Texas' Compassionate Use Program Bypasses Public Health Protections

Texas is also one of 41 States and the District of Columbia that requires a prescriber or pharmacist to ensure that drug prescriptions are based on an actual physical examination of the patient and prohibiting licensed pharmacists from filling certain drugs if there is any doubt they were prescribed following an exam. According to Public Health Law Program under the Centers for Disease Control and Prevention, most States have multiple physical examination regulations under multiple categories. Texas is one of them.

Texas' Compassionate Use program is designed to bypass any such established professional consumer protections, beyond violating professional rules for writing prescriptions only for FDA-approved medications. The CUP registered doctors are concentrated around a few big cities. There is no way all of the dispensaries across the State and mail order CBD shops are even attempting to ensure CBD "prescribers" had actually examined the CBD patients. Nor is it reasonable to believe that these doctors are physically examining and medically following these patients or are their primary physicians treating these patients' specialized conditions.

In "medical marijuana" programs around the country, patients can get a green card or "recommendation" online without ever seeing a specialist treating their qualifying condition. Texas' CUP is no different. Simply fill out a form online at Compassionate Cultivation or at Surterra Texas and a doctor will visit with you remotely and you'll be on your way. Beyond the eleven qualifying conditions approved by the Texas legislature, Compassionate Cultivation offers prescriptions for 146 conditions.

Compassionate Use and "medical marijuana" programs clearly compromise medical professionals and the practice of medicine, wrote Dr. Gregory K. Pike, Director of Adelaide Centre for Bioethics and Culture. The scientific process has advanced modern medicine and with it, a sound ethical framework for the doctor-patient relationship which prioritizes the health and well being of their patients. "Medical marijuana" needs to be considered in the context of its conflicts with all medical Codes of Ethics.

"Medicalizing" a harmful and ineffective substance results in truly ill people not getting proper medical care, thinking that because marijuana may make them feel better, they are getting better. That's not the right thing to do. Medical professionals and others who are truly concerned for the welfare of patients have higher standards and greater compassion. We want patients to get the best medicine they need.

Is Texas' CBD Compassionate Use Program Backed by Science?

Intense marketing has made it very challenging for the public to learn what the quality scientific evidence and medical experts have concluded about CBD products. Texas politicians have no such excuse.  They hold the responsibility to enact sound laws that are in the best interests of their constituents, to research the credible medical literature and follow the recommendations of medical professionals and reputable experts.

CBD Never Was A Treatment for Epilepsy

While CBD is most espoused for epilepsy and was used to launch Texas' Compassionate Use and Hemp programs, it has never been recognized as a treatment for epilepsy. The American Epilepsy Society, Academy of Pediatrics and American Medical Association, along with epilepsy practitioners surveyed by the journal Epilepsy Currents, only support medications that are approved by the FDA, following sound double-blind, randomized controlled clinical trials.

Epidiolex is a "purified and uniform preparation administered under the guidance and close monitoring of an appropriate medical professional," wrote the American Epilepsy Society. In contrast, the "artisanal" cannabis products used in State CBD or "medical cannabis" programs are vastly different substances. As they cautioned:

These products sold directly to consumers are not regulated for purity or uniformity and have resulted in epilepsy specialists in Colorado "at the bedside of children having severe dystonic reactions and other movement disorders, developmental regression, intractable vomiting and worsening seizures that can be so severe they have to put the child into a coma to get the seizures to stop.

Because these products are unregulated, it is impossible to know if these dangerous adverse reactions are due to the CBD or because of contaminants found in these artisanal preparations. The Colorado team has also seen families who have gone into significant debt, paying hundreds of dollars a month for oils that do not appear to work for the vast majority. For all these reasons, not a single pediatric neurologist in Colorado recommends the use of artisanal cannabis preparations."

"In sum, there simply is no clinical, controlled research to support the adoption of new CBD legislation for epilepsy such as your State is considering," said Dr. Brooks-Kayal to the Governor of Idaho. "The anecdotal results of a few families in Colorado, shared in the media, should not be the basis for law making."

Opposed By Texas Doctors

The Texas Medical Association echoed this opposition to Texas' CBD and Hemp legislation, writing a letter to Texas Department of State Health Services (DSHS) on behalf of nearly 53,000 doctors and medical students across Texas. It said consumers needed accurate information and disclosures about CBD products and doctors needed to be informed so they can appropriately advise their patients. It urged the DSHS "to prohibit any false, deceptive, or misleading advertising of health claims relating to these products – statements should be made based on proven, scientifically accurate research."

