide range of products, including fabrics and textiles, yarns and spun fibers, paper, carpeting, home furnishings, construction and insulation materials, auto parts, and composites. Hurds are used in various applications such as animal bedding, material inputs, papermaking, and composites. Hemp seed and oilcake are used in a range of foods and beverages, and can be an alternative food protein source. Oil from the crushed hemp seed is used as an ingredient in a range of body-care products and nutritional supplements.17Hemp seed is also used for industrial oils, cosmetics and personal care products, and pharmaceuticals, among other composites."

Johnson, Renée, "Hemp As An Agricultural Commodity," Congressional Research Service (Washington, DC: Library of Congress, July 24, 2013), p. 4.

10. What the research shows about marijuana and driving
1380-marijuana.pdf
https://www.drugabuse.gov...

11. Marijuana and Driving
"This study of crash risk found a statistically significant increase in unadjusted crash risk for drivers who tested positive for use of illegal drugs (1.21 times), and THC specifically (1.25 times). However, analyses incorporating adjustments for age, gender, ethnicity, and alcohol concentration level did not show a significant increase in levels of crash risk associated with the presence of drugs. This finding indicates that these other variables (age, gender, ethnicity and alcohol use) were highly correlated with drug use and account for much of the increased risk associated with the use of illegal drugs and with THC.

"This study found a statistically significant association between driver alcohol level and crash risk both before and after adjustment for demographic factors. These findings were generally consistent with similar analyses conducted in prior crash risk studies. Findings from this study indicate that crash risk grows exponentially with increasing BrAC. The study shows that at low levels of alcohol (e.g., 0.03 BrAC) the risk of crashing is increased by 20 percent, at moderate alcohol levels (0.05 BrAC) risk increases to double that of sober drivers, and at a higher level (0.10 BrAC) the risk increases to five and a half times. At a BrAC of 0.15, the risk is 12 times, and by BrACs of 0.20+ the risk is over 23 times higher."

Compton, R. P. & Berning, A. (2015, February). Drug and alcohol crash risk. (Traffic Safety Facts Research Note, Report No. DOT HS 812 117). Washington, DC: National Highway Traffic Safety Administration, p. 8.
http://www.nhtsa.gov...
http://www.nhtsa.gov...

12. Do people in the US still get arrested for simple possession of marijuana?
Although the intent of a 'War on Drugs' may have been to target drug smugglers and 'King Pins,' according to the FBI's annual Uniform Crime Reports, of the 1,488,707 arrests for drug law violations in 2015, 83.9% (1,249,025) were for mere possession of a controlled substance. Only 16.1% (239,682) were for the sale or manufacturing of a drug. Further, the majority (43.2%) of drug arrests in 2015 were for marijuana -- a total of 643,121. Of those, an estimated 574,641 arrests (38.6% of all drug arrests) were for marijuana possession alone. By contrast in 2000, a total of 734,497 Americans were arrested for marijuana offenses, of which 646,042 (40.9%) were for possession alone.

"Crime in the United States 2015 - Arrests," FBI Uniform Crime Report (Washington, DC: US Dept. of Justice, September 2015), p. 1, and Arrest Table: Arrests for Drug Abuse Violations.
https://ucr.fbi.gov/crime-in-t...
https://ucr.fbi.gov/crime-in-t...
https://ucr.fbi.gov/crime-in-t...
https://ucr.fbi.gov/crime-in-t...
https://ucr.fbi.gov/crime-in-t...

13. Cost Of Marijuana Arrests
"The costs of this national obsession, in both money and time, are astonishing. Each year, enforcing laws on possession costs more than $3.6 billion, according to the American Civil Liberties Union. It can take a police officer many hours to arrest and book a suspect. That person will often spend a night or more in the local jail, and be in court multiple times to resolve the case. The public-safety payoff for all this effort is meager at best: According to a 2012 Human Rights Watch report that tracked 30,000 New Yorkers with no prior convictions when they were arrested for marijuana possession, 90 percent had no subsequent felony convictions. Only 3.1 percent committed a violent offense."
* Important here to note that New York is a decriminalized state, that is, personal possession of less than 25 grams of marijuana by an adult is supposedly decriminalized.

New York Times, "The Injustice of Marijuana Arrests," By Jesse Wegman, July 28, 2014.
http://www.nytimes.com...

14. Racism and The History Of Marijuana Prohibition
"The law enforcement view of marijuana was indelibly shaped by the fact that it was initially connected to brown people from Mexico and subsequently with black and poor communities in this country. Police in Texas border towns demonized the plant in racial terms as the drug of 'immoral' populations who were promptly labeled 'fiends.'

"As the legal scholars Richard Bonnie and Charles Whitebread explain in their authoritative history, 'The Marihuana Conviction,' the drug’s popularity among minorities and other groups practically ensured that it would be classified as a 'narcotic,' attributed with addictive qualities it did not have, and set alongside far more dangerous drugs like heroin and morphine.

"By the early 1930s, more than 30 states had prohibited the use of marijuana for nonmedical purposes. The federal push was yet to come.

"The stage for federal suppression of marijuana was set in New Orleans, where a prominent doctor blamed 'muggle-heads' — as pot smokers were called — for an outbreak of robberies. The city was awash in sensationalistic newspaper articles that depicted pushers hovering by the schoolhouse door turning children into 'addicts.' These stories popularized spurious notions about the drug that lingered for decades. Law enforcement officials, too, trafficked in the 'assassin' theory, under in which killers were said to have smoked cannabis to ready themselves for murder and mayhem."

The New York Times, "The Federal Marijuana Ban Is Rooted in Myth and Xenophobia," by Brent Staples, July 29, 2014.
http://www.nytimes.com...

15. The NY Times On Marijuana Prohibition And Racism
"It was not until 1951, when Congress again took up the issue, that a reputable researcher was called to testify. Dr. Harris Isbell, director of research at the Public Health Service Hospital in Lexington, Ky., disputed the insanity, crime and addiction theories, telling Congress that 'smoking marijuana has no unpleasant aftereffects, no dependence is developed on the drug, and the practice can easily be stopped at any time.'
"Despite Dr. Isbell’s testimony, Congress ratcheted up penalties on users. The states followed the federal example; Louisiana, for instance, created sentences ranging from five to 99 years, without parole or probation, for sale, possession or administration of narcotic drugs. The rationale was not that marijuana itself was addictive — that argument was suddenly relinquished — but that it was a 'steppingstone' to heroin addiction. This passed largely without comment at the time.
"The country accepted a senselessly punitive approach to sentencing as long as minorities and the poor paid the price. But, by the late 1960s, weed had been taken up by white college students from the middle and upper classes. Seeing white lives ruined by marijuana laws altered public attitudes about harsh sentencing, and, in 1972, the National Commission on Marihuana and Drug Abuse released a report challenging the approach."

The New York Times, "The Federal Marijuana Ban Is Rooted in Myth and Xenophobia," by Brent Staples, July 29, 2014.
http://www.nytimes.com...

16. The NY Times On Marijuana And Substance Use Treatment
The Times misses part of the story when they write:
"Nearly 70 percent of the teenagers in residential substance-abuse programs run by Phoenix House, which operates drug and alcohol treatment centers in 10 states, listed marijuana as their primary problem."
http://www.nytimes.com...

Indeed. However, the majority of treatment referrals for marijuana were directly through the criminal justice system or at least in anticipation of going through the criminal justice system. Treatment alternatives to incarceration and drug courts can be effective means of dealing with drug using offenders yet they sometimes cherry-pick people to be referred to treatment, choosing those with the greatest probability of success. People who do not use drugs problematically are the most likely to succeed in drug treatment, since they didn't have a problem in the first place:
"Additional results reveal that, in practice, large numbers of drug courts are admitting offenders who are abusing alcohol and marijuana, but may not be clinically dependent or abusing more serious drugs. Consistent with the number of courts admitting individuals with lower levels of substance use and the number admitting individuals with DWI/DUI offenses, 65.6 percent of courts reported that a participant can be admitted into drug court for alcohol abuse only. An even larger percentage of courts (87.7 percent) indicated that participants can enter drug court for marijuana abuse only. Allowing participants into drug court based on alcohol abuse only did not vary by type of geographic area; however, allowing participants into drug court based on marijuana abuse only did vary geographically (X2=10.2, p<.01). The majority of courts that do not accept participants into drug court based only on marijuana abuse are located in urban areas (62.2 percent), suggesting they may have a greater focus on more serious drug problems."
Source: Rossman, Shelli B., et al., "Final Report, Volume 2: The Multi-Site Adult Drug Court Evaluation: What's Happening with Drug Courts? A Portrait of Adult Drug Courts 2004" (Washington, DC: Urban Institute, June 2011), p. 27.

According to the federal Treatment Episode Data Set, in 2011 there were 333,578 admissions to treatment with marijuana reported as the primary substance of abuse out of the total 1,844,719 admissions for all substances that year.
According to the TEDS report:
"• Marijuana was reported as the primary substance of abuse by 18 percent of TEDS admissions aged 12 and older in 2011 [Table 1.1b].
"• The average age at admission for primary marijuana admissions was 24 years [Table 2.1a], although the peak age at admission for both genders in all race/ethnicities was 15 to 17 years [Figure 12]. Forty percent of marijuana admissions were under age 20 (vs. 11 percent of all admissions), and primary marijuana abuse accounted for 74 percent of all admissions aged 12 to 14 years and 76 percent of admissions aged 15 to 17 years [Tables 2.1a-b].
"• Non-Hispanic Whites accounted for 45 percent of primary marijuana admissions (32 percent males and 13 percent females), and non-Hispanic Black males accounted for 24 percent [Table 2.3a].
"• Twenty-five percent of primary marijuana admissions had first used marijuana by age 12 and another 32 percent by age 14 [Table 2.5].
"• Primary marijuana admissions were less likely than all admissions combined to be self- or individually referred to treatment (16 percent vs. 35 percent). Primary marijuana admissions were most likely to be referred by a criminal justice/DUI source (52 percent) [Table 2.6].
"• More than 4 in 5 marijuana admissions (85 percent) received ambulatory treatment compared with about 3 in 5 of all admissions combined (62 percent) [Table 2.7].
"• Fifty-six percent of primary marijuana admissions reported abuse of additional substances. Alcohol was reported by 41 percent [Table 3.8]."
Source: Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. Treatment Episode Data Set (TEDS): 2001-2011. National Admissions to Substance Abuse Treatment Services. BHSIS Series S-65, HHS Publication No. (SMA) 13-4772. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013, p. 19; and p. 43, Table 1.1a.

The New York Times, "What Science Says About Marijuana," by Philip M. Boffey, July 30, 2014.
http://www.nytimes.com...
Rossman, Shelli B., et al., "Final Report, Volume 2: The Multi-Site Adult Drug Court Evaluation: What's Happening with Drug Courts? A Portrait of Adult Drug Courts 2004" (Washington, DC: Urban Institute, June 2011), p. 27.
Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. Treatment Episode Data Set (TEDS): 2001-2011. National Admissions to Substance Abuse Treatment Services. BHSIS Series S-65, HHS Publication No. (SMA) 13-4772. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013, p. 19; and p. 43, Table 1.1a.

17. The NY Times On Marijuana And Emergency Department Admissions
The Times misses part of the story when they write:
"Marijuana was found -- alone or in combination with other drugs -- in more than 455,000 patients visiting emergency rooms in 2011."
http://www.nytimes.com...

A drug mention does not mean that the drug is what caused the visit. Rather, it simply means that the substance was in their system. Arguably, drug mentions in an emergency room may have some meaning yet unless the drug is at fault, those mentions are merely an indicator of prevalence of use:
"DAWN captures drugs that are explicitly named in the medical record as being involved in the ED visit. The relationship between the ED visit and the drug use need not be causal. That is, an implicated drug may or may not have directly caused the condition generating the ED visit; the ED staff simply named it as being involved." (p. 15)

According to the DAWN report, "Of the approximately 2.5 million drug misuse or abuse ED visits that occurred during 2011, a total of 1,252,500, or just over half (50.9%), involved illicit drugs (Table 4). A majority (56.3%) of illicit drug ED visits involved multiple drugs. Overall, 27.9 percent of visits involving illicit drugs also involved alcohol.
"Cocaine and marijuana were the most commonly involved drugs, with 505,224 ED visits (40.3%) and 455,668 ED visits (36.4%), respectively. Cocaine and marijuana were followed by heroin, at 258,482 ED visits, or 20.6 percent, and then by amphetamines/methamphetamine, at 159,840 visits, or 12.8 percent." (DAWN ED Report 2011, p. 25)

The New York Times, "What Science Says About Marijuana," by Philip M. Boffey, July 30, 2014.
http://www.nytimes.com...
Substance Abuse and Mental Health Services Administration, Drug Abuse Warning Network, 2011: National Estimates of Drug-Related Emergency Department Visits. HHS Publication No. (SMA) 13-4760, DAWN Series D-39. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013, p. 25 and p. 15.

18. Marijuana Arrests in Washington State Following Legalization
"Preliminary look at racial disparities in select counties of Washington

"The Crime, Cannabis & Police Research Group at Washington State University used preliminary data from a Department of Justice funded study to compare white vs. Black arrests.11 Latinos were not included in the analysis, because of difficulties measuring ethnicity in arrest data. Their main preliminary findings are that after legalization in Washington, African Americans/Blacks continue to be disproportionally arrested for the possession and selling of marijuana when compared to whites. Though the disparity in marijuana possession between African American/Blacks and whites was reduced slightly after legalization, the disparity for selling marijuana has more than doubled since legalization.

"Local trends

"While statewide studies have the ability to control for individual law enforcement agencies or police departments, monitoring trends in marijuana-related crimes within a local police department can provide details of violations that statewide data systems do not. For example, violations for public consumption of marijuana cannot be directly queried from state-derived data; however, local law enforcement agencies and municipal courts maintain details on the nature of the crime that would indicate whether someone was ticketed for public consumption vs. possession or a different drug-related charge. One example of the potential of local data to explore issues of criminal justice can be made using data from the Seattle Police Department (SPD). A 2015 report for the Seattle Community Police Commission showed a disproportionate number of citations for marijuana public consumption issued to African Americans/Blacks in Seattle.12 Using local police department data is key to understanding differences in the implementation and enforcement of polices pertaining to the legalization of marijuana."

Firth C. Marijuana Legalization in Washington State: Monitoring the Impact on Racial Disparities in Criminal Justice. Alcohol & Drug Abuse Institute, University of Washington, June 2018.
http://adai.uw.edu/pubs/pdf/20...

19. Racial Disparities in Marijuana Arrests in Colorado and Oregon Following Legalization
"Compelling evidence in other states suggest racial disparities persist or have become worse after legalization and the opening of a licensed marijuana market, even while total marijuana-related criminal justice incidents have decreased.

"In Colorado, marijuana court filings decreased by 85% from 2010 to 2014 after legalizing marijuana in 2012. During the same time frame the rate of arrests for marijuana possession among African Americans/Blacks remained 2.4 times higher compared to the arrest rate for whites. The disparities for African American/Blacks were even larger for arrests for marijuana cultivation (2.5 times the arrest rate for whites) and distribution of marijuana (5.4 times the arrest rate for whites).13

"Results from Oregon are consistent with findings in Colorado. The Oregon Public Health Division examined changes in the age-adjusted rates of marijuana arrests by racial groups.14 The age adjusted rate of marijuana arrests for African Americans/Blacks was 2 to 3 times the rate of whites during 2010–2014. Oregon legalized marijuana in 2014 and in the following year the disparity between African Americans/Blacks and whites persisted. Specifically, the rate of arrest was 77% higher among African Americans/Blacks in 2015 when compared to whites.

"Preliminary results suggest that legalization of marijuana for adults has greatly reduced the number of people arrested and convicted for marijuana-related crimes, yet racial disparities persist in Washington and in other states. Other factors may contribute to sustaining the racial disparities, such as over-policing in low-income neighborhoods, racial profiling, and other racially biased police practices. 15 These inequitable practices may minimize the potential positive impacts of I-502 and marijuana legalization on all communities."

Firth C. Marijuana Legalization in Washington State: Monitoring the Impact on Racial Disparities in Criminal Justice. Alcohol & Drug Abuse Institute, University of Washington, June 2018.
http://adai.uw.edu/pubs/pdf/20...

20. Impact of Marijuana Legalization on the State of Washington
"In these initial investigations, we found no evidence that I-502 enactment, on the whole, affected cannabis abuse treatment admissions. Further, within Washington State, we found no evidence that the amount of legal cannabis sales affected cannabis abuse treatment admissions.

"The bulk of outcome analyses in this report used the within-state approach to focus on identifying effects of the amount of legal cannabis sales. We found no evidence that the amount of legal cannabis sales affected youth substance use or attitudes about cannabis or drug-related criminal convictions.

"We did find evidence that higher levels of retail cannabis sales affected adult cannabis use in certain subgroups of the population. BRFSS respondents 21 and older who lived in counties with higher levels of retail cannabis sales were more likely to report using cannabis in the past 30 days and heavy use of cannabis in the past 30 days.

"We also found two effects that are difficult to interpret. Among the portion of the population aged 18 to 21, BRFSS respondents living in counties with higher sales were less likely to report using cannabis in the past 30 days, in some analyses. It may be that legal cannabis sales have made cannabis more difficult to access by persons below the legal age, for instance, by reducing black market supply through competition.

"We also found that in the portion of the BRFSS sample who smoked cigarettes, respondents living in counties with higher levels of legal cannabis sales were less likely to report past-month cannabis use. It is particularly difficult to explain why increased sales would lead to lower cannabis use among cigarette smokers."

Darnell, A.J. & Bitney, K. (2017). I-502 evaluation and benefit-cost analysis: Second
required report. (Document Number 17-09-3201). Olympia: Washington State Institute for Public Policy.
https://www.wsipp.wa.gov/Repor...

21. Prevalence of Past-Month (Current) Marijuana Use in the US
https://www.samhsa.gov/data/
https://www.samhsa.gov/data/si...
https://www.samhsa.gov/data/si...

22. Total Annual Arrests in the US by Type of Offense
Click here to open table displaying Total Annual Arrests in the US by Year and Type of Offense, 1996-2017

"Crime in the United States 2017 - Arrests," FBI Uniform Crime Report (Washington, DC: US Dept. of Justice, September 2018), p. 1, and Arrest Table: Arrests for Drug Abuse Violations.
https://ucr.fbi.gov/crime-in-t...
https://ucr.fbi.gov/crime-in-t...
"Crime in the United States - 2000," FBI Uniform Crime Reports (Washington, DC: US Government Printing Office, 2001), p. 216, Tables 29 and 4.1.
http://www.fbi.gov/about-us/cj...

23. Positivity Rate for Marijuana Use Among US Workers Subjected to Drug Testing
"Marijuana positivity continued its upward climb in both the federally-mandated, safety-sensitive and general U.S. workforces. In oral fluid testing, which detects recent drug use, marijuana positivity increased nearly 75 percent, from 5.1 percent in 2013 to 8.9 percent in 2016 in the general U.S. workforce. Marijuana positivity also increased in both urine testing (2.4% in 2015 versus 2.5% in 2016) and hair testing (7.0% in 2015 versus 7.3% in 2016) in the same population.
"Among the federally-mandated, safety-sensitive workforce, which only utilizes urine testing, marijuana positivity increased nearly ten percent (0.71% in 2015 versus 0.78% in 2016), the largest year-over-year increase in five years.
"In Colorado and Washington, the first states in which recreational marijuana use was legalized, the overall urine positivity rate for marijuana outpaced the national average in 2016 for the first time since the statutes took effect. The increase was more pronounced in Colorado, which increased 11 percent (2.61% in 2015 versus 2.90% in 2016), than in Washington, which increased nine percent (2.82% in 2015 versus 3.08% in 2016). The national positivity rate for marijuana in the general U.S. workforce in urine testing increased four percent (2.4% in 2015 compared to 2.5% in 2016).
"'We have been tracking the trends in marijuana positivity in states that have passed medical and recreational marijuana use statutes for several years now. 2016 is the first year since Colorado and Washington approved recreational use that the rates of year-over-year change were sharply higher than the national average,' said Dr. Sample."

"Quest Diagnostics Drug Testing Index™ Full year 2016 tables," Quest Diagnostics, Table 2, last accessed Nov. 13, 2017.
http://www.questdiagnostics.co...
http://www.questdiagnostics.co...
"Increases in Illicit Drugs, Including Cocaine, Drive Workforce Drug Positivity to Highest Rate in 12 Years, Quest Diagnostics Analysis Finds," Quest Diagnostics, May 16, 2017.
http://newsroom.questdiagnosti...

24. Federal Interagency Assessment of Cannabis Use in the US
"One area representative, from New York City, reported the continuing predominance in indicators and serious consequences of marijuana (as well as heroin and cocaine) and changes in marijuana trends as a key finding in that area for this reporting period. Marijuana indicator levels continued to be reported as high relative to other drugs, however, across all CEWG areas, based on treatment admissions and reports identified as marijuana/cannabis among drug items seized and analyzed. New marijuana/cannabis laws legalizing both medical and recreational marijuana use were expected by area representatives to be influencing indicators in several areas currently and in the future. Representatives from Texas and Chicago reported a shift in trafficking and marketing away from Mexican marijuana (due to a drought and poor quality Mexican marijuana) to local markets and local 'grow' operations."

"Epidemiologic Trends in Drug Abuse: Proceedings of the Community Epidemiology Work Group, Advance Report, June 2013" (Bethesda, MD: National Institute on Drug Abuse, December 2013), p. 18.
http://www.drugabuse.gov...

25. Vulnerability of Teens to Effects of Drugs
http://www.casacolumbia.org...

26. Prevalence of Marijuana Use among People in the US Aged 12 or Older
Click here for the complete datatable "Marijuana Use in Lifetime, Past Year, and Past Month among Persons in the US Aged 12 or Older, by Demographic Characteristics: Number in Thousands"

Center for Behavioral Health Statistics and Quality. (2016). 2015 National Survey on Drug Use and Health: Detailed Tables. Substance Abuse and Mental Health Services Administration, Rockville, MD, p. 242, Table 1.33A.
https://www.samhsa.gov...
https://www.samhsa.gov...

27. Effect of Cannabis on Mortality
"In summary, this study showed little, if any, effect of marijuana use on non-AIDS mortality in men and on total mortality in women. The increased risk of AIDS mortality in male marijuana users probably did not reflect a causal relationship, but most likely represented uncontrolled confounding by male homosexual behavior. The risk of mortality associated with marijuana use was lower than that associated with tobacco cigarette smoking."

Stephen Sidney, MD, Jerome E. Beck, DrPH, Irene S. Tekawa, MA, Charles P Quesenberry, Jr, PhD, and Gary D. Friedman, MD, “Marijuana Use and Mortality.” American Journal of Public Health 87.4 (1997) pp. 589–590.
http://www.ncbi.nlm.nih.gov...

28. Prevalence of Marijuana Use in the US, by State, 2009-2010
"In 2009-2010, past month marijuana use was reported by 6.8 percent of the U.S. population aged 12 years or older, an increase from 6.4 percent in 2008-2009 (Table C.3). Nine States that were in the top fifth for past month illicit drug use among persons aged 12 or older also were ranked in the top fifth for past month marijuana use: Alaska, Colorado, District of Columbia, Maine, Massachusetts, New Hampshire, Oregon, Rhode Island, and Vermont (Figures 2.1 and 2.9).
"Seven States were ranked in the top fifth for past month marijuana use in age groups 12 to 17, 18 to 25, 26 or older, and 12 or older: Colorado, Maine, Massachusetts, New Hampshire, Oregon, Rhode Island, and Vermont (Figures 2.9 to 2.12). The rate of past month marijuana use in the 12 or older population ranged from 3.1 percent in Utah to 11.8 percent in Alaska (Table B.3). Utah had the lowest rate in all age groups. Between 2008-2009 and 2009-2010, past month marijuana use among persons 12 or older increased in 10 States: Colorado, District of Columbia, Idaho, Illinois, Massachusetts, Michigan, New Mexico, Oklahoma, Texas, and Washington (Table C.3). During the same time period, past month marijuana use increased in one State among 12 to 17 year olds (District of Columbia), eight States among 18 to 25 year olds (Florida, Illinois, Iowa, New Mexico, North Carolina, Oklahoma, Pennsylvania, and Washington), and four States among persons aged 26 or older (District of Columbia, Idaho, Michigan, and Texas). Decreases only occurred in two States: Tennessee, among persons aged 12 or older, and Utah, among youths aged 12 to 17. All four census regions had higher rates of past month marijuana use among persons aged 12 or older in 2009-2010 compared with 2008-2009."

Substance Abuse and Mental Health Services Administration, State Estimates of Substance Use and Mental Disorders from the 2009-2010 National Surveys on Drug Use and Health, NSDUH Series H-43, HHS Publication No. (SMA) 12-4703. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012.
http://www.samhsa.gov...
http://www.samhsa.gov...

29. The NY Times On Marijuana And Health
http://www.nytimes.com...

30. Early Initiation of Substance Use
“When initiation of substance use occurs in preadolescence or early in adolescence, the risk of addiction is magnified.8 CASA’s analysis of national data finds that individuals‡ who first used any addictive substance before age 15 are six and a half times as likely to have a substance use disorder as those who did not use any addictive substance until age 21 or older (28.1 percent vs. 4.3 percent).”

"Adolescent Substance Use: America’s #1 Public Health Problem," The National Center on Addiction and Substance Abuse at Columbia University (New York, NY: National Center on Addiction and Substance Abuse at Columbia University, June 2011), p. 38
http://www.casacolumbia.org...

31. Alcohol Use v Marijuana Use - US Youth and "The Displacement Hypothesis"
"Alcohol and marijuana are the two most commonly used substances by teenagers to get high, and a question that is often asked is to what extent does change in one lead to a change in the other. If the substances co-vary negatively (an increase in one is accompanied by a decrease in the other) they are said to be substitutes; if they co-vary positively, they are said to be complements. Note that there is no evidence that the 13-year decline in marijuana use observed between 1979 and 1992 led to any accompanying increase in alcohol use; in fact, through 1992 there was some parallel decline in annual, monthly, and daily alcohol use, as well as in occasions of heavy drinking among 12th graders, suggesting that the two substances are complements. Earlier, when marijuana use increased in the late 1970s, alcohol use also increased. As marijuana use increased again in the 1990s, alcohol use again increased with it, although not as sharply. In sum, there has been little evidence from MTF over the years that supports what we have termed 'the displacement hypothesis,' which asserts that an increase in marijuana use will somehow lead to a decline in alcohol use, or vice versa.8 Instead, both substances appear to move more in harmony, perhaps both reflecting changes in a more general construct, such as the tendency to use psychoactive substances, whether licit or illicit, or in the frequency with which teens party. However, with alcohol use decreasing and marijuana use increasing over the past few years, it is possible that the displacement hypothesis is gaining some support. As a number of states are changing their policies regarding marijuana, our continued monitoring will provide the needed evidence concerning whether alcohol and marijuana are substitutes or complements."

Miech, R. A., Johnston, L. D., O’Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2015). Monitoring the Future national survey results on drug use, 1975–2014: Volume I, Secondary school students. Ann Arbor: Institute for Social Research, The University of Michigan, pp. 161-162.
http://monitoringthefuture.org...
http://monitoringthefuture.org...

32. Marijuana Use Among 50-Year-Olds in the US
"Among 50-year-old high school graduates in 2012, we estimate that about three quarters (74%) have tried marijuana, and that about two thirds (64%) have tried an illicit drug other than marijuana. (These estimates are adjusted to correct for panel attrition, as described in chapter 4 of Volume II.)
"Their current behavior is far less extreme than those statistics might suggest, but it is not by any means negligible. One in eight (12%) indicates using marijuana in the last 12 months, and one in ten (10%) indicates using any other illicit drug in the same period. Their past-month prevalence rates are lower—7.3% and 6.2%, respectively, for marijuana and any other illicit drug. About 1 in 43 (2.3%) is a current daily marijuana user, though substantially more indicate that they have used marijuana daily at some time in the past."

Johnston, L. D., O’Malley, P. M., Bachman, J. G., and Schulenberg, J. E., (2013). Monitoring the Future national survey results on drug use, 1975–2012: Volume 2, College students and adults ages 19–50. Ann Arbor: Institute for Social Research, The University of Michigan, p. 37.
http://www.monitoringthefuture...

33. Daily Marijuana, Alcohol, and Tobacco Use Among 19-30 Year Olds in the US
"Daily marijuana use held steady at 6.8% in 2015 among young adults, but that is triple the rate in 1992 (2.3%), the low point since estimates for this age group first became available in 1986. The 2014 and 2015 rates are the highest levels of daily use ever observed in this young adult population since tracking of their use began 29 years ago."

Click here for complete datatable of Thirty-Day Prevalence of Daily Marijuana, Alcohol, and Tobacco Use Among 19-30 Year Olds in the US

Johnston, L. D., O’Malley, P. M., Bachman, J. G., Schulenberg, J. E. & Miech, R. A. (2016). Monitoring the Future national survey results on drug use, 1975-2015: Volume 2, College students and adults ages 19–55. Ann Arbor: Institute for Social Research, The University of Michigan, p. 141, and Table 4-5, p. 117. Available at http://monitoringthefuture.org...
http://monitoringthefuture.org...

34. Lower Opioid Overdose Mortality Rates In States With Medical Cannabis Laws
"Although the mean annual opioid analgesic overdose mortality rate was lower in states with medical cannabis laws compared with states without such laws, the findings of our secondary analyses deserve further consideration. State-specific characteristics, such as trends in attitudes or health behaviors, may explain variation in medical cannabis laws and opioid analgesic overdose mortality, and we found some evidence that differences in these characteristics contributed to our findings. When including state-specific linear time trends in regression models, which are used to adjust for hard-to-measure confounders that change over time, the association between laws and opioid analgesic overdose mortality weakened. In contrast, we did not find evidence that states that passed medical cannabis laws had different overdose mortality rates in years prior to law passage, providing a temporal link between laws and changes in opioid analgesic overdose mortality. In addition, we did not find evidence that laws were associated with differences in mortality rates for unrelated conditions (heart disease and septicemia), suggesting that differences in opioid analgesic overdose mortality cannot be explained by broader changes in health. In summary, although we found a lower mean annual rate of opioid analgesic mortality in states with medical cannabis laws, a direct causal link cannot be established."

Bacchuber, Marcus A., MD; Saloner, Brendan, PhD; Cunningham, Chinazo O., MD, MS; and Barry, Colleen L., PhD, MPP. "Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999-2010." JAMA Intern Med. doi:10.1001/jamainternmed.2014.4005. Published online August 25, 2014.
jamanetwork.com...

35. Estimated Prevalence of Cannabis Dependence or Abuse in the US
"• Marijuana was the illicit drug with the largest number of persons with past year dependence or abuse in 2013, followed by pain relievers, then by cocaine. Of the 6.9 million persons aged 12 or older who were classified with illicit drug dependence or abuse in 2013, 4.2 million persons had marijuana dependence or abuse (representing 1.6 percent of the total population aged 12 or older, and 61.4 percent of all those classified with illicit drug dependence or abuse), 1.9 million persons had pain reliever dependence or abuse, and 855,000 persons had cocaine dependence or abuse (Figure 7.2)."
"• The number of persons who had marijuana dependence or abuse in 2013 (4.2 million) was similar to the number in 2012 (4.3 million) and in each year from 2002 through 2011 (ranging from 3.9 million to 4.5 million) (Figure 7.3). The rate of marijuana dependence or abuse in 2013 (1.6 percent) was lower than the rates in 2002 (1.8 percent) and 2004 (1.9 percent). Otherwise, the rate in 2013 was similar to the rates in prior years (ranging from 1.6 to 1.8 percent).
"• The number of persons who had pain reliever dependence or abuse in 2013 (1.9 million) was similar to the number in 2012 (2.1 million) and in each year from 2006 through 2011 (ranging from 1.6 million to 1.9 million) (Figure 7.3). However, the number in 2013 was higher than the numbers in 2002 to 2005 (ranging from 1.4 million to 1.5 million)."

Substance Abuse and Mental Health Services Administration, Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-48, HHS Publication No. (SMA) 14-4863. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014, p. 83.
http://www.samhsa.gov...
http://www.samhsa.gov...

36. Estimated Prevalence of Cannabis Dependence
http://www.ncbi.nlm.nih.gov...
http://www.ncbi.nlm.nih.gov...

37. Admissions to Treatment for Marijuana in the US
According to the Substance Abuse and Mental Health Service's Treatment Episode Data Set, in 2015 in the US there were 213,001 admissions to treatment with marijuana reported as the primary substance of abuse out of the total 1,537,025 admissions to treatment in the US for those aged 12 and older for all substances that year. This is the lowest number of marijuana admissions and total treatment admissions in at least a decade: marijuana admissions peaked in 2009 at 373,338, and total admissions peaked in 2008 at 2,074,974.

Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. Treatment Episode Data Set (TEDS): 2005-2015. National Admissions to Substance Abuse Treatment Services. BHSIS Series S-91, HHS Publication No. (SMA) 17-5037. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2017, Table 1.1A, p. 47.
https://www.samhsa.gov/data/si...

38. Daily/Frequent Marijuana Use in the US
"In 2011, an estimated 16.7 percent of past year marijuana users aged 12 or older used marijuana on 300 or more days within the past 12 months. This translates into nearly 5.0 million persons using marijuana on a daily or almost daily basis over a 12-month period.
"• In 2011, an estimated 39.1 percent (7.1 million) of current marijuana users aged 12 or older used marijuana on 20 or more days in the past month. This was similar to the 2010 estimate of 39.8 percent or 6.9 million users."

Substance Abuse and Mental Health Services Administration, Results from the 2011 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-44, HHS Publication No. (SMA) 12-4713. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012, p. 27.
http://www.samhsa.gov...

39. Difficulties in Assessing "Problem" Marijuana Use
"The issues of measurement and conceptualization described above in relation to efforts to screen for problematic or harmful cannabis use highlight the shortcomings of ‘one-size-fits-all’ approaches to screening. Our examination of the existing literature and of cannabis users from a general population study and from a mixed-methods study of adult, stable, socially integrated users suggests that many cannabis users who may otherwise meet the criteria for being at moderate risk for problematic use are nonetheless able to successfully integrate cannabis use into everyday life with few associated problems. Indeed, our findings advocate that regular use of small amounts of cannabis does not appear to increase an individual’s likelihood of experiencing problems, and it does not threaten one’s ability to function well and perform expected roles. Even so, the tools used to assess potentially harmful cannabis use invariably serve to classify almost all ‘regular’ users as problematic users."

Asbridge M, Duff C, Marsh D, C, Erickson P, G, Problems with the Identification of ‘Problematic' Cannabis Use: Examining the Issues of Frequency, Quantity, and Drug Use Environment. Eur Addict Res 2014;20:254-267.
https://www.ncbi.nlm.nih.gov/p...
https://www.karger.com/Article...

40. Racial Bias In Marijuana Arrests
http://www.cjcj.org...

41. Estimated Risk of Arrest for Marijuana Possession
"To provide a sense of the intensity of enforcement, we calculated the risk a marijuana user faces of being arrested for possession. If calculated per joint consumed, the figure nationally is trivial—perhaps one arrest for every 11,000–12,000 joints.4 However, the relevant risk may be the probability of being arrested during a year of normal consumption. Since marijuana is mostly consumed by individuals who use it at least once a month,5 we estimated the risk that such individuals face. We know from prior studies (e.g., Reuter, Hirschfield, and Davies, 2001) that these risks are higher for youth. Table 2.2 presents separate estimates for those aged 12–17 and for the entire population 12 and over. We observe that the annual risk of misdemeanor arrest for those 12–17 (6.6 percent) is more than twice the rate for the full population (3.0 percent)."

Kilmer, Beau; Caulkins, Jonathan P.; Pacula, Rosalie Liccardo; MacCoun, Robert J.; Reuter, Peter H., "Altered State? Assessing How Marijuana Legalization in California Could Influence Marijuana Consumption and Public Budgets" Drug Policy Research Center (Santa Monica, CA: RAND Corporation, 2010), p. 8.
http://www.rand.org...

42. Impact of Medical Marijuana Laws on Crime Rates
"The central finding gleaned from the present study was that MML is not predictive of higher crime rates and may be related to reductions in rates of homicide and assault. Interestingly, robbery and burglary rates were unaffected by medicinal marijuana legislation, which runs counter to the claim that dispensaries and grow houses lead to an increase in victimization due to the opportunity structures linked to the amount of drugs and cash that are present. Although, this is in line with prior research suggesting that medical marijuana dispensaries may actually reduce crime in the immediate vicinity [8]."

Robert G. Morris, Michael TenEyck, JC Barnes, and Tomislav V. Kovandzic, "The Effect of Medical Marijuana Laws On Crime: Evidence From State Panel Data, 1990-2006," PLoS ONE 9(3): e92816. March 2014. doi: 10.1371/journal.pone.0092816
http://www.plosone.org...

43. Effect of Medical Marijuana Legalization On Crime Rates
"In sum, these findings run counter to arguments suggesting the legalization of marijuana for medical purposes poses a danger to public health in terms of exposure to violent crime and property crimes. To be sure, medical marijuana laws were not found to have a crime exacerbating effect on any of the seven crime types. On the contrary, our findings indicated that MML precedes a reduction in homicide and assault. While it is important to remain cautious when interpreting these findings as evidence that MML reduces crime, these results do fall in line with recent evidence [29] and they conform to the longstanding notion that marijuana legalization may lead to a reduction in alcohol use due to individuals substituting marijuana for alcohol [see generally 29, 30]. Given the relationship between alcohol and violent crime [31], it may turn out that substituting marijuana for alcohol leads to minor reductions in violent crimes that can be detected at the state level. That said, it also remains possible that these associations are statistical artifacts (recall that only the homicide effect holds up when a Bonferroni correction is made)."

Robert G. Morris, Michael TenEyck, JC Barnes, and Tomislav V. Kovandzic, "The Effect of Medical Marijuana Laws On Crime: Evidence From State Panel Data, 1990-2006," PLoS ONE 9(3): e92816. March 2014. doi: 10.1371/journal.pone.0092816
http://www.plosone.org...

44. Effect Of Medical Marijuana Legalization On Crime Rates
"Given that the current results failed to uncover a crime exacerbating effect attributable to MML, it is important to examine the findings with a critical eye. While we report no positive association between MML and any crime type, this does not prove MML has no effect on crime (or even that it reduces crime). It may be the case that an omitted variable, or set of variables, has confounded the associations and masked the true positive effect of MML on crime. If this were the case, such a variable would need to be something that was restricted to the states that have passed MML, it would need to have emerged in close temporal proximity to the passage of MML in all of those states (all of which had different dates of passage for the marijuana law), and it would need to be something that decreased crime to such an extent that it ‘‘masked’’ the true positive effect of MML (i.e., it must be something that has an opposite sign effect between MML [e.g., a positive correlation] and crime [e.g., a negative correlation]). Perhaps the more likely explanation of the current findings is that MML laws reflect behaviors and attitudes that have been established in the local communities. If these attitudes and behaviors reflect a more tolerant approach to one another’s personal rights, we are unlikely to expect an increase in crime and might even anticipate a slight reduction in personal crimes."

Robert G. Morris, Michael TenEyck, JC Barnes, and Tomislav V. Kovandzic, "The Effect of Medical Marijuana Laws On Crime: Evidence From State Panel Data, 1990-2006," PLoS ONE 9(3): e92816. March 2014. doi: 10.1371/journal.pone.0092816
http://www.plosone.org...

45. Treatment Admissions for Marijuana in the US, 1992-2002, and Referrals from the Criminal Justice System
" A recent issue of The DASIS Report2 examined marijuana treatment admissions between 1992 and 2002 and found that between these years [1992 and 2002] the rate of substance abuse treatment admissions reporting marijuana as their primary substance of abuse3 per 100,000 population increased 162 percent. Similarly, the proportion of marijuana admissions increased from 6 percent of all admissions in 1992 to 15 percent of all admissions reported to the Treatment Episode Data Set (TEDS) in 2002.
"During this time period, the percentage of marijuana treatment admissions that were referred from the criminal justice system increased from 48 percent of all marijuana admissions in 1992 to 58 percent of all marijuana admissions in 2002."

"Differences in Marijuana Admissions Based on Source of Referral: 2002," The DASIS Report (Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applied Studies, June 5, 2005), pp. 1-2.
http://drugwarfacts.org...

46. Estimated Number Of People In The US Sentenced To State and Federal Prison For Marijuana Offenses
Total Federal Prisoners 2004 = 170,535
Total State Prisoners 2004 = 1,244,311

Percent of federal prisoners held for drug law violations = 55%
Percent of state prisoners held for drug law violations = 21%

Marijuana/hashish, Percent of federal drug offenders, 2004 = 12.4%
Marijuana/hashish, Percent of state drug offenders, 2004 = 12.7%

(Total prisoners x percent drug law) x percent marijuana = "marijuana prisoners"

Federal marijuana prisoners in 2004 = 11,630
State marijuana prisoners in 2004 = 33,186
Total federal and state marijuana prisoners in 2004 = 44,816

Note: These data only address people in prisons and thus exclude the 700,000+ offenders who may be in local jails because of a marijuana conviction.

Mumola , Christopher J. and Karberg, Jennifer C., "Drug Use and Dependence, State and Federal Prisoners, 2004," Bureau of Justice Statistics (Washington, DC: U.S. Department of Justice, January 2007) NCJ 213530, p. 4.
http://www.bjs.gov...
Harrison, Paige M. and Beck, Allan J., "Prisoners in 2004," Bureau of Justice Statistics, (Washington, DC: US Department of Justice, October 2005), NCJ 210677, Table 1, page 2.
http://www.bjs.gov...

47. Treatment Admissions in the US with Marijuana as a Primary Substance, 2014
"• Marijuana/hashish was reported as the primary substance of abuse by 15 percent of TEDS admissions aged 12 and older in 2014 [Table 1.1b].
"• The average age at admission for primary marijuana/hashish admissions was 26 years [Table 2.1b], although the peak age at admission for both genders in all race/ethnicities was about 16 to 17 years [Figure 12]. Thirty-two percent of marijuana/hashish admissions were under age 20 (vs. 8 percent of all admissions combined), and primary marijuana/hashish abuse accounted for 78 percent of admissions aged 12 to 14 and 76 percent of admissions aged 15 to 17 years [Table 2.1c].
"• Non-Hispanic Whites accounted for 44 percent of primary marijuana/hashish admissions (30 percent were males and 14 percent were females), and non-Hispanic Blacks accounted for 31 percent (24 percent were males and 8 percent were females) [Table 2.3b].
"• Twenty-four percent of primary marijuana/hashish admissions had first used marijuana/hashish by age 12 and another 30 percent had first used it by age 14 [Table 2.5b].
"• Primary marijuana/hashish admissions were most likely to be referred by the court/criminal justice system (52 percent). Primary marijuana/hashish admissions were less likely than all admis-sions combined to be self- or individually referred to treatment (18 vs. 37 percent) [Table 2.6b].
"• More than 4 in 5 marijuana/hashish admissions (86 percent) received ambulatory treatment; among all admissions combined, 3 in 5 (61 percent) received ambulatory treatment [Table 2.7b].
"• Sixty-three percent of primary marijuana/hashish admissions reported abuse of additional sub-stances. Alcohol was reported by 37 percent [Table 3.8]."

Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. Treatment Episode Data Set (TEDS): 2004-2014. National Admissions to Substance Abuse Treatment Services. BHSIS Series S-84, HHS Publication No. (SMA) 16-4986. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2016, pp. 21-22.
https://www.samhsa.gov...
https://www.samhsa.gov...

48. Primary Marijuana Cultivation States
"California, Hawaii, Kentucky, Oregon, Tennessee, Washington, and West Virginia are the primary marijuana cultivation states (M7 states). Domestic Cannabis Eradication/Suppression Program (DCE/SP) data show that more than 8 million plants were eradicated in 2008, 89 percent (7,136,133 plants of 8,013,308 plants) of which were eradicated in the M7 States."

National Drug Intelligence Center, "Domestic Cannabis Cultivation Assessment 2009," (Johnstown, PA: July, 2009), p. 1.
http://www.justice.gov...

49. Marijuana Decriminalization and Effect on Use
"In conclusion, our results suggest that participation in the use of both licit and illicit drugs is price sensitive. Participation is sensitive to own prices and the price of the other drugs. In particular, we conclude that cannabis and cigarettes are complements, and there is some evidence to suggest that cannabis and alcohol are substitutes, although decriminalization of cannabis corresponds with higher alcohol use. Alcohol and cigarettes are found to be complements."

Cameron, Lisa & Williams, Jenny, "Cannabis, Alcohol and Cigarettes: Substitutes or Complements?" The Economic Record (Hawthorn, Victoria, Australia: The Economic Society of Australia, March 2001), p. 32.
http://cms.sem.tsinghua.edu.cn...

50. Marijuana Potency
"Although marijuana grown in the United States was once considered inferior because of a low concentration of THC, advancements in plant selection and cultivation have resulted in higher THC-containing domestic marijuana. In 1974, the average THC content of illicit marijuana was less than one percent. Today most commercial grade marijuana from Mexico/Columbia and domestic outdoor cultivated marijuana has an average THC content of about 4 to 6 percent. Between 1998 and 2002, NIDA-sponsored Marijuana Potency Monitoring System (MPMP) analyzed 4,603 domestic samples. Of those samples, 379 tested over 15 percent THC, 69 samples tested between 20 and 25 percent THC and four samples tested over 25 percent THC."

Lyman, Michael "Practical Drug Enforcement, Third Edition" CRC Press (Boca Raton, FL: 2007), p. 74.
http://mapinc.org...

51. Average THC, CBD, and CBN Levels of Seized Domestic Cannabis in the US, 1995-2015
Click here for the complete datatable of Average Tetrahydrocannabinol (THC), Cannabidiol (CBD), and Cannabinol (CBN) Levels of Seized Samples of Domestic Cannabis in the US, 1995-2015

National Drug Control Strategy Data Supplement 2016, Executive Office of the President: Office of National Drug Control Policy, Jan. 2017, Table 77, p. 87, citing University of Mississippi, National Center for Natural Products Research, Research Institute of Pharmaceutical Sciences. Quarterly Report #134, Potency Monitoring Program (September 2016).
archives.gov
Quarterly Report #104, Dec. 16, 2008 - March 15, 2009, University of Mississippi Potency Monitoring Project (Oxford, MS: National Center for Natural Products Research, a Division of the Research Institute of Pharmaceutical Sciences, 2008), Mahmoud A. ElSohly, PhD, Director, NIDA Marijuana Project (NIDA Contract #N01DA-5-7746), pp. 8 and 10.
https://www.ncjrs.gov...

52. THC Potency of Seized Cannabis, by Type, 1985-2014
Click here for complete datatable of THC Potency of Tested Cannabis from Federal Seizure and State and Local Eradication Samples, by Type, 1985-2014.

"National Drug Control Strategy Data Supplement 2015," Executive Office of the President, Office of National Drug Control Policy, November 2015, Table 78, p. 92, citing as its sources: University of Mississippi, National Center for Natural Products Research, Research Institute of Pharmaceutical Sciences. Quarterly Report #129, Potency Monitoring Program July 13, 2015) for data from 1995 to 2014; Quarterly Report 107 (January 12, 2010) for data from 1985 to 1994.
archives.gov...

53. Average Potency of Seized Cannabis in the UK, 2008
"• Twenty-three Police Forces in England and Wales participated in the study. Forces were requested to submit samples confiscated from street-level users. In early 2008, they submitted 2,921 samples for analysis to either the Forensic Science Service Ltd (FSS) or LGC Forensics at Culham (LGC F).
"• Initial laboratory examination showed that 80.8% were herbal cannabis and 15.3% were cannabis resin. The remaining 3.9% were either indeterminate or not cannabis.
"• Microscopic examination of around two-thirds of the samples showed that over 97% of the herbal cannabis had been grown by intensive methods (sinsemilla). The remainder was classed as traditional imported herbal cannabis.
"• Regional variations were found in the market share of herbal cannabis. Thus North Wales, South Wales, Cleveland and Devon and Cornwall submitted proportionately fewer herbal cannabis samples, whereas Essex, Metropolitan and Avon and Somerset submitted proportionately more. These differences were statistically significant at the 0.1% confidence interval.
"• The mean THC concentration (potency) of the sinsemilla samples was 16.2% (range = 4.1 to 46%). The median potency was 15.0%, close to values reported by others in the past few years.
"• The mean THC concentration (potency) of the traditional imported herbal cannabis samples was 8.4% (range = 0.3 to 22%); median = 9.0%. Only a very small number of samples were received and analysed.
"• The mean potency of cannabis resin was 5.9% (range = 1.3 to 27.8%). The median = 5.0% was typical of values reported by others over many years.
"• Cannabis resin had a mean CBD content of 3.5% (range = 0.1 to 7.3%), but the CBD content of herbal cannabis was less than 0.1% in nearly all cases.
"• There was a weak, but statistically-significant, correlation (r = 0.48; N = 112; P < 0.001) between the THC and the CBD content of resin."

Hardwick, Sheila; King, Leslie, "Home Office Cannabis Potency Study 2008," Home Office Scientific Development Branch (Sandridge, St Albans, UK: May 2008), p. 1.
http://www.dldocs.stir.ac.uk...

54. Trends in Cannabis Potency in the US, 1980-1995
"Data on the THC content of cannabis products in the USA have been collected by ElSohly et al. (1984, 2000) for many years as part of the University of Mississippi Potency Monitoring Project. Samples were submitted by law enforcement agencies and it has to be assumed that they were representative of the market. Mean THC values are shown in Figure 16 for normal herbal cannabis, sinsemilla and resin. The anomalously high value for resin in 1997 (19.24 %) has been excluded; it was based on only five values and is over nine standard deviations above the mean potency for the period 1980–1996. Although there has been an increase in the potency of herbal cannabis over the twenty-five-year period, cannabis resin (and hash oil) showed no long-term trends since 1980 when data were first collected. Although the potency of sinsemilla showed a clear upward trend in the final three years of the study, no such trend was obvious when the longer period of 1980–1995 is examined, particularly in view of the wide variations in potency that occurred from year to year (ElSohly et al., 2000). The THC content of herbal cannabis increased from around 1% before 1980 to around 4% in 1997. This increase, when seen in the European context, is deceptive. Before 1980, all mean herbal cannabis THC levels in the ElSohly study were less than 2.4%. By contrast, and as shown in Figure 10, comparable levels at that time in the United Kingdom were twice as great. In other words, it must be assumed that the quality of herbal cannabis consumed in the USA more than twenty years ago was unusually poor, but that in recent years it has risen to levels typical of Europe. So even the modest increase found by ElSohly et al. (2000) may be less significant than it seems. A recent analysis of cannabis seized in Florida in 2002 (Newell, 2003) showed amounts of THC found in samples ranging from 1.41% to 12.62%; the average THC content was 6.20%, which is almost identical to the 2002 value reported by the University of Mississippi Potency Monitoring Project."

EMCDDA Insights #6: An Overview of Cannabis Potency in Europe, European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2004), p. 52.
http://www.emcdda.europa.eu...

55. Average Cannabis Potency in Europe and the US
"Statements in the popular media that the potency of cannabis has increased by ten times or more in recent decades are not support by the data from either the USA or Europe. As discussed in the body of this report, systematic data are not available in Europe on long-term trends and analytical and methodological issues complicate the interpretation of the information that is available. Data are stronger for medium and short-term trends where no major differences are apparent in Europe, although some modest increases are found in some countries. The greatest long-term changes in potency appear to have occurred in the USA. It should be noted here that before 1980 herbal cannabis potency in the USA was, according to the available data, very low by European standards."

King, Leslie A., European Monitoring Centre for Drugs and Drug Addiction, "EMCDDA Insights - An Overview of Cannabis Potency in Europe" (Luxembourg: Office for Official Publications of the European Communities, 2004), p. 14.
http://www.emcdda.europa.eu...

56. How do people get marijuana in states where it's not legal?
"Despite continuing increases in the amount of cannabis produced domestically, much of the marijuana available within the United States is foreign-produced. The two primary foreign source areas for marijuana distributed within the United States are Canada and Mexico. Mexican drug trafficking organizations (DTOs) have relocated many of their outdoor cannabis cultivation operations in Mexico from traditional growing areas to more remote locations in central and northern Mexico, primarily to reduce the risk of eradication and gain easier access to U.S. drug markets. Asian criminal groups are the primary producers of high-potency marijuana in Canada."

National Drug Intelligence Center, "Domestic Cannabis Cultivation Assessment 2009," (Johnstown, PA: July, 2009), p. 1.

57. Estimated Lethal Dose of Cannabis
http://www.green215.com...

58. Marijuana and Overdose Mortality
An exhaustive search of the literature finds no deaths induced by marijuana. The US Drug Abuse Warning Network (DAWN) records instances of drug mentions in medical examiners' reports, and though marijuana is mentioned, it is usually in combination with alcohol or other drugs. Marijuana alone has not been shown to cause an overdose death.

Federal Drug Abuse Warning Network (DAWN); also see Janet E. Joy, Stanley J. Watson, Jr., and John A. Benson, Jr., "Marijuana and Medicine: Assessing the Science Base," Division of Neuroscience and Behavioral Research, Institute of Medicine (Washington, DC: National Academy Press, 1999); and US Department of Justice, Drug Enforcement Administration, "In the Matter of Marijuana Rescheduling Petition" (Docket #86-22), September 6, 1988, p. 57.
www.samhsa.gov
http://www.nap.edu...

59. Relative Public Health Risk of Cannabis Use
"There are health risks of cannabis use, most particularly when it is used daily over a period of years or decades. Considerable uncertainty remains about whether these effects are attributable to cannabis use alone, and about what the quantitative relationship is between frequency, quantity and duration of cannabis use and the risk of experiencing these effects.
"On existing patterns of use, cannabis poses a much less serious public health problem than is currently posed by alcohol and tobacco in Western societies."

Hall, W., Room, R. & Bondy, S., "WHO Project on Health Implications of Cannabis Use: A Comparative Appraisal of the Health and Psychological Consequences of Alcohol, Cannabis, Nicotine and Opiate Use," (Geneva, Switzerland: World Health Organization, March 1998).
http://www.druglibrary.net...

60. Public Health Impact of Marijuana Use
"The public health burden of cannabis use is probably modest compared with that of alcohol, tobacco, and other illicit drugs. A recent Australian study96 estimated that cannabis use caused 0·2% of total disease burden in Australia—a country with one of the highest reported rates of cannabis use. Cannabis accounted for 10% of the burden attributable to all illicit drugs (including heroin, cocaine, and amphetamines). It also accounted for around 10% of the proportion of disease burden attributed to alcohol (2·3%), but only 2·5% of that attributable to tobacco (7·8%)."

Hall, Wayne and Degenhardt, Louise, "Adverse health effects of non-medical cannabis use," The Lancet (London, United Kingdom: October 17, 2009) Vol. 374, p. 1389.
http://www.thelancet.com...
http://www.ncbi.nlm.nih.gov...

61. Safety of Medicinal Cannabis According to DEA Administrative Law Judge Francis Young
In 1988, the DEA's Administrative Law Judge, Francis Young, concluded: "In strict medical terms marijuana is far safer than many foods we commonly consume. For example, eating 10 raw potatoes can result in a toxic response. By comparison, it is physically impossible to eat enough marijuana to induce death. Marijuana in its natural form is one of the safest therapeutically active substances known to man. By any measure of rational analysis marijuana can be safely used within the supervised routine of medical care."

US Department of Justice, Drug Enforcement Administration, "In the Matter of Marijuana Rescheduling Petition," [Docket #86-22], (September 6, 1988), p. 57.
http://medicalmarijuana.procon.org...

62. Shafer Commission on Marijuana's Relative Safety
"A careful search of the literature and testimony of the nation's health officials has not revealed a single human fatality in the United States proven to have resulted solely from ingestion of marihuana. Experiments with the drug in monkeys demonstrated that the dose required for overdose death was enormous and for all practical purposes unachievable by humans smoking marihuana. This is in marked contrast to other substances in common use, most notably alcohol and barbiturate sleeping pills."

Shafer, Raymond P., et al, Marihuana: A Signal of Misunderstanding, Ch. III, (Washington DC: National Commission on Marihuana and Drug Abuse, 1972).
http://druglibrary.net...

63. Mentions of Marijuana in Emergency Department Visits in the US, 2011
"Of the approximately 2.5 million drug misuse or abuse ED visits that occurred during 2011, a total of 1,252,500, or just over half (50.9%), involved illicit drugs (Table 4). A majority (56.3%) of illicit drug ED visits involved multiple drugs. Overall, 27.9 percent of visits involving illicit drugs also involved alcohol.
"Cocaine and marijuana were the most commonly involved drugs, with 505,224 ED visits (40.3%) and 455,668 ED visits (36.4%), respectively. Cocaine and marijuana were followed by heroin, at 258,482 ED visits, or 20.6 percent, and then by amphetamines/methamphetamine, at 159,840 visits, or 12.8 percent."

Note: According to the DAWN report, "DAWN captures drugs that are explicitly named in the medical record as being involved in the ED visit. The relationship between the ED visit and the drug use need not be causal. That is, an implicated drug may or may not have directly caused the condition generating the ED visit; the ED staff simply named it as being involved." (p. 15)

Substance Abuse and Mental Health Services Administration, Drug Abuse Warning Network, 2011: National Estimates of Drug-Related Emergency Department Visits. HHS Publication No. (SMA) 13-4760, DAWN Series D-39. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013, p. 25 and p. 15.
http://www.samhsa.gov...
http://www.samhsa.gov...

