Who Smokes Marijuana Where?

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In Search of the Marijuana Breathalyzer

Pissing in a cup may be on the way out.

The good news: Marijuana breathalyzers are coming. The bad news: Marijuana breathalyzers are coming.

For years now, urinalysis using a mass spectrometer has been, if you’ll excuse the expression, the gold standard for drug testing. But in the case of alcohol, exhaled breath has always been the detection matrix of choice. And now, after the publication of several papers analyzing the detection of various drugs of abuse in exhaled breath, companies are hoping to leap into the market for cannabis breathalyzers.

A 2013 paper in the delightfully named Journal of Breath Research, written by neuroscience researchers at the Karolinska Institute in Stockholm, sought to confirm recent research suggesting that amphetamine, THC, and other drugs can be reliably detected in users who exhale into specially treated breath pads. The researchers collected breath, plasma, and urine samples from 47 patients. They tested for metabolites of methadone, amphetamine, morphine, benzodiazepines, cocaine, buprenorphine, and THC.

The results of the testing “provide further support to the possibility of using exhaled breath as a readily available specimen for drugs of abuse testing…. The detection rate for most investigated substances appears to be high, and higher than previously reported, with the exception of benzodiazepines.” The false positive rate was about 8%, which is very good, and is due, presumably, to improved sampling sensitivity.

In collaboration with Karolinska, NIDA researchers published a paper in Clinical Chemistry showing that cannabinoids blown onto breath pads were stable for up to 8 hours at room temperature—and up to 6 months in cold storage evidence lockers. The researchers tested 13 chronic smokers and 11 occasional smokers. Analysis of breath pad samples nailed all 13 of the serious smokers, and all but one of the casual smokers an hour after smoking. With current technology, the cannabis detection window remains very small, somewhere between 30 minutes and two hours. However, testing positive tells us nothing about when, and how much, marijuana was smoked.

Furthermore: “If a correlation to blood concentration can be shown for exhaled breath levels, it may become a substitute matrix for monitoring impairment.” And that, readers, is the Big If. What, exactly, are we testing FOR? Impairment, or just any and all use? Is there a reliable standard for marijuana, like the 0.08 blood level standard for alcohol? Or is a plethora of spurious positives on the horizon?

Roadside drug breathalyzers are presently under development or are in the prototype stage at several North American companies. One such device is a marijuana breathalyzer with a two-hour test window soon to be on offer from Cannabix Technologies. It was developed by a former member of the Royal Canadian Mounted Police because, says the company, there is no standardized way “to detect whether someone has been using marijuana on the spot like a breathalyzer does for alcohol.” So Cannabix is collaborating with Field Forensics Inc. to develop a testing device for roadside use.

An analysis last month at MarketWatch.com  saw a silver lining in the Cannabix breathalyzer, calling it “possibly the next major step towards normalization of more widespread marijuana use being allowed as such a device would offer a ready means of addressing key sticking points that have kept industry, legislators and law enforcement from agreeing on how best to regulate cannabis.”

North America is viewed as a “target-rich market” that is “ripe for the advent of a pot breathalyzer.” In the end, “roadside blood draws by law enforcement and other invasive methods of screening for THC intoxication, like zero-tolerance urine testing at the workplace, are increasing impractical as medical and even recreational cannabis gain ground throughout North America.”

The coming cannabis breathalyzers will be able to tell us the “when.” And soon they may even be able to tell us how much. But it remains unclear whether marijuana breathalyzers will ever be able to tell us how high—to reliably measure cannabis impairment behind the wheel. Somewhat mysteriously, the level of 5 nanograms of THC per blood milliliter has emerged as the de facto standard. But it’s clear to people who are actually familiar with marijuana’s effects that experienced users don’t react the same way as naïve users, and it’s perfectly logical to presume that some users can drive with complete safety at the 5ng level—users such as daily consumers of medical cannabis, whose tolerance is high even though daily quantities smoked is usually low.

One inspiration behind the cannabis breathalyzer is law enforcement’s love of the alcohol breathalyzer. In 1938, Dr. Rolla Harger of Indiana University introduced his Drunkometer, the first device for testing alcohol on a person’s breath. But it wasn’t portable. And it wasn’t until 1954 that Indiana University’s Robert Borkenstein came up with the portable Breathalyzer. The rest is drunk driving history.

