Stoney Girl
New Member
SCIENCE of ADDICTION
Marijuana and the Brain
There is a growing body of research documenting how marijuana use impacts the brain. The limbic system in the brain regulates emotions and motivation. The system's amygdala and hippocampus are important for memory functions. Memories and current sensory input generate an individual's response to a given situation. Memories store how the body is working in relationship to a given activity. The limbic system also regulates pleasure. Scientists have discovered what is being called the "cannabinoid system" in the brain. The brain produces compounds called endocannabinoids, neurotransmitters which act on receptors associated with anxiety and fear. Research has also discovered a relationship between dopamine, the neurotransmitter associated with pleasure (the "reward system"), and the hippocampus and amygdala. Researchers are exploring the relationship between
the brain's natural "cannabinoid" system and THC, the compound in marijuana which produces the euphoric, pleasure response.
In addition to the research on brain effects, scientific indications of the drug's therapeutic effectiveness have been established with:
- HIV wasting and chemotherapy-induced nausea and vomiting;
- Appetite stimulation and counteracting nausea and vomiting;
- Glaucoma; and
- Neurological and Movement Disorders (Multiple Sclerosis, spinal cord injuries, HIV neuropathy).
A 1999 National Academy of Science report found medical marijuana "moderately well suited" for nausea, vomiting and AIDS, but mixed findings for uses of marijuana related to seizure disorders and pain. Some studies on uses for pain have indicated that relief is short-term and leads to increased sensitivity to pain after 45 minutes. Adverse effects, both physical and on the brain, are also well documented: Smoked marijuana increases heart rate and impairs short-term memory, attention, motor skills and the organization of complex information. Chronic effects of smoked marijuana are associated with cancer, lung damage, bacterial pneumonia and poor pregnancy outcomes. This is not surprising because the gas and tar phases contain the same compounds as tobacco smoke. Additional research is needed to determine further effects on the brain, therapeutic properties and to set standards for dosing and route of administration and assessment of comparability of alternatives. Members of the Oregon Medical Marijuana Program have suggested using surplus funds raised from fee collections be used for research. The suggestion has merit.
PREVENTION DOMINO
Medical Marijuana Accommodation
The voter-passed referendum says there need be "no accommodation" made in the workplace. The assumption was that people on medical marijuana would be too sick to work. Reality proved to be something quite different. Medical marijuana card holders do work and have demanded accommodation. It was hoped that litigation would resolve a variety of concerns associated with medical marijuana use, but unfortunately that hasn't happened. Attempts to clarify the questions were made by the Legislature during the 2005 legislative session, but employers and law enforcement officials still have concerns.
One of the problems employers face in Oregon has to do with federally mandated testing programs that require marijuana to be prohibited. Consequently, employers are caught between Oregon law and federal regulation. Employers are advised to review their policies, but questions remain:
- Do they identify provisions affecting marijuana users?
- Do they delete any language that absolutely prohibits marijuana use?
- Should they be so straightforward as to give notice to employees of how marijuana use will be treated?
- Should employers require advance notice from an employee who has obtained a medical marijuana card?
Certainly employers should consider treating marijuana the same as prescription medication, but they need to be careful about language. Marijuana cannot be prescribed, but instead it is authorized and those with authorization are registered in the Oregon Medical Marijuana Program. Employers should remind employees of ORS 475.30 prohibitions including:
- No use on the premises;
- No use during work;
- No driving under the influence of marijuana; and
- No use in public view.
Another unresolved concern is whether a card holder has a disability and whether "reasonable accommodation" is required? The answers may be based on whether reasonable accommodation is available in other situations. Employers also have to assess whether the accommodation being requested or anticipated is reasonable or even possible. Finally, 70 percent of all drug screen failures are from marijuana use. By comparison, the national average is 52 percent. While only 13 percent of Oregon employers have comprehensive drug-free workplace programs, 64 percent of employers conduct pre-employment or random drug-testing. With no way to measure impairment, employers are challenged to protect the rest of their employees from cardholder mistakes due to impairment at dangerous or safety sensitive jobs. The program is almost 10 years old. It's time we resolve these legal and policy questions identified by employers.
HEALTH CARE DOMINO
Medical Marijuana
The paradox of medical marijuana continues. An illegal drug available as medicine, medical marijuana has created problems for educators, treatment providers, prevention professionals, employers, and law enforcement. Still, the Oregon Medical Marijuana Program thrives. Registered card holders have increased 42 percent since the last Council report two years ago. Revenues continue to climb as well, up 50 percent since the 2007- 2009 report. Fees for new applications and renewal are $20 for those on the Oregon Health Plan or who receive Supplemental Security Income benefits (SSI). All others are $100. As of April 2008 the Oregon Medical Marijuana Program had 16,635 card holders and 8,164 caregiver/growers registered, nearing 25,000 individuals who are directly involved. Most card holders are male: 61 percent and the majority are over age 41. Revenue raised is in the neighborhood of $1.6 million. Some 2,865 physicians have signed applications for a card holder. As of April 1, there were 2,348 pending applications. Other changes since the last report include a procedure for registering minors as card holders. Minors being registered is another issue where practice has strayed from the referendum passed by voters. At the time of this report, there are 19 cardholders under the age of 18 and 1,232 cardholders between the ages of 18 and 25. Given the research on developing adolescent brains there is reason to be concerned about registering anyone in this age range.
