Testimony before the IL Senate on Marijuana Legalization: Leslie Mendoza Temple, MD, ABOIM

grygielny Decriminalization, Drug Education, IL

January 22, 2018 Good morning, Senator Steans, Representative Davis and esteemed members of the General Assembly. My name is Leslie Mendoza Temple. I am a board-certified Family and Integrative Medicine physician in Glenview, Illinois. I also served as the former Chair of the Medical Cannabis Advisory Board for the Illinois Department of Public Health.  It is important to note for the record that I am not speaking on behalf of any institution or my employer.  I am speaking from my personal viewpoints and experience as a clinician….and as the proud mother of 3 sons, ages 7, 9 and 11 years old.  I have no financial or other beneficial relationship with the medical cannabis industry. My Integrative Medicine practice attracts patients with complex medical conditions- primarily cancer, chronic pain, neurologic, psychiatric, and digestive conditions.  Many of my patients seek my care as the last-ditch effort, referred by their physicians, they prefer to treat their conditions as naturally as possible and find their way to me. I have written certifications for over 400 patients, with over 200 patients returning so far for their follow up appointments, providing me feedback on their medical cannabis experience. I have studied this feedback. An independent chart review of my certified patients showed that over 80 percent of them had  experienced relief of one or more symptoms from their chronic condition.  Medical cannabis plus or minus medications have reduced or completely relieved many of my patients’ insomnia, pain, seizures, and digestive problems. I have seen my patients reduce their benzodiazepines, their sleep medications, and most importantly, reduced or eliminated the opioids.\ Considering the opioid and heroin epidemic, medical cannabis is a crucial part of the solution to this crisis and needs more eligible conditions to be added to the program.  Anytime opioids have been prescribed for chronic pain from all sources, patients should have the option to use medical cannabis instead. Medical cannabis is not a perfect drug however, with 29% of my patients experiencing confusion about what to take, how to take it, and varying strain availability from the cultivators and dispensaries. Despite these challenges, medical cannabis is without a doubt, one of the most important tools I have discovered in my practice, alongside good nutrition, exercise, sleep regulation, acupuncture, meditation, medications, and stress reduction strategies. As I gain more experience with patients using cannabis in a medical, therapeutic way, I have learned more about this substance, far beyond what I was ever taught during medical school or residency training. I have struggled with how to approach the question about legalizing it for adult use.  After speaking with folks on both sides of the issue, both with passionate belief and strong conviction in their viewpoints, and without investment in the industry, and with the mother’s lens.  I have come to the following conclusions which I hope are helpful to this panel and the audience. I am in favor of regulating cannabis for adult use, over age 21. I am against its prohibition given that our current system of prohibition has failed on many levels. Regulating cannabis production and sale may help increase safety of untainted supply by going through vetted cultivators; taxation can create funding to improve drug addiction and education services; legalizing it has implications that can divert funding away from the criminal system and towards education and rehabilitation. Regarding the commercialization of legal recreational cannabis, I would say there is already a very large scale, for-profit industry surrounding current usage.  It is an illegal black market industry run by addiction profiteers who manage (with crime and violence) the supply and sale of billions of dollars annually to people of all ages. They are the gateway drug towards harder substances like heroin, crack, cocaine, and LSD. We are well aware of the public health costs of that “industry’s” 80+ yrs control of the market – and none of them are funneling money into drug education.  I’d like to try a different approach now, please. My editorial:  I do not condone its use, personally, for getting high – whether one is an adult or a child. I don’t condone alcohol or cigarettes either – for anyone. But, it is not my place to govern this aspect of life for others but rather, to guide my patients towards making healthy choices. If funds towards drug education and increased resources towards drug rehabilitation are NOT included in the legislation, then I will not support this bill.  If marketing is not controlled with strict limits on advertising targeted at youth, then I will oppose the bill.  On another note, I don’t want to see a cannabis leaf emblem marketed on every billboard going down the 294, nor do I want to see a cannabis dispensary on every street corner.  In a free market economy, I am not sure how this will all shake out if this passes. So, that’s what the hearing process is all about.  It’s a chance for our voices to be heard about how this legislation should go, if legalized adult cannabis is going to be a reality. Cannabis should be kept out of the hands of children (and their pregnant mothers) whose brains are at risk for cognitive harm. I believe that strong education can help youth make better decisions about the true potential risks of underage cannabis use, which is loss of one’s highest intellectual potential while the brain is still forming, among other risks.  There’s a recent publication on the Monitoring the Future study, a survey of 1.1 million 8th-12th graders.  In the journal, Addiction, researchers made an interesting observation.  The perception of cannabis’ harmfulness increased in 8th graders in medical cannabis states while their use of cannabis decreased by 33%.      I see a huge opportunity here.  Education is an area I believe where we physicians, policymakers, schools, and the addiction healthcare community can shine in Illinois. If we take a stronger role in educating youth about the hazard of cannabis use at an early age on the brain, we could protect more kids from the potential damage they can sustain from early cannabis use.  Let’s learn from the mistakes and missed opportunities seen in early adopter recreational states – if Illinois is to legalize cannabis for adult use.   Keyes KM, et al. How does state marijuana policy affect US youth? Medical marijuana laws, marijuana use and perceived harmfulness: 1991-2014. Addiction . 2016 Dec;111(12):2187-2195.

