Answer the question

CASE STUDY DISCUSSION QUESTIONS:

Case Study Topic: Marijuana and the Brain INTRODUCTION In November 2012 voters in the states of Colorado and Washington approved ballot initiatives that legalized marijuana for recreational use. Since then more than 13 states have or are considering a similar initiative which continues the national debate. Both supporters and opponents of such initiatives make numerous claims about state-level marijuana legalization. Advocates think legalization reduces crime, raises tax revenue, lowers criminal justice expenditures, improves public health, bolsters traffic safety, and stimulates the economy. Critics argue that legalization spurs marijuana and other drug or alcohol use, increases crime, diminishes traffic safety, harms public health, and lowers teen educational achievement. This case study will help you better understand marijuana’s physiological affects on the body so you can better understand the long and short term effects of marijuana use on the brain. Source of above info: https://www.cato.org/publications/policy-analysis/dose-reality-effect-state-marijuana- legalizations#full MARIJUANA INFO Marijuana is the slang term for portions of the Cannabis plant. It is one of the oldest psychoactive substances used by man. Marijuana, also called pot, weed, ganja, mary jane, and a host of other nicknames, is made from the Cannabis plant, which has three species:Cannabis sativa; Cannabis indica and Cannabis ruderalis. The flowering plant, which can grow to 16 feet (5 meters) high, likely originated in the Central Asian steppe, near the Altai or Tian Shian Mountains, and was first cultivated in China and India, according to "Cannabis and Cannabinoids: Pharmacology, Toxicology and Therapeutic Potential," (Routledge, 2002). The leaves, stems, flower buds and extracts from the marijuana plant can be eaten, brewed in a tea or put into a tincture. It can also be vaporized using an e-cigarette pen. Yale University researchers surveyed 3,847 Connecticut high school students about this practice in a 2015 study that was published in the journal Pediatrics. The study found nearly one in five e-cigarette users also have vaporize cannabis or byproducts like hash oil using the device. "This is a relatively novel way of using marijuana, and kids are using it at a fairly high rate," said lead author of the study Meghan E. Morean in a Yale press release. There are hundreds of compounds in marijuana, but scientists believe the one responsible for the drugs' psychoactive effects is tetrahydrocannbinol, or THC. THC binds to cannabinoid receptors throughout the body, and marijuana's "high" comes from THC's binding to brain regions responsible for pleasure, time perception and pain, according to the National Institute on Drug Abuse (NIDA). This binding in turn triggers a chemical cascade that eventually stimulates the production of dopamine, a brain chemical often called the "feel good chemical," which is part of the body's reward system," said Mitch Earleywine, a psychology professor at the University at Albany in New

York, who studies marijuana's health effects. "Subjective effects really vary," Earleywine said. "Folks who like it emphasize the euphoria and the relaxation, and then depending on the strain, it's mildly stimulating, or mildly sedating." Because cannabinoid receptors are in so many parts of the brain and body, the effects of THC are wide-ranging: It can slow down a person’s reaction time (which can impair driving or athletic skills), disrupt the ability to remember things that just happened, cause anxiety, and affect judgment. THC also affects parts of the brain that make a person feel good—this is what gives people the feeling of being “high.” But over time THC can change how the EC system works in these brain areas, which can lead to problems with memory, addiction, and mental health. The information above was taken directly from the following website: http://headsup.scholastic.com/students/endocannabinoid ACTIVITY 1 – REQUIRED - Please watch the following video which explains how THC affects the brain: https://www.youtube.com/watch?v=r2_skiJAHsQ The following infographics will also help explain how THC works on the brain – Endocannabinoid System.

The following infographics will also help explain how THC works on the brain – TCH receptor locations and effects.

Images from: http://headsup.scholastic.com/students/endocannabinoid

MARIJUANA EFFECTS Medical marijuana use has been legal for several years because studies have shown it can can soothe nausea and increase appetite, quiet pain, soothe anxiety and even reduce epileptic seizures. However. Recreational use of marijuana is more controversial because it does not have medical value, it is simply used to alter one's mental state in a way that modifies emotions, perceptions, and feelings for recreational purposes. Regardless of the purpose for use, the mechanism of action is the same. Currently, more than half of the United States has legalized marijuana for medical use. However it is important to note that the amount of THC in marijuana has grown over the past few decades. In the early 1990s, the average THC content in marijuana was about 3.74 percent in the early 1990s and in 2013 it was almost 10 percent, according to NIDA. The increase in THC content enhances the effect of the drug on the body.