64. Pulmonary Effects of Cannabis
"For physiological and pharmacological reasons,61 smoking cannabinoid herbals does not seem to have a similar health hazard profile as tobacco smoking, aside from the potential for bronchial irritation and bronchitis. Smoking cannabis was not associated with an increased risk of developing chronic obstructive pulmonary disease ..."

Aggarwal, Sunil K., "Cannabinergic Pain Medicine: A Concise Clinical Primer and Survey of Randomized-controlled Trial Results," Clinical Journal of Pain (Philadelphia, PA: February 23, 2012), p. 4.
http://www.ncbi.nlm.nih.gov...

65. Cannabis Smoking and Pulmonary Function
"In this 20-year study of marijuana and pulmonary function, we confirmed the expected reductions in FEV1 [Forced expiratory volume in the first second of expiration] and FVC [forced vital capacity] from tobacco use. In contrast, marijuana use was associated with higher FEV1 and FVC at the low levels of exposure typical for most marijuana users. With up to 7 joint-years of lifetime exposure (eg, 1 joint/d for 7 years or 1 joint/wk for 49 years), we found no evidence that increasing exposure to marijuana adversely affects pulmonary function. This association, however, was nonlinear: at higher exposure levels, we found a leveling off or even a reversal in this association, especially for FEV1. Although our sample contained insufficient numbers of heavy users to confirm a detrimental effect of very heavy marijuana use on pulmonary function, our findings suggest this possibility."

Pletcher, Mark J., et al., "Association Between Marijuana Exposure and Pulmonary Function Over 20 Years," Journal of the American Medical Association, Jan. 11, 2012, Vol. 307, No. 2, p. 177.
http://jama.jamanetwork.com...
http://jama.jamanetwork.com...

66. Lung Cancer Risk from Cannabis Use
"Despite these findings, the small number of observational studies fail to demonstrate a clear association between marijuana smoking and diagnoses of lung cancer. Therefore, we must conclude that no convincing evidence exists for an association between marijuana smoking and lung cancer based on existing data. Nonetheless, certain logistic properties of marijuana smoking may increase the risk of carcinogenic exposure compared with conventional tobacco smoking, raising questions as to why observational studies have not demonstrated an association with lung cancer."

Mehra, Reena; Moore, Brent A.; Crothers, Kristina; Tetrault, Jeanette; Fiellin, David A., "The Association Between Marijuana Smoking and Lung Cancer: A Systemic Review," Archives of Internal Medicine, (Chicago, IL: American Medical Association, July 10, 2006), Vol. 166, p. 1365.
http://archinte.jamanetwork.com...
http://archinte.jamanetwork.com...

67. Cannabis and Head and Neck Squamous Cell Carcinoma
"We found that moderate marijuana use was significantly associated with reduced risk of HNSCC [head and neck squamous cell carcinoma]. This association was consistent across different measures of marijuana use (marijuana use status, duration, and frequency of use). Diminished risk of HNSCC did not differ across tumor sites, or by HPV [human papillomavirus] 16 antibody status. Further, we observed that marijuana use modified the interaction between alcohol and cigarette smoking, resulting in a decreased HNSCC risk among moderate smokers and light drinkers, and attenuated risk among the heaviest smokers and drinkers."

Liang, Caihua; McClean, Michael D., et al., "A Population-Based Case-Control Study of Marijuana Use and Head and Neck Squamous Cell Carcinoma," Cancer Research Prevention (New Milford, CT: American Association for Cancer Research, August 2009), p. 766.
http://cancerpreventionresearch...

68. Cancer Risk from Marijuana Use
"Nonetheless, and contrary to our expectations, we found no positive associations between marijuana use and lung or UAT cancers. Although we observed positive dose-response relations of marijuana use to oral and laryngeal cancers in the crude analyses, the trend was no longer observed when adjusting for potential confounders, especially cigarette smoking. In fact, we observed ORs <1 for all cancers except for oral cancer, and a consistent monotonic association was not apparent for any outcome. Similar findings were found when the analyses were restricted to subjects who never smoked cigarettes. The 95% confidence intervals for the adjusted ORs did not extend far above 1 (e.g., were under 2 for marijuana and lung cancer), which suggests that associations of marijuana use with the study cancers are not strong and may be below detectable limits for this type of study."

Mia Hashibe, Hal Morgenstern, Yan Cui, Donald P. Tashkin, Zuo-Feng Zhang, Wendy Cozen, Thomas M. Mack, and Sander Greenland, "Marijuana Use and the Risk of Lung and Upper Aerodigestive Tract Cancers: Results of a Population-Based Case-Control Study," Cancer Epidemiology, Biomarkers & Prevention (October 2006), p. 1833.
http://cebp.aacrjournals.org...

69. Cannabis and Lung Cancer
"Despite several lines of evidence suggesting the biological plausibility of marijuana use being carcinogenic (1), it is possible that marijuana use does not increase cancer risk, as suggested in the recent commentary by Melamede (26). Although the adjusted ORs <1 may be chance findings, they were observed for all non-reference exposure categories with all outcomes except oral cancer. Although purely speculative, it is possible that such inverse associations may reflect a protective effect of marijuana. There is recent evidence from cell culture systems and animal models that 9-tetrahydrocannabinol, the principal psychoactive ingredient in marijuana, and other cannabinoids may inhibit the growth of some tumors by modulating key signaling pathways leading to growth arrest and cell death, as well as by inhibiting tumor angiogenesis (27-29). These antitumoral associations have been observed for several types of malignancies including brain, prostate, thyroid, lung, and breast."

Mia Hashibe, Hal Morgenstern, Yan Cui, Donald P. Tashkin, Zuo-Feng Zhang, Wendy Cozen, Thomas M. Mack, and Sander Greenland, "Marijuana Use and the Risk of Lung and Upper Aerodigestive Tract Cancers: Results of a Population-Based Case-Control Study," Cancer Epidemiology, Biomarkers & Prevention (October 2006), p. 1833.
http://cebp.aacrjournals.org...

70. Cannabis and Diabetes
"In the current study, we demonstrated that chronic cannabis smokers had relative visceral adiposity and adipose tissue insulin resistance but not hepatic steatosis, glucose insulin insensitivity, impaired pancreatic b-cell function, glucose intolerance, or dyslipidemia compared with age-, sex-, ethnicity-, and BMI-matched control individuals. Our study results suggest that chronic, daily cannabis use may have differential tissue-specific effects on insulin sensitivity, but these effects appear to have minimal impact on glucose or lipid metabolism."

Muniyappa, Ranganath, MD, PhD, et al., "Metabolic Effects of Chronic Cannabis Smoking," Diabetes Care, e-published before print on March 25, 2013. DOI: 10.2337/dc12-2303. Clinical trial reg. no. NCT00428987, clinicaltrials.gov.
http://care.diabetesjournals.org...

71. Cannabis and Diabetes
"Our analyses of adults aged 20-59 years in the NHANES [National Health and Nutrition Examination Survey] III database showed that participants who used marijuana had lower prevalence of DM [Diabetes Mellitus] and had lower odds of DM relative to non-marijuana users. We did not find an association between the use of marijuana and other chronic diseases, such as hypertension, stroke, myocardial infarction and heart failure. This could be due to the smaller prevalence of stroke, myocardial infarction and heart failure in the examined age group.
"We noted the lowest prevalence of DM in current light marijuana users, with current heavy marijuana users and past users also having a lower prevalence of DM than non-marijuana users. The finding that past marijuana users had lower odds of prevalent DM than non-users suggests that early exposure to marijuana may affect the development of DM and a window of time of marijuana exposure earlier in life could be a factor to study. Similarly, our findings of a significant association between marijuana use and DM was only found in those aged $40 years suggest that the possibility of some protection from marijuana use may require many years before they become manifested. By contrast, it could reflect the increased prevalence of DM with age and the ability to detect an association with a lesser sample size when there is a greater cohort at risk for DM. The possible association of light marijuana use with decreased DM is similar to that of alcohol on DM and the metabolic syndrome, in which mild alcohol use was associated with lower prevalence of DM and the metabolic syndrome,14 15 and higher alcohol use associated with higher prevalence of DM and the metabolic syndrome.14 16"

Shaheen M, Norris KC, et al., "Decreased prevalence of diabetes in marijuana users: cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) III." BMJ Open 2012;2:e000494. doi:10.1136/bmjopen-2011-000494.
http://bmjopen.bmj.com...

72. Cannabis Use and Diet
Marijuana use is associated with higher daily caloric intake. In the NHANES III and CARDIA study, heavy cannabis users had ;20% higher calorie intake than nonusers (25,26). The increase in calories was from higher intake of all macronutrients. Specifically, the frequency and amount of consumption of soda, cheese, salty snacks, pork, and alcohol was higher in cannabis users. Consistent with other studies, the quality of diets consumed by cannabis users was poor (27). Furthermore, the percent of daily calories derived from carbohydrates relatively rich in simple sugars was significantly higher in marijuana smokers. These findings are consistent with human and animal studies demonstrating that cannabinoids stimulate food intake, specifically highly palatable sweet-tasting foods (28). Cannabis smokers in our study exhibited characteristics typically observed in marijuana smokers in the general population."

Muniyappa, Ranganath, MD, PhD, et al., "Metabolic Effects of Chronic Cannabis Smoking," Diabetes Care, e-published before print on March 25, 2013. DOI: 10.2337/dc12-2303. Clinical trial reg. no. NCT00428987, clinicaltrials.gov.
http://care.diabetesjournals.o...

73. Cannabis and Dependence
http://www.ncbi.nlm.nih.gov...
http://www.ncbi.nlm.nih.gov...

74. Pharmacologic Treatments for Cannabis Use Disorder (CUD)
"As research on pharmacological treatments for CUD continues, a few key findings are of note. First, cannabinoid agonists (nabilone, dronabinol in combination with lofexidine, and lofexidine alone), were the only drugs that decreased drug-taking in a human laboratory model of relapse, supporting the notion that agonist replacement and attenuation of noradrenergic activity show promise for relapse prevention. Although dronabinol alone failed to clinically reduce cannabis use, a higher dose might have been more effective. Further, that study was designed to evaluate the initiation of abstinence; dronabinol or the more bioavailable agonist nabilone, might have greater utility in the prevention of relapse [25•]. These studies also support further testing of lofexidine in combination with other drugs, and generally illustrate the utility that can be gained from combining medications.
"Second, gabapentin and NAC were the only drugs tested in placebo-controlled clinical trials that decreased cannabis use (abstinence induction). Third, the ability of a drug to reduce cannabis withdrawal symptoms is not predictive of its ability to alter drug-taking behaviors (reduce use or prevent relapse). However, all the studies that reported positive changes in drug use also reported a reduction in withdrawal during early abstinence, suggesting that this feature is an important component of an efficacious medication."

Rebecca E. Balter, Ziva D. Cooper, and Margaret Haney, "Novel Pharmacologic Approaches to Treating Cannabis Use Disorder," Current Addiction Reports, March 1, 2014, DOI 10.1007/s40429-014-0011-1.
http://link.springer.com...

75. Cannabis Use Disorder (CUD) Definition and Symptoms
"CUD is defined in the DSM-5 as a problematic pattern of cannabis use leading to clinically significant impairment or distress occurring within a 12-month period as manifested by cannabinoid tolerance and withdrawal; increasing amounts of cannabis use over time; inability to control consumption; craving; and recurrent cannabis use having negative implications on social, professional and educational life [3]. Withdrawal symptoms usually appear approximately 24 hours after abstinence initiation, peak within two to six days and remit within two weeks [4]. Symptoms may include irritability, anger or aggression; nervousness or anxiety; sleep difficulty (insomnia, disturbing dreams); decreased appetite or weight loss; restlessness; depressed mood; or physical discomforts (abdominal pain, shakiness/tremors, fever, chills or headache) [5, 6, 7•]. Withdrawal is diagnosed if at least three of these symptoms develop. A week after cessation of use, additional symptoms may appear such as fatigue, yawning, difficulty in concentration, and rebound periods of increased appetite or hypersomnia [3]."

Rebecca E. Balter, Ziva D. Cooper, and Margaret Haney, "Novel Pharmacologic Approaches to Treating Cannabis Use Disorder," Current Addiction Reports, March 1, 2014, DOI 10.1007/s40429-014-0011-1.
http://link.springer.com...

76. Medical Cannabis Patients and Other Drug Use
"Analysis of the demographic and social characteristics of a large sample of applicants seeking approval to use marijuana medically in California supports an interpretation of long term non problematic use by many who had first tried it as adolescents, and then either continued to use it or later resumed its use as adults. In general, they have used it at modest levels and in consistent patterns which anecdotally-often assisted their educational achievement, employment performance, and establishment of a more stable life-style. These data suggest that rather than acting as a gateway to other drugs, (which many had also tried), cannabis has been exerting a beneficial influence on most."

Thomas J O'Connell and Ché B Bou-Matar, "Long term marijuana users seeking medical cannabis in California (2001–2007): demographics, social characteristics, patterns of cannabis and other drug use of 4117 applicants," Harm Reduction Journal, (November 2007).
http://www.harmreductionjourna...

77. Smoking Behavior and Potential for Developing Dependence on Cannabis
"Differences in cannabis smoking behaviour may also represent different risks for cannabis dependence independently of total THC exposure. Similar to cigarette smokers [16,21–24], cannabis smokers typically gradually decrease the puff volume and puff duration during the course of one joint, whereas puff velocity and interpuff interval gradually increase [20]. Interestingly, in a 2-year prospective study, nicotine dependence has been shown to develop more rapidly in tobacco smokers who smoke with stable or increasing puff volume and increasing puff duration ('atypical' smoking) [16]. One interpretation of this finding is that the risk of becoming nicotine-dependent is lower in smokers who reach nicotine saturation before the cigarette is finished and decrease their pace of smoking. If this mechanism also applies to cannabis smoking, one may expect that the risk for and the severity of cannabis dependence is associated with 'atypical' cannabis smoking."

Peggy van der Pol, Nienke Liebregts, Tibor Brunt, Jan van Amsterdam, Ron de Graaf, Dirk J. Korf, Wim van den Brink & Margriet van Laar, "Cross-sectional and prospective relation of cannabis potency, dosing and smoking behaviour with cannabis dependence: an ecological study," Addiction, March 16, 2014, doi:10.1111/add.12508.
http://onlinelibrary.wiley.com...

78. High-Potency Cannabis and Potential For Developing Dependence
"This study among 98 experienced cannabis smokers is the first naturalistic study to examine whether users of cannabis with high THC concentration titrate the psychoactive effects by using lower doses and/or by reduced inhalation, and whether cannabis smoking behaviour (topography) predicts cannabis dependence severity independently of total THC exposure.
"In contrast to our hypothesis, there was a positive association between cannabis THC concentration and cannabis dose, indicating that users of stronger cannabis generally used larger amounts of cannabis to prepare their regular joint. However, in line with our hypothesis, the negative association between THC concentration of joints and total inhaled smoke volume indicates that users of stronger joints inhaled smaller smoke volumes, thus resulting in partial titration of the total THC exposure. Overall, as exemplified by the comparison of the average user with the user with the maximum THC concentration, users of high-potency cannabis will generally be exposed to higher total doses of THC (at least in this sample). This is in line with Cappell et al.’s observations through a one-way mirror experiment in 1973 where users only partly adapted their intake [14]. Indeed, increased THC concentrations of cannabis have recently been linked to increased internal THC exposure assessed in blood [28]."

Peggy van der Pol, Nienke Liebregts, Tibor Brunt, Jan van Amsterdam, Ron de Graaf, Dirk J. Korf, Wim van den Brink & Margriet van Laar, "Cross-sectional and prospective relation of cannabis potency, dosing and smoking behaviour with cannabis dependence: an ecological study," Addiction, March 16, 2014, doi:10.1111/add.12508.
http://onlinelibrary.wiley.com...

79. High-Potency Cannabis and Titration of Dosage Among Experienced Users
"Although experienced young adult cannabis users with a preference for stronger joints titrated their THC exposure to some extent by inhaling less smoke, in general more potent cannabis was used in higher dosages leading to a higher THC exposure compared to users preferring lower potency cannabis. None the less, in our population of frequent cannabis users, total THC exposure was only a weak predictor of dependence severity, and did not remain significant after adjustment for baseline dependence severity. However, cannabis smoking behaviours predicted cannabis dependence severity independently of baseline THC exposure and baseline cannabis dependence severity. As the amount of explained variance was low, due possibly to the multifactorial aetiology of dependence, future studies should include other predictors, such as genetic variations, early traumatic experiences and — most importantly — time-dependent variables representing the dynamic nature of personal and dependence development. Meanwhile, smoking variables, such as smoking topography and completely finishing high-dose/high-potent joints in one smoking session, may be helpful to identify people at risk of escalating cannabis dependence severity."

Peggy van der Pol, Nienke Liebregts, Tibor Brunt, Jan van Amsterdam, Ron de Graaf, Dirk J. Korf, Wim van den Brink & Margriet van Laar, "Cross-sectional and prospective relation of cannabis potency, dosing and smoking behaviour with cannabis dependence: an ecological study," Addiction, March 16, 2014, doi:10.1111/add.12508.
http://onlinelibrary.wiley.com...

80. Marinol Withdrawal
"An abstinence syndrome has been reported after the abrupt discontinuation of dronabinol [Marinol®] in volunteers receiving dosages of 210 mg/day for 12 to 16 consecutive days. Within 12 hours after discontinuation, these volunteers manifested symptoms such as irritability, insomnia, and restlessness. By approximately 24 hours post-dronabinol discontinuation, withdrawal symptoms intensified to include 'hot flashes', sweating, rhinorrhea, loose stools, hiccoughs and anorexia.
"These withdrawal symptoms gradually dissipated over the next 48 hours. Electroencephalographic changes consistent with the effects of drug withdrawal (hyperexcitation) were recorded in patients after abrupt dechallenge. Patients also complained of disturbed sleep for several weeks after discontinuing therapy with high dosages of dronabinol."

"MARINOL® (dronabinol) Capsules," (Abbott Laboratories: Abbott Park, IL, July 2006), pp. 11.
http://www.accessdata.fda.gov...

81. Cannabinoid Withdrawal
"The withdrawal syndrome associated with dronabinol, the API [Active Pharmaceutical Ingredient] in Marinol®, produces symptoms in humans such as restlessness, irritability, mild agitation, anxiety, anger, insomnia, sleep EEG disturbances, nausea, decreased appetite, and decreased weight. Since a withdrawal syndrome is indicative of physical dependence, it is reasonable to conclude that generic dronabinol products (both naturally-derived [from the cannabis plant] or synthetically produced, and in hard or soft gelatin capsules) in sesame oil, will also produce physical dependence similar to those produced by Marinol®."

Federal Register, "Listing of Approved Drug Products Containing Dronabinol in Schedule III," Vol. 75, No. 210, Monday, November 1, 2010, pp. 67054 to 67059.
http://www.gpo.gov...
===
"MARINOL® (dronabinol) Capsules," (Abbott Laboratories: Abbott Park, IL, July 2006), pp. 11.
http://www.accessdata.fda.gov...

82. Marijuana Use as a Gateway to Other Drug Use
"There is no conclusive evidence that the drug effects of marijuana are causally linked to the subsequent abuse of other illicit drugs."

Janet E. Joy, Stanley J. Watson, Jr., and John A Benson, Jr., "Marijuana and Medicine: Assessing the Science Base," Division of Neuroscience and Behavioral Research, Institute of Medicine (Washington, DC: National Academy Press, 1999), p. 6.
http://books.nap.edu...

83. Patterns in Progression of Drug Use Over Time
"Patterns in progression of drug use from adolescence to adulthood are strikingly regular. Because it is the most widely used illicit drug, marijuana is predictably the first illicit drug most people encounter. Not surprisingly, most users of other illicit drugs have used marijuana first. In fact, most drug users begin with alcohol and nicotine before marijuana, usually before they are of legal age."

Janet E. Joy, Stanley J. Watson, Jr., and John A Benson, Jr., "Marijuana and Medicine: Assessing the Science Base," Division of Neuroscience and Behavioral Research, Institute of Medicine (Washington, DC: National Academy Press, 1999), p. 99.
http://books.nap.edu...

84. Effect of Marijuana Use by Adolescents on Cognition and IQ Development
http://jop.sagepub.com...
http://jop.sagepub.com...

85. Effect of Marijuana Use by Adolescents on Cognition and IQ
"In summary, the notion that cannabis use itself is causally related to lower IQ and poorer educational performance was not supported in this large teenage sample. However, this study indeed has limitations, in particular the young age of outcome assessment. While we have demonstrated that confounding may be an explanation for links between cannabis use and poorer outcomes, large prospective cohorts tracking young people prior to, during and after stopping cannabis use, using more objective measures of drug use (e.g. the new NIH-funded ‘ABCD study’ in the United States; National Institute on Drug Abuse, 2015) are required before we can make strong conclusions. Cigarette smoking in particular has once again (Hooper et al., 2014; McCaffrey et al., 2010; Silins et al., 2014; Stiby et al., 2014) been highlighted as an important factor in adolescent outcomes, as well as a robust independent predictor of educational performance, and the reasons for this need to be elucidated."

C Mokrysz, R Landy, SH Gage, MR Munafò, JP Roiser, and HV Curran, "Are IQ and educational outcomes in teenagers related to their cannabis use? A prospective cohort study," Journal of Psychopharmacology, 0269881115622241, first published on January 6, 2016 doi:10.1177/0269881115622241
http://jop.sagepub.com...
http://jop.sagepub.com...

86. Effect of Cannabis Use and Nicotine Use by Adolescents on Cognition and IQ
"Compared with those in our sample who had never tried cannabis, teenagers who had used cannabis at least 50 times were 17 times more likely (84% vs. 5%) to have smoked cigarettes more than 20 times in their lifetime. Accounting for group differences in cigarette smoking dramatically attenuated the associations between cannabis use and both IQ and educational performance. Further, even after excluding those who had never tried cannabis, cigarette users were found to have lower educational performance (adjusted performance 2.9 percentage points lower, approximately equivalent to dropping two grades on one subject taken at GCSE) relative to those who had never tried cigarettes. A relationship between cigarette use and poorer cognitive (Chamberlain et al., 2012; Hooper et al., 2014; Weiser et al., 2010; Whalley et al., 2005) and educational (McCaffrey et al., 2010; Silins et al., 2014; Stiby et al., 2014) outcomes has been noted previously, and may have a number of explanations. Cigarette use may have a negative impact on cognitive ability. However, this is not supported by the experimental psychopharmacology literature, which robustly shows that acute nicotine administration results in transient cognitive enhancement (Heishman et al., 2010). Alternatively, reverse causality may contribute to this relationship, for example performing poorly at school may lead to increased engagement in risky behaviours such as cigarette smoking. Further, residual confounding may contribute to this link: cigarette smoking may be a marker of unmeasured factors, for example social adversity during adolescence, that influence both IQ and educational attainment."

C Mokrysz, R Landy, SH Gage, MR Munafò, JP Roiser, and HV Curran, "Are IQ and educational outcomes in teenagers related to their cannabis use? A prospective cohort study," Journal of Psychopharmacology, 0269881115622241, first published on January 6, 2016 doi:10.1177/0269881115622241
http://jop.sagepub.com...
http://jop.sagepub.com...

87. IQ Decline Among Adolescent-Onset Marijuana Users
"In the present study, the most persistent adolescent-onset cannabis users evidenced an average 8-point IQ decline from childhood to adulthood. Quitting, however, may have beneficial effects, preventing additional impairment for adolescent-onset users. Prevention and policy efforts should focus on delivering to the public the message that cannabis use during adolescence can have harmful effects on neuropsychological functioning, delaying the onset of cannabis use at least until adulthood, and encouraging cessation of cannabis use particularly for those who began using cannabis in adolescence."

Madeline H. Meier, Avshalom Caspi, Antony Ambler, HonaLee Harrington, Renate Houts, Richard S. E. Keefe, Kay McDonald, Aimee Ward, Richie Poulton, and Terrie E. Moffitt, "Persistent Cannabis Users Show Neuropsychological Decline from Childhood to Midlife, Proceedings of the National Academy of Sciences, 2012, p. 6.
www.pnas.org...

88. Marijuana Use and IQ
"Although the heavy current users experienced a decrease in IQ score, their scores were still above average at the young adult assessment (mean 105.1). If we had not assessed preteen IQ, these subjects would have appeared to be functioning normally. Only with knowledge of the change in IQ score does the negative impact of current heavy use become apparent."

Fried, Peter, Barbara Watkinson, Deborah James, and Robert Gray, "Current and former marijuana use: preliminary findings of a longitudinal study of effects on IQ in young adults," Canadian Medical Association Journal, April 2, 2002, 166(7), p. 890.
http://www.ncbi.nlm.nih.gov...

89. Cannabis and Cognition
"The results of our meta-analytic study failed to reveal a substantial, systematic effect of long-term, regular cannabis consumption on the neurocognitive functioning of users who were not acutely intoxicated. For six of the eight neurocognitive ability areas that were surveyed. the confidence intervals for the average effect sizes across studies overlapped zero in each instance, indicating that the effect size could not be distinguished from zero. The two exceptions were in the domains of learning and forgetting."

Grant, Igor, et al., "Non-Acute (Residual) Neurocognitive Effects Of Cannabis Use: A Meta-Analytic Study," Journal of the International Neuropsychological Society (Cambridge University Press: July 2003), 9, p. 685.
http://www.csdp.org...

90. Cognitive Deficit Among Adolescent-Onset Marijuana Users
"Our findings suggest that regular cannabis use before age 18 y predicts impairment, but others have found effects only for younger ages (10, 15). Given that the brain undergoes dynamic changes from the onset of puberty through early adulthood (37, 38), this developmental period should be the focus of future research on the age(s) at which harm occurs."

Madeline H. Meier, Avshalom Caspi, Antony Ambler, HonaLee Harrington, Renate Houts, Richard S. E. Keefe, Kay McDonald, Aimee Ward, Richie Poulton, and Terrie E. Moffitt, "Persistent Cannabis Users Show Neuropsychological Decline from Childhood to Midlife, Proceedings of the National Academy of Sciences, 2012, p. 1.
http://www.pnas.org...

91. Marijuana Use and Cognition
"In conclusion, our meta-analysis of studies that have attempted to address the question of longer term neurocognitive disturbance in moderate and heavy cannabis users has failed to demonstrate a substantial, systematic, and detrimental effect of cannabis use on neuropsychological performance. It was surprising to find such few and small effects given that most of the potential biases inherent in our analyses actually increased the likelihood of finding a cannabis effect."

Grant, Igor, et al., "Non-Acute (Residual) Neurocognitive Effects Of Cannabis Use: A Meta-Analytic Study," Journal of the International Neuropsychological Society (Cambridge University Press: July 2003), 9, p. 687.
http://www.csdp.org...

92. Medical Marijuana - Research - 12-20-09
"Nevertheless, when considering all 15 studies (i.e., those that met both strict and more relaxed criteria) we only noted that regular cannabis users performed worse on memory tests, but that the magnitude of the effect was very small. The small magnitude of effect sizes from observations of chronic users of cannabis suggests that cannabis compounds, if found to have therapeutic value, should have a good margin of safety from a neurocognitive standpoint under the more limited conditions of exposure that would likely obtain in a medical setting."

Grant, Igor, et al., "Non-Acute (Residual) Neurocognitive Effects Of Cannabis Use: A Meta-Analytic Study," Journal of the International Neuropsychological Society (Cambridge University Press: July 2003), 9, pp. 687-8.
http://www.csdp.org...

93. Marijuana Use and Cognition
"Current marijuana use had a negative effect on global IQ score only in subjects who smoked 5 or more joints per week. A negative effect was not observed among subjects who had previously been heavy users but were no longer using the substance. We conclude that marijuana does not have a long-term negative impact on global intelligence. Whether the absence of a residual marijuana effect would also be evident in more specific cognitive domains such as memory and attention remains to be ascertained."

Fried, Peter, Barbara Watkinson, Deborah James, and Robert Gray, "Current and former marijuana use: preliminary findings of a longitudinal study of effects on IQ in young adults," Canadian Medical Association Journal, April 2, 2002, 166(7), p. 887.
http://www.ncbi.nlm.nih.gov...

94. Marijuana Use and Cognition
"Other studies have found short term residual effects of cannabis use on memory and cognition (34, 35) that are more severe among women (36) and heavy users (37). However, our data suggest that over the long term cannabis use is not associated with greater declines in cognition among men, women, or heavy users. The study design we used included several of the features proposed by Pope et al. (34) as critical to addressing the long term effects of cannabis on cognition: naturalistic follow-up, a large sample size, a population basis, comparison of light cannabis use with heavy use, and the construction of models accounting for the effects of gender and use of illicit drugs, alcohol, and tobacco. Therefore, these results would seem to provide strong evidence of the absence of a long term residual effect of cannabis use on cognition."

Constantine G. Lyketsos, Elizabeth Garrett, Kung-Yee Liang, and James C. Anthony. (1999). "Cannabis Use and Cognitive Decline in Persons under 65 Years of Age," American Journal of Epidemiology, Vol. 149, No. 9.
http://aje.oxfordjournals.org/...

95. Marijuana Use and Memory
"These results can be interpreted in several ways. A statistically reliable negative effect was observed in the domain of learning and forgetting, suggesting that chronic long-term cannabis use results in a selective memory defect. While the results are compatible with this conclusion, the effect size for both domains was of a very small magnitude. The "real life" impact of such a small and selective effect is questionable. In addition, it is important to note that most users across studies had histories of heavy longterm cannabis consumption. Therefore, these findings are not likely to generalize to more limited administration of cannabis compounds, as would be seen in a medical setting."

Grant, Igor, et al., "Non-Acute (Residual) Neurocognitive Effects Of Cannabis Use: A Meta-Analytic Study," Journal of the International Neuropsychological Society (Cambridge University Press: July 2003), 9, p. 686.
http://www.csdp.org...

96. Psychological Effects of Cannabis Compared With Exercise
"The [endo] cannabinoids produce psychological states that closely parallel several experiences described as being related to the runner’s high. Compared with the opioid analgesics, the analgesia produced by the endocannabinoid system is more consistent with exercise induced analgesia. Activation of the endocannabinoid system also produces sedation, anxiolysis, a sense of wellbeing, reduced attentional capacity, impaired working memory ability, and difficulty in time estimation. This behavioural profile is similar to the psychological experiences reported by long distance runners."

Dietrich, A and McDaniel, W, "Endocannabinoids and exercise," British Journal of Sports Medicine (Middlesex, United Kingdom: British Association of Sport and Exercise Medicine, October 2004), Volume 38, pp. 539-540.
http://www.ncbi.nlm.nih.gov/pm...

97. Marijuana Use and "Amotivational Syndrome"
"One of the major concerns about the psychological effects of chronic heavy cannabis use has been that it impairs adult motivation. The evidence for an 'amotivational syndrome' among adults consists largely of case histories and observational reports (e.g. Kolansky and Moore, 1971; Millman and Sbriglio, 1986). The small number of controlled field and laboratory studies have not found compelling evidence for such a syndrome (Dornbush, 1974; Negrete, 1983; Hollister, 1986). The evidential value of the field studies is limited by their small sample sizes, and the limited sociodemographic characteristics of their samples, while the evidential value of the laboratory studies is limited by the short periods of drug use, the youthful good health of the volunteers, and minimal demands made on volunteers in the laboratory (Cohen, 1982). Some regular cannabis users report a loss of ambition and impaired school and occupational performance as adverse effects of their use (e.g. Hendin et al, 1987) and that some ex-cannabis users give impaired occupational performance as a reason for stopping (Jones, 1984). Nonetheless, it is doubtful that cannabis use produces a well defined amotivational syndrome. It may be more parsimonious to regard the symptoms of impaired motivation as symptoms of chronic cannabis intoxication rather than inventing a new psychiatric syndrome."

Hall, W., Room, R. & Bondy, S., WHO Project on Health Implications of Cannabis Use: A Comparative Appraisal of the Health and Psychological Consequences of Alcohol, Cannabis, Nicotine and Opiate Use, August 28, 1995 (Geneva, Switzerland: World Health Organization, March 1998).
http://www.druglibrary.net...

98. Overall Psychological Safety of Cannabis: Schizophrenia and Psychosis
http://www.ncbi.nlm.nih.gov...

99. Cannabis and Psychotic Experiences
"This 10 year follow-up study showed that incident cannabis use significantly increased the risk of incident psychotic experiences. The association was independent of age, sex, socioeconomic status, use of other drugs, urban/rural environment, and childhood trauma; additional adjustment for other psychiatric diagnoses similarly did not change the results. There was no evidence for self medication effects as psychotic experiences did not predict later cannabis use. The results thus help to clarify the temporal association between cannabis use and psychotic experiences by systematically addressing the issue of reverse causality, given that the long follow-up period allowed exclusion of all individuals with pre-existing psychotic experiences or pre-existing cannabis use. In addition, cannabis use was confirmed as an environmental risk factor impacting on the risk of persistence of psychotic experiences (fig 3)."

Keupper, Rebecca, van Os, Jim, et al., "Continued Cannabis Use and Risk of Incidence and Persistence of Psychotic Symptoms: 10-Year Follow-Up Cohort Study, British Medical Journal, 2011;342:d738 doi:10.1136/bmj.d738

100. Cannabis and Diagnoses of Schizophrenia and Psychoses
"In terms of the model set out in the Introduction, the expected rise in diagnoses of schizophrenia and psychoses did not occur over a 10 year period. This study does not therefore support the specific causal link between cannabis use and the incidence of psychotic disorders based on the 3 assumptions described in the Introduction. This concurs with other reports indicating that increases in population cannabis use have not been followed by increases in psychotic incidence (Macleod et al., 2006; Arsenault et al., 2004; Rey and Tennant, 2002). However, it is not in line with findings of a rise in first admission rates for psychotic disorders among young people in Zurich following increases in cannabis availability and consumption (Ajdacic-Gross et al., 2007). One factor involved in this discrepancy may be the potency of the cannabis consumed, which varies considerably within Europe (EMCDDA, 2008). In addition, a Netherlands study found that high-potency cannabis obtained from ‘coffee shops’ led to higher levels of tetrahydrocannabinol (THC) in the blood, with young males aged 18–45 at particular risk for excessive consumption (Mensinga et al., 2006)."

Frisher, Martin; Crome, Ilana; Orsolina, Martino; and Croft, Peter, "Assessing the impact of cannabis use on trends in diagnosed schizophrenia in the United Kingdom from 1996 to 2005," Schizophrenia Research (Nashville, Tennessee: Schizophrenia International Research Society, September 2009) Vol. 113, Issue 2, p. 126.
http://www.ukcia.org...

101. Cannabis and Psychosis
"Although individual lifetime risk of chronic psychotic disorders such as schizophrenia, even in people who use cannabis regularly, is likely to be low (less than 3%), cannabis use can be expected to have a substantial effect on psychotic disorders at a population level because exposure to this drug is so common."

Moore, Theresa H M; Zammit, Stanley; Lingford-Hughes, Anne; Barnes, Thomas R E; Jones, Peter B; Burke, Margaret; Lewis, Glyn, "Cannabis use and risk of psychotic or aff ective mental health outcomes: a systematic review," The Lancet (London, United Kingdom: July 28, 2007) Vol 370, p. 327.
http://www.ncbi.nlm.nih.gov...
http://www.thelancet.com...

102. Cannabis and Psychosis
"First, the use of cannabis and rates of psychotic symptoms were related to each other, independently of observed/non-observed fixed covariates and observed time dynamic factors (Table 2). Secondly, the results of structural equation modeling suggest that the direction of causation is that the use of cannabis leads to increases in levels of psychotic symptoms rather than psychotic symptoms increasing the use of cannabis. Indeed, there is a suggestion from the model results that increases in psychotic symptoms may inhibit the use of cannabis."

Fergusson, David M., John Horwood & Elizabeth M. Ridder, "Tests of Causal Linkages Between Cannabis Use and Psychotic Symptoms," Addiction, Vol. 100, No. 3, March 2005, p. 363.
http://www.ncbi.nlm.nih.gov...
http://www.csdp.org...

103. Cannabis and Psychosis
"The lead researcher in the Christchurch study, Professor David Fergusson, said the role of cannabis in psychosis was not sufficient on its own to guide legislation. 'The result suggests heavy use can result in adverse side-effects,' he said. 'That can occur with ( heavy use of ) any substance. It can occur with milk.' Fergusson's research, released this month, concluded that heavy cannabis smokers were 1.5 times more likely to suffer symptoms of psychosis that non-users. The study was the latest in several reports based on a cohort of about 1000 people born in Christchurch over a four-month period in 1977. An effective way to deal with cannabis use would be to incrementally reduce penalties and carefully evaluate its impact, Fergusson said. 'Reduce the penalty, like a parking fine. You could then monitor ( the impact ) after five or six years. If it did not change, you might want to take another step.'

Bleakley, Louise, "NZ Study Used in UK Drug Review," The Press (Christchurch, New Zealand), March 22, 2005.
http://www.mapinc.org...

104. Marijuana Use and Violent Behavior
"Laboratory studies also find no link between THC intoxication and violence. Most people who ingest THC before performing a competitive task in the laboratory do not show more aggression than people who receive placebos; occasionally they show decreased hostility. Numerous scientific panels sponsored by various governments invariably report that marijuana does not lead to violence.(751)"

Carter, Gregory T.; Earleywine, Mitchell; McGill, Jason T., "Exhibit B: Statement of Grounds," Rulemaking petition to reclassify cannabis for medical use from a Schedule I controlled substance to a Schedule II (Office of Lincoln D. Chafee, Governor Rhode Island and Office of Christine O. Gregoire, Governor of Washington: Letter to Michelle Leonhard, Administrator of the Drug Enforcement Administration, November 30, 2011), p. 38.
http://big.assets.huffingtonpost.com...

105. Early Use of Marijuana
"The younger and more often teens use marijuana, the more likely they are to engage in other substance use and the higher their risk of developing a substance use disorder. Among high school students, 7.5 percent used marijuana for the first time before the age of 13. CASA’s analysis of national data finds that the average age of initiation of marijuana use among high school students is 14.3 years old. Compared to those who began using marijuana after age 21, those who first used it before age 15 are:
• More likely to have ever smoked a cigarette (93.3 percent vs. 86.4 percent);
• More than twice as likely to have ever misused controlled prescription drugs (56.5 percent vs. 22.9 percent); and
• Two and a half times as likely to have ever used other illicit drugs (70.2 percent vs. 27.8 percent)."

"Adolescent Substance Abuse: America's #1 Public Health Problem," National Center on Addiction and Substance Abuse at Columbia University, June 2011, p. 27.
http://www.casacolumbia.org...

106. Prevalence and Perceived Risk From Marijuana Use Among Young People in the US
"Annual marijuana prevalence peaked among 12th graders in 1979 at 51%, following a rise that began during the 1960s. Then use declined fairly steadily for 13 years, bottoming at 22% in 1992—a decline of more than half. The 1990s, however, saw a resurgence of use. After a considerable increase (one that actually began among 8th graders a year earlier than among 10th and 12th graders), annual prevalence rates peaked in 1996 at 8th grade and in 1997 at 10th and 12th grades. After these peak years, use declined among all three grades through 2007 or 2008. After these declines, an upturn occurred in use in all three grades, lasting for three years in the lower grades and longer in grade 12. Annual marijuana prevalence among 8th graders increased in use from 2007 to 2010, decreased slightly from 2010 to 2012, and then declined significantly in 2016. Among 10th graders, use increased somewhat from 2008 to 2013 and then declined after that. Among 12th graders, use increased from 2006 to 2011 and then held level through 2016. As shown in Table 8, daily use increased in all three grades after 2007, reaching peaks in 2011 (at 1.3% in 8th), 2013 (at 4.0% in 10th), and 2011 (at 6.6% in 12th), before declining slightly since. Daily prevalence rates in 2016 were 0.7%, 2.5%, and 6.0%, respectively, with one in seventeen 12th graders smoking daily."

Johnston, L. D., O’Malley, P. M., Miech, R. A., Bachman, J. G., & Schulenberg, J. E. (2017). Monitoring the Future national survey results on drug use, 1975-2016: Overview, key findings on adolescent drug use. Ann Arbor: Institute for Social Research, The University of Michigan, p. 11.
http://monitoringthefuture.org...
http://monitoringthefuture.org...

107. Marijuana Use vs. Tobacco Use
"High school students are more likely to use marijuana than to smoke cigarettes. High school students are:
"• More likely to have tried marijuana than tobacco (24 percent vs. 15 percent); and
"• More likely to say their close friends use marijuana than smoke cigarettes (51 percent vs. 39 percent)."

QEV Analytics, LTD., "National Survey of American Attitudes on Substance Abuse XVII: Teens," The National Center on Addiction and Substance Abuse at Columbia University (New York, NY: National Center on Addiction and Substance Abuse at Columbia University, August 2012), p. 30.
http://www.casacolumbia.org...

108. Marijuana Use by Peers and Perception of Harm
"Teens also say they are seeing more peers in school smoking marijuana and more teens (73 percent) report having friends who smoke marijuana regularly (71 percent) – significantly higher than four years ago. Since 2008, there have also been significant declines in teen perceptions that they will lose respect, harm themselves, or mess up their lives if they use marijuana."

"The Partnership Attitude Tracking Study: 2011 Parents and Teens Full Report," MetLife Foundation and The Partnership at Drugfree.org (New York, NY: May 2, 2012), p. 7.
http://www.drugfree.org...

109. 12th Graders and Attitudes Toward Legalizing Marijuana
"• Table 8-8 lists the proportions of 12th graders in 2015 who favor various legal consequences for marijuana use: making it entirely legal (42%), a minor violation like a parking ticket but not a crime (27%), or a crime (15%). The remaining 15% said they 'don’t know.' It is noteworthy just how variable attitudes about this contentious issue are.
"• Asked whether they thought it should be legal to sell marijuana if it were legal to use it, about three in five (64%) said “yes.” However, about 86% of those answering 'yes' (55% of all respondents) would permit sale only to adults. A small minority (9%) favored the sale to anyone, regardless of age, while 23% said that sale should not be legal even if use were made legal, and 13% said they 'don’t know.' Thus, while the majority subscribe to the idea of legal sale, if use is allowed, the great majority agree with the notion that sale to underage people should not be legal.
"• Most 12th graders felt that they would be little affected personally by the legalization of either the sale or the use of marijuana. Over half (53%) of the respondents said that they would not use the drug even if it were legal to buy and use, while others indicated that they would use it about as often as they do now (14%) or less often (1%). Only 9% said they would use it more often than they do at present, while 13% thought they would try it. Another 11% said they did not know how their behavior would be affected if marijuana were legalized. Still, this amounts to 22% of all 12th graders, or about one in five, who thought that they would try marijuana, or that their use would increase, if marijuana were legalized."

Miech, R. A., Johnston, L. D., O’Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2016). Monitoring the Future national survey results on drug use, 1975–2015: Volume I, Secondary school students. Ann Arbor: Institute for Social Research, The University of Michigan. Pages 397-398. Available at
http://monitoringthefuture.org...
http://monitoringthefuture.org...

110. Disapproval of Marijuana Use Among Youth in the US
"The proportion of students seeing great risk from using marijuana regularly fell during the rise in use in the 1970s, and again during the subsequent rise in the 1990s. Indeed, at 10th and 12th grades, perceived risk declined a year before use rose in the upturn of the 1990s, making perceived risk a leading indicator of change in use. (The same may have happened at 8th grade as well, but we lack data starting early enough to know.) The decline in perceived risk halted in 1996 in 8th and 10th grades; the increases in use ended a year or two later, again making perceived risk a leading indicator. From 1996 to 2000, perceived risk held fairly steady and the decline in use in the upper grades stalled. After some decline prior to 2002, perceived risk increased in all grades through 2004 as use decreased. Perceived risk fell after 2004 and 2005 in 8th and 12th grades respectively, (and since 2008 in 10th grade) presaging the more recent increase in use. In 2011 perceived risk continued to decline in grades 10 and 12 and leveled in grade 8."

Johnston, L. D., O’Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2012). Monitoring the Future national results on adolescent drug use: Overview of key findings, 2011. Ann Arbor: Institute for Social Research, The University of Michigan, p. 12.
http://www.samhsa.gov...

111. Support for Legalized Sale of Marijuana in the US Among Youth, 2011
"Asked whether they thought it should be legal to sell marijuana if it were legal to use it, about three in five (62%) said 'yes.' However, about 80% of those answering 'yes' (51% of all respondents) would permit sale onlyto adults. A small minority (11%) favored the sale to anyone, regardless of age, while 28% said that sale should not be legal even if use were made legal, and 10% said they 'don’t know.'"

Johnston, L. D., O’Malley, P. M., Bachman, J. G., & Schulenberg, J. E., Monitoring the Future national survey results on drug use, 1975–2011: Volume I, Secondary school students," Institute for Social Research (Ann Arbor, Michigan: The University of Michigan, 2012), p. 379.
http://www.monitoringthefuture...

112. Cannabis and Adolescent Motivation
"The apparent strength of these relationships in cross-sectional studies (e.g. Kandel, 1984) has been exaggerated because those adolescents who are most likely to use cannabis have lower academic aspirations and poorer high school performance prior to using cannabis than their peers who do not (Newcombe and Bentler, 1988). It remains possible that factors other than the marijuana use account for apparent causal relations. To the extent they may exist, these adverse effects of cannabis and other drug use upon development over and above the effect of pre-existing nonconformity may cascade throughout young adult life, affecting choice of occupation, level of income, choice of mate, and the quality of life of the user and his or her children."

Hall, W., Room, R., & Bondy, S., WHO Project on Health Implications of Cannabis Use: A Comparative Appraisal of the Health and Psychological Consequences of Alcohol, Cannabis, Nicotine and Opiate Use August 28, 1995 (Geneva, Switzerland: World Health Organization, 1998).
http://www.druglibrary.net...

113. Thresholds for Serum THC Level Compared With Blood Alcohol Content
http://www.druid-project.eu...

114. Marijuana, Alcohol, and Driving
"As with cannabis, alcohol use increased variability in lane position and headway (Casswell, 1979; Ramaekers et al., 2000; Smiley et al., 1981; Stein et al., 1983) but caused faster speeds (Casswell, 1977; Krueger & Vollrath, 2000; Peck et al., 1986; Smiley et al., 1987; Stein et al., 1983). Some studies also showed that alcohol use alone and in combination with cannabis affected visual search behavior (Lamers & Ramaekers, 2001; Moskowitz, Ziedman, & Sharma, 1976). Alcohol consumption combined with cannabis use also worsened driver performance relative to use of either substance alone. Lane position and headway variability were more exaggerated (Attwood et al., 1981; Ramaekers et al., 2000; Robbe, 1998) and speeds were faster (Peck et al., 1986).
"Both simulator and road studies showed that relative to alcohol use alone, participants who used cannabis alone or in combination with alcohol were more aware of their intoxication. Robbe (1998) found that participants who consumed 100 g/kg of cannabis rated their performance worse and the amount of effort required greater compared to those who consumed alcohol (0.05 BAC). Ramaekers et al. (2000) showed that cannabis use alone and in combination with alcohol consumption increased self-ratings of intoxication and decreased self-ratings of performance. Lamers and Ramaekers (2001) found that cannabis use alone (100 g/kg) and in combination with alcohol consumption resulted in lower ratings of alertness, greater perceptions of effort, and worse ratings of performance."

Laberge, Jason C., Nicholas J. Ward, "Research Note: Cannabis and Driving -- Research Needs and Issues for Transportation Policy," Journal of Drug Issues, Dec. 2004, pp. 978.

115. Cannabis Use and Motor Vehicle Accident Risk
"Our primary analysis looked at the risk of a motor vehicle collision while under the influence of cannabis and included all nine studies (relating to 49 411 participants). The pooled risk of a motor vehicle collision while driving under the influence of cannabis was almost twice the risk while driving unimpaired (odds ratio 1.92 (95% confidence interval 1.35 to 2.73); P=0.0003); we noted heterogeneity among the individual study effects (I2=81%).
"We also assessed culpability and non-culpability studies separately and explored differences between motor vehicle collisions resulting in deaths and non-fatal injuries. Meta-analyses on subgroups of studies explored the potential effect of specific features related to study design and potential biases: case-control studies versus culpability studies, fatal collisions versus non-fatal collisions, and high quality studies versus medium quality studies (fig 3?).
"High quality studies had a pooled odds ratio that was higher than that for medium quality studies, although both results showed a significant association at the 0.05 level. Furthermore, case-control studies (2.79 (1.23 to 6.33); P=0.01) estimated the effect of cannabis use on crash risk to be higher than that estimated by culpability studies (1.65 (1.11 to 2.46); P=0.07). Studies of fatal collisions (2.10 (1.31 to 3.36); P=0.002) had a pooled odds ratio that was statistically significant, but studies of non-fatal collisions (1.74 (0.88 to 3.46); P=0.11) did not show significant results.
"In all studies assessing cannabis use in conjunction with alcohol, the estimated odds ratio for cannabis and alcohol combined was higher than for cannabis use alone, suggesting the presence of a synergistic effect."

Asbridge, Mark, et al., "Acute Cannabis Consumption and Motor Vehicle Collision Risk: Systematic Review of Observational Studies and Meta-analysis," British Medical Journal, 2012;344:e536 doi: 10.1136/bmj.e536 (Published 9 February 2012).
http://www.bmj.com...

116. Estimated Prevalence Of Substance Use Among Drivers In Fatal Auto Accidents
"Overall, 23,591 (90.9%) of the 25,951 drivers who died within 1 hour of a crash in these 6 states underwent toxicological testing. Drivers who were tested for drugs were similar in crash circumstances to those who were not tested, but they appeared to be slightly younger (mean age = 39.4 (standard deviation, 19.4) years vs. 43.4 (standard deviation, 27.7) years), more likely to be male (77.7% vs. 75.8%), more likely to be involved in nighttime crashes (51.4% vs. 47.0%), and more likely to have been involved in a crash in the previous 3 years (15.7% vs. 13.9%) than those who were not tested.
"Of the 23,591 drivers tested, 39.7% were positive for alcohol, and 24.8% tested positive for other drugs. The prevalence of alcohol involvement was stable at approximately 39% from 1999 to 2010 (Z = ?1.4, P = 0.16). Alcohol involvement was more prevalent in men (43.6%) than in women (26.1%), but trends were stable for both sexes (Table 1). In contrast, the prevalence of nonalcohol drugs showed a statistically significant increasing trend over the study period, rising from 16.6% (95% confidence interval (CI): 14.8, 18.4) in 1999 to 28.3% (95% CI: 26.0, 30.7) in 2010 (Z = ?10.19, P < 0.0001). The prevalence rates of non-alcohol drugs and 2 or more nonalcohol drugs increased significantly over the study period in both sexes (Table 1). The prevalence of nonalcohol drug use increased significantly across all age groups (Figure 1)."

Joanne E. Brady and Guohua Li. "Trends in Alcohol and Other Drugs Detected in Fatally Injured Drivers in the United States, 1999–2010." American Journal of Epidemiology. (2014) 179 (6): 692-699. doi: 10.1093/aje/kwt327.
http://aje.oxfordjournals.org/...

117. Cannabis Use, Alcohol Use, Smartphone Use, and Accident Risk
"Although for the mobile phone conversation and cannabis studies the reaction times were slightly different, they were still comparable. The same visual stimulus was used and was presented in the same visual scene. When reaction times under each condition were compared with the baseline reaction times measured, alcohol gave a 12.5% increase in reaction times, cannabis a 21% increase, a hands-free mobile phone conversation increased reaction times by 26.5%, texting by 37.4%, using a smartphone for social networking by 37.6% and using a mobile phone for a hand-held mobile phone conversation increased reaction times by 45.9% compared to the baseline condition. Thus, using a smartphone for social networking resulted in a greater impairment to reaction times than alcohol, cannabis, hand held mobile phone conversations and texting, but less than a hand held mobile conversation."

Basacik, D.; Reed N. & Robbins, R., "Smartphone use while driving: A simulator study," Institute of Advanced Motorists (London, United Kingdom: Transport Research Laboratory, 2011), pp. 37-38.
http://www.iam.org.uk...

118. Odds Of Involvement In Fatal Auto Accidents Associated With Use Of Various Substances
"The prevalence of drugs detected in cases was higher than in controls across the drug categories (Table 3). Marijuana, narcotics, stimulants, and depressants were each associated with a significantly increased risk of fatal crash involvement, with estimated odds ratios ranging from 1.83 for marijuana to 4.83 for depressants (Table 3). Polydrug use, defined as use of two or more non-alcohol drugs, was associated with a 3.4-fold increased risk of fatal crash involvement (Table 3).
"About one-fifth (20.5%) of the cases tested positive for alcohol and one or more drugs, compared with 2.2% of the controls. Relative to drivers who tested positive for neither alcohol nor drugs, the estimated odds of fatal crash involvement increased over 13 folds for those who were alcohol-positive but drug-negative, more than two folds for those who were alcohol-negative but drug-positive, and 23 folds for those who were positive for both alcohol and drugs (Table 4)."

Guohua Li, Joanne E. Brady, and Qixuan Chen. Drug use and fatal motor vehicle crashes: A case-control study. Accident Analysis and Prevention 60 (2013) 205–210.
http://dx.doi.org...
http://www.cuinjuryresearch.org...

119. Times for THC Absorption, Bioavailability, and Excretion
"Absorption is slower following the oral route of administration with lower, more delayed peak THC levels. Bioavailability is reduced following oral ingestion due to extensive first pass metabolism. Smoking marijuana results in rapid absorption with peak THC plasma concentrations occurring prior to the end of smoking. Concentrations vary depending on the potency of marijuana and the manner in which the drug is smoked, however, peak plasma concentrations of 100-200 ng/mL are routinely encountered. Plasma THC concentrations generally fall below 5 ng/mL less than 3 hours after smoking. THC is highly lipid soluble, and plasma and urinary elimination half-lives are best estimated at 3-4 days, where the rate-limiting step is the slow redistribution to plasma of THC sequestered in the tissues. Shorter half-lives are generally reported due to limited collection intervals and less sensitive analytical methods. Plasma THC concentrations in occasional users rapidly fall below limits of quantitation within 8 to 12 h. THC is rapidly and extensively metabolized with very little THC being excreted unchanged from the body. THC is primarily metabolized to 11-hydroxy-THC which has equipotent psychoactivity. The 11-hydroxy-THC is then rapidly metabolized to the 11-nor-9-carboxy-THC (THC-COOH) which is not psychoactive. A majority of THC is excreted via the feces (~65%) with approximately 30% of the THC being eliminated in the urine as conjugated glucuronic acids and free THC hydroxylated metabolites."

Couper, Fiona J., Logan, Barry K., et al., "Drugs and Human Performance Fact Sheets," (Washington, DC: National Highway Traffic Safety Administration, April 2004), p. 8.
http://www.nhtsa.gov...

120. Cannabis Use and Motor Vehicle Accident Risk
"We found only limited evidence to support the claim that cannabis use increases accident risk. Participants who had driven under the influence of cannabis in the previous year appeared to be no more likely than drug-free drivers to report that they had had an accident in the previous 12 months. Prima facie, this would seem to suggest that cannabis-intoxicated driving is not a risk factor for non-fatal accidents. In this sense, the results would support those of Longo et al. (2000b) who found no relationship between recent cannabis use and driver culpability for non-fatal accidents."

Jones, Craig; Donnelly, Neil; Swift, Wendy; Weatherburn, Don, "Driving under the influence of cannabis: The problem and potential countermeasures," Crime and Justice Bulletin, NSW Bureau of Crime Statistics and Research (Syndey, Australia: September 2005). p. 11.
http://www.lawlink.nsw.gov.au...

121. THC and Cannabis Dosages
"THC is the major psychoactive constituent of cannabis. Potency is dependent on THC concentration and is usually expressed as %THC per dry weight of material. Average THC concentration in marijuana is 1-5%, hashish 5-15%, and hashish oil ³ 20%. The form of marijuana known as sinsemilla is derived from the unpollinated female cannabis plant and is preferred for its high THC content (up to 17% THC). Recreational doses are highly variable and users often titer their own dose. A single intake of smoke from a pipe or joint is called a hit (approximately 1/20th of a gram). The lower the potency or THC content the more hits are needed to achieve the desired effects; 1-3 hits of high potency sinsemilla is typically enough to produce the desired effects. In terms of its psychoactive effect, a drop or two of hash oil on a cigarette is equal to a single “joint” of marijuana. Medicinally, the initial starting dose of Marinol® is 2.5 mg, twice daily."

Couper, Fiona J., Logan, Barry K., et al., "Drugs and Human Performance Fact Sheets," (Washington, DC: National Highway Traffic Safety Administration, April 2004), p. 7.
http://www.nhtsa.gov...

122. Cannabis Use and Motor Vehicle Accident Risk
"A review of over a dozen of these [laboratory] experiments reveals three findings. First, after using marijuana, people drive more slowly. In addition, they increase the distance between their cars and the car in front of them. Third, they are less likely to attempt to pass other vehicles on the road. All of these practices can decrease the chance of crashes and certainly limit the probability of injury or death if an accident does occur. These three habits may explain the slightly lower risk of accidents that appears in the epidemiological studies. These results contrast dramatically to those found for alcohol. Alcohol intoxication often increases speed and passing while decreasing following distance, and markedly raises the chance of crashes.(632)"

"Rulemaking petition to reclassify cannabis for medical use from a Schedule I controlled substance to a Schedule II, Exhibit B: Statement of Grounds," Prepared by Carter, Gregory T.; Earleywine, Mitchell; and McGill, Jason T. (Office of Lincoln D. Chafee, Governor Rhode Island and Office of Christine O. Gregoire, Governor of Washington, November 30, 2011), Filed With US Drug Enforcement Administration on November 30, 2011, p. 37.
http://www.digitalarchives.wa.gov...