Testimony before the Illinois Senate Hearing on Cannabis Regulation and Taxation: Molly Lotz

grygielny Decriminalization, Drug Education, IL

January 22, 2018 Good morning esteemed members of the Illinois General Assembly My name is Molly Lotz.  I am a School Social Worker and Counselor from Colorado.  When Colorado legalized recreational marijuana consumption and sales I was working in an alternative school in a mountain town.  Still working at the same school, two years later, and after early sales of recreational marijuana, my students started to come to me and ask for straightforward information on how marijuana use might affect the developing brain.  They had been exposed to a DARE type of program during their early education and now, just 6 years later, legalized recreational marijuana was my students’ reality.  They had parents who were using recreationally, they had grandparents who were using marijuana medicinally and I realized that in Colorado at least, we couldn’t teach marijuana to our youth in the same way as other substances.  We had to tease out marijuana education and not lump it with heroin and methamphetamine.  My students needed, and were, in fact, asking for accurate, fact-based, not fear-based, information on how marijuana might affect them and their developing bodies and brains.  I took a look and found not a single post-legalization, marijuana-specific curriculum available to help me support my students navigate this new reality.   So I teamed up with a fellow educator and we decided to create what our students were asking for:  A comprehensive marijuana-specific, curriculum that informs and empowers youth using up-to-date research and information on how marijuana use affects them.  What we knew is that youth needed the facts about how marijuana affects them and understand the difference between adult use and youth use as well as recreational use and medicinal use.  We  created a program that promotes delaying first use and/or abstinence during adolescence by supporting youth’s self-efficacy and to inform them using honest and accurate information.  Recognizing the detrimental educational impacts of a marijuana policy violation, we also created a program that allows administrators to keep kids with a marijuana policy infraction in schools and at the same time still addressing the policy violation in an effective way thus disruption the school to suspension to drip out to prison pipeline. This approach has been shown to increase youths’ perception of risk around youth marijuana use while at the same time not vilifying the adults in their life who may use medicinally or recreationally.  Youth need to be made aware of increasing marijuana potencies and concentrates as well as how early marijuana use can impact brain and cognitive development and functioning.  Youth need to know that a marijuana policy violation in their school or community can lead to long term consequences like impacting educational opportunities such as FAFSA eligibility and a possible school suspension or expulsion.  If we don’t give our youth this information to accompany recreational marijuana campaigns or commercial rollout, we are doing them a great disservice.  Additionally, if we doing acknowledge and educate youth on how their classmates may be using marijuana medicinally we are going backwards and not evolving with the changing landscape.  We have to help educators find the balance between educating youth about the risks of adolescent recreational use and providing a safe and compassionate environment for medicinal needs.  Old drug education programs do not do this. One of the top issues on voter’s minds is youth marijuana access and education.  Colorado legalized before proper marijuana educational programs were in place and is not paying catch up.  Illinois can prevent this.  Several Colorado schools and youth serving organizations have already adopted this progressive approach to youth marijuana education.  I would ask that as you develop recreational marijuana policies and appropriations that you consider implementing a progressive youth marijuana educational campaign so you can go to your constituents and feel confident that there is an effective solution to addressing the concerns around youth access and education. Thank you for the opportunity to speak with you today. Molly Lotz, LCSW Co-founder of Marijuana Education Initiative School Social Worker

