 Hello, welcome to the Judge Ben Show. My name is Ben Joseph. I'm a retired Vermont Superior Court judge. And this is one of a series of programs in which I interview people about issues that concern the Vermont legal system. I'm very happy to tell you that my guest today is Dr. Catherine Antley. Dr. Antley has offices in South Burlington. And she's been very much involved in efforts to limit the use of marijuana, particularly by young people. Thanks for being here. Thanks for having me. No, it's a pleasure. It really is. I read recently that more than 90% of adults who have a substance abuse disorder begin smoking, drinking, or using drugs before the age of 18. Is that your understanding? That's what I hear from Mariah Sanderson in the prevention who are experts in that area. So yes, that's a true statement. And it's actually foundational to a lot of the successful prevention work in Vermont and in the world. And has the Vermont Department of Health done a lot to try to delay the age of first use of drugs? Sure. That's if you delay your first use, as the first statement implies, you'll decrease the number of people who eventually get caught up in use disorder. So it's a proven method to decrease the pain and suffering which substance misuse produces in our society. I've read recently that the Vermont THC cap is 60%. Is that correct? Our commercialization law, which was passed, has a flower limit of 30%. And it concentrates limit of 60%. And that's a little bit like putting a speed limit on the highway of 250 miles per hour. It's great. It's better than having no speed limit, quite honestly. It is, which is what we have in Colorado and almost every. I think we were the first in the nation to put a THC cap. So that's a good thing. But it's astronomically high. And it's quite dangerous from a physiological standpoint. I should have said earlier. And THC stands for, let's see if I can get this right, tetrahydrocannabinoid? That's correct. It's one of almost 450 components in cannabis. And when Colorado legalized, they illegalized the entire plant. So all of those known and unknown components were legalized. And they're just now starting to discover some others, which are psychoactive and potentially also dangerous. But THC is understood? Right now, THC is the thing that people focus on and is measured. That's the thing that makes people high? It makes people high. Well, you mentioned Colorado, I think. I think there's been a fair amount written about Colorado because Colorado was the first state, I believe, to really start to promote the use of marijuana legally. Is that right? Right. It was first legalized in Colorado. And recently, there's been really a two-year movement in Colorado. People have been organizing and working on educating legislators, especially about issues around THC for the last two years. And recently, in the last few months, last month, they were able to pass legislation, which is aimed at eventually capping their THC levels and decreasing youth access to marijuana. If you want, I can sort of frame it a little bit in the context of what's. Hey, you're the expert. Do it. So the first video clip I have is from Dr. Chris Rogers. And he's the medical director of one of the largest, I believe, non-publicly-owned psychiatric facility in Colorado. And so he sort of frames the issue that he's seen. And then we'll talk a little bit about why Vermonters tend to have a low perception of harm of marijuana and sort of compare and contrast this information that Dr. Chris Rogers is giving us versus what many Vermonters see. And then we'll hear from the attorney general in Colorado. So we'll have the medical perspective and the legal perspective, who also is alarmed at the increase in youth use. And then again, compare that to our community in Vermont and how we're sort of responding to the same issue. But your understanding is that the perception in Vermont is that it's the use of marijuana is not harmful. That's right. When I was presiding in court one day in Vermont, I had a status conference of a case where a guy was driving under the influence of marijuana on a highway at 90 miles an hour going the wrong way. And he crashed into another car and killed five kids. And his THC content and his blood was like six times the legal limit in Colorado. He's just stoned. Right. That's a unique experience in some ways. And it's very emblematic in other ways. There was that person apparently suffered from psychiatric issues, which presumably followed his high THC use, which was reportedly chronic. He had presented himself to the ER twice and was discharged. So you have this sort of interface between the acute impairment, which contributed, obviously, to the deaths of those 14s, but also the psychiatric issues that he was suffering from that contributed. And I think that's a good example of the confusion around cannabis. Why are we saying cannabis now instead of marijuana? Do you understand that? When we first started, marijuana was generally accepted to, it was the word that people used to describe the drug that people get high. And cannabis was used to describe other things, or anything else, or everything associated with the plant. Now there's a move towards using cannabis for everything. I'm sort of neutral on this. Cannabis is technically fine. I think that when you listen to Sir Robin Murray, for example, who's an expert in cannabis and psychosis and schizophrenia, he uses the word cannabis. And he also says in the same breath that all teens, it's common knowledge in the UK that cannabis is contributing factor to psychosis and schizophrenia. I want to talk about that a little bit later, too. But the word is