123. Cannabis Use and Motor Vehicle Accident Risk
"Cannabis use impairs cognitive, memory and psycho-motor performance in ways that may impair driving.10Recent data suggest that approximately 5% of Canadian drivers/adults report driving after cannabis use in the past year.39 Large-scale epidemiological studies using different methodologies (e.g., retrospective epidemiological and case control studies) have found that cannabis use acutely increases the risk of motor vehicle accident (MVA) involvement and fatal crashes among drivers.40,41 Recent reviews have found the increase in risk to be approximately 1.5-3.0, an increase which is substantially lower, however, than that in alcohol-impaired drivers. The impairment from concurrent alcohol and cannabis use may be multiplicative, so individuals who drive under the influence of both drugs may be at higher risk for MVAs.42 An expert consensus view was that a THC concentration of 7-10 nanograms per millilitre in serum would produce impairment equivalent to that of 0.05% blood alcohol content (BAC). It was suggested that this level could serve as a 'per se' limit to define cannabis-impaired driving.43 Current research suggests that acute impairment from cannabis typically clears 3-4 hours after use.44
"This time span could be recommended to users as a minimum wait period before driving. The required wait before driving would need to be longer for higher doses, and would also vary on the basis of individual variation."

Fischer, Benedikt; Jeffries, Victoria; Hall, Wayne; Room, Robin; Goldner, Elliot; Rehm, Jürgen, "Lower Risk Cannabis Use Guidelines for Canada (LRCUG): A Narrative Review of Evidence and Recommendations," Canadian Journal of Public Health (Ottawa, Ontario: Canadian Public Health Association, September/October 2011) Vol. 102, No. 5, p. 325.
http://journal.cpha.ca...

124. Cannabis Use and Driving Impairment
"There is considerable evidence from laboratory studies that cannabis (marijuana) impairs reaction time, attention, tracking, hand-eye coordination, and concentration, although not all of these impairments were equally detected by all studies (Couper & Logan, 2004a; Heishman, Stitzer, & Yingling, 1989; Gieringer, 1988; Moskowitz, 1985). In reviewing the literature on marijuana, Smiley (1998) concluded that marijuana impairs performance in divided attention tasks (i.e., a poorer performance on subsidiary tasks). Jones et al. (2003) adds that Smiley’s finding is relevant to the multitasking essence of driving, in particular by making marijuana impaired drivers perhaps less able to handle unexpected events. Interestingly, there is also evidence showing that, unlike alcohol, marijuana enhances rather than mitigates the individual’s perception of impairment (Lamers & Ramaekers, 1999; Robbe & O'Hanlon, 1993; Perez-Reyes, Hicks, Bumberry, Jeffcoat, & Cook, 1988). Robbe and O'Hanlon (1993) reported that in laboratory conditions, drivers under the influence of marijuana were aware of their impairment, which led them to decrease speed, avoid passing other vehicles, and reduce other risk-taking behaviors. Such was not the case with alcohol; for the authors reported that alcohol-impaired drivers were generally not aware of impairment, and therefore did not adjust their driving accordingly."

Lacey, John H.; Kelley-Baker, Tara; Furr-Holden, Debra; Voas, Robert B.; Romano, Eduardo; Ramirez, Anthony; Brainard, Katharine; Moore, Christine; Torres, Pedro; and Berning, Amy , "2007 National Roadside Survey of Alcohol and Drug Use by Drivers," Pacific Institute for Research and Evaluation (Calverton, MD: National Highway Traffic Safety Administration, December 2009), p. 9.
http://www.nhtsa.gov...

125. Driving After Cannabis Consumption
"Cannabis is only considered a risk factor for traffic accidents if drivers operate vehicles after consuming the drug. Robbe (1994) found that 30% to 90% of his participants were willing to drive after consuming a typical dose of cannabis. This is consistent with a recent Australian survey in which more than 50% of users drove after consuming cannabis (Lenne, Fry, Dietze, & Rumbold, 2000). A self administered questionnaire given to 508 students in grades 10 to 13 in Ontario, Canada, found that 19.7% reported driving within an hour after using cannabis (Adlaf, Mann, & Paglia, 2003)."

Laberge, Jason C., Nicholas J. Ward, "Research Note: Cannabis and Driving -- Research Needs and Issues for Transportation Policy," Journal of Drug Issues (Tallahassee, FL: School of Criminology & Criminal Justice, Florida State University, 2004) Volume 34, Number 4, pp. 974-5.
http://www2.criminology.fsu.edu...

126. Cannabis and Driving Impairment
"Participants receiving active marijuana decreased their speed more so than those receiving the placebo cigarette during a distracted section of the drive, An overall effect of marijuana was seen for the mean speed during the distracted driving (PASAT [Paced Auditory Serial-Addition Test] section), While no other changes in driving performance were found, marijuana appeared to hinder practice effects on the PASAT task, suggesting individuals may not be able to adequately use information and experience previously acquired while under the influence of marijuana, While only minimal differences in driving performance were found, this failure to benefit from prior practice may be detrimental to driving performance. Research has shown that graduated driver's licensing programs in which participants receive more on the road training results in a decrease in fatal crashes in 16-year-olds (Baker, Chen & Li 2006), If marijuana indeed impairs one's ability to use prior experience to improve performance, this will likely impair driving under pretrained conditions (e,g,, steering into a skid, allowing increased stopping time on slippery roads, etc)."

Anderson, Beth M.; Rizzo, Matthew; Block, Robert I.; Pearlson, Godfrey D.; O'Leary, Daniel S., "Sex differences in the effects of marijuana on simulated driving performance," Journal of Psychoactive Drugs (San Francisco, CA: Haight Ashbury Publications, March 1, 2010), Vol. 42, No. 1.
http://www.thefreelibrary.com...

127. Cannabis and Driving Impairment
"The present study's subtle finding of decreased speed under the influence of acute marijuana is generally consistent with the literature, which has found that marijuana's effects on driving can be subtle. In Berghaus's review of the literature prior to 1995, 45% of driving simulator studies showed no impairment from marijuana within the first hour after use (Berghaus, Scheer & Schmidt 1995), More cautious driving behaviors were found in several studies (Lamers & Ramaekers 2001; Stein et al, 1983; Ellingstad, McFarling & Struckman 1973; Rafaelsen, Bech & Rafaelsen 1973; Dott 1972), while an increased reaction time for stopping was the most common finding (Liguori, Gatto & Robinson 1998; Rafaelsen, Bech & Rafaelsen 1973), Moskowitz, Ziedman and Sharma (1976) also found slowed reaction times for a visual choice-reaction time task administered while driving and Smiley, Moskowitz and Zeidman (1981) found increased variability in velocity and lateral position while following curves and while controlling the car in gusts of wind with a high dose of marijuana (200 mcg/kg THC) but not with a lower dose (100 mcg/kg THC), They also found an increase in variability of headway and lateral position while following other cars."

Anderson, Beth M.; Rizzo, Matthew; Block, Robert I.; Pearlson, Godfrey D.; O'Leary, Daniel S., "Sex differences in the effects of marijuana on simulated driving performance," Journal of Psychoactive Drugs (San Francisco, CA: Haight Ashbury Publications, March 1, 2010), Vol. 42, No. 1.
http://www.thefreelibrary.com...

128. Marijuana and Driving - More Data Needed
"The decreased speed during the simulated drive could be interpreted as an attempt to compensate for perceived cognitive impairment, Alternatively, marijuana may not have affected decision making and judgment and the reduction in speed would improve safety margins, While the clinical significance of a 3% to 5% decrease in speed may be questioned, previous research suggests such a decrease will result in approximately a 7% decrease in all injuries and a 15% decrease in fatalities (Nilsson 1981), Use of an alternate task design in which subjects are requested to drive as quickly and as safely as possible rather than following a posted speed limit may provide more insight into compensatory strategies employed while driving under the influence of marijuana, Use of a more challenging road paradigm (e.g., icy or gravel roads) which capitalizes on the use of practice effects may aid in identifying differences in driving performance under the influence of marijuana, There was significant between-subject variability in driving measures and future studies would be further strengthened by using a within-subjects design."

Anderson, Beth M.; Rizzo, Matthew; Block, Robert I.; Pearlson, Godfrey D.; O'Leary, Daniel S., "Sex differences in the effects of marijuana on simulated driving performance," Journal of Psychoactive Drugs (San Francisco, CA: Haight Ashbury Publications, March 1, 2010), Vol. 42, No. 1.
http://www.thefreelibrary.com...

129. Cannabis and Driving
"Epidemiological studies have been inconclusive regarding whether cannabis use causes an increased risk of motor vehicle accidents; in contrast, unanimity exists that alcohol use increases crash risk.30 In tests using driving simulation, neurocognitive impairment varies in a dose-related fashion, and symptoms are more pronounced with highly automatic driving functions than with more complex tasks that require conscious control.31 Cannabis smokers tend to over-estimate their impairment and compensate effectively while driving by utilizing a variety of behavioral strategies."

"Cannabis and the Regulatory Void: Background Paper and Recommendations," California Medical Association (Sacramento, CA: 2011), p. 10.
http://www.cmanet.org...

130. Marijuana, Alcohol, and Driving
"When compared to alcohol, cannabis is detected far less often in accident-involved drivers. Drummer et al. (2003) cited several studies and found that alcohol was detected in 12.5% to 79% of drivers involved in accidents. With regard to crash risk, a large study conducted by Borkenstein, Crowther, Shumate, Zeil and Zylman (1964) compared BAC in approximately 6,000 accident-involved drivers and 7,600 nonaccident controls. They determined the crash risk for each BAC by comparing the number of accident-involved drivers with detected levels of alcohol at each BAC to the number of nonaccident control drivers with the same BAC. They found that crash risk increased sharply as BAC increased. More specifically, at a BAC of 0.10, drivers were approximately five times more likely to be involved in an accident.
"Similar crash risk results were obtained when data for culpable drivers were evaluated. Drummer (1995) found that drivers with detected levels of alcohol were 7.6 times more likely to be culpable. Longo et al. (2000) showed that drivers who tested positive for alcohol were 8.0 times more culpable, and alcohol consumption in combination with cannabis use produced an odds ratio of 5.4. Similar results were also noted by Swann (2000) and Drummer et al. (2003)."

Laberge, Jason C., Nicholas J. Ward, "Research Note: Cannabis and Driving -- Research Needs and Issues for Transportation Policy," Journal of Drug Issues, Dec. 2004, pp. 981.
http://www2.criminology.fsu.edu...

131. Cannabis Substitution Effects
"Another paradigm used to assess crash risk is to use cross-sectional surveys of reported nonfatal accidents that can be related to the presence of risk factors, such as alcohol and cannabis consumption. Such a methodology was employed in a provocative dissertation by Laixuthai (1994). This study used data from two large surveys that were nationally representative of high school students in the United States during 1982 and 1989. Results showed that cannabis use was negatively correlated with nonfatal accidents, but these results can be attributed to changes in the amount of alcohol consumed. More specifically, the decriminalization of cannabis and the subsequent reduction in penalty cost, as well as a reduced purchase price of cannabis, made cannabis more appealing and affordable for young consumers. This resulted in more cannabis use, which substituted for alcohol consumption, leading to less frequent and less heavy drinking. The reduction in the amount of alcohol consumed resulted in fewer nonfatal accidents."

Laberge, Jason C., Nicholas J. Ward, "Research Note: Cannabis and Driving -- Research Needs and Issues for Transportation Policy," Journal of Drug Issues (Tallahassee, FL: School of Criminology & Criminal Justice, Florida State University, 2004) Volume 34, Number 4, pp. 974-5.
http://www2.criminology.fsu.edu...

132. Driving and THC Levels
"Most of the research on cannabis use has been conducted under laboratory conditions. The literature reviews by Robbe (1994), Hall, Solowij, and Lemon (1994), Border and Norton (1996), and Solowij (1998) agreed that the most extensive effect of cannabis is to impair memory and attention. Additional deficits include problems with temporal processing, (complex) reaction times, and dynamic tracking. These conclusions are generally consistent with the psychopharmacological effects of cannabis mentioned above, including problems with attention, memory, motor coordination, and alertness.
"A meta-analysis by Krüger and Berghaus (1995) profiled the effects of cannabis and alcohol. They reviewed 197 published studies of alcohol and 60 studies of cannabis. Their analysis showed that 50% of the reported effects were significant at a BAC of 0.073 g/dl and a THC level of 11 ng/ml. This implies that if the legal BAC threshold for alcohol is 0.08 g/dl, the corresponding level of THC that would impair the same percentage of tests would be approximately 11 ng/ml."

Laberge, Jason C., Nicholas J. Ward, "Research Note: Cannabis and Driving -- Research Needs and Issues for Transportation Policy," Journal of Drug Issues (Tallahassee, FL: School of Criminology & Criminal Justice, Florida State University, 2004) Volume 34, Number 4, pp. 974-5.
http://www2.criminology.fsu.edu...

133. Cannabis and Driving Performance
"Several studies have examined cannabis use in driving simulator and on-road situations. The most comprehensive review was done by Smiley in 1986 and then again in 1999. Several trends are evident and can be described by three general performance characteristics:
"1. Cannabis increased variability of speed and headway as well as lane position (Attwood, Williams, McBurney, & Frecker, 1981; Ramaekers, Robbe, & O'Hanlon, 2000; Robbe, 1998; Sexton et al., 2000; Smiley, Moskowitz, & Zeidman, 1981; Smiley, Noy, & Tostowaryk, 1987). This was more pronounced under high workload and unexpected conditions, such as curves and wind gusts.
"2. Cannabis increased the time needed to overtake another vehicle (Dott, 1972 [as cited in Smiley, 1986]) and delayed responses to both secondary and tracking tasks (Casswell, 1977; Moskowitz, Hulbert, & McGlothlin,
1976; Sexton et al., 2000; Smiley et al., 1981).
"3. Cannabis resulted in fewer attempts to overtake another vehicle(Dott, 1972) and larger distances required to pass (Ellingstad et al., 1973 [as cited in Smiley, 1986]). Evidence of increased caution also included slower speeds (Casswell, 1977; Hansteen, Miller, Lonero, Reid, & Jones, 1976; Krueger & Vollrath, 2000; Peck, Biasotti, Boland, Mallory, & Reeve, 1986; Sexton et al., 2000; Smiley et al., 1981; Stein, Allen, Cook, & Karl, 1983) and larger headways (Robbe, 1998; Smiley et al., 1987)."

Laberge, Jason C., Nicholas J. Ward, "Research Note: Cannabis and Driving -- Research Needs and Issues for Transportation Policy," Journal of Drug Issues (Tallahassee, FL: School of Criminology & Criminal Justice, Florida State University, 2004) Volume 34, Number 4, pp. 974-5.
http://www2.criminology.fsu.edu...

134. Marijuana, Alcohol, Intoxication Self-Ratings, and Driving Performance
"Both simulator and road studies showed that relative to alcohol use alone, participants who used cannabis alone or in combination with alcohol were more aware of their intoxication. Robbe (1998) found that participants who consumed 100 g/kg of cannabis rated their performance worse and the amount of effort required greater compared to those who consumed alcohol (0.05 BAC). Ramaekers et al. (2000) showed that cannabis use alone and in combination with alcohol consumption increased self-ratings of intoxication and decreased self-ratings of performance. Lamers and Ramaekers (2001) found that cannabis use alone (100 g/kg) and in combination with alcohol consumption resulted in lower ratings of alertness, greater perceptions of effort, and worse ratings of performance."

Laberge, Jason C., Nicholas J. Ward, "Research Note: Cannabis and Driving -- Research Needs and Issues for Transportation Policy," Journal of Drug Issues (Tallahassee, FL: School of Criminology & Criminal Justice, Florida State University, 2004) Volume 34, Number 4, pp. 974-5.
http://www2.criminology.fsu.edu...

135. Driving Behavioral Compensation
"Both Australian studies suggest cannabis may actually reduce the responsibility rate and lower crash risk. Put another way, cannabis consumption either increases driving ability or, more likely, drivers who use cannabis make adjustments in driving style to compensate for any loss of skill (Drummer, 1995). This is consistent with simulator and road studies that show drivers who consumed cannabis slowed down and drove more cautiously (see Ward & Dye, 1999; Smiley, 1999. This compensation could help reduce the probability of being at fault in a motor vehicle accident since drivers have more time to respond and avoid a collision. However, it must be noted that any behavioral compensation may not be sufficient to cope with the reduced safety margin resulting from the impairment of driver functioning and capacity."

Laberge, Jason C., Nicholas J. Ward, "Research Note: Cannabis and Driving -- Research Needs and Issues for Transportation Policy," Journal of Drug Issues (Tallahassee, FL: School of Criminology & Criminal Justice, Florida State University, 2004) Volume 34, Number 4, pp. 974-5.
http://www2.criminology.fsu.edu...

136. Mediation of Cannabis Impairment
"In conclusion, cannabis impairs driving behaviour. However, this impairment is mediated in that subjects under cannabis treatment appear to perceive that they are indeed impaired. Where they can compensate, they do, for example, by not overtaking, by slowing down and by focusing their attention when they know a response will be required. However, such compensation is not possible where events are unexpected or where continuous attention is required. Effects of driving behaviour are present up to an hour after smoking but do not continue for extended periods."
"Thus, not only is it problematic to estimate the percentage of accident involvements associated with cannabis use alone, there is no evidence that impairment resulting from cannabis use causes accidents. Attempts to alleviate these problems by calculating risk of culpability for an accident (rather than the risk of having an accident) suggest that cannabis may actually reduce responsibility for accidents."

Department for Transport, "Cannabis and driving: a review of the literature and commentary (No.12)," (London, United Kingdom: May 2000).
http://mapinc.org...

137. U.S. Penal Code violations for marijuana and possible sentences
http://frwebgate.access.gpo.gov...
http://mapinc.org...

138. Harms of Cannabis Versus Harms of Prohibition
"Based on the research to date, the harms associated with the actual use of cannabis likely pale in comparison with the widely observed harms attributable to cannabis prohibition. As such, policymakers should integrate the scientific research conducted on the likely impacts of current prohibitive approaches to cannabis use into the process of optimising cannabis policy."

Werb, Daniel; Fischer, Benedikt; and Wood, Evan, "Cannabis policy: Time to move beyond the psychosis debate," International Journal of Drug Policy (London, United Kingdom: International Harm Reduction Association: July 2010) Vol. 21, Issue 4, p. 262.
http://www.ncbi.nlm.nih.gov...

139. Cannabis in Canada
"RECOMMENDATIONS
"1. The severity of punishment for a cannabis possession charge should be reduced. Specifically, cannabis possession should be converted to a civil violation under the Contraventions Act.
"The current law involves considerable enforcement and other criminal justice costs, as well as adverse consequences to individual drug offenders, with little evidence of a substantial deterrent impact on cannabis use, and at best marginal benefits to the public health and safety of Canadians. As a minimal measure, jail should be removed as a sentencing option for cannabis possession. The available evidence indicates that removal of jail as a sentencing option would lead to considerable cost savings without leading to increases in rates of cannabis use. Punishing cannabis possession with a fine only would be consistent with current practices and prevailing public opinion."

Single, Eric, "Cannabis Control in Canada: Options Regarding Possession" National Working Group on Addictions Policy (Ottawa, Canada: Canadian Centre on Substance Abuse, May 1998).
http://www.druglibrary.net...

140. The Netherlands and Depenalization of Cannabis Use
"There is no evidence that the depenalization component of the 1976 policy, per se, increased levels of cannabis use. On the other hand, the later growth in commercial access to cannabis, after de facto legalization, was accompanied by steep increases in use, even among youth. In interpreting that association, three points deserve emphasis. First, the association may not be causal; we have already seen that recent increases occurred in the United States and Oslo despite very different policies. Second, throughout most of the first two decades of the 1976 policy, Dutch use levels have remained at or below those in the United States. And third, it remains to be seen whether prevalence levels will drop again in response to the reduction to a 5-g limit, and to recent government efforts to close down coffee shops and more aggressively enforce the regulations."

MacCoun, Robert and Reuter, Peter, "Interpreting Dutch Cannabis Policy: Reasoning by Analogy in the Legalization Debate," Science (New York, NY: American Association for the Advancement of Science, October 3, 1997), pp. 50-51.
http://faculty.publicpolicy.um...

141. Real Risk of Arrest for Marijuana Possession in the US
"It is also important to point out that in no Western country is a user at much risk of being criminally penalized for using marijuana. The rates of arrest for past-year marijuana users in Western countries are typically less than or equal to 3 percent (Kilmer, 2002; Room et al., 2010). More important, almost none of those convicted of simple possession is incarcerated or receives a fine exceeding $1,000 (Pacula, MacCoun, et al., 2005)."

Kilmer, Beau; Caulkins, Jonathan P.; Pacula, Rosalie Liccardo; MacCoun, Robert J.; Reuter, Peter H., "Altered State? Assessing How Marijuana Legalization in California Could Influence Marijuana Consumption and Public Budgets" Drug Policy Research Center (Santa Monica, CA: RAND Corporation, 2010), p. 13.
http://www.rand.org...

142. Marijuana Use Rates and Decriminalization
"In California and Ohio, surveys before and after decriminalisation showed that cannabis use increased, but not at a greater rate than in US states which had not decriminalised cannabis. Single (1989) also reviewed data from two large US national surveys of drug use in the 1970s that compared rates of cannabis use in states which had and had not decriminalised cannabis. He found that the prevalence of cannabis use increased in all states, with a larger increase in those states which had not decriminalised (Single, 1989)."

Donnelly, Neil; Hall, Wayne; Christie, Paul, "Cannabis Expiation Notice Scheme on levels and patterns of cannabis use in South Australia: evidence from the National Drug Strategy Household Surveys 1985–1995," Department of Health and Aged Care (Canberra, Australia: May 1998), p. 12.
health.gov.au...

143. Federal Source of Legal Cannabis
"In 1968, the National Institute of Mental Health began funding a Drug Supply Program to provide researchers with compounds necessary to conduct biomedical research. Initially, the program focused on THC and other naturally occurring cannabinoids, and then gradually expanded to a wide range of compounds. (Since its beginning, the program has synthesized or obtained over 1,500 different compounds that have been supplied to over 2,500 researchers.) Cannabis was among the first substances to be made available through the Drug Supply Program for use by scientists conducting both nonhuman research and human research under a variety of investigational new drug protocols. It was grown through a contract with the University of Mississippi. With its establishment in 1974, NIDA became the successor to NIMH as the administrator of the cannabis contract and the sole U.S. source for legal cannabis."

"Provision of Marijuana and Other Compounds For Scientific Research - Recommendations of The National Institute on Drug Abuse National Advisory Council," National Institute on Drug Abuse (Bethesda, MD: Department of Health and Human Services, National Institutes of Health, January 1998).
http://archives.drugabuse.gov/...

144. Recommendation by the Canadian Senate's Special Committee on Illegal Drugs
"... the Government of Canada amend the Controlled Drugs and Substances Act to create a criminal exemption scheme. This legislation should stipulate the conditions for obtaining licenses as well as for producing and selling cannabis; criminal penalties for illegal trafficking and export; and the preservation of criminal penalties for all activities falling outside the scope of the exemption scheme."

"Cannabis: Our Position for a Canadian Public Policy," report of the Canadian Senate Special Committee on Illegal Drugs (Ottawa, Canada: Senate of Canada, September 2002), p. 46.
http://www.parl.gc.ca...

145. UK Police Foundation
"Our conclusion is that the present law on cannabis produces more harm than it prevents. It is very expensive of the time and resources of the criminal justice system and especially of the police. It inevitably bears more heavily on young people in the streets of inner cities, who are also more likely to be from minority ethnic communities, and as such is inimical to police-community relations. It criminalizes large numbers of otherwise law-abiding, mainly young, people to the detriment of their futures. It has become a proxy for the control of public order; and it inhibits accurate education about the relative risks of different drugs including the risks of cannabis itself."

Police Foundation of the United Kingdom, "Drugs and the Law: Report of the Independent Inquiry into the Misuse of Drugs Act of 1971", April 4, 2000. The Police Foundation, based in London, England, is a nonprofit organization presided over by Charles, Crown Prince of Wales, which promotes research, debate and publication to improve the efficiency and effectiveness of policing in the UK.

146. 1972 National Commission on Marihuana and Drug Abuse
http://druglibrary.net...

147. 1972 National Commission on Marihuana and Drug Abuse
"Marihuana's relative potential for harm to the vast majority of individual users and its actual impact on society does not justify a social policy designed to seek out and firmly punish those who use it. This judgment is based on prevalent use patterns, on behavior exhibited by the vast majority of users and on our interpretations of existing medical and scientific data. This position also is consistent with the estimate by law enforcement personnel that the elimination of use is unattainable."

Shafer, Raymond P., et al, Marihuana: A Signal of Misunderstanding, Ch. V, (Washington DC: National Commission on Marihuana and Drug Abuse, 1972).
http://druglibrary.net...

148. Marijuana Decriminalization and Prevalence of Use
"Proponents of criminalization attribute to their preferred drug-control regime a special power to affect user behavior. Our findings cast doubt on such attributions. Despite widespread lawful availability of cannabis in Amsterdam, there were no differences between the 2 cities [Amsterdam and San Francisco] in age at onset of use, age at first regular use, or age at the start of maximum use."
"Our findings do not support claims that criminalization reduces cannabis use and that decriminalization increases cannabis use."

Reinarman, Craig; Cohen, Peter D.A.; Kaal, Hendrien L., "The Limited Relevance of Drug Policy: Cannabis in Amsterdam and in San Francisco," American Journal of Public Health (Washington, DC: American Public Health Association, May 2004) Vol 94, No. 5, pp. 840 and 841.
http://ajph.aphapublications.org...

149. Cannabis Substitution Treatment
"Only orally given THC and, to a lesser extent, nefazodone have shown promise [in treating marijuana dependence]. THC reduced craving and ratings of anxiety, feelings of misery, difficulty sleeping, and chills (Haney et al., 2004). In addition, participants could not distinguish active THC from placebo. These findings were replicated in an outpatient study, which found that a moderate oral dosage of THC (10 mg, three times daily) suppressed many marijuana withdrawal symptoms and that a higher dosage (30 mg, three times daily) almost completely abolished withdrawal symptoms (Budney et al., 2007)."

Budney, Alan J.; Roffman, Roger; Stephens, Robert S.; Walker, Denise, "Marijuana Dependence and Its Treatment," Addiction Science & Clinical Practice (Rockville, MD: National Institute on Drug Abuse, December 2007), p. 11.
https://www.ncbi.nlm.nih.gov/p...

150. Decriminalization and Use Rates
"The available evidence suggests that removal of the prohibition against possession itself (decriminalization) does not increase cannabis use. In addition to the Dutch experience from 1976 to 1983, we have similar findings from analysis of weaker decriminalization (with fines retained for the offense of simple possession of small quantities) in 12 US states (Single, 1989) and South Australia and the Australian Capital Territory (Hall, 1997; McGeorge & Aitken, 1997). The fact that Italy and Spain, which have decriminalized possession for all psychoactive drugs, have marijuana use rates comparable to those of neighboring countries provides further support."

MacCoun, Robert and Reuter, Peter, "Evaluating alternative cannabis regimes," British Journal of Psychiatry (London, United Kingdom: American Royal College of Psychiatrists, February, 2001) Vol. 178, p. 127.
http://bjp.rcpsych.org...

151. NIDA Cannabis for Research
"Under the current contract with the University of Mississippi for any given year NIDA [National Institute on Drug Abuse] has the option to grow either 1.5 or 6.5 acres of cannabis, or to not grow any at all, depending on research demand. Generally, 1.5 acres are grown in alternate years. The number of cannabis cigarettes produced from 1.5 acres is about 50,000-60,000, although it can be higher. Cigarettes are produced in three potencies: strength 1 - 3-4 %; strength 2 - 1.8-2.2 %; and strength 3 - placebo, as close to 0% as possible. During the past three years, the following quantities have been shipped: 1994 - 24,000 cigarettes; 1995 - 23, 100 - cigarettes; and 1996 17,700 cigarettes. Virtually all of the cigarettes shipped in the last three years have been for single patient INDs. As of March 1997 there were 278, 100 cigarettes in stock. The cigarettes are maintained in frozen storage and have a useful life of approximately five years."

"Provision of Marijuana and Other Compounds For Scientific Research - Recommendations of The National Institute on Drug Abuse National Advisory Council," National Institute on Drug Abuse (Bethesda, MD: Department of Health and Human Services, National Institutes of Health, January 1998).
http://archives.drugabuse.gov...

152. Synthetic Cannabinoids
http://www.fas.org...

153. Synthetic Cannabinoids
"Synthetic cannabinoids are functionally similar to delta9-tetrahydrocannabinol (THC), the psychoactive principle of cannabis, and bind to the same cannabinoid receptors in the brain and peripheral organs."

Fattore, Liana and Fratta, Walter "Beyond THC: the new generation of cannabinoid designer drugs," Frontiers in Behaviorial Neuroscience (Lausanne, Switzerland: September 2011) Volume 5, Article 60, p. 1.
http://www.ncbi.nlm.nih.gov...

154. Use of "Spice" and Other Synthetic Cannabinoids Among Young People In The US
"MTF first addressed the use of synthetic marijuana in its 2011 survey, by asking 12th graders about their use in the prior 12 months (which would have covered a considerable period of time prior to the drugs being scheduled). Annual prevalence was found to be 11.4%, making synthetic marijuana the second most widely used class of illicit drug after marijuana among 12th graders. Despite the DEA’s intervention, use among 12th graders remained unchanged in 2012 at 11.3%, which suggests either that compliance with the new scheduling has been limited or that producers of these products have succeeded in continuing to change their chemical formulas to avoid using the ingredients that have been scheduled. In 2012 for the first time 8th and 10th graders were asked about their use of synthetic marijuana; annual prevalence rates were 4.4% and 8.8%, respectively. Use in all 3 grades dropped in 2013, but the decline was significant only among 12th graders. The 2013 rates were 4.0%, 7.4%, and 7.9% for 8th, 10th, and 12th graders, respectively. Among 8th graders, this was the third highest category of illicit drug being used after marijuana and inhalants."

Johnston, L. D., O’Malley, P. M., Miech, R. A., Bachman, J. G., & Schulenberg, J. E. (2014). Monitoring the Future national results on drug use: 1975-2013: Overview, Key Findings on Adolescent Drug Use. Ann Arbor: Institute for Social Research, The University of Michigan, p. 13.
http://www.monitoringthefuture...

155. "Spice" and Synthetic Cannabinoids
"Despite its [marijuana's] long history of use and abuse for both medical and recreational purposes, a new generation of synthetic cannabinoids has recently emerged on the market, which are sold on the Internet as herbal mixtures under the brand names of 'Spice,' 'Spice Gold,' 'Spice Diamond,' 'Arctic Spice,' 'Silver,' 'Aroma,' 'K2,' 'Genie,' 'Scene' or 'Dream,' and advertised as incense products, meditation potpourris, bath additives, or air fresheners. These products are often referred to as 'herbal highs' or 'legal highs' because of their legal status and purported natural herbal make-up."

Fattore, Liana and Fratta, Walter "Beyond THC: the new generation of cannabinoid designer drugs," Frontiers in Behaviorial Neuroscience (Lausanne, Switzerland: September 2011) Volume 5, Article 60, p. 1.
http://www.ncbi.nlm.nih.gov...

156. "Spice" and Other Herbal Highs
"‘Spice’ and other ‘herbal’ products are often referred to as ‘legal highs’ or ‘herbal highs’, in reference to their legal status and purported natural herbal make-up (McLachlan, 2009; Lindigkeit et al., 2009; Zimmermann et al., 2009). However, albeit not controlled, it appears that most of the ingredients listed on the packaging are actually not present in the ‘Spice’ products and it is seems likely that the psychoactive effects reported are most probably due to added synthetic cannabinoids, which are not shown on the label. There is no evidence that JWH, CP and/or HU [three chemically distinct groups of synthetic cannabinoids] compounds are present in all ‘Spice’ products or even batches of the same product. Different amounts or combinations of these substances seem to have been used in different ‘Spice’ products to produce cannabis-like effects. It is possible that substances from these or other chemical groups with a cannabinoid agonist or other pharmacological activity could be added to any herbal mixture (17) (Griffiths et al., 2009).
"The emergence of new, smokable herbal products laced with synthetic cannabinoids can also be seen as a significant new development in the field of so-called ‘designer drugs’. With the appearance, for the first time, of new synthetic cannabinoids, it can be anticipated that the concept of ‘designer drugs’ being almost exclusively linked to the large series of compounds with phenethylamine and tryptamine nucleus will change significantly (18). There are more than 100 known compounds with cannabinoid receptor activity and it can be assumed that further such substances from different chemical groups will appear (with direct or indirect stimulation of CB1 receptors)."

"Understanding the 'Spice' phenomenon," European Monitoring Centre for Drugs and Drug Addiction (Luxembourg: Office for Official Publications of the European Communities, 2009), p. 21.
http://www.emcdda.europa.eu...

157. Synthetic Cannabinoids K2 and "Spice"
"Clemson University Professor John Huffman is credited with first synthesizing some of the cannabinoids, such as JWH-018, now used in 'fake pot' substances such as K2. The effects of JWH-018 can be 10 times stronger than those of THC. Dr. Huffman is quoted as saying, 'These things are dangerous—anybody who uses them is playing Russian roulette. They have profound psychological effects. We never intended them for human consumption.'"

Sacco, Lisa N. and Finklea, Kristin M., "Synthetic Drugs: Overview and Issues for Congress, Congressional Research Service (Washington, DC: Library of Congress, October 28, 2011), p. 5.
http://www.fas.org...

158. Prevalence of Synthetic Cannabinoid Use Among Young People in the US
"Synthetic marijuana, so named because it contains synthetic versions of some of the cannabinoids found in marijuana, is a recent and important addition to the smorgasbord of drugs available to young people in the US. These designer chemicals are sprayed onto herbal materials that are then sold in small packets under such brand names as Spice and K-2. They have been readily available as over-the-counter drugs on the Internet and in venues like head shops and gas stations. While many of the most widely used chemicals were scheduled by the Drug Enforcement Administration in March of 2011, making their sale no longer legal, purveyors of these products have skirted the restrictions by making small changes in the chemical composition of the cannabinoids used. Use of these products was first measured in MTF in 2011 in a tripwire question for 12th graders, asking about their frequency of use in the prior 12 months (see Table 2-2). Annual prevalence was found to be 11.4%, making synthetic marijuana the second most widely used class of illicit drug after marijuana that year. In spite of the DEA’s scheduling of the most common ingredients, use among 12th graders remained unchanged in 2012, with 11.3% annual prevalence. Eighth and 10th graders were also asked about use of these drugs in 2012, and their annual prevalence levels were 4.4% and 8.8%, respectively, making synthetic marijuana the second most widely used illicit drug among 10th graders, as well, and the third among 8th graders behind marijuana and inhalants. In 2013 use dropped appreciably in all five populations, including statistically significant drops among 12th graders, college students, and young adults. These declines continued in 2014 with significant drops in prevalence among young adults, college students, 12th and 10th graders (a decline among 8th-grade students was not statistically significant). Efforts by the DEA and various states to make their sale illegal may well have had an impact. In 2015 prevalence continued to decline for 8th, 10th, and 12th grade students, although none of the one-year declines were statistically significant. Among young adults and college students prevalence has leveled, with signs of a possible reversal in course with a slight uptick of .2 points (ns) for young adults and .6 (ns) for college students. There is a relatively low level of perceived risk for trying synthetic marijuana once or twice, despite growing evidence of serious problems resulting from the use of these drugs."

Miech, R. A., Johnston, L. D., O’Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2016). Monitoring the Future national survey results on drug use, 1975–2015: Volume I, Secondary school students. Ann Arbor: Institute for Social Research, The University of Michigan, pp. 15-16. Available at http://monitoringthefuture.org...
http://monitoringthefuture.org...

159. "Spice" Prohibition
"Because of health concerns and the abuse potential of herbal incense products, many have been banned in several European countries, 18 U.S. states, and the U.S. military.33,38 In March 2011, the FDA placed 5 synthetic cannabinoids (JWH-018, JWH-073, JWH-200, CP-47,497, and cannabicyclohexanol) on Schedule I, making them illegal to possess or sell in the United States.38"

Pierre, Joseph M., "Cannabis, synthetic cannabinoids, and psychosis risk: What the evidence says," Current Psychiatry (Parsippany, NJ: September 2011) Vol. 10, No. 9, p. 56.
www.mdedge.com...

160. Scheduling of "Spice"
"On March 1, 2011, the DEA used its temporary scheduling authority and issued a final rule to place five synthetic cannabinoids on the list of controlled substances under Schedule I of the CSA.26 The five substances are
"• 1-pentyl-3-(1-naphthoyl)indole (JWH-018);
"• 1-butyl-3-(1-naphthoyl)indole (JWH-073);
"• 1-[2-(4-morpholinyl)ethyl]-3-(1-naphthoyl)indole (JWH-200);
"• 5-(1,1-dimethylheptyl)-2-[(1R,3S)-3-hydroxycyclohexyl]-phenol (CP-47,497); and
"• 5-(1,1-dimethyloctyl)-2-[(1R,3S)-3-hydroxycyclohexyl]-phenol (cannabicyclohexanol; CP-47,497 C8 homologue).
"Pursuant to the temporary scheduling authority, these substances will remain on the list of Schedule I controlled substances for one year, and then may be given one six-month temporary extension. To remain on Schedule I thereafter, the substances would need to be permanently scheduled within the CSA."

Sacco, Lisa N. and Finklea, Kristin M., "Synthetic Drugs: Overview and Issues for Congress, Congressional Research Service (Washington, DC: Library of Congress, October 28, 2011), p. 6.
http://www.fas.org...

161. State Bans on Synthetic Cannabinoids
"At this time, forty-six (46) states and the federal government have scheduled one or more synthetic cannabinoids by statute or regulation and twenty-nine (29) states have some form of the generic language. Of the four states that have not scheduled one or more of the synthetic cannabinoids, Louisiana and Nebraska include the generic language. The only two states that have not yet scheduled any of the synthetic cannabinoids or the generic language are Maryland and Rhode Island. Maryland had four bills pending this legislative session, but was unable to get legislation passed before the session adjourned. There is still a regulation pending in Maryland that would schedule certain cannabinoids. The District of Columbia also has legislation pending. Rhode Island, however, does not have anything pending at this time."

Gray, Heather, "An Introduction to Synthetic Drugs," National Alliiance for Model State Drug Laws (Santa Fe, NM: June 2012), p. 11.
http://www.namsdl.org...

162. Schedule One and Limits on Research
"There is shared concern among researchers that adding these substances to Schedule I could hinder medical research. As previously mentioned, Professor Huffman did not intend for K2 to be consumed by humans. He is, however, against adding synthetic cannabinoids to Schedule I, asserting that there is still much to learn about synthetic cannabinoids and that placing them on Schedule I would create too many hurdles for researchers who need to access these drugs.58 Professor Huffman has created several synthetic cannabinoids that are seen as showing promise in treating skin cancers, pain, and inflammation."

Sacco, Lisa N. and Finklea, Kristin M., "Synthetic Drugs: Overview and Issues for Congress, Congressional Research Service (Washington, DC: Library of Congress, October 28, 2011), p. 13.
http://www.fas.org...

163. Testing for Use of Synthetic Cannabinoids
"Most of the synthetic cannabinoids added as not-listed ingredients to Spice products are very difficult to detect by commonly used drug screening procedures. Apart from the analogs of THC such as HU-210, the structure of these new synthetic cannabinoids differs from that of THC, so that they probably will not trigger a positive test for cannabinoids in immunoassays of body fluids."

Fattore, Liana and Fratta, Walter "Beyond THC: the new generation of cannabinoid designer drugs," Frontiers in Behaviorial Neuroscience (Lausanne, Switzerland: September 2011) Volume 5, Article 60, p. 4.
http://www.ncbi.nlm.nih.gov...

164. Monitoring of Spice and New Psychoactive Substances
"A dramatic online snapshot of the Spice phenomenon as an emerging trend has been recently given by an important web mapping program, the Psychonaut Web Mapping Project, a European Commission-funded project involving researchers from seven European countries (Belgium, Finland, Germany, Italy, Norway, Spain, and UK), which aims to develop a web scanning system to identify newly marketed psychoactive compounds, and their combinations (e.g., ketamine and Spice, cannabis and Spice), on the basis of the information available on the Internet (Psychonaut Web Mapping Research Group, 2010). As a major result of the Project, a new and updated web-based database is now widely accessible to implement a regular monitoring of the web for novel and recreational drugs."

Fattore, Liana and Fratta, Walter "Beyond THC: the new generation of cannabinoid designer drugs," Frontiers in Behaviorial Neuroscience (Lausanne, Switzerland: September 2011) Volume 5, Article 60, p. 3.
http://www.ncbi.nlm.nih.gov...

165. Cannabis Prohibition Ineffective
http://www.cfenet.ubc.ca...

166. Taxonomy of Cannabis
"The biological (reproductive) definition of a species states that all specimens of a population are of a single species if they are naturally able to sexually reproduce, generating fertile offspring. This is the case throughout the genus Cannabis, and by this definition, therefore, there are no clear biological grounds to separate it into different species.However, within the species Cannabis sativa L., several subspecies are sometimes identified (Small and Cronquist, 1976).
"Despite this, modern Cannabis taxonomy remains confused, as a scientific minority prefers to define species according to their typological or morphological characteristics. In 1974, Schultes et al. described three putative species, Cannabis sativa L. (a typically tall species used for fibre, seed or psychoactive use), Cannabis indica Lam. (a short, wide-leafed plant from Afghanistan, used to produce resin) and Cannabis ruderalis Jan. (a short unbranched roadside plant with minimal drug content)."

"EMCDDA Insights: Cannabis production and markets in Europe," European Monitoring Centre for Drugs and Drug Addiction (Lisbon, Portugal: 2012), p. 21.
http://www.emcdda.europa.eu...

167. The Cannabis Plant
"Cultivated Sinsemilla: Female cannabis plant which has not been pollinated. May grow from cutting or from seed. May contain some seed (if un-pollinated the seed will be sterile). Common illicit indoor grow technique.
"Cultivated Non Sinsemilla: Male or Female cannabis plant commonly grown for illicit drug use.
"Cultivated Ditchweed: Male or Female cannabis plant which grows wild in many states that has in some way been tended by man. Examples of tending are: weeding, watering, topping, fertilizing, harvesting.
"Ditchweed: Unattended, wild male or female cannabis that is native to many states.
"Cannabis Bud: Flowering top of a female cannabis plant. The Bud may contain seed. Most valuable portion of a cannabis plant to the illicit grower. Bud formation occurs late in plant development.
"Leaf: Cannabis leaf potency tends to correlate to position on the plant. The most potent part of the plant is the new leaves at the top of the plant. As you move downward on the plant potency decreases. The least potent leaves on the plant are the large leaves at the bottom of the plant.
"Mature Cannabis: Mature cannabis plants have a higher potency than immature plants. Determination of plant maturity should be made using all available contextual factors. For example, is the plant outdoors and it only June or July, if so, then the plant is likely immature. However, if the growing season is near an end, such as September or October, then the plant is probably mature. Note male cannabis plants are mature as early as August when grown outdoors. It is more difficult to generalize regarding maturity of indoor grows. “Spike” cannabis plants can mature in as little as 6-8 weeks whereas an indoor grow with plants 3-4 feet in height may take 60-120 days to mature.
"Already Harvested: Cannabis plant material recently dried or packaged. May be either bud or leaf.
"Average Plant Canopy Diameter: Record the diameter of a typical mature cannabis plant at its broadest point through the center. Diameter data can be used to predict usable yield with good accuracy."

"Cannabis Potency Monitoring Form," Cannabis Potency Monitoring Project (University, MS: Univesity of Mississippi).
http://www.fl-aglaw.com...

168. Political History of Marijuana Law Reform
"The identification of cannabis as a potentially dangerous psychoactive substance did not, however, prevent a substantial number of these enquiries to explore the issue of whether current legislation reflected the real dangers posed by cannabis. Already in 1944, the La Guardia Committee Report on Marihuana concluded that ‘the practice of smoking marihuana does not lead to addiction in the medical sense of the word’ and that ‘the use of marihuana does not lead to morphine or heroin or cocaine addiction’ (Zimmer and Morgan, 1997). In 1968 the Wootton Report stated that ‘the dangers of cannabis use as commonly accepted in the past and the risk of progression to opiates have been overstated’ and ‘cannabis is less harmful than other substances (amphetamines, barbiturates, codeine-like compounds)’. A similar conclusion was arrived at 34 years later in 2002 when the Advisory Committee on Drug Dependence proposed the reclassification of cannabis from Class B to Class C (enforced by law in 2004 and confirmed in 2005). These views were reiterated by other enquiries, such as the Baan Committee in the Netherlands, which affirmed in 1971 that ‘cannabis use does not lead directly to other drug use’ (16) or by the US National Commission on Marihuana and Drug Abuse, which in 1973 stated that ‘the existing social and legal policy is out of proportion to the individual and social harm engendered by the use of the drug [cannabis]’ (17). The Canadian Le Dain Commission saw ‘the UN Single Convention of 1961 as responsible’ for such a situation which ‘might have reinforced the erroneous impression that cannabis is to be assimilated to the opiate narcotics’. The same commission, however, suggested that the UN Convention did ‘not prevent domestic legislation from correcting this impression’ (18)."

EMCDDA (2008), "A cannabis reader: global issues and local experiences," Monograph series 8, Volume 1, European Monitoring Centre for Drugs and Drug Addiction, Lisbon, p. 108.
http://www.emcdda.europa.eu...

169. Effect of Prohibition on Drug Use
"Prohibition has two effects: on one hand it raises supplier costs, disrupts market functioning and prevents open promotion of the product; on the other, it sacrifices the authorities’ ability to tax transactions and regulate operation of the market, product characteristics and promotional activity of suppliers. The cannabis prevalence rates presented in Figure 1 show clearly that prohibition has failed to prevent widespread use of the drug and leaves open the possibility that it might be easier to control the harmful use of cannabis by regulation of a legal market than to control illicit consumption under prohibition. The contrast between the general welcome for tobacco regulation (including bans on smoking in public places) and the deep suspicion of prohibition policy on cannabis is striking and suggests that a middle course of legalised but limited consumption may find a public consensus."

"Pudney, Stephen, "Drugs Policy – What Should We Do About Cannabis?" Centre for Economic Policy Research (London, United Kingdom: April 2009), p. 23.
http://dev3.cepr.org...

170. History of Marijuana Use
"There are indications that cannabis was used as early as 4000 B.C. in Central Asia and north-western China, with written evidence going back to 2700 B.C. in the pharmacopeia of emperor Chen-Nong. It then gradually spread across the globe, to India (some 1500 B.C., also mentioned in Altharva Veda, one of four holy books about 1400 B.C.1), the Near and Middle East (some 900 B.C.), Europe (some 800 B.C.), various parts of South-East Asia (2nd century A.D.), Africa (as of the 11th century A.D.) to the Americas (19th century) and the rest of the world.2"

"A Century of International Drug Control," United Nations Office on Drugs and Crime (Vienna, Austria: 2009), p. 15.
http://www.unodc.org...

171. THC Content
"The secretion of THC is most abundant in the flowering heads and surrounding leaves. The amount of resin secreted is influenced by environmental conditions during growth (light, temperature and humidity), sex of the plant, and time of harvest. The THC content varies between parts of the plant: from 10-12 % in flowers, 1-2 % in leaves, 0.1-0.3 % in stalks, to less than 0.03 % in the roots."

United Nations Office on Drugs and Crime, "World Drug Report 2009" (Vienna, Austria: United Nations, 2009), p. 97.
http://ahrn.net...
 

roots69

Rising Star
BGOL Investor
Medical Cannabis/Marijuana

Looking for specific, detailed information on cannabidiol (CBD)? In addition to the items below, check out Project CBD.

1. States That Legally Regulate Medical and/or Adult Social Use of Marijuana
As of November 7, 2018, a total of 32 states plus the District of Columbia and Guam have what are called "effective" state medical marijuana laws. These states include: Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, Utah, Vermont, Washington state, and West Virginia.

Ten states have legalized adult (aged 21 and older) personal use of marijuana: Alaska, California, Colorado, Maine, Massachusetts, Michigan, Nevada, Oregon, Vermont, and Washington state. In addition, nine of those ten states - Vermont is the exception - legally regulate the production, distribution, and sale of marijuana. The District of Columbia has also legalized limited personal possession and cultivation of marijuana by adults aged 21 and older.

Marijuana Policy Project, "State by State Medical Marijuana Laws 2015 with a December 2016 Supplement - How to Remove the Threat of Arrest," (Washington, DC: MPP, February 2017), p. 1, last accessed September 27, 2017.
https://www.mpp.org...
West Virginia: https://www.mpp.org/states/wes...
Vermont: "Governor Phil Scott Signs H.511," Office of the Governor of Vermont, News Release, Jan. 22, 2018.
http://governor.vermont.gov/pr...
"An act relating to eliminating penalties for possession of limited amounts of marijuana by adults 21 years of age or older"
https://legislature.vermont.go...
Oklahoma: Oklahoma State Question 788, Medical Marijuana Legalization Initiative (June 2018) https://ballotpedia.org/...
Michigan, Missouri, and Utah: http://www.drugpolicy.org/pres...

2. More Than 148 Million Americans Live In a State With Effective Medical Marijuana Laws
"In all, more than 148 million Americans — about 47% of the U.S. population — now live in the 23 states, or the federal district, with effective medical marijuana laws. Eighty-five percent live in a state that has some form of medical cannabis legislation on the books."

Marijuana Policy Project, "State by State Medical Marijuana Laws 2015 with a December 2016 Supplement - How to Remove the Threat of Arrest," (Washington, DC: MPP, March 2017), p. 10, last accessed April 26, 2017.
https://www.mpp.org/issues/med...

3. Impact of Medical Marijuana Laws on Marijuana Use by Young People
"In summary, current evidence does not support the hypothesis that MML passage is associated with increased marijuana use prevalence among adolescents in states that have passed such laws up until 2014. Based on this evidence, we recommend several steps to advance the understanding of current and future marijuana policy effects. First, continued exploration of the effects of these state policies on different measures of use among adolescents is warranted. While evidence is clear regarding MML effects on annual and past-month prevalence, evidence regarding effects on daily/near-daily use, marijuana abuse/dependence and intensity of use have not been explored as thoroughly, and warrant additional consideration in light of decreasing national trends in marijuana risk perceptions among adolescents [54,86]. Secondly, continued monitoring of adolescent marijuana use in MML states is critical in light of differential development of commercialized markets. Recent studies have shown a rapid diffusion of medical marijuana stores and increased commercialization in selective states following the 2009 Ogden memo,which de-prioritized federal enforcement against individuals compliant with state MMLs [51,75,87–89]. Studies evaluating the impact of this rapid commercialization on youth marijuana use have shown a more consistently positive effect [51,90,91]. Such findings are particularly relevant in light of recent recreational marijuana laws, all of which so far allow commercial distribution systems [92]. Thirdly, further studies should be conducted in adults, for which the limited literature suggests a positive effect of MMLs on marijuana use [65,69,75]. Fourthly, investigators should experiment with process-based models of information and product diffusion that can estimate MML effects even in the presence of spill-over effects into non-MML states [93]. Finally, increased coordination among researchers across multiple disciplines is needed to maximize efficiency in studying these urgent research questions in the context of rapidly changing marijuana policy."

Sarvet, A. L., Wall, M. M., Fink, D. S., Greene, E., Le, A., Boustead, A. E., Pacula, R. L., Keyes, K. M., Cerdá, M., Galea, S., and Hasin, D. S. (2018) Medical marijuana laws and adolescent marijuana use in the United States: a systematic review and meta‐analysis. Addiction, 113: 1003–1016. doi: 10.1111/add.14136.
https://onlinelibrary.wiley.co...
https://onlinelibrary.wiley.co...

4. Number of Approved Medical Cannabis Patients in the US
"Determining exactly how many patients use medical marijuana with state approval is difficult. According to a 2002 study published in the Journal of Cannabis Therapeutics, an estimated 30,000 California patients and another 5,000 patients in eight other states possessed a physician’s recommendations to use cannabis medically.67 More recent estimates are much higher. The New England Journal of Medicine reported in August 2005, for example, that an estimated 115,000 people have obtained marijuana recommendations from doctors in the states with programs.68
"Although 115,000 people may be approved medical marijuana users, the number of patients who have actually registered is much lower. A July 2005 CRS telephone survey of the state programs revealed a total of 14,758 registered medical marijuana users in eight states.69 (Maine and Washington do not maintain state registries, and Rhode Island, New Mexico, and Michigan had not yet passed their laws.) This number vastly understates the number of medical marijuana users, however, because California’s state registry was in pilot status, with only 70 patients so far registered."

Eddy, Mark, "Medical Marijuana: Review and Analysis of Federal and State Policies," Congressional Research Service (Washington, DC: March 31, 2009), p. 19.
http://www.fas.org/sgp/crs/mis...

5. Impact of Medical Marijuana Laws on Adolescent Marijuana Use
"Concerns about laws and policy measures that may inadvertently affect youth drug use merit careful consideration. Our study does not show evidence of a clear relationship between legalization of marijuana for medical purposes and youth drug use for any age group, which may provide some reassurance to policymakers who wish to balance compassion for individuals who have been unable to find relief from conventional medical therapies with the safety and well-being of youth. Further research is required to track the trends in marijuana use among adolescents, particularly with respect to different types of marijuana laws and implementation of laws in each state."

Choo, Esther K. et al. (2014), "The Impact of State Medical Marijuana Legislation on Adolescent Marijuana Use," Journal of Adolescent Health, Volume 55, Issue 2, p. 160 - 166.
http://www.jahonline.org/artic...
http://www.jahonline.org/artic...

6. Potential Therapeutic Uses of Cannabidiol (CBD)
"Recent developments suggest that non-psychotropic phytocannabinoids exert a wide range of pharmacological effects (Figure 1), many of which are of potential therapeutic interest. The most studied among these compounds is CBD, the pharmacological effects of which might be explained, at least in part, by a combination of mechanisms of action (Table 1, Figure 1). CBD has an extremely safe profile in humans, and it has been clinically evaluated (albeit in a preliminary fashion) for the treatment of anxiety, psychosis, and movement disorders. There is good pre-clinical evidence to warrant clinical studies into its use for the treatment of diabetes, ischemia and cancer. The design of further clinical trials should: i) consider the bell-shaped pattern of the dose–response curve that has been observed in pre-clinical pharmacology, and ii) establish if CBD is more effective or has fewer unwanted effects than other medicines. A sublingual spray that is a standardized Cannabis extract containing approximately equal quantities of CBD and D9-THC (Sativex®), has been shown to be effective in treating neuropathic pain in multiple sclerosis patients [76].
"The pharmacology of D9-THCV (i.e. CB1 antagonism associated with CB2 agonist effects) is also intriguing because it has the potential of application in diseases such as chronic liver disease or obesity—when it is associated with inflammation—in which CB1 blockade together with some CB2 activation is beneficial.
"The plant Cannabis is a source of several other neglected phytocannabinoids such as CBC and CBG. Although the spectrum of pharmacological effects of these compounds is largely unexplored, their potent action at TRPA1 and TRPM8 might make these compounds new and attractive tools for pain management."

Izzo,Angelo A.; Borrelli, Francesca; Capasso, Raffaele; Di Marzo, Vincenzo; and Mechoulam, Raphael, "Non-psychotropic plant cannabinoids: new therapeutic opportunities from an ancient herb," Trends in Pharmacological Sciences (London, United Kingdom: October 2009) Vol. 30, Issue 10, pp. 525-526.
http://www.ncbi.nlm.nih.gov/pu...
http://cannabisinternational.o...

7. Known Therapeutic Benefits From Medicinal Cannabinoids
"Cannabis preparations exert numerous therapeutic effects. They have antispastic, analgesic, antiemetic, neuroprotective, and anti-inflammatory actions, and are effective against certain psychiatric diseases. Currently, however, only one cannabis extract is approved for use. It contains THC and CBD [cannabidiol] in a 1:1 ratio and was licensed in 2011 for treatment of moderate to severe refractory spasticity in multiple sclerosis (MS). In June 2012 the German Joint Federal Committee (JFC, Gemeinsamer Bundesausschuss) pronounced that the cannabis extract showed a 'slight additional benefit' for this indication and granted a temporary license valid up to 2015.
"The cannabis extract, which goes by the generic name nabiximols, has been approved by regulatory bodies in Germany and elsewhere for use as a sublingual spray. In the USA, dronabinol has been licensed since 1985 for the treatment of nausea and vomiting caused by cytostatic therapy and since 1992 for loss of appetite in HIV/Aids-related cachexia. In Great Britain, nabilone has been sanctioned for treatment of the side effects of chemotherapy in cancer patients (Box 1).
"In addition to these confirmed indications, there is solid evidence from a large number of small controlled trials that cannabinoid receptor agonists have an analgesic action, particularly in neuropathic pain; however, no country has yet approved their use for this purpose."

Franjo Grotenhermen, Dr. med., and Kirsten Müller-Vahl, Prof. Dr. med., "The Therapeutic Potential of Cannabis and Cannabinoids," Deutsch Arzteblatt International, 2012 July; 109(29-30): 495–501. doi: 10.3238/arztebl.2012.0495
http://www.ncbi.nlm.nih.gov/pm...