Testimony before the IL General Assembly on Marijuana Legalization, Public Health and the Cannabis Regulation and Taxation Act (SB 316, HB 2353): David L. Nathan, MD, DFAPA

grygielny Decriminalization, Drug Education, IL

January 22, 2018 Good morning, Senator Heather Steans, Representative William Davis and esteemed members of the General Assembly. My name is David Nathan. Originally from the Philadelphia area, I graduated with high honors from Princeton University. I received my medical degree from the University of Pennsylvania School of Medicine and completed my residency at McLean Hospital of Harvard Medical School. I am a board-certified psychiatrist, and for the past twenty years I have maintained a private practice in Princeton, New Jersey, where I live with my wife and our two teenage children. I am the Director of Continuing Medical Education for Penn Medicine Princeton Health and the Director of Professional Education for Princeton House Behavioral Health. I am a Clinical Associate Professor at the Rutgers Robert Wood Johnson Medical School. On the topic of cannabis policy, I do not speak for the institutions with whom I have an affiliation. I am a Distinguished Fellow of the American Psychiatric Association, which is the highest membership honor bestowed by the APA. I have published numerous articles in the national psychiatric and lay press about a variety of topics in history and science, one of which is the legal status of marijuana. I am the founder and board president of Doctors for Cannabis Regulation (or DFCR). With a prestigious roster of physicians, including former Surgeon General Joycelyn Elders and integrative medicine pioneer Andrew Weil, DFCR is the first and only national medical association dedicated to the legalization, taxation and – above all – the effective regulation of marijuana in the United States. DFCR has members in nearly every state and US territory, including right here in Chicago. DFCR does not promote cannabis use. Rather, we advocate for the legalization of cannabis for adults, because effective regulation requires a legalized environment. We therefore support a core set of common-sense measures – our “Platform of Regulations” – to control the marijuana industry and protect public health. We believe that the government should oversee all cannabis production, testing, distribution, and sales. Cannabis products should be labeled with significant detail, including (but not limited to) THC and CBD levels, dosing information and ingredients. There should be restrictions on marketing and advertising of cannabis products. Cannabis packaging and advertising that targets or attracts underage users should be completely prohibited. All cannabis products should have child-resistant packaging. There should be harsh penalties for adults who enable diversion of cannabis to minors. Taxation of the cannabis trade should be used to fund research, education, and prevention, including public information for adults on the use and misuse of cannabis and youth programs that emphasize the risks of underage cannabis use. And since cannabis prohibition has worsened the poverty of the impoverished – particularly in communities of color – DFCR believes that the government has an obligation to rebuild the communities disproportionately affected by the war on marijuana. There are many ways this can be done, but if nothing else, we must expunge the criminal records of individuals convicted of minor cannabis crimes and ensure diversity in the cannabis industry. Esteemed members of the General Assembly: The time has come to end the failed and harmful prohibition of marijuana in the State of Illinois. This historic and beloved city of Chicago knows all too well the destruction brought by well-intended but sadly misguided efforts by society to control addiction through prohibitions. From the violence in the streets under Alcohol Prohibition, to the violence in the streets we see today, Chicago has paid a heavy price for the heavy-handed criminal approach to addiction, which is fundamentally a health problem, not a moral one. Alcohol Prohibition was repealed after just thirteen years because of unintended consequences: organized crime, increased use of hard alcohol, and government waste. So, what have we gotten from our eighty-year experiment with marijuana prohibition? Organized crime, increased use of stronger marijuana, and government waste. And yet, Alcohol Prohibition was a success compared to our war on marijuana. Alcohol consumption decreased during the 1920s, but marijuana use has increased drastically since its prohibition. Today, 22,000,000 Americans use cannabis each month, and even more partake on a less frequent basis. Marijuana prohibition began in the 1930s – over the objections of the American Medical Association – based on scare tactics and fabricated evidence that suggested that the drug was highly addictive, made users violent, and was fatal in overdose. We now know that none of those assertions are true. Cannabis is less addictive than alcohol and tobacco. It doesn’t make users violent, and there are no documented cases of fatal cannabis overdose. In short, from the medical standpoint, marijuana should never have been illegal for consenting adults. While Doctors for Cannabis Regulation firmly supports the legalization and regulation of marijuana for adult use, it emphatically opposes underage recreational use of marijuana. Evidence suggests that both marijuana and alcohol can adversely affect brain development in minors. Studies of underage users show that health effects are worse when kids start younger and consume more frequently. But cannabis prohibition for adults does not prevent underage use. For decades, preventive education reduced the rates of alcohol and tobacco use by minors, while underage marijuana use rose steadily despite its prohibition for adults. The