This is the power point that Dr Sabet presented on September 23, 2013.

1. Current Drug Use Trends
Kevin A. Sabet, Ph.D.
Co-Founder, Project SAM (Smart Approaches to Marijuana)
Asst. Professor, UF College of Medicine
www.kevinsabet.com
www.learnaboutsam.org

2. Overview
• Prescription Drug Abuse
• Synthetics
• Other Drugs
• (Cocaine, Heroin, Methamphet
amine)
• Marijuana

3. Prescription Drug Abuse
1. Depressants: central nervous system include sedatives (calm
and drowsy) and tranquilizers (reduce tension or anxiety).
Ex. Zyperxa, Seroquel, Haldol
1. Opioids and Morphine Derivatives: Painkillers.
Ex. Codeine, Hydrocodone, Oxycodone, Fentanyl
1. Stimulants: Increase energy, alertness but also blood pressure
and heart rate. ADD/ADHD
Ex. Ritalin, Concerta, Dexedrine, Adderall
2. Antidepressants: Psychiatric drugs supposed to handle
depression.
Ex. Prozac, Celexa, Zoloft, Paxil

4. Commonly Abused Prescription Drugs

5. Youth: Prescription Drugs (RX)
• Every day in the US, 2,500 youth (12-17) abuse a
prescription pain relievers for the first time.
– The average age for first time users is now 13 to 14.
– 8% of American 12th graders used narcotics in the past 12 months
(MTF, 2012).
• A 2012 study in the US found that 1.7% of 12 and
13-year olds and 2.5% of 14 and 15-year olds had
abused a prescription drug in the past month
(NSDUH, 2013).
• Almost 50% of teens believe that prescription
drugs are much safer than illegal street drugs.

6. Youth: Prescription Drugs (RX)
• 2.5 million teenagers (12 to 17) in the US have used
prescription drugs in their lifetime (NSDUH, 2013).
– Over 2 million used pain killers such as OxyContin
– Nearly half a million used stimulants such as
methamphetamine.
• According to the National Center on Addiction and
Substance Abuse at Columbia university, teens who
abuse prescription drugs are 2x as likely to use
alcohol, 5x more likely to use marijuana, and 12-20x
more likely to use illegal streets drugs such as
heroin, ecstasy, and cocaine.

7. Prescription Drug Abuse (Rx)
• Of the 1.4 million drug-related emergency room
admissions, 598, 542 were associated with
abuse of prescription drugs
• Prescription drug abuse causes the largest
percentage of deaths from drug overdosing. Of
the 22, 400 drug overdose deaths, opioid
painkillers were the most commonly found
drug, accounting for 38.2% of these deaths.

8. Prescriptions Dispensed for Select Opioids in U.S.
Outpatient Retail Pharmacies, 2000-2009
0
20,000,000
40,000,000
60,000,000
80,000,000
100,000,000
120,000,000
140,000,000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Hydrocodone Oxyocodne methadone buprenorphine tramadol
NumberofPrescriptions
Source: SDI, Vector One: National. Extracted June 2010.

9. Sources of Nonmedical
Prescription Drugs1
9
1 2010; Most recent nonmedical pain reliever use among past year users ≥12 years.
2 The Other category includes the sources: “Wrote Fake Prescription,” “Stole from Doctor’s
Office/Clinic/Hospital/Pharmacy,” and “Some Other Way.”
Bought/Took
from Friend/Relative
16.2%
Drug Dealer/
Stranger
4.4%
Bought on
Internet
0.4% Other 2
4.9%
Free from
Friend/Relative
7.3%
Bought/Took
from
Friend/Relative
4.9%
One
Doctor
79.4%
Drug Dealer/
Stranger
2.3%
Other 2
2.2%
Source Where Respondent Obtained:
Source Where Friend/Relative Obtained:
One Doctor
17.3%
More than
One Doctor
1.6%
Free from
Friend/Relative
55.0%
More than One Doctor
3.3%
SAMHSA
2010, 2011

10. Emergency Department Visits

11. Persons Classified with Substance
Abuse/Dependence on Psychotherapeutics
Results from the 2009-2013 National Surveys on Drug Use and Health (NSDUH)
NSDUH

12. 12
Percent Increase in Admissions
for Specific Opioid Analgesics1:
2000-2006 1 Includes admissions where
primary, secondary, or tertiary
substance was reported as
Other opiates/synthetics.
Excludes admissions for non-
prescription use of methadone.
Analysis restricted to 13 States
that reported detailed drug
codes for 2000 and 2006.