8. Known Therapeutic Benefits From Medicinal Cannabinoids
"Evidence is accumulating that cannabinoids may be useful medicine for certain indications. Control of nausea and vomiting and the promotion of weight gain in chronic inanition are already licensed uses of oral THC (dronabinol capsules). Recent research indicates that cannabis may also be effective in the treatment of painful peripheral neuropathy and muscle spasticity from conditions such as multiple sclerosis [58]. Other indications have been proposed, but adequate clinical trials have not been conducted. As these therapeutic potentials are confirmed, it will be useful if marijuana and its constituents can be prescribed, dispensed, and regulated in a manner similar to other medications that have psychotropic effects and some abuse potential. Given that we do not know precisely which cannabinoids or in which combinations achieve the best results, larger and more representative clinical trials of the plant product are warranted. Because cannabinoids are variably and sometimes incompletely absorbed from the gut, and bioavailability is reduced by extensive first pass metabolism, such trials should include delivery systems that include smoking, vaporization, and oral mucosal spray in order to achieve predictable blood levels and appropriate titration. Advances in understanding the medical indications and limitations of cannabis in its various forms should facilitate the regulatory and legislative processes."

Igor Grant, J. Hampton Atkinson, Ben Gouaux and Barth Wilsey, "Medical Marijuana: Clearing Away The Smoke," The Open Neurology Journal, 2012, 6:18-25. doi: 10.2174/1874205X01206010018.
http://www.ncbi.nlm.nih.gov/pm...

9. Medical Cannabis and Epilepsy
"We synthesised available evidence on the safety and efficacy of cannabinoids as an adjunctive treatment to conventional AEDs [Antiepileptic Drugs] in treating drug-resistant epilepsy. In many cases, there was qualitative evidence that cannabinoids reduced seizure frequency in some patients, improved other aspects of the patients’ quality of life and were generally well tolerated with mild-to-moderate AEs [Adverse Events]. We can be much more confident about this statement in the case of children than adults, because the recent, larger, well-conducted RCTs [Randomized Controlled Trials] were performed in children and adolescents.

"In studies where there was greater experimental control over the type and dosage of cannabinoid used, there was evidence that adjuvant use of CBD
reduced the frequency of seizures, particularly in treatment-resistant children and adolescents, and that patients were more likely to achieve complete seizure freedom. There was a suggestion that the benefits of adding CBD may be greater when patients were also using clobazam.11 12 However because clobazam and CBD are both metabolised in the cytochrome P450 pathway, the pharmacokinetic interactions of these two drugs still need to be fully determined.56 Further randomised, double-blind studies with a placebo or active control are needed to strengthen this conclusion.

"Non-RCT evidence was consistent with RCT evidence that suggested cannabinoids may reduce the frequency of seizures. In most of these studies, cannabinoid products and dosages were less well-controlled, and outcomes were based on self-report (often by parents). These studies provide lower quality evidence compared with RCTs due to the potential for selection bias in the study populations, and other weaknesses in study design. There was also some evidence that studies at very high risk of bias had higher reported proportions of participants reporting reductions in seizures and lower proportions reporting AEs. In RCTs, and most of the non-RCTs, cannabinoids were used as an adjunctive therapy rather than as a standalone intervention, so at present there is little evidence to support any recommendation that cannabinoids can be recommended as a replacement for current standard AEDs."

Stockings, Emily & Zagic, Dino & Campbell, Gabrielle & Weier, Megan & Hall, Wayne & Nielsen, Suzanne & K Herkes, Geoffrey & Farrell, Michael & Degenhardt, Louisa. (2018). Evidence for cannabis and cannabinoids for epilepsy: a systematic review of controlled and observational evidence. Journal of Neurology, Neurosurgery & Psychiatry. jnnp-2017. 10.1136/jnnp-2017-317168.
https://www.ncbi.nlm.nih.gov/p...
http://jnnp.bmj.com/content/ea...

10. Medical Cannabis in the Treatment of Epilepsy
"We synthesised available evidence on the safety and efficacy of cannabinoids as an adjunctive treatment to conventional AEDs [Anti Epileptic Drugs] in treating drug-resistant epilepsy. In many cases, there was qualitative evidence that cannabinoids reduced seizure frequency in some patients, improved other aspects of the patients’ quality of life and were generally well tolerated with mild-to-moderate AEs [Adverse Events]. We can be much more confident about this statement in the case of children than adults, because the recent, larger, well-conducted RCTs [Randomized Controlled Trials] were performed in children and adolescents.

"In studies where there was greater experimental control over the type and dosage of cannabinoid used, there was evidence that adjuvant use of CBD [cannibidiol] reduced the frequency of seizures, particularly in treatment-resistant children and adolescents, and that patients were more likely to achieve complete seizure freedom. There was a suggestion that the benefits of adding CBD may be greater when patients were also using clobazam.11 12 However because clobazam and CBD are both metabolised in the cytochrome P450 pathway, the pharmacokinetic interactions of these two drugs still need to be fully determined.56 Further randomised, double-blind studies with a placebo or active control are needed to strengthen this conclusion.

"Non-RCT evidence was consistent with RCT evidence that suggested cannabinoids may reduce the frequency of seizures. In most of these studies, cannabinoid products and dosages were less well-controlled, and outcomes were based on self-report (often by parents). These studies provide lower quality evidence compared with RCTs due to the potential for selection bias in the study populations, and other weaknesses in study design. There was also some evidence that studies at very high risk of bias had higher reported proportions of participants reporting reductions in seizures and lower proportions reporting AEs. In RCTs, and most of the non-RCTs, cannabinoids were used as an adjunctive therapy rather than as a standalone intervention, so at present there is little evidence to support any recommendation that cannabinoids can be recommended as a replacement for current standard AEDs."

Stockings E, Zagic D, Campbell G, et al. Evidence for cannabis and cannabinoids for epilepsy: a systematic review of controlled and observational evidence. J Neurol Neurosurg Psychiatry 2018;89:741-753.
https://jnnp.bmj.com/content/8...
https://www.ncbi.nlm.nih.gov/p...

11. Use of Cannabis as a Response to the Overdose Crisis
"The opioid epidemic is a public health crisis that is at least partially driven by harms associated with POM [Prescription Opioid Medication] use. States are passing laws allowing use of MC [Medical Cannabis] and patients are using MC, but currently there is little understanding of how this influences POM use or of MC-related harms. This literature review provides preliminary evidence that states with MC laws have experienced reported decreases in POM use, abuse, overdose, and costs. However, existing evidence is limited by significant methodological shortcomings; so, general conclusions are difficult to draw.

"The use of MC as an alternative to POMs for pain management warrants additional empirical attention as a potential harm reduction strategy. NASEM (2017) recommends more clinical trials to elucidate appropriate MC forms, routes of administration, and combination of products for treating pain, but access to MC products to fully evaluate these questions is challenging due to federal regulations. However, the recently funded National Institutes of Health longitudinal study to research the impacts of MC on opioid use is a critical step in the right direction (National Institute of Health, 2017, Williams, 2017). MCs potential as an alternative pain treatment modality to help mitigate the major public health opioid crisis, could be a missed opportunity if data on safety, efficacy, and outcomes are not collected and explored. Health care practitioners, particularly nurses who are charged with ensuring patient comfort, have a vested interest in providing viable alternatives to POMs when appropriate, as part of an integrative approach to pain management, and must advocate for more research to better understand the public health implications and risks and benefits of such alternatives."

Vyas, Marianne Beare et al. The use of cannabis in response to the opioid crisis: A review of the literature. Nursing Outlook, January-February 2018, Volume 66, Issue 1, 56 - 65.
https://www.ncbi.nlm.nih.gov/p...
www.nursingoutlook.org
www.nursingoutlook.org

12. Impact of State-Legal Medical Marijuana on Adolescent Marijuana Use
"In conclusion, our study of self-reported marijuana use by adolescents in states with a medical marijuana policy compared with a sample of geographically similar states without a policy does not demonstrate increases in marijuana use among high school students that may be attributed to the policies."

Choo, Esther K. et al., "The Impact of State Medical Marijuana Legislation on Adolescent Marijuana Use," Journal of Adolescent Health, August 2014, Volume 55, Issue 2, p. 160 - 166.
http://www.jahonline.org/...
http://www.jahonline.org/...

13. Medicinal Cannabis as an Alternative to Prescription Opioid Medicines
"The use of MC [Medical Cannabis] as an alternative to POMs [Prescription Opioid Medications] for pain management warrants additional empirical attention as a potential harm reduction strategy. NASEM (2017) recommends more clinical trials to elucidate appropriate MC forms, routes of administration, and combination of products for treating pain, but access to MC products to fully evaluate these questions is challenging due to federal regulations. However, the recently funded National Institutes of Health longitudinal study to research the impacts of MC on opioid use is a critical step in the right direction (NIH, 2017; Williams, 2017). MCs potential as an alternative pain treatment modality to help mitigate the major public health opioid crisis, could be a missed opportunity if data on safety, efficacy, and outcomes are not collected and explored. Health care practitioners, particularly nurses who are charged with ensuring patient comfort, have a vested interest in providing viable alternatives to POMs when appropriate, as part of an integrative approach to pain management, and must advocate for more research to better understand the public health implications and risks and benefits of such alternatives."

Vyas, Marianne Beare et al. The use of cannabis in response to the opioid crisis: A review of the literature. Nursing Outlook, Volume 66, Issue 1, 56 - 65.
https://www.nursingoutlook.org/...
https://www.nursingoutlook.org/...

14. Cannabinoids and the Chemical Composition of Cannabis
"Essentially a herbal cannabinoid drug, the resin-secreting flowers of select varietals of the female cannabis plant contain approximately 6 dozen of different phytocannabinoids or plant-derived cannabinoids; these compounds are generally classified structurally as terpenophenolics with a 21-carbon molecular scaffold.24Other compounds, such as terpenoids, flavonoids, and phytosterols, which are common to many other botanicals, are also produced by cannabis and have some demonstrated pharmacologic properties.25,26 The best known naturally produced analgesic cannabinoids generally found in highest concentrations are THC and cannabidiol. They occur in their acid forms in herbal cannabis and must be decarboxylated to become activated. Five minutes of heating at 200 to 210°C has been determined as the optimal conditions for maximal decarboxylation; with a flame, where temperatures of 600°C are achieved, only a few seconds are needed.27"

Aggarwal, Sunil K., "Cannabinergic Pain Medicine: A Concise Clinical Primer and Survey of Randomized-controlled Trial Results," Clinical Journal of Pain (Philadelphia, PA: February 23, 2012), p. 2.
http://www.ncbi.nlm.nih.gov/pu...

15. Safety of Cannabis
"Generally, as analgesics, cannabinoids have minimal toxicity and present no risk of lethal overdose.48 End-organ failure secondary to medication effect has not been described and no routine laboratory monitoring is required in patients taking these medications."

Aggarwal, Sunil K., "Cannabinergic Pain Medicine: A Concise Clinical Primer and Survey of Randomized-controlled Trial Results," Clinical Journal of Pain (Philadelphia, PA: February 23, 2012), p. 3.
http://www.ncbi.nlm.nih.gov/pu...

16. Lower Opioid Overdose Mortality Rates In States With Medical Cannabis Laws
"Although the mean annual opioid analgesic overdose mortality rate was lower in states with medical cannabis laws compared with states without such laws, the findings of our secondary analyses deserve further consideration. State-specific characteristics, such as trends in attitudes or health behaviors, may explain variation in medical cannabis laws and opioid analgesic overdose mortality, and we found some evidence that differences in these characteristics contributed to our findings. When including state-specific linear time trends in regression models, which are used to adjust for hard-to-measure confounders that change over time, the association between laws and opioid analgesic overdose mortality weakened. In contrast, we did not find evidence that states that passed medical cannabis laws had different overdose mortality rates in years prior to law passage, providing a temporal link between laws and changes in opioid analgesic overdose mortality. In addition, we did not find evidence that laws were associated with differences in mortality rates for unrelated conditions (heart disease and septicemia), suggesting that differences in opioid analgesic overdose mortality cannot be explained by broader changes in health. In summary, although we found a lower mean annual rate of opioid analgesic mortality in states with medical cannabis laws, a direct causal link cannot be established."

Bacchuber, Marcus A., MD; Saloner, Brendan, PhD; Cunningham, Chinazo O., MD, MS; and Barry, Colleen L., PhD, MPP. "Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999-2010." JAMA Intern Med. doi:10.1001/jamainternmed.2014.4005. Published online August 25, 2014.
jamanetwork.com...

17. Effect of CBD on Learned Fear and Potential in Treatment of Post Traumatic Stress Disorder (PTSD)
"A growing body of literature provides compelling evidence that CBD has anxiolytic effects and recent studies have established a role for CBD in regulating learned fear by dampening its expression, disrupting its reconsolidation, and facilitating its extinction. The opposing effects of CBD on fear memory reconsolidation and extinction make it particularly attractive as a potential adjunct to psychological therapy as both may lead to lasting reductions in learned fear expression. Our novel data also suggests that CBD reduces the expression of fear memory related to both discrete and contextual cues. Although we found no effect of CBD on auditory fear extinction, decreasing fear expression during extinction without interfering in its encoding is still a useful property that has clinical implications. In this respect CBD might be an improvement over other available drugs used for treating the fear-related symptoms of phobias and PTSD, which can impair extinction (e.g., benzodiazepines) or have a less favorable side effect profile (e.g., antidepressants)."

Jurkus R, Day HLL, Guimarães FS, Lee JLC, Bertoglio LJ, Stevenson CW. Cannabidiol Regulation of Learned Fear: Implications for Treating Anxiety-Related Disorders. Frontiers in Pharmacology. 2016;7:454. doi:10.3389/fphar.2016.00454.
https://www.ncbi.nlm.nih.gov/p...
https://www.ncbi.nlm.nih.gov/p...

18. Impact of Medical Marijuana Laws on Crime Rates
"The central finding gleaned from the present study was that MML is not predictive of higher crime rates and may be related to reductions in rates of homicide and assault. Interestingly, robbery and burglary rates were unaffected by medicinal marijuana legislation, which runs counter to the claim that dispensaries and grow houses lead to an increase in victimization due to the opportunity structures linked to the amount of drugs and cash that are present. Although, this is in line with prior research suggesting that medical marijuana dispensaries may actually reduce crime in the immediate vicinity [8]."

Robert G. Morris, Michael TenEyck, JC Barnes, and Tomislav V. Kovandzic, "The Effect of Medical Marijuana Laws On Crime: Evidence From State Panel Data, 1990-2006," PLoS ONE 9(3): e92816. March 2014. doi: 10.1371/journal.pone.0092816
http://www.plosone.org...

19. Effect of Medical Marijuana Legalization On Crime Rates
"In sum, these findings run counter to arguments suggesting the legalization of marijuana for medical purposes poses a danger to public health in terms of exposure to violent crime and property crimes. To be sure, medical marijuana laws were not found to have a crime exacerbating effect on any of the seven crime types. On the contrary, our findings indicated that MML precedes a reduction in homicide and assault. While it is important to remain cautious when interpreting these findings as evidence that MML reduces crime, these results do fall in line with recent evidence [29] and they conform to the longstanding notion that marijuana legalization may lead to a reduction in alcohol use due to individuals substituting marijuana for alcohol [see generally 29, 30]. Given the relationship between alcohol and violent crime [31], it may turn out that substituting marijuana for alcohol leads to minor reductions in violent crimes that can be detected at the state level. That said, it also remains possible that these associations are statistical artifacts (recall that only the homicide effect holds up when a Bonferroni correction is made)."

Robert G. Morris, Michael TenEyck, JC Barnes, and Tomislav V. Kovandzic, "The Effect of Medical Marijuana Laws On Crime: Evidence From State Panel Data, 1990-2006," PLoS ONE 9(3): e92816. March 2014. doi: 10.1371/journal.pone.0092816
http://www.plosone.org...

20. Effect Of Medical Marijuana Legalization On Crime Rates
"Given that the current results failed to uncover a crime exacerbating effect attributable to MML, it is important to examine the findings with a critical eye. While we report no positive association between MML and any crime type, this does not prove MML has no effect on crime (or even that it reduces crime). It may be the case that an omitted variable, or set of variables, has confounded the associations and masked the true positive effect of MML on crime. If this were the case, such a variable would need to be something that was restricted to the states that have passed MML, it would need to have emerged in close temporal proximity to the passage of MML in all of those states (all of which had different dates of passage for the marijuana law), and it would need to be something that decreased crime to such an extent that it ‘‘masked’’ the true positive effect of MML (i.e., it must be something that has an opposite sign effect between MML [e.g., a positive correlation] and crime [e.g., a negative correlation]). Perhaps the more likely explanation of the current findings is that MML laws reflect behaviors and attitudes that have been established in the local communities. If these attitudes and behaviors reflect a more tolerant approach to one another’s personal rights, we are unlikely to expect an increase in crime and might even anticipate a slight reduction in personal crimes."

Robert G. Morris, Michael TenEyck, JC Barnes, and Tomislav V. Kovandzic, "The Effect of Medical Marijuana Laws On Crime: Evidence From State Panel Data, 1990-2006," PLoS ONE 9(3): e92816. March 2014. doi: 10.1371/journal.pone.0092816
http://www.plosone.org...

21. Harm Reduction and Alternative Delivery Methods for Cannabis Consumption
"The use of a vaporizing device may mitigate some of these symptoms. Cannabis vaporization is a technique aimed at suppressing the formation of irritating respiratory toxins by heating cannabis to a temperature where active cannabinoids are volatilized, but below the point of combustion where smoke and associated toxins form. The use of a vaporizer is associated with higher plasma THC concentrations than smoking marijuana cigarettes, little if any carbon monoxide production, and significantly fewer triggered respiratory symptoms."

American Medical Association, Council on Science and Public Health, "Report 3 of the Council on Science and Public Health: Use of Cannabis for Medicinal Purposes" (December 2009), p. 15.
http://drugwarfacts.org/cms/fi...

22. Safety of Medicinal Cannabis According to DEA Administrative Law Judge Francis Young
In 1988, the DEA's Administrative Law Judge, Francis Young, concluded: "In strict medical terms marijuana is far safer than many foods we commonly consume. For example, eating 10 raw potatoes can result in a toxic response. By comparison, it is physically impossible to eat enough marijuana to induce death. Marijuana in its natural form is one of the safest therapeutically active substances known to man. By any measure of rational analysis marijuana can be safely used within the supervised routine of medical care."

US Department of Justice, Drug Enforcement Administration, "In the Matter of Marijuana Rescheduling Petition," [Docket #86-22], (September 6, 1988), p. 57.
http://medicalmarijuana.procon.org...

23. Medicinal Cannabis and HIV-Related Neuropathic Pain
http://cdc.coop/docs/neuropath...

24. Cannabis and Cancer Pain
"• Cannabinoids, the active components of Cannabis sativa and their derivatives, act in the organism by mimicking endogenous substances, the endocannabinoids, that activate specific cannabinoid receptors. Cannabinoids exert palliative effects in patients with cancer and inhibit tumour growth in laboratory animals.
"• The best-established palliative effect of cannabinoids in cancer patients is the inhibition of chemotherapy-induced nausea and vomiting. Today, capsules of ?9-tetrahydrocannabinol (dronabinol (Marinol)) and its synthetic analogue nabilone (Cesamet) are approved for this purpose.
"• Other potential palliative effects of cannabinoids in cancer patients — supported by Phase III clinical trials — include appetite stimulation and pain inhibition. In relation to the former, dronabinol is now prescribed for anorexia associated with weight loss in patients with AIDS.
"• Cannabinoids inhibit tumour growth in laboratory animals. They do so by modulating key cell-signalling pathways, thereby inducing direct growth arrest and death of tumour cells, as well as by inhibiting tumour angiogenesis and metastasis.
"• Cannabinoids are selective antitumour compounds, as they can kill tumour cells without affecting their non-transformed counterparts. It is probable that cannabinoid receptors regulate cell-survival and cell-death pathways differently in tumour and non-tumour cells.
"• Cannabinoids have favourable drug-safety profiles and do not produce the generalized toxic effects of conventional chemotherapies. The use of cannabinoids in medicine, however, is limited by their psychoactive effects, and so cannabinoid-based therapies that are devoid of unwanted side effects are being designed.
"• Further basic and preclinical research on cannabinoid anticancer properties is required. It would be desirable that clinical trials could accompany these laboratory studies to allow us to use these compounds in the treatment of cancer."

Guzman, Manuel, "Cannabinoids: Potential Anticancer Agents." Nature Reviews: Cancer (October 2003), p. 746.
http://www.ncbi.nlm.nih.gov/pu...
http://herb.com/guzman.pdf

25. Medical Cannabis Laws and Opioid Overdose Mortality Rates
"In an analysis of death certificate data from 1999 to 2010, we found that states with medical cannabis laws had lower mean opioid analgesic overdose mortality rates compared with states without such laws. This finding persisted when excluding intentional overdose deaths (ie, suicide), suggesting that medical cannabis laws are associated with lower opioid analgesic overdose mortality among individuals using opioid analgesics for medical indications. Similarly, the association between medical cannabis laws and lower opioid analgesic overdose mortality rates persisted when including all deaths related to heroin, even if no opioid analgesic was present, indicating that lower rates of opioid analgesic overdose mortality were not offset by higher rates of heroin overdose mortality. Although the exact mechanism is unclear, our results suggest a link between medical cannabis laws and lower opioid analgesic overdose mortality."

Bacchuber, Marcus A., MD; Saloner, Brendan, PhD; Cunningham, Chinazo O., MD, MS; and Barry, Colleen L., PhD, MPP. "Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999-2010." JAMA Intern Med. doi:10.1001/jamainternmed.2014.4005. Published online August 25, 2014.
http://archinte.jamanetwork.co...

26. cannabis and neuropathic pain
“A Double-Blind, Placebo-Controlled Crossover Trial of the Antinociceptive Effects of Smoked Marijuana on Subjects with Neuropathic Pain“
"Barth Wilsey, M.D., University of California, Davis"
"This study’s objective was to examine the efficacy of two doses of smoked cannabis on pain in persons with neuropathic pain of different origins (e.g., physical trauma to nerve bundles, spinal cord injury, multiple sclerosis, diabetes). In a double-blind, randomized clinical trial participants received either lowdose, high-dose, or placebo cannabis cigarettes. As customary in CMCR trials, participants were allowed to continue their usual regimen of pain medications (e.g., codeine, morphine, and others).
"The full results of this study have been published in the Journal of Pain (Wilsey, et al., 2008 – see reference list). Thirty-eight patients underwent a standardized procedure for smoking either high-dose (7%), low-dose (3.5%), or placebo cannabis; of these, 32 completed all three smoking sessions. The study demonstrated an analgesic response to smoking cannabis with no significant difference between the low and the high dose cigarettes. The study concluded that both low and high cannabis doses were efficacious in reducing neuropathic pain of diverse causes."

Center for Medicinal Cannabis Research, "Report to the Legislature and Governor of the State of California presenting findings pursuant to SB847 which created the CMCR and provided state funding," University of California, (San Diego, CA: February 2010), p. 11.
http://cdc.coop/docs/neuropath...

27. The Effect of Cannabis on Neuropathic Pain in HIV-Related Peripheral Neuropathy
"The primary objective of this study was to evaluate the efficacy of smoked cannabis when used as an analgesic in persons with neuropathic pain from HIV-associated distal sensory polyneuropathy (DSPN). In a double blind, randomized, five-day clinical trial patients received either smoked cannabis or placebo cannabis cigarettes. Patients continued on any concurrent analgesic medications (e.g., gabapentin, amitriptyline, narcotics, NSAIDs) which they were prescribed prior to the trial; the dose and amount of the medications were recorded daily.
"The full results of this study appear in the journal Neurology (Abrams, et al., 2007– see reference list). In brief, 55 patients were randomized and 50 completed the entire trial. Smoked cannabis reduced daily pain by 34% compared to 17% with placebo. The study concluded that a significantly greater proportion of patients who smoked cannabis (52%) had a greater than 30% reduction in pain intensity compared to only 24% in the placebo group."

Center for Medicinal Cannabis Research, "Report to the Legislature and Governor of the State of California presenting findings pursuant to SB847 which created the CMCR and provided state funding," University of California, (San Diego, CA: February 2010), p. 10.
http://cdc.coop/docs/neuropath...

28. Cannabis and Neuropathic Pain
"In this randomized clinical trial, smoked cannabis at maximum tolerable dose (1–8% THC), significantly reduced neuropathic pain intensity in HIV-associated DSPN [distal sensory predominant polyneuropathy] compared to placebo, when added to stable concomitant analgesics. Using verbal descriptors of pain magnitude from DDS [Descriptor Differential Scale], cannabis was associated with an average reduction of pain intensity from ‘strong’ to ‘mild to moderate’. Also, cannabis was associated with a sizeable (46%) and significantly greater (vs 18% for placebo) proportion of patients who achieved what is generally considered clinically meaningful pain relief (eg X30% reduction in pain; Farrar et al, 2001). Mood disturbance, physical disability, and quality of life all improved significantly for subjects during study treatments, regardless of treatment order."

Ellis, Ronald J; Toperoff, Will; Vaida, Florin; van den Brande, Geoffrey; Gonzales, James; Gouaux, Ben; Bentley, Heather; and Atkinson, J. Hampton, "Smoked Medicinal Cannabis for Neuropathic Pain in HIV: A Randomized, Crossover Clinical Trial," Neuropsychopharmacology (Nashville, TN : American College of Neuropsychopharmacology, 2009), Vol. 34, p. 678.
http://www.nature.com/npp/jour...

29. Cannabis and Fibromyalgia
"We observe significant improvement of symptoms of FM [fibromyalgia] in patients using cannabis in this study although there was a variability of patterns. This information, together with evidence of clinical trials and emerging knowledge of the endocannabinoid system and the role of the stress system in the pathopysiology of FM suggest a new approach to the suffering of these patients. The present results together with previous evidence seem to confirm the beneficial effects of cannabinoids on FM symptoms."

Fiz, Jimena; Dura´n, Marta; Capella, Dolors; Carbonel, Jordi; Farre, Mag?, "Cannabis Use in Patients with Fibromyalgia: Effect on Symptoms Relief and Health-Related Quality of Life," PLoS Medicine (Cambridge, United Kingdom: Public Library of Science, April 2011) Vol. 6, Issue 4, p. 4.
http://www.ncbi.nlm.nih.gov/pm...

30. Pain and Medical Cannabis Use
"By providing a medical geographic patient utilization 'snapshot' of 236.4 patient-years of the use of MC [Medical Cannabis] at a regional pain clinic, this study provides further insight into the applicability of cannabinoid botanicals in the management of a broad range of refractory chronic pain conditions in adults, from myofascial pain and discogenic back pain to neuropathic pain and central pain syndromes. With physicians employing proper chart documentation of appropriate use, efficacy, and side effects at patient visits, in a manner similar to that used in opioid management of pain, there will hopefully be additional reports in the future on MC use in pain management to add to the clinical database.
"Such a literature can grow only if certain stereotypes and myths about MC use are dispelled amongst pain management specialists and their regulators. The results presented here should help to deconstruct mythologies about the kinds of patients accessing MC treatment, including their young age or their propensity to malinger or feign disease. One prominent mythology is that patients who receive treatment with MC are not 'truly sick.'45 An examination of the chart review data, which includes both subjective and objective diagnostic data substantiating patients’ chronic pain illnesses, helps to deflate this concern."

Aggarwal, Sunil K.; Carter, Gregory T.; Sullivan, Mark D.; ZumBrunnen, Craig; Morrill, Richard; and Mayer, Jonathan D., "Characteristics of patients with chronic pain accessing treatment with medical cannabis in Washington State," Journal of Opiod Management, (Weston, Massachusetts: September/October 2009), Vol. 5, p. 264.
http://www.ncbi.nlm.nih.gov/pu...

31. Medicinal Cannabis and Neuropathic Pain
"We found that 25 mg herbal cannabis with 9.4% tetrahydrocannabinol, administered as a single smoked inhalation three times daily for five days, significantly reduced average pain intensity compared with a 0% tetrahydrocannabinol cannabis placebo in adult participants with chronic post-traumatic or postsurgical neuropathic pain. We found significant improvements in measures of sleep quality and anxiety. We have shown the feasibility of a single-dose delivery method for smoked cannabis, and that blinding participants to treatment allocation is possible using this method."

Ware, Mark A.; Wang, Tongtong; Shapiro, Stan; Robinson, Ann; Ducruet, Thierry; Huynh,Thao; Gamsa, Ann; Bennett, Gary J.; and Collet, Jean-Paul,"Smoked cannabis for chronic neuropathic pain: a randomized controlled trial" (Ottawa, ON: Canadian Medical Association, October 5, 2010), p. E697-E700.
http://www.cmaj.ca/cgi/reprint...

32. Analgesic Efficacy of Smoked Cannabis
"This study used an experimental model of neuropathic pain to determine whether pain induced by the injection into the skin of capsaicin, a compound which is the 'hot' ingredient in chili peppers, could be alleviated by smoked cannabis. Another aim of the study was to examine the effects of 'dose' of cannabis, and the time course of pain relief. In a randomized double-blinded placebo controlled trial, volunteers smoked low, medium, and high dose cannabis (2%, 4%, 8% THC by weight) or placebo cigarettes.
"The full results of this study were published in the journal Anesthesiology (Wallace, et al., 2007 – see reference list). Nineteen healthy volunteers were enrolled, and 15 completed all four smoking sessions. In brief, five minutes after cannabis exposure, there was no effect on capsaicin-induced pain at any dose. By 45 minutes after cannabis exposure there was a significant decrease in capsaicin-induced pain with the medium dose (4%) and a significant increase in pain with the high dose (8%). There was no significant effect seen with low dose (2%). There was a significant inverse relationship between pain perception and plasma THC. In summary, this study suggested that there may be a 'therapeutic window' (or optimal dose) for smoked cannabis: low doses were not effective; medium doses decreased pain; and higher doses actually increased pain. These results suggest the mechanism(s) of cannabinoid analgesia are complex, in some ways like non-opioid pain relievers (e.g., aspirin, ibuprofen) and in others like opioids (e.g., morphine)."

Center for Medicinal Cannabis Research, "Report to the Legislature and Governor of the State of California presenting findings pursuant to SB847 which created the CMCR and provided state funding," University of California, (San Diego, CA: February 2010), pp. 11.
http://cdc.coop/docs/neuropath...

33. Medicinal Cannabis and Migraines
"The information reviewed above indicates that cannabis has a long established history of efficacy in migraine treatment. Clinical use of the herb and its extracts for headache has waxed and waned for 1200 years, or perhaps much longer, in a sort of cannabis interruptus. It is only contemporaneously that supportive biochemical and pharmacological evidence for the indication is demonstrable. Cannabis’ unique ability to modulate various serotonergic receptor subtypes, inhibit glutamatergic-mediated toxicities, simultaneously provide antiinflammatory activity and provide acute symptomatic and chronic preventive relief make it unique among available treatments for this disorder."

Russo, Ethan, "Hemp for Headache: An In-Depth Historical and Scientific Review of Cannabis in Migraine Treatment," Journal of Cannabis Therapeutics (September 2000) Vol. 1, pp. 73-74.
https://www.tandfonline.com/do...

34. Cannabinoids and Gastrointestinal Functions
http://link.springer.com/artic...

35. Medicinal Cannabis and Nausea
"This study was designed to determine how therapeutic users of cannabis rate its effectiveness as an anti-emetic, and particularly as a treatment for nausea and vomiting of pregnancy. In general (not specific to pregnancy), the vast majority of our respondents considered cannabis to be extremely effective or effective as a therapy for nausea (93%) and vomiting (75%), and as an appetite stimulant (95%). In the context of pregnancy, cannabis was rated as extremely effective or effective by 92% of the respondents who had used it as a therapy for nausea and vomiting (morning sickness)."

Westfall, Rachel E.; Janssen, Patricia A.; Lucas, Philippe; and Capler, Rielle, "Survey of medicinal cannabis use among childbearing women: Patterns of its use in pregnancy and retroactive self-assessment of its efficacy against ‘morning sickness'," Contemporary Therapies in Clinical Practice (United Kingdom: November 2009) Vol. 15, Issue 4, p. 32.
http://www.ncbi.nlm.nih.gov/pu...
http://safeaccess.ca/research/...

36. Cannabinoids and Multiple Sclerosis
Cannabis and Multiple Sclerosishttp://www.cmaj.ca/content/ear...

37. Medical Marijuana - Research - 11-9-12
“Short-Term Effects of Cannabis Therapy on Spasticity in Multiple-Sclerosis”
Jody Corey-Bloom, M.D., University of California, San Diego
(cannabis and muscle spasticity) "This objective of this study was to determine the potential for smoked cannabis to ameliorate marked muscle spasticity (chronic painful contraction of muscles), a severe and disabling symptom of multiple sclerosis. In a placebo-controlled, randomized clinical trial spasticity and global functioning was examined before and after treatment with smoked cannabis. Patients were allowed to continue their usual treatments for spasticity and pain while participating in the research.
"The full results of this study are being submitted for publication. Initial results were presented at the meeting of the American College of Neuropsychopharmacology in 2007. Thirty patients with multiple sclerosis were enrolled. Compared to placebo cigarettes, cannabis was found to significantly reduce both an objective measure of spasticity, and pain intensity. This study concluded that smoked cannabis was superior to placebo in reducing spasticity and pain in patients with multiple sclerosis, and provided some benefit beyond currently prescribed treatments."

Center for Medicinal Cannabis Research, "Report to the Legislature and Governor of the State of California presenting findings pursuant to SB847 which created the CMCR and provided state funding," University of California, (San Diego, CA: February 2010), p. 12.
http://cdc.coop/docs/neuropath...

38. Cannabis and Multiple Sclerosis
"We found evidence that combined extracts of THC and CBD [cannabidiol] may reduce symptoms of spasticity in patients with MS. Although the subjective experience of symptom reduction was generally found to be significant, objective measures of spasticity failed to provide significant changes. In a previous study of spasticity-related pain, MS patients also reported a subjective perception of symptom reduction with cannabinoids [10]. However, since at least one past animal study has provided objective, physiological evidence for the antispastic properties of cannabinoids [7], the distinction between perceived symptom relief and objective physiological changes in humans should therefore be primary in future research efforts.

"Given that adverse events occurred in each reviewed trial, we also encourage future comparison studies of cannabis treatments at a wide range of dosage in order to balance potential side effects with maximum therapeutic benefit.

"Finally, there is evidence that cannabinoids may provide neuroprotective and anti-inflammatory benefits in MS. Neuroinflammation, found in autoimmune diseases such as MS, has been shown to be reduced by cannabinoids through the regulation of cytokine levels in microglial cells [25]. The therapeutic potential of cannabinoids in MS is therefore comprehensive and should be given considerable attention."

Lakhan, Shaheen E and Rowland, Marie, "Whole plant cannabis extracts in the treatment of spasticity in multiple sclerosis: a systematic review," BMC Neurology (Los Angeles, CA: Global Neuroscience Initiative Foundation, December 2009) Vol. 9, p. 63.
http://www.biomedcentral.com/c...

39. Medical Marijuana - Research - 12-16-09
Cannabis and HIV/AIDShttp://annals.org/article.aspx...

40. Medical Marijuana - Research - 12-16-09
(Medical Cannabis and HIV) "Conclusions: Smoked and oral cannabinoids did not seem to be unsafe in people with HIV infection with respect to HIV RNA levels, CD4+ and CD8+ cell counts, or protease inhibitor levels over a 21-day treatment."

Abrams, Donald I., MD, et al., "Short-Term Effects of Cannabinoids in Patients with HIV-1 Infection - A Randomized, Placebo-Controlled Clinical Trial," Annals of Internal Medicine, Aug. 19, 2003, Vol. 139, No. 4 (American College of Physicians), p. 258.
http://annals.org/article.aspx...

41. Cannabis and Viral Load in HIV-Positive Patients and Patients with Hep C Infections
"Short-term use of smoked cannabis did not affect viral load in 15 HIV-positive patients and also is associated with adherence to therapy and reduced viral loads in 16 patients with hepatitis C infections."

American Medical Association, Council on Science and Public Health, "Report 3 of the Council on Science and Public Health: Use of Cannabis for Medicinal Purposes" (December 2009), p. 15.
http://drugwarfacts.org/cms/fi...

42. Safety of Medical Cannabis During Treatment
"Cannabinoids have a favourable drug safety profile. Acute fatal cases due to cannabis use in humans have not been substantiated, and median lethal doses of THC in animals have been extrapolated to several grams per kilogram of body weight. Cannabinoids are usually well tolerated in animal studies and do not produce the generalized toxic effects of most conventional chemotherapeutic agents. For example, in a 2-year administration of high oral doses of THC to rats and mice, no marked histopathological alterations in the brain and other organs were found. Moreover, THC treatment tended to increase survival and lower the incidence of primary tumours. Similarly, long-term epidemiological surveys, although scarce and difficult to design and interpret, usually show that neither patients under prolonged medical cannabinoid treatment nor regular cannabis smokers have marked alterations in a wide array of physiological, neurological and blood tests."

Guzman, Manuel, "Cannabinoids: Potential Anticancer Agents." Nature Reviews: Cancer (October 2003), p. 752.
http://www.ncbi.nlm.nih.gov/pu...
http://herb.com/guzman.pdf

43. Research Into Potential Therapeutic Uses of Medical Cannabis
http://pharmrev.aspetjournals....

44. Medical Marijuana - Research - 5-21-10
(Endocannabinoid Deficiency) "Baker et al. have described how endocannabinoids may demonstrate an impairment threshold if too high, and a range of normal function below which a deficit threshold may be crossed [112]. Syndromes of CECD [Clinical Endocannabinoid Deficiency] may be congenital or acquired. In the former case, one could posit that genetically-susceptible individuals might produce inadequate endocannabinoids, or that their degradation is too rapid. The same conditions might be acquired in injury or infection."

Russo, Ethan, "Clinical Endocannabinoid Deficiency (CECD): Can this Concept Explain Therapeutic Benefits of Cannabis in Migraine, Fibromyalgia, Irritable Bowel Syndrome and other Treatment-Resistant Conditions?," Neuroendocrinology Letters (Stockholm, Sweden: Society of Integrated Sciences, Feb-Apr 2004) Nos.1/2, Vol.25, p. 38.
http://www.ncbi.nlm.nih.gov/pu...
http://www.freedomtoexhale.com...

45. Medical Marijuana - Research - 8-23-10
Anti-Tumor Propertieshttp://www.jci.org/articles/vi...

46. Medical Cannabis Use Among Patients Receiving Substance Abuse Treatment
"It is clear, however, that cannabis use did not compromise substance abuse treatment amongst the medical marijuana using group. In fact, medical marijuana users seemed to fare equal to or better than non-medical marijuana users in every important outcome category. Movement from more harmful to less harmful drugs is an improvement worthy of consideration by treatment providers and policymakers. The economic cost of alcohol use in California has been estimated at $38 billion [30]. Add to this the harm to individuals, families, communities, and society from methamphetamine, heroin, and cocaine, and a justification can be made for medical marijuana in addictions treatment as a harm reduction practice. As long as marijuana use is not associated with poorer outcomes, then replacing other drug use with marijuana may lead to social and economic savings."

Swartz, Ronald, "Medical marijuana users in substance abuse treatment," Harm Reduction Journal (London, United Kingdom: March 2010) Vol. 7, p. 7-8.
http://www.harmreductionjourna...

47. Medical Marijuana - Research - 8-23-10
(Cannabis and Mantle Cell Lymphoma) "In conclusion, our study demonstrates that the cannabinoid receptor agonists R(+)-MA and Win55 induce a sequence of signaling events leading to cell death of MCL [Mantle Cell Lymphoma] cells. The requirement of ligation of both CB1 and CB2 [receptors] raises the possibility that cannabinoids may be used to selectively target MCL cells to undergo apoptosis."
Note: According to the study authors: "MCL is a malignant B-cell lymphoma with an aggressive course and generally a poor clinical outcome. MCL tumors respond to chemotherapy, but the remissions are short and the median survival is only 3 years."

Gustafsson, Kristin; Christensson, Birger; Sander, Birgitta; and Flygare, Jenny, "Cannabinoid Receptor-Mediated Apoptosis Induced by R(+)-Methanandamide and Win55,212-2 Is Associated with Ceramide Accumulation and p38 Activation in Mantle Cell Lymphoma," Molecular Pharmacology (Bethesda, MD: The American Society for Pharmacology and Experimental Therapeutics, August 2006), p. 1619.
http://molpharm.aspetjournals....

48. Medical Marijuana - Research - 6-20-10
(Potential Antitumor Properties of Cannabinoids) "In conclusion, our data indicate that cannabidiol, and possibly Cannabis extracts enriched in this natural cannabinoid, represent a promising nonpsychoactive antineoplastic strategy. In particular, for a highly malignant human breast carcinoma cell line, we have shown here that cannabidiol and a cannabidiol-rich extract counteract cell growth both in vivo and in vitro as well as tumor metastasis in vivo. Cannabidiol exerts its effects on these cells through a combination of mechanisms that include either direct or indirect activation of CB2 and TRPV1 receptors and induction of oxidative stress, all contributing to induce apoptosis."

Ligresti, Alessia; Moriello, Aniello Schiano; Starowicz, Katarzyna; Matias, Isabel; Pisanti, Simona; De Petrocellis, Luciano; Laezza, Chiara; Portella, Giuseppe; Bifulco, Maurizio; and Di Marzo, Vincenzo, "Antitumor Activity of Plant Cannabinoids with Emphasis on the Effect of Cannabidiol on Human Breast Carcinoma," The Journal of Pharmacology and Experimental Therapeutics (Bethesda, MD: The American Society for Pharmacology and Experimental Therapeutics, March 2004) Vol. 318, No. 3, pp. 1386-1387.
http://jpet.aspetjournals.org/...

49. Medical Marijuana - Research - 1-11-10
(Potential of Cannabinoids in Cancer Therapy) "The use of cannabinoids in medicine is limited by the psychoactive effects mediated by neuronal CB1 receptors (1, 2). Although these adverse effects are within the range of those accepted for other medications, especially in cancer treatment, and tend to disappear with tolerance upon continuous use, it is obvious that cannabinoid-based therapies devoid of side effects would be desirable (3–5). Because glioma cells express functional CB2 receptors (7), we tested the effect of the nonpsychoactive, CB2 receptor-selective agonist JWH-133 and found that it indeed depresses MMP-2 expression in vivo. Likewise, the use of CB receptor type–selective antagonists indicates that CB2 receptors participate in THC-induced inhibition of MMP-2 expression in glioma cells. As selective CB2 receptor activation to mice has been shown to inhibit the growth and angiogenesis of gliomas (11, 13, 27), skin carcinomas (8) and melanomas (15), our observations further support the possibility of finding cannabinoid-based antitumoral strategies devoid of nondesired psychotropic side effects."

Cristina Bla´zquez, Mar?´a Salazar, Arkaitz Carracedo, Mar Lorente, Ainara Egia, Luis Gonza´lez-Feria, Amador Haro, Guillermo Velasco, and Manuel Guzman, "Cannabinoids Inhibit Glioma Cell Invasion by Down-regulating Matrix Metalloproteinase-2 Expression," Cancer Research (March 2008), p. 1951.
http://cancerres.aacrjournals....

50. Medical Marijuana - Research - 10-27-10
(Cannabidiol (CBD) and Breast Cancer) "Our results, which were obtained in a clinically relevant animal model of ErbB2-positive breast cancer, suggest that these highly aggressive and low responsive tumors could be efficiently treated with nonpsychoactive CB2-selective agonists without affecting the surrounding healthy tissue."

Caffarel, María M; Andradas, Clara; Mira, Emilia; Pérez-Gómez, Eduardo; Cerutti; Camilla; Moreno-Bueno, Gema; Flores, Juana; García-Realm, Isabel; Palacios, José; Mañes, Santos; Guzmán, Manuel; Sánchez, Cristina, "Cannabinoids reduce ErbB2-driven breast cancer progression through Akt inhibition," Molecular Cancer (London, United Kingdom: July 22, 2010), p. 1 and P. 8.
http://www.molecular-cancer.co...
http://www.ncbi.nlm.nih.gov/pm...

51. Medical Marijuana - Research - 6-5-10
(Cannabinoids and Cancer Cells) "Cannabinoids, the active components of marijuana and their other natural and synthetic analogues have been reported as useful adjuvants to conventional chemotherapeutic regimens for preventing nausea, vomiting, pain, and for stimulating appetite. Before the discovery of specific cannabinoid systems and receptors, it was speculated that cannabinoids produced their effects via nonspecific interaction with cell membranes. Cannabinoids are proving to be unique based on their targeted action on cancer cells and their ability to spare normal cells. Variation in the effects of cannabinoids in different cell lines and tumor model could be due to the differential expression of CB1 and CB2 receptors. Thus, overexpression of cannabinoid receptors may be effective in killing tumors, whereas low or no expression of these receptors could lead to cell proliferation and metastasis because of the suppression of the antitumor immune response."

Sarfaraz, Sami; Adhami, Vaqar M.; Syed, Deeba N.; Afaq, Farrukh; and Mukhtar, Hasan, "Cannabinoids for Cancer Treatment: Progress and Promise," Cancer Research (Philadelphia, PA: American Association for Cancer Research, January 2008) Vol. 68, pp. 341-342.
http://cancerres.aacrjournals....

52. Medical Marijuana - Research - 1-6-10
(Cannabidiol (CBD) and Cancer Therapy) "In conclusion, a cannabinoid-based therapeutic strategy for neural diseases devoid of undesired psychotropic side effects could find in CBD [a cannabinoid] a valuable compound in cancer therapies along with the perspective of evaluating a synergistic effect with other cannabinoid molecules and/or with other chemotherapeutic agents as well as with radiotherapy. Whatever the precise mechanism underlying the CBD effects, the present results suggest a possible application of CBD as a promising, nonpsychoactive, antineoplastic agent."

Massi, Paola; Vaccani, Angelo; Ceruti, Stefania; Colombo, Arianna; Abbracchio, Maria P., and Parolaro, Daniela, "Antitumor Effects of Cannabidiol, a Nonpsychoactive Cannabinoid, on Human Glioma Cell Lines," The Journal of Pharmacology and Experimental Therapeutics (Bethesda, MD: The American Society for Pharmacology and Experimental Therapeutics, March 2004) Vol. 308, p. 845.
http://jpet.aspetjournals.org/...

53. Medical Marijuana - Research - 12-22-10
Cannabis and Diabeteshttp://www.natap.org/2010/news...
http://www.jaccjournaloftheacc...

54. Medical Marijuana - Research - 6-12-10
(Cannabidiol (CBD) and Diabetic Retinopathy) "Drugs that enhance extracellular adenosine signaling have been of clinical interest in treatment of inflammation after myocardial or cerebral ischemia.25,26 CBD as an anti-inflammatory drug is an attractive alternative to smoking marijuana because of its lack of psychoactive effects.27 CBD is known to be nontoxic in humans,28 which has previously been a problem for other nucleoside inhibitor drugs.29,30"

Liou, Gregory I.; Auchampach, John A.; Hillard, Cecilia J.; Zhu, Gu; Yousufzai, Bilal; Salman, Mian; Khan, Sohail; and Khalifa, Yousuf, "Mediation of Cannabidiol Anti-inflammation in the Retina by Equilibrative Nucleoside Transporter and A2A Adenosine Receptor," Investigative Ophthalmology & Visual Science (Rockville, MD: Association for Research in Vision and Ophthalmology, December 2008), Vol. 49, No. 12, p. 5531.
http://www.iovs.org/cgi/reprin...

55. Cannabidiol (CBD) and Diabetic Retinopathy
"Recent evidence suggests that local inflammation plays a major role in the pathogenesis of diabetic retinopathy. The function of CBD as an antioxidant to block oxidative stress and as an inhibitor of adenosine reuptake to enhance a self-defense mechanism against retinal inflammation represents a novel therapeutic approach to the treatment of ophthalmic complications associated with diabetes."

Loiu, George, " Diabetic retinopathy: Role of inflammation and potential therapies for anti-inflammation, " World Journal of Diabetes (Beijing, China: Beijing Baishideng BioMed Scientific Co., March 15, 2010), p. 15.
https://www.ncbi.nlm.nih.gov/p...
https://www.ncbi.nlm.nih.gov/p...

56. Cannabidiol (CBD) As Antipsychotic
"Our results provide evidence that the non-cannabimimetic constituent of marijuana, cannabidiol, exerts clinically relevant antipsychotic effects that are associated with marked tolerability and safety, when compared with current medications."

Leweke, FM; Piomelli, D; Pahlisch, F; Muhl, D; Gerth, CW; Hoyer, C; Klosterkotter, J; Hellmich, M; and Koethe, D, "Cannabidiol enhances anandamide signaling and alleviates psychotic symptoms of schizophrenia," Translational Psychiatry (New York, NY: Nature Publishing Company, March 2012), p. 6.
http://www.nature.com/tp/journ...

57. Medical Marijuana - Research - 8-12-10
Substance Abuse and Mental Health Treatmenthttp://www.jneurosci.org/cgi/r...

58. Medical Marijuana - Research - 11-14-10
(Cannabidiol (CBD) and Schizophrenia Treatment) "These studies suggest, therefore, that CBD has an antipsychotic-like profile in healthy volunteers and may possess antipsychotic properties in schizophrenic patients, but not in the resistant ones. Confirming this suggestion, a preliminary report from a 4-week, double-blind controlled clinical trial, using an adequate number of patients and comparing the effects of CBD with amisulpride in acute schizophrenic and schizophreniform psychosis, showed that CBD significantly reduced acute psychotic symptoms after 2 and 4 weeks of treatment when compared to baseline. In this trial CBD did not differ from amisulpride except for a lower incidence of side effects (49).
"In conclusion, results from pre-clinical and clinical studies suggest that CBD is an effective, safe and well-tolerated alternative treatment for schizophrenic patients. Future trials of this cannabinoid in other psychotic conditions such as bipolar disorder (50) and comparative studies of its antipsychotic effects with those produced by clozapine in schizophrenic patients are clearly needed."

"Zuardi, A.W.; Crippa, J.A.S.; Hallak, J.E.C.; Moreira, F.A.; and Guimarães, F.S., "Cannabidiol, a Cannabis sativa constituent, as an antipsychotic drug," Brazilian Journal of Medical and Biological Research (Ribeirão Preto, Brazil: April 2006), Volume 39, Issue 4, p. 427-428.
http://www.scielo.br/pdf/bjmbr...

59. Cannabinoids and PTSD
"A chart review of patients diagnosed with PTSD who were referred to a private psychiatric clinic suggests that the synthetic cannabinoid, nabilone, has beneficial effects beyond its official indication in regard to abolishing or greatly reducing nightmares that persisted in spite of treatment with conventional PTSD medications.
"The subjects concomitantly received nabilone in addition to the one or more psychiatric medications that they were already taking for 2 years or more. No tolerance to nabilone was observed among the patients. This may indicate its potential longer-term safety and efficacy.
"The author recognizes the limits of this study (e.g., there was no placebo control, the measurements were limited to subjective reports to nightmare changes, the study was on a small number of patients, and there was a selective bias by nature of referrals to a specific clinic from which the patients were selected). Nonetheless, on the basis of these retrospective findings, nabilone appears to be a significant treatment for nightmares in the PTSD population."

Fraser, George A., "The Use of a Synthetic Cannabinoid in the Management of Treatment-Resistant Nightmares in Posttraumatic Stress Disorder (PTSD)," CNS Neuroscience & Therapeutics (Hoboken, NJ: Wiley-Blackwell, Winter 2009), p. 87.
http://onlinelibrary.wiley.com...

60. Substitution of Cannabis for Other Drugs
"Eighty five percent of the BPG [Berkeley Patients Group] sample reported that cannabis has much less adverse side effects than their prescription medications. Additionally, the top two reasons listed by participants as reasons for substituting cannabis for one of the substances previously mentioned were less adverse side effects from cannabis (65%) and better symptom management from cannabis (57.4%).
"Conclusion
"The substitution of one psychoactive substance for another with the goal of reducing negative outcomes can be included within the framework of harm reduction. Medical cannabis patients have been engaging in substitution by using cannabis as an alternative to alcohol, prescription and illicit drugs."

Reiman, Amanda, "Cannabis as a Substitute for Alcohol and Other Drugs," Harm Reduction Journal (London, United Kingdom: December 2009).
harmreductionjournal.com

61. Medical Cannabis Legalization and Adolescent Cannabis Use
http://www.fas.org/sgp/crs/mis...

62. Impact of Medical Marijuana Laws (MMLs) on Cannabis Use by Youth
"We replicated the findings of Wall et al. (2) that marijuana use was higher in states that have passed MMLs, and our analysis suggests this is unlikely to be a causal association. Our difference-in-differences estimates suggest little detectable effects of passing MMLs on marijuana use or perceived riskiness of use among adolescents or adults, which is consistent with some limited prior evidence on arrestees and emergency department patients (17). Future analyses that take advantage of additional policy changes may provide further evidence on this question, but our results suggest that such analyses should adequately control for potential confounding by unmeasured state characteristics."

Sam Harper, Erin C. Strumpf, and Jay S. Kaufman, "Do Medical Marijuana Laws Increase Marijuana Use? Replication Study and Extension," Annals of Epidemiology, March 2012 (Vol. 22, Issue 3, Pages 207-212, DOI: 10.1016/j.annepidem.2011.12.002).
http://download.journals.elsev...

63. Adolescents - Usage - 12-24-09
(Non-Recreational Adolescent Marijuana Use) "The findings of this study provide one of the first in-depth descriptions of youths' use of marijuana for non-recreational purposes, adding to the growing body of research on the use of drugs to self-medicate among young people. Teens involved in regular and long-term use of marijuana for relief constructed their use of marijuana as essential to feeling better or 'normal' in situations where they perceived there were few other options available to them. Unlike the spontaneity typically involved in recreational use, these youth were thoughtful and prescriptive with their marijuana use – carefully monitoring and titrating their use to optimize its therapeutic effect. The findings also point to important contextual factors that further support youth's use of marijuana for relief that extend beyond the availability of marijuana and dominant discourses that construct marijuana as a natural product with medicinal properties."

Bottorff, Joan L , Johnson, Joy L, Moffat, Barbara M, and Mulvogue, Tamsin, "Relief-oriented use of marijuana by teens," Journal of Substance Abuse Treatment, Prevention, and Policy (Vancouver, BC: April 2009), doi:10.1186/1747-597X-4-7.
http://www.ncbi.nlm.nih.gov/pm...

64. Youth Medical Marijuana Use and Unmet Health Needs
"Of key importance in the findings are the unmet health needs of these youth. Health issues such as depression, insomnia, and anxiety were significant problems that interfered with these youths' ability to function at school, maintain relationships with family and friends, and feel that they could live a normal life. The level of distress associated with these health concerns, along with the lack of effective interventions by heath care providers and family members appeared to leave them with few alternatives. Researchers have reported that when adolescents in rural communities experience barriers to seeking health care, they think they can take care of the problems themselves [30]. Similarly, our study participants believed that their best option was to assume responsibility for treating their problems by using marijuana. Unpleasant side effects with prescribed medications and long, ineffective therapies resulted in little hope that the medical system could be counted on as beneficial. In contrast, marijuana provided these youth with immediate relief for a variety of health concerns. Nevertheless, the regular use of marijuana put youth at risk. Cannabis use has been identified as a risk factor for mental illness such as psychosis, schizophrenia [21,31,32] and psychiatric symptoms such as panic attacks [33]. Teens who smoked marijuana at least once per month in the past year were found to be three times more likely to have suicidal thoughts than non-users [34], and there is evidence that exposure to cannabis may worsen depression in youth [35]. Marijuana use among youth has also been associated with other substance use and school failure [36]. What is interesting is that the findings of this study suggest that youth have little awareness of some of these risks; rather, some are using marijuana to counteract these very problems (e.g., depression, school failure). Teens' perceptions that their health concerns were not addressed suggest that more attention is needed to assess these issues and ensure that other options are available to them. Parents and health care providers need to make a concerted effort to not only understand the pressures and influences on youth [37], but also gain a better understanding of the effect of youths' health problems on their ability to engage in healthy lifestyle choices."

Bottorff, Joan L , Johnson, Joy L, Moffat, Barbara M, and Mulvogue, Tamsin, "Relief-oriented use of marijuana by teens," Journal of Substance Abuse Treatment, Prevention, and Policy (Vancouver, BC: April 2009), doi:10.1186/1747-597X-4-7.
http://www.ncbi.nlm.nih.gov/pm...

65. Youth Medical Marijuana Use and Reasons for Self-Medication
"Underlying problems related to youth health concerns also need to be addressed. In many situations, the participants' symptoms appeared to be directly related to their life circumstances. Along with the challenges inherent in being an adolescent in today's complex world, some teens were also trying to deal with significant losses (death of a close friend or family member), extremely difficult family relationships, disappointments with friends, school and sports, and a fragile family and peer support network. The risk of substance use increases substantially when youth are attempting to deal with these kinds of situations in isolation. Although marijuana provided the youth with temporary relief, the underlying situation often went unattended – leading the teens into a regular pattern of use. Appropriate guidance and targeted support from counselors and health care providers must be sensitive to meeting the needs of youth as they work through such situations and life altering events. In addition, adults working with youth must find better ways to talk with young people about how they are coping with their health issues, including their marijuana use. Based on the experiences of youth in this study, there is a wide range of support that may benefit youth including counseling, stress management, social skills training, anger management, study skills, pain management, and sleep hygiene. The youth in this study had minimal access to these types of resources."

Bottorff, Joan L , Johnson, Joy L, Moffat, Barbara M, and Mulvogue, Tamsin, "Relief-oriented use of marijuana by teens," Journal of Substance Abuse Treatment, Prevention, and Policy (Vancouver, BC: April 2009), doi:10.1186/1747-597X-4-7.
http://www.ncbi.nlm.nih.gov/pm...