government’s own statistics show that 80-90% of eighteen-year-olds have consistently reported easy access to the drug since the 1970s. Opponents of legalization like to say: “This isn’t your parents’ marijuana.” And they’re right. Cannabis cultivation has led to the development of more potent strains, to the extent that illegal marijuana today is typically about three to five times stronger than it was 30 years ago. In states where marijuana is legal, the government requires potency labeling. Adult users can make informed decisions about their intake based on potency, much as people do with alcohol – say, drinking a small amount of vodka compared with two beers. But in Illinois, where it’s illegal and uncontrolled, marijuana products aren’t labeled and users consume an unknown product of unknown potency. Thus, the opposition’s claim is a medically sound argument… to legalize and regulate marijuana so that products are properly labeled with potency, ingredients and serving sizes. Opponents of legalization say – again without evidence – that marijuana legalization “sends the wrong message” to kids. In other words, they argue that if a drug or activity is legal for adults, then kids will think it’s safe for them. If there is an association, it is the opposite of what opponents claim. When cannabis is against the law for everyone, the government is saying that marijuana is dangerous for everyone, and kids know that’s not true. If adults can’t be trusted to tell the truth about responsible adult use of marijuana, why should kids listen to us when we say it’s harmful for them? By making a legal distinction between marijuana use by adults and minors, we demonstrate a respect for scientific evidence – and the sanctity of the law – that we would want our children to emulate. Whether in sex education or drug education, when kids know we’re being honest with them and trust the information we’re providing, they’re more likely to take that advice seriously. And we know that preventive drug education works—the rates of underage tobacco and alcohol use have been falling for many years, even though it remains legal for adults. During that same time, underage marijuana use – which until recently was illegal in all 50 states – has risen. Today, teen use has remained level across the nation, including in legalized states. While we cannot predict the future, there are good reasons to believe legalization may actually decrease underage use. Now I would like to address what may be the biggest misconception about marijuana – namely, that it is a “gateway” to the use of harder drugs. We hear this repeated over and over again, and always without supporting evidence. A study by the Institute of Medicine, the health branch of the National Academy of Sciences, concluded that marijuana “does not appear to be a gateway drug to the extent that it is the cause or even that it is the most significant predictor of serious drug abuse.” While it’s true that users of hard drugs often tried marijuana first, they’re even more likely to have tried alcohol and tobacco. And the vast majority of those who try marijuana, alcohol and tobacco don’t go on to use harder drugs. Simply put, the fact that some people who use hard drugs also used marijuana in no way implies that marijuana causes people to use hard drugs. The marijuana “gateway” hypothesis is an archaic, misleading and oversimplified explanation of substance misuse, and it trivializes the serious discussion of how to address one of the greatest public health crises in history: our nation’s deadly opioid epidemic. Times are changing. In 2018, even physicians who oppose legalization generally believe that marijuana should be decriminalized, reducing penalties for users while keeping the drug illegal. Although decriminalization is certainly a step in the right direction, DFCR physicians believe it to be an inadequate substitute for legalization and regulation for a number of reasons. First, decriminalization does not empower the government to regulate product labeling and purity, which leaves marijuana vulnerable to contamination and adulteration. This also renders consumers unable to judge the potency of marijuana, which is like drinking alcohol without knowing its strength. Moreover, where marijuana is merely decriminalized, the point-of-sale remains in the hands of drug dealers who will sell marijuana – as well as more dangerous drugs – to children. Contrary to popular belief, decriminalization doesn’t actually end the arrests of marijuana users. Despite New York State decriminalizing marijuana in the 1970s, New York City makes tens of thousands of marijuana possession arrests every year, with continuing racial disparities in enforcement. Finally, under a decriminalized system the government continues to prosecute and constrict the supply chain. This drives up the price of marijuana, making the untaxed illegal market more lucrative, competitive, and violent. When we describe the days of Al Capone, we call it “Alcohol Prohibition”, but it was actually more properly called “Alcohol Decriminalization”. It was perfectly legal to obtain and consume alcohol for medical purposes or religious rituals, or if you made it at home for your personal use. So, when opponents tout decriminalization as an answer to prohibition, ask them what they think will happen if we remove penalties for consumers while prosecuting growers and sellers, and how this could be expected to work when Alcohol Prohibition didn’t. Ladies and gentlemen, I thank you for your time and attention. I would be happy to answer your questions. Respectfully submitted, David L. Nathan, MD, DFAPA dnathan@dfcr.org 609-688-0400 (phone) 609-688-0401 (fax) 601 Ewing Street, Suite C-10 Princeton, New Jersey 08540 Doctors for Cannabis Regulation. “Platform of Regulations.” Updated January 2018. https://dfcr.org/platform-of-regulations/