cannabis. It's not a clean word. It's not a word that connotes this as medicine or good for all things, like the 15 lists of things that people say that it's useful for. And I think it's the correct word. So I'm happy to use that word. So this is, like I said, Dr. Chris Rogers. He's in charge of the largest non-public psychiatric facility. I think it's important to listen to what he has to say all these years after they've legalized. I'm the medical director of Child and Adolescent Services at the Medical Center of Aurora, the largely non-publicly owned psychiatric hospital in the state. Here, I'm an inpatient psychiatrist with a front row seat to the emerging epidemic of cannabis abuse and addiction that threatens to swallow the lives of a whole generation of Coloradans. On our adult inpatient unit, it's hard to keep count of the number of psychotic and suicidal patients they're admitted with THC on board. And regardless of the data or clear evidence of how cannabis contributes to their illness, person after person refuses to accept that marijuana could be bad for them. How could it be? They have been taught to believe this is a harmless plan, a medicine that is good for anything from headaches to cancer to anxiety. It's natural, without side effects, without risk of addiction. This is the lie that is ruining the lives of far too many people in our state. The story on our adolescent unit is even more tragic, as we repeatedly treat kids too psychotic to know what's real, who they can trust, or where they are. The rates of adolescent psychosis have grown steadily since legalization, and in almost every single case is linked to the use of high THC and potency concentrates. Products known as dabs or wax or shatter that are made in the lab light is still in down the most psychoactive component of the marijuana plan and concentrating it into what is better described as a hard drug than the weed people voted for in Amendment 64. Kids as young as 11 or 12 are using blow torches and glass ribs to use to smoke these highly addictive and harmful chemicals sometimes every night just to go to sleep. We have very little research to try and understand what this does to the developing brain, but as any child psychiatrist who treats these kids can tell you, we don't need a randomized control trial to see how dangerous and often tragic the effects are. We do know there's a clear risk between developing depression or even committing suicide related to an earlier age of first use as well as the potency of products. This means a 12-year-old trying a marijuana concentrate is at far greater risk of developing a mood disorder or even eventually killing themselves than a 30-year-old experimenting with a joint of flower. Unfortunately, it's far too easy for these 12-year-olds to get access to these products and not from the black market or a shady drug dealer. They're getting them from friends at school or older siblings, many of whom have medical marijuana cards themselves and ready access to as much shattered dab or wax as they could ever want. It's time for this to change. House Bill 1317 will provide stronger safeguards to keeping cannabis products out of the hands of Colorado's kids. Having reasonable limits on daily purchases of these highly addictive substances makes good sense. Maintaining adequate guidelines for providers to uphold when recommending cannabis, especially the young brain or young kids, is a no-brainer. We need a more robust tracking mechanism to better understand who is using medical cannabis products, how much, and in what form. And Colorado should be leading the way in researching high-quality THC products. We certainly are leading the way in their sales. We have a long way to go to help the kids in my hospital, but House Bill 1317 has a great place to start. Whole country is watching Colorado as other states look to legalize cannabis. Let's lead the country into a sustainable and responsible future we can all be proud of. Thank you. So that's Dr. Chris Rogers. And I mean, that's a very powerful statement. He's talking about the kids in his hospital and how sick they are, and not just children, but also not just teens, but also adults who come in and they often have this idea there's nothing wrong and they don't understand why they're ill. Another person I think is really important to listen to from that same is the Colorado Attorney General. He also testified. And I think it's important that we hear both from law and from medicine. As has been discussed, the rise in teenage youths of high THC concentration marijuana is a critical public health challenge. It demands action and it's important what's being done today. It is a model for the nation. Just consider the latest report from the Colorado Department of Health, Public Health and Environment in their Healthy Kids Colorado Survey. They surveyed the use of dabbing which has been discussed when accessing high THC potency. It went from 4.3% of students in 2015 to over 20% in 2019. This is an alarming rise and this House Bill 1317 represents an important and critical response to this threat. The substance abuse trend in response task force which I chair and Matt Bock was with me today head of our office community engagement and his vice chair has focused on this issue with leadership from parents, from public health advocates identifying this troubling trend. This legislation meets that trend and addresses the fact that our medical marijuana laws have enabled teen access to high potency marijuana as we can come out of work to address this public health challenge and refine the regulatory program for overseeing legal habits. We need to do so in a way that protects kids. So what he's saying there is that teen use of this high THC dabs which they use a blowtorch to use and whatnot has increased from 4.8 to almost 5% to 20% and surely 20% of teenagers. 