13. 13
% Increase in Admissions for
Heroin and Opioid Analgesics1:
2001-2011
1 Includes admissions where primary, secondary, or tertiary
substance was reported as Other opiates/synthetics.
Excludes admissions for non-prescription use of methadone.
47.66%
0.33%
406.92%
0%
50%
100%
150%
200%
250%
300%
350%
400%
450%
Total visits Heroin Opioid Analgesics
N-SSATS, 2011: TEDS 2001-2011

14. 14
Treatment Admissions
Involving Opioid Analgesics1
1 Includes admissions where primary, secondary, or tertiary
substance was reported as Other opiates/synthetics. Excludes
admissions for non-prescription use of methadone.
SAMHSA
2007
300
320
340
360
380
400
420
440
460
480
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Numberofadmissionsx1000
N-SSATS, 2011: TEDS 2001-2011

15. Drug-Induced Deaths vs. Other Injury
Deaths, 1999–2009*
Source: National Center for Health Statistics, Centers for Disease Control and Prevention. National Vital Statistics Reports
Deaths: Final Data for the years 1999 to 2007 (2001 to 2009); Deaths: Preliminary Data for the years 2008 and 2009
(2010 and 2011).
*Data for 2008 and 2009 are provisional and subject to change.
Causes of death attributable to drugs include accidental or intentional poisonings by drugs and deaths from medical conditions resulting from chronic drug use.
Drug-induced causes exclude accidents, homicides, and other causes indirectly related to drug use. Not all injury cause categories are mutually exclusive.
9/2011

17. 0
1
2
3
4
5
6
7
8
9
10
'70 '72 '74 '76 '78 '80 '82 '84 '86 '88 '90 '92 '94 '96 '98 '00 '02 '04 '06
Deathrateper100,000
Heroin
Cocaine
27,658 unintentional drug overdose deaths
Unintentional Drug Overdose Deaths
United States, 1970–2007
National Vital Statistics System, http://wonder.cdc.gov
Year
Rx Drugs

18. Public Health Impact of Opioid Analgesic Use
Mortality figure is for unintentional overdose deaths due to opioid analgesics in 2007, from CDC
Treatment admissions are for with a primary cause of synthetic opioid abuse in 2007, from TEDS
Emergency department (ED) visits related to opioid analgesics in 2007, from DAWN
Abuse/dependence and nonmedical use of pain relievers in the past month are from the 2008 National Survey on Drug Use and Health
450
148
29
7
Nonmedical users
People with abuse/dependence
ED visits for misuse or abuse
Abuse treatment admissions
For every 1 overdose death in 2007, there were…

19. Economic Costs
• Illicit drug use in the United States is
estimated to have cost the U.S. economy
more than $193 billion in 20071
• $55.7 billion in costs for prescription drug
abuse in 20072
– $24.7 billion in direct healthcare costs
• Opioid abusers generate, on average, annual
direct health care costs 8.7 times higher than
nonabusers3
1. National Drug Intelligence Center. The Economic Impact of Illicit Drug Use on American Society. 2010. http://www.justice.gov/ndic/pubs44/44731/44731p.pdf
2. Birnbaum HG, White, AG, Schiller M, Waldman T, et al. Societal Costs of Prescription Opioid Abuse, Dependence, and Misuse in the United States. Pain Medicine.
2011;12:657-667.
3. White AG, Birnbaum, HG, Mareva MN, et al. Direct Costs of Opioid Abuse in an Insured Population in the United States. J Manag Care Pharm. 11(6):469-479. 2005

20. Prescription Drug Abuse Prevention Plan
• Coordinated effort across
the Federal government
• 4 focus areas
– Education
– Prescription Drug Monitoring
Programs
– Proper Medication Disposal
– Enforcement

21. Education
• Education Goals for
youth, parents, and patients
• Increase awareness about prescription drug abuse
• Patients and parents understand how to use medications
safely, and how to store and dispose them properly
• Main Actions
• Evidence-based public education campaign partnering
with local anti-drug coalitions, and other organizations
(chain pharmacies, community pharmacies, boards of
pharmacies, boards of medicine)