In the bad old days before anybody “blew” a 0.08, prosecuting a DUI required court evidence—dash cam footage, field sobriety tests, officer assessments and testimony, and on and on. At present, that’s the situation for law enforcement when it comes to prosecuting a DUI for marijuana. For years, the prevailing court test has been the Duquenois-Levine test—the dominant method for field-testing marijuana since 1930—and it is considered by many to be wildly inaccurate. It involves inserting a bit of the substance in question into a prepared pipette, then waiting to see if it turns purple. If it does, the suspect can be charged with possession. (One U.S. Superior Court judge referred to the test as “pseudo-scientific”).

According to the official drug policy of the United Nations, a positive marijuana ID requires gas chromatography/mass spectrometry analysis. But even sophisticated tests have angered courts, due to the DEA’s muddled standards for lab protocols. A former FBI agent told the Texas Tech Law Review: “We are arresting vast numbers of citizens for possession of a substance that we cannot identify by utilizing the forensic protocol that is presently in use in most crime labs in the United States.”

Russ Belville, writing at the Huffington Post, concludes in a similar vein: “Until science shows a reliable test that only snares pot-impaired drivers and not unimpaired drivers who happen to be pot smokers, [prosecutors] are just asking for an easier way to discriminate against legal cannabis consumers.”

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Who Smokes Dope, And How Much?

Marijuana stats skew perceptions of use.

Most statistical surveys of marijuana focus on a single quantitative measurement: How many people are using? But there’s a problem: More marijuana use does not necessarily translate into more marijuana users. And that’s because a clear majority of the consumption, and black market dollars, come from the heaviest smokers.

Drug policy researchers at the RAND corporation decided that frequency of use and amount of consumption were valuable parameters gone missing in most policy discussions. So they put the focus not just on use, but also on “use-days,” and pulled a number of buried tidbits from a very big data pile. If you zero in on consumption, and not just consumers, they insist, you will find a wholly different set of inferences.

For example: “Although daily/near-daily users represented less than one-quarter of past-month cannabis users in 2002 and roughly one-third of past-month users in 2011, they account for the vast majority of use-days and are thus presumably responsible for the majority of consumption,” write Rachel M. Burns and her RAND colleagues in Frontiers of Psychiatry. As with alcohol, the majority of cannabis consumption can be accounted for by a minority of users. The heaviest users, the upper 20 percent, consume 88 percent of the U.S. marijuana supply, say the RAND researchers. “Furthermore, if over time there were no change in the number of cannabis users, but the ratio of light vs. heavy users switched from 80/20 to 20/80, then consumption would increase by 250% even though there was no change whatsoever in the number of users.”

The RAND group used two data sets on cannabis consumption—the National Survey on Drug Use and Health (NSDUH) in the U.S., and the EU Drugs Markets II (EUMII) in Europe. Data included figures for past-year and past-month use, past-month use days, and past-month purchases.

Other intriguing figures come to light when you study cannabis use, as opposed to cannabis users. The researchers declared that “only 14% of past-year cannabis users [primarily males] meet the criteria for cannabis abuse or dependence, but they account for 26% of past-month days of use and 37% of past-month purchases.”

Happen to smoke blunts? That turns out to be very telling, according to the RAND study. “Perhaps the most striking contrast concerns blunts. Only 27% of past-year cannabis users report using a blunt within the last month, but those individuals account for 73% of cannabis purchases.” Casual users, it seems, don’t do blunts.

Clearly, it takes a lot of casual users to smoke as much marijuana as one heavy user. But exactly how many? The RAND researchers ran the numbers and concluded that, in terms of grams consumed per month, it would take more than 40 casual smokers to equal the intake of a single heavy user. The share of the market represented by daily/near-daily users is clearly the motive force in their analysis.

The study in Frontiers in Psychiatry also found patterns of interest on the buy side. General use took an upswing beginning in 2007. While the probability of arrest per marijuana smoking episode hovers somewhere in the neighborhood of 1 in 3,000, everything changes if you are purchasing cannabis. RAND reported that young people collectively make more purchases per day of reported use than do older users. Therefore, “statistics indicating that the burden of arrest falls disproportionately on youth relative to their share of all users may not be prima facie evidence of discrimination if making more purchases per day of use increases the risk of arrests per year of use.” Once again, those aging Baby Boomer potheads get the best deal. They have more money with which to buy bigger amounts less often, thereby greatly lessening their chances of arrest and prosecution.

