Cannabis Lecture Notes


Cannabis vs. Marijuana

  • Marijuana refers to the dried leaves, flowers, stems, and seeds from the Cannabis sativa or Cannabis indica plant. (NIDA, 2019)

  • "Marijuana has been intertwined with race and ethnicity in America since well before the word \"marijuana\" was coined." (Thompson, 2013)

  • Marijuana, cannabis, hemp: Why Minnesota is choosing its words carefully.

Connection between 420 and Cannabis

  • The most credible story traces 4/20 to Marin County, Calif. In 1971, five students at San Rafael High School would meet at 4:20 p.m. by the campus’ statue of chemist Louis Pasteur to partake.

  • They chose that specific time because extracurricular activities had usually ended by then.

  • This group — Steve Capper, Dave Reddix, Jeffrey Noel, Larry Schwartz, and Mark Gravich — became known as the “Waldos” because they met at a wall.

  • They would say “420” to each other as code for marijuana.

Cannabis Use History

  • References to use in China approximately 4,000 years ago.

  • THC (the component of cannabis that causes intoxication) was identified in internal organs of an Egyptian mummy from approximately 950 BCE.

  • Cannabis was introduced to eastern Europe around 700 BCE but didn't become part of European culture until the 1800s.

  • By the 1840s, recreational cannabis use was popular in France.

  • Early 1900s: Cannabis use begins to impact United States.

The Cannabis Plant

  • Hemp: strong fiber in the stem; used to make rope, cloth, paper.

  • Leaves, flower: when dried, used as marijuana.

  • Roots: have been used to make medicines.

  • Seeds: have been used as food

  • Legally:

    • Hemp: cannabis plant that contains 0.3% or less THC.

    • Marijuana: cannabis plant that contains more than 0.3% THC.

THC

  • THC (delta-9-tetrahydrocannabinol) is the most psychoactive chemical in a cannabis plant.

  • THC is found in the plant’s resin.

  • Resin is most concentrated in the flowers but can also be found elsewhere on the plant.

  • Cannabidiolic acid (CBDA) predominates early in maturation converted to cannabidiol (CBD) converted to THC as plant reaches its floral peak converted to cannabinol (CBN) as the plant matures into the late stages.

  • “Drug quality” is determined by to what extent CBD is converted to THC.

Drug Grades and Other Products

  • Marijuana

    • Low-grade marijuana: made from all the leaves of both sexes of plants; 1% THC or lower

    • Medium-grade marijuana: made from flowering tops of female cannabis plants raised with/fertilized by male plants

    • High-grade marijuana: made from flowering tops of female plants raised in isolation from male plants; 12-16% THC

  • Hashish: resin separated from the plant material; 8-20% THC

  • Hash oil: result of boiling a plant in alcohol and filtering out the solids; 20-70% THC

How THC Moves Through The Body

  • How much THC is absorbed into the body varies based on administration route:

    • One cigarette/joint: 10-20% of THC transferred into body

    • Pipe: 40-50% of THC transferred into body

    • Water pipe (“bong”): 80-95% of THC transferred into body

  • About ½ of THC is still present 24 hours after smoking

    • THC stays in fatty deposits of body [extremely fat soluble!]

    • ~30% may remain in body a full week later and may continue to affect mental and physical functions

    • Remnants of a large dose may be detectable for 3 weeks

How Edible THC Moves Through The Body

  • THC taken into the stomach (e.g., edibles) goes to the liver first

    • The liver will break down some of the THC before it gets to the brain

    • The remaining THC reaches the brain more slowly because the route is less direct

  • Peak THC levels will last longer because the body absorbs it more slowly when eaten

General Effects

  • People’s experiences with cannabis vary widely and depend on the potency of the drug taken

  • General relaxation & elevation in mood; then drowsiness & sedation; increased appetite; subjective experience varies widely

  • Lethal overdose is virtually impossible [however, kids unknowingly eat and go into coma]