Public Policy Considerations
The Oregon Medical Marijuana Program has been in existence for nine years and is not going away. There appears to be no way to legalize marijuana or get the federal government to accommodate card holders. It is time to resolve the public policy issues surrounding the program. There are several:
1. Impairment needs to be defined. This issue is explored in the Workplace Domino Section. Briefly, the issue is twofold: There is no generally available, evidence-based, economical test; even if there were it would need to be administered with fidelity.
2. There are no standards for dosage, thus developing an impairment standard would be quite difficult. There is no science establishing dose standards; consequently no one can determine the appropriate amount to use, the frequency of use, what variables there might be for age or weight - none of the standards normally applied to determine medicinal use of a substance.
3. Employers are expected to accommodate use despite language to the contrary in the referendum.
4. Diseases/illnesses that were thought to be eligible given language in the referendum have extended beyond what was originally assumed. Severe pain is the most common reason for having medical marijuana, with 88 percent of all card holders, an increase of 64 percent since our last report.
5. Science has confirmed the addictive properties of marijuana. It is logical to assume that some card holders will become addicted as well. Revenues from registration fees should be available to support treatment for them as well as others.
The Oregon Medical Marijuana Program Advisory Committee and the Council have a meeting scheduled to explore these and other issues.
________________________________________________________
Council's Medical Marijuana Position:
a. Youth card holders are increasing. The Council is concerned about this trend. These registrations need to be more carefully monitored.
b. As the law states, employers should not have to accommodate card holders. Neither should schools or child care providers.
c. Grow sites must be regularly monitored.
d. The fee should be increased w/ the additional revenue going to prevention and treatment.
e. Doctors should screen for alcohol/drug problems before authorizing a card for a patient (similar to the screening that occurs w/opiate Rx).
f. Treatment providers do not have to accept card holders into their programs.
g. The Council will participate in the OMMP OAR revision committee.
Marijuana and the Brain
There is a growing body of research documenting how marijuana use impacts the brain. The limbic system in the brain regulates emotions and motivation. The system's amygdala and hippocampus are important for memory functions. Memories and current sensory input generate an individual's response to a given situation. Memories store how the body is working in relationship to a given activity. The limbic system also regulates pleasure. Scientists have discovered what is being called the "cannabinoid system" in the brain. The brain produces compounds called endocannabinoids, neurotransmitters which act on receptors associated with anxiety and fear. Research has also discovered a relationship between dopamine, the neurotransmitter associated with pleasure (the "reward system"), and the hippocampus and amygdala. Researchers are exploring the relationship between
the brain's natural "cannabinoid" system and THC, the compound in marijuana which produces the euphoric, pleasure response.
In addition to the research on brain effects, scientific indications of the drug's therapeutic effectiveness have been established with:
- HIV wasting and chemotherapy-induced nausea and vomiting;
- Appetite stimulation and counteracting nausea and vomiting;
- Glaucoma; and
- Neurological and Movement Disorders (Multiple Sclerosis, spinal cord injuries, HIV neuropathy).
A 1999 National Academy of Science report found medical marijuana "moderately well suited" for nausea, vomiting and AIDS, but mixed findings for uses of marijuana related to seizure disorders and pain. Some studies on uses for pain have indicated that relief is short-term and leads to increased sensitivity to pain after 45 minutes. Adverse effects, both physical and on the brain, are also well documented: Smoked marijuana increases heart rate and impairs short-term memory, attention, motor skills and the organization of complex information. Chronic effects of smoked marijuana are associated with cancer, lung damage, bacterial pneumonia and poor pregnancy outcomes. This is not surprising because the gas and tar phases contain the same compounds as tobacco smoke. Additional research is needed to determine further effects on the brain, therapeutic properties and to set standards for dosing and route of administration and assessment of comparability of alternatives. Members of the Oregon Medical Marijuana Program have suggested using surplus funds raised from fee collections be used for research. The suggestion has merit.
PREVENTION DOMINO
Medical Marijuana Accommodation
The voter-passed referendum says there need be "no accommodation" made in the workplace. The assumption was that people on medical marijuana would be too sick to work. Reality proved to be something quite different. Medical marijuana card holders do work and have demanded accommodation. It was hoped that litigation would resolve a variety of concerns associated with medical marijuana use, but unfortunately that hasn't happened. Attempts to clarify the questions were made by the Legislature during the 2005 legislative session, but employers and law enforcement officials still have concerns.
