Advancing Marijuana Prevention
Efforts Through Social Norm Change
Campaigns
Presented by:
Daisy Lopez
Program Manager
California Health Collaborative
Performing Above the High
PATH Project
Overview
•
•
•
•
•
•
Marijuana Use Data
Is Marijuana Harmful?
National Drug Policy
National Prevention Strategies
Trends in Risk and Use of Marijuana
Prevention Needs
• Center for Substance Abuse Prevention Strategies
• The PATH Project
Marijuana Use Data
- Marijuana is the number 1 used illicit drug in the U.S.
(National Institute on Drug Abuse)
- By 2001 more than 12 million Americans (about 5% of the
population) were using marijuana on a monthly basis
(average of 18.7 joints)(SAMHSA, 2002)
- In Fresno County, 11% of Middle School Students and 27%
of High School Students have used Marijuana (CHKS)
Age of First Use
CA Healthy Kids Survey Data, 2009
Is Marijuana Harmful?
Acute Effects of Marijuana –
During Intoxication (1)
•
•
•
•
•
•
•
Euphoria
Calmness
Appetite stimulation
Altered perception of time
Impairs coordination and balance
Acute psychosis; Panic (anxiety)
Increases heart rate: 20 - 100%
– Some evidence for increased risk of heart attack, may be exacerbated in
vulnerable individuals (e.g., baby boomers)
• Impaired Driving
– Increased risk of accidents
– Increased culpability
1. Hall W & Degenhard L (2009). Adverse health effects of non-medical cannabis use. Lancet, 374:1383-1391.
Acute Effects of Marijuana –
During Intoxication
• Cognitive Dysfunction (1)
– Impaired short-term memory
• Difficulty with complex tasks
• Difficulty learning
– Impaired decision-making
• Increased risky sexual behavior – HIV
• Increased Risk of Injuries (2)
– 30% higher according to one Kaiser study
– Increased risk of hospitalized injury from all causes: self-inflicted, motor
vehicle, assaults
– Individuals admitted into hospitals with marijuana abuse/dependence as
their primary diagnosis have median lengths of stay that are twice to
three times longer than those experienced by patients admitted for
alcohol, cocaine or heroin and therefore result in higher average charges
1. NIDA, Research Report Series: Cannabis Abuse, 2010 & Hall W & Degenhard L (2009). Adverse health effects of non-medical
cannabis use. Lancet, 374:1383-1391..
2. Polen, M.R; Sidney, S.; Tekawa, I.S.; Sadler. M.; and Friedman, G.D. Health care use by frequent marijuana smokers who do not
smoke tobacco. West J Med 158:596-601, 1993.
Pacula RL, Ringel J, Dobkins C, and K Truong, "The Incremental Health Services Cost Associated with Marijuana Use," Drug and
Alcohol Dependence, 92:248-257, 2008.
Emergency Department
Marijuana Mentions
In 2008, there were >370,000 ED visits with Marijuana mentions
140,000
Number of ER Visits
120,000
100,000
18 to 24
80,000
35 and older
60,000
25 to 34
12 to 17
40,000
20,000
0
2004
2005
2006
2007
Source: SAMHSA, Drug Abuse Warning Network, 2008.
2008
Long-Term Effects of Marijuana
•Cognitive Impairment (1)
– Deficits in learning, memory, attention, executive function
– Greater impulsivity, less cognitive flexibility
– Reversible with prolonged abstinence
•Negative Impact on Educational Outcomes (2)
– Greater drop out rates
– General dissatisfaction with life achievement, mental health, social
relationships
1. Solowij, N., et al. (2002). Cognitive functioning of long-term heavy cannabis users seeking treatment. Journal of the American
Medical Association, 287, 1123-1131. and Schweinsburg AD, Brown, SA, & Tapert, SF (2008). The influence of cannabis use on
neurocognitive functioning in adolescents. Current Drug Abuse Reviews, 1:99-111.
2. Macleod, J.; Oakes, R.; Copello, A.; Crome, I.; Egger, M.; Hickman, M.; Oppenkowski, T.; Stokes-Lampard, H.; and Davey Smith,
G. Psychological and social sequelae of cannabis and other illicit drug use by young people: A systematic review of longitudinal,
general population studies. Lancet 363(9421):1579-1588, 2004.