Testimony Before Illinois General Assembly Committees on Marijuana Legalization: Rev. Alexander E. Sharp

grygielny Decriminalization, Drug Education, IL

January 22, 2018 I am the Rev. Alexander Sharp, Executive Director, Clergy for a New Drug Policy.  We reach out to clergy nationally to end the War on Drugs and seek a health, not punishment response to drug policy.  Because we are based in Illinois, and I have been doing faith-based education and advocacy work for over 20 years, a substantial number of clergy and lay leaders in Illinois are aware of our work. It might seem unusual for clergy to be advocating for marijuana legalization.  I am not advocating for marijuana use, although I don’t think it is wrong, any more than using alcohol, a far more dangerous drug, is wrong. Many clergy support marijuana legalization because of our sense of how best to influence and even change behavior, especially of our youth.  What the failed War on Drugs has taught us over the past 45 years is that prohibition does not work. Why?  Prohibition refuses to accept reality.   Drugs are a reality in our society.  Cigarettes, alcohol, and potentially addictive behaviors like gambling are with us.  The issue, therefore, becomes how to prevent not use but abuse.  I wish someone would make this point to U.S. Attorney General Jeff Sessions when he appears to say that all drug use is bad. Instead of prohibition, we need to focus on preventing abuse though regulation and education.  Cigarettes are legal, but smoking has gone down by 50% in the last 25 years.  Alcohol is legal, but that we have made progress here as well.  Marijuana is illegal, and use has not gone down.  What’s wrong with this picture is that with marijuana, we have persisted in mindless prohibition. I stress to my clergy colleagues that “legalization” is the wrong word.  We seek the “regulation” of marijuana.  That means that marijuana now obtained in the illicit market will be clearly labeled and packaged. People will know what and how much they are using.  That is far from the case with back alley and school yard purchases. I’ve used these policy arguments with clergy across the country, and they get it. But beyond these policy wonk arguments, at the end of the day, we must educate each other, especially of our young people.  We must communicate with them in a way that makes sense to them.  They need to trust us.  I don’t see how that is possible when we equate marijuana and prohibition. Our youth didn’t believe us when we preached “Just Say No” in the 1980’s.  When it comes to marijuana, they do not believe us now. The DARE programs where a law enforcement officer stands in front of a classroom and says “this is your brain on drugs” didn’t work when they were first tried.  These programs have adjusted since the 1980’s but they are still not effective. I have attended many conferences where medical experts have described in elaborate detail how marijuana if heavily used can be harmful to young, still developing brains.  It can affect motivation.  I believe them. The problem is not that these facts are wrong.  Our kids should hear and take to heart every one of them.  The problem is that it is very hard to communicate them in the context of a policy – namely prohibition – rooted in abstinence. Further, the very concept of harm reduction is impossible if abstinence is the only response to drug use.  To deny the goal of harm reduction is immoral.  The best in our faith traditions tells us that persuasion, with compassion, mercy and forgiveness; rather than punishment – in the form of jail and incarceration – are the best paths to changing hearts and minds. All of this gives us a response to one final question that is frequently asked:  We’ve got alcohol and cigarettes, but why marijuana?  Do we really need another legal drug? My response: if really believe regulation and education are the best way to shape individual moral behavior, we should legalize marijuana even if alcohol and cigarettes had never happened. Marijuana legalization stands on its own merits.  That why I urge your support for SB 316.