22. Education Gaps
• Physicians:
• 2000 survey: 56 % of residency programs required
substance use disorder training, median number of
curricular hours ranged from 3 to 12 hours1
• 2008 follow-up: ―Although the education of physicians
on substance use disorders has gained increased
attention, and progress has been made to improve
medical school, residency, and postresidency substance
abuse education since 2000, these efforts have not been
uniformly applied.‖2
1. Isaacson JH, Fleming M, Kraus M, Kahn R, Mundt M. A National Survey of Training in Substance Use Disorders in Residency Programs. J Stud Alcohol. 61(6):912-915. 2000.
2. Polydorou S, Gunderson EW, Levin FR. Training Physicians to Treat Substance Use Disorders. Curr Psychiatry Rep. 10(5):399-404. 2008.
3. Lafferty L. Hunter TS, Marsh WA. Knowledge, attitudes and practices of pharmacists concerning prescription drug abuse. J Psychoactive Drugs. 2006 Sep:38(3):229-232.

23. Education Gaps
• Pharmacists
• 67.5% report receiving two hours or less of addiction
or substance abuse education in pharmacy school
• 29.2% reported receiving no addiction education
Pharmacists with greater amounts of
addiction-specific education:
• Higher likelihood of correctly answering questions relating to
the science of addiction and substance abuse counseling
• Counseled patients more frequently and felt more confident
about counseling

24. Prescription Drug Monitoring Programs
http://www.pmpalliance.org/pdf/pmpstatusmap2010.pdf

25. Prescription Drug Monitoring Programs
• Develop and implement ―interoperability‖
system (PMIX, NABP, others)
• Link PDMP with State Health Information
Exchanges (HIE)
• Liberate PDMP data to healthcare providers
as part of provider ―work flow‖ operation
• Ensure Emergency Departments have ―real-
time‖ access to RX data

26. Proper Medication Disposal
• Goals:
• Easily accessible, environmentally friendly method of drug disposal
that reduces the amount of prescription drugs available for
diversion and abuse
• Main Actions
• Publish and implement regulations allowing patients and caregivers
to easily dispose of controlled substance medications
• DEA will continue holding a take-back day at least every 6 months
until a Final Rule is implemented
• Once regulations are in place, partner with stakeholders to promote
proper medication disposal programs

27. Pharmacy Based Programs
• Completes the drug distribution loop
– Patient/pharmacist relationship already exists
• Potential for clinical intervention
– Reasons for unused medication - adverse events, ineffective, cost, etc.
– Stronger patient/pharmacist/prescriber relationship
– Improved health outcomes
• Reverse distribution and disposal mechanisms already in place
• Security and diversion safe guards already in place for current
drug inventory
• Pharmacy based programs have been effectively operating in
other countries and in the U.S.

28. Enforcement
• Goals:
• Assist states in addressing ―pill mills‖ and doctor shopping
• Main Actions
• Provide technical assistance to states on model
regulations/laws for pain clinics
• Encourage High-Intensity Drug Trafficking Areas (HIDTAs) to
work on prescription drug abuse issues
• Support prescription drug abuse-related training programs for
law enforcement

29. Conclusions
• This is a critical time for the ―marriage‖
merging of Public Health and Public
Safety Strategies…
• Striking the right balance of strategies will
ensure the critical availability of these
medications while preventing/reduce
diversion and abuse .

30. What Can The Rx Problem
Teach Us About Illicit Drug
Use?

31. • Rx Drugs Are ―Highly‖ Controlled
• Available and Abused at Extremely
High Rates
• Medical Properties
• Cause Billions in Societal Costs

32. First Choice Drugs:
Youth(Grades 8, 10, 12 Combined)
Substance Past Month Use Past Year
Alcohol 25.5% 45.3%
Cigarettes 18.2% 23.7%
Marijuana 15.2% 25%
Monitoring the Future: Johnston, L. D., O’Malley, P. M., Bachman, J. G., &
Schulenberg, J. E. (2012). Monitoring the Future national results on adolescent drug
use: Overview of key findings, 2011. Ann Arbor: Institute for Social Research, The
University of Michigan.

33. Alcohol
• Alcoholic beverages have been and are the most
widely used psychoactive substances by American
young people.
• Binge drinking (5 > drinks in a row during the
prior two-week interval at least once) is probably
of greatest concern from a public health
perspective.
• In 2011, all measures of alcohol use—
lifetime, annual, 30-day, and binge drinking in the
prior two weeks—reached historic lows.