Short- and Long-Term Effects

  • Short-term effects

    • Increases heart rate, reduces heart’s pumping efficiency during exercise

    • Impairs judgment and complex coordination (like what is needed to drive car)

    • Inhibits memory formation and storing new information

  • Long-term effects

    • Decreases lung airflow

    • Effects brain systems controlling vision and regulating physical movement

    • Suppresses production of reproductive system hormones

    • Impairs learning and memory [esp. in adolescent brains]

  • THC produces fewer unpleasant side effects in adolescents than in adults

Tolerance, Dependence, Withdrawal

  • Development of tolerance isn’t simple or clear-cut

  • Some psychological dependence, but even heavy users don’t seem to be dependent in ways users of other drugs do

  • Mild withdrawal: some irritability, restlessness, mild nausea, insomnia

Illicit Drug Use Statistics

  • Cannabis is the most commonly used “illicit" drug

  • 21.8% of people aged 12 or older used cannabis in the past year

  • Use was highest among young adults aged 18-25 (36.5%)

Cannabis Use Among UMN Students

  • Trends Over Time: Data from 1998 to 2024 indicate fluctuations in current cannabis use among 18- to 24-year-old students.

Method of Using Cannabis

  • Past 12 Months:

    • Smoking: 57.9%

    • Vaping: 31.8%

    • Eating or Drinking: 76.8%

    • Dabbing Waxes, Shatter, or Concentrates: 5.7%

    • Putting Drops, Strips, Lozenges, or Sprays in Mouth or Under Tongue: 3.3%

    • Applying Lotion, Cream, or Patches to Skin: 1.9%

    • Taking Pills: 0.7%

    • Some Other Way: 1.4%

Cannabis Use Among LGB Adults

  • Cannabis use in the past year among sexual minority females was 2-3 times higher compared with cannabis use among straight females.

  • Cannabis use in the past year among sexual minority males was nearly 2 times higher compared with cannabis use among straight males.

Cannabis Use by Race

  • Cannabis use was lower among folks who identify as Hispanic or Asian compared to folks who identify as other races

Racial Disparities in Cannabis Arrests

  • Marijuana is used at similar rates by Black and white people across America, yet Black and Brown people are disproportionately targeted for and harmed by its criminalization, subjected to stops, frisks, arrests, and convictions of marijuana-related offenses because of their race.

  • Extreme racial disparities in marijuana possession arrests persist through the country and have not improved since 2010:

    • Black people are 3.64 times more likely than white people to be arrested for marijuana possession, even though there are comparable usage rates

    • Trend in racial disparities has not changed since 2010

    • In every state, Black people are more likely to be arrested for marijuana possession, in some states Black people were up to 6, 8, or 10 times more likely to be arrested

    • In 31 states racial disparities were larger in 2018 than 2010

Racial Disparities in Minnesota

  • In Minnesota, which decriminalized marijuana in 1976, the racial disparity in arrests is higher than average, with Black people 5.4 times more likely to be arrested for marijuana than white people.

  • Racial disparity decreased between 2010 and 2018.

Illegality

  • Schedule I drug (i.e., no currently accepted medical use, a high potential for misuse)

  • Because people use the product but cannot purchase it legally (yet) in many places, illegal networks are able to thrive

  • Costs associated with apprehending, prosecuting, and imprisoning people on cannabis charges

  • Revenue from controlled cultivation, sale, and taxation could be significant

Cannabis Use While Pregnant

  • One study found that 30% of pregnant women surveyed responded “no” when asked if they believed cannabis is harmful to the fetus

  • Women asked to identify substances most likely to harm baby during pregnancy:

    • Alcohol (70%)

    • Tobacco (16%)

    • cannabis (2%)

Using Cannabis While Pregnant

  • New evidence suggests that over past 10 yrs. more women use cannabis during pregnancy than ever before

  • Evidence of safety during pregnancy is limited and conflicting

  • Many women report health care providers do not talk with them about cannabis use during pregnancy