66. Effects of State Medical Marijuana Laws (MMLs) on Youth Marijuana Use
"We found no evidence of intermediate-term effects of passage of state MMLs on the prevalence or frequency of adolescent nonmedical marijuana use in the states evaluated, with 2 minor exceptions. From 2003 through 2009, adolescent lifetime prevalence of marijuana use and frequency of daily marijuana use decreased significantly in Montana, as compared with a more modest decrease in lifetime prevalence and an increase in daily frequency observed in Delaware (Ps = .03). These 2 statistically significant findings do not appear to represent real effects. Our difference-in-differences study design involved 40 planned comparisons (before---after differences in treatment vs comparison states), and naturally 2 significant results (at the P < .05 level) of a possible 40 can be expected according to chance alone.
"Moreover, the pattern is not consistent with an effect of MMLs. A significant effect was found for lifetime marijuana use but not past-month marijuana use. Self-reported lifetime use requires a much longer recall period than past-month use and is characterized by higher measurement error.13 Also, one would expect the 30-day use measure to be more sensitive than lifetime use to the effects of a change in MMLs, because most of the period covered by respondents’ lifetime reports occurred before passage of an MML.
"Finally, the significant increase in daily marijuana use was observed for the comparison state of Delaware, which had not enacted an MML during the years under evaluation, whereas the frequency of daily marijuana use in Montana decreased. This is the opposite of
what would be expected if MMLs had the deleterious effect of increasing the frequency of nonmedical marijuana use.
"Conversely, the significant effects observed were found between the 2 states that differed the most on the timing of MML enactment, maximizing the length of the follow-up period. Hence, it is reasonable to suspect that enacting an MML may influence the prevalence and frequency of adolescent nonmedical marijuana use half a decade later, despite no evidence of more proximal effects."

Sarah D. Lynne-Landsman, PhD, Melvin D. Livingston, BA, and Alexander C. Wagenaar, PhD, "Effects of State Medical Marijuana Laws on Adolescent Marijuana Use," American Journal of Public Health, June 13, 2013.
Abstract at: http://ajph.aphapublications.o...

67. Medical Marijuana - Dronabinol - 2-26-11
Marinol and Dronabinolhttp://www.merckmanuals.com/pr...
"MARINOL® (dronabinol) Capsules," (Abbott Laboratories: Abbott Park, IL, July 2006), pp. 11.
http://www.accessdata.fda.gov/...
Federal Register, "Listing of Approved Drug Products Containing Dronabinol in Schedule III," Vol. 75, No. 210, Monday, November 1, 2010, pp. 67054 to 67059.
http://www.gpo.gov/fdsys/pkg/F...
"United States Adopted Name," The Bantam medical dictionary, p. 685.
http://mapinc.org/url/lRc4R0vb

68. Marinol (Synthetic THC
MARINOL® (dronabinol) Capsules
"CLINICAL PHARMACOLOGY
"Pharmacodynamics
"After oral administration, dronabinol has an onset of action of approximately 0.5 to 1 hours and peak effect at 2 to 4 hours. Duration of action for psychoactive effects is 4 to 6 hours, but the appetite stimulant effect of dronabinol may continue for 24 hours or longer after administration.
"INDICATIONS AND USAGE
"MARINOL Capsules is indicated for the treatment of:
"1. anorexia associated with weight loss in patients with AIDS; and
"2. nausea and vomiting associated with cancer chemotherapy in patients who have failed to respond adequately to conventional antiemetic treatments.
"ADVERSE REACTIONS"
"A cannabinoid dose-related “high” (easy laughing, elation and heightened awareness) has been reported by patients receiving MARINOL® Capsules in both the antiemetic (24%) and the lower dose appetite stimulant clinical trials (8%)
"DRUG ABUSE AND DEPENDENCE
"MARINOL Capsules is one of the psychoactive compounds present in cannabis, and is abusable and controlled [Schedule III (CIII)] under the Controlled Substances Act. Both psychological and physiological dependence have been noted in healthy individuals receiving dronabinol, but addiction is uncommon and has only been seen after prolonged high dose administration.
"Chronic abuse of cannabis has been associated with decrements in motivation, cognition, judgement, and perception. The etiology of these impairments is unknown, but may be associated with the complex process of addiction rather than an isolated effect of the drug. No such decrements in psychological, social or neurological status have been associated with the administration of MARINOL Capsules for therapeutic purposes.
"In an open-label study in patients with AIDS who received MARINOL Capsules for up to five months, no abuse, diversion or systematic change in personality or social functioning were observed despite the inclusion of a substantial number of patients with a past history of drug abuse.
"OVERDOSAGE
"Signs and symptoms following MILD MARINOL Capsules intoxication include drowsiness, euphoria, heightened sensory awareness, altered time perception, reddened conjunctiva, dry mouth and tachycardia; following MODERATE intoxication include memory impairment, depersonalization, mood alteration, urinary retention, and reduced bowel motility; and following SEVERE intoxication include decreased motor coordination, lethargy, slurred speech, and postural hypotension. Apprehensive patients may experience panic reactions and seizures may occur in patients with existing seizure disorders.
Note: Marinol® is now marketed by Abbott Laboratories.

"MARINOL® (dronabinol) Capsules," (Abbott Laboratories: Abbott Park, IL, July 2006), pp. 1, 2, 6, 9, 10, 11, and 13.
http://global.abbottgrowth.com...
Abbott Marinol® pricing as of 2/27/11:
http://mapinc.org/url/WQiRxgLB
http://www.accessdata.fda.gov/...

69. Rescheduling
Other Laws & Policieshttp://www.nejm.org/doi/pdf/10...

70. Legalizing Without Congress
"Not surprisingly, the Obama Administration would have been more successful had it simply legalized medical marijuana.143 In fact, the CSA [Controlled Substances Act] authorizes the Attorney General to do so, in consultation with the Secretary of Health and Human Services and the DEA.144 In other words, the President would not need the consent of the Congress to make this, more fundamental change to federal law."

Miklos, Robert A., "A Critical Appraisal of the Department of Justice's New Approach to Medical Marijuana" (February 23, 2011). Stanford Law & Policy Review, Vol. 201, p. 101, 2011 ; Vanderbilt Public Law Research Paper No. 11-07, pp. 665-666.
http://papers.ssrn.com/sol3/De...

71. Current Scheduling of Cannabis
Cannabis (marijuana) is listed in Schedule I of the 1970 Controlled Substance Act. Schedule 1 classification is supposed to mean: "(A) The drug or other substance has a high potential for abuse. (B) The drug or other substance has no currently accepted medical use in treatment in the United States. (C) There is a lack of accepted safety for use of the drug or other substance under medical supervision."

U.S. Code. Title 21, Chapter 13 -- Drug Abuse Prevention and Control -- Section 812, Schedules of Controlled Substances, p. 384.
http://frwebgate.access.gpo.gov...
http://mapinc.org/url/1NCZaa7Q

72. Exceptions to Federal Ban
"Only two limited exceptions to the federal ban on marijuana have been made. The first, a compassionate use program created under President Carter, is superficially analogous to extant state medical use programs; it allows patients to use marijuana legally for therapeutic purposes. The marijuana for the program is supplied by a federally approved grow-site at the University of Mississippi (the only federally approved grow-site in the United States). However, the program stopped accepting new applications in 1992, and only eight (yes, eight) patients currently receive marijuana through it. Over its entire history, only thirty-six patients have been enrolled.52 The second and only other way to obtain marijuana legally under federal law is by participating in an FDA-approved research study. But since the federal government approves so few marijuana research projects—eleven since 200053—only a small fraction of the population that currently qualifies for state exemptions could participate."

Miklos, Robert A., "On the Limits of Supremacy: Medical Marijuana and the States’ Overlooked Power to Legalize Federal Crime," Vanderbilt Law Review (Nashville, TN: Vanderbilt University Law School, March 9, 2009), p. 113.
http://papers.ssrn.com/sol3/De...

73. Medical Marijuana - 4-11-10
(History) "For most of American history, growing and using marijuana was legal under both federal law and the laws of the individual states. By the 1840s, marijuana’s therapeutic potential began to be recognized by some U.S. physicians. From 1850 to 1941 cannabis was included in the United States Pharmacopoeia as a recognized medicinal.4 By the end of 1936, however, all 48 states had enacted laws to regulate marijuana.5 Its decline in medicine was hastened by the development of aspirin, morphine, and then other opium-derived drugs, all of which helped to replace marijuana in the treatment of pain and other medical conditions in Western medicine.6"

Eddy, Mark, "Medical Marijuana: Review and Analysis of Federal and State Policies," Congressional Research Service (Washington, DC: March 31, 2009), p. 1.
http://www.fas.org/sgp/crs/mis...

74. NIDA's Federal Medical Cannabis Program
"It is a judicial fluke that the National Institute on Drug Abuse has provided medical marijuana to a handful of patients (never more than 32, currently 4 surviving) as the outcome of the settlement in a lawsuit pressed in 1976 by a man with cannabis-responsive glaucoma. That settlement became the basis for the FDA’s Compassionate Investigational New Drug Study program for patients with marijuana responsive conditions. No patient has been enrolled since 1992, when the George H. W. Bush administration suspended new registration in reaction to a large influx of applications from AIDS patients."

Bostwick, J. Michael, "Blurred Boundaries: The Therapeutics and Politics of Medical Marijuana," Mayo Clinic Proceedings (Rochester, MN: Mayo Clinic, February 2012), Vol. 87, No. 2, p. 182.
http://download.journals.elsev...

75. Medical Marijuana - Law & Policy - 7-13-12
"Although Raich established Congress’s constitutional authority to enact the existing federal prohibition on marijuana, principles of federalism prevent the federal government from mandating that the states support or participate in enforcing the federal law. While state resources may be helpful in combating the illegal use of marijuana, Congress’s ability to compel the states to enact similar criminal prohibitions, to repeal medical marijuana exemptions, or to direct state police officers to enforce the federal law remains limited. The Tenth Amendment likely prevents such an intrusion into state sovereignty."

Garvey, Todd, "Medical Marijuana: The Supremacy Clause, Federalism, and the Interplay Between State and Federal Laws," Congressional Research Service (Washington, DC: Library of Congress, March 6, 2012), p. 5.
http://www.fas.org/sgp/crs/mis...

76. Medical Marijuana - Law & Policy - 6-22-12
(Medical Cannabis and the Constitution's Commerce Clause) "Congress has exercised its Commerce Clause authority to categorically ban marijuana. The Supreme Court has upheld this plenary prohibition.19 In Gonzales v Raich, a divided Court held that the Commerce Clause enables Congress to prohibit the local cultivation and use of marijuana, despite more permissive regulations under California law.20 Writing for the majority, Justice Stevens found that precedent 'firmly established' Congress’ power under the Commerce Clause to regulate purely local activities that have a substantial effect on interstate commerce.21 The Raichmajority held that Congress can prohibit local marijuana cultivation and use, because it was part of a 'class of activities' constituting the national black market for marijuana.22 The Court reasoned that local cultivation and use, even for limited medical purposes, affected supply and demand in the national black market, making regulation over local use 'essential' to undermining the broader underground industry nationwide.23The majority distinguished Raich from earlier precedent that circumscribed Congress’ Commerce Clause power, finding that those earlier cases involved statutes that regulated purely non-economic activities, while this one aims to nullify a particular application of a valid statutory scheme.24"

Woods, Jordan Blair, "The Kingpin Act vs. Calfornia's Compassionate Use Act: The Dubious Battle Between State and Federal Drug Laws," University of the District of Columbia Law Review (Washington, DC: The University of the District of Columbia David A. Clarke School of Law, 2011) Volume 15, Number 1, p. 50.
http://www.udclawreview.com/wp...

77. Medical Marijuana in States Prior to Passage of California's Prop 215
Beginning in 1978, thirty-seven states enacted some form of medicinal cannabis legislation other than effective laws. These include:
Therapeutic Research Programs (state-run therapeutic research programs, not operable because of federal obstruction): Alabama, California, Georgia, Illinois, Massachusetts, Minnesota, New Jersey, New York, South Carolina, Texas.
Symbolic Prescriptions (patients allowed to possess cannabis only if obtained through prescription, not operable because the CSA bars physicians from writing prescriptions for Schedule I drugs): Arizona, California, Connecticut, District of Columbia, Iowa, New Hampshire, Tennessee, Virginia, Wisconsin.
State Rescheduling (not operable because federal scheduling supersedes state schedules): Alaska, Iowa, Montana, Tennessee, and the District of Columbia.
Non-binding Resolutions Urging Federal Rescheduling: California, Michigan, Missouri, New Hampshire, New Mexico, Rhode Island, Washington.

"Beginning in the late 1970s, a number of state governments sought to give large numbers of patients legal access to medical marijuana through federally approved research programs.

"While 26 states passed laws creating therapeutic research programs, only seven obtained all of the necessary federal permissions, received marijuana and/or THC (tetrahydrocannabinol, the primary active ingredient in marijuana) from the federal government, and distributed the substances to approved patients through approved pharmacies. Those seven states were California, Georgia, Michigan, New Mexico, New York, Tennessee, and Washington.

"Typically, patients were referred to the program by their personal physicians. These patients, who often had not responded well to conventional treatments, underwent medical and psychological screening processes. Then, the patients applied to their state patient qualification review board, which resided within the state health department. If granted permission, they would receive marijuana from approved pharmacies. Patients were required to monitor their usage and marijuana’s effects, which the state used to prepare reports for the FDA. (Interestingly, former Vice President Al Gore’s sister received medical marijuana through the Tennessee program while undergoing chemotherapy for cancer in the early 1980s.)

"These programs were designed to enable patients to use marijuana. The research was not intended to generate data that could lead to FDA approval of marijuana as a prescription medicine. For example, the protocols did not involve doubleblind assignment to research and control groups, nor did they involve the use of placebos.

"Such programs were discontinued by the mid-1980s, and the federal government has since made it more difficult for researchers to obtain marijuana for study, preferring to approve only those studies that are well-controlled clinical trials designed to yield essential scientific data."

Marijuana Policy Project, "State by State Medical Marijuana Laws 2015 with a December 2016 Supplement - How to Remove the Threat of Arrest," (Washington, DC: MPP, February 2017), p. 1, last accessed January 8, 2019.
https://www.mpp.org...

78. Medical Marijuana - Supporters - 5-15-11
(US Department of Veterans Affairs, Medical Marijuana, and Pain Management) "If a Veteran obtains and uses medical marijuana in manner consistent with state law, testing positive for marijuana would not preclude the Veteran from receiving opioids for pain management in the Department of Veteran Affairs (VA) facility. The Veteran would need to inform his provider of the use of medical marijuana, and of any other non-VA prescribed medications he or she is taking to ensure that all medications, including opioids, are prescribed in a safe manner. Standard pain management agreements should draw a clear distinction between use of illegal drugs, and legal medical marijuana. However, the discretion to prescribe, or not prescribe, opioids in conjunction with medical marijuana, should be determined on clinical grounds, and thus will remain the decision of the individual health care provider. The provider will take the use of medical marijuana into account in all prescribing decisions, just as the provider would for any other medication. This is a case-by-case decision, based on the provider's judgment, and the needs of the patient."

Petzel, Robert A., Letter to Michael Krawitz from the Dept. of Veterans Affairs concerning its postion on medical marijuana, (Washington, DC: Department of Veterans Affairs, Under Secretary for Health, July 6, 2010).
http://www.veteransformedicalm...

79. American Nurses Association Position Statement on Medical Cannabis
"'It is the shared responsibility of professional nursing organizations to speak for nurses collectively in shaping health care and to promulgate change for the improvement of health and health care' (ANA, 2015, p. 36). Therefore, the ANA strongly supports:

"#&149; Scientific review of marijuana’s status as a federal Schedule I controlled substance and relisting marijuana as a federal Schedule II controlled substance for purposes of facilitating research.

"• Development of prescribing standards that includes indications for use, specific dose, route, expected effect and possible side effects, as well as indications for stopping a medication.

"• Establishing evidence-based standards for the use of marijuana and related cannabinoids.

"• Protection from criminal or civil penalties for patients using therapeutic marijuana and related cannabinoids as permitted under state laws.

"• Exemption from criminal prosecution, civil liability, or professional sanctioning, such as loss of licensure or credentialing, for health care practitioners who discuss treatment alternatives concerning marijuana or who prescribe, dispense or administer marijuana in accordance with professional standards and state laws."

"Revised Position Statement: Therapeutic Use of Marijuana and Related Cannabinoids." American Nurses Association Board of Directors. 2016.
https://www.nursingworld.org/p...
https://www.nursingworld.org/~...

80. Medical Marijuana - 5-29-10
(Categories of Cannabinoid Medicines) "They [cannabinoid medicines] fall into three categories: single molecule pharmaceuticals, cannabisbased liquid extracts, and phytocannabinoid-dense botanicals–the main focus of this article (Figure 2). The first category includes US Food and Drug Administration (FDA)-approved synthetic or semisynthetic single molecule cannabinoid pharmaceuticals available by prescription. Currently, these are dronabinol, a Schedule III drug and nabilone, a Schedule II drug. Though both are also used offlabel, dronabinol, a (-)trans-[delta]9-tetrahydrocannabinol (THC) isomer found in natural cannabis, has been approved for two uses since 1985 and 1992, respectively: the treatment of nausea and vomiting associated with cancer chemotherapy in patients who have failed to respond adequately to conventional antiemetic treatments and the treatment of anorexia associated with weight loss in patients with AIDS.10,11 Nabilone, a synthetic molecule shaped similarly to THC, has also been approved since 1985 for use in the treatment of nausea and vomiting associated with cancer chemotherapy.12,13
"The second category of cannabinoid medicines being used in the United States includes a line of cannabis-based medicinal extracts developed by several companies. The industry leader is GW Pharmaceuticals, a UK-based biopharmaceutical company whose lead product is currently undergoing FDA-approved, multisite Phase IIb clinical trials for the treatment of opioid-refractory cancer pain in the United States14 and has received prior approval for Phase III clinical trials in the United States. This botanical drug extract which goes by the nonproprietary name nabiximols has already secured approval in Canada for use in the treatment of central neuropathic pain in multiple sclerosis (in 2005) and in the treatment of intractable cancer pain (in 2007).15 It is also available on a named patient basis in the United Kingdom and Catalonia,16,17a scheme which allows a doctor to prescribe an unlicensed drug to a particular “named patient,” and has been exported to 22 countries to date.
"The third category of cannabinoid medicines currently being used in the United States includes the Schedule I medicinal plant Cannabis sativa L. itself, which, while currently unavailable for general prescription use in the United States, is in use in the context of two active controlled clinical trials,18,19 33 completed controlled clinical trials,20-52 and one on-going, yet essentially defunct, three-decade investigational clinical study.53,54"

Aggarwal, Sunil K.; Carter, Gregory T.; Sullivan, Mark D.; ZumBrunnen, Craig; Morrill, Richard; and Mayer, Jonathan D., "Medicinal use of cannabis in the United States: Historical perspectives, current trends, and future directions" Journal of Opioid Management, (Weston, Massachusettes: May/June 2009) Vol. 5:3, pp. 153-154.
http://www.ncbi.nlm.nih.gov/pu...
http://www.letfreedomgrow.com/...

81. California Medical Association and Medical Cannabis
"CMA [California Medical Association] policy has acknowledged the criminalization of cannabis to be a failed public health policy (HOD 704a-09) and has recognized a public movement toward the legalization of cannabis (HOD 101a-10). Cannabis illegality has perpetuated the effective prohibition of clinical research on the properties of cannabis and has prevented the development of state and national standards governing the cultivation, manufacture, and labeling of cannabis products, similar to those governing food, tobacco and alcohol products, most of which are promulgated by federal agencies."

"Cannabis and the Regulatory Void: Background Paper and Recommendations," California Medical Association (Sacramento, CA: 2011), 11.
http://www.cmanet.org/files/pd...

82. No Association Between Medical Marijuana Dispensaries and Crime
(Dispensaries and Crime) "The cross-sectional results suggest that dispensaries are not associated with crime rates; however, current media and policy efforts have focused their attention on the place-based regulation of these dispensaries to protect the public against crime (California Police Chief’s Association, 2009; City of Los Angeles, 2010; Lopez, 2010). Based on the limited evidence presented by this study, it is unclear if place-based policies will be effective."

Kepple, Nancy J. and Freisthlere, Bridget, "Exploring the Ecological Association Between Crime and Medical Marijuana Dispensaries," Journal of Studies on Alcohol and Drugs (Piscataway, NJ: The State University of New Jersey Rutgers, July 2012) Volume 73, Issue 4, p. 529.
https://www.ncbi.nlm.nih.gov/p...
https://www.ncbi.nlm.nih.gov/p...

83. Medical Marijuana - Law & Policy - 1-4-12
(Ethics of Recommending Medical Cannabis to Patients) "Portions of the American Medical Association’s Code of Medical Ethics, Opinion 1.02 – The Relation of Law and Ethics reads, 'Ethical values and legal principles are usually closely related, but ethical obligations typically exceed legal duties. In some cases, the law mandates unethical conduct.' 'In exceptional circumstances of unjust laws, ethical responsibilities should supersede legal obligations.'[56] An 'exceptional circumstance of unjust laws' may be interpreted as the federal ban on cannabis for medical use. Sixteen states and the District of Columbia found the federal government’s prohibition on prescribing and using medicinal cannabis so unjust as to create laws in direct violation of federal statute. Therefore, one could surmise that prescribing cannabis for the purpose of harm reduction is ethical even though it violates federal law. In addition, Hayry suggests that the idea of 'freedom' also provides an ethical reason for prescribing cannabis and he writes, '… whatever the legal situation, respect for the freedom of the individual would imply that requests like this (for medicinal cannabis) should be granted, either by health professionals, or by society as a whole.'[57]"

Collen, Mark, "Prescribing Cannabis for Harm Reduction," Harm Reduction Journal (London, United Kingdom: January 2012) Vol. 9, Issue 1, p. 5.
http://www.harmreductionjourna...

84. Medical Marijuana - Research - 11-9-12
“Vaporization as a ‘Smokeless’ Cannabis Delivery System”
Donald Abrams, M.D., University of California, San Francisco
(vaporization of cannabis) "The aim of this study was to evaluate the use of a vaporization system (the Volcano; VAPORMED® Inhalatoren; Tüttlingen, Germany) as a “smokeless” delivery system for inhaled cannabis. Because of concerns regarding the practicality and palatability of using cannabis cigarettes as a standard treatment, there has been an interest in developing alternative delivery systems. Participants were randomly assigned to receive low, medium, or high dose (1.7, 3.4, or 6.8% tetrahydrocannabinol) cannabis cigarettes delivered by smoking or by the vaporization
system on six study days.
"The full results of this study have been published in the journal Clinical Pharmacology & Therapeutics (Abrams, et al., 2007 – see reference list). Eighteen healthy volunteers were recruited to participate in the research. The analysis indicated that the blood levels of vaporized cannabis are similar to those of smoked cannabis over a six hour period. However, blood concentrations of THC at 30 and 60 minutes after inhalation were significantly higher in vaporized cannabis as compared to smoked cannabis. In addition, carbon monoxide levels were significantly reduced with vaporization compared with smoked cannabis. Fourteen participants preferred vaporization, 2 preferred smoking, and 2 reported no preference. In summary, vaporization of cannabis was found to be a safe mode of delivery, and participants had a preference for vaporization over smoking as a delivery system in this trial."

Center for Medicinal Cannabis Research, "Report to the Legislature and Governor of the State of California presenting findings pursuant to SB847 which created the CMCR and provided state funding," University of California, (San Diego, CA: February 2010), p. 12.
http://cdc.coop/docs/neuropath...

85. Medical Marijuana - Law and Policy - 5-17-11
(Federally-Subsidized Public Housing and Medical Cannabis) "In sum, PHAs [Public Housing Agencies] and owners may not grant reasonable accommodations that would allow tenants to grow, use, or otherwise possess, or distribute medical marijuana, even if in doing so tenants are complying with state laws authorizing medical marijuana-related conduct. Further, PHAs and owners must deny admission to those applicant households with individuals who are, at the time of consideration for admission, using marijuana. See 42 U.S.C. § 13661(b)(1)(A); Lester Memorandum at 2.
"We note, however, that PHAs and owners have statutorily-authorized discretion with respect to evicting or refraining from evicting current residents on account of their use of medical marijuana. See 42 U.S.C. § 13662(b)(1); Lester Memorandum at 5-7. If a PHA or owner desires to allow a resident who is currently using medical marijuana to remain as an occupant, the PHA or owner may do so as an exercise of that discretion, but not as reasonable accommodation. HUD regulations provide factors that PHAs and owners may consider when determining how to exercise their discretion to terminate tenancies because of current illegal drug use. See 24 C.F.R. § 966.4(1)(5)(vii)(B)(factors for PHAs); 5.852 (factors for PHAs and owners operating other assisted housing programs)."

Kanovsky, Helen, R. "Medical Use of Marijuana and Reasonable Accommodation in Federal Public and Assisted Housing," U.S. Department of Housing and Urban Development (Washington, DC: January 20, 2011), pp. 10-11.
http://www.scribd.com/doc/4765...

86. Medical Marijuana - Orgs - 12-19-09
US-Based Medical and Scientific Organizations Which Support Access to Medical Cannabis:
The American Academy of Family Physicians (1989, 1995); American Academy of HIV Medicine (2003); American College of Physicians (2008); American Medical Association's Council on Scientific Affairs (2001); American Medical Students Association (1993); American Nurses Association (2003); American Preventive Medical Association (1997); American Public Health Association (1995); Association of Nurses in AIDS Care (1999); Federation of American Scientists (1994); HIV Medicine Association (2006); Institute of Medicine (1982 & 1999); Kaiser Permanete (1997); Lymphoma Foundation of America (1997); National Association for Public Health Policy (1998); National Nurses Society on Addictions (1995); and Physicians Association for AIDS Care.

Patients out of Time, "Organizations Supporting Access to Therapeutic Cannabis," (Howardsville, VA: January 2009).
http://www.medicalcannabis.com...

87. History of Medical Cannabis in the US
"Cannabis indica became available in American pharmacies in the 1850’s following its introduction to western medicine by William O'Shaughnessy (1839).6 In its original pharmaceutical usage, it was regularly consumed orally, not smoked. The first popular American account of cannabis intoxication was published in 1854 by Bayard Taylor, writer, world traveler and diplomat."

Geiringer, Dale, "Origins of Cannabis Prohibition in California" Contemporary Drug Problems," originally published as "The Forgotten Origins of Cannabis Prohibition in California," Contemporary Drug Problems, (Summer 1999 - substantially revised June 2006) Vol 26, #2, p. 4.
http://www.canorml.org/backgro...

88. General Conclusions
IOM's Marijuana and Medicine: Assessing the Science Base (1999)http://books.nap.edu/openbook....

89. Therapeutic Value
The Institute of Medicine's 1999 report on medical marijuana stated, "The accumulated data indicate a potential therapeutic value for cannabinoid drugs, particularly for symptoms such as pain relief, control of nausea and vomiting, and appetite stimulation."

Janet E. Joy, Stanley J. Watson, Jr., and John A Benson, Jr., "Marijuana and Medicine: Assessing the Science Base," Division of Neuroscience and Behavioral Research, Institute of Medicine (Washington, DC: National Academy Press, 1999).
http://books.nap.edu/openbook....

90. Increased Use
The Institute of Medicine's 1999 report on medical marijuana examined the question whether the medical use of marijuana would lead to an increase of marijuana use in the general population and concluded that, "At this point there are no convincing data to support this concern. The existing data are consistent with the idea that this would not be a problem if the medical use of marijuana were as closely regulated as other medications with abuse potential." The report also noted that, "this question is beyond the issues normally considered for medical uses of drugs, and should not be a factor in evaluating the therapeutic potential of marijuana or cannabinoids."

Janet E. Joy, Stanley J. Watson, Jr., and John A Benson, Jr., "Marijuana and Medicine: Assessing the Science Base," Division of Neuroscience and Behavioral Research, Institute of Medicine (Washington, DC: National Academy Press, 1999). p. 99.
http://books.nap.edu/openbook....

91. Movement Disorders and Medical Cannabis
"The abundance of CB1 receptors in basal ganglia and reports of animal studies showing the involvement of cannabinoids in the control of movement suggest that cannabinoids would be useful in treating movement disorders in humans. Marijuana or CB1 receptor agonists might provide symptomatic relief of chorea, dystonia, some aspects of parkinsonism, and tics."

Janet E. Joy, Stanley J. Watson, Jr., and John A Benson, Jr., "Marijuana and Medicine: Assessing the Science Base," Division of Neuroscience and Behavioral Research, Institute of Medicine (Washington, DC: National Academy Press, 1999), p. 169.
http://books.nap.edu/...

92. Tolerance
In the Institute of Medicine's report on medical marijuana, the researchers examined the physiological risks of using marijuana and cautioned, "Marijuana is not a completely benign substance. It is a powerful drug with a variety of effects. However, except for the harms associated with smoking, the adverse effects of marijuana use are within the range of effects tolerated for other medications."

Janet E. Joy, Stanley J. Watson, Jr., and John A Benson, Jr., "Marijuana and Medicine: Assessing the Science Base," Division of Neuroscience and Behavioral Research, Institute of Medicine (Washington, DC: National Academy Press, 1999), p. 126-127.
http://books.nap.edu/openbook....

93. Uses for Medical Cannabis
"Advances in cannabinoid science of the past 16 years have given rise to a wealth of new opportunities for the development of medically useful cannabinoid-based drugs. The accumulated data suggest a variety of indications, particularly for pain relief, antiemesis, and appetite stimulation. For patients such as those with AIDS or who are undergoing chemotherapy, and who suffer simultaneously from severe pain, nausea, and appetite loss, cannabinoid drugs might offer broad-spectrum relief not found in any other single medication."

Janet E. Joy, Stanley J. Watson, Jr., and John A Benson, Jr., "Marijuana and Medicine: Assessing the Science Base," Division of Neuroscience and Behavioral Research, Institute of Medicine (Washington, DC: National Academy Press, 1999), p. 177.
http://books.nap.edu/...

94. Potential Adverse Effects of Cannabis
"For most people, the primary adverse effect of acute marijuana use is diminished psychomotor performance. It is, therefore, inadvisable to operate any vehicle or potentially dangerous equipment while under the influence of marijuana, THC, or any cannabinoid drug with comparable effects."

Janet E. Joy, Stanley J. Watson, Jr., and John A Benson, Jr., "Marijuana and Medicine: Assessing the Science Base," Division of Neuroscience and Behavioral Research, Institute of Medicine (Washington, DC: National Academy Press, 1999), p. 125-126.
http://books.nap.edu/...
 

roots69

Rising Star
BGOL Investor
Cocaine and Crack
1. Drug Overdose Deaths in the US Involving Cocaine and Psychostimulants On the Rise
"Deaths involving cocaine and psychostimulants have increased in the United States in recent years; among 70,237 drug overdose deaths in 2017, nearly a third (23,139 [32.9%]) involved cocaine, psychostimulants, or both. From 2016 to 2017, death rates involving cocaine and psychostimulants each increased by approximately one third, and increases occurred across all demographic groups, Census regions, and in several states. In 2017, nearly three fourths of cocaine-involved and roughly one half of psychostimulant-involved overdose deaths, respectively, involved at least one opioid. After initially peaking in 2006, trends in overall cocaine-involved death rates declined through 2012, when they began to rise again. The 2006–2012 decrease paralleled a decline in cocaine supply coupled with an increase in cost. Similar patterns in death rates involving both cocaine and opioids were observed, with increases for cocaine- and synthetic opioid-involved deaths occurring from 2012 to 2017. From 2010 to 2017, increasing rates of deaths involving psychostimulants occurred and persisted even in the absence of opioids."

Kariisa M, Scholl L, Wilson N, Seth P, Hoots B. Drug Overdose Deaths Involving Cocaine and Psychostimulants with Abuse Potential — United States, 2003–2017. MMWR Morb Mortal Wkly Rep 2019;68:388–395. DOI: http://dx.doi.org/10.15585/mmw...
https://www.cdc.gov/mmwr/volum...

2. Estimated Past Year Prevalence of Cocaine and Crack Use Among Young People in the US
"Past-year cocaine use in 2015 among 12th graders has been essentially the same across regions and varied between 1.8% and 2.3%, with the exception that the West stood out and climbed to 4.4% in 2015 (Figure 5-10b; also Tables 36-38 and Figure 81 in Occasional Paper 86). In past years regional variation in cocaine use was the largest observed for any of the drugs. Large regional differences in cocaine use emerged when the nation’s epidemic grew in the late 1970s and early 1980s. By 1981, annual use had roughly tripled in the West and Northeast and nearly doubled in the Midwest, while it increased only by about one-quarter in the South. This pattern of large regional differences held for about six years, until much sharper declines in the Northeast and West reduced the differences substantially. In recent years use has been in a fairly steady decline in all regions in all grades although in 2015 there was some increase in three of the regions among 10th graders and in the West among 12th graders. For most of the years of the study, the West had the highest level of cocaine use at all three grade levels, but in recent years the differences have not been very large or entirely consistent.
"In all three grades, past-year crack use has almost always been highest in the West, although these differences are considerably smaller today than in the past (Tables 39-41 and Figure 87 in Occasional Paper 86). When crack use was first measured among 12th graders in 1986, there were large regional differences, with the West and Northeast again having far higher prevalence than the Midwest and South. Crack use dropped appreciably in all four regions over the next several years (though prevalence did not peak in the Midwest until 1987 or in the South until 1989, perhaps due to continued diffusion of the drug to areas that previously did not have access). Because the declines were large and very sharp in the West and Northeast, little regional difference remained by 1991, although the West still had the highest level of use. After 1991 or 1992, during the relapse phase of the drug epidemic, there were increases in all regions, but particularly in the West. Again, the West showed the largest increases and the highest levels of use at all three grades, while the other three regions were fairly similar in their annual prevalence of use. In general, all regions showed evidence of a leveling or decline in crack use at all three grade levels in recent years, along with a diminution of regional differences."

Miech, R. A., Johnston, L. D., O’Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2016). Monitoring the Future national survey results on drug use, 1975–2015: Volume I, Secondary school students. Ann Arbor: Institute for Social Research, The University of Michigan. Page 193. Available at
http://monitoringthefuture.org...
http://monitoringthefuture.org...

3. Prevalence of Cocaine and Crack Use in the US by Demographic Characteristics
Click here for complete datatable Estimated Prevalence of Cocaine and Crack Use in the US, by Demographic Characteristics

Center for Behavioral Health Statistics and Quality. (2016). 2015 National Survey on Drug Use and Health: Detailed Tables. Substance Abuse and Mental Health Services Administration, Rockville, MD, Table 1.38A and Table 1.43A.
http://www.samhsa.gov/data/pop...
https://www.samhsa.gov/data/si...
https://www.samhsa.gov/data/si...

4. Estimated Prevalence and Trends in Use of Cocaine Including Crack in the US
"In 2016, the estimate of about 1.9 million people aged 12 or older who were current users of cocaine (Figure 15) included about 432,000 current users of crack. The numbers correspond to about 0.7 percent of the population aged 12 or older who were current users of cocaine (Figure 22) and 0.2 percent who were current users of crack (Table A.7B in Appendix A). The 2016 estimate for current cocaine use was similar to the estimates in most years between 2007 and 2015, but it was lower than the estimates in 2002 to 2006. The 2016 estimate of crack use was similar to the estimates in most years from 2008 to 2015, but it was lower than the estimates in most years between 2002 to 2007."

Substance Abuse and Mental Health Services Administration. (2017). Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health (HHS Publication No. SMA 17-5044, NSDUH Series H-52). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/
https://www.samhsa.gov/data/si...
https://www.samhsa.gov/data/si...

5. Perceived Risk and Prevalence of Crack Use and Among Young People in the US
"Crack cocaine use spread rapidly from the early to mid-1980s. Still, among 12th graders, the use of crack remained relatively low during this period (3.9% annual prevalence in 1987). Clearly, crack had quickly attained a reputation as a dangerous drug, and by the time of our first measurement of perceived risk in 1987, it was seen as the most dangerous of all drugs. Annual prevalence dropped sharply in the next few years, reaching 1.5% by 1991, where it remained through 1993. Perceived risk began a long and substantial decline after 1990 – again serving as a driver and leading indicator of use. (The decline in perceived risk in this period may well reflect generational forgetting of the dangers of this drug.)
"Annual prevalence among 12th graders rose gradually after 1993, from 1.5% to 2.7% by 1999. It finally declined slightly in 2000 and then held level through 2007. Since then, some additional decline has occurred. In 2016, annual prevalence for crack cocaine was at 0.8%.
"Among 8th and 10th graders, crack use rose gradually in the 1990s: from 0.7% in 1991 to 2.1% by 1998 among 8th graders, and from 0.9% in 1992 to 2.5% in 1998 among 10th graders. And, as just discussed, use among 12th graders peaked in 1999 at 2.7% and among young adults at 1.4%. Since those peak years, crack use has declined appreciably -- more than half among 8th, 10th, and 12th graders -- yet it held fairly steady among college students and young adults, at least until 2007, when use among college students finally began to decline. The 2016 prevalence levels for this drug were relatively low – less than 1% in all five groups. Twelfth graders had the highest prevalence. Annual crack prevalence among the college-bound has generally been considerably lower than among those not bound for college. Among 12th graders, the levels of use in 2016 were 0.7% for college-bound and 1.2% for noncollege-bound.
"We believe that the particularly intense and early media coverage of the hazards of crack cocaine likely had the effect of capping an epidemic early by deterring many would-be users and motivating many experimenters to desist use. As has been mentioned, when we first measured crack use in 1987, it had the highest level of perceived risk of any illicit drug. Also, it did not turn out to be “instantly addicting” upon first-time use, as had been widely reported. In some earlier years, 1994 and 1995 for example, 3% of 12th graders reported ever trying crack; however, only about 2% used in the prior 12 months and only about 1.0% used in the prior 30 days. It thus appears that, among the small numbers of 12th graders who have ever tried crack, the majority of those who tried it did not establish a pattern of continued use, let alone develop an addiction."

Miech, R. A., Johnston, L. D., O’Malley, P. M., Bachman, J. G., Schulenberg, J. E., & Patrick, M. E. (2017). Monitoring the Future national survey results on drug use, 1975–2016: Volume I, Secondary school students. Ann Arbor: Institute for Social Research, The University of Michigan, pp. 20-21. Available at http://monitoringthefuture.org...
http://monitoringthefuture.org...

6. Worldwide Coca Cultivation As Estimated by the UN Office on Drugs and Crime
"Although global coca bush cultivation in 2014 increased by 10 per cent compared with the previous year, the total area under coca bush cultivation worldwide, 132,300 ha, was the second smallest since the late 1980s. Global coca bush cultivation in 2014 was 19 per cent lower than in 2009, 40 per cent lower than the peak level in 2000 and 31 per cent lower than in 1998.157

"Of the three main countries cultivating coca bush, Colombia has shown the strongest decrease in the total area under coca bush cultivation (-58 per cent) since the peak of 2000; that decline was initially related to widespread aerial spraying, followed by manual eradication and, after 2007, by increased alternative development efforts. However, 2014 saw a strong increase (of 44 per cent) in the total area under coca bush cultivation in Colombia, price157 increase and expectations among farmers that they might benefit more from alternative development if they were growing coca bush during the peace negotiations.158 There are also indications that the new upward trend in coca bush cultivation in Colombia continued into 2015. In 2014, the total area under coca bush cultivation in Colombia amounted to 69,000 ha, accounting for 52 per cent of global coca bush cultivation."

United Nations Office on Drugs and Crime, World Drug Report 2016 (United Nations publication, Sales No. E.16.XI.7), p. 35.
https://www.unodc.org/wdr2016/
https://www.unodc.org/doc/wdr2...

7. Estimated Worldwide Cocaine Seizures According to UNODC
"Global production of cocaine (expressed at a purity of 100 per cent) can be estimated for 2014 at 746 tons (using the “old” conversion ratio) and 943 tons (using the “new” conversion ratio); those values are slightly higher than in the previous year but still 24-27 per cent lower than the peak in 2007, and thus back to the levels reported in the late 1990s. There are, however, indications that the overall upward trend observed in 2014 continued into 2015.

"Data suggest that the global cocaine interception rate, based on cocaine production estimates and quantities of cocaine seized, reached a level of between 43 and 68 per cent in 2014.

"Most of the increases in the global cocaine interception rate occurred after 1998, when the General Assembly held its twentieth special session, dedicated to countering the world drug problem together. The global cocaine interception rate almost doubled between the periods 1990-1997 and 2009-2014."

United Nations Office on Drugs and Crime, World Drug Report 2016 (United Nations publication, Sales No. E.16.XI.7), p. 36.
https://www.unodc.org/wdr2016/
https://www.unodc.org/doc/wdr2...

8. Misleading Official Statistics on Interdiction and Seizures
"Comparing absolute numbers of total cocaine seizures and manufacture could be misleading. To understand the relationship between the amount of annual seizures reported by States (694 tons cocaine of unknown purity in 2010) and the estimated level of manufacture (788-1,060 tons of cocaine of 100 per cent purity), it would be necessary to take into account several factors, and the associated calculations would depend on a level of detail in seizure data that is often unavailable. Making purity adjustments for bulk seizures, which contain impurities, cutting agents and moisture, to make them directly comparable with the cocaine manufacture estimates, which refer to a theoretical purity of 100 per cent, is difficult, as in most cases the purity of seized cocaine is not known and varies significantly from one consignment to another. The total amount of seized cocaine reported by States is also likely to be an overestimation. Large-scale maritime seizures, which account for a large part of the total amount of cocaine seized, often require the collaboration of several institutions in a country or even in several countries.76 Therefore, double counting of reported seizures of cocaine cannot be excluded."

UNODC, World Drug Report 2012 (United Nations publication, Sales No. E.12.XI.1), pp. 36-37.
https://www.unodc.org/document...

9. Estimated Global Prevalence of Cocaine Use
"Cocaine use remained stable over 2012, with 14 million-21 million estimated past-year users globally (0.4 per cent annual prevalence). Cocaine use remained high in North and South America (1.8 per cent and 1.2 per cent annual prevalence rates, respectively), Oceania (1.5 per cent) and Western and Central Europe (1 per cent). While there has been an increase in cocaine use in North America (between 2011 and 2012) due to a number of factors explained below, prevalence of cocaine use in Western and Central Europe declined from an estimated 1.3 per cent in 2010 to 1.0 per cent in 2012."

United Nations Office on Drugs and Crime, World Drug Report 2014 (United Nations publication, Sales No. E.14.XI.7), p. 35.
http://www.unodc.org/wdr2014/
http://www.unodc.org/documents...

10. Cocaine Supply Shortages
"Cocaine shortages have persisted in many U.S. drug markets since early 2007, primarily because of decreased cocaine production in Colombia but also because of increased worldwide demand for cocaine, especially in Europe; high cocaine seizure levels that continued through 2009; and enhanced GOM counterdrug efforts. These factors most likely resulted in decreased amounts of cocaine being transported from Colombia to the U.S.–Mexico border for subsequent smuggling into the United States."

National Drug Intelligence Center, "National Drug Threat Assessment 2010," (Johnstown, PA: February 2010), p. 1.
http://www.justice.gov/archive...

11. Estimated Prevalence of Crack and Powder Cocaine Use Among Latino Youth in the US
"• Hispanics now have the highest annual prevalence for crack and cocaine at all three grade levels. The prevalence of cocaine for Hispanic students has tended to be high compared to the other two racial/ethnic groups, particularly in the lower grades. It bears repeating that Hispanics have a considerably higher dropout rate than Whites or African Americans, based on Census Bureau statistics, which should tend to diminish any such differences by 12th grade, yet there remain sizeable differences in the upper grades.
"• An examination of racial/ethnic comparisons at lower grade levels shows Hispanics having higher levels of use of many of the substances on which they have the highest levels of use in 12th grade, as well as for several other drugs. For example, in 2015, other cocaine (i.e., powder cocaine) had a lifetime prevalence in 8th grade for Hispanics, Whites, and African Americans of 2.0%, 0.9%, and 0.9%, respectively. In fact, in 8th grade -- before most dropping out occurs -- Hispanics had the highest levels of use of almost all substances, whereas by 12th-grade Whites have the highest levels of use of most. Certainly the considerably higher dropout rate among Hispanics could help explain this shift, and it may be the most plausible explanation. Another explanation worth consideration is that Hispanics may tend to start using drugs at a younger age, but Whites overtake them at older ages. These explanations are not mutually exclusive, of course, and to some degree both explanations may hold true.14"

Miech, R. A., Johnston, L. D., O’Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2016). Monitoring the Future national survey results on drug use, 1975–2015: Volume I, Secondary school students. Ann Arbor: Institute for Social Research, The University of Michigan. Pages 109-110. Available at
http://monitoringthefuture.org...
http://monitoringthefuture.org...

12. Estimated Prevalence of Current Cocaine Use in the US
http://www.samhsa.gov/data/
http://www.samhsa.gov/data/sit...
http://www.samhsa.gov/data/sit...

13. Initiation of Cocaine or Crack Use in the US, 2013
"• In 2013, there were 601,000 persons aged 12 or older who had used cocaine for the first time within the past 12 months; this averages to approximately 1,600 initiates per day. This estimate was similar to the number in 2008 to 2012 (ranging from 623,000 to 724,000). The annual number of cocaine initiates in 2013 was lower than the estimates from 2002 through 2007 (ranging from 0.9 million to 1.0 million).
"• The number of initiates of crack cocaine ranged from 209,000 to 353,000 in 2002 to 2008 and declined to 95,000 in 2009. The number of initiates of crack cocaine has been similar each year since 2009 (e.g., 58,000 in 2013).
"• In 2013, most (81.9 percent) of the 0.6 million recent cocaine initiates were aged 18 or older when they first used. The average age at first use among recent initiates aged 12 to 49 was 20.4 years. The average age estimates have remained fairly stable since 2002."

Substance Abuse and Mental Health Services Administration, Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-48, HHS Publication No. (SMA) 14-4863. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014, p. 62.
http://www.samhsa.gov/data/NSD...
http://www.samhsa.gov/data/NSD...

14. Cocaine Toxicity or Overdose
http://www.merckmanuals.com/pr...

15. Community Epidemiology Working Group Assessment of Cocaine Use and Availability in the US, 2013
"Cocaine continued to be reported as a drug of concern in CEWG areas in all four regions of the United States. The impact of cocaine abuse continued to be reported by area representatives as high in Baltimore/Maryland/Washington, DC; Boston; Chicago; New York City; Philadelphia; and the South Florida/Miami-Dade and Broward Counties area. However, the decline in cocaine indicators reported at recent CEWG meetings continued to be observed by many area representatives. Seven of 19 CEWG area representatives reported decreasing indicators for cocaine: Atlanta; Baltimore/Maryland/Washington, DC; Chicago; Denver/Colorado; Detroit; San Francisco (where the decline was a key finding for this reporting period); and Texas. Eight CEWG area representatives reported mixed indicators for cocaine (with some increasing, some decreasing, and some stable): Boston, Los Angeles, Maine, Minneapolis/St. Paul, New York City, Philadelphia, Phoenix, and Seattle. Cocaine indicators were reported as stable from 2012 to 2013 by four area representatives: Cincinnati, St. Louis, San Diego, and South Florida/Miami-Dade and Broward Counties."

"Epidemiologic Trends in Drug Abuse: Proceedings of the Community Epidemiology Work Group, Highlights and Executive Summary, June 2014" (Bethesda, MD: National Institute on Drug Abuse, September 2014), p. 9.
http://www.drugabuse.gov/about...
http://www.drugabuse.gov/sites...

16. Legal Use of Cocaine in the US
"Once the cocaine has been legally produced from the coca leaf, it is exported to various countries for medicinal use, basically as a topical anesthetic (applied to the surface, not injected, only treating a particular area). In the United States the crystalline powder is imported to pharmaceutical companies who process and package the cocaine for medical use. Merck Pharmaceutical Company and Mallinckrodt Chemical Works distribute cocaine in crystalline form (hydrochloride salt) in dark colored glass bottles to pharmacies and hospitals throughout the United States. Cocaine, in the alkaloid form (base drug containing no additives such as hydrochloride in the crystalline form) is rarely used for medicinal purposes. Cocaine hydrochloride crystals or flakes come in 1/8, 1/4 and 1 oz bottles from the manufacturer and has a wholesale price of approximately $20-$25/oz (100% pure).
"Cocaine is still a drug of choice among many physicians as a topical local anesthetic because the drug has vasoconstrictive qualities as it stops the flow of blood oozing. And although synthetic local anesthetics such as novacaine and xylocaine (lidocaine) have been discovered and are used extensively as local anesthetics, they do not have the same vasoconstrictive effects as cocaine."

Frye, Enno, and Levy, Joseph, "Pharmacology and Abuse of Cocaine, Amphetamines, Ecstasy and Related Designer Drugs: A Comprehensive Review on Their Mode of Action, Treatment of Abuse and Intoxication" (Springer, 2009), p. 33.
http://books.google.com/books?...

17. Legal Coca Production
http://www.emcdda.europa.eu/at...

18. History of Coca
"Modern archaeology suggests that descendants of nomadic Siberian people may have established communities in the Andes Mountains as early as 10,000 B.C.E.37 Aymara-speaking tribes migrated to the Bolivian altiplano38 around 700 B.C.E, and sometime after 700 B.C.E, Andean people began growing coca in the altiplano.39 Before the Spanish conquest, Indians of eastern Bolivia grew coca for tea, chewing, and ritual use."

Freisinger, Will, "The Unintended Revolution: U.S. Anti-drug Policy and the Socialist Movement in Bolivia," California Western International Law Journal (San Diego, CA: California Western School of Law, Spring 2009) Volume 39, Number 2,
http://www.accionandina.org/do...

19. Cocaine - History of Coca
(History of Coca) "Archaeological evidence has confirmed that the coca leaf has been cultivated and used by the indigenous people of the Andes region for at least 4,000-5,000 years while other estimates put this as far back as 20,000 years. By the time of the Spanish colonial conquest, coca use extended all the way from what is today Costa Rica and Venezuela, through the Brazilian Amazon (coca’s place of origin) and on down to Paraguay, northern Argentina and Chile."

Forsberg, Alan, "The Wonders of the Coca Leaf," Accion Andina (Cochabamba, Bolivia: January 2011), p. 1.
http://accionandina.org/images...
http://accionandina.org/index....

20. History of Crack
"Most Americans first learned about crack cocaine through media stories, which usually disclosed tragic details of public figures’ addictions. Coverage of the dangers associated with the use of all forms of cocaine intensified in 1979 with the emergence of the practice of smoking cocaine, colloquially referred to as 'freebasing.'63Rolling Stone magazine focused on smokeable forms of cocaine, calling it the 'top-of-the-line model of the Cadillac of drugs,' yet cautioned that 'freebasing seemed to be much more dangerous than snorting.'64 In 1980, when comedian Richard Pryor sustained third-degree burns after reportedly using a butane torch to light cocaine freebase, newspapers capitalized on the incident.65 Outlets including The Philadelphia Inquirer, Chicago Tribune, and The Boston Globe ran stories about the new trend of freebasing cocaine.66
"In 1985, The New York Times became the first major media outlet to use the term 'crack cocaine,'67 and a follow-up article appeared on the front page less than two weeks later, detailing crack cocaine and its intensely addictive quality.68 By 1986, major news outlets had declared crack cocaine usage to be in 'epidemic proportions.'69"

Beaver, Alyssa L., "Getting a Fix on Cocaine Sentencing Policy: Reforming the Sentencing Scheme of the Anti-Drug Abuse Act of 1986," Fordham Law Review (New York, NY: Fordham University School of Law, April 2010) Vol. 78, No. 5, p. 2539.
http://fordhamlawreview.org/as...

21. History of Cocaine's Use as Anaesthetic
"One of the main properties of the coca leaf, which has been and continues to be used industrially, is its medical potential as an anaesthetic and analgesic. This characteristic of cocaine, which was part of ancestral practices and knowledge in the Andean-Amazon region, came to light in the 1880s and led to a revolution in medical science, particularly in surgery. As a local anaesthetic, it offered an alternative for operations that had previously been painful and hazardous. These properties were used to ease childbirth pains and dental treatments, among other things, taking the coca leaf and cocaine rapidly to the pinnacle of pharmacology and medicine.
"In 1923, Richard Willstatter of the University of Munich synthesised the cocaine molecule for the first time, basing his work on the molecule found in the coca leaf and maintaining its anaesthetic and energizing effects, which later found a series of applications. Unlike natural cocaine isolated from the coca leaf, the synthetic version lacks vaso-constrictive properties. This was useful for some applications, but not for others. A long list of pharmaceuticals (benzocaine, novocaine/procaine, lidocaine, etc.) was soon included in the anaesthetist’s vade mecum."

"Coca yes, cocaine, no? Legal options for the coca leaf," Transnational Institute (Amsterdam, The Netherlands: May 2006), p. 16.
http://www.tni.org/sites/www.t...

22. Cocaine Powder, Freebase, and Crack
"Cocaine is derived from the coca plant, which, upon consumption, anesthetizes and stimulates the central nervous system.75 The coca plant can be chewed to induce a high and is difficult to obtain in the United States, as cocaine is usually exported from South America in powder form.76
"The chemical name for powder cocaine is cocaine hydrochloride, which is created through a complex process of heating and cooling coca leaves.77 After pulverizing coca leaves into a coarse powder, alcohol is added and distilled off in order to extract the most pure form of cocaine alkaloid.78 Powder cocaine is ingested intranasally, through snorting, and takes effect within five to fifteen minutes; the euphoria lasts up to two hours.79
"Cocaine freebase, first created in the 1970s, is smokeable. To create cocaine freebase, cocaine hydrochloride must be heated and then mixed with ammonia and ether.80 The substance cools and yields smokeable cocaine crystals after drying.81 Ether, an extremely flammable substance, renders the process of smoking cocaine freebase quite dangerous.82 After inhalation, cocaine reaches the brain within ten seconds, and the high lasts for up to five minutes.83
"In the 1980s, a less dangerous form of cocaine freebase was invented: crack cocaine.84 When cocaine powder is mixed with baking soda to form a paste and heated, the substance hardens into rocks.85 This product was given the street name 'crack,' for the crackling sound it makes when smoked.86"

Beaver, Alyssa L., "Getting a Fix on Cocaine Sentencing Policy: Reforming the Sentencing Scheme of the Anti-Drug Abuse Act of 1986," Fordham Law Review (New York, NY: Fordham University School of Law, April 2010) Vol. 78, No. 5, p. 2540.
http://fordhamlawreview.org/as...

23. Physiological and Psychological Effects of Cocaine
http://www.merckmanuals.com/pr...

24. How Cocaine Affects the Brain
"Cocaine is a strong central nervous system stimulant that increases levels of dopamine, a brain chemical (or neurotransmitter) associated with pleasure and movement, in the brain’s reward circuit. Certain brain cells, or neurons, use dopamine to communicate. Normally, dopamine is released by a neuron in response to a pleasurable signal (e.g., the smell of good food), and then recycled back into the cell that released it, thus shutting off the signal between neurons. Cocaine acts by preventing the dopamine from being recycled, causing excessive amounts of the neurotransmitter to build up, amplifying the message to and response of the receiving neuron, and ultimately disrupting normal communication. It is this excess of dopamine that is responsible for cocaine’s euphoric effects. With repeated use, cocaine can cause long-term changes in the brain’s reward system and in other brain systems as well, which may eventually lead to addiction. With repeated use, tolerance to the cocaine high also often develops. Many cocaine abusers report that they seek but fail to achieve as much pleasure as they did from their first exposure. Some users will increase their dose in an attempt to intensify and prolong the euphoria, but this can also increase the risk of adverse psychological or physiological effects."

National Institute on Drug Abuse DrugFacts: Cocaine (Rockville, MD: US Department of Health and Human Services, revised March 2010), last accessed Dec. 13, 2012.
http://www.drugabuse.gov/publi...

25. Treatment for Cocaine Toxicity
" Treatment of mild cocaine intoxication is generally unnecessary because the drug is extremely short-acting. Benzodiazepines are the preferred initial treatment for most toxic effects, including CNS excitation and seizures, tachycardia, and hypertension. Lorazepam 2 to 3 mg IV q 5 min titrated to effect may be used. High doses and a continuous infusion may be required. Propofol infusion, with mechanical ventilation, may be used for resistant cases. Hypertension that does not respond to benzodiazepines is treated with IV nitrates (eg, nitroprusside) or phentolamine; ?-blockers are not recommended because they allow continued ?-adrenergic stimulation. Hyperthermia can be life threatening and should be managed aggressively with sedation plus evaporative cooling, ice packs, and maintenance of intravascular volume and urine flow with IV normal saline solution. Phenothiazines lower seizure threshold, and their anticholinergic effects can interfere with cooling; thus, they are not preferred for sedation. Occasionally, severely agitated patients must be pharmacologically paralyzed and mechanically ventilated to ameliorate acidosis, rhabdomyolysis, or multisystem dysfunction.
"Cocaine-related chest pain is evaluated as for any other patient with potential myocardial ischemia or aortic dissection, with chest x-ray, serial ECG, and serum cardiac markers. As discussed, ?-blockers are contraindicated, and benzodiazepines are a first-line drug. If coronary vasodilation is required after benzodiazepines are given, nitrates are used, or phentolamine 1 to 5 mg IV given slowly can be considered."

"Cocaine," The Merck Manual for Health Care Professionals, Special Subjects, Drug Use and Dependence, Cocaine (Merck & Co. Inc.: July 2008), last accessed Dec. 13, 2012.
http://www.merckmanuals.com/pr...