TMA called for a public awareness campaign on the health risks of these products. "Most supplemental, non-prescribed products are not regulated, and some can potentially alter the effectiveness of or cause an adverse reaction to a patient’s prescribed medications. Many patients taking supplements do not know that these products are not regulated, not approved by the U.S. Food and Drug Administration, and not tested for quality, effectiveness, or safety," they wrote.

The Marijuana Policy issued by the Texas Medical Association specifically does not endorse State-based cannabis programs or the legalization of marijuana in any form, adding that scientific evidence on the therapeutic use of cannabis does not meet the current standards for a prescription medication. Writing in Texas Medicine, TMA voiced its support for evidence-based strategies that will help reduce marijuana use.

The State legislature and DHSH disregarded the expertise of Texas medical professionals.

American Medical Association Opposition

The Texas Medical Association emphasized the seriousness of concerns of medical professionals about marijuana by posting on the front page of the TMA website an announcement from a special meeting held by the American Medical Association in November. The AMA clarified its policy to make sure there are no doubts as to the position of medical professionals. The AMA "believes that cannabis is a dangerous drug and as such is a serious public health concern."

TMA went on to report that the AMA policy was also amended to clearly state that the "sale of cannabis should not be legalized; that physicians should discourage its use, particularly among youth and pregnant and breast-feeding women;" and that states that have already "legalized" medical cannabis be required to take steps to regulate it effectively to protect public health and safety.

It is reasonable for doctors to try and have conversations with their patients who've tried medical cannabis about its potential risks and help them understand that the only evidence for potential benefits of cannabis comes from specific FDA-approved prescriptions of certain derivatives, wrote Dr. Kevin P. Hill, MD, MHS with Beth Israel Deaconess Hospital Division of Addiction Psychiatry. But these prescription drugs are "very different from cannabis obtained from dispensaries."

"The reality is that patients are being misled," wrote Dr. Kenneth Finn, MD, a graduate of the University of Texas at Houston and now Board certified in Physical Medicine and Rehabilitation and Pain Medicine. Cannabis and CBD products are everywhere, "but there is little scientific evidence to support the hype that surrounds them," he wrote. While medical professionals recognize there is no clear and convincing evidence for the safety and efficacy of most cannabis products, "a local budtender might recommend these CBD products enthusiastically. But does the budtender realize that the product might be contaminated with heavy metals, pesticides, fungicides, rodenticides, insecticides, molds, E. coli, or fungus, just to name a few?"

Studies across the country of cannabis products on the market have found many don't contain what is claimed on labels, and significant numbers have failed tests for purity and safety, he added. Oregon's regulations are so lapse, 97% of dispensaries in Oregon hadn't even had the mandated inspections, exposing customers to multiple contaminants.

"Fellow physicians and allied health care professionals, we can’t wait any longer. We must speak up, loudly and often, and warn the public about the potential risks they face. Let’s put public health and safety ahead of commercial interests. Let’s put our patients first."

The Sleight of Hand Plan for Texas

Lobbyists and marketers bandy about terms interchangeably trying to confuse the public and normalize the idea of marijuana use as medicinal and benign. The terms CBD, low-THC cannabis, cannabidiol, cannabis, hemp and "medical marijuana" are tossed around as if they are one in the same. They are not.

Even more subtly, many of the cannabis bills being proposed for the Texas 2021 legislative session are based on the existing Compassionate Use Program legislation – which allows cannabidiol (CBD), "low-THC cannabis." Taking that legislation, drafters relabel CBD as "medical marijuana," add the term "medical marijuana" to the legislation or use the terms interchangeably, hoping credulous politicians and the public will think they are the same thing. They are not.

Notice how the UT-Austin student writers at the Texas Tribune, for example, continually refer to Texas' Compassionate Use program (based on cannabidiol, CBD) as the State's "medical cannabis" program? It’s a tactic. They are hoping legislators and gullible Texas voters will believe they are the same thing.

Why is the Texas Compassionate Use program not as popular as other States' "medical marijuana" programs – with only 0.17% of "eligible patients" in Texas enrolled, as they lament? Because, as they know and hopefully Texans are figuring out, the program has nothing to do with "medicine." You can be sure that "patient" enrollment will increase as soon as legislators relabel the program as "medical cannabis."