Long-Term Effects of Marijuana
• Brain Effects (1)
– Structural abnormalities have not been consistently identified.
– But chronic users show consistent alterations in brain activation of
higher cognitive networks.
– Emerging preliminary evidence suggests that heavy cannabis use
during adolescence may affect normal brain development.
• Respiratory system (2)
– Increases cough, phlegm production, and wheezing.
– Increased bronchitis, worsening of asthma symptoms or cystic fibrosis
symptoms
– No increase in emphysema
– Conflicting evidence for lung/upper airway cancer
1. Giedd. J. N. (2004). Structural magnetic resonance imaging of the adolescent brain. Annals of the NY Academy of
Sciences, 1021, 77-85. and Hall W & Degenhard L (2009). Adverse health effects of non-medical cannabis use. Lancet,
374:1383-1391.
2. Tetrault, J.M., et al. Effects of cannabis smoking on pulmonary function and respiratory complications: a
systematic review. Arch Intern Med 167, 221-228 (2007).
Tashkin, DP (2005). Smoked cannabis as a cause of lung injury. Monaldi Archives for Chest Disease, 63(2):93-100.
NIDA, Research Report Series: Cannabis Abuse, 2010.
Hall W & Degenhard L (2009). Adverse health effects of non-medical cannabis use. Lancet, 374:1383-1391.
Long-Term Effects of Marijuana
• Mental illness
– Population studies have found evidence of an association between
cannabis use and increased risk of schizophrenia (and/or psychotic
symptoms), and to a lesser extent, depression, anxiety, and suicidal
behavior/ideation. (1)
1. McGrath, et al. (2010). Association between cannabis use and psychosis-related outcomes using sibling pair analysis in a cohort
of young adults. Archives of General Psychiatry, 67(5):440-447.
Room, R., Fischer, B., Hall, W., Lenton, S. and Reuter, P. (2010). Cannabis Policy: Moving Beyond Stalemate, Oxford, UK: Oxford
University Press.
Large, M., Sharma S, Compton M., Slade, T. & O., N. (2011). Cannabis use and earlier onset of psychosis: a systematic metaanalysis. Archives of General Psychiatry. 68. Also see Arseneault L, et al. (2002). Cannabis use in adolescence and risk for
adult psychosis: longitudinal prospective study. British Medical Journal. 325, 1212-1213.
Long Term Effects of Marijuana
Percent
Addiction: About 9% of users may become dependent, 1 in 6
who start use in adolescence, 25-50% of daily users
35
30
25
20
15
10
5
0
32
23
17
15
11
9
*
8
5
*
Estimated Prevalence of Dependence Among Users
Source: Wagner, F.A. & Anthony, J.C. From first drug use to drug dependence; developmental periods of risk for dependence upon
cannabis, cocaine, and alcohol. Neuropsychopharmacology 26, 479-488 (2002).
Dependence on or Abuse of
Specific Illicit Drugs in the Past Year
Among Persons 12 or Older, 2008
Sedatives
126
Inhalants
175
Heroin
282
Stimulants
351
Hallucinogens
358
Tranquilizers
451
Cocaine
1,411
Pain Relievers
1,716
Marijuana
4,199
0
500
1,000 1,500 2,000 2,500 3,000 3,500 4,000 4,500
Number in Thousands
Substance Abuse and Mental Health Services Administration. (2009). Office of Applied Studies. Treatment Episode Data Set (TEDS): 2009
Discharges from Substance Abuse Treatment Services, DASIS.
Increased Marijuana Treatment
Admissions 1993 and 2007
Percent of Admissions
60
1993
50
2007
40
30
20
10
0
Alcohol
Cocaine
Heroin
Source: Treatment Episode Data Set, US Health and Human Services, 1993 & 2007.
Marijuana
Treatment Admissions
by Drug, 2007
25
Percent
20
15
10
22.3
18
15.8
13.6
9.2
7.9
5
5
3.7
0.5
0
Source: Treatment Episode Data Set, US Health and Human Services, 1993 & 2007.