26. Black Cocaine
"Black cocaine is created by a chemical process used by drug traffickers to evade detection by drug sniffing dogs and chemical tests. The traffickers add charcoal and other chemicals to cocaine, which transforms it into a black substance that has no smell and does not react when subjected to the usual chemical tests."

United States General Accounting Office, "Drug Control: Narcotics Threat from Colombia Continues to Grow" (Washington, DC: USGPO, 1999), p. 5.
http://www.gao.gov/archive/199...

27. Economics - Data - 2004 - 1-15-10
(Price of Cocaine) In 2010, a kilogram of cocaine base in Colombia typically sold for $1,474.50 and a kilogram of cocaine typically sold for $2,438.80. In Peru in 2008, a kilogram of cocaine base typically sold for $850 and a kilogram of cocaine typically sold for $1,250. In Mexico in 2010, a kilogram of cocaine typically sold for $12,500. In the United States in 2010, the cost of a kilogram of cocaine typically ranged from $11,500-$50,000, and the cost of a kilogram of crack ranged from $14,000-$45,000.

UN Office on Drugs and Crime, World Drug Report 2012 (United Nations publication, Sales No. E.12.XI.1), Cocaine-type Retail and wholesale prices and purity levels, by drug, region and country or territory (prices expressed in US$)
http://www.unodc.org/unodc/en/...
http://www.unodc.org/documents...

28. Traditional Uses of the Coca Leaf
"Coca has traditionally been used in one of two ways: either as a chew or in coca tea.45 Coca leaves contain many nutrients, including vitamins A and B, phosphorus, and iron.46 In high-altitude communities where green vegetables are scarce, the extra nutrients provided by coca leaves are often much needed.47 Coca is also widely used to diminish the effects of the decreased oxygen at high altitudes, as any visitor to an Andean city will discover.48 Much like coffee, coca is a mild stimulant and is the social drink of choice for many. Coca is also believed to be a panacea for numerous ailments and is even used as an aphrodisiac.49"

Reisinger, Will, "The Unintended Revolution: U.S. Anti-drug Policy and the Socialist Movement in Bolivia," California Western International Law Journal (San Diego, CA: California Western School of Law, Spring 2009) Volume 39, Number 2, p. 248.
http://scholarlycommons.law.cw...

29. Uses of Coca Leaf
"Coca leaf consumption is an integral part of Andean cultural tradition and world view. The principle uses are:
"• Energizer: provides an energy boost for working or for combating fatigue and cold. Although it reduces feelings of hunger, the coca leaf is not considered a food.
"• Medicinal: in teas, syrups and plasters for diagnosing and treating a series of illnesses. It is used as a local anesthetic.
"• Sacred: to communicate with the supernatural world and obtain its protection, especially with offerings to the Pachamama, the personification and spiritual form of the earth.
"• Social: to maintain social cohesion and cooperation among members of the community, it is used in community ceremonies, as a 'payment' for labor exchange and a social relations instrument."

"Coca yes, cocaine, no? Legal options for the coca leaf," Transnational Institute (Amsterdam, The Netherlands: May 2006), p. 6.
http://www.tni.org/sites/www.t...

30. Cocaine - Law - 10-23-09
Law and Policywww.gpo.gov, last accessed Dec. 13, 2012.
http://www.gpo.gov/fdsys/pkg/U...

31. Crack/Powder Cocaine Sentencing Disparity Changed In 2010
On August 3, 2010, President Barack Obama "signed an historic piece of legislation that narrows the crack and powder cocaine sentencing disparity from 100:1 to 18:1 and for the first time eliminates the mandatory minimum sentence for simple possession of crack cocaine."

American Civil Liberties Union, "President Obama Signs Bill Reducing Cocaine Sentencing Disparity," August 3, 2010, last accessed July 26, 2016.
https://www.aclu.org/news/pres...

32. How the Crack vs Powder Disparity Was Created
"In July 1986, in the midst of a surge of articles regarding the crack 'epidemic'37 both the United States Senate and the House of Representatives held hearings on the perceived crisis.38 At these hearings, it was asserted that crack: (1) was more addictive than powder cocaine,39 (2) produced physiological effects that were different from and worse than those caused by powder cocaine,40 (3) attracted users who could not afford powder cocaine, especially young people,41 and (4) led to more crime than powder cocaine did.42"

Graham, Kyle, "Sorry seems to be the hardest word: The Fair Sentencing Act of 2010, Crack, and Methamphetamine, "University of Richmond Law Review (Richmond, VA: Richmond School of Law, March 2011) Vol. 45, Issue 3, pp. 771-773.
http://lawreview.richmond.edu/...

33. Crack Smoking and Risk of HIV
http://www.cmaj.ca/cgi/reprint...

34. "Crack Baby" Myth
"In the final analysis, the notion of the 'crack baby' is a myth. So-called 'cocaine babies' and 'crack babies' are more likely suffering from their mothers’ multiple drug use (particularly alcohol), and/or are 'poverty babies' suffering from a lack of medical care and poor nutrition."

Inciardi, James A., "The Irrational Politics of American Drug Policy: Implications for Criminal Law and the Management of Drug-Involved Offenders," Ohio State Journal of Criminal Law (Columbus, OH: Moritz College of Law, The Ohio State University, Fall 2003) Volume 1, Issue 1, p. 278.
http://moritzlaw.osu.edu/osjcl...

35. Spraying Counterproductive
"Critics note that the spraying has not prevented the tripling of the area under coca cultivation since Pastrana's inauguration, and that the spraying simply destroys the means of livelihood of subsistence farmers and displaces the crops deeper into the jungle. The coca producers have also adapted by developing new varieties of the coca plant, such as the Tingo Maria, which produces three times as much coca as the traditional varieties."

Rabasa, Angel & Peter Chalk, "Colombian Labyrinth: The Synergy of Drugs and Insurgency and Its Implications for Regional Instability" (Santa Monica, CA: RAND Corporation, 2001), Chapter 6, p. 66.
http://www.rand.org/pubs/monog...
http://www.rand.org/pubs/monog...

36. Land Subjected To Crop Eradication in Colombia
"Between 1998 and 2009, the area subjected to manual eradication increased from 3,125 ha to 60,577 ha, while aerial spraying—using a formula known as Roundup® (a mixture of glyphosate and Cosmo-FluxTM)—rose by more than 58 percent, from 66,029 ha to 104,772 ha.3 Between 2003 and 2009, the Bogotá government invested $835 million to underwrite these programs, a figure that is expected to surge to $1.5 billion by 2013.4"

Chalk, Peter, "The Latin American Drug Trade: Scope, Dimensions, Impact, and Response," RAND Corporation for the the United States Air Force (Santa Monica, CA: 2011), p. 60.
http://www.rand.org/content/da...
 

roots69

Rising Star
BGOL Investor
The Opioid Overdose Crisis

Looking for a referral to, or more information about, mental health or substance use treatment services? The American Board of Preventive Medicine provides this service to locate physicians who are certified in specialists in Addiction Medicine

The federal Substance Abuse and Mental Health Services Administration has a free, confidential National Helpline at 1-800-662-HELP (4357).
"SAMHSA’s National Helpline, 1-800-662-HELP (4357), (also known as the Treatment Referral Routing Service) is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations. Callers can also order free publications and other information."
SAMHSA's website also offers a free, confidential Behavioral Health Treatment Services Locator.

1. Estimated Prevalence of Current Heroin Use in the US
"About 475,000 people aged 12 or older were current heroin users in 2016, which rounds to the 0.5 million people shown in Figure 15. This number corresponds to about 0.2 percent of the population aged 12 or older (Figure 23).
"Despite the dangers associated with heroin use, its use has increased in recent years. The percentage of current heroin users aged 12 or older in 2016 was higher than the percentages in most years between 2002 and 2013, but it was similar to the percentages in 2014 and 2015 (Figure 23). However, even when there was a statistically significant difference between the 2016 estimate and estimates in prior years, the estimates ranged between 0.1 and 0.2 percent."

Substance Abuse and Mental Health Services Administration. (2017). Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health (HHS Publication No. SMA 17-5044, NSDUH Series H-52). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, p. 18. Retrieved from https://www.samhsa.gov/data/
https://www.samhsa.gov/data/si...
https://www.samhsa.gov/data/si...

2. Deaths Attributed to Drug Overdose in the US, 2017
According to the Centers for Disease Control, using data available for analysis on September 5, 2018, there were a reported 70,652 deaths attributed to drug overdose in the US for the year ending December 2017. Some deaths were still under investigation. The CDC projects that the total for 2017 will be 72,222.

Of these:
Opioids were detected in 47,863 reported deaths, and are predicted to be involved in 49,031 deaths.
Synthetic opioids, excluding methadone, were detected in 28,644 reported deaths, and are predicted to be involved in 28,644 deaths.
Heroin was detected in 15,585 reported deaths, and is predicted to be involved in 15,941 deaths.
Natural and semi-synthetic opioids were detected in 14,553 reported deaths, and are predicted to be involved in 14,940 deaths.
Cocaine was detected in 14,065 reported deaths, and is predicted to be involved in 14,612 deaths.
Psychostimulants with abuse potential were detected in 10,420 reported deaths, and are predicted to be involved in 10,703 deaths.
Methadone was detected in 3,209 reported deaths, and is predicted to be involved in 3,286 deaths.

Note: Categories are not mutually exclusive because deaths may involve more than one drug.

Ahmad FB, Rossen LM, Spencer MR, Warner M, Sutton P. Provisional drug overdose death counts. National Center for Health Statistics, Centers for Disease Control. 2018. Last accessed September 13, 2018.
https://www.cdc.gov/nchs/nvss/...

3. Drugs Most Frequently Mentioned in Overdose Deaths in the US 2011-2016
"The number of drug overdose deaths per year increased 54%, from 41,340 deaths in 2011 to 63,632 deaths in 2016 (Table A). From the literal text analysis, the percentage of drug overdose deaths mentioning at least one specific drug or substance increased from 73% of the deaths in 2011 to 85% of the deaths in 2016. The percentage of drug overdose deaths that mentioned only a drug class but not a specific drug or substance declined from 5.1% of deaths in 2011 to 2.5% in 2016. Review of the literal text for these deaths indicated that the deaths that mentioned only a drug class frequently involved either an opioid or an opiate (ranging from 54% in 2015 to 60% in 2016). The percentage of deaths that did not mention a specific drug or substance or a drug class declined from 22% of drug overdose deaths in 2011 to 13% in 2016."

Hedegaard H, Bastian BA, Trinidad JP, Spencer M, Warner M. Drugs most frequently involved in drug overdose deaths: United States, 2011–2016. National Vital Statistics Reports; vol 67 no 9. Hyattsville, MD: National Center for Health Statistics. 2018.
https://www.cdc.gov/nchs/produ...
https://www.cdc.gov/nchs/data/...

4. Changes in Types of Opioids Involved in Overdose Deaths in the US
"• The rate of drug overdose deaths involving synthetic opioids other than methadone, which include drugs such as fentanyl, fentanyl analogs, and tramadol, increased from 0.3 per 100,000 in 1999 to 1.0 in 2013, 1.8 in 2014, 3.1 in 2015, 6.2 in 2016, and 9.0 in 2017 (Figure 4). The rate increased on average by 8% per year from 1999 through 2013 and by 71% per year from 2013 through 2017.

"• The rate of drug overdose deaths involving heroin increased from 0.7 in 1999 to 1.0 in 2008 to 4.9 in 2016. The rate in 2017 was the same as in 2016 (4.9).

"• The rate of drug overdose deaths involving natural and semisynthetic opioids, which include drugs such as oxycodone and hydrocodone, increased from 1.0 in 1999 to 4.4 in 2016. The rate in 2017 was the same as in 2016 (4.4).

"• The rate of drug overdose deaths involving methadone increased from 0.3 in 1999 to 1.8 in 2006, then declined to 1.0 in 2016. The rate in 2017 was the same as in 2016 (1.0)."

Hedegaard H, Miniño AM, Warner M. Drug overdose deaths in the United States, 1999–2017. NCHS Data Brief, no 329. Hyattsville, MD: National Center for Health Statistics. 2018.
https://www.cdc.gov/nchs/produ...
https://www.cdc.gov/nchs/data/...

5. Drugs Most Frequently Involved in Drug Overdose Deaths in the US 2011–2016
"For the top 15 drugs:

"• Among drug overdose deaths that mentioned at least one specific drug, oxycodone ranked first in 2011,heroin from 2012 through 2015, and fentanyl in 2016.

"• In 2011 and 2012, fentanyl was mentioned in approximately 1,600 drug overdose deaths each year, but mentions increased in 2013 (1,919 deaths),2014 (4,223 deaths), 2015 (8,251 deaths), and 2016(18,335 deaths). In 2016, 29% of all drug overdose deaths mentioned involvement of fentanyl.

"• The number of drug overdose deaths involving heroin increased threefold, from 4,571 deaths or 11% of all drug overdose deaths in 2011 to 15,961 deaths or 25% of all drug overdose deaths in 2016.

"• Throughout the study period, cocaine ranked second or third among the top 15 drugs. From 2014 through 2016, the number of drug overdose deaths involving cocaine nearly doubled from 5,892 to 11,316.

"• The number of drug overdose deaths involving methamphetamine increased 3.6-fold, from 1,887 deaths in 2011 to 6,762 deaths in 2016.

"• The number of drug overdose deaths involving methadone decreased from 4,545 deaths in 2011 to 3,493 deaths in 2016."

Hedegaard H, Bastian BA, Trinidad JP, Spencer M, Warner M. Drugs most frequently involved in drug overdose deaths: United States, 2011–2016. National Vital Statistics Reports; vol 67 no 9. Hyattsville, MD: National Center for Health Statistics. 2018.
https://www.cdc.gov/nchs/produ...
https://www.cdc.gov/nchs/data/...

6. Drugs Most Frequently Involved in Drug Overdose Deaths in the US 2011–2016
"The percentage of deaths with concomitant involvement of other drugs varied by drug. For example, almost all drug overdose deaths involving alprazolam or diazepam (96%) mentioned involvement of other drugs. In contrast, 50% of the drug overdose deaths involving methamphetamine, and 69% of the drug overdose deaths involving fentanyl mentioned involvement of one or more other specific drugs.

"Table D shows the most frequent concomitant drug mentions for each of the top 10 drugs involved in drug overdose deaths in 2016.

"• Two in five overdose deaths involving cocaine also mentioned fentanyl.

"• Nearly one-third of drug overdose deaths involving fentanyl also mentioned heroin (32%).

"• Alprazolam was mentioned in 26% of the overdose deaths involving hydrocodone, 22% of the deaths involving methadone, and 25% of the deaths involving oxycodone.

"• More than one-third of the overdose deaths involving cocaine also mentioned heroin (34%).

"• More than 20% of the overdose deaths involving methamphetamine also mentioned heroin."

Hedegaard H, Bastian BA, Trinidad JP, Spencer M, Warner M. Drugs most frequently involved in drug overdose deaths: United States, 2011–2016. National Vital Statistics Reports; vol 67 no 9. Hyattsville, MD: National Center for Health Statistics. 2018.
https://www.cdc.gov/nchs/produ...
https://www.cdc.gov/nchs/data/...

7. Deaths from Drug Overdose in the United States in 2015
https://www.cdc.gov/mmwr/volum...
https://www.cdc.gov/mmwr/volum...

8. Opioid Involvement in Deaths in the US Attributed to Drug Overdose, 2016
According to the US Centers for Disease Control, in 2016, there were 63,632 drug overdose deaths in the United States. The CDC further estimates that of those, 42,249 deaths involved any opioid.

The CDC reports that in 2016, 15,469 deaths involved heroin; 14,487 deaths involved natural and semi-synthetic opioids; 3,373 deaths involved methadone; and 19,413 deaths involved synthetic opioids other than methadone, a category which includes fentanyl. The sum of those numbers is greater than the total opioid involved deaths because, as noted by the CDC, "Deaths involving more than one opioid category (e.g., a death involving both methadone and a natural or semisynthetic opioid such as oxycodone) are counted in both categories."

Hedegaard H, Warner M, Miniño AM. Drug overdose deaths in the United States, 1999–2016. NCHS Data Brief, no 294. Hyattsville, MD: National Center for Health Statistics. 2017.
https://www.cdc.gov/nchs/produ...
https://www.cdc.gov/nchs/data/...
https://www.cdc.gov/nchs/data/...

9. Key Factors Underlying Increasing Rates of Heroin Use and Opioid Overdose in the US
"A key factor underlying the recent increases in rates of heroin use and overdose may be the low cost and high purity of heroin.45,46 The price in retail purchases has been lower than $600 per pure gram every year since 2001, with costs of $465 in 2012 and $552 in 2002, as compared with $1237 in 1992 and $2690 in 1982.45 A recent study showed that each $100 decrease in the price per pure gram of heroin resulted in a 2.9% increase in the number of hospitalizations for heroin overdose.46"

Wilson M. Compton, M.D., M.P.E., Christopher M. Jones, Pharm.D., M.P.H., and Grant T. Baldwin, Ph.D., M.P.H. Relationship between Nonmedical Prescription-Opioid Use and Heroin Use. N Engl J Med 2016; 374:154-163. January 14, 2016. DOI: 10.1056/NEJMra1508490
http://www.nejm.org/doi/full/1...

10. Factors in the Transition from Prescription Opiate Use to Heroin Use
"Multiple studies that have examined why some persons who abuse prescription opioids initiate heroin use indicate that the cost and availability of heroin were primary factors in this process. These reasons were generally consistent across time periods from the late 1990s through 2013.34-41 Some interviewees made reference to doctors generally being less willing to prescribe opioids as well as to increased attention to the issue by law enforcement, which may have affected the available supply of opioids locally.38,40"

Wilson M. Compton, M.D., M.P.E., Christopher M. Jones, Pharm.D., M.P.H., and Grant T. Baldwin, Ph.D., M.P.H. Relationship between Nonmedical Prescription-Opioid Use and Heroin Use. N Engl J Med 2016; 374:154-163. January 14, 2016. DOI: 10.1056/NEJMra1508490
http://www.nejm.org/doi/full/1...
http://www.nejm.org/doi/pdf/10...

11. Provisional Counts of Overdose Deaths Can Be Misleading
The federal Centers for Disease Control reported on December 21, 2017, that there had been a total of 63,600 deaths attributed to drug overdose in the US in 2016. Based on data available for analysis on Oct. 1, 2017, the CDC's provisional count of drug overdose deaths in the US for the 12-month period ending in December 2016 had been 71,135. The difference is attributed to data quality: provisional counts are by definition incomplete, which means they can be misleading.

The CDC compiles and publishes official data on annual causes of death in the United States. Demand for data on drug overdose deaths, and on drug overdoses generally, is so great that the CDC is now making raw data on these subjects available to the public. Those data are provisional, not final, and so can be misleading. Several caveats that must be understood before examining the numbers. According to the CDC:

"Provisional counts are often incomplete and causes of death may be pending investigation (see table Notes). Data quality measures, such as percent completeness in overall death reporting and percentage of deaths pending investigation, are included to aid interpretation of provisional data, because both data completeness and the percentage of records pending investigation are related to the accuracy of provisional counts (see Technical Notes). Provisional data are based on available records that meet certain data quality criteria at the time of analysis and may not include all deaths that occurred during a given time period. Therefore, they should not be considered comparable with final data and are subject to change. Reporting of specific drugs and drug classes varies by jurisdiction, and comparisons across selected states should not be made (see Technical Notes)."

Hedegaard H, Warner M, Miniño AM. Drug overdose deaths in the United States, 1999–2016. NCHS Data Brief, no 294. Hyattsville, MD: National Center for Health Statistics. 2017.
https://www.cdc.gov/nchs/produ...
https://www.cdc.gov/nchs/data/...
https://www.cdc.gov/nchs/data/...
"Provisional Drug Overdose Death Counts," U.S. Centers for Disease Control, Atlanta, GA, based on data available for analysis on Oct. 1, 2017, last accessed Oct. 19, 2017 at https://www.cdc.gov/nchs/...

12. Changes in Synthetic Opioid Involvement in Overdose Deaths in the US and Involvement of Other Drugs in Combination
"Among the 42 249 opioid-related overdose deaths in 2016, 19,413 involved synthetic opioids, 17,087 involved prescription opioids, and 15,469 involved heroin. Synthetic opioid involvement in these deaths increased significantly from 3007 (14.3% of opioid-related deaths) in 2010 to 19,413 (45.9%) in 2016 (P for trend <.01). Significant increases in synthetic opioid involvement in overdose deaths involving prescription opioids, heroin, and all other illicit or psychotherapeutic drugs were found from 2010 through 2016 (Table).

"Among synthetic opioid–related overdose deaths in 2016, 79.7% involved another drug or alcohol. The most common co-involved substances were another opioid (47.9%), heroin (29.8%), cocaine (21.6%), prescription opioids (20.9%), benzodiazepines (17.0%), alcohol (11.1%), psychostimulants (5.4%), and antidepressants (5.2%) (Figure)."

Jones CM, Einstein EB, Compton WM. Changes in Synthetic Opioid Involvement in Drug Overdose Deaths in the United States, 2010-2016. JAMA. 2018;319(17):1819–1821. doi:10.1001/jama.2018.2844
https://jamanetwork.com/journa...

13. Factors That May Skew Estimates of Overdose Deaths Attributed to Specific Drugs, Particularly Opioids
"First, factors related to death investigation might affect rate estimates involving specific drugs. At autopsy, the substances tested for, and circumstances under which tests are performed to determine which drugs are present, might vary by jurisdiction and over time. Second, the percentage of deaths with specific drugs identified on the death certificate varies by jurisdiction and over time. Nationally, 19% (in 2014) and 17% (in 2015) of drug overdose death certificates did not include the specific types of drugs involved. Additionally, the percentage of drug overdose deaths with specific drugs identified on the death certificate varies widely by state, ranging from 47.4% to 99%. Variations in reporting across states prevent comparison of rates between states. Third, improvements in testing and reporting of specific drugs might have contributed to some observed increases in opioid-involved death rates. Fourth, because heroin and morphine are metabolized similarly (9), some heroin deaths might have been misclassified as morphine deaths, resulting in underreporting of heroin deaths. Finally the state-specific analyses of opioid deaths are restricted to 28 states, limiting generalizability."

Rudd RA, Seth P, David F, Scholl L. Increases in Drug and Opioid-Involved Overdose Deaths — United States, 2010–2015. MMWR Morb Mortal Wkly Rep 2016;65:1445–1452. DOI: http://dx.doi.org/10.15585/mmw...
https://www.cdc.gov/mmwr/volum...
https://www.cdc.gov/mmwr/volum...

14. Growth of Fentanyl Related Deaths in the US
"Preliminary estimates of U.S. drug overdose deaths exceeded 60,000 in 2016 and were partially driven by a fivefold increase in overdose deaths involving synthetic opioids (excluding methadone), from 3,105 in 2013 to approximately 20,000 in 2016 (1,2). Illicitly manufactured fentanyl, a synthetic opioid 50–100 times more potent than morphine, is primarily responsible for this rapid increase (3,4). In addition, fentanyl analogs such as acetylfentanyl, furanylfentanyl, and carfentanil are being detected increasingly in overdose deaths (5,6) and the illicit opioid drug supply (7). Carfentanil is estimated to be 10,000 times more potent than morphine (8). Estimates of the potency of acetylfentanyl and furanylfentanyl vary but suggest that they are less potent than fentanyl (9). Estimates of relative potency have some uncertainty because illicit fentanyl analog potency has not been evaluated in humans."

Julie K. O’Donnell, PhD; John Halpin, MD; Christine L. Mattson, PhD; Bruce A. Goldberger, PhD; R. Matthew Gladden, PhD. Deaths Involving Fentanyl, Fentanyl Analogs, and U-47700 — 10 States, July–December 2016. Morbidity and Mortality Weekly Report. Vol. 66. Centers for Disease Control. October 27, 2017.
https://www.cdc.gov/mmwr/volum...

15. Pain as a Public Health Problem
http://www.nap.edu/openbook.ph...

16. Prevalence of Chronic Pain in the US
"To estimate the prevalence of chronic pain and high-impact chronic pain in the United States, CDC analyzed 2016 National Health Interview Survey (NHIS) data. An estimated 20.4% (50.0 million) of U.S. adults had chronic pain and 8.0% of U.S. adults (19.6 million) had high-impact chronic pain, with higher prevalences of both chronic pain and high-impact chronic pain reported among women, older adults, previously but not currently employed adults, adults living in poverty, adults with public health insurance, and rural residents."

Dahlhamer J, Lucas J, Zelaya, C, et al. Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults — United States, 2016. MMWR Morb Mortal Wkly Rep 2018;67:1001–1006. DOI: http://dx.doi.org/10.15585/mmw...
https://www.cdc.gov/mmwr/volum...

17. CDC Opioid Prescribing Guidelines Are Making It Difficult For Cancer Patients To Obtain Pain Medication
"There has been a significant increase in cancer patients and survivors being unable to access their opioid prescriptions since 2016, when the Centers for Disease Control and Prevention (CDC) finalized opioid prescribing guidelines."

Percent of cancer patients and survivors who report being unable to get opioid prescription pain medication because the pharmacy did not have the particular drug in stock:
December 2016: 16%
May 2018: 41%

Percent of cancer patients and survivors who report being questioned by a pharmacist about why they needed their opioid pain medication:
December 2016: 16%
May 2018: 35%

Percent of cancer patients and survivors who report being unable to get their prescription pain medication because the pharmacist would not fill it for whatever reason even though the pharmacist had it in stock?
December 2016: 12%
May 2018: 27%

Percent of cancer patients and survivors who report being unable to get their opioid prescription pain medication because their insurance would not cover it:
December 2016: 11%
May 2018: 30%

Percent of cancer patients and survivors who report that their insurance company has limited them to just one pharmacy to go to for filling their opioid prescription pain medication.
December 2016: 14%
May 2018: 32%

Percent of cancer patients and survivors who report that their insurance company has reduced the number of times their opioid prescription can be refilled:
December 2016: 21%
May 2018: 36%

Percent of cancer patients and survivors who report that their insurance company has reduced the number of pills in their opioid prescription pain medication:
December 2016: 19%
May 2018: 25%

American Cancer Society Cancer Action Network, Patient Quality of Life Coalition, and Public Opinion Strategies. Key Findings Summary: Opioid Access Research Project. June 2018.
https://www.acscan.org/release...
https://www.acscan.org/sites/d...

18. Involvement of Fentanyl in Overdose Deaths in the US
"Fentanyl was detected in 56.3% of 5,152 opioid overdose deaths in the 10 states during July–December 2016 (Figure). Among these 2,903 fentanyl-positive deaths, fentanyl was determined to be a cause of death by the medical examiner or coroner in nearly all (97.1%) of the deaths. Northeastern states (Maine, Massachusetts, New Hampshire, and Rhode Island) and Missouri** reported the highest percentages of opioid overdose deaths involving fentanyl (approximately 60%–90%), followed by Midwestern and Southern states (Ohio, West Virginia, and Wisconsin), where approximately 30%–55% of decedents tested positive for fentanyl. New Mexico and Oklahoma reported the lowest percentage of fentanyl-involved deaths (approximately 15%–25%). In contrast, states detecting any fentanyl analogs in >10% of opioid overdose deaths were spread across the Northeast (Maine, 28.6%, New Hampshire, 12.2%), Midwest (Ohio, 26.0%), and South (West Virginia, 20.1%) (Figure) (Table 1).

"Fentanyl analogs were present in 720 (14.0%) opioid overdose deaths, with the most common being carfentanil (389 deaths, 7.6%), furanylfentanyl (182, 3.5%), and acetylfentanyl (147, 2.9%) (Table 1). Fentanyl analogs contributed to death in 535 of the 573 (93.4%) decedents. Cause of death was not available for fentanyl analogs in 147 deaths.†† Five or more deaths involving carfentanil occurred in two states (Ohio and West Virginia), furanylfentanyl in five states (Maine, Massachusetts, Ohio, West Virginia, and Wisconsin), and acetylfentanyl in seven states (Maine, Massachusetts, New Hampshire, New Mexico, Ohio, West Virginia, and Wisconsin). U-47700 was present in 0.8% of deaths and found in five or more deaths only in Ohio, West Virginia, and Wisconsin (Table 1). Demographic characteristics of decedents were similar among overdose deaths involving fentanyl analogs and fentanyl (Table 2). Most were male (71.7% fentanyl and 72.2% fentanyl analogs), non-Hispanic white (81.3% fentanyl and 83.6% fentanyl analogs), and aged 25–44 years (58.4% fentanyl and 60.0% fentanyl analogs) (Table 2).

"Other illicit drugs co-occurred in 57.0% and 51.3% of deaths involving fentanyl and fentanyl analogs, respectively, with cocaine and confirmed or suspected heroin detected in a substantial percentage of deaths (Table 2). Nearly half (45.8%) of deaths involving fentanyl analogs tested positive for two or more analogs or fentanyl, or both. Specifically, 30.9%, 51.1%, and 97.3% of deaths involving carfentanil, furanylfentanyl, and acetylfentanyl, respectively, tested positive for fentanyl or additional fentanyl analogs. Forensic investigations found evidence of injection drug use in 46.8% and 42.1% of overdose deaths involving fentanyl and fentanyl analogs, respectively. Approximately one in five deaths involving fentanyl and fentanyl analogs had no evidence of injection drug use but did have evidence of other routes of administration. Among these deaths, snorting (52.4% fentanyl and 68.8% fentanyl analogs) and ingestion (38.2% fentanyl and 29.7% fentanyl analogs) were most common. Although rare, transdermal administration was found among deaths involving fentanyl (1.2%), likely indicating pharmaceutical fentanyl (Table 2). More than one third of deaths had no evidence of route of administration."

Julie K. O’Donnell, PhD; John Halpin, MD; Christine L. Mattson, PhD; Bruce A. Goldberger, PhD; R. Matthew Gladden, PhD. Deaths Involving Fentanyl, Fentanyl Analogs, and U-47700 — 10 States, July–December 2016. Morbidity and Mortality Weekly Report. Vol. 66. Centers for Disease Control. October 27, 2017.
https://www.cdc.gov/mmwr/volum...

19. Estimated Economic Impact of Illegal Opioid Use and Opioid-Related Overdose Deaths
The White House Council of Economic Advisers [CEA] released its analysis of the economic costs of illegal opioid use, related overdoses, and overdose mortality in November 2017. It reported a dramatically higher estimate than previous analyses, largely due to a change in methodology. Previous analyses had used a person's estimated lifetime earnings to place a dollar value on that person's life. According to the CEA, "We diverge from the previous literature by quantifying the costs of opioid-related overdose deaths based on economic valuations of fatality risk reduction, the “value of a statistical life” (VSL)."

The CEA noted that "According to a recent white paper prepared by the U.S. Environmental Protection Agency’s (EPA) Office of Policy for review by the EPA’s Science Advisory Board (U.S. EPA 2016), the EPA’s current guidance calls for using a VSL estimate of $10.1 million (in 2015 dollars), updated from earlier estimates based on inflation, income growth, and assumed income elasticities. Guidance from the U.S. Department of Health and Human Services (HHS) suggests using the range of estimates from Robinson and Hammitt (2016) referenced earlier, ranging from a low of $4.4 million to a high of $14.3 million with a central value of $9.4 million (in 2015 dollars). The central estimates used by these three agencies, DOT, EPA, and HHS, range from a low of $9.4 million (HHS) to a high of $10.1 million (EPA) (in 2015 dollars)."

In addition, the CEA assumed that the number of opioid-related overdoses in the US in 2015 was significantly under-reported. According to its report, "However, recent research has found that opioids are underreported on death certificates. Ruhm (2017) estimates that in 2014, opioid-involved overdose deaths were 24 percent higher than officially reported.4 We apply this adjustment to the 2015 data, resulting in an estimated 41,033 overdose deaths involving opioids. We apply this adjustment uniformly over the age distribution of fatalities."

The combination of that assumption with the methodology change resulted in a dramatically higher cost estimate than previous research had shows. According to the CEA, "CEA’s preferred cost estimate of $504.0 billion far exceeds estimates published elsewhere. Table 3 shows the cost estimates from several past studies of the cost of the opioid crisis, along with the ratio of the CEA estimate to each study’s estimate in 2015 dollars. Compared to the recent Florence et al. (2016) study—which estimated the cost of prescription opioid abuse in 2013—CEA’s preferred estimate is more than six times higher, reported in the table’s last column as the ratio of $504.0 billion to $79.9 billion, which is Florence et al.’s estimate adjusted to 2015 dollars. Even CEA’s low total cost estimate of $293.9 billion is 3.7 times higher than Florence et al.’s estimate."

In contrast, the CEA noted that "Among the most recent (and largest) estimates was that produced by Florence et al. (2016), who estimated that prescription opioid overdose, abuse, and dependence in the United States in 2013 cost $78.5 billion. The authors found that 73 percent of this cost was attributed to nonfatal consequences, including healthcare spending, criminal justice costs and lost productivity due to addiction and incarceration. The remaining 27 percent was attributed to fatality costs consisting almost entirely of lost potential earnings." According to the CDC, there were 25,840 deaths in 2013 related to an opioid overdose.

According to the CEA, "We also present cost estimates under three alternative VSL assumptions without age-adjustment: low ($5.4 million), middle ($9.6 million), and high ($13.4 million), values suggested by the U.S. DOT and similar to those used by HHS. For example, our low fatality cost estimate of $221.6 billion is the product of the adjusted number of fatalities, 41,033, and the VSL assumption of $5.4 million. Our fatality cost estimates thus range from a low of $221.6 billion to a high of $549.8 billion."

"The Underestimated Cost of the Opioid Crisis," Council of Economic Advisers, Executive Office of the President of the United States, November 2017.
https://www.whitehouse.gov/sit...
Warner M, Trinidad JP, Bastian BA, et al. Drugs most frequently involved in drug overdose deaths: United States, 2010–2014. National vital statistics reports; vol 65 no 10. Hyattsville, MD: National Center for Health Statistics. 2016. Table B, p. 64.
https://www.cdc.gov/nchs/data/...
https://www.cdc.gov/nchs/produ...

20. Reasons Why Many in the US Receive Inadequate Treatment for Pain
"Currently, large numbers of Americans receive inadequate pain prevention, assessment, and treatment, in part because of financial incentives that work against the provision of the best, most individualized care; unrealistic patient expectations; and a lack of valid and objective pain assessment measures. Clinicians’ role in chronic pain care is often a matter of guiding, coaching, and assisting patients with day-to-day self-management, but many health professionals lack training in how to perform this support role, and there is little reimbursement for their doing so. Primary care is often the first stop for patients with pain, but primary care is organized in ways that rarely allow clinicians time to perform comprehensive patient assessments. Sometimes patients turn to, or are referred to, pain specialists or pain clinics, although both of these are few in number. Unfortunately, patients often are not told, or do not understand, that their journey to find the best combination of treatments for them may be long and full of uncertainty."

Institute of Medicine, "Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research" (Washington, DC: National Academy of Sciences, 2011), p. 8.
http://www.nap.edu/openbook.ph...

21. Restrictions On Opioid Prescribing Are Negatively Impacting People With Cancer And Other Serious Illnesses
"A growing number of restrictions on opioid prescribing are already impacting these patient populations."

According to a survey conducted for the American Cancer Society Cancer Action Network and the Patient Quality of Life Coalition:

Patients answering yes to "Has your doctor indicated his or her treatment options for your pain were limited by laws, guidelines, or your insurance coverage?"
Patients Being Treated For Cancer: 48%
Patients Being Treated For Chronic Pain: 40%
Patients Being Treated For Other Serious Illnesses: 56%

Patients answering yes to "Has your insurance company or pharmacy required you to only have opioid prescriptions from one doctor?"
Patients Being Treated For Cancer: 36%
Patients Being Treated For Chronic Pain: 25%
Patients Being Treated For Other Serious Illnesses: 26%

Patients answering yes to "Has your doctor refused to give you a prescription for an opioid plan medication?"
Patients Being Treated For Cancer: 35%
Patients Being Treated For Chronic Pain: 25%
Patients Being Treated For Other Serious Illnesses: 36%

Patients answering yes to "Has the pharmacist give you only part of your opioid prescription (for example: for 7 days instead of 30 days the prescription was written), and told you to call your doctor for a new prescription if you need more?"
Patients Being Treated For Cancer: 31%
Patients Being Treated For Chronic Pain: 18%
Patients Being Treated For Other Serious Illnesses: 21%

Patients answering yes to "Have you been unable to get your opioid prescription pain medication because the pharmacist or pharmacy sent you home without your prescription because they had to contact your doctor before filling the prescription?"
Patients Being Treated For Cancer: 26%
Patients Being Treated For Chronic Pain: 30%
Patients Being Treated For Other Serious Illnesses: 22%

Patients answering yes to "Has the pharmacist given you only part of your opioid prescription (for example: for 7 days instead of 30 days the prescription had been written), and told you to come back if you need more?"
Patients Being Treated For Cancer: 25%
Patients Being Treated For Chronic Pain: 26%
Patients Being Treated For Other Serious Illnesses: 26%

Patients answering yes to "Has your doctor or pharmacist told you that you have been flagged in their system as a potential opioid abuser?"
Patients Being Treated For Cancer: 21%
Patients Being Treated For Chronic Pain: 14%
Patients Being Treated For Other Serious Illnesses: 11%

American Cancer Society Cancer Action Network, Patient Quality of Life Coalition, and Public Opinion Strategies. Key Findings Summary: Opioid Access Research Project. June 2018.
https://www.acscan.org/release...
https://www.acscan.org/sites/d...

22. Prevalence Of Illegal Use of Prescription Drugs In The US
https://www.samhsa.gov/data/
https://www.samhsa.gov/data/si...
https://www.samhsa.gov/data/si...

23. Prevalence of Undertreatment of Pain
"Approximately 100 million American adults experience pain from common chronic conditions, and additional millions experience short-term acute pain (Chapter 2). Many people could have better outcomes if they received incrementally better care as part of the treatment of the chronic diseases that are causing their pain. A nationwide health system straining to contain costs will be hard pressed to address the problem, however, unless early savings can be clearly demonstrated through reduced health care utilization and disability and fewer dollars wasted on ineffective treatments. The high prevalence of pain suggests that it is not being adequately treated, and undertreatment generates enormous costs to the system and to the nation’s economy (see Chapter 2)."

Institute of Medicine, "Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research" (Washington, DC: National Academy of Sciences, 2011), p. 153.
http://www.nap.edu/openbook.ph...

24. Unrelieved Pain A Serious Health Problem In The US
"It is well-documented that unrelieved pain continues to be a serious public health problem for the general population in the United States.1-8 This issue is particularly salient for children,9-14 the elderly,15-19 people of racial and ethnic subgroups,20-24 people with developmental disabilities,25;26 people in the military or military veterans27-30 as well as for those with diseases such as cancer,31-36 HIV/AIDS,37-40 or sickle-cell disease.41-43Clinical experience has demonstrated that adequate pain management leads to enhanced functioning and quality of life, while uncontrolled severe pain contributes to disability and despair.4;44"

Pain & Policy Studies Group, "Achieving Balance in State Pain Policy: A Progress Report Card (CY 2013)" (Madison, WI: University of Wisconsin Carbone Cancer Center, July 2014), p. 10.
http://www.painpolicy.wisc.edu...
http://www.painpolicy.wisc.edu...

25. Opioid Use for Pain Management
"'Opioid' is a generic term for natural or synthetic substances that bind to specific opioid receptors in the CNS, producing an agonist action. Opioids are also called narcotics—a term originally used to refer to any psychoactive substance that induces sleep. Opioids have both analgesic and sleep-inducing effects, but the 2 effects are distinct from each other.
"Some opioids used for analgesia have both agonist and antagonist actions. Potential for abuse among those with a known history of abuse or addiction may be lower with agonist-antagonists than with pure agonists, but agonist-antagonist drugs have a ceiling effect for analgesia and induce a withdrawal syndrome in patients already physically dependent on opioids.
"In general, acute pain is best treated with short-acting pure agonist drugs, and chronic pain, when treated with opioids, should be treated with long-acting opioids (see Table: Opioid Analgesicsand Equianalgesic Doses of Opioid Analgesics*). Because of the higher doses in many long-acting formulations, these drugs have a higher risk of serious adverse effects (eg, death due to respiratory depression) in opioid-naive patients."

"Treatment of Pain." The Merck Manual for Health Professionals. Merck & Co. Inc. Last accessed November 1, 2017.
http://www.merckmanuals.com/pr...

26. Law Enforcement's "Chilling Effect" on Pain Treatment
"The under-treatment of pain is due in part to a kind of undesirable 'chilling effect.' The concept of a chilling effect, generally, is a useful law enforcement tool. When publicity surrounding a righteous prosecution 'chills' related criminal conduct, that chilling effect is intended, appropriate, and a public good. A chilling effect on the appropriate use of pain medicine, however, is not a public good. Recent research by members of the Law Enforcement Roundtable confirms that prosecutions of doctors for diversion of prescription drugs are rare.2But, on occasion, overly-sensationalized stories of investigation of doctors have hit the nightly news. When that happens, the resulting chilling effect reaches far beyond a 'good' chilling effect on bad actors, and directly affects appropriate medical practice. The consequence is extreme, and not what law enforcement would ever seek – our parents and other loved ones who are in pain simply cannot get the medicines they need."

"Balance, Uniformity and Fairness: Effective Strategies for Law Enforcement for Investigating and Prosecuting the Diversion of Prescription Pain Medications While Protecting Appropriate Medical Practice," Center for Practical Bioethics (Kansas City, MO: February 2009), p. 3.
http://www.fsmb.org/Media/Defa...

27. Opioids and Pain Management
"Opioid analgesics are useful in managing acute and chronic pain. They are sometimes underused in patients with severe acute pain or with pain and a terminal disorder such as cancer, resulting in needless pain and suffering. Reasons for undertreatment include
"• Underestimation of the effective dose
"• Overestimation of the risk of adverse effects
"Generally, opioids should not be withheld when treating acute, severe pain; however, simultaneous treatment of the condition causing the pain usually limits the duration of severe pain and the need for opioids to a few days or less. Also, opioids should generally not be withheld when treating cancer pain; in such cases, adverse effects can be prevented or managed, and addiction is less of a concern.
"In patients with chronic noncancer pain, nonopioid therapy should be tried first (see Chronic Pain : Treatment). Opioids should be used when the benefit of pain reduction outweighs the risk of adverse effects and of drug misuse. If nonopioid therapy has been unsuccessful, opioid therapy should be considered. In such cases, obtaining informed consent may help clarify the goals, expectations, and risks of treatment and facilitate education and counseling about misuse. Patients receiving chronic (> 3 mo) opioid therapy should be regularly assessed for pain control, adverse effects, and signs of misuse. If patients have persistent severe pain despite increasing opioid doses, do not adhere to the terms of treatment, or have deteriorating physical or mental function, opioid therapy should be tapered and stopped.
"Physical dependence (development of withdrawal symptoms when a drug is stopped) should be assumed to exist in all patients treated with opioids for more than a few days. Thus, opioids should be used as briefly as possible, and in dependent patients, the dose should be tapered to control withdrawal symptoms when opioids are no longer necessary. Patients with pain due to an acute, transient disorder (eg, fracture, burn, surgical procedure) should be switched to a nonopioid drug as soon as possible. Dependence is distinct from addiction, which, although it does not have a universally accepted definition, typically involves compulsive use and overwhelming involvement with the drug including craving, loss of control over use, and use despite harm."

"Treatment of Pain." The Merck Manual for Health Professionals. Merck & Co. Inc. Last accessed November 1, 2017.
http://www.merckmanuals.com/pr...

28. Substance Use Disorders and Effective Pain Treatment
"Persons with substance use disorders are less likely than others to receive effective pain treatment (Rupp and Delaney, 2004). The primary reason is clinicians' concern that they may misuse opioids. Although mild to moderate pain can often be treated effectively with a combination of physical modalities (e.g., ice, rest, and splints) and nonopioid analgesics (e.g., nonsteroidal anti-inflammatory drugs [NSAIDs], acetaminophen, or other adjuvant medications), management of severe pain, especially when cancer-related, often requires opioids. Moreover, physicians are increasingly using opioids to treat chronic non-cancer-related pain, and an emerging body of evidence suggests that, for some patients, this approach both reduces pain and may foster modest improvements in function and quality of life (Devulder, Richarz, and Nataraja, 2005; Haythornthwaite et al., 1998; Kalso et al., 2004; Martell et al., 2007; Noble et al., 2008; Passik et al., 2005; Portenoy et al., 2007; Portenoy and Foley, 1986)."

Savage, Seddon R., Kenneth L. Kirsh, and Steven D. Passik. "Challenges in Using Opioids to Treat Pain in Persons With Substance Use Disorders." Addiction Science & Clinical Practice 4.2 (2008): 4–25.
http://www.ncbi.nlm.nih.gov/pm...
http://www.ncbi.nlm.nih.gov/pm...

29. Balancing Control And Availability Of Opioid Painkillers In Pain Management
"Because opioid analgesics have both a medical indication and an abuse liability, their prescribing, dispensing, and administration, indeed their very availability in commerce, is governed by a combination of policies, including international treaties and U.S. federal and state laws and regulations. The main purpose of these policies is drug control: to prevent diversion and abuse of prescription medications. However, international and federal policies also express clearly a second purpose of drug control, that being availability: recognizing that many opioids (referred to in law as narcotic drugs or controlled substances) are necessary for pain relief and that governments must ensure their adequate availability for medical and scientific purposes. When both control and availability are appropriately recognized in public policy, and implemented in everyday practice, this is referred to as a balanced approach (American Medical Association?Department of Substance Abuse, 1990; Cooper, Czechowicz, Petersen, & Molinari, 1992; Drug Enforcement Administration et al., 2001; Fishman, 2012; Gilson, 2010a; Gilson, Joranson, Maurer, Ryan, & Garthwaite, 2005; Joranson & Dahl, 1989; Office of National Drug Control Policy, 2011; Woodcock, 2009; World Health Organization, 2011a)."

Pain & Policy Studies Group. Achieving Balance in Federal and State Pain Policy: A Guide to Evaluation (CY 2013). (University of Wisconsin Carbone Cancer Center: Madison, WI, July 2014), p. 17.
http://www.painpolicy.wisc.edu...
http://www.painpolicy.wisc.edu...

30. Using Opioids for Treatment of Acute Pain
"Mild to moderate acute pain is often relieved by physical interventions—such as the application of ice, transcutaneous electrical nerve stimulation (TENS), massage or stretching, and/or bracing—along with a mild analgesic such as an NSAID or acetaminophen. More severe pain often requires opioid therapy, which will be discussed in depth below. When appropriately skilled clinicians are available in a system that is comfortable supporting such treatments, nerve blocks or spinal infusions can sometimes control more severe acute pain. Examples of common acute pain procedures are rib blocks for rib fractures or thoracic incisions; epidural infusions for thoracic, abdominal, or lower body surgery or trauma; and brachial plexus infusions for upper extremity postsurgical or trauma-related pain.
"Clinicians should generally not let concerns about addiction deter them from using opioids that are needed for severe acute pain. Carefully supervised short-term use of opioids in the context of time-limited treatment of such pain has not been documented to affect the long-term course of addictive disorders. Rather, inadequate pain control and treatment that frustrates, stresses, or confuses patients may lead to relapse (Wasan et al., 2006)."

Savage, Seddon R., Kenneth L. Kirsh, and Steven D. Passik. "Challenges in Using Opioids to Treat Pain in Persons With Substance Use Disorders." Addiction Science & Clinical Practice 4.2 (2008): 4–25.
http://www.ncbi.nlm.nih.gov/pm...
http://www.ncbi.nlm.nih.gov/pm...

31. Tighter Prescribing Regulations Drive Illegal Sales
"The US Drug Enforcement Administration introduced a schedule change for hydrocodone combination products in October 2014. During the period of our study, October 2013 to July 2016, the percentage of total drug sales represented by prescription opioids in the US doubled from 6.7% to 13.7%, which corresponds to a yearly increase of 4 percentage points in market share. It is not possible to determine the location of buyers from cryptomarket data. We cannot know, for example, if a drug shipped from a vendor in Europe was purchased by a US customer. Nevertheless, cryptomarket users often prefer buying and selling from vendors in the same country; international shipments carry risks of loss, interception by officials, and increased delivery times. A study of cryptomarkets in Australia found that local vendors were often preferred over international counterparts, despite substantially higher prices.24 Another study36 also noted the downward trends of international sales and therefore an increase in domestic sales, and yet another study47 found that drug trading through cryptomarket is heavily constrained by offline geography. This preference for domestic trading, combined with the relatively large numbers of US drug vendors trading in cryptomarkets, leads us to presume that most sales of prescription drugs by US vendors will be sold to customers based in the US. Conversely, most transactions generated by non-US vendors will not be sold to US customers.

"The results of our interrupted time series suggest the possibility of a causal relation between the schedule change and the percentage of sales represented by prescription opioids on cryptomarkets. Our analysis cannot rule out other possible causal explanatory factors, but our results are consistent with the possibility that the schedule change might have directly contributed to the changes we observed in the supply of illicit opioids. This possibility is reinforced by the fact that the increased availability and sales of prescription opioids on cryptomarkets in the US after the schedule change was not replicated for cryptomarkets elsewhere.

"Our results are consistent with the possibility of demand led increases. The first increase observed for prescription opioids was for actual sales (fig 1); with increases for active listings, and then all listings, following. One explanation is that cryptomarket vendors perceived an increase in demand and responded by placing more listings for prescription opioids and thereby increasing supply. Our results are also consistent with the iron law of prohibition34 insofar as we identified the largest sales increases for more potent prescription opioids—specifically, oxycodone and fentanyl. Cryptomarkets may function as a supply gateway48: customers who initially sought out illicit hydrocodone on cryptomarkets after the schedule change might then have favoured more potent opioids available on the marketplace."

Martin James, Cunliffe Jack, Décary-Hétu David, Aldridge Judith. Effect of restricting the legal supply of prescription opioids on buying through online illicit marketplaces: interrupted time series analysis. British Medical Journal. 2018; 361:k2270.
https://www.bmj.com/content/36...

32. Barriers to Effective Pain Care
"A number of barriers to effective pain care involve the attitudes and training of the providers of care. First, health professionals may hold negative attitudes toward people reporting pain and may regard pain as not worth their serious attention. As discussed in detail in Chapter 2, patients can be at a particular disadvantage if they are members of racial or ethnic minorities, female, children, or infirm elderly. They also may have less access to care if they are perceived as drug seeking or if they have, or are perceived to have, mental health problems. A literature review showed that people with pain, especially women, often have attitudes and goals that are different from, and sometimes opposed to, the attitudes and goals of their practitioners; patients seek to have their pain legitimized, while practitioners focus on diagnosis and therapy (Frantsve and Kerns, 2007). Consumers testified before the committee that patients often believe practitioners trivialize pain, which makes them feel even worse. Researchers working with patient focus groups have noted the 'perceived failures of providers to fully respect, trust, and accept the patient, to offer positive feedback and support, and to believe the participants’ reports of the severity and adverse effects of their pain' (Upshur et al., 2010, p. 1793)."

Institute of Medicine, "Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research" (Washington, DC: National Academy of Sciences, 2011), pp. 153-154.
http://www.nap.edu/openbook.ph...

33. Impact of Drug Control Policy on Medical Treatment of Pain
"Opioid medications also have a potential for abuse (a discussion of this important issue is in the Executive Summary and Section III of the Evaluation Guide 2013). Consequently, opioid analgesics and the healthcare professionals who prescribe, administer, or dispense them are regulated pursuant to federal and state controlled substances laws, as well as under state laws and regulations that govern professional practice.70;71Such policies are intended to prevent illicit trafficking, drug abuse, and substandard practice related to prescribing and patient care. However, in some states these policies go well beyond the usual framework of controlled substances and professional practice policy, and can negatively affect legitimate healthcare practices and create undue burdens for practitioners and patients,72-76 resulting in interference with appropriate pain management.

"Examples of such policy language include:
"• Limiting medication amounts that can be prescribed and dispensed for every patient;
"• Unduly restricting the period for which prescriptions are valid;
"• Unconditionally denying treatment access to patients with pain who also have a history of substance abuse;
"• Requiring special government-issued prescription forms only for a certain class of medications;
"• Requiring opioids to be a treatment of last resort regardless of the clinical situation;
"• Using outdated definitions that confuse physical dependence with addiction; and
"• Defining 'unprofessional conduct' to include 'excessive' prescribing, without defining the standard or criteria under which such a determination is made."

Pain & Policy Studies Group, "Achieving Balance in State Pain Policy: A Progress Report Card (CY 2013)" (Madison, WI: University of Wisconsin Carbone Cancer Center, July 2014), p. 11.
http://www.painpolicy.wisc.edu...
http://www.painpolicy.wisc.edu...

34. Undertreated Chronic Pain and Development of Substance Dependence
"In our study, there was greater evidence for an association between substance use and chronic pain among inpatients than among MMTP [Methadone Maintenance Treatment Program] patients. Among inpatients, there were significant bivariate relationships between chronic pain and pain as a reason for first using drugs, multiple drug use, and drug craving. In the multivariate analysis, only drug craving remained significantly associated with chronic pain. Not surprisingly, inpatients with pain were significantly more likely than those without pain to attribute the use of alcohol and other illicit drugs, such as cocaine and marijuana, to a need for pain control. These results suggest that chronic pain contributes to illicit drug use behavior among persons who were recently using alcohol and/or cocaine. Inpatients with chronic pain visited physicians and received legitimate pain medications no more frequently than those without pain, raising the possibility that undertreatment or inability to access appropriate medical care may be a factor in the decision to use illicit drugs for pain."

Rosenblum, Andrew, PhD, Herman Joseph, PhD, Chunki Fong, MS, Steven Kipnis, MD, Charles Cleland, PhD, Russell K. Portenoy, MD, "Prevalence and Characteristics of Chronic Pain Among Chemically Dependent Patients in Methadone Maintenance and Residential Treatment Facilities," Journal of the American Medical Association (Chicago, IL: American Medical Association, May 14, 2003), Vol. 289, No. 18, pp. 2376-2377.
http://jama.jamanetwork.com/ar...

35. Tolerance of Opiates and Escalation of Effective Dosage
"During long-term treatment, the effective opioid dose can remain constant for prolonged periods. Some patients need intermittent dose escalation, typically in the setting of physical changes that suggest an increase in the pain (eg, progressive neoplasm). Fear of tolerance should not inhibit appropriate early, aggressive use of an opioid. If a previously adequate dose becomes inadequate, that dose must usually be increased by 30 to 100% to control pain."

"Treatment of Pain." The Merck Manual for Health Professionals. Merck & Co. Inc. Last accessed November 1, 2017.
http://www.merckmanuals.com/pr...

36. Majority of Pain Patients Use Prescription Drugs Properly
"The research findings noted above need to be set against the testimony of people with pain, many of whom derive substantial relief from opioid drugs. This tension perhaps reflects the complex nature of pain as a lived experience, as well as the need for biopsychosocial assessments and treatment strategies that can maximize patients’ comfort and minimize risks to them and society. Regardless, the majority of people with pain use their prescription drugs properly, are not a source of misuse, and should not be stigmatized or denied access because of the misdeeds or carelessness of others."

Institute of Medicine, "Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research" (Washington, DC: National Academy of Sciences, 2011), p. 145.
http://www.nap.edu/openbook.ph...

37. Regulatory Barriers to Adequate Pain Care
"In the United States, many pain experts agree that physicians should prescribe opioids when necessary regardless of outside pressures as an exercise of their 'moral and ethical obligations to treat pain' (Payne et al., 2010, p. 11). For some time, observers have attributed U.S. patients’ difficulty in obtaining opioids to pressures on physicians from law enforcement and risk-averse state medical boards. Federal and state drug abuse prevention laws, regulations, and enforcement practices have been considered impediments to effective pain management since 1994, when the Agency for Health Care Policy and Research (now the Agency for Healthcare Research and Quality [AHRQ]) adopted clinical practice guidelines on cancer pain (Jacox et al., 1994a,b).
"Like AHRQ, the American Medical Directors Association (nursing home physicians) and American Geriatrics Society cite delays in access to prescribed opioids for nursing home patients, including those who are terminally ill, and the American Cancer Society has recognized the frequent inaccessibility of opioids necessary for treating some pain. The American Pain Society has developed evidence-based guidelines for controlling cancer pain, including the use of opioids when other treatments fail or when severe pain relief needs must be met immediately (Gordon et al., 2005). Fourteen years ago, the Institute of Medicine Committee on Care at the End of Life called for efforts to reduce regulatory barriers to pain relief at the end of life and termed some regulatory restrictions 'outdated and flawed' (IOM, 1997, p. 56)."

Institute of Medicine, "Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research" (Washington, DC: National Academy of Sciences, 2011), p. 145.
http://www.nap.edu/openbook.ph...

38. Risk of Opioid Medication Abuse by Pain Patients
"Opioid medications present some risk of abuse by patients as well. A structured review of 67 studies found that 3 percent of chronic noncancer pain patients regularly taking opioids developed opioid abuse or addiction, while 12 percent developed aberrant drug-related behavior (Fishbain et al., 2008). A recent analysis revealed that half of patients who received a prescription for opioids in 2009 had filled another opioid prescription within the previous 30 days, indicating that they were seeking and obtaining more opioids than prescribed by any single physician (NIH and NIDA, 2011)."

Institute of Medicine, "Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research" (Washington, DC: National Academy of Sciences, 2011), p. 146.
http://www.nap.edu/openbook.ph...