Why? "Medical marijuana" or "medical cannabis" is just a legislative or political term for marijuana. "Medical marijuana" is the exact same thing as recreational pot, street pot, weed, and cannabis products. It is not the cannabidiol (CBD) that the Texas' Compassionate Use Program is currently based upon.

By relabeling it "medical marijuana," the program would be instantly transformed into a way to get the psychoactive THC high with the blessings of the State. It's a sleight of hand, a back door way to legalize marijuana in Texas, and make Texas' laws just like other "medical marijuana" States. The pot lobbyists know that attempts to limit or regulate THC content of "medical marijuana" products are useless and have failed in every State in the country that's tried. As States with "medical marijuana" programs have learned the hard way, legalization in any form opens the door to pot, at grave costs to their States, communities and especially children.

If Texas legislators allow themselves to be duped, or delude the public, and expand the Compassionate Use program to include "medical marijuana," they will have brought legalized pot to Texas.

Texas leaders will go from being seen as snake oil salesmen selling sham CBD medicinals to promoting drugs.

Abuses of "Medical Marijuana" Programs Are The Rule

Texans may have come to believe that State "medical marijuana" programs are genuine ways for patients to get medicines and that these programs mirror established medical prescription practices. The public is assured that they've been designed with regulations and oversight to protect patients and the community. 

 

Texas legislators should have known when they patterned their CBD Compassionate Use program precisely like "medical marijuana" programs around the country, that regulatory oversight of these programs has proven to be dismal in every State in the country and that a plethora of abuses and corruption quickly surfaced with every program.

No State has been able to curtail the rampant abuses in "medical marijuana" programs.

According to a DEA report, a third of prescribing doctors under States' "medical marijuana" programs had blemished licensing board records, including disciplinary actions against them for fraud, misuse of prescription or illicit drugs and negligence. In Oregon, a single doctor at a marijuana clinic wrote 8,760 marijuana authorizations in a year, one every 15 minutes. More than 70% of recommendations in the entire State of Colorado had been written by fewer than 15 physicians. In Arizona, exams and green cards were purchased on the internet from doctors who had never seen patients. Similar problems have been documented in Colorado, California, Michigan and elsewhere − with doctors developing entire profitable practices around providing "medical marijuana" eligibility for patients not in their care.

Arizona was a poster child for "medical marijuana" abuses. Naturopaths, not licensed medical professionals, were writing most of the recommendations for medical marijuana cards and a ADHS study found that just two dozen practitioners had written more than 34,000 recommendations, at a rate of one an hour. One naturopath alone had written 3,000. Worse, the director of the Naturopathic Physicians Medical Board and the Arizona Acupuncture Board of Examiners was forced to resign and his license suspended after an investigation led to felony indictments when it was uncovered his dispensary was illegally selling "medical marijuana" out the back door, operating a criminal syndicate, and involved in fraud and forgery. While the manager of the dispensary faced criminal charges, the owners merely changed the name of their corporation and the names listed on the business license, and under a new name, opened another dispensary in another town with the approval of local officials.

"Medical marijuana" has been sold to the public as a way to help terminally ill patients and those suffering from conditions with no other treatment options – but this is not the reality in any "medical marijuana" program in the country. Arizona Department of Health Services, for example, as well as national figures, reveal that “medical marijuana” programs are being used primarily as a ruse and way for people to get pot to get high.

This fact has been known since these programs began. An examination of more than a quarter-million “medical marijuana” users across seven States, published in the Journal of Global Drug Policy and Practice, found virtually none of the "medical marijuana" users had serious medical conditions. Only 0.01% were terminally-ill patients in hospice, 1.3% reportedly had AIDS/HIV, and 3.18% stated they had cancer. Instead, nearly all − 91% − obtained “medical marijuana” cards for reported pain, a subjective and unverifiable complaint, while they did not report an associated serious medical condition.

Arizona DHS quickly found that its "medical marijuana" laws were being abused, and five years into the program, the abuses only continued. Of the qualifying conditions to obtain "medical marijuana" green cards, only 2.7% of registrants stated they had cancer; 1.13% said they had PTSD, and less than 1% of patients made up each of the other serious conditions. Most “medical marijuana” registrants (over 80%) cited chronic pain as their qualifying condition. Yet most card holders are under age 40, with two-thirds under age 50, and men outnumber women more than 2:1. This describes the exact profile of marijuana substance abusers…not patients suffering from chronic pain. It is well documented in the medical literature that legitimate chronic pain sufferers are primarily older women.