34. Alcohol Trends
• In 2011, all measures of alcohol use—lifetime, annual, 30-
day, and binge drinking in the prior two weeks—reached
historic lows.
• In 2011, 40% of 12th graders and 27% of 10th
graders reported drinking alcohol in the past
month.
• Since 2003, perceived risk as well as disapproval of
weekend binge drinking has risen in all grades
including in 2011.
– Accredited to public service advertising campaigns.

35. Tobacco
• In 2011, 18.7% of 12th graders and 11.8% of 10th
graders reported using cigarettes in the past
month.
• Perception: 77% of 12th graders perceive
smoking one or more packs of cigarettes a day
as harmful.
• For all three grades, the 2011 levels of perceived
risk are the highest ever observed.

36. Synthetic Marijuana (K2, Spice)
• Synthetic marijuana is a new and major
concern – it refers to herbal mixtures laced with
synthetic cannabinoids, chemicals that act in
the brain similarly to THC, the primary
psychoactive active ingredient in marijuana.
• These mixtures can be obtained legally as
―herbal incense‖ and are perceived as a safe
alternative to marijuana.
• Marketed as a ―legal‖ high.

37. Synthetic Marijuana
• Synthetic marijuana (K2, Spice) was added to
Monitoring the Future, University of Michigan
study in 2o11.
• In that year, 11.4% of 12th graders or 1 in 9 reported
using the substance in the past year.
• According to data from the American Association
of Poison Control Centers, 2,915 calls were
received related to synthetic marijuana in
2010, and 5,471 calls were received in 2011.

38. Synthetic Marijuana
• Health warnings have been issued in numerous
State and local health departments describing
the adverse health affects associated with its
use.
• Hallucinations, Withdrawal, Anxiety, Nausea
• The DEA and state drug control agencies have
recognized the need to monitor and, when
necessary, control these substances. In March
2011, five synthetic cannabinoids were
categorized as Schedule 1 substances.

39. Cocaine
• According to the 2013 National Survey on Drug
Use and Health, the estimated percentage of
persons 12 or older who use cocaine in the past
month was 0.6%, which were similar to the
2011 and 2008 rates.
• Over the last decade, annual prevalence among
12th graders has been declining and stands at a
historical low in 2012 at 2.7%

40. Heroin
• According to the 2013 National Survey on Drug
Use and Health, the number of current (past
month) heroin users 12 or older increased from
281,000 in 2011 to 335,000 in 2012.
• In 2012, there were 156,000 persons aged 12 or
older who used heroin for the first time within the
past year.
• The annual prevalence of heroin users among 12th
graders have fluctuated between 0.7% and 0.9%
from 2005 through 2011. Use has declined in the
past two years.

41. Methamphetamine
• According to the 2013 National Survey on Drug
Use and Health, the number of past-month
methamphetamine users aged 12 or older
decreased by over 20% between 2010 and 2012
(and even more since 2008).
• 530,000 – 2010
• 439,000 – 2011
• 440,000 – 2012
• From 2002 to 2008, past-month use of
methamphetamine declined significantly among
youth aged 12-17, from 0.3 percent to 0.1
percent, and young adults 18-25 also reported a
decline from 0.6 percent to 0.2 percent in 2008.

42. Past Year Methamphetamine Initiates among Persons Aged 12 or Older and
Mean Age at First Use of Methamphetamine among Past Year
Methamphetamine Initiates Aged 12 to 49: 2002-2012

43. Marijuana

44. Marijuana
• The number and percentage of persons aged 12 or older
who were current marijuana users in 2012 were 18.9
million or 7.3% - similar to 2010 and 2011 rates, but
higher than those in 2002 through 2009.
• After a decline in marijuana use among 12th graders from
2006-08, an upturn occurred until 2011.
• In 2012, 22.9% of 12th graders used marijuana in the
past month – an increase from 18.8% in 2007.
– Only 22% of 12th graders perceive smoking marijuana
occasionally as harmful.