One of the problems employers face in Oregon has to do with federally mandated testing programs that require marijuana to be prohibited. Consequently, employers are caught between Oregon law and federal regulation. Employers are advised to review their policies, but questions remain:
- Do they identify provisions affecting marijuana users?
- Do they delete any language that absolutely prohibits marijuana use?
- Should they be so straightforward as to give notice to employees of how marijuana use will be treated?
- Should employers require advance notice from an employee who has obtained a medical marijuana card?
Certainly employers should consider treating marijuana the same as prescription medication, but they need to be careful about language. Marijuana cannot be prescribed, but instead it is authorized and those with authorization are registered in the Oregon Medical Marijuana Program. Employers should remind employees of ORS 475.30 prohibitions including:
- No use on the premises;
- No use during work;
- No driving under the influence of marijuana; and
- No use in public view.
Another unresolved concern is whether a card holder has a disability and whether "reasonable accommodation" is required? The answers may be based on whether reasonable accommodation is available in other situations. Employers also have to assess whether the accommodation being requested or anticipated is reasonable or even possible. Finally, 70 percent of all drug screen failures are from marijuana use. By comparison, the national average is 52 percent. While only 13 percent of Oregon employers have comprehensive drug-free workplace programs, 64 percent of employers conduct pre-employment or random drug-testing. With no way to measure impairment, employers are challenged to protect the rest of their employees from cardholder mistakes due to impairment at dangerous or safety sensitive jobs. The program is almost 10 years old. It's time we resolve these legal and policy questions identified by employers.
HEALTH CARE DOMINO
Medical Marijuana
The paradox of medical marijuana continues. An illegal drug available as medicine, medical marijuana has created problems for educators, treatment providers, prevention professionals, employers, and law enforcement. Still, the Oregon Medical Marijuana Program thrives. Registered card holders have increased 42 percent since the last Council report two years ago. Revenues continue to climb as well, up 50 percent since the 2007- 2009 report. Fees for new applications and renewal are $20 for those on the Oregon Health Plan or who receive Supplemental Security Income benefits (SSI). All others are $100. As of April 2008 the Oregon Medical Marijuana Program had 16,635 card holders and 8,164 caregiver/growers registered, nearing 25,000 individuals who are directly involved. Most card holders are male: 61 percent and the majority are over age 41. Revenue raised is in the neighborhood of $1.6 million. Some 2,865 physicians have signed applications for a card holder. As of April 1, there were 2,348 pending applications. Other changes since the last report include a procedure for registering minors as card holders. Minors being registered is another issue where practice has strayed from the referendum passed by voters. At the time of this report, there are 19 cardholders under the age of 18 and 1,232 cardholders between the ages of 18 and 25. Given the research on developing adolescent brains there is reason to be concerned about registering anyone in this age range.
Public Policy Considerations
The Oregon Medical Marijuana Program has been in existence for nine years and is not going away. There appears to be no way to legalize marijuana or get the federal government to accommodate card holders. It is time to resolve the public policy issues surrounding the program. There are several:
1. Impairment needs to be defined. This issue is explored in the Workplace Domino Section. Briefly, the issue is twofold: There is no generally available, evidence-based, economical test; even if there were it would need to be administered with fidelity.
2. There are no standards for dosage, thus developing an impairment standard would be quite difficult. There is no science establishing dose standards; consequently no one can determine the appropriate amount to use, the frequency of use, what variables there might be for age or weight - none of the standards normally applied to determine medicinal use of a substance.
3. Employers are expected to accommodate use despite language to the contrary in the referendum.
4. Diseases/illnesses that were thought to be eligible given language in the referendum have extended beyond what was originally assumed. Severe pain is the most common reason for having medical marijuana, with 88 percent of all card holders, an increase of 64 percent since our last report.
5. Science has confirmed the addictive properties of marijuana. It is logical to assume that some card holders will become addicted as well. Revenues from registration fees should be available to support treatment for them as well as others.
The Oregon Medical Marijuana Program Advisory Committee and the Council have a meeting scheduled to explore these and other issues.
________________________________________________________
Council's Medical Marijuana Position:
a. Youth card holders are increasing. The Council is concerned about this trend. These registrations need to be more carefully monitored.
b. As the law states, employers should not have to accommodate card holders. Neither should schools or child care providers.
c. Grow sites must be regularly monitored.
d. The fee should be increased w/ the additional revenue going to prevention and treatment.
e. Doctors should screen for alcohol/drug problems before authorizing a card for a patient (similar to the screening that occurs w/opiate Rx).
f. Treatment providers do not have to accept card holders into their programs.
g. The Council will participate in the OMMP OAR revision committee.