More than a decade later, Arizona's "medical marijuana" program's abuses are even more pronounced and the program has been proven to be completely illegitimate. Yet the State has been disinterested in doing anything it. Their latest report for November 2020 shows that, while participants reflect an even younger population, 94% of green card holders claim to have chronic pain. In comparison, only 0.45% reporting to be suffering from seizures, for example.

Nationwide, the overwhelming majority (64%-74%) of “medical marijuana” registrants are young men. Usage data reveal that nearly all have a history of recreational pot use. "Medical marijuana" programs do not have the usual controls of modern medical practices to ensure the best interests of patients.

Instead, they essentially enable substance abuse.

"Medical Marijuana" – Raising Pot Users

State-endorsed "medical marijuana" programs have given the public the misleading perception that marijuana is safe. Legislating the ability of physicians to write "prescriptions" for "medical marijuana" has only added to the impression of safety and validity, wrote researchers in Clinical Microbiology and Infection. Referring to marijuana as "medical marijuana" has especially given young people the message that it's a medicine and therefore must be okay. Not only innocent young people, but vulnerable patients desperately hoping for relief, are being put in danger.

They become users.

"Medical marijuana" users become regular users. People taking marijuana products for medicinal purposes are three times more likely to use cannabis daily or almost daily, according to addiction specialists from Ann Arbor, Michigan.

People taking "medical marijuana" products medicinally also unknowingly consume higher potency doses that are many times higher than any suggested medicinal use for pain, reported North Carolina researchers. Their study of 8,505 products from 653 dispensaries across the country being sold to consumers online as "medical cannabis," found that the advertised potencies ranged from 15% to 30% THC and were no different than the potencies being sold for recreational use by dispensaries in Colorado and Washington. No matter how compared, they said, there is no meaningful difference between medicinal and recreational cannabis being sold to consumers anywhere in the country.

Together with today's high potencies, this higher exposure to marijuana puts "medical marijuana" users at the greatest risks for the most serious dangers, such as substance abuse disorder and psychosis.

"Severe intoxication, hyperemesis, psychiatric symptoms, and severe cardiovascular events have been reported to be a major cause of cannabis-related visits to emergency departments in Colorado," they said. The prolonged use of high potency cannabis increases the risk for psychotic disorders by five-fold in daily users compared to never users, increases the risk of memory impairment and paranoia, and is associated with cannabis admissions to drug treatment. "Our data suggests that medicinal programs in the U.S. are not using scientific evidence to develop a legal framework for the safe provision of medicinal cannabis," they concluded.

Medical researchers in Colorado examined hospitalizations and emergency department visits and found that mental illness emergency room visits associated with marijuana were five-fold higher than those unassociated with marijuana. Reporting their analysis in the journal Preventive Medicine, they added that after local liberal "medical marijuana" legislation in 2010, the number of marijuana exposure calls to poison control also more than doubled.

Remember, "medical marijuana" is the exact same thing as recreational street pot
in every way. Legislative differentiations do not change that fact.

Yet, fewer than half of all "medical marijuana" dispensaries advise patients of potential side effects and almost none warn of potential contraindications, the North Carolina researchers said, while nearly all "promote ill-supported medical benefits."

The "Marijuana" Message to Young People

The messaging and more relaxed attitudes towards marijuana in legalization States have worked to change cultural norms and make it seem more acceptable and less dangerous. Residents in States with legalized recreational or medical marijuana are more likely to believe marijuana has healthful benefits, that smoking is safer than cigarettes, and to use marijuana, according to recent research in the Journal of Addictive Medicine.

Marketing works and what people come to believe is reflected in their actions. Marijuana use is highest in recreational legalization States (20%), followed by "medical marijuana" States (14.1%) and lowest in States where pot remains illegal (12%). "This is cause for concern, given the tide of commercialization, growing number of high-potency cannabis products, and favorable media coverage promoting use for health problems," the addiction researchers said.

Children most take what they see and hear around them to heart. Forty percent of young people have come to believe that marijuana is not addictive or harmful. States that have legalized marijuana in any form are also the top States for teen pot use. Not only are more young people using marijuana in “legal” States, they are using it more frequently, according to Monitoring the Future study and University of Washington researchers. They found that legalization resulted in a six-fold increase in self-reported use among youth.