45. 0
5
10
15
20
25
30
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Percentreportingpastmonthuse
8th graders
10th graders
12th graders
Trends in current use of any illicit drugs – Past 30 days

47. What drugs do we use?
52.10%
26.70%
7.30%
0%
10%
20%
30%
40%
50%
60%
Current use among persons 12 and older: 2012
NSDUH, 2013
47
TobaccoAlcohol Marijuana

48. 48
Myth 1:
Marijuana Is
Harmless and
Non-addictive

49. 1 in 6 teens become addicted
• The adolescent brain
is especially
susceptible to
marijuana use.
• When kids use, they
have a greater chance
of addiction since
their brains are being
primed.
Wagner, F.A. & Anthony, J.C. , 2002; Giedd. J. N., 2004
1 in 10 adults and 1 in 6
adolescents who try
marijuana will become
addicted to it.
49

50. Addictive Nature of Drugs When
Different Drug Use Starts in
Adolescence
Tobacco
24%
15%
8%
9%
Alcohol Marijuana Cocaine Stimulant Analgesics Psychedelics
Source:Anthony JC, Warner LA, Kessler RC (1994): Comparative epidemiology of dependence
on tobacco, alcohol, controlled substances, and inhalants: Basic findings from the National
Comorbidity Survey. Experimental and Clinical Psychopharmacology 2: 244 - 268
Heroin
25%
20%
17%
14%
50

51. Primary Substance: Admissions (Aged 12 -17)
1993 (Orange) and 2008(Purple)AdmissionNumbersinThousands
Substance(s)
Marijuana Alcohol Stimulants Opiates Cocaine Other Drugs

52. Dependence on or
Abuse of Specific Illicit
Drugs
Persons 12 or Older, 2008
Substance Abuse and Mental Health Services Administration. (2009). O$ ce of Applied Studies.
Treatment Episode Data Set (TEDS):2009 Discharges from Substance Abuse Treatment Services, DASIS.
1,411
Cocaine
4,199
Marijuana
1,716
Pain Relievers
126
Sedatives
175
Inhalants
282
Heroin
351
Stimulants 358
Hallucinogens
451
Tranquilizers
52

53. Today‘s marijuana is not the
marijuana of the 1960s.
• In the past 15 years, marijuana
potency has tripled and since
1960 it grown 5 times stronger.
Increased Potency
53

54. 196
0
196
5
197
0
197
4
197
8
198
0
198
3
198
4
198
5
198
6
199
0
199
2
199
3
199
5
199
6
199
7
199
8
199
9
200
0
200
1
200
2
200
3
200
4
200
5
200
6
200
7
200
8
200
9
201
0
201
1
THC 0. 0. 0. 0. 1 1 1. 3. 3. 3. 3. 3. 3. 4 4. 5. 5 4. 5. 6. 7. 7. 8. 8. 9. 10 10 9. 11 11
CBD 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0.
0
2
4
6
8
10
12
14
MARIJUANAPOTENCY
CBD:
NON-
Psychoactive
Ingredient
Average THC and CBD
Levels in the US: 1960 -
2011
Mehmedic et al., 2010
THC:
Psychoactive
Ingredient
54

55. Cannabis-related emergency hospital
admission rates have been rising
sharply in the US
• From an estimated 16,251 in 1991 to over
374,000 in 2008
ER admission rates rising
SAMHSA, 2011
55

56. Harmful effects on the brain
Marijuana use directly affects the brain
• It affects parts of the brain responsible for:
• memory,
• learning attention,
• and reaction time.
• These affects can last up to 28 days after
abstinence from the drug
Giedd. J.N., 2004 56

57. • Increased risk of mental illness
• Schizophrenia (6 fold)
• Psychosis
• Depression
• Anxiety
Harmful effects on mental
health
Andréasson S, Allebeck
P, Engström A, Rydberg U. , 1987;
Arseneault, L., 2002
57

58. Research shows that marijuana smoke is an
irritant to the lungs.
• Results in greater prevalence of:
• bronchitis,
• cough,
• and phlegm production.
Harmful effects on the lungs
Tetrault, J.M, 2007 58

59. • It contains 50-70 percent more carcinogenic
hydrocarbons than tobacco smoke.
• Evidence linking marijuana and cancer is mixed.
However, marijuana smoke contains an enzyme
that converts hydrocarbons into a cancer-causing
form.
• Evidence on cancer is mixed.
Marijuana smoke is carcinogenic.
Hoffman, D., et al., 1975; Brambilla, C., &
Colonna, M., 2008; Bello, D., 2006;
Tashkin, D. P., 1999
59