20% as I understand it, 50% of teens who use marijuana use high potency. So a much higher percentage of the teens who are using marijuana at all are using this high potency and that's got something to do with why they're having the high ER rates. And so- They go to an emergency room for treatment of psychosis. Right, and we're seeing that in Vermont too. And so I wanna talk a little bit about why Vermonters have this inappropriately low perception of harm of cannabis use. Please, please, please do. And what is the impact on our policy in Vermont and also misuse rates and use use rates? So, for example, one thing that we're seeing is that in the ERs in Vermont, we're having a high, a lot of children, adolescents are showing up in the ERs very high to the point that they've had repeated sort of, consideration in the legislature of the issue. And it's been in the newspapers as well. There are a number of articles talking about this, but we couldn't find any media coverage of the link between the high, you know, teen ER usage and it's psychiatric usage and marijuana. However, when we looked at the testimony of what the legislature doors were hearing, this is an example of one that they heard that's in response to a specific hearing about this. And this is from a child psychiatrist. I spent last weekend on call in the ER department talking to kids, talking to adults, and I have observed over my time on call that a significant portion of young people who are hospitalized psychiatrically or come to the ER department are heavy cannabis users. And we also know that cannabis that is used today, which can be 20, 30, 40% THC is nowhere near what it was in the 1960s. And the research is that this, there is a significant psychiatric risk for a whole host of problems, most notably psychosis, but I think also suicide and aggression. And this is becoming increasingly recognized at the same time that the public perception of harm is going in exactly the opposite direction. And so I am really hoping that people will pay attention to this because it would really impose a really large burden on our mental health and substance abuse treatment system moving forward. So this is- This is a physician who's testifying in the Vermont legislature? This is word for word what the legislators are hearing. I'm just saying who's the source? Who's saying- The source is a psychiatrist, respected child psychiatrist in the state of Vermont, you know, who was asked as an authority to testify to the legislature's tours on this topic. We have a crisis. That's how it's framed in the newspapers. We have a crisis in Vermont. You know, parents are at their wits end. The average wait time is many, many hours and going into days of- In an emergency room. Before, yes, before the teens or children are able to be seen or get an inpatient bed. And meanwhile, they're next to all of the trauma that is associated with an ER, you know? Someone comes in with a heart attack, a bleeding ulcer, you know, trauma from a car accident. So they're subjected to all of that while they're waiting and they're suicidal or they're psychotic. And psychosis is a medical emergency by definition or it was according to whoever admitted these children. Let's put it that way. So we looked at our newspapers because newspapers affect what the public sees as a perception of harm. And, you know, we saw these three articles. We read through them. No mention of cannabis and do psychosis or that cannabis may be a contributing factor to suicidality, which apparently was mentioned in the car, the five teens and the driver of the truck in that case. So that's one big piece of why Vermonters don't have an appropriate perception of harm. And I just wanted to put this up, which is a diagram from a well-respected researcher in Denmark. And he's showing that as marijuana, as cannabis use increases, your psychosis rates increase and so does schizophrenia. And there's a very large article out this week, actually, which is very powerful, is associated with millions of people in Denmark and they're showing the same trend. And up above you see the cannabis use is increasing at the same time in the youth. And this just is an important reminder that in Vermont we have a significant increase on our surveys that we conduct as well, showing that teen use of marijuana is going up significantly. And these two, this is decriminalization, this is legalization. So we're on an upward trend here. And this, I think, is important for people to understand is that marijuana use in the past month, Vermont's number one in the country. And you know, that- I'm sorry, you mean number one per capita in years? Marijuana use in the past month. Oregon is number two and Vermont is number one. And it's at least conceivable that the messaging that we're getting in the media and in general is associated maybe from industry, I don't know, indirectly or online is associated with that increased use. And this is what you talked about, 90% of people with a substance use problem began smoking, drinking or using drugs by the age 18. And so it's no, and then this one, these, the substances are not siloed. They, if you are using marijuana or three times as likely to be addicted to opiates and whatnot, that's from the CDC. And then, of course, that leads into illicit drug use, all drug use in Vermont. We're again, we're number one. So, you know, the state of urgency in Vermont is actually pretty high. We have ERs which are flooded with