There's been a steady increase in daily marijuana use among our country's 8th, 10th and 12th graders over the past five years. By 2020, 35.2% of high school seniors had used marijuana that year, nearly three out of ten 10th graders, and more than one in ten 8th graders, the Monitoring the Future Study reports. Marijuana is the most used illicit substance among young people today. Alcohol use has also been increasing, but daily use of marijuana among seniors, for example, is 2 1/2 times higher than those using alcohol daily.

According to the latest September 2020 report from on the impact of legalization in Colorado, regular marijuana use in ages 12+ in Colorado is 76% higher than the national average, and use among adults 18+ is 73% higher than the national average. These trends and numbers are even greater among young adults 18-25, according to Smart Approaches to Marijuana's report on State marijuana legalization.

Kids and teens have found it easy to get pot in States that have legalized marijuana. By 2016, 11th graders in Oregon said pot was easier to get than cigarettes, according to the latest report from Oregon-Idaho High Intensity Drug Trafficking Area. The latest 2017 Oregon Healthy Teens Survey found 6.7% of 8th graders and 21% of 11th graders said they'd used marijuana within the past month.

"Medical marijuana" legalization gives young people an especially dangerous message − that pot is not just safe but even good, since it is a "medicine" with supposed health benefits. “Medical marijuana” laws are widely recognized as responsible for most of the growth in teen use of marijuana.

The growth of young people using marijuana is greater in "medical marijauana" legal States. National Survey on Drug Use and Health data found that the number of teens who smoke pot increased by 33% in “medical marijuana” States, while increasing 6% in the rest of the country.

State "medical marijuana" laws are leading larger numbers of young people to try marijuana, concluded researchers at UC- San Francisco. They analyzed U.S. National Survey on Drug Use and Health data from 2004-2013 and found that young people in States with "medical marijuana" laws were more likely to initiate using marijuana compared to States without such programs. Delaying the age that young people start using marijuana can reduce their risks for use disorders later in life, they said..

Not only is the "medical marijuana" messaging dangerous for young people, it makes it more available to minors and puts them most at risk of the consequences. In Colorado, 48.8% of teens admitted to substance abuse treatment had obtained their pot from a registered "medical marijuana" user.

Neighborhoods, doctors and clinics near marijuana dispensaries in Denver, for example, report the destructive impact "medical marijuana" has had on youth. Dr. Christian Thurstone, Medical Director of an Adolescent Substance Abuse Treatment Program said that 95% of the hundreds of young people referred to the clinic are having problems with marijuana. They are making poor choices, getting into trouble, dropping out of school, having unplanned pregnancies, sexually transmitted diseases and having accidents. As they withdraw, they can become aggressive and get into fights, leading to more trouble, he said. These young adults have mostly gotten their pot through the State's "medical marijuana" program, either getting their own green card by going online and paying a small fee to a marijuana doctor for a marijuana recommendation or they get it from green card holders selling their grows on the side.

The Myth of Regulating Cannabis

Marijuana legislation in any form − "medical marijuana" and recreational – invites illegal black market sales, illegal growers, drug trafficking and diversion to minors…all under assurances of government "regulations" and oversight. Not one single State in the country has successfully regulated marijuana and contained abuses. Regulations forbidding sales to minors, attempts to limit THC levels, limit quantities allowed for possession or for growing at home for personal use, and every other regulatory effort has been tried − and all have failed, in every State. 

The abuses and problems associated with marijuana legalization are the same with any form of legalization, but are especially morally egregious with "medical marijuana" programs that were sold to the public in the name of compassion.

The Department of Justice and the U.S. Supreme Court recognized nearly fifteen years ago, that there was no difference between "medical marijuana" and recreational marijuana, and that "medical marijuana" exemptions would only serve to increase the supply of illegal street pot. "Medical marijuana" simply offered new opportunities for people who were growing and selling illegally to find some protection from arrest and prosecution by getting a doctor's recommendation to use or be designated as a caregiver. "Overnight, the criminal status of many shifted to one cloaked in legitimacy," wrote George Caplan, former dean of Pacific McGeorge School of Law.

"Medical marijuana" programs also created a new class of illicit sellers who resell "medical marijuana" to recreational users for a profit, Caplan added. "A law born of compassion and humanitarian instincts" has resulted in a big profit-making industry, yet we still have next to no knowledge of marijuana as a successful medical treatment.