39. Undertreatment of Pain More Common Among African-American Patients Than Whites
"Undertreatment of pain among African Americans has been well documented. For example, children with sickle-cell anemia (a painful disease that occurs most often among African Americans) who presented to hospital emergency departments (EDs) with pain were far less likely to have their pain assessed than were children with long-bone fractures (Zempsky et al., 2011).
"In general, moreover, a number of studies have shown that physicians tend to prescribe less analgesic medication for African Americans than for whites (Bernabei et al., 1998; Edwards et al., 2001; Green and Hart-Johnson, 2010). A study that used a pain management index to evaluate pain control found that blacks were less likely than whites to obtain prescriptions for adequate pain relief, based on reported pain severity and the strength of analgesics provided. Because such an index is a way to quantify a person’s response to pain medication alone, it is likely that people in this study did not receive other types of treatment for pain either."

Institute of Medicine, "Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research" (Washington, DC: National Academy of Sciences, 2011), p. 68.
http://www.nap.edu/openbook.ph...

40. Definition of Diversion of Licit, Legally Prescribed Drugs
"'Drug diversion' is best defined as the diversion of licit drugs for illicit purposes. It involves the diversion of drugs from legal and medically necessary uses towards uses that are illegal and typically not medically authorized or necessary."

"Drug Diversion in the Medicaid Program: State Strategies for Reducing Prescription Drug Diversion in Medicaid," Centers for Medicare & Medicaid Services (Baltimore, MD: January 2012), p. 1.
https://www.cms.gov/Medicare-M...

41. Number Of Painkiller Prescriptions Written Annually In The US
"Prescribers wrote 82.5 OPR [Opioid Pain Reliever] prescriptions and 37.6 benzodiazepine prescriptions per 100 persons in the United States in 2012 (Table). LA/ER [Long-Acting or Extended Release] OPR accounted for 12.5%, and high-dose OPR accounted for 5.1% of the estimated 258.9 million OPR prescriptions written nationwide. Prescribing rates varied widely by state for all drug types. For all OPR combined, the prescribing rate in Alabama was 2.7 times the rate in Hawaii."

Leonard J. Paulozzi, MD1, Karin A. Mack, PhD2, Jason M. Hockenberry, PhD, "Vital Signs: Variation Among States in Prescribing of Opioid Pain Relievers and Benzodiazepines — United States, 2012," Morbidity and Mortality Weekly Report, July 4, 2014, US Centers for Disease Control, p. 564.
http://www.cdc.gov/mmwr/pdf/wk...

42. The Burden of Opioid-Related Mortality in the United States
"Over the 15-year study period, 335,123 opioid-related deaths in the United States met our inclusion criteria, with an increase of 345% from 9489 in 2001 (33.3 deaths per million population) to 42,245 in 2016 (130.7 deaths per million population). By 2016, men accounted for 67.5% of all opioid-related deaths (n = 28,496), and the median (interquartile range) age at death was 40 (30-52) years. The proportion of deaths attributable to opioids increased over the study period, rising 292% (from 0.4% [1 in 255] to 1.5% [1 in 65]), and increased steadily over time in each age group studied (P < .001 for all age groups) (Figure). The largest absolute increase between 2001 and 2016 was observed among those aged 25 to 34 years (15.8% increase from 4.2% in 2001 to 20.0% in 2016), followed by those aged 15 to 24 years (9.4% increase from 2.9% to 12.4%). However, the largest relative increases occurred among adults aged 55 to 64 years (754% increase from 0.2% to 1.7%) and those aged 65 years and older (635% increase from 0.01% to 0.07%). Despite the fact that confirmed opioid-related deaths represent a small percentage of all deaths in these older age groups, the absolute number of deaths is moderate. In 2016, 18.4% (7762 of 42,245) of all opioid-related deaths in the United States occurred among those aged 55 years and older.

"In our analysis of the burden of early loss of life from opioid overdose, we found that opioid-related deaths were responsible for 1,681,359 YLL [Years of Life Lost] (5.2 YLL per 1000 population) in the United States in 2016 (Table); however, this varied by age and sex. In particular, when stratified by age, adults aged 25 to 34 years and those aged 35 to 44 years experienced the highest burden from opioid-related deaths (12.9 YLL per 1000 population and 9.9 YLL per 1000 population, respectively). We also found that the burden of opioid-related death was higher among men (1,125,711 YLL; 7.0 YLL per 1000 population) compared with women (555,648 YLL; 3.4 YLL per 1000 population). Importantly, among men aged 25 to 34 years, this rate increased to 18.1 YLL per 1000 population, and the total YLL in this population represented nearly one-quarter of all YLL in the United States in 2016 (411,805 of 1,681,359 [24.5%])."

Gomes T, Tadrous M, Mamdani MM, Paterson JM, Juurlink DN. The Burden of Opioid-Related Mortality in the United States. JAMA Network Open. 2018;1(2):e180217. doi:10.1001/jamanetworkopen.2018.0217
https://jamanetwork.com/journa...

43. Prosecutions and Administrative Reviews Of Physicians For Offenses Involving The Prescribing Of Opiates
"We identified a total of 986 cases over the 1998–2006 study time frame in which physicians had been criminally charged and/or administratively reviewed with offenses involving the prescribing of opioid analgesics. 335 were criminal cases (178 state, 157 federal) and 651 were administrative cases (525 state medical board cases, 126 DEA administrative actions regarding CS registrations).

"Numbers and Specialties of Study Physicians

"The 725 individual physicians involved in these cases over the study time period represent 0.1% of the total 691,873 patient-care physicians active in 2003, or one out of 954 physicians.

"As shown in Table 1, General Practice/Family Medicine physicians comprised the largest proportion of physicians involved in the criminal and administrative cases (39.3%). Pain Medicine specialists, both self-identified and board certified, comprised 3.5% of the physicians involved in these cases."

Goldenbaum, Donald M.; Christopher, Myra; Gallagher, Rollin M.; Fishman, Scott; Payne, Richard; Joranson, David; Edmondson, Drew; McKee, Judith; Thexton, Arthur, "Physicians Charged with Opioid Analgesic-Prescribing Offenses" Pain Medicine (Glenview, IL: American Academy of Pain Medicine, September 2008) Volume 9, Issue 6, pp. 741.
http://onlinelibrary.wiley.com...

44. Prevalence and Cost of Migraines
"Migraine headaches are a major public health problem affecting more than 28 million persons in this country.1 Nearly 25 percent of women and 9 percent of men experience disabling migraines.2,3 The impact of these headaches on patients and their families is tremendous, with many patients reporting frequent and significant disability.4 The economic burden of migraine headaches in the United States is also tremendous. Persons with migraines lose an average of four to six work days each year, with an annual total loss nationwide of 64 to 150 million work days. The estimated direct and indirect costs of migraine approach $17 billion.5,6 Despite the prevalence of migraines and the availability of multiple treatment options, this condition is often undiagnosed and untreated.7 About one half of patients stop seeking medical care for their migraines, in part because of dissatisfaction with the therapy they have received.4"

Aukerman, Glen; Knutson, Doug; and Miser, William F. M., "Management of the Acute Migraine Headache," American Family Physician (Shawnee Mission, KS: American Academy of Family Physicians, December 2002), Volume 66, Issue 11, p. 2123.
http://www.aafp.org/afp/2002/1...

45. Global Pain Growth Projection
"In the future, the global need for pain medicine will increase rapidly. In developed and developing countries, the world’s population is aging, resulting in an increase of the prevalence of chronic, painful conditions and cancer. By 2025, there will be 1.2 billion people over the age of 60, which is double the current estimate of 600 million.14 Future demand for such care is also expected to rise due to the dramatically expanding prevalence of HIV/AIDS in several parts of the world. Tragically, the greatest need for pain relief is increasingly concentrated in developing countries, where access to morphine and other opioid analgesics is inadequate or non-existent. For example, WHO estimates that the burden of cancer will increasingly shift from industrialized countries to developing states, so that by the year 2020, 70 percent of the estimated 20 million new cancer cases will occur in developing states.15"

Taylor, Allyn L. "Addressing the Global Tragedy of Needless Pain: Rethinking the United Nations Single Convention on Narcotic Drugs," Journal of Law, Medicine & Ethics (Washington, DC: Georgetown University Law Center, January 2008 ) Vol. 35, No. 556, p. 558.
http://papers.ssrn.com/sol3/De...

46. Prevalence Of Persistent Pain Among Adults In The US
"Approximately 19.0% of adults in the United States reported persistent pain in 2010, but prevalence rates vary significantly by subgroup (Table 1). Older adults are much more likely to report persistent pain than younger adults, with adults aged 60 to 69 at highest risk (AOR = 4.0, 95% CI = 2.7–5.8). Women are at slightly higher risk than men (AOR = 1.4, 95% CI = 1.2–1.7), as are adults who did not graduate from high school (AOR = 1.3, 95% CI = 1.1–1.7). Approximately half of adults who rated their health as fair or poor say they suffer from persistent pain (AOR = 4.7, 95% CI = 3.7–6.0). Recent hospitalization (AOR = 1.6, 95% CI = 1.3–2.1) and obesity (AOR = 1.6, 95% CI = 1.3–2.0) are also linked to higher rates of persistent pain. In contrast, Latino (AOR = .5, 95% CI = .4–.6) and African American (AOR = .6, 95% CI = .4–.7) adults are less likely to report persistent pain than their white counterparts."

Jae Kennedy, John M. Roll, Taylor Schraudner, Sean Murphy, and Sterling McPherson, "Prevalence of Persistent Pain in the U.S. Adult Population: New Data From the 2010 National Health Interview Survey," The Journal of Pain, Vol. 15, No. 10 (October), 2014, pp. 979-984. http://dx.doi.org/10.1016/j.jp...
http://www.jpain.org/article/S...

47. Barriers to Adequate Pain Care
"Adequate pain treatment and follow-up may be thwarted by a mix of uncertain diagnosis and the societal stigma that is applied, consciously or unconsciously, to people reporting pain, particularly if they do not respond readily to treatment. Questions and reservations may cloud perceptions of clinicians, family, employers, and others: Is he really in pain? Is she drug seeking? Is he just malingering? Is she just trying to get disability payments? Certainly, there is some number of patients who attempt to 'game the system' to obtain drugs or disability payments, but data and studies to back up these suspicions are few. The committee members are not naïve about this possibility, but believe it is far smaller than the likelihood that someone with pain will receive inadequate care. Religious or moral judgments may come into play: Mankind is destined to suffer; giving in to pain is a sign of weakness. Popular culture, too, is full of dismissive memes regarding pain: Suck it up; No pain, no gain."

Institute of Medicine, "Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research" (Washington, DC: National Academy of Sciences, 2011), pp. 46-47.
http://www.nap.edu/openbook.ph...

48. Insurance Barriers to Adequate Pain Treatment
"Costly team care, expensive medications, and procedural interventions—all common types of treatment for pain—are not readily obtained by the 19 percent of Americans under age 65 who lack health insurance coverage (Holahan, 2011) or by the additional 14 percent of under-65 adults who are underinsured (Schoen et al., 2008). Together, these groups make up one-third of the nation’s population. Lack of insurance coverage also may contribute to disparities in care. An inability to pay for pain care is especially prevalent among minorities and women (Green et al., 2011). As discussed above, even for people with insurance coverage, third-party reimbursement systems tend not to cover or to cover well psychosocial services and team approaches that represent the best care for people with the most difficult pain problems. Surmounting this barrier may require coordinated action by advocates for improvement."

Institute of Medicine, "Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research" (Washington, DC: National Academy of Sciences, 2011), p. 156.
http://www.nap.edu/openbook.ph...

49. Significance and Growing Prevalence of Lower Back Pain
"The potential impact of the growing prevalence of pain on the health care system is substantial. Although not all people with chronic low back pain are treated within the health care system, many are, and 'back problems' are one of the nation’s 15 most expensive medical conditions. In 1987, some 3,400 Americans with back problems were treated for every 100,000 people; by 2000, that number had grown to 5,092 per 100,000. At the same time, health care spending for these treatments had grown from $7.9 billion to $17.5 billion. Thorpe and colleagues (2004) estimate that low back pain alone contributed almost 3 percent to the total national increase in health care spending from 1987 to 2000. While about a quarter of the $9.5 billion increase could be attributable to increased population size, and close to a quarter was attributable to increased costs of treatment, more than half of the total (53 percent) was attributable to a rise in the prevalence of back problems."

Institute of Medicine, "Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research" (Washington, DC: National Academy of Sciences, 2011), p. 64.
http://www.nap.edu/openbook.ph...

50. Community Epidemiology Working Group Assessment of Non-Prescription Use of Prescription Analgestic in the US, 2012
"Mixed results were noted for prescription opioids, with increases in indicators for prescription opioids as a key finding reported by representatives in two areas—New York City and San Francisco—based on treatment admissions data (primary treatment admissions for opioids/opiates other than heroin increased in 2012 from 2011 in New York City), numbers of prescriptions (the Prescription Drug Monitoring Programs in both New York City and San Francisco showed increases in numbers of prescriptions in 2012), death data (unintentional opioid analgesic poisoning deaths increased in New York City by 65 percent from 2005 to 2011), and ED visit data (visits involving prescription opioids/other opiates increased in New York City from 2010 to 2011 and in San Francisco from 2004 to 2011). A decline in indicators for prescription opioids/opiates other than heroin was reported as a key finding in three other CEWG areas—Maine, Seattle, and South Florida/Miami-Dade and Broward Counties. Deaths related to prescription opioids/opiates other than heroin declined from 2011 to 2012 in Seattle and both Miami-Dade and Broward Counties in South Florida. Treatment admissions and drug reports among drug items seized and analyzed in NFLIS laboratories declined in 2012 from 2011 in the two South Florida counties. Arrests showed decreases in Maine from 2011 to 2012, and reported use of prescription-type opiates in the last month to 'get high' among high school students decreased significantly from 2010 to 2012 in the Seattle area."

"Epidemiologic Trends in Drug Abuse: Proceedings of the Community Epidemiology Work Group, Advance Report, June 2013" (Bethesda, MD: National Institute on Drug Abuse, December 2013), p. 4.
http://www.drugabuse.gov/sites...

51. Association of Opioid Overdose Laws with Opioid Use and Mortality
https://www.sciencedirect.com/...

52. Tightened Restrictions on Legal Prescription Hydrocodone Led to Increase in Illegal Sales
"Objective: To examine the effect on the trade in opioids through online illicit markets (“cryptomarkets”) of the US Drug Enforcement Administration’s ruling in 2014 to reschedule hydrocodone combination products.

"Design: Interrupted time series analysis.

"Setting: 31 of the world’s largest cryptomarkets operating from October 2013 to July 2016.

"Main outcome measures: The proportion of total transactions, advertised and active listings for prescription opioids, prescription sedatives, prescription steroids, prescription stimulants, and illicit opioids, and the composition of the prescription opioid market between the US and elsewhere.

"Results: The sale of prescription opioids through US cryptomarkets increased after the schedule change, with no statistically significant changes in sales of prescription sedatives, prescription steroids, prescription stimulants, or illicit opioids. In July 2016 sales of opioids through US cryptomarkets represented 13.7% of all drug sales (95% confidence interval 11.5% to 16.0%) compared with a modelled estimate of 6.7% of all sales (3.7% to 9.6%) had the new schedule not been introduced. This corresponds to a 4 percentage point yearly increase in the amount of trade that prescription opioids represent in the US market, set against no corresponding changes for comparable products or for prescription opioids sold outside the US. This change was first observed for sales, and later observed for product availability. There was also a change in the composition of the prescription opioid market: fentanyl was the least purchased product during July to September 2014, then the second most frequently purchased by July 2016.

"Conclusions: The scheduling change in hydrocodone combination products coincided with a statistically significant, sustained increase in illicit trading of opioids through online US cryptomarkets. These changes were not observed for other drug groups or in other countries. A subsequent move was observed towards the purchase of more potent forms of prescription opioids, particularly oxycodone and fentanyl."

Martin James, Cunliffe Jack, Décary-Hétu David, Aldridge Judith. Effect of restricting the legal supply of prescription opioids on buying through online illicit marketplaces: interrupted time series analysis. British Medical Journal. 2018; 361:k2270.
https://www.bmj.com/content/36...

53. Likelihood That Young People with Diagnosed Mental Health Conditions Will be Put on Long Term Opioid Therapy
"In this nationwide study of commercially insured adolescents, LTOT [Long Term Opioid Therapy] was relatively uncommon. The estimated incidence of LTOT receipt was 3.0 per 1000 adolescents within 3 years of filling an initial opioid prescription. Although adolescents with a wide range of preexisting mental health conditions and treatments were modestly more likely than adolescents without those conditions or treatments to receive an initial opioid, the former had substantially higher rates of subsequent transitioning to LTOT. Associations were strongest for OUD [Opioid Use Disorder], OUD medications, nonbenzodiazepine hypnotics, and other SUDs. The associations were stronger sooner after first opioid receipt for OUD, as well as for anxiety and sleep disorders and their treatments, suggesting that adolescents with these conditions and treatments were more likely to quickly transition into LTOT."

Quinn PD, Hur K, Chang Z, et al. Association of Mental Health Conditions and Treatments With Long-term Opioid Analgesic Receipt Among Adolescents. JAMA Pediatr. 2018;172(5):423–430. doi:10.1001/jamapediatrics.2017.5641
https://jamanetwork.com/journa...
https://www.ncbi.nlm.nih.gov/p...

54. Rise in Opiate Prescriptions in US
"Even though opioids have been controlled in the United States with regulations and restrictions, opioid utilization has been increasing at an unprecedented pace (1-10). Manchikanti et al (1), in an evaluation of opioid usage over a period of 10 years, showed an overall increase of 149% in retail sales of opioids from 1997 to 2007 in the United States, with an increase of 1,293% for methadone, 866% for oxycodone, and 525% for fentanyl. Similarly, the increase in therapeutic opioid use in the United States in milligrams per person from 1997 to 2007 increased 402% overall, with the highest increase in methadone of 1,124% mg/person and oxycodone of 899% mg/person."

Christo,Paul J.; Manchikanti, Laxmaiah; Ruan, Xiulu; Bottros, Michael; Hansen, Hans; Solanki, Daneshvari R.; Jordan, Arthur E.; and Colson, James , "Urine Drug Testing In Chronic Pain," Pain Physician (Paducah, KY: American Society of Interventional Pain Physicians, March/April 2011), Vol. 14, Issue 2, p. 124.
https://www.ncbi.nlm.nih.gov/p...
painphysicianjournal.com/...

55. Likelihood That Young People with Diagnosed Mental Health Conditions Will be Put on Long Term Opioid Therapy
"Of the 1,000,453 opioid recipients (81.7%) with at least 6 months of follow-up, 51.1% were female, and the median age was 17 years (interquartile range, 16-18 years). Among these adolescents, the estimated cumulative incidence of LTOT [Long Term Opioid Therapy] after first opioid receipt was 1.1 (95% CI, 1.1-1.2) per 1000 recipients within 1 year, 3.0 (95% CI, 2.8-3.1) per 1000 recipients within 3 years, 8.2 (95% CI, 7.8-8.6) per 1000 recipients within 6 years, and 16.1 (95% CI, 14.2-18.0) per 1000 recipients within 10 years. The prevalence of mental health conditions and treatments in this sample is shown in eTable 3 in the Supplement.

"All mental health conditions and treatments were associated with higher rates of transitioning from a first opioid prescription to long-term therapy. Table 2 provides the estimated incidence of LTOT among those with and without mental health conditions and treatments.Adjusted relative increases in the rate of LTOT ranged from a factor of 1.73 for ADHD [Attention-Deficit/Hyperactivity Disorder] (hazard ratio
, 1.73; 95% CI, 1.54-1.95) to approximately 4-fold for benzodiazepines (HR, 3.88; 95%CI, 3.39-4.45) and nonopioid SUDs [Substance Use Disorders] (HR, 4.02;95%CI, 3.48-4.65) to 6-fold for non benzodiazepine hypnotics (HR, 6.15; 95%CI, 5.01-7.55) and to nearly 9-fold for OUD [Opioid Use Disorder] (HR, 8.90; 95%CI, 5.85-13.54). In addition, relative to no condition, the number of condition types was also associated with higher LTOT rates (1 condition: HR, 2.21; 95% CI, 2.01-2.43; 2 or more conditions: HR, 4.01; 95% CI, 3.62-4.46).

"Given the strong associations for OUD, we explored other mental health factors and opioid receipt among those with preexisting OUD. These adolescents were more likely than
adolescents without OUD to have other mental health conditions and treatments (eTable 4 in the Supplement). For example, 76.1% of adolescents with OUD had other SUDs, 61.0% had depressive disorders, and 52.6% had received an SSRI [Selective Serotonin Reuptake Inhibitor]. During follow-up, those with preexisting OUD received opioid drugs similar to those received by adolescents without OUD, although the former were more likely to receive certain opioids (eg, oxycodone and tramadol; eTable 5 in the Supplement). Of those with preexisting OUD, 15.5% filled a prescription for OUD medication treatment during follow-up."

Quinn PD, Hur K, Chang Z, et al. Association of Mental Health Conditions and Treatments With Long-term Opioid Analgesic Receipt Among Adolescents. JAMA Pediatr. 2018;172(5):423–430. doi:10.1001/jamapediatrics.2017.5641
https://jamanetwork.com/journa...
https://www.ncbi.nlm.nih.gov/p...

56. Risk of Heroin Dependence After Onset of Use
"When observed within approximately 1 to 12 months after heroin onset, an estimated 23% to 38% of new heroin users have become dependent on heroin. Rank-order correlation and post hoc exploratory analyses prompt a hypothesis of recently increased odds of becoming dependent on heroin.

"Seeking estimates for comparison, we found 3 published studies on how often heroin dependence was found among people who have used heroin at least once in their lifetime. The National Comorbidity Survey (1990-1992) estimate was 23% dependence rate (with a standard error [SE] of 5%); National Epidemiologic Survey on Alcohol and Related Conditions (2001-2002) estimate (SE) was 28% (4%); and National Epidemiologic Survey on Alcohol and Related Conditions-III (2012-2013) estimate (SE) was 25% (2%).4,6 These 3 values yield a random-effects meta-analysis summary of 26%, with a 95% CI of 22% to 29%, which clearly overlaps this study’s overall finding of 23% to 38% of all participants becoming heroin dependent soon after first heroin use."

Rivera OJS, Havens JR, Parker MA, Anthony JC. Risk of Heroin Dependence in Newly Incident Heroin Users. JAMA Psychiatry. Published online May 30, 2018. doi:10.1001/jamapsychiatry.2018.1214
https://jamanetwork.com/journa...

57. Vivitrol and Risk of Opioid Overdose
"Vulnerability to Opioid Overdose
"After opioid detoxification, patients are likely to have reduced tolerance to opioids. VIVITROL blocks the effects of exogenous opioids for approximately 28 days after administration. However, as the blockade wanes and eventually dissipates completely, patients who have been treated with VIVITROL may respond to lower doses of opioids than previously used, just as they would have shortly after completing detoxification. This could result in potentially life-threatening opioid intoxication (respiratory compromise or arrest, circulatory collapse, etc.) if the patient uses previously tolerated doses of opioids. Cases of opioid overdose with fatal outcomes have been reported in patients who used opioids at the end of a dosing interval, after missing a scheduled dose, or after discontinuing treatment.

"Patients should be alerted that they may be more sensitive to opioids, even at lower doses, after VIVITROL treatment is discontinued, especially at the end of a dosing interval (i.e., near the end of the month that VIVITROL was administered), or after a dose of VIVITROL is missed. It is important that patients inform family members and the people closest to the patient of this increased sensitivity to opioids and the risk of overdose [see Patient Counseling Information (17)].

"There is also the possibility that a patient who is treated with VIVITROL could overcome the opioid blockade effect of VIVITROL. Although VIVITROL is a potent antagonist with a prolonged pharmacological effect, the blockade produced by VIVITROL is surmountable. The plasma concentration of exogenous opioids attained immediately following their acute administration may be sufficient to overcome the competitive receptor blockade. This poses a potential risk to individuals who attempt, on their own, to overcome the blockade by administering large amounts of exogenous opioids. Any attempt by a patient to overcome the antagonism by taking opioids is especially dangerous and may lead to life-threatening opioid intoxication or fatal overdose. Patients should be told of the serious consequences of trying to overcome the opioid blockade [see Patient Counseling Information (17)]."

Full Prescribing Information. Vivitrol (Naltrexone for Extended-Release Injectable Suspension). Revised December 2015.
https://www.vivitrol.com/conte...

58. War on Pain Doctors
"The government is waging an aggressive, intemperate, unjustified war on pain doctors. This war bears a remarkable resemblance to the campaign against doctors under the Harrison Act of 1914, which made it a criminal felony for physicians to prescribe narcotics to addicts. In the early 20th century, the prosecutions of doctors were highly publicized by the media and turned public opinion against physicians, painting them not as healers of the sick but as suppliers of narcotics to degenerate addicts and threats to the health and security of the nation."

Libby, Ronald T., "Treating Doctors as Drug Dealers The DEA’s War on Prescription Painkillers," CATO Institute (Washington, DC: June 2005), p. 21.
http://www.csdp.org/research/c...

59. Use of Cannabis as a Response to the Overdose Crisis
"The opioid epidemic is a public health crisis that is at least partially driven by harms associated with POM [Prescription Opioid Medication] use. States are passing laws allowing use of MC [Medical Cannabis] and patients are using MC, but currently there is little understanding of how this influences POM use or of MC-related harms. This literature review provides preliminary evidence that states with MC laws have experienced reported decreases in POM use, abuse, overdose, and costs. However, existing evidence is limited by significant methodological shortcomings; so, general conclusions are difficult to draw.

"The use of MC as an alternative to POMs for pain management warrants additional empirical attention as a potential harm reduction strategy. NASEM (2017) recommends more clinical trials to elucidate appropriate MC forms, routes of administration, and combination of products for treating pain, but access to MC products to fully evaluate these questions is challenging due to federal regulations. However, the recently funded National Institutes of Health longitudinal study to research the impacts of MC on opioid use is a critical step in the right direction (National Institute of Health, 2017, Williams, 2017). MCs potential as an alternative pain treatment modality to help mitigate the major public health opioid crisis, could be a missed opportunity if data on safety, efficacy, and outcomes are not collected and explored. Health care practitioners, particularly nurses who are charged with ensuring patient comfort, have a vested interest in providing viable alternatives to POMs when appropriate, as part of an integrative approach to pain management, and must advocate for more research to better understand the public health implications and risks and benefits of such alternatives."

Vyas, Marianne Beare et al. The use of cannabis in response to the opioid crisis: A review of the literature. Nursing Outlook, January-February 2018, Volume 66, Issue 1, 56 - 65.
https://www.ncbi.nlm.nih.gov/p...
www.nursingoutlook.org
www.nursingoutlook.org

60. Growth of Federal Oxycontin Investigations and Arrests
"DEA has increased enforcement efforts to prevent abuse and diversion of OxyContin. From fiscal year 1996 through fiscal year 2002, DEA initiated 313 investigations involving OxyContin, resulting in 401 arrests. Most of the investigations and arrests occurred after the initiation of the action plan. Since the plan was enacted, DEA initiated 257 investigations and made 302 arrests in fiscal years 2001 and 2002. Among those arrested were several physicians and pharmacists. Fifteen health care professionals either voluntarily surrendered their controlled substance registrations or were immediately suspended from registration by DEA. In addition, DEA reported that $1,077,500 in fines was assessed and $742,678 in cash was seized by law enforcement agencies in OxyContin-related cases in 2001 and 2002."

General Accounting Office, "Prescription Drugs: OxyContin Abuse and Diversion and Efforts to Address the Problem," GAO-04-110 (Washington, DC: Government Printing Office, Dec. 2003), p. 37.
http://www.gao.gov/new.items/d...

61. Opioid-overdose laws association with opioid use and overdose mortality
"Results
"By 2014, 30 states had a naloxone access and/or Good Samaritan law. States with naloxone access laws or Good Samaritan laws had a 14% (p = 0.033) and 15% (p = 0.050) lower incidence of opioid-overdose mortality, respectively. Both law types exhibit differential association with opioid-overdose mortality by race and age. No significant relationships were observed between any of the examined laws and non-medical opioid use.

"Conclusions
"Laws designed to increase layperson engagement in opioid-overdose reversal were associated with reduced opioid-overdose mortality. We found no evidence that these measures were associated with increased non-medical opioid use."

McClellan, Chandler, Lambdin, Barrot H., et al. Opioid-overdose laws association with opioid use and overdose mortality. Addictive Behaviors. March 19, 2018.
https://www.sciencedirect.com/...

62. Prevalence of Neuropathic Pain
"Neuropathic pain (NP) is defined as pain caused by a lesion or disease of the central or peripheral somatosensory nervous system.[1] NP affects between 5% and 10% of the US population [2] and examples include diabetic neuropathy, complex regional pain syndrome, radiculopathy, phantom limb pain, HIV sensory neuropathy, multiple sclerosis-related pain, and poststroke pain.[3]"

Collen, Mark, "Prescribing Cannabis for Harm Reduction," Harm Reduction Journal (London, United Kingdom: January 2012) Vol. 9, Issue 1, p. 1.
http://www.harmreductionjourna...

63. Medicinal Cannabis as an Alternative to Prescription Opioid Medicines
"The use of MC [Medical Cannabis] as an alternative to POMs [Prescription Opioid Medications] for pain management warrants additional empirical attention as a potential harm reduction strategy. NASEM (2017) recommends more clinical trials to elucidate appropriate MC forms, routes of administration, and combination of products for treating pain, but access to MC products to fully evaluate these questions is challenging due to federal regulations. However, the recently funded National Institutes of Health longitudinal study to research the impacts of MC on opioid use is a critical step in the right direction (NIH, 2017; Williams, 2017). MCs potential as an alternative pain treatment modality to help mitigate the major public health opioid crisis, could be a missed opportunity if data on safety, efficacy, and outcomes are not collected and explored. Health care practitioners, particularly nurses who are charged with ensuring patient comfort, have a vested interest in providing viable alternatives to POMs when appropriate, as part of an integrative approach to pain management, and must advocate for more research to better understand the public health implications and risks and benefits of such alternatives."

Vyas, Marianne Beare et al. The use of cannabis in response to the opioid crisis: A review of the literature. Nursing Outlook, Volume 66, Issue 1, 56 - 65.
https://www.nursingoutlook.org/...
https://www.nursingoutlook.org/...

64. Pain-Related Lost Productivity
Researchers used data from the American Productivity Audit to measure lost productivity in the US due to common pain conditions. In an article published in the Journal of the American Medical Association in 2003, they reported that "Overall, the estimated $61.2 billion per year in pain-related lost productive time in our study accounts for 27% of the total estimated work-related cost of pain conditions in the US workforce."

Stewart, Walter F., PhD, MPH, Judith A. Ricci, ScD, MS, Elsbeth Chee, ScD, David Morganstein, MS, Richard Lipton, MD, "Lost Productive Time and Cost Due to Common Pain Conditions in the US Workforce," Journal of the American Medical Association (Chicago, IL: American Medical Association, Nov. 12, 2003), Vol. 290, No. 18, p. 2449.
http://jama.jamanetwork.com/ar...

65. Limited Data Available on Pain Treatment
"National survey data that provide detailed data on use of treatments are limited. Of the common pain conditions, sufficient details have only been reported on migraine headaches. Recent data indicate that only 41% of individuals who have migraine headaches in the US population ever receive any prescription drug for migraine. Only 29% report that satisfaction with treatment is moderate, especially among those who are often disabled by their episodes. Randomized trials demonstrate that optimal therapy for migraine dramatically reduces headache-related disability time in comparison with usual care."

Stewart, Walter F., PhD, MPH, Judith A. Ricci, ScD, MS, Elsbeth Chee, ScD, David Morganstein, MS, Richard Lipton, MD, "Lost Productive Time and Cost Due to Common Pain Conditions in the US Workforce," Journal of the American Medical Association (Chicago, IL: American Medical Association, Nov. 12, 2003), Vol. 290, No. 18, p. 2453.
http://jama.jamanetwork.com/ar...

66. Cost of Pain-Related Lost Productivity
"Our estimate of $61.2 billion per year in pain-related lost productive time does not include costs from4 other causes. First, we did not include lost productive time costs associated with dental pain, cancer pain, gastrointestinal pain, neuropathy, or pain associated with menstruation. Second, we do not account for pain-induced disability that leads to continuous absence of 1 week or more. Third, we did not consider secondary costs from other factors such as the hiring and training of replacement workers or the institutional effect among coworkers. Taking these other factors into consideration could increase, decrease, or have no net effect on health-related lost productive time cost estimates. Fourth, we may be prone to underestimating current lost productive time among those with persistent pain problems (eg, chronic daily headache). To the extent that these workers remain employed,they may adjust both their performance and perception of their performance over time. The latter, a form of perceptual accommodation, makes it difficult to accurately ascertain the impact of a chronic pain condition on work in the recent past through self-report."

Stewart, Walter F., PhD, MPH, Judith A. Ricci, ScD, MS, Elsbeth Chee, ScD, David Morganstein, MS, Richard Lipton, MD, "Lost Productive Time and Cost Due to Common Pain Conditions in the US Workforce," Journal of the American Medical Association (Chicago, IL: American Medical Association, Nov. 12, 2003), Vol. 290, No. 18, p. 2452.
http://jama.jamanetwork.com/ar...

67. Populations At Increased Risk For Chronic Pain And For Inadequate Treatment
"An important message from epidemiologic studies cited by Blyth and colleagues (2010) is 'the universal presence across populations of characteristic subgroups of people with an underlying propensity or increased risk for chronic pain, in the context of a wide range of different precipitating or underlying diseases and injuries' (p. 282). These vulnerable subgroups are most often those of concern to public health.5Increased vulnerability to pain is associated with the following:
"• having English as a second language,
"• race and ethnicity,
"• income and education,
"• sex and gender,
"• age group,
"• geographic location,
"• military veterans,
"• cognitive impairments,
"• surgical patients,
"• cancer patients, and
"• the end of life.
"Many of these same groups also are at risk of inadequate treatment."

Institute of Medicine, "Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research" (Washington, DC: National Academy of Sciences, 2011), pp. 64-65.
http://www.nap.edu/openbook.ph...

68. Overdose Risk Based on Prescription Type
"Dunn et al4 found that risk of drug-related adverse events among individuals treated for chronic noncancer pain with opioids was increased at opioid doses equivalent to 50 mg/d or more of morphine. Our analyses similarly found that the risk of opioid overdose increased when opioid dose was equivalent to 50 mg/d or more of morphine.
"The present study also extended prior research in several important ways. We used a large, national sample of individuals and focused exclusively on opioid overdose deaths. Because the circumstances that lead to overdose death may vary by the condition for which the opioid is prescribed and substance use disorder status, we conducted analyses for subgroups of patients, including those with cancer, acute pain, and substance use disorders.
"The present study also extended the prior research by exploring a novel risk factor, ie, concurrent prescriptions of regularly scheduled and as-needed opioids. We found that those patients who were simultaneously treated with as-needed and regularly scheduled opioids, a strategy for treating pain exacerbations,7,8 did not have a statistically significant increased risk of opioid overdose in adjusted models. Recent treatment guidelines have indicated that the long-term safety of this strategy for pain exacerbation has not been established,5,9 and in the present study we did not find evidence of greater overdose risk associated with this treatment practice after accounting for maximum daily dose and patient characteristics."

Bohnert, Amy S.B., et al., "Association Between Opioid Prescribing Patterns and Opioid Overdose-Related Deaths," Journal of the American Medical Association, April 6, 2011, Vol 305, No. 13, pp. 1319-1320.
http://jama.jamanetwork.com/ar...

69. Sources of Psychotherapeutic Drugs Used Nonmedically in the US, 2012
"• Past year nonmedical users of psychotherapeutic drugs are asked how they obtained the drugs they most recently used nonmedically. Rates averaged across 2011 and 2012 show that more than one half of the nonmedical users of pain relievers, tranquilizers, stimulants, and sedatives aged 12 or older got the prescription drugs they most recently used 'from a friend or relative for free.' About 4 in 5 of these nonmedical users who obtained prescription drugs from a friend or relative for free indicated that their friend or relative had obtained the drugs from one doctor."

Substance Abuse and Mental Health Services Administration, Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-46, HHS Publication No. (SMA) 13-4795. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013, p. 29.
http://www.samhsa.gov/data/NSD...
http://www.samhsa.gov/data/NSD...

70. Sources of Pain Relievers Used Nonmedically in the US, 2012
"• Among persons aged 12 or older in 2011-2012 who used pain relievers nonmedically in the past year, 54.0 percent got the pain relievers they most recently used from a friend or relative for free (Figure 2.16). Nearly 1 in 5 (19.7 percent) received them through a prescription from one doctor (which was higher than the 17.3 percent in 2009-2010). Another 10.9 percent bought them from a friend or relative. In addition, 4.0 percent of these nonmedical users in 2011-2012 took pain relievers from a friend or relative without asking. An annual average of 4.3 percent got pain relievers from a drug dealer or other stranger; 1.8 percent got pain relievers from more than one doctor; 0.8 percent stole pain relievers from a doctor's office, clinic, hospital, or pharmacy (which was higher than the 0.2 percent in 2009-2010); and 0.2 percent bought the pain relievers on the Internet.
"• Among persons aged 12 or older in 2011-2012 who used pain relievers nonmedically in the past year and indicated that they most recently obtained the drugs from a friend or relative for free, 82.2 percent of the friends or relatives obtained the drugs from just one doctor (Figure 2.16). About 1 in 20 of these past year nonmedical users of pain relievers (5.4 percent) reported that the friend or relative got the pain relievers from another friend or relative for free, 4.1 percent reported that the friend or relative bought the pain relievers from a friend or relative, 1.4 percent reported that the friend or relative bought the pain relievers from a drug dealer or other stranger (which was lower than the 2.3 percent in 2009-2010), 1.3 percent reported that the friend or relative took the pain relievers from another friend or relative without asking, and 0.2 percent reported that the friend or relative bought the pain relievers on the Internet."

Substance Abuse and Mental Health Services Administration, Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-46, HHS Publication No. (SMA) 13-4795. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013, pp. 29-30.
http://www.samhsa.gov/data/NSD...
http://www.samhsa.gov/data/NSD...

71. Undertreatment of Pain Among Those With Chemical Dependency
"The undertreatment of pain is a significant concern in populations with chemical dependency. In painful disorders for which there is a broad consensus about the role of opioid therapy, specifically cancer and AIDS-related pain, studies have documented that this treatment commonly diverges from accepted guidelines. Undertreatment is far more challenging to assess when a broad consensus concerning optimal treatment approaches does not exist. It would be difficult, therefore, to determine the extent to which the pain and functional impairments experienced by patients in this study relate to inadequate pain management. However, given the number of barriers identified as potential reasons for inadequate pain management, it is appropriate to raise concerns about undertreatment and to investigate it further."

Rosenblum, Andrew, PhD, Herman Joseph, PhD, Chunki Fong, MS, Steven Kipnis, MD, Charles Cleland, PhD, Russell K. Portenoy, MD, "Prevalence and Characteristics of Chronic Pain Among Chemically Dependent Patients in Methadone Maintenance and Residential Treatment Facilities," Journal of the American Medical Association (Chicago, IL: American Medical Association, May 14, 2003), Vol. 289, No. 18, p. 2377.
http://jama.jamanetwork.com/ar...

72. Racial and Socioeconomic Disparities in Availability of Opioid Analgesic Availability
"Disparities in pain assessment and treatment on the basis of race and ethnicity are well documented.29Diminished ability to obtain access to opioid analgesics in local pharmacies is a significant barrier to quality pain care. The present investigation provides evidence that Michigan pharmacies in predominantly minority areas were significantly less likely to have sufficient prescription opioid analgesic supplies when compared with predominantly white areas. Regardless of median income and median age, significant differences were found in opioid analgesic availability on the basis of ethnic composition. These results support the findings of Morrison et al38 that pharmacies in predominantly minority neighborhoods stock insufficient opioid analgesic supplies more so than those in predominantly white neighborhoods. However, these results also extend their findings by demonstrating the role of both social class and income on opioid analgesic availability. More specifically, the odds for not having sufficient opioid analgesic supplies are significantly higher among pharmacies in low income areas when compared with higher income areas, regardless of race. More importantly, we identified that the odds of having insufficient supplies in minority neighborhoods changed significantly on the basis of income (ie, high or low) (OR, 13.36 vs 54.42). Thus, social class and poverty seem to play a role for whites more so than minorities. Noncorporate pharmacies were also more likely to have sufficient opioid analgesic supplies than corporate pharmacies. These results suggest that if an opioid analgesic is prescribed for pain management, persons living in minority zip codes (even in higher income areas) or those living in low income zip codes (regardless of minority status) face additional barriers to quality pain care. Thus, vulnerable populations (eg, minorities and low income individuals) are at increased risk for inefficient and lesser quality pain care."

Carmen R. Green, S. Khady Ndao-Brumblay, Brady West, and Tamika Washington, "Differences in Prescription Opioid Analgesic Availability: Comparing Minority and White Pharmacies Across Michigan," The Journal of Pain - October 2005 (Vol. 6, Issue 10, Pages 689-699, DOI: 10.1016/j.jpain.2005.06.002), p. 695.
Abstract: http://www.ncbi.nlm.nih.gov/pu...
http://www.jpain.org/article/S...

73. Undertreatment of Pain Among the Elderly
"Factors affecting the severity of pain in the elderly include
"• complex manifestations of pain;
"• underreporting of pain;
"• concurrent problems and multiple diseases (comorbidities), which complicate diagnosis and treatment;
"• higher rates of medication side effects; and
"• higher rates of treatment complications (American Geriatrics Society, 2009).
"In general, these same factors also contribute to the documented undertreatment of pain in the elderly, along with the lack of an evidence base concerning the pharmacokinetic and pharmacodynamic changes that occur with aging (Barber and Gibson, 2009). Similar to the situation with children in the past, elderly people rarely are included in clinical trials of medications, so clinicians have inadequate information about appropriate dosages and potential interactions with medications being taken for other chronic diseases (Barber and Gibson, 2009).
"A study of more than 13,000 people with cancer aged 65 and older discharged from the hospital to nursing homes found that, among the 4,000 who were in daily pain, those aged 85 and older were more than 1.5 times as likely to receive no analgesia than those aged 65-74; only 13 percent of those aged 85 and older received opioid medications, compared with 38 percent of those aged 65-74 (Bernabei et al., 1998). (A similar excess risk of receiving no analgesia was found among African Americans, Hispanics, and Asians compared with whites.)"

Institute of Medicine, "Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research" (Washington, DC: National Academy of Sciences, 2011), pp. 79-80.
http://www.nap.edu/openbook.ph...

74. Estimated Prevalence of Opioid Diversion by "Doctor Shoppers" in the US
"We applied our composite probability distribution to each patient to calculate the probability that the patient was a member of the 'extreme' group. That is, we multiplied the size of each stratum of patients by its posterior probability of population 3 membership to estimate the total number of probable shoppers in the United States. Summing these probabilities, we estimated that of the 19 million patients in the US who purchased opioids in the first 60 days of 2008, 135,000 (0.7%) were members of this extreme population (Table 2).
"Although only a small fraction of active patients, members of this extreme population obtained an estimated 1.9% (4.3 million) of all 223 million opioid prescriptions dispensed during 2008, and 2.8% of all oxycodone prescriptions (Table 3). They purchased an average of 32 opioid prescriptions that year. When we accounted for the quantity of drugs prescribed, their share of the market was even larger: an estimated 4.0% of the total amounts of these drugs dispensed that year, or about 11.1 million grams. This was equivalent to approximately 5.4 million grams of morphine. This would have provided an average of 109 morphine equivalent milligrams per patient in this extreme group for every day in 2008."

Douglas C. McDonald and Kenneth E. Carlson, "Estimating the Prevalence of Opioid Diversion by 'Doctor Shoppers' in the United States," PLoS One, 2013; 8(7): e69241. Published online 2013 July 17. doi: 10.1371/journal.pone.0069241.
http://www.ncbi.nlm.nih.gov/pm...
http://www.ncbi.nlm.nih.gov/pm...

75. Barriers to Availability of Legal Opioid Analgesics in the US
"The most common reason cited as a barrier to opioid availability was low demand (93.1%). However, this did not vary by opioid analgesic sufficiency, pharmacy racial composition, pharmacy type, level of zip code urbanization, level of opioid analgesic supply, median age, household income, or proportion of residents ?65 years old. The fear that patients might use opioid analgesics for illicit purposes was the second most prevalent barrier identified (8.5%). Concern with illicit opioid analgesic use was more likely to be reported as a barrier by pharmacies with insufficient opioid analgesic supplies when compared with those with sufficient supplies (30.3% vs 4.3%; P ? .01). Again, this did not vary by pharmacy racial composition, pharmacy type, level of zip code urbanization, median age, household income, or proportion of residents ?65 years old. Too much paperwork (1%) and fear of robbery (1%) were rarely identified as potential reasons for opioid analgesic unavailability. Measures of association between covariates and barriers were not computed for the least common barriers (ie, too much paperwork, fear of robbery, and drug disposal regulations) because of empty cells. Other responses cited for failing to supply opioid analgesics (eg, pharmacy was located in a small community, pharmacy was near a major medical center, and community residents do not have adequate health insurance coverage) were of low frequency and were not analyzed further."

Carmen R. Green, S. Khady Ndao-Brumblay, Brady West, and Tamika Washington, "Differences in Prescription Opioid Analgesic Availability: Comparing Minority and White Pharmacies Across Michigan," The Journal of Pain - October 2005 (Vol. 6, Issue 10, Pages 689-699, DOI: 10.1016/j.jpain.2005.06.002), p. 694.
Abstract: http://www.ncbi.nlm.nih.gov/pu...

76. Global Lack of Pain Relief
"Current estimates suggest that upward of 80% of the world’s population lacks access to basic pain relief [6]. Paradoxically, those 80% are mostly in poorer countries, and their need for pain relief is heightened by a relative absence of curative care such as surgery, or treatment for both communicable and non-communicable diseases causing pain (e.g., HIV/AIDS, cancer)[7]."

Nickerson, Jason W., and Attaran, Amir, "The Inadequate Treatment of Pain: Collateral Damage from the War on Drugs," PLoS Medicine (Cambridge, United Kingdom: Public Library of Science, Jan. 2012) Vol. 9, Issue 1, p. 1.
http://www.plosmedicine.org/ar...

77. Global Medical Opiate Shortage
"We determined per capita need of strong opioids for pain related to three important pain causes for 188 countries. These needs were extrapolated to the needs for all the various types of pain by using an adequacy level derived from the top 20 countries in the Human Development Index. By comparing with the actual consumption levels for relevant strong opioid analgesics, we were able to estimate the level of adequacy of opioid consumption for each country. Good access to pain management is rather the exception than the rule: 5.5 billion people (83% of the world’s population) live in countries with low to nonexistent access, 250 million (4%) have moderate access, and only 460 million people (7%) have adequate access. Insufficient data are available for 430 million (7%). The consumption of opioid analgesics is inadequate to provide sufficient pain relief around the world. Only the populations of some industrialized countries have good access."

Marie-Josephine Seya, Susanne F. A. M. Gelders, Obianuju Uzoma Achara, Barbara Milani, and Willem Karel Scholten, "A First Comparison Between the Consumption of and the Need for Opioid Analgesics at Country, Regional, and Global Levels," Journal of Pain & Palliative Care Pharmacotherapy. 2011;25:6–18. ISSN: 1536-0288 print / 1536-0539 online. DOI: 10.3109/15360288.2010.536307
http://apps.who.int/medicinedo...

78. Global Lack of Access to Pain Medication
"Opioid medications are essential not only for drug dependence treatment but also for pain management. WHO estimates that 5 billion people live in countries with little or no access to controlled medicines that are used to treat moderate to severe pain.90 Up to 80% of the estimated 1 million patients in the end stages of AIDS are in great pain, but very few have access to pain relieving drugs91 because of insufficient knowledge among physicians, inadequate health systems, fears of addiction, antiquated laws, and unduly strict regulations.92"

Jürgens, Ralf; Csete, Joanne; Amon, Joseph J.; Baral, Stefan; and Beyrer, Chris, "People who use drugs, HIV, and human rights," The Lancet (London, United Kingdom: August 7, 2010) Vol. 376, Issue 9739, pp. 478-479.
http://www.thelancet.com/journ...

79. Societal Impact of Diversion
"The societal impact of CPD [controlled prescription drugs] diversion and abuse is considerable. Violent and property crime associated with CPD diversion and abuse has increased in all regions of the United States over the past 5 years, according to the National Drug Intelligence Center (NDIC) National Drug Threat Survey (NDTS). However, the association between crime and CPD diversion is reported much less frequently than the association between crime and illicit drugs. Increases in crime rates often result in higher budgetary expenditures for additional law enforcement resources. Moreover, the estimated cost of CPD diversion and abuse to public and private medical insurers is $72.5 billion a year,3 much of which is passed to consumers through higher health insurance premiums. Additionally, the abuse of prescription opioids is burdening the budgets of substance abuse treatment providers, particularly as prescription opioid abuse might be fueling heroin abuse rates in some areas of the United States."

National Drug Intelligence Center, Drug Enforcement Administration, "National Prescription Drug Threat Assessment," (Washington DC, April 2009), p. IV.
http://www.justice.gov/archive...

80. Unrelieved Pain Continues To Burden Americans
"Pain remains one of the most common physical complaints upon a person’s admission into the healthcare system (Burton, Fanciullo, Beasley, & Fisch, 2007; Foley et al., 2005; Freburger et al., 2009; McCarberg, 2010; Peterlin, Rosso, Rapoport, & Scher, 2009; Schug & Chong, 2009; Weiss, Emanuel, Fairclough, & Emanuel, 2001). Pain is prevalent in cancer, especially near the end of life (Paice, 2010; Smith et al., 2010), and in other diseases and conditions such as HIV/AIDS (Breitbart & Cortes?Ladino, 2010; Tsao, Stein, & Dobalian, 2010) and sickle?cell anemia (American Pain Society, 1999; Ballas, 2010); indeed, persistent pain itself is increasingly being recognized as a disease (Institute of Medicine Committee on Advancing Pain Research, 2011). However, insufficient treatment attention often is given to appropriate pain relief, especially when pain is severe or prolonged. In extreme circumstances, pain can impair all aspects of life and sometimes contribute to a person’s wish for death (Fishman & Rathmell, 2010; Ilgen et al., 2013; Institute of Medicine Committee on Advancing Pain Research, 2011; Institute of Medicine National Cancer Policy Board, 2001; Wasan, Sullivan, & Clark, 2010). When pain relief is achieved, it can result in improved quality of living for people with prolonged pain and can decrease suffering for people at the end of life (Higginson & Evans, 2010)."

Pain & Policy Studies Group. Achieving Balance in Federal and State Pain Policy: A Guide to Evaluation (CY 2013). (University of Wisconsin Carbone Cancer Center: Madison, WI, July 2014), p. 13.
http://www.painpolicy.wisc.edu...
http://www.painpolicy.wisc.edu...

81. Psychosocial Interventions and Chronic Pain Outcomes in Older Adults
"Mean treatment results demonstrated in the present study obscure variations at the individual patient level. Some older patients with chronic pain may receive substantial benefit through psychological therapy, while others may not benefit. There is no evidence that the beneficial results identified at the completion of treatment persisted up to 6 months for outcomes other than pain reduction. There were too few studies reporting long-term outcomes to determine completely whether this finding was due to decreased power or to a tapering of treatment benefits over time.

"The observed benefits were strongest when delivered using group-based approaches. Potential mechanisms that could account for this finding include access to peer support, social facilitation of target behaviors, and public commitment to therapy goals.52 No other results of participant, intervention, or study characteristics were found. Treatment benefits were equally likely to occur in older men and women irrespective of age and duration of chronic pain."

Niknejad B, Bolier R, Henderson CR, et al. Association Between Psychological Interventions and Chronic Pain Outcomes in Older AdultsA Systematic Review and Meta-analysis. JAMA Intern Med. Published online May 07, 2018. doi:10.1001/jamainternmed.2018.0756
https://jamanetwork.com/journa...

82. Reasons for Non-Prescription Use of Prescription Opioids by US High School Seniors
"Approximately 12.3% of the respondents -- high school seniors in the United States -- reported lifetime nonmedical use of prescription opioids and 8.0% reported past-year nonmedical use. Table 1 shows the prevalence of motives for nonmedical use of prescription opioids among high school seniors in the United States. The leading motives included 'to relax or relieve tension' (56.4%), 'to feel good or get high' (53.5%), 'to experiment-see what it's like' (52.4%), 'to relieve physical pain' (44.8%), and 'to have a good time with friends' (29.5%).

Sean Esteban McCabe, Phd, et al., "Motives for Nonmedical Use of Prescription Opioids among High School Seniors in the United States: Self-Treatment and Beyond," Archives of Pediatric and Adolescent Medicine, 2009 August; 163(8): 739-744. doi:10.1001/archpediatrics.2009.120.
http://www.ncbi.nlm.nih.gov/pu...
http://www.ncbi.nlm.nih.gov/pm...

83. Prevalence of Chronic Pain
According to a survey conducted by Roper Starch Worldwide for the American Pain Society in 1999, "Chronic pain as defined by this study is a severe and ever present problem. It can be as much of a problem to middle age adults as seniors and is one women are more likely to face than men. The majority of chronic pain sufferers have been living with their pain for over 5 years. Although the more common type is pain that flares up frequently versus being constant, it is still present on average almost 6 days in a typical week.
"About one third of all chronic sufferers describe their pain as being almost the worst pain one can possibly imagine. Their pain is more likely to be constant than flaring up frequently and two-thirds of them have been living with it for over 5 years."

Roper Starch Worldwide, Inc., "Chronic Pain In America: Roadblocks To Relief," research conducted for the American Pain Society, the American Academy of Pain Medicine and Janssen Pharmaceutica, Jan. 1999.

84. Pain Management - Data - 1999 - 2-20-10
According to a public opinion poll released in 1999, "It is estimated that 9% of the U.S. adult population suffer from moderate to severe non-cancer related chronic pain."

Roper Starch Worldwide, Inc., "Chronic Pain In America: Roadblocks To Relief," research conducted for the American Pain Society, the American Academy of Pain Medicine and Janssen Pharmaceutica, Jan. 1999.

85. Pain Relief and Non-Prescription Use of Prescription Opioids by US High School Seniors
"The lifetime medical use of prescription opioids was reported by approximately 14.0% of those who did not engage in past-year nonmedical use of prescription opioids, 76.1% of nonmedical users of prescription opioids motivated only by pain relief, 71.4% of those motivated by pain relief and other motives, and 46.7% of those who reported non-pain relief motives only (p < 0.001). Among past-year nonmedical users of prescription opioids, approximately 56.5% of those motivated only by pain relief as compared to 23.1% of those who reported pain relief and other motives, and 14.2% of those who reported only non-pain relief motives had initiated medical use of prescription opioids before nonmedical use of prescription opioids. In contrast, approximately 19.6% of those motivated only by pain relief as compared to 48.3% of those who reported pain relief and other motives, and 32.5% of those who reported only non-pain relief motives initiated nonmedical use of prescription opioids before medical use of prescription opioids."

Sean Esteban McCabe, Phd, et al., "Motives for Nonmedical Use of Prescription Opioids among High School Seniors in the United States: Self-Treatment and Beyond," Archives of Pediatric and Adolescent Medicine, 2009 August; 163(8): 739-744. doi:10.1001/archpediatrics.2009.120.
http://www.ncbi.nlm.nih.gov/pu...
http://www.ncbi.nlm.nih.gov/pm...

86. Prescribing Patterns and Opioid Overdose-Related Deaths
"There is some evidence that higher prescribed doses increase the risk of drug overdose among individuals treated with opioids for chronic non-cancer pain.4 Specifically, the risk of drug-related adverse events is higher among individuals prescribed opioids at doses equal to 50 mg/d or more of morphine. The association of opioid prescribing patterns with risk of over-dose may vary across groups of patients; opioid treatment recommendations for pain are typically specific to particular subgroups such as those with chronic noncancer pain,5 cancer-related pain, and substance use disorders.6 However, potential subgroup differences in opioid prescribing have not been examined."

Bohnert, Amy S.B., et al., "Association Between Opioid Prescribing Patterns and Opioid Overdose-Related Deaths," Journal of the American Medical Association, April 6, 2011, Vol 305, No. 13, p. 1315.
http://jama.jamanetwork.com/ar...

87. Estimated Prevalence of Current Nonmedical Use of Psychotherapeutics in the US, 2014
http://www.samhsa.gov/data/sit...
http://www.samhsa.gov/data/sit...