This also applies to minority arrests for marijuana offenses. “Non-Hispanic blacks represent 13% of past-year cannabis users vs. 23% of drug arrests reported by those users, but they report making 24% of the buys. Thus, some of their higher arrest rate may be a consequence of purchase patterns… African-Americans may not only make more buys but also make riskier buys (e.g., more likely to buy outdoors).”

The researchers were able to draw some conclusions about the growth in marijuana usage from 2002 through 2011, based on the NSDUH data. Their main conclusion, after exploring the demographics of this 10-year record of use, is that “consumption grew primarily because of an increase in the average frequency of use, not just because of an increase in the overall number of users.”  The driver of consumption turns out to be… greater consumption. And that increased consumption is coming from… older adults. Those older adults, it turns out, are smoking more weed.

The shift is dramatic: “In 2002, there were more than three times as many youth as older adults using cannabis on a daily/near-daily basis; in 2011 there were 2.5 times more older adults than youth using on a daily/near-daily basis.” The record of alcohol and cigarette use over the same period showed no such inversion of use patterns.  And the tweeners? “In 2002, 12-17-year-olds represented 13% of daily/near-daily users; in 2011, that had dwindled to 7%.” These trends are not just the obvious result of an increase in the proportion of older adults in the population at large. Increases in the proportion of older heavy cannabis users were much greater than the general population drift.

Among the questions raised by the RAND analysis:

— Are older marijuana smokers primarily recreational, or medicinal?

—Do increased use days among older, college-educated marijuana smokers indicate greater social acceptance, or something else?

—Are younger people replacing traditional cannabis use with other substances?

—Why did Hispanic use increase more over the study period than other ethnic groups?

Burns R.M., Caulkins J.P., Everingham S.S. & Kilmer B. (2013). Statistics on Cannabis Users Skew Perceptions of Cannabis Use, Frontiers in Psychiatry, 4   DOI: 10.3389/fpsyt.2013.00138

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Marijuana and the Gateway Hypothesis

Smoke pot, shoot smack?

The Great Gateway Hypothesis has had a long, controversial run as a central tenet of American anti-drug campaigns. As put forth by Denise B. Kandell of Columbia University and others in 1975, and refined and redefined ever since, the gateway theory essentially posits that soft drugs like alcohol, cigarettes, and marijuana—particularly marijuana—make users more likely to graduate to hard drugs like cocaine and heroin. What is implied is that gateway drugs cause users to move to harder drugs, by some unknown mechanism. The gateway theory forms part of the backbone of the War on Drugs. By staying tough on marijuana use, policy makers believe they will have much broader impacts on hard drug use down the road.

This notion is virtually an article of faith in the drug prevention community. It just feels intuitively right: Scratch a junkie, and you’ll find a younger, embryonic pot smoker or furtive teenage drinker. Ergo, prevent teen pot smoking, and you will block the blossoming of a multitude of future hard drug addicts.

For years, the gateway hypothesis has had its share of contentious opponents. The countervailing theory is known primarily as CLA, for Common Liability to Addiction, the genetically based approach that lines up with the notion of addiction as a chronic disease entity. Most genetic association studies have failed to record risk variations for addiction that are specific to one addictive drug. Writing last year in Drug and Alcohol Dependence, Michael M. Vanyukov of the University of Pittsburgh, along with a large group of prominent addiction researchers, argued that the gateway hypothesis is essentially a form of circular reasoning. “It is drug use itself that is viewed as the cause of drug use development,” they write. The staged progression from one drug to another “is defined in a circular manner: a stage is said to be reached when a certain drug is used, but this drug is supposed to be used only upon reaching this stage. In other words, the stage both is identified by the drug and identifies the drug. In effect, the drug is identical to the stage.”

The researchers reject any causal claims on behalf of the gateway hypothesis and insist there is no necessary usage of soft drugs at an earlier stage to pave the way for hardcore addiction, however watertight the idea might sound. The high correlations are “artifactual,” they argue, “because they are estimated among hard drug users, without taking into account the large population of those who try or even habitually use marijuana but never transition to harder drugs.” A common cause, such as an underlying vulnerability to all drugs of abuse, seems more to the point, they insist. There is nothing out there to suggest that “these stages are either obligatory or universal, nor that all persons must progress through each in turn… the initiation order is frequently reversed even for the licit-to-illicit sequence.” There is only one stage that universally precedes hard drug use, they argue. And that is non-use. “It is the non-use then, which should be the actual gateway condition.”