60. • Persistent and heavy use among adolescents
reduces IQ by 6-8 points
• Dunedin study; vigorously defended
• According to a government survey, youth with
poor academic results are more than four times
likely to have used marijuana in the past year
than youth with an average of higher grades.
Marijuana use has significant
effects on IQ and learning
Meier, M.H., et al., 2012; MacLeod, J., et al., 2004. 60

61. • Linked with:
• dropping out of school,
• unemployment,
• social welfare dependence,
• and lower self-reported quality of life
Marijuana use is linked to low
productivity and job performance
Fergusson, D. M. and Boden, J.M., 2008 61

62. • Employee marijuana use is linked with
increased:
• absences,
• tardiness,
• accidents,
• worker‘s compensation claims,
• and job turnover
Marijuana use is linked to low
productivity and job performance
NIDA, 2011 62

63. Increased use can lead to increased
drugged driving
• ―Drivers who test
positive for marijuana
or self-report using
marijuana are more
than twice as likely as
other drivers to be
involved in motor
vehicle crashes.‖
63
Mu-Chen Li, J.E., et al., 2011

64. 64
Myth 2:
Smoked/Eaten
Marijuana is
Medicine

65. Marijuana has medical
properties, BUT we don‘t need to
smoke or eat it!
We don’t smoke opium to derive the
benefits of morphine.
So we don’t need to smoke marijuana
to receive it’s potential benefits.
• A distinction must be made between raw, crude
marijuana and marijuana‘s components
Is marijuana medicine?
65

66. Is marijuana medicine?
66
No: smoked or inhaled raw marijuana is not
medicine
Yes: there are marijuana-based pills available
and other medications coming soon
Maybe: research is ongoing

67. Kevin A. Sabet, Ph.D., www.kevinsabet.com
Marijuana is NOT approved as medicine
by:
• The FDA
• The American Medical Association
• The National Multiple Sclerosis Society
• The American Psychiatric Association
• The American Glaucoma Society
• The American Academy of Ophthalmology
• The American Cancer Society
• The American Academy of Pediatrics

68. Studies show that components or
constituents within marijuana have
medical value.
• For instance, dronabinol (also known as
Marinol®) contains lab-made THC and is
widely available at pharmacies as capsules to
treat nausea/vomiting from cancer
chemotherapy
Marijuana has medicinal properties
68

69. Marijuana-based medicines are being
scientifically developed.
• However this process needs improvement
• Research must be done on marijuana‘s
components, not the raw, crude plant
Marijuana-based medicines
69

70. • Sativex® is in the process
of being studied in the
USA.
• THC:CBD = 1:1
• It is administered via an
oral mouth spray
• Already approved in
Canada and Europe
Marijuana-based medicines
70

72. • 87.9% had tried marijuana
before age 19
• 75% of Caucasian patients
had used cocaine and 50%
had used methamphetamine
in their lifetime.
Average medical marijuana
patients
O‘Connell, T.J. & Bou-Matar, C.B., 2007
Profile: 32-year old
white male
history of alcohol and substance abuse
no history of life-threatening illnesses
72

73. • In Colorado, 2% reported
cancer, less than 1% reported
HIV/AIDS, and 1% reported
glaucoma as their reason for
using medical marijuana.
• In Oregon, these numbers are less
than 4%, less than 2%, and
1%, respectively.
Only a small proportion of medical
marijuana users report any serious illness
Colorado Department of Public Health and
Environment, 2011; Oregon Public Health
Authority, 2011
73

74. Majority of medical marijuana users report
using marijuana to treat ‗chronic or severe
pain‘
• 96% in Colorado
• 91% in Oregon
• 93% in Montana
Chronic pain
Colorado Department of Public Health and Environment, 2011;
Oregon Public Health Authority, 2011; Montana Department of
Public Health and Human Services, 2011
74

75. ―We will use [medical marijuana] as
a red-herring to give marijuana a
good name.‖ —Keith Stroup, head of
NORML to the Emory Wheel, 1979
• Advocates have pushed their agenda through
―medicine by popular vote‖ rather than the
rigorous scientific testing system devised by the
FDA.
Legalization behind the
smokescreen
Emory Wheel Entertainment Staff, 6
February 1979 75