88. Initiation of Nonmedical Use of Prescription Psychotherapeutics in the US, 2013
"• Nonmedical use of psychotherapeutics includes nonmedical use of any prescription-type pain relievers, tranquilizers, stimulants, or sedatives. Over-the-counter substances are not included. In 2013, there were approximately 2.0 million persons aged 12 or older who used psychotherapeutics nonmedically for the first time within the past year, which averages to about 5,500 initiates per day. The number of new nonmedical users of psychotherapeutics in 2013 was lower than the estimates for prior years from 2002 through 2012 (ranging from 2.3 million to 2.8 million).
"• In 2013, the numbers of initiates were 1.5 million for pain relievers, 1.2 million for tranquilizers, 603,000 for stimulants, and 128,000 for sedatives (Figure 5.6).
"• The number of new nonmedical users of pain relievers in 2013 (1.5 million) was lower than the numbers in 2002 through 2012 (ranging from 1.9 million to 2.5 million) (Figure 5.6). The number of past year initiates for nonmedical use of tranquilizers has been fairly stable from 2002 to 2013 (ranging from 1.1 million to 1.4 million). The number of initiates for nonmedical use of stimulants in 2013 was similar to the numbers in 2003, 2005, and in 2007 to 2012 (ranging from 602,000 to 715,000), but was lower than the numbers in 2002, 2004, and 2006 (ranging from 783,000 to 846,000). The number of initiates for nonmedical use of sedatives in 2013 was similar to the numbers in 2002, 2003, 2007 to 2009, 2011, and 2012 (ranging from 159,000 to 209,000), but was lower than the numbers in 2004 to 2006 and in 2010 (ranging from 240,000 to 267,000).
"• In 2013, the average age at first nonmedical use of any psychotherapeutics among recent initiates aged 12 to 49 was 22.4 years. Average ages at first nonmedical use were 21.6 years for stimulants, 21.7 years for pain relievers, 25.0 years for sedatives, and 25.4 years for tranquilizers. All of these 2013 estimates were similar to the corresponding estimates in 2012.
"• In 2013, the number of new nonmedical users of OxyContin® aged 12 or older was 436,000, which was similar to the estimates for prior years from 2004 through 2012. The average age at first use of OxyContin® among past year initiates aged 12 to 49 was similar in 2012 and 2013 (22.0 and 23.6 years, respectively)."

Substance Abuse and Mental Health Services Administration, Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-48, HHS Publication No. (SMA) 14-4863. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014, pp. 64-66.
http://www.samhsa.gov/data/NSD...
http://www.samhsa.gov/data/NSD...

89. Nonmedical Prescription Drug Use by Young Adults Aged 18-25 in the US, 2013
"• Among young adults aged 18 to 25, the rate of current nonmedical use of psychotherapeutic drugs in 2013 (4.8 percent) was similar to the rates in 2011 (5.0 percent) and 2012 (5.3 percent), but it was lower than the rates in 2002 to 2010 (ranging from 5.5 to 6.5 percent) (Figure 2.9). The rate of current nonmedical use of pain relievers among young adults in 2013 (3.3 percent) was lower than the rates in 2012 (3.8 percent) and in 2002 to 2010 (ranging from 4.1 to 5.0 percent), but it was similar to the rate in 2011 (3.6 percent)."

Substance Abuse and Mental Health Services Administration, Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-48, HHS Publication No. (SMA) 14-4863. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014, p. 23.
http://www.samhsa.gov/data/NSD...
http://www.samhsa.gov/data/NSD...

90. Nonmedical Use of Psychotherapeutic Drugs by Type, 2004
"In 2004, 6.0 million persons were current users of psychotherapeutic drugs taken nonmedically (2.5 percent). These include 4.4 million who used pain relievers, 1.6 million who used tranquilizers, 1.2 million who used stimulants, and 0.3 million who used sedatives. These estimates are all similar to the corresponding estimates for 2003.
"There were significant increases in the lifetime prevalence of use from 2003 to 2004 in several categories of pain relievers among those aged 18 to 25. Specific pain relievers with statistically significant increases in lifetime use were Vicodin®, Lortab®, or Lorcet® (from 15.0 to 16.5 percent); Percocet®, Percodan®, or Tylox® (from 7.8 to 8.7 percent); hydrocodone products (from 16.3 to 17.4 percent); OxyContin® (from 3.6 to 4.3 percent); and oxycodone products (from 8.9 to 10.1 percent)."

Substance Abuse and Mental Health Services Administration, Results from the 2004 National Survey on Drug Use and Health: National Findings (Rockville, MD: US Dept. of Health and Human Services, Office of Applied Studies, 2005), p. 1.
http://www.oas.samhsa.gov/nsdu...

91. OxyContin Availability
"The large amount of OxyContin available in the marketplace may have increased opportunities for abuse and diversion. Both DEA and Purdue have stated that an increase in a drug's availability in the marketplace may be a factor that attracts interest by those who abuse and divert drugs."

General Accounting Office, "Prescription Drugs: Oxycontin Abuse and Diversion and Efforts to Address the Problem," GAO-04-110 (Washington, DC: Government Printing Office, December 2003), p. 30.
http://www.gao.gov/new.items/d...

92. Oxycontin
"There are several factors that may have contributed to the abuse and diversion of OxyContin. OxyContin's formulation as a controlled- release opioid that is twice as potent as morphine may have made it an attractive target for abuse and diversion. In addition, the original label’s safety warning advising patients not to crush the tablets because of the possible rapid release of a potentially toxic amount of oxycodone may have inadvertently alerted abusers to possible methods for misuse. Further, the rapid growth in OxyContin sales increased the drug's availability in the marketplace and may have contributed to opportunities to obtain the drug illicitly. The history of abuse and diversion of prescription drugs in some geographic areas, such as those within the Appalachian region, may have predisposed some states to problems with OxyContin. However, we could not assess the relationship between the growth in OxyContin prescriptions or increased availability with the drug's abuse and diversion because the data on abuse and diversion are not reliable, comprehensive, or timely."

General Accounting Office, "Prescription Drugs: Oxycontin Abuse and Diversion and Efforts to Address the Problem," GAO-04-110 (Washington, DC: Government Printing Office, December 2003), p. 29.
http://www.gao.gov/new.items/d...

93. Estimated Prevalence of Non-Medical Use of Pain Relievers in the US, 2014
"Overall estimates of current nonmedical use of prescription psychotherapeutic drugs among the population aged 12 or older that were described previously have largely been driven by the nonmedical use of prescription pain relievers. In 2014, about two thirds of the current nonmedical users of psychotherapeutic drugs who were aged 12 or older reported current nonmedical use of pain relievers (Figure 5).
"The estimated 4.3 million people aged 12 or older in 2014 who were current nonmedical users of pain relievers represent 1.6 percent of the population aged 12 or older (Figures 5 and 6). The percentage of people aged 12 or older who were current nonmedical users of pain relievers in 2014 was lower than the percentages in most years from 2002 to 2012, but it was similar to the percentage in 2013."

Center for Behavioral Health Statistics and Quality. (2015). Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health (HHS Publication No. SMA 15-4927, NSDUH Series H-50), p. 7.
http://www.samhsa.gov/data/sit...
http://www.samhsa.gov/data/sit...

94. Source of Pain Relievers Used Non-Medically
"Among persons aged 12 or older in 2010-2011 who used pain relievers nonmedically in the past year, 54.2 percent got the pain relievers they most recently used from a friend or relative for free (Figure 2.14). Another 12.2 percent bought them from a friend of relative (which was higher than the 9.9 percent in 2008-2009). In addition, 4.4 percent of these nonmedical users in 2010-2011 took pain relievers from a friend or relative without asking. More than one in six (18.1 percent) indicated that they got the drugs they most recently used through a prescription from one doctor. Less than 1 in 20 users (3.9 percent) got pain relievers from a drug dealer or other stranger, 1.9 percent got pain relievers from more than one doctor, and 0.3 percent bought them on the Internet. These other percentages were similar to those reported in 2008-2009."

Substance Abuse and Mental Health Services Administration, Results from the 2011 National
Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-44, HHS Publication No. (SMA) 12-4713. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012, p. 28.
http://www.samhsa.gov/data/NSD...

95. Source For Pain Relievers Used Non-Medically Which Were Obtained From A Friend Or Relative For Free
"Among persons aged 12 or older in 2010-2011 who used pain relievers nonmedically in the past year and indicated that they most recently obtained the drugs from a friend or relative for free in the past year, 81.6 percent of the friends or relatives obtained the drugs from just one doctor (Figure 2.14). About 1 in 20 of these past year nonmedical users of pain relievers (5.5 percent) reported that the friend or relative got the pain relievers from another friend or relative for free, 3.9 percent reported that the friend or relative bought the drugs from a friend or relative, 1.9 percent reported that the friend or relative bought the drugs from a drug dealer or other stranger, and 1.8 percent reported that the friend or relative took the drugs from another friend or relative without asking."

Substance Abuse and Mental Health Services Administration, Results from the 2011 National
Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-44, HHS Publication No. (SMA) 12-4713. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012, p. 28.
http://www.samhsa.gov/data/NSD...

96. Pain Treatment and Opioid Abuse
"Conventional wisdom suggests that the abuse potential of opioid analgesics is such that increases in medical use of these drugs will lead inevitably to increases in their abuse. The data from this study with respect to the opioids in the class of morphine provide no support for this hypothesis. The present trend of increasing medical use of opioid analgesics to treat pain does not appear to be contributing to increases in the health consequences of opioid analgesic abuse."

Joranson, David E., MSSW, Karen M. Ryan, MA, Aaron M. Gilson, PhD, June L. Dahl, PhD, "Trends in Medical Use and Abuse of Opioid Analgesics," Journal of the American Medical Association, Vol. 283, No. 13, April 5, 2000, p. 1713.
http://jama.jamanetwork.com/ar...

97. Prescription Opioid Overdose
http://www.cdc.gov/mmwr/pdf/wk...

98. Prescribing Patterns and Opioid Overdose-Related Deaths
"There is some evidence that higher prescribed doses increase the risk of drug overdose among individuals treated with opioids for chronic non-cancer pain.4 Specifically, the risk of drug-related adverse events is higher among individuals prescribed opioids at doses equal to 50 mg/d or more of morphine. The association of opioid prescribing patterns with risk of over-dose may vary across groups of patients; opioid treatment recommendations for pain are typically specific to particular subgroups such as those with chronic noncancer pain,5 cancer-related pain, and substance use disorders.6 However, potential subgroup differences in opioid prescribing have not been examined."

Bohnert, Amy S.B., et al., "Association Between Opioid Prescribing Patterns and Opioid Overdose-Related Deaths," Journal of the American Medical Association, April 6, 2011, Vol 305, No. 13, p. 1315.
http://jama.jamanetwork.com/ar...

99. Factors Influencing Methadone-Related Mortality
http://atforum.com/documents/C...

100. Insurance Fraud and Diversion
"Insurance fraud is the main financier and enabler of drug diversion. Even so, few health insurers understand the pivotal role insurance fraud plays in a diversion epidemic that costs insurers up to $72.5 billion a year.
"More specifically:
"• Swindlers and drug abusers obtain the bulk of their illicit prescription narcotics through fraudulent insurance claims for bogus prescriptions, treating phantom injuries and other illegal deceptions;
"• Drug diversion drains health insurers of up to $72.5 billion a year, including up to $24.9 billion annually for private insurers. The losses include insurance schemes, plus the larger hidden costs of treating patients who develop serious medical problems from abusing the addictive narcotics they obtained through the swindles;
"• Insurers are potentially vulnerable to enormous liability lawsuits for failing to reasonably prevent fraud schemes that kill and injure people addicted by diversion schemes. Drug manufacturers and pharmacists already face such lawsuits."

The Mahon Consulting Group LLC for the Coalition Against Insurance Fraud, "Prescription for Peril: How Insurance Fraud Finances Theft and Abuse of Addictive Prescription Drugs," (Washington, DC: December, 2007), p. 4.
http://www.insurancefraud.org/...

101. Cost of Controlled Prescription Drug (CPD) Diversion
"Moreover, the estimated cost of CPD diversion and abuse to public and private medical insurers is $72.5 billion a year,3 much of which is passed to consumers through higher health insurance premiums. Additionally, the abuse of prescription opioids is burdening the budgets of substance abuse treatment providers, particularly as prescription opioid abuse might be fueling heroin abuse rates in some areas of the United States."

National Drug Intelligence Center, Drug Enforcement Administration, "National Prescription Drug Threat Assessment," (Washington DC, April 2009), p. V.
http://www.justice.gov/archive...

102. Theft of Pharmaceuticals
The Journal of Pain and Symptom Management published a research letter by scientists from the Pain & Policy Studies Group at the University of Wisconsin-Madison on drug crime as a source of diverted pharmaceuticals. The researchers examined data maintained by the US Drug Enforcement Administration on thefts and other incidents of loss of controlled substances by DEA registrants including pharmacists, manufacturers, and distributors. The data was complete for the years 2000-2003 for 22 Eastern states representing 53% of the US population. According to the researchers:
"A total of 12,894 theft/loss incidents were reported in these states between 2000 and 2003. Theft/losses were primarily from pharmacies (89.3%), with smaller portions from medical practitioners, manufacturers, distributors, and some addiction treatment programs that reported theft/losses of methadone.
"Over the 4-year period, almost 28 million dosage units of all controlled substances were diverted. The total number of dosage units for the six opioids is as follows: 4,434,731 for oxycodone; 1,026,184 for morphine; 454,503 for methadone; 325,921 for hydromorphone; 132,950 for meperidine; 81,371 for fentanyl."

Joranson, David E. MSSW & Aaron M. Gilson, PhD, Pain & Policy Studies Group, University of Wisconsin-Madison, "Drug Crime is a Source of Abuse Pain Medication in the United States," Letters, Journal of Pain & Symptom Management, Vol. 30, No. 4, Oct. 2005, p. 299.
http://www.painpolicy.wisc.edu...

103. Prescriptions for OxyContin and Other Opioids
"According to IMS Health data, the annual number of OxyContin prescriptions for noncancer pain increased nearly tenfold, from about 670,000 in 1997 to about 6.2 million in 2002. In contrast, during the same 6 years, the annual number of OxyContin prescriptions for cancer pain increased about fourfold, from about 250,000 in 1997 to just over 1 million in 2002. The noncancer prescriptions therefore increased from about 73 percent of total OxyContin prescriptions to about 85 percent during that period, while the cancer prescriptions decreased from about 27 percent of the total to about 15 percent. IMS Health data indicated that prescriptions for other schedule II opioid drugs, such as Duragesic and morphine products, for noncancer pain also increased during this period. Duragesic prescriptions for noncancer pain were about 46 percent of its total prescriptions in 1997, and increased to about 72 percent of its total in 2002. Morphine products, including, for example, Purdue's MSContin, also experienced an increase in their noncancer prescriptions during the same period. Their noncancer prescriptions were about 42 percent of total prescriptions in 1997, and increased to about 65 percent in 2002."

General Accounting Office, "Prescription Drugs: Oxycontin Abuse and Diversion and Efforts to Address the Problem," GAO-04-110 (Washington, DC: Government Printing Office, December 2003), p. 18.
http://www.gao.gov/new.items/d...

104. Deaths Related to Opioid Analgesic Use
"By 2002, opioid analgesics were involved in more deaths than either of the illicit drugs responsible for most urban drug abuse in the 1990s: heroin and cocaine. These trends are generally consistent with trends in drug-related emergency department visits reported by DAWN from 1997 to 2002: a 101.4% increase in opioid analgesics, a 23.7% increase in cocaine, and a 32.2% increase in heroin.
"The increased involvement of these analgesics is related to exponential growth in their domestic sales over the past decade as physicians began to treat chronic pain with stronger analgesics.10 Oxycodone sales in grams increased 402.9% from 1997 to 2002; methadone (excluding that used in narcotics treatment programs) increased 410.8%; and fentanyl increased 226.7%.11 OxyContin, introduced in 1996, accounted for 68% of oxycodone sales by 2002."

Paulozzi, Leonard J., "Opioid Analgesic Involvement in Drug Abuse Deaths in American Metropolitan Areas," American Journal of Public Health (Vol 96, No. 10), October 2006, p. 1756.
http://www.ncbi.nlm.nih.gov/pm...

105. OxyContin Investigations, Arrests, and Seizures, 1996-2002
"From fiscal year 1996 through fiscal year 2002, DEA initiated 313 investigations involving OxyContin, resulting in 401 arrests. Most of the investigations and arrests occurred after the initiation of the action plan. Since the plan was enacted, DEA initiated 257 investigations and made 302 arrests in fiscal years 2001 and 2002. Among those arrested were several physicians and pharmacists. Fifteen health care professionals either voluntarily surrendered their controlled substance registrations or were immediately suspended from registration by DEA. In addition, DEA reported that $1,077,500 in fines was assessed and $742,678 in cash was seized by law enforcement agencies in OxyContin-related cases in 2001 and 2002."

General Accounting Office, "Prescription Drugs: Oxycontin Abuse and Diversion and Efforts to Address the Problem," GAO-04-110 (Washington, DC: Government Printing Office, December 2003), p. 37.
http://www.gao.gov/new.items/d...

106. Illicit Sales of OxyContin, 2001
"According to a 2001 HIDTA [High Intensity Drug Trafficking Area] report, the Appalachian region, which encompasses parts of Kentucky, Tennessee, Virginia, and West Virginia, has been severely affected by prescription drug abuse, particularly pain relievers, including oxycodone, for many years. Three of the four states -- Kentucky, Virginia, and West Virginia -- were among the initial states to report OxyContin abuse and diversion. Historically, oxycodone, manufactured under brand names such as Percocet, Percodan, and Tylox, was among the most diverted prescription drugs in Appalachia. According to the report, OxyContin has become the drug of choice of abusers in several areas within the region. The report indicates that many areas of the Appalachian region are rural and poverty-stricken, and the profit potential resulting from the illicit sale of OxyContin may have contributed to its diversion and abuse. In some parts of Kentucky, a 20-milligram OxyContin tablet, which can be purchased by legitimate patients for about $2, can be sold illicitly for as much as $25. The potential to supplement their incomes can lure legitimate patients into selling some of their OxyContin to street dealers, according to the HIDTA report."

General Accounting Office, "Prescription Drugs: Oxycontin Abuse and Diversion and Efforts to Address the Problem," GAO-04-110 (Washington, DC: Government Printing Office, December 2003), pp. 31-32.
http://www.gao.gov/new.items/d...

107. Price of Naloxone Has Skyrocketed Since 2006
"We contribute nationally representative evidence to help answer each of these questions, including wholesale pricing data from a proprietary drug sales database spanning January 2006 to February 2017. We find that all formulations of naloxone increased in price since 2006 except for Narcan Nasal Spray. These cumulative increases totaled 2281% for the 0.4 MG single-dose products, 244% for the 2 MG single-dose products, 3797% for the 4 MG multi-dose products, and 469% for the 0.4 MG Evzio auto-injector. We believe that increased demand for naloxone from the opioid epidemic may explain the more gradual price increases for the 0.4 MG single-dose and 4 MG multi-dose products prior to 2012. On the other hand, we believe that the sudden, sustained prices increases occurring for all of the products since 2012 may be the result of a drug shortage for the 0.4 MG single-dose products and the fact that each naloxone product has historically been sold by only a single competitor."

Matthew Rosenberg, Grace Chai, Shekhar Mehta, Andreas Schick, Trends and economic drivers for United States naloxone pricing, January 2006 to February 2017, Addictive Behaviors, 2018, ISSN 0306-4603, https://doi.org/10.1016/j.addb....
http://www.sciencedirect.com/s...

108. Growth in Overdose Deaths and Treatment Admissions, 2001-2006
"According to the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics, unintentional overdose deaths involving prescription opioids increased 114 percent from 2001 (3,994) to 2005 (8,541), the most recent nationwide data available. Further, the number of treatment admissions for prescription opioids as the primary drug of abuse increased 74 percent from 46,115 in 2002 to 80,131 in 2006, the most recent data available, according to the SAMHSA Treatment Episode Data Set (TEDS)."

National Drug Intelligence Center, Drug Enforcement Administration, "National Prescription Drug Threat Assessment," (Washington DC, April 2009), p. III.
http://www.justice.gov/archive...

109. Oxycodone Production Quotas
"Until 2011, the DEA had increased the quota for oxycodone every year since 2002101 with the exception of 2008, when the quota remained unchanged from 2007.102 In 2010, the quota for oxycodone available for sale was 105,500,000 grams.103 In 2002, the quota for oxycodone available for sale was 34,482,000 grams, which means that over that eight-year period, the DEA permitted a 206% increase in the oxycodone quota.104 The DEA decreased the quota to 98,000,000 grams in 2011.105 OxyContin is available in seven dosage strengths, ranging from ten milligram to eighty milligram tablets.106 Although oxycodone is used in other medications, if one assumes, for illustrative purposes, that OxyContin was the only medication manufactured from oxycodone, the 2010 quota would permit the production of between 15,050,000,000 (for ten milligram tablets) and 1,881,250,000 (for eighty milligram tablets) tablets of OxyContin. Although the DEA has the power to limit OxyContin production through its quota authority, the DEA has dramatically increased the availability of oxycodone over the last eight years. While this may be warranted for legitimate users, the increase remains in stark contrast to the limited availability of addiction-assistance medications.107 Additionally, while the rate of marijuana dependence or abuse has remained steady over the last eight years, the number of people suffering from pain reliever dependence or abuse has increased from 1.5 million to 1.9 million over the same period of time.108"

Ferrara, Melissa M., "The Disparate Treatment of Medications and Opiate Pain Medications Under the Law: Permitting the Proliferation of Opiates and Limiting Access to Treatment," Seton Hall Law Review (South Orange, NJ: Seton Hall University, May 24, 2012) Volume 42, Issue 2, pp. 751-752.
http://scholarship.shu.edu/cgi...

110. Diversion and Fraud
"According to law enforcement reporting, some individuals and criminal groups divert CPDs [controlled prescription drugs] through doctor-shopping and use insurance fraud to fund their schemes. In fact, Aetna, Inc. reports that nearly half of its 1,065 member fraud cases in 2006 (the latest year for which data are available) involved prescription benefits, and most were related to doctor-shopping, according to the Coalition Against Insurance Fraud (CAIF). CAIF further reports that diversion of CPDs collectively costs insurance companies up to $72.5 billion annually, nearly two-thirds of which is paid by public insurers. Individual insurance plans lose an estimated $9 million to $850 million annually, depending on each plan’s size; much of that cost is passed on to consumers through higher annual premiums."

National Drug Intelligence Center, Drug Enforcement Administration, "National Prescription Drug Threat Assessment," (Washington DC, April 2009), p. 20.
http://www.justice.gov/archive...

111. Pharmaceutical Drug Distribution in the US
"Drugs in the United States generally do not travel straight from the line of production to the dispensing pharmacy. Rather, a serpentine maze provides a ripe environment for the infiltration of counterfeit, adulterated, and diverted drugs.15

"The distribution system is primarily tiered among manufacturers, the “Big 3” distributors/drug wholesalers, secondary wholesalers,16 and repackagers. The FDA has identified three primary routes for drug sales in the United States, and each involves drugs passing through multiple hands, demonstrating the vulnerability of the distribution system to counterfeit, adulterated, and diverted products.17 The “Big 3” wholesalers—Cardinal Health,18 McKesson19 and Amerisource Bergen,20 which collectively account for nearly 90% of the primary wholesale arket21—sell drugs into a distribution web containing large governmental agencies, secondary wholesalers, and criminal actors.22 “Repackagers” of drugs further obscure the origin of a particular drug when they break wholesale drugs in bulk containers into smaller units for sale to pharmacies or, conversely, re-aggregate smaller units purchased as overstock from pharmacies into larger bundles for resale to wholesalers.23 Because of the multiple distributors and the repackaging, the true origin of drugs in this net remains obscure.24"

Aleong, Stephanie Feldman, "Green Medicine: Using Lessons From Tort Law and Environmental Law to Hold Pharmaceutical Manufacturers and Authorized Distributors Liable for Injuries Caused by Counterfeit Drugs," University of Pittsburgh Law Review (Pittsburgh, PA: Winter 2007) Volume 69, Issue 2, p. 248-250.
http://lawreview.law.pitt.edu/...
http://lawreview.law.pitt.edu/...

112. Wholesale Price of Heroin in the US and Around the World
According to the United Nations Office on Drugs and Crime:

In the United States in 2015 (the most recent year for which data are available), the wholesale price of black tar heroin ranged from $12,000 to $100,000 per kilogram; the wholesale price of South American heroin ranged from $10,000 to $100,000 per kilogram and the price of southwest Asian heroin ranged from $50,000 to $85,000 per kilogram.

In Mexico in 2015 (the most recent year for which data are available), the wholesale price of heroin was $35,000 per kilogram.

In Colombia in 2015 (the most recent year for which data are available), the wholesale price of raw opium was $694.50 per kilogram; the wholesale price of illicit morphine was $3,746.10 per kilogram; and the wholesale price of heroin was $5,523.90 per kilogram.

In Hong Kong in 2015 (the most recent year for which data are available), the wholesale price of heroin ranged from $47,603.70 to $51,152.10 per kilogram.

In Thailand in 2015 (the most recent year for which data are available), the wholesale price of opium ranged from $519.70 to $779.50 per kilogram; the wholesale price of heroin ranged from $9,146.30 to $12,472.30 for 700 grams.

In Afghanistan in 2015 (the most recent year for which data are available), the wholesale price of raw opium was $150 per kilogram; the wholesale price of heroin was $2,229.50 per kilogram; and the wholesale price of high purity heroin was $3,294.50 per kilogram.

In Pakistan in 2015 (the most recent year for which data are available), the wholesale price of raw opium ranged from $322 to $439 per kilogram; the wholesale price of illicit morphine ranged from $600.90 to $1089 per kilogram; and the wholesale price of heroin ranged from $2,469.50 to $3,468.10 per kilogram.

Drug Prices Report: Opioids. Region: Americas. Retail and wholesale prices and purity levels, by drug, region and country or territory. United Nations Office on Drugs and Crime. Data retrieved via UNODC Statistics at https://stats.unodc.org on June 1, 2018.
http://drugwarfacts.org/sites/...

113. Retail Price of Heroin in the US, Canada and the UK
According to the United Nations Office on Drugs and Crime:

In the United States in 2015 (the most recent year for which data are available), the retail price of black tar heroin ranged from $20 to $300 per gram; the retail price of South American heroin ranged from $25 to $400 per gram; and the retail price of southwest Asian heroin ranged from $120 to $300 per gram.

In Canada in 2014 (the most recent year for which data are available), the retail price of opium ranged from $43 to $55.90 per gram; and the retail price of heroin ranged from $154.80 to $300.90 per gram.

In the UK in 2015 (the most recent year for which data are available), the retail price of heroin number 2 (heroin base) ranged from $59.30 to $88.9 per gram.

Drug Prices Report: Opioids. Region: Americas. Retail and wholesale prices and purity levels, by drug, region and country or territory. United Nations Office on Drugs and Crime. Data retrieved via UNODC Statistics at https://stats.unodc.org on June 1, 2018.
http://drugwarfacts.org/sites/...

114. Wholesale Price of Heroin in 2010
In 2010, a kilogram of heroin typically sold for an average wholesale price of $2,527.60 in Pakistan. The 2010 wholesale price for a kilogram of heroin in Afghanistan ranged around $2,266. In Colombia, a kilogram of heroin typically sold for $10,772.3 wholesale in 2010. In the United States in 2010, a kilogram of heroin ranged in price between $33,000-$100,000.

UN Office on Drugs and Crime, World Drug Report 2012 (United Nations publication, Sales No. E.12.XI.1), Opioids: Retail and wholesale prices by drug type and country (2010 or latest available year)
http://www.unodc.org/unodc/en/...
http://www.unodc.org/documents...

115. Health Care Reform and Development of Pain Management Policies
Laws & Policieshttp://www.nap.edu/openbook.ph...

116. Progress In Achieving Balance In Pain Management Policy In The US
"Alabama and Idaho now join Georgia, Iowa, Kansas, Maine, Massachusetts, Michigan, Montana, Oregon, Rhode Island, Vermont, Virginia, Washington, and Wisconsin as having the most balanced policies in the country related to pain management, including with the appropriate use of pain medications for legitimate medical purposes. Over time, these 15 states took advantage of available policy templates and resources, and repealed all excessively restrictive and ambiguous policy. This achievement does not mean that their work is finished, because policy needs to be properly implemented (see next section). Importantly, there is no ceiling on policy quality, so states with high grades should continue to explore how additional policy can help to improve access to pain management while avoiding the adoption of restrictive requirements or limitations. In fact, 25 states that achieved an A for positive language in the past have continued to adopt policy language promoting appropriate pain management during this evaluation timeframe.h"

Pain & Policy Studies Group, "Achieving Balance in State Pain Policy: A Progress Report Card (CY 2013)" (Madison, WI: University of Wisconsin Carbone Cancer Center, July 2014), p. 23.
http://www.painpolicy.wisc.edu...
http://www.painpolicy.wisc.edu...

117. Pain Contracts
"Another control strategy that has gained traction is opioid 'contracts' or 'treatment agreements' between health care providers and patients, under which medication use by highrisk patients is closely monitored. In a study of a primary are clinic’s use of such contracts, three-fifths of patients adhered to the agreement (with a median follow-up of 23 months) (Hariharan et al., 2006). However, many pain experts have concluded that pain agreements/contracts do not necessarily improve the treatment of pain or minimize diversion and abuse of prescription drugs, particularly when used indiscriminately. A systematic review of the literature found only weak evidence to support either pain contracts or urine tests as a strategy for reducing opioid abuse (Starrels et al., 2010)."

Institute of Medicine, "Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research" (Washington, DC: National Academy of Sciences, 2011), p. 147.
http://www.nap.edu/openbook.ph...

118. Strategies to Reduce Risk of Abuse
"Current voluntary strategies to reduce opioid abuse include
"• the clinician’s assessment in a history and physical exam that includes psychosocial factors, family history, and risk of abuse;
"• the clinician’s regular monitoring of the progress of patients on opioids and assessment for aberrant behavior that may indicate abuse;
"• random urine drug screening and pill counts for patients at risk;
"• state prescription drug monitoring programs (the U.S. Justice Department and other agencies have cooperated in forming an interstate information exchange for such programs);
"• new drug formulations intended to prevent abuse by (1) hindering the extraction of active ingredients through physical barrier mechanisms, (2) releasing agents that neutralize the opioid effects when products are tampered with, and (3) introducing substances that cause unpleasant side effects when drugs are consumed to excess (Fishbain et al., 2010); and
"• removing unused drugs from home medicine cabinets and disposing of them at 'drug take-back' events (see Box 2-4 in Chapter 2) (Office of National Drug Control Policy, 2010)."

Institute of Medicine, "Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research" (Washington, DC: National Academy of Sciences, 2011), p. 146.
http://www.nap.edu/openbook.ph...

119. Development of Pain Management Model Policy
"In the wake of criticism of state medical boards’ actions against physicians who prescribed large amounts of opioids, the Federation of State Medical Boards developed a model policy in 1998—since adopted by many individual state boards—that supports use of opioids for pain management if appropriately documented by the treating physician (Federation of State Medical Boards of the United States, 2004). State medical boards generally are believed to be the best locus for sanctioning physicians for their opioid prescribing patterns, as opposed to criminal prosecution (Reidenberg and Willis, 2007). However, sanctions and prosecutions are rare: between 1998 and 2006, only 0.1 percent of practicing physicians were charged by prosecutors, medical licensing boards, or other administrative agencies with opioid-related prescribing offenses, providing 'little objective basis for concern that pain specialists have been ‘singled out’ for prosecution or administrative sanctioning' (Goldenbaum et al., 2008, p. 2)."

Institute of Medicine, "Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research" (Washington, DC: National Academy of Sciences, 2011), p. 144.
http://www.nap.edu/openbook.ph...
The Federation of State Medical Board's Model Policy on the Use of Controlled Substances for the Treatment of Pain (2004) is available at http://www.painpolicy.wisc.edu...

120. AMA on Controlled Substances and Pain
"The AMA [American Medical Association] supports the position that:
"1. physicians who appropriately prescribe and/or administer controlled substances to relieve intractable pain should not be subject to the burdens of excessive regulatory scrutiny, inappropriate disciplinary action, or criminal prosecution. It is the policy of the AMA that state medical societies and boards of medicine develop or adopt mutually acceptable guidelines protecting physicians who appropriately prescribe and/or administer controlled substances to relieve intractable pain before seeking the implementation of legislation to provide that protection;
"2. education of medical students and physicians to recognize addictive disorders in patients, minimize diversion of opioid preparations, and appropriately treat or refer patients with such disorders; and
"3. the prevention and treatment of pain disorders through aggressive and appropriate means, including the continued education of physicians in the use of opioid preparations."

American Medical Association, "About the AMA Position on Pain Management Using Opioid Analgesics," 2004.
Note: This report no longer available on the AMA's website, however its content is discussed in "California law eases threat to pain medication prescribers," American Medical News, Sept. 13, 2004.
http://www.amednews.com/articl...

121. American Medical Association on the Undertreatment of Pain, 2004
"Unbalanced and misleading media coverage on the abuse of opioid analgesics not only perpetuates misconceptions about pain management; it also compromises the access to adequate pain relief sought by over 75 million Americans living with pain.
"In the past several years, there has been growing recognition on the part of health care providers, government regulators, and the public that the undertreatment of pain is a major societal problem.
"Pain of all types is undertreated in our society. The pediatric and geriatric populations are especially at risk for undertreatment. Physicians' fears of using opioid therapy, and the fears of other health professionals, contribute to the barriers to effective pain management."

American Medical Association, "About the AMA Position on Pain Management Using Opioid Analgesics," 2004.
Note: This report no longer available on the AMA's website, however its content is discussed in "California law eases threat to pain medication prescribers," American Medical News, Sept. 13, 2004.
http://www.amednews.com/articl...

122. Legal Opium Producers
"Almost half14 of global opium is legally produced for processing into various opiate based medicines. Any country can formally apply to the UN’s Commission on Narcotic Drugs to cultivate, produce and trade in licit opium, under the auspices of the UN Single Convention on Narcotics Drugs 1961 and under the supervision and guidance of the International Narcotic Control Board (INCB). As of 2001 there were eighteen countries that do, including Australia, Turkey, India, China and the UK."

Transform Drug Policy Foundation, "After the War on Drugs: Blueprint for Regulation," (Bristol, United Kingdom: September 2009), p. 32.
http://www.tdpf.org.uk/resourc...

123. International Law and the "Central Principle of Balance"
"In 1998, WHO [World Health Organization], in cooperation with its collaborating center at the University of Wisconsin, elaborated the concept of the 'Central Principle of Balance' in order to guide the development of national drug regulatory policies pursuant to the Single Convention.64 According to WHO, 'The Central Principle of Balance' represents the dual imperative of preventing the abuse, trafficking, and diversion of narcotic drugs while, at the same time, ensuring medical availability. As stated by WHO, 'When misused, opioids pose a threat to society; a system of control is necessary to prevent abuse, trafficking, and diversion, but the system of control is not intended to diminish the medical usefulness of opioids, nor interfere in their legitimate medical uses and patient care.'65
"The concept of the Central Principle of Balance should not be limited to national regulatory policies, but should also guide the development and implementation of international drug control policies."

Taylor, Allyn L. "Addressing the Global Tragedy of Needless Pain: Rethinking the United Nations Single Convention on Narcotic Drugs," Journal of Law, Medicine & Ethics (Washington, DC: Georgetown University Law Center, January 2008) Vol. 35, No. 556, p. 564.
http://papers.ssrn.com/sol3/De...

124. PDMP Definition
"Prescription drug monitoring programs are designed to facilitate the collection, analysis, and reporting of information on the prescribing, dispensing, and use of controlled substances within a state. They provide data and analysis to state law enforcement and regulatory agencies to assist in identifying and investigating activities potentially related to the illegal prescribing, dispensing, and procuring of controlled substances."

General Accounting Office, "Prescription Drugs: OxyContin Abuse and Diversion and Efforts to Address the Problem," GAO-04-110 (Washington, DC: Government Printing Office, Dec. 2003), p. 15.
http://www.gao.gov/new.items/d...

125. State Prescription Drug Monitoring Programs
https://obamawhitehouse.archiv...
https://obamawhitehouse.archiv...

126. PDMPs and Limits on Access to Pain Medication
"In this survey of a random sample of Kentucky Medicaid beneficiaries, nearly 90% of respondents report they are unaffected by the KASPER [Kentucky All Schedule Prescription Electronic Reporting] program. Of the small group affected, Hispanic respondents are more likely to report discussing KASPER with a health care provider. Respondents with non-cancer chronic pain conditions are also more apt to report discussing KASPER with a health care provider as well as difficulty obtaining controlled substance prescriptions due to KASPER when confounding factors are controlled for in multivariate analyses. Respondents living in rural counties report less difficulty obtaining and filling controlled substance prescriptions due to KASPER. This result is not surprising, given that data reported by the KASPER program consistently shows higher usage of controlled substances (per 1,000 patients) in Kentucky’s rural counties compared with urban counties (16)."

Amie Goodin, MPP, Karen Blumenschein, PharmD, Patricia Rippetoe Freeman, PhD, and Jeffrey Talbert, PhD, "Consumer/Patient Encounters with Prescription Drug Monitoring Programs: Evidence from a Medicaid Population," Pain Physician 2012; 15:ES169-ES175.
https://www.ncbi.nlm.nih.gov/p...
http://www.painphysicianjourna...

127. Effect of Implementation of PDMP
"Our analysis showed that the implementation of a province-wide centralized prescription network was associated with large, immediate and sustained reductions in filled prescriptions for opioid analgesics and benzodiazepines deemed inappropriate by our definition. These findings provide empirical evidence that centralized prescription networks can reduce inappropriate prescribing and dispensing of prescriptions by offering health care professionals real-time access to prescription data. Physicians did not have access to PharmaNet when it was first introduced; consequently, the reductions observed in our study likely reflect the availability of real-time prescription information to front-line pharmacists."

Dormuth, Colin R., et al., "Effect of a centralized prescription network on inappropriate prescriptions for opioid analgesics and benzodiazepines," Canadian Medical Association Journal, November 6, 2012, vol. 184, no. 16, DOI:10.1503/cmaj.120465, p. 854.
http://www.cmaj.ca/content/184...

128. PDMPs and Reduction of Diversion
"States with PDMPs have realized benefits in their efforts to reduce drug diversion. These include improving the timeliness of law enforcement and regulatory investigations. For example, Kentucky's state drug control investigators took an average of 156 days to complete the investigation of an alleged doctor shopper prior to the implementation of the state's PDMP. The average investigation time dropped to 16 days after the program was established. In addition, law enforcement officials in Kentucky and other states view the programs as a deterrent to doctor shopping, because potential diverters are aware that any physician from whom they seek a prescription may first examine their prescription drug utilization history based on PDMP data."

General Accounting Office, "Prescription Drugs: State Monitoring Programs Provide Useful Tool to Reduce Diversion" (Washington, DC: Government Printing Office, May 2002), GAO-PO-634, p. 3.
http://www.gao.gov/new.items/d...

129. Effectiveness of PDMPs
"States with PDMPs [prescription drug monitoring programs] have experienced considerable reductions in the time and effort required by law enforcement and regulatory investigators to explore leads and the merits of possible drug diversion cases. The presence of a PDMP helps a state reduce its illegal drug diversion, but diversion activities may increase in contiguous states without PDMPs."

General Accounting Office, "Prescription Drugs: State Monitoring Programs Provide Useful Tool to Reduce Diversion" (Washington, DC: Government Printing Office, May 2002), GAO-PO-634, p. 15.
http://www.gao.gov/new.items/d...

130. Impact of PDMPs on Drugs Being Prescribed
"The presence of a PDMP [prescription drug monitoring program] may also have an impact on the use of drugs more likely to be diverted. For example, DEA rank-ordered all states for 2000 by the number of OxyContin prescriptions per 100,000 people. Eight of the 10 states with the highest number of prescriptions-West Virginia, Alaska, Delaware, New Hampshire, Florida, Pennsylvania, Maine, and Connecticut-had no PDMPs, and only 2 did-Kentucky and Rhode Island. Six of the 10 states with the lowest number of prescriptions-Michigan, New Mexico,14 Texas, New York, Illinois, and California-had PDMPs, and 4-Kansas, Minnesota, Iowa, and South Dakota-did not."

General Accounting Office, "Prescription Drugs: State Monitoring Programs Provide Useful Tool to Reduce Diversion" (Washington, DC: Government Printing Office, May 2002), GAO-PO-634, p. 16.
http://www.gao.gov/new.items/d...

131. Physician Concerns Over PDMPs
"Physicians are concerned that their prescribing decisions and patterns may be questioned and that they could be investigated without sufficient cause. Some physicians contend that patients may suffer because physicians will be reluctant to prescribe appropriate controlled substances to manage a patient's pain or treat their condition. Patients are concerned that their personal information may be used inappropriately by those with authorized access or shared with unauthorized entities. Pharmacists have also expressed concerns."

General Accounting Office, "Prescription Drugs: State Monitoring Programs Provide Useful Tool to Reduce Diversion" (Washington, DC: Government Printing Office, May 2002), GAO-PO-634, p. 18.
http://www.gao.gov/new.items/d...

132. Effects of PDMPs
"Although several studies found implementation of prescription monitoring programs for Schedule II opioids associated with a decrease in prescription rates for Schedule II opioids and a shift towards increased rates of Schedule III, non-monitored opioid prescribing, the studies were not designed to determine whether the changes were due to a decrease in inappropriate or unnecessary Schedule II opioid use, or if these changes resulted in subsequent undertreatment of pain.317, 318 No study has evaluated patient outcomes such as pain relief, functional status, ability to work, and abuse/addiction associated with implementation of a prescription monitoring program, formulary restriction, or other policies related to opioids prescribing. Claims of positive effects of prescription monitoring programs on reducing diversion are primarily based on anecdotal reports of impressions of efficacy from policymakers and law enforcement officials.316"

"Clinical Guideline for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain: Evidence Review," The American Pain Society in Conjunction with The American Academy of Pain Medicine (Glenview, IL: American Pain Society, February 2009), pp. 98-99.
http://americanpainsociety.org...

133. PDMP start-ups
"Officials from DEA, the Alliance [National Alliance for Model State Drug Laws], and state PDMPs told us that states considering establishing a PDMP, or expanding an existing one, face several challenges. These include educating the public and policymakers about the extent of prescription drug diversion and abuse in their state and the benefits of a PDMP, responding to the concerns of physicians, patients, and pharmacists regarding the confidentiality of prescription information, and funding the cost of program development and operations. Given a state's particular funding availability and budget priorities, program costs can be a major hurdle. The start-up costs for the three most recent PDMPs were $415,000 for Kentucky, $134,000 for Nevada, and $50,000 for Utah. Estimated annual operating costs for these PDMPs varied from a high of about $500,000 in Kentucky, to $150,000 in Utah and $112,000 in Nevada. Costs in these three states vary because of differences in the PDMP systems implemented, the number of pharmacies reporting drug dispensing data, and the number of practitioners and law enforcement agencies seeking information from the systems."

General Accounting Office, "Prescription Drugs: State Monitoring Programs Provide Useful Tool to Reduce Diversion" (Washington, DC: Government Printing Office, May 2002), GAO-PO-634, pp. 3-4.
http://www.gao.gov/new.items/d...

134. PDMP Growth
"As users become more familiar with the benefits of PDMP report data, requests and the attendant costs to provide them may increase. In Kentucky, Nevada, and Utah, usage has increased substantially, mostly because of the increased number of requests by physicians to check patients' prescription drug histories. In Kentucky, these physician requests increased from 28,307 in 2000, the first full year of operation, to 56,367 in 2001, an increase of nearly 100 percent. Law enforcement requests increased from 4,567 in 2000 to 5,797 in 2001, an increase of 27 percent. Similarly, Nevada's requests from all authorized users have also increased-from 480 in 1997, its first full year, to 6,896 in 2001, an increase of about 1,400 percent. Additionally, as a PDMP matures, the needs it addresses may change, and operating costs may increase as a result."

General Accounting Office, "Prescription Drugs: State Monitoring Programs Provide Useful Tool to Reduce Diversion" (Washington, DC: Government Printing Office, May 2002), GAO-PO-634, p. 14.
http://www.gao.gov/new.items/d...

135. PDMPs and Neighboring States
"The existence of a PDMP [prescription drug monitoring program] within a state, however, appears to increase drug diversion activities in contiguous non-PDMP states. When states begin to monitor drugs, drug diversion activities tend to spill across boundaries to non-PDMP states. One example is provided by Kentucky, which shares a boundary with seven states, only two of which have PDMPs—Indiana and Illinois. As drug diverters became aware of the Kentucky PDMP’s ability to trace their drug histories, they tended to move their diversion activities to nearby nonmonitored states. OxyContin diversion problems have worsened in Tennessee, West Virginia, and Virginia—all contiguous non-PDMP states—because of the presence of Kentucky’s PDMP, according to a joint federal, state, and local drug diversion report."

General Accounting Office, "Prescription Drugs: State Monitoring Programs Provide Useful Tool to Reduce Diversion" (Washington, DC: Government Printing Office, May 2002), GAO-PO-634, pp. 16-17.
http://www.gao.gov/new.items/d...

136. Definition Of Complementary And Alternative Medicine (CAM) In Pain Management
http://www.nap.edu/openbook.ph...

137. Reasons People Use Complementary And Alternative Medicines (CAM) For Pain Management
"CAM holds special appeal for many people with pain for several reasons:
"• deficits in the way that many physicians treat pain, using only single modalities without attempting to track their effectiveness for a particular person over time or to coordinate diverse approaches;
"• the higher preponderance of pain in women (see Chapter 2), given that 'women are more likely than men to seek CAM treatments; (IOM, 2005, p. 10); and
"• a welcoming, less reserved attitude toward people with pain on the part of CAM practitioners and an apparent willingness to listen to the story of a patient’s pain journey.
"Whatever the reasons, pain is a common complaint presented to CAM practitioners (NIH and NCCAM, 2010). In 2007, 44 percent of people with pain or neurologic conditions sought help from CAM practitioners (Wells et al., 2010).
"In 2002, three-fifths of people who turned to CAM for relief of back pain found a 'great deal' of benefit as a result (Kanodia et al., 2010). The National Center for Complementary and Alternative Medicine’s strategic plan, released in February 2011, supports the development of better strategies for managing back pain, in particular."

Institute of Medicine, "Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research" (Washington, DC: National Academy of Sciences, 2011), pp. 134-135.
http://www.nap.edu/openbook.ph...

138. Extent Of Use And Types Of Pain Conditions For Which Complementary And Alternative Medicine (CAM) Are Used In The US
"For which pain conditions are CAM treatments most often used? In the 2007 National Health Interview Survey (NHIS), adults reported using CAM in the previous year most often to treat various musculoskeletal problems. Just over 17 percent of adults — more than 14 million Americans—used CAM for back pain/problems, almost 6 percent (5 million) for neck pain/problems, 5 percent for joint pain/stiffness (5 million), and 44 percent specifically for arthritis (3 million). An additional 1.5 million used CAM for other musculoskeletal problems, 1 million for severe headache or migraine, 11 million for 'regular headaches,' and 0.8 million for fibromyalgia (Barnes et al., 2008). Rates of reported use of CAM for these conditions had remained relatively unchanged since 2002. Even among children, NHIS data show that CAM therapies are used most often for back or neck pain (7 percent of all children).7"

Institute of Medicine, "Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research" (Washington, DC: National Academy of Sciences, 2011), p. 135.
http://www.nap.edu/openbook.ph...

139. Alternative Therapies
"Medical therapies are not providing sufficient relief, since the majority of chronic pain sufferers, especially those with severe pain, have also turned to non-medicinal therapies. The primary one is a hot/cold pack. Surprisingly, almost all of the major non-medicinal therapies currently used are perceived as providing more relief by their users than OTCs, the most widely used medicines; the one exception are herbs/dietary supplements/vitamins which are perceived as offering the least amount of relief than any medicines or other major non-medicinal therapies.
"The overall favorable perceptions of non-medicinal therapies are driven by those with moderate pain. Although those with very severe pain are more likely to use them, they have a significantly lower opinion of their efficacy versus medicinal therapies."

Roper Starch Worldwide, Inc., "Chronic Pain In America: Roadblocks To Relief," research conducted for the American Pain Society, the American Academy of Pain Medicine and Janssen Pharmaceutica, Jan. 1999.

140. Pain Management - Research - 2-20-10
Sociopolitical and Clinical ResearchTherapeutic Opioid Use and Risk of Impairment
"Opioids are associated with adverse events such as sedation and dizziness that could potentially impact driving or work safety83. However, some studies suggest that opioids do not necessarily impair or may improve psychomotor and cognitive functioning in patients on opioids for chronic noncancer pain.224-227"

"Clinical Guideline for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain: Evidence Review," The American Pain Society in Conjunction with The American Academy of Pain Medicine (Glenview, IL: American Pain Society, February 2009), p. 65.
http://americanpainsociety.org...

142. Likelihood of Seeing a Physician for Pain
"Almost all chronic pain sufferers have gone to a doctor for relief of their pain at one time or another. Almost 4 of every 10 are not currently doing so, since they think either there is nothing more a doctor can do or in one way or another their pain is under control or they can deal with it themselves.
"This is not the case with those having very severe pain; over 7 of every 10 are currently going to a doctor for pain relief. In addition, significant numbers of those with very severe pain are significantly more likely to require emergency room visits, hospitalization and even psychological counseling or therapy to treat their pain.
"A significant proportion (over one-fourth) of all chronic pain sufferers wait for at least 6 months before going to a doctor for relief of their pain because they underestimate the seriousness of it and think they can tough it out."

Roper Starch Worldwide, Inc., "Chronic Pain In America: Roadblocks To Relief," research conducted for the American Pain Society, the American Academy of Pain Medicine and Janssen Pharmaceutica, Jan. 1999.

143. Medical Cannabis Laws and Opioid Overdose Mortality Rates
"In an analysis of death certificate data from 1999 to 2010, we found that states with medical cannabis laws had lower mean opioid analgesic overdose mortality rates compared with states without such laws. This finding persisted when excluding intentional overdose deaths (ie, suicide), suggesting that medical cannabis laws are associated with lower opioid analgesic overdose mortality among individuals using opioid analgesics for medical indications. Similarly, the association between medical cannabis laws and lower opioid analgesic overdose mortality rates persisted when including all deaths related to heroin, even if no opioid analgesic was present, indicating that lower rates of opioid analgesic overdose mortality were not offset by higher rates of heroin overdose mortality. Although the exact mechanism is unclear, our results suggest a link between medical cannabis laws and lower opioid analgesic overdose mortality."

Bacchuber, Marcus A., MD; Saloner, Brendan, PhD; Cunningham, Chinazo O., MD, MS; and Barry, Colleen L., PhD, MPP. "Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999-2010." JAMA Intern Med. doi:10.1001/jamainternmed.2014.4005. Published online August 25, 2014.
http://archinte.jamanetwork.co...

144. Pain-Related Lost Productive Time
"A total of 52.7% of the workforce reported having headache, back pain, arthritis, or other musculoskeletal pain in the past 2 weeks. Overall, 12.7% of the workforce lost productive time in a 2-week period due to a common pain condition; 7.2% lost 2 h/wk or more of work. Headache was the most common pain condition resulting in lost productive time, affecting 5.4% (2.7% with >= 2/wk) of the workforce (Table 1), which was followed by back pain (3.2%), arthritis (2.0%), and other musculoskeletal pain (2.0%)."

Stewart, Walter F., PhD, MPH, Judith A. Ricci, ScD, MS, Elsbeth Chee, ScD, David Morganstein, MS, Richard Lipton, MD, "Lost Productive Time and Cost Due to Common Pain Conditions in the US Workforce," Journal of the American Medical Association (Chicago, IL: American Medical Association, Nov. 12, 2003), Vol. 290, No. 18, p. 2446.
http://jama.jamanetwork.com/da...

145. Self-Medication with Alcohol
"A small, but significant, percent of chronic pain sufferers have at one time or another turned to alcohol for relief; this occurred more often among middle age adults and men."

Roper Starch Worldwide, Inc., "Chronic Pain In America: Roadblocks To Relief," research conducted for the American Pain Society, the American Academy of Pain Medicine and Janssen Pharmaceutica, Jan. 1999.

146. Pain-Related Lost Productive Time
"Lost productive time varied to some degree in the workforce. First, little or no variation was observed by age. In large part, the lack of differences by age was due to the counterbalancing effects of different pain conditions. Headache, common at younger ages (ie, 18-34 years), rapidly declines in prevalence thereafter. In contrast, the other 3 pain conditions are either more common with increasing age (eg, arthritis) or peak at a later age than headache (eg, back pain)."

Stewart, Walter F., PhD, MPH, Judith A. Ricci, ScD, MS, Elsbeth Chee, ScD, David Morganstein, MS, Richard Lipton, MD, "Lost Productive Time and Cost Due to Common Pain Conditions in the US Workforce," Journal of the American Medical Association (Chicago, IL: American Medical Association, Nov. 12, 2003), Vol. 290, No. 18, p. 2449.
http://jama.jamanetwork.com/ar...

147. Pain Patients in Methadone Treatment
"Pain was very prevalent in representative samples of 2 distinct populations with chemical dependency, and chronic severe pain was experienced by a substantial minority of both groups. Methadone patients differed from patients recently admitted to a residential treatment center in numerous ways and had a significantly higher prevalence of chronic pain (37% vs. 24%). Although comparisons with other studies of pain epidemiology are difficult to make because of methodological differences, the prevalence of chronic pain in these samples is in the upper range reported in surveys of the general population. The prevalence of chronic pain in these chemically dependent patients also compares with that in surveys of cancer patients undergoing active therapy, approximately a third of whom have pain severe enough to warrant opioid therapy."

Rosenblum, Andrew, PhD, Herman Joseph, PhD, Chunki Fong, MS, Steven Kipnis, MD, Charles Cleland, PhD, Russell K. Portenoy, MD, "Prevalence and Characteristics of Chronic Pain Among Chemically Dependent Patients in Methadone Maintenance and Residential Treatment Facilities," Journal of the American Medical Association (Chicago, IL: American Medical Association, May 14, 2003), Vol. 289, No. 18, p. 2376.
http://jama.jamanetwork.com/ar...

148. Pain Patients in Methadone Treatment
"Although MMTP [Methadone Maintenance Treatment Program] patients were significantly more likely than inpatients to report chronic pain, and almost a quarter reported that pain was one of the reasons for first using drugs, there was relatively little evidence that pain was associated with current levels of substance abuse. In the multivariate analysis, the associations between chronic pain and the substance abuse behaviors observed in the bivariate analysis (pain as a reason for first using drugs and drug craving) were not sustained. Moreover, the bivariate associations that were found in the inpatient group between chronic pain and multiple drug use, and between pain and the use of illicit drugs to treat pain complaints, were not identified among MMTP patients."

Rosenblum, Andrew, PhD, Herman Joseph, PhD, Chunki Fong, MS, Steven Kipnis, MD, Charles Cleland, PhD, Russell K. Portenoy, MD, "Prevalence and Characteristics of Chronic Pain Among Chemically Dependent Patients in Methadone Maintenance and Residential Treatment Facilities," Journal of the American Medical Association (Chicago, IL: American Medical Association, May 14, 2003), Vol. 289, No. 18, p. 2377.
http://jama.jamanetwork.com/ar...

149. Reasons for Changing Doctors
"Chronic pain sufferers are having difficulty in finding doctors who can effectively treat their pain, since almost one half have changed doctors since their pain began; almost a fourth have made at least 3 changes. The primary reasons for a change are the doctor not taking their pain seriously enough, the doctor's unwillingness to treat it aggressively, the doctor's lack of knowledge about pain and the fact they still had too much pain. This level of frustration is significantly higher among those with very severe pain where the majority have changed doctors at least once and almost of every 3 have done it 3 or more times. Their primary reason for changing was still having too much pain after treatment."

Roper Starch Worldwide, Inc., "Chronic Pain In America: Roadblocks To Relief," research conducted for the American Pain Society, the American Academy of Pain Medicine and Janssen Pharmaceutica, Jan. 1999.

150. Getting Pain Under Control
"Just over one-half of chronic pain sufferers say their pain is pretty much under control. But, this can be attributed primarily to those with moderate pain. The majority of those with the most severe pain do not have it under control and among those who do, it took almost half of them over a year to reach that point. In contrast, 7 of every 10 with moderate pain say they have it under control and it took the majority less than a year to reach that point. Pain can become more severe even when it is under control. Among those with very severe pain, 4 of every 10 said their pain was moderate or severe before getting their pain under control."

Roper Starch Worldwide, Inc., "Chronic Pain In America: Roadblocks To Relief," research conducted for the American Pain Society, the American Academy of Pain Medicine and Janssen Pharmaceutica, Jan. 1999.

151. Chronic Pain Severity and Control
"Chronic pain sufferers currently taking narcotic pain relievers differ from other chronic pain sufferers as to the severity of their pain, being less likely to have it under control, changing doctors more often, requiring more intensive treatment at hospitals, taking more pills per day, more likely following their doctors prescribed regimen and lastly, to being referred to a specialized program/clinic for their pain."

Roper Starch Worldwide, Inc., "Chronic Pain In America: Roadblocks To Relief," research conducted for the American Pain Society, the American Academy of Pain Medicine and Janssen Pharmaceutica, Jan. 1999.

152. Medical Marijuana - Supporters - 5-15-11
(US Department of Veterans Affairs, Medical Marijuana, and Pain Management) "If a Veteran obtains and uses medical marijuana in manner consistent with state law, testing positive for marijuana would not preclude the Veteran from receiving opioids for pain management in the Department of Veteran Affairs (VA) facility. The Veteran would need to inform his provider of the use of medical marijuana, and of any other non-VA prescribed medications he or she is taking to ensure that all medications, including opioids, are prescribed in a safe manner. Standard pain management agreements should draw a clear distinction between use of illegal drugs, and legal medical marijuana. However, the discretion to prescribe, or not prescribe, opioids in conjunction with medical marijuana, should be determined on clinical grounds, and thus will remain the decision of the individual health care provider. The provider will take the use of medical marijuana into account in all prescribing decisions, just as the provider would for any other medication. This is a case-by-case decision, based on the provider's judgment, and the needs of the patient."

Petzel, Robert A., Letter to Michael Krawitz from the Dept. of Veterans Affairs concerning its postion on medical marijuana, (Washington, DC: Department of Veterans Affairs, Under Secretary for Health, July 6, 2010).
http://www.veteransformedicalm...
 
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