Potency: Increased THC Content in
Percent THC
Seized Marijuana, 1983-2009
10
9
8
7
6
5
4
3
2
1
0
Year
Sources: The University of Mississippi Potency Monitoring Project
What Does Increased
Potency Mean?
• Potential for greater exposure, more adverse
health effects, higher rates of addiction
• ER visits involving marijuana have been going
up
Dependence rates increased between 19922002 in specific subgroups (1)
1.
Compton, W., Grant, B., Colliver, J., Glantz, M., Stinson, F. Prevalence of Cannabis Use Disorders in the United States: 19911992 and 2001-2002 Journal of the American Medical Association.. 291:2114-2121.
Office of National Drug Control Policy
The National Strategy
Interdiction and Enforcement…Stopping the
supply of drugs
Treatment…Helping people who are already
addicted
Prevention…Stopping the demand for drugs
Drug Demand Reduction Program
Prevention Strategy:
Community Norm Change
1.
2.
3.
4.
5.
6.
7.
Information Dissemination
Training and Education
Alternative Activities
Early Intervention
20%
Access to Services
80%
Systems Change
Policy Change
Why is Community Norm Change
so Important?
Because Attitudes
Drive Behavior
Trends in Risk and Use of Marijuana
% 40
40
Risk
32
25
30
20
18
10
Use
6
12
0
'91
'92
'93
'94
'95
'96
Source: Monitoring the Future Study;
8th Graders Use in Past Year
'97
'98
'99
'00
'01
'02
'03
'04
Partnership for a Drug-Free America®
Trends in Risk and Use of Cocaine
%
57
60
51
Risk
50
40
34
30
20
Use
10
13
3
5
0
'85 '86 '87 '88 '89 '90 '91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04
Source: 2004 Monitoring the Future Study;
12th Graders Use in Past Year
Partnership for a Drug-Free America®
Prevention Needs






Prevention Largely Fragmented
Strong National Message
Not Typically Family Based
Mixed Messages
Many Negative Societal Images
Funding
WHAT IS “NO-USE” DRUG EDUCATION?
• Teaches the student that any use of an illicit drug is
unlawful and harmful
• Provides information on alternatives to using drugs
• Provides information on how to find abstinencebased treatment
• Focuses on the majority of young people
Impact on Prevention
• Drug education is being shifted from
educating children against drugs to educating
children about drugs.
• Children are being taught that they can use
drugs safely if they just know how.
• Children are being taught how to use drugs.
California Health Collaborative
PATH Project
SAMHSA / CSAP PREVENTION
STRATEGIES
THE CENTER FOR SUBSTANCE ABUSE
PREVENTION (CSAP)
HAS DEVELOPED & RECOGNIZES
SIX PREVENTION STRATEGIES
A comprehensive approach using as many or all six prevention
strategies works best!
http://www.samhsa.gov/
CSAP PREVENTION STRATEGIES
1. Dissemination of Information
This strategy provides information about the nature of drug use,
abuse, addiction and the effects on individuals, families and
communities. It also provides information of available prevention
programs and services. The dissemination of information is
characterized by one-way communication from the source to the
audience, with limited contact between the two. Examples of
methods used for this strategy include the following:
• Clearinghouse and other information resource centers
• Resource Directories
• Media Campaigns
• Brochures
• Radio and Television Public Service Announcements
• Speaking Engagements
• Health Fairs
* NOT EFFECTIVE AS STAND ALONE
CSAP PREVENTION STRATEGIES
2. Prevention Education
This strategy involves two-way communication and is distinguished
from merely disseminating information by the fact that it is based on
an interaction between the educator and the participants. Activities
under this strategy aim to affect critical life and social skills, including
decision-making, refusal skills and critical analysis (e.g. of media
messages). Examples of methods used for this strategy include the
following:
•
•
•
•
•
Classroom and Small Group Sessions
Parenting and Family Management Classes
Peer Leader and Peer Helper Programs
Education Programs for Youth Groups
Groups for Children of Substance Abusers
CSAP PREVENTION STRATEGIES
3. Alternative Activities
This strategy provides for the participation of the target populations in
activities that exclude drug use. The assumption is that because
constructive and healthy activities offset the attraction to drugs, or