76. After the Compassionate Use Act passed in
California in 1996, Allen St. Pierre, the
director of NORML admitted in a TV
interview that
―in California, marijuana has also
been de facto legalized under the
guise of medical marijuana‖
Behind the smokescreen
CNN Newsroom 9 May 2009
76

77. Residents of states with medical marijuana
laws have abuse/dependence rates almost
twice as high as states with no such laws.
Pacula et al (RAND) found that two
characteristics of medical marijuana states
– (1) Dispensaries and (2) Home
Cultivation – were positively associated
with marijuana use
Medical marijuana has led to
increased use
Cerda, M., et al., 2012; Wall, M., et
al., 2011; Pacula et al. 2013. 77

78. • Dispensaries – Are these
serving the sick and dying??

79. Bypassing the FDA Process
Before FDAapproves a drug as medicine, testing is done to:
Determine the
benefits and risks
of the drug
Determine how it
may interact with
other drugs
Assure
standardization
of the drug
Determine the
appropriate
dosage levels
Identify and
monitor
side effects
Identify
safe drug
administration
79

80. Marijuana-Based Medications
• NIH is responsible for research into
marijuana-derived medications.
• 288 NIH-supported projects on
cannabinoids.
• Scheduling less relevant
– Cocaine is Schedule II, no ―Dispensaries‖ allowed
– But it Would Be A Symbolic Victory for
Advocates
– Need an individual FDA-approved product for
medical use

81. A Compassionate
Access Proposal
• Before marijuana-based medications
become more widely available, offer
non-smoked marijuana
components, regulated in
strength, purity, and composition, to:
• Cancer patients
• Terminally ill
• Those with MS, ALS, and AIDS
whose bona fide physicians have
recommended marijuana because
other medications have not worked

82. Bottom Line
We don‘t smoke opium to get the effects of
morphine.
So why would we smoke
marijuana to get its potential
medical effects?

83. 83
Myth 3:
Countless People Are
Behind Bars for
Smoking Marijuana

84. 6%
1.40%
0.40% 0.30% 0.10%
0%
1%
2%
3%
4%
5%
6%
7%
Drug possession Crimes involving
only MJ
MJ-only drug
offenders; no prior
sentences
MJ-only possession MJ-only possession;
no prior sentences
Offense
Drug Possession Offenders
in State Prisons
Percent of State Prisoners, 2004
Bureau of Justice Statistics, 2004 84

85. • Only 0.4% of prisoners with no prior offenses are in
prison for marijuana possession
• 99.8% of Federal prisoners sentenced for drug
offenses were incarcerated for drug trafficking
• The risk of arrest for each join smoked is 1 for
every 12,000 joints
Countless people are NOT behind bars
for smoking marijuana
Bureau of Justice Statistics, 2004 and 2012;
Kilmer, B., et al., 2010
85

86. NumberofSentencedPrisoners
38,900
148,600
224,900 263,800 251,400
0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
1,400,000
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
Estimated Number of Sentenced Prisoners and Drug
Offenders Under State Jurisdiction, 1985 to 2009
Source: Bureau of Justice Statistics, Prisoners in 2009 (December 2010); Prisoners in
1996 (June 1997).
6/2011
All Offenses
Drug Offenses
86

87. Bureau of Justice Statistics, 2010
18%
82%
99.80%
0.20%
Among sentenced prisoners under state
jurisdiction in 2008, 18% were sentenced
for drug offenses.
Of those 18%, 99.8% were
sentenced for drug trafficking
Only 0.2% are
for drug
possession
87

88. 88
Myth 4:
The Legality of Alcohol
and Tobacco
Strengthen the Case
for Marijuana
Legalization

89. Alcohol and Tobacco: A Model?
• Use levels for alcohol and tobacco
are much higher than marijuana
• Industries promote addiction and
target kids
89
Schiller JS, Lucas JW, Peregoy JA. Summary health statistics for U.S. adults: National Health Interview
Survey, 2011. National Center for Health Statistics. Vital Health Stat 10(256). 2012.
Centers for Disease Control and Prevention. Vital Signs: Current Cigarette Smoking Among Adults Aged ≥ 18
Years—United States, 2005–2010. Morbidity and Mortality Weekly Report 2011;60(33):1207–12

90. Alcohol and tobacco use among
teens
• 50% and 44% of youth report that they can
obtain alcohol and
cigarettes, respectively, within a day.
• Youth are least likely to report that they can
get marijuana within a day (31%); 45% report
that they would be unable to get marijuana at
all
The National Center on Addiction and
Substance Abuse at Columbia
University (CASA), 2012
90

91. What incentives do legal corporations
have to keep price low and
consumption high?
• ―Enjoy Responsibly‖
• Taxes today for alcohol are 1/5 of what they
were during the Korean War (adjusted for
inflation)
91
Cook, P. J. (2007). Paying the tab: The economics of alcohol policy.
Princeton, NJ: Princeton University Press.