  • Lack of communication about risks of cannabis use frequently taken to be indication that it is safe for use during pregnancy

  • Fewer people, in general, and pregnant women specifically, consider cannabis to be a drug

Some Evidence of Harm From Using Cannabis During Pregnancy

  • Research on health effects of cannabis during pregnancy is limited

  • In part due to ethical and human subjects constraints in studying a potentially harmful substances while women are pregnant

  • This limits the types of studies that can be done- mostly survey & retrospective after birth

Evidence of Harm

  • Studies have shown:

    • Increased risk of problems for mom/baby (ex. anemia, low birth weight, stillbirth, NICU admittance)

    • Most recent study (Rompala, Nomura, & Hurd, November 2021):

      • Maternal cannabis use associated with lower expression of immune-activating genes

      • Found children showed higher anxiety, aggression, hyperactivity and levels of cortisol, when compared with mothers who did not use cannabis during pregnancy

  • Many professional organizations recommend women not use cannabis when trying to conceive, pregnant, & breastfeeding

Potential Benefits of Use

  • Promote appetite [cancer, HIV/AIDS]

  • Decrease nausea [chemotherapy]

  • Potential anti-tumor activity [cancer]

  • Treatment for glaucoma (reducing pressure of fluid within the eye)

  • Multiple Sclerosis & other disorders that produce impaired muscle control, seizures, chronic pain and migraine headaches [used as muscle relaxant and analgesics (pain relievers)

  • However, many studies do not show conclusive evidence of benefits.

What is CBD?

  • Cannabidiol (CBD)

  • Does not cause a “high”

  • Legal status currently mixed

    • All 50 states have laws legalizing CBD with varying restrictions

    • Federal government still considers CBD in same class as marijuana

  • THC vs. CBD

  • What’s in Your CBD?

Synthetic Marijuana

  • Nearly 200 different chemical mixtures have been marketed as “synthetic marijuana”

  • Nearly 700 street names, including spice, K2, fake weed, Yucatan Fire, Moon Rocks, Skunk

  • Herbal mixtures with synthetic cannabinoids (chemicals that act similarly to THC in the brain)

  • Chemical composition of these products is usually unknown

  • Symptoms include: agitation, vomiting, increased heart rate and blood pressure, tremors, seizures, hallucinations, paranoid behavior, etc.

Lower-Risk Cannabis Use Guidelines

  • The most effective way to avoid cannabis use–related health risks is abstinence,

  • Avoid early age initiation of cannabis use (i.e., definitively before the age of 16 years),

  • Choose low-potency tetrahydrocannabinol (THC) or balanced THC-to-cannabidiol (CBD)–ratio cannabis products,

  • Abstain from using synthetic cannabinoids,

  • Avoid combusted cannabis inhalation and give preference to nonsmoking use methods,

  • Avoid deep or other risky inhalation practices,

  • Avoid high-frequency (e.g., daily or near-daily) cannabis use,

  • Abstain from cannabis-impaired driving,

  • Populations at higher risk for cannabis use–related health problems (e.g., individuals with predisposition for, or a first-degree family history of, psychosis and substance use disorders, pregnant women) should avoid use altogether, and

  • Avoid combining previously mentioned risk behaviors (e.g., early initiation & high-frequency use).

Minnesota Medical Cannabis Program

  • Medical cannabis legislation was signed into law in Minnesota on May 29, 2014

  • Medical cannabis products became available for patients on the state’s Medical Cannabis Registry on July 1, 2015.