otherwise meet the needs usually filled by drugs, then the population
would avoid using drugs. Examples of methods used for this strategy
include the following:
• Drug-free Social and Recreational Activities
• Drug-free Dances and Parties
• Youth and Adult Leadership Activities
• Community Drop-in Centers
• Community Service Activities
• Mentoring Programs
*NOT RECOMMENDED AS STAND ALONE
CSAP PREVENTION STRATEGIES
4. Community-Based Processes
This strategy aims to enhance the ability of the community to more
effectively provide prevention and treatment services for drug abuse
disorders. Activities in this strategy include organizing, planning,
enhancing the efficiency and effectiveness of service implementation,
building coalitions and networking. Examples of methods used for
this strategy include the following:
• Community and Volunteer Training (e.g. neighborhood action training,
training of key people in the system)
• Systematic Planning
• Multi-Agency Coordination and Collaboration
• Accessing Service and Funding
• Community Team-Building
CSAP PREVENTION STRATEGIES
5. Environmental Approaches
This strategy seeks to establish or change community standards,
codes and attitudes, thereby influencing the incidence and
Prevalence of drug abuse in the general population. Examples
of methods used for this strategy include the following:
•
•
•
•
•
•
The Establishment and Review of Drug Policies in Schools
Technical assistance to communities to maximize local enforcement procedures
governing the availability and distribution of drugs.
The Review and Modification of Alcohol and Tobacco Advertising Practices
Product Pricing Strategies
Social Norms Strategies
Media Literacy
CSAP PREVENTION STRATEGIES
6. Problem Identification and Referral
This strategy aims to identify those who have indulged in the illegal
use of drugs in order to assess if their behavior can be reversed
through education. It should be noted, however, that this strategy
does not include any activity designed to determine if an individual is
in need of treatment. Examples of methods used for this strategy
include the following:
•
•
•
•
Driving-while-intoxicated Education Programs
Employee Assistance Programs
Student Assistance Programs
Teen Courts
Performing Above the High Project
The Performing Above the High (PATH) Project
was created through funding from the Fresno
County Department of Behavioral Health to
reduce marijuana use among youth and young
adults, ages 12-20, in Fresno County.
School Based Prevention Education Services
Implementation of Evidence-based
interventions in the classroom and/or in an
afterschool setting taking place in various
Fresno County High Schools, Middle Schools,
as well as in Community College and
University Settings.
CNC Campaign 1:
iPATH Campaign
Youth Advisory Board trained to serve as Peer
Educators for Marijuana Use Prevention, as
well as advocates within the community in
attempting to de-glamorize the view of
Marijuana use among youth and young adults.
CNC Campaign 2: PATH4Life
Presentations and trainings tailored to
increase parental knowledge on the
effects of marijuana among adolescents,
as well as recognition of the signs of
marijuana use among their children.
CNC Campaign 3:
PATH-N-LAW
Collaboration with Law Enforcement
to strategically plan and formulate
solutions that involve enforcement of
marijuana use/possession laws in all
sectors of the community.
CNC Campaign 4
YouthPATH
Outreach presentations and informational
booths with use of a customized mobile unit
equipped with a sound system and television
screens playing Public Service Announcements
and other Marijuana Prevention videos.
CNC Campaign 6
YouthPATH
Progress Made:
– Path Project Staff has reached an estimated 5000 members of the
community
– Mobile Unit is ready for outreach
– Will be making appearance at several community events
throughout Fresno County. For booking, contact the PATH
Project.
CNC Campaign 6
YouthPATH
CNC Campaign 6
YouthPATH
CNC Campaign 6
YouthPATH
CNC Campaign 6
YouthPATH
Performing Above The High Project
Project Staff
Daisy Lopez, Program Manager
[email protected]
Phone: 559-244-4526
Darnell Fisher, Outreach Specialist
Araceli Chavez, Outreach Specialist
[email protected]
[email protected]
Phone: 559-244-4537
Phone: 559-244-4559