Martin Luther King Jr’s Dream: Civic and Economic Justice

Rev. Alexander E. Sharp Decriminalization, Racial Inequality, Reparations

  Almost 50 years after the assassination of Dr. Martin Luther King Jr., it is only natural to wonder what he might teach us in these profoundly troubling days.  It is worth remembering that, especially in the last three years of his life, his most strident calls were for economic justice. “I have a dream today that my four little children will one day live in a nation where they will not be judged by the color of their skin but by the content of their character.” As the minister and scholar Michael Eric Dyson reminds us, these 34 words are more famous than anything else King ever said.  These are the words we carry in our hearts.  But this was far from the full message. It is now commonplace to observe that the United States is the prison capital of the world.  We incarcerate more people per capita than any other nation on earth, with Russia a not so close second.  This monstrous reality has fallen most heavily on African Americans and Hispanics. While he did not live to see that our criminal justice system would become perhaps the leading civil rights issue of our day, Dr. King knew intuitively what must happen if we are ever to move beyond Jim Crow: civil rights laws alone could not address three centuries of racism and economic exploitation. He was killed in Memphis, where he had gone to lead a strike of sanitation workers, and his next destination was to be Washington D.C. where he was mobilizing a Poor People’s Campaign. Three weeks before the end of his life, he spoke of how in the 1860s Americans had been given land if they moved west to build their economic future even as blacks remained slaves.   Listen to Martin Luther King in this video.  He is tired, impatient, even close to anger. Anticipating a Poor People’s Campaign, he said, “Now when we come to Washington in this campaign, we are coming to get our check.”  Is this not a call for reparations? For most Americans, the idea of reparations is a non-starter.  It seems at best impractical. But consider the perspective of African Americans who cannot get a job due to a marijuana arrest on their records as we move to the legalization of marijuana. They are witnessing young white men creating businesses to sell a substance that blacks went to jail for possessing. The growing marijuana industry as an argument for reparations is a small slice of a much deeper problem. Even if we cannot devise a clear-cut reparations policy as such, it is worth keeping front and center the idea of helping people overcome the challenges of almost three centuries of oppression.  Ta-Nehisi Coates tells us why: “Perhaps no number can fully capture the multi-century plunder of black people in America…But I believe that wrestling publicly with these questions matters as much – if not more than – the specific questions that might be produced.” In this, he is surely right.  Let us remember today that as King called for the brotherhood and sisterhood of us all, he knew this could not be achieved without economic justice. If only to help us discuss this fundamental truth, it worthwhile to discuss what society can and should do in the way of reparation. Dr. King surely would have approved.