  • Patient enrollment

    • 5,000 patients, March 2017

    • 10,000 patients, May 2018

    • 20,000 patients, April 2020

    • 30,000 patients, January 2022

    • 40,000 patients, January 2023

Qualifying Conditions

  • Alzheimer's disease

  • Amyotrophic lateral sclerosis (ALS)

  • Autism spectrum disorder (must meet DSM-5)

  • Cancer*

  • Chronic motor or vocal tic disorder

  • Chronic pain

  • Glaucoma

  • HIV/AIDS

  • Inflammatory bowel disease, including Crohn’s disease

  • Intractable Pain

  • Irritable bowel syndrome

  • Obsessive-compulsive disorder

  • Obstructive Sleep Apnea

  • Post-traumatic stress disorder (PTSD)

  • Seizures, including those characteristic of epilepsy

  • Severe and persistent muscle spasms, including those characteristic of multiple sclerosis (MS)

  • Sickle cell disease

  • Terminal illness, with a probable life expectancy of less than one year*

  • Tourette syndrome

  • Any medical condition for which a patient’s health care practitioner has recommended, approved, or authorized the use of cannabis by that individual to treat the condition

MN Medical Cannabis Registry: Top Qualifying Medical Conditions

  • The top two qualifying medical conditions are chronic pain (57.91%) and post-traumatic stress disorder (33.20%).

    • Chronic Pain: 27,998

    • Post-Traumatic Stress Disorder: 16,054

    • Cancer: 2,319

    • Obstructive Sleep Apnea: 2,088

    • Severe and Persistent Muscle Spasms: 1,938

    • Inflamm. Bowel Disease (incl. Crohn's): 1,014

    • Autism: 905

    • Seizures: 856

    • Irritable Bowel Syndrome: 600

    • OCD: 390

    • HIV/AIDS: 305

    • Glaucoma: 275

    • Terminal Illness: 148

    • Tourette Syndrome: 134

    • Chronic Vocal or Motor Tic Disorder: 78

    • Alzheimer's Disease: 46

    • ALS: 28

    • Sickle Cell Disease: 17

Hemp-Derived THC Products

  • As of August 1, 2022, Minnesotans 21 and older can buy hemp-derived THC products (remember, hemp=cannabis plant that contains 0.3% or less THC)

  • Products can contain up to 5 milligrams of THC per serving, packages can contain up to 50 milligrams of THC

  • Edibles must be in childproof and tamper-evident packages and carry the label, “Keep this product out of reach of children.”

  • Products can’t be “modeled after a brand of products primarily consumed by or marketed to children” or “packaged in a way that resembles the trademarked, characteristic, or product-specialized packaging of any commercially available food product.”

  • Products must be tested for mold, heavy metals, pesticides, fertilizers and solvents.

Cannabis Legalization in MN: Key Points

  • Effective Aug. 1, 2023, full decriminalization allows the possession, use, and home grow of cannabis in Minnesota for people 21 and older.

  • The legislation proposes that retail sales for adult use cannabis in Minnesota begin in the first quarter of 2025.

  • Cannabis remains illegal under federal law, where it is still classified as a controlled substance.

  • Lower-potency THC hemp edibles will continue to be allowed.

Cannabis Legalization in MN: Limitations

  • Cannabis can be used by people 21 and older on private property, private residences and places with approved licenses or an event permit.

  • Cannabis cannot be used when operating a motor vehicle.

  • Cannabis cannot be used or possessed in/on:

    • Public schools or charter schools and school buses

    • State correctional facilities

    • Location where the smoke, aerosol or vapor of a cannabis product could be inhaled by a minor

    • Federal property (eg., courthouses, airports, national parks)

  • Smoking cannabis is prohibited anywhere smoking commercial tobacco is prohibited.

  • Smoking or vaping adult-use cannabis products is prohibited in a multifamily housing building (03/01/25).

Cannabis Legalization in MN: Expungement

  • The legislation called for automatically expunging low-level cannabis convictions and for creating a Cannabis Expungement Board, which will review felonies for expungement or resentencing.

  • Expungement seals a person’s conviction record, making the record not publicly accessible from the Bureau of Criminal Apprehension.

  • Sealing records is intended to remove barriers for people with cannabis-related offenses who are subject to a background check for a job or housing.

  • In May 2024, Minnesota expunged approximately 58,000 misdemeanor cannabis records