adolescents, parents who are frantic, newspapers who say this is a crisis, and the authorities in psychiatry and pediatrics are testifying to the legislature saying there's a connection here between our high marijuana use in our youth and in our young adults in general. And in this morbidity, or morbidity admission to the ER that we're seeing in Vermont. And I just wanted to show this, because there's a lot of messaging that marijuana is gonna help decrease our opiate use, and there's a lot of anecdotal information. But we haven't seen Colorado or California, the overdose rate continues to climb. Actually, it climbs quite significantly. So it hasn't helped. And then this is an article, which is a peer-reviewed article, very good article, which shows adolescent use between 2017, 2018, 2018, 2019. Adolescent use significantly increased after legalization. And so why did we in Vermont legalize when we have potentially all these health issues that we knew might crop up, and which are to some extent cropping up? Well, it was for the criminal justice and racial justice issues. But if we look at that carefully, there's a new study out of UVM that says legalization of cannabis has not narrowed the increased rate at which BIPOC drivers are stopped compared to white drivers. And the study finds legalization of cannabis did a little to narrow black and litinex search rate disparities with white drivers. And the ACLU came out with a similar study. So we're seeing that in Vermont, that this intervention, the intervention of legalizing cannabis in order to promote racial justice hasn't delivered on that promise. And this is just a graphic, which you can see that in, this is Washington, DC, after they legalized marijuana between 2015 and 16, the arrests of minority went up. In fact, there is a representative from, well, Pelegre, I believe, Mary Hooper, I think, who actually voted against legalization on one of the votes and her explanation of her vote, which I'm doing from memory, so I might not have it exactly right. But she was referencing this data and she said, if we legalize, we will have more use. And as we have more use, all specters will use, parts of our population will use more. And therefore, based on the data, we'll have more arrests of minority members. That's not something that I want, and therefore I vote against. That's a paraphrase, you can go to the internet and find her exact quote. But I think she was right on with that. Here's from the health department. After Decrim only, we saw a significant increase in people who earned less than $25,000 a year and less than a high school education. So we're not helping our disadvantaged, struggling communities. I just wanna ask you, because we have some kind of a time limit. Is it possible that the cannabis control board could limit the amount of THC in substances that are being sold legally? Yes. I don't know, actually, I think they could. I know that we have the one limits that I mentioned there, but I think that's something that, if people were concerned about the psychosis ending up in the ERs, they could call the governor's office and ask for a physician or public health representatives on the cannabis control board to put forward that idea so that what our policy is, is based on science. Because in the United States, what's happening around cannabis is we're having a change in policy around a drug which normally would go through the FDA, the EPA, and we're asking ordinary people, citizens, to make these determinations. And yet, we're not having messaging from our media which reflects what the science is really out there. So for example, this quote from Beau Kilner, we had one of our media newspapers of record refuse to print this. And all it says is commercial cannabis industry must focus on creating and maintaining heavy users. Dependence is good for the bottom line. Our free speech doctrine makes it very difficult to restrict advertising and marketing. And that's from Beau Kilner of the RAND report, a quote from his Senate Finance Committee. But we didn't get any of that in the media. And I think that contributes to our decreased perception of harm. And this is something from Jonathan Calkins, which I think is also really important that the public understand that this industry is really not interested in someone who uses casually. 80% of their profit come from people who have a use disorder or dependency. Or who use it daily. Who use it daily and sometime astronomically, all day, every day, high potency. That's where their profit center is. That's why they want high potency, THC. They need high potency, THC, for their profit. And this is a very interesting quote from Jonathan Calkins talking about this in the past, but he saw the future. He said, already 80% of sales are nearly users. Half of all the sales are to people with a substance use disorder. Occasional users who make up the majority of pot customers account for only a modest share of the sales, but may provide political cover for an industry that gets rich supplying people who struggle. The damage... I think we've really run out of time. That's a good place to stop, actually. That last thing you just said. The damage according, he says, the damage according to our public health will be substantial. And I have more examples of messaging. We're just gonna have to have you back and do another show. I want to thank you all for looking in. This is a very serious subject. And I think that the more information such as what Catherine's put out here, it's gotta be broadcasted. So broadcast it to your friends, to your family. It's very important, very important to help our children. Thank you for looking in. Bye-bye.