The leading theory supporting the gateway hypothesis is that some as yet undetermined mechanism of “sensitization” occurs after using a gateway drug. But there is no science supporting this notion. “If sensitization does occur,” the researchers say, “it is equivalent to an increase in individual liability at the level of neurochemical mechanisms of addiction.”

The paper in Drug and Alcohol Dependence notes that in Japan, where marijuana is used by less than 5 percent of young people, “cannabis is not used first by a staggering 83.2% of the users of other illicit drugs, thus violating the gateway sequence.” Japan also handily knocks down the idea of alcohol as a gateway drug: Whereas the prevalence of aldehyde dehydrogenase deficiency—the so-called alcohol flush reaction—keeps many Asians from drinking alcohol regularly, this does not correlate with lower rates of non-alcohol substance use in that population.

All of this would seem to put the last nail in the notion that “involvement in various classes of drugs is not opportunistic but follows definite pathways,” as Vanyukov et. al. put it. Common sense seems to be ahead of official drug policy in this regard. According to Maia Szalavitz, writing at TimeHealthland, “only 38% of people now agree with the idea that ‘for most people, the use of marijuana leads to the use of hard drugs’ compared to 60% in 1977.”

For proponents of common liability to addiction models, any staged sequencing of drug use is considered opportunistic and trivial. Which, interestingly, is how many addicts tend to view the gateway theory. But the idea of marijuana or alcohol as a gateway drug just feels intuitively correct to many people. Part of the problem is chronological. “At the relatively distal time when genetic relationships are usually evaluated,” the authors maintain, “the role of this early-acting factor may be as difficult to detect as it is to find a match that started a forest fire.” Your genetic endowment is with you from birth, while your first drink or toke of marijuana does not happen for a decade or two. Individual environmental conditions, from epigenetic changes to a move to a different neighborhood, determine how it will play out down the road, but these factors are mostly invisible at the time of addiction.

All of this matters from a policy point of view, because research “may be hindered or misdirected if a concept lacking substance, validity and utility is accorded prominence.” However, even when the gateway hypothesis is taken as a given, different legal and social outcomes are still possible. The best example is found in The Netherlands. The prevailing belief there is that “the pharmacological effects of cannabis increase adolescents’ likelihood of using other drugs,” as stated  by Wayne Hall, a professor of public health policy at the University of Queensland, Australia. Writing in Addiction, Hall says that drug policy analysts in The Netherlands have argued that the fabled gateway “is a consequence of the fact that cannabis and other illicit drugs are sold in the same black market; they have advocated for the decriminalization of cannabis use and small retail sales in order to break the nexus between cannabis use and the use of other illicit drugs.”

This “Marijuana Shop” approach may have direct relevance in the U.S., in the wake of cannabis legalization in Washington and Colorado. James Anthony, a professor of epidemiology at the Bloomberg School of Public Health at Johns Hopkins, writes about the real-world ramifications of the cannabis shop in Addiction: “Do we actually achieve a near-term delay in the time to a young person’s first chance to try cocaine or heroin... [or] do we run the risk of accumulating more cases of dependence on marijuana, or other hazards attributable to non-essential marijuana use?

The true gateways to addiction appear to be behavioral. As part of their genetic endowment, budding addicts are far more likely than other people to exhibit behavioral “dysregulation” when young, in the form of disinhibition, impulsivity, and antisocial behaviors. More than half of all addicts are co-morbid, meaning they also have a psychological or behavioral disorder in addition to addiction. Further analysis of this fact would seem to be a more fruitful research avenue than simply prodding at alcohol or marijuana in an effort to uncover their chemical “secrets” for compelling future drug use.

Photo Credit: http://tcktcktck.org/ Creative Commons: Randi Shooters, 2010

Time for a Sales Tax on Sinsemilla?

Will states let marijuana revenue go up in smoke?

As California State Assembly member Tom Ammiano put it: “What if California could raise hundreds of millions of dollars in new revenue to preserve vital state services without any tax increase?”

That question is likely to hook any state legislature’s attention these days. When times are tough, you go with your strengths. In California, one of those strengths is the nation’s most robust homegrown marijuana industry—virtually all of it off the books at present.

Reeling from a $42 billion budget deficit, the California government has been slashing deeply into state spending. The marijuana industry, variously estimated at anywhere between $4 and $14 billion per year, is the state’s largest cash crop.