Short-term use of the drug impairs thinking and coordination. In long-term studies, teens who smoke marijuana have lower IQs later on, as well as structural differences in their brains, though scientists debate whether this is an effect of the drug or a result of habitual pot smokers seeking out less intellectually stimulating pursuits. A 2016 study on almost 300 students by the University of Montreal published in the journal Development and Psychopathology found that teens who start smoking around age 14 do worse on some cognitive tests by age 20 than non-smokers. They also have a higher school dropout rate. If they wait until age 17 to start, though, the smokers do not seem to have the same impairments, according to the study. Marijuana use has been linked to mental illnesses such as schizophrenia, according to NIDA. Marijuana smokers are also likelier to suffer from bronchitis, according to a 2014 New England Journal of Medicine review of marijuana's health effects. Stroke and heart failure have also been linked to marijuana. AMERICAN HISTORY OF MARIJUANA The Cannabis plant can grow up to 18 feet tall. In the Americas, Cannabis extract was a popular medicinal drug in the 1800s. But in the 1900s, the tide began to turn against the drug. In the 1920s, Mexican immigrants became associated with the smoked, recreational version of the drug, and anti-immigrant sentiments fueled marijuana prohibition. By the 1930s, marijuana was banned in 24 states. The newly minted Federal Bureau of Narcotics launched a campaign against the drug, and newspapers fueled hysteria with headlines like the 1933 Los Angeles Examiner's "Murder Weed Found Up and Down the Coast — Deadly Marihuana Dope Plant Ready for Harvest That Means Enslavement of California Children." By 1937, Congress passed the Marihuana Tax Act, which effectively banned marijuana except for a few medicinal purposes, according to "Smoke Signals: A Social History of Marijuana – Medical, Recreational and Legal" (Scribner, 2012). In the 1950s, the Narcotics Control Act and the Boggs Act stiffened penalties for marijuana possession, with first-time offenses requiring two to 10 year sentences and a minimum $20,000 fine, according to PBS.org. Penalties were relaxed in the 1970s, but President Ronald Reagan increased federal penalties for marijuana possession in the 1980s. On the federal level, marijuana is now regulated under the Controlled Substances Act as a schedule 1 drug, meaning the government considers it to have a high potential for abuse with no legitimate medical or therapeutic uses. However, numerous states (including Washington) have decriminalized or legalized marijuana. As of early 2017, 26 states and the District of Columbia have legalized pot in some form of medical and/or recreational use, with other states soon to follow. Recreational use of marijuana was approved by initiative 502 in 2012. By 2014, the first “pot” shops were open for business IN Washington. Debate continues about the benefits of the legalization of marijuana so this case study will consider the mechanism of action and the long and short term effects of marijuana use on the brain. Information above was taken directly from the following site: http://www.livescience.com/24559-marijuana-facts-cannabis.html

ACTIVITY 2 – REQUIRED – Please click on the following website to compare the effects of THC with at least one other drug, the interactive Mouse Party website which will allow you to compare the mechanisms of several drugs: http://learn.genetics.utah.edu/content/addiction/mouse/ ACTIVITY 3 – REQUIRED – Plaese review the following paper that assesses recent marijuana legalizations and related policies in Colorado, Washington, Oregon, and Alaska. https://www.cato.org/publications/policy-analysis/dose-reality-effect- state-marijuana-legalizations#full ACTIVITY 4 - REQUIRED - RESPOND TO THE FOLLOWING CASE STUDY A DISCUSSION QUESTIONS: As more states consider the legalization of medical and/or recreational marijuana the debate will continue. Consider the case study reading assignment and the activities you just did before answering 2 of the following questions. ANSWER the following question (everyone):

• As a practicing health provider, what would you advise a patient who wanted to know more about using recreational marijuana to help them relax and/or de-stress. Would your response be different if they wanted to use marijuana for chronic IBS or back pain?

ANSWER one of the following questions (please pick one):

• Based on the information you’ve learned in this case study, do you think marijuana is a gateway drug that introduces people to harder, more addictive drugs? Explain why or why not.

• Consider the information you reviewed in Activity 3, did it change your opinion about the legalization of marijuana in Washington state? Explain why or why not.