Rev. Scott Imler, the cofounder of California's medical marijuana law, Proposition 215, told media he was sickened at what's going on in California in the name of compassion. “Our medical marijuana program is going into the toilet." Dispensaries routinely refer “would-be patients” to an ‘in house doc-in-the-box’” who provides a recommendation to any one with the cash, he said. We created Prop. 215 so that patients would not have to deal with black market profiteers. "But today it is all about the money," he said. "Most of the dispensaries operating in California are little more than dope dealers with store fronts."

Huge amounts of "medical marijuana" is being diverted and sold out the back door of dispensaries illegally across the country, to escape taxes and regulations. Abuses of "medical marijuana" programs are widespread and reported in every State that's enacted marijuana legalization legislation.

The DEA's April 2013 report chronicles years of abuses so overwhelming, State legislative efforts couldn't chase after them fast enough. After Montana legalized "medical marijuana" in 2004, abuses proliferated. Just a couple of examples: a cannabis mobile clinic caravan issued thousands of medical green cards for $150 apiece; illegal dispensaries increased 500%; one doctor operating a cannabis clinic had "seen" 150 patients in 14 ½ hours, claiming to have completed an exam, medical history, and medical plan on each one. The Montana Board of Medical Examiners stated in 2010 that tele-doc services for medical marijuana approvals did not meet standards for prescribing which require hands-on physical examinations but they continued.

After serving 14 warrants at marijuana dispensaries, San Diego County District Attorney said "these so-called 'marijuana dispensaries' are nothing more than for-profit storefront drug dealing operations run by drug dealers hiding behind the State's medical marijuana law."

Oregon has had a State-sanctioned "medical cannabis" program since 1998 and began allowing legal recreational sales in 2015. It epitomizes the catastrophe of marijuana regulations.

Oregon State Police Drug Enforcement Section reported that growers are simply using the green cardholders for cover, and selling their crops on the black market. County sheriffs estimate that as much as half of the illegal street marijuana they’re seeing is being grown under the protection of the State’s "medical marijuana" program. The marijuana drug trade is rough and dangerous, and all carry firearms, said the Sheriffs. They also report a huge increase in home invasion robberies of medical marijuana dealers, many extremely violent.

Sold on the need to eliminate the huge diversion problem and black market of marijuana grown through its "medical marijuana" program, new legislation was introduced in Oregon in 2005 with Senate Bill 1085. It made it illegal for dispensaries or growers to sell "medical marijuana;" liberally increased the number of marijuana plants that card holders could grow, transport or possess; and allowed card holders to have their marijuana grown by other growers with a verification system. Since then, the State has issued endless legislative measures attempting to regulate their "medical marijuana" program and reign in the problems and abuses. None have worked.

Five years into marijuana legalization, Oregon High Intensity Drug Trafficking Area issued the first comprehensive analysis of the marijuana situation in the State. It wasn't pretty. It declared Oregon's cannabis market a "woefully under-regulated industry." Oregon's fueled a massive illegal black market, drug trafficking, and a huge glut of marijuana due to legislation that allows a grow site for every 19 users −  1075% more pot grown than the State's recreational consumers demand. The State has licensed at least 737 recreational retailers and 226 recreational wholesales and given over 20,000 medical caregiver cards allowing them to also grow pot for card carriers.

The report documented that during the first 2 ½ years of legalization:

·       an estimated $48 million in cannabis was trafficked from Oregon to 37 States around the country in an organized black market;

·       illegal grows on public lands continued unabated with 84% of trespass illicit grow sites found on U.S. Forest lands through 2016;

·       53 clandestine extraction labs were discovered resulting in 21 explosions or fires;

·       Oregon Burn Center treated 71 burn victims, one person died;

·       25% of adults reported using marijuana more often and 128,000 said that use pot multiple times a day;

·       21% of 11th graders reported using pot in the last 30 days, along with 6.7% of 8th graders.

In just the first year, cannabis-related emergency room visits increased 85% and poison control calls tripled. State licensed cannabis distributors were concentrated in lower income communities and historically disenfranchised areas. The report also touched on cannabis facilities targeted by violent armed robberies; sexual exploitation and forced labor linked to grows facilities; and bud-trimmers being raped, trafficked and abused.

In Part Five, we'll look at when cannabis turns dangerous.

by Sandy Szwarc, BSN