Is this any time to be turning down a couple of billion dollars a year in potential state revenue? The question of marijuana decriminalization may begin to be seen under a different light, as cash-strapped states look in every corner for ways to add revenue.

The Marijuana Control, Regulation and Education Act, introduced in the California legislature last week, would legalize the possession and sale of marijuana for people over 21—with a hefty sales tax similar to the taxes imposed on the sale of alcohol and cigarettes. The bill would prohibit open street sales or sales near schools. Marijuana wholesalers would be charged several thousand dollars up front to distribute the crop, and an individual sales fee of $50 per ounce at the retail level would be applied.

Proponents of the bill claimed it would generate more than $1 billion annually, according to a report by Stu Woo in the Wall Street Journal. The California chapter of NORML estimates that the take for the Golden State could be as high as $2.5 billion a year, when excise taxes, savings in law enforcement expenditures, and spinoff industries like coffee houses are taken into account.

Ammiano, the Democrat from San Francisco who introduced the bill, told Salon: “I do have support from a lot of colleagues, who say, ‘Oh my God, I think this is great, but I don’t think I can vote for it.’” In an opinion piece for the San Francisco Chronicle, Ammiano wrote that his reason for introducing the bill was to begin “a rational public policy discussion about how best to regulate the state’s largest cash crop, estimated to be worth roughly $14 billion annually. Placing marijuana under the same regulatory system that now applies to alcohol represents the natural evolution...” In addition, Ammiano suggests, “Regulation allows common-sense controls and takes the marijuana industry out of the hands of unregulated criminals.”

A lobbyist for California police groups told the Wall Street Journal that the bill was “based on a fallacious assumption that if we could only legalize marijuana, that we will have fiscal and social Shangri-La.”

Nonetheless, more than a dozen states have signaled a willingness to move toward more liberal marijuana enforcement policies recently. All of these efforts eventually collide with competing federal statutes, making the possession and sale of marijuana potentially a federal crime. As with the issue of gay marriage, it is possible that states will continue to push back, resisting federal efforts to nullify state changes in marijuana enforcement policy.

Photo Credit: Forest Service Drug Control Program

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U.K. Marijuana Panic Continues

British Prime Minister plans to stiffen pot penalties.

The national hysteria over "skunk" marijuana shows no signs of abating in Great Britain, as Prime Minister Gordon Brown is poised to overrule his advisors and reclassify cannabis as a more dangerous drug. Lost in the debate is any semblance of reasonable discussion about scientific research on marijuana.

British health authorities continue to find the basics of cannabis to be an inscrutable mystery. Some months ago, they declared that "skunk" cannabis was linked to the onset of schizophrenia. Since no one knows what, exactly, causes schizophrenia, and recent findings continue to point toward genetic causes, this was a doubly astonishing claim.

Now, continuing in the same vein of misinformation, The University College of London reports that different strains of marijuana cause different types of psychological maladies. Recently, Prime Minister Brown "publically described new strains of cannabis as 'lethal,' as if they could trigger a fatal overdose," according to an editorial in the Guardian. The Guardian went on to note that "Whitehall's own panel of experts has concluded that increased marijuana use has not been matched by a corresponding rise in mental illness."

The move to shift marijuana to Class B status from its current Class C designation has been fueled by these dubious reports. As long as British politicians continue to believe that something called "skunk" is a new and lethal derivative of marijuana, and that it causes psychosis, schizophrenia and suicide, no substantive debate on cannabis regulation can possibly take place. Colin Blakemore, a prominent professor of neuroscience at the Universities of Oxford and Warwick, tackled the issue in an article for the Guardian:

And what of the alarming stories of horrifying powerful "skunk"? Some newspapers have told us that the level of THC, the active ingredient, in street cannabis today is 20 or 30 times higher than 10 years ago. That would be rather surprising, given that THC content was 7 per cent on average in 1995. In reality, two studies, due to be published later this year, concluded that the average THC content has doubled.

Professor David Clark, a British psychologist who maintains a substance abuse information service called Wired In, writes on his blog: " I have to confess that I really cannot see what reclassifying the drug will do, other than criminalise and alienate more of our young people. It won't reduce harms that the drug can cause to some people. In saying this, I am not arguing that cannabis is safe - but nor are alcohol, tobacco and a wide range of prescription drugs which are all legal. "

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