92. Will legalization diminish the power of
cartels and the black market?
• Marijuana accounts for 15-25% of revenues
gained from drug trafficking groups
• More money is found in human
trafficking, kidnapping, and other illicit drugs
Kilmer, B., et al., 2010 92

93. Will legalization diminish the power of
cartels and the black market?
• In a legal market, where drugs are taxed and
regulated (for instance to keep THC potency below a
certain level or to prevent sale to minors), the black
market has every incentive to remain
• Legalizing marijuana would not deter these groups
from continuing to operate
Kilmer, B., et al., 2010 93

94. Can we trust companies and Big Corporations
not to target youth and the vulnerable?
‗Big marijuana‘
94

95. 95

96. The ―Yale MBAs Are Here‖
Steve DeAngelo Troy Dayton
96

97. ArcView
with investors at the
Washington Athletic Club
97

98. ―Business is driving the change. Business
is the most powerful platform for political
change that‘s existed, when there is money
for government, money for
investors, money for entrepreneurs, and
benefits to communities, that‘s a powerful
incentive for change‖
ArcView Co-Founder Troy Dayton

99. ―The use of marijuana ... has important implications for
the tobacco industry in terms of an alternative product
line. [We] have the land to grow it, the machines to roll it
and package it, the distribution to market it. In
fact, some firms have registered trademarks, which are
taken directly from marijuana street jargon. These trade
names are used currently on little-known legal
products, but could be switched if and when marijuana is
legalized. Estimates indicate that the market in legalized
marijuana might be as high as $10 billion annually.‖
From a report commissioned by cigarette manufacturer Brown and
Williamson (now merged with R.J. Reynolds) in the 1970s.
‗Big marijuana‘
99

100. R.J.Reynolds, 1984 est.:
http://legacy.library.ucsf.edu/tid/eyn18c00
100

101. Tobacco Institute, 1989:
http://legacy.library.ucsf.edu/tid/pvt37b00
101

102. Brown and Williamson, 1972:
http://legacy.library.ucsf.edu/tid
/wwq54a99
102

103. ‗The 2nd Annual National Marijuana
Business Conference And Expo‘ – Nov. 6-
8, 2013 in Seattle
• Expecting nearly 600 people including:
• Dispensary owners and license holders
• Professional cultivators
• Edibles and infused product makers
• Ancillary goods and services firms, from
attorneys to security technology
• Investors and angel investing group leaders
• Conference registration costs $600
‗Big marijuana‘
103

104. 104
Will Big Marijuana
become the new Big
Tobacco?

105. Several vending machines and billboards
have already emerged throughout the
country
105

106. A variety of medical marijuana products
and ‗edibles‘ can be found at
dispensaries:
• Brownies, cake, cookies, peanut butter, granola bars, ice
cream
• Many such as ‗Ring Pots‘ and ‗Pot Tarts‘ are marketed
with cartoons and characters appealing to children:
106

107. 107
Alcohol and Tobacco
legalization teach us
there is no money in
this for anyone
other than
Big Marijuana

108. 108
Myth 5:
Legal Marijuana Will
Solve the
Government‘s
Budgetary Problems

109. Will legalization solve budgetary
problems?
• Few people are currently in jail for
smoking marijuana
• Arrests and regulatory costs will
increase with legal marijuana
109

110. 2.7million
Arrests for alcohol-related crimes in
2008
847,000
Marijuana-related
arrests in 2008
(Does NOT include violence;
Includes violations of liquor laws and
driving under the influence)
―If Only We Treated It Like Alcohol…‖
110

111. Alcohol & Tobacco:
Money Makers or Dollar Drainers?
• For every $1 gained from alcohol and
tobacco tax revenues, $10 is lost in
legal, health, social, and regulatory costs
$$$$$$$$$$$
Urban Institute and Brookings
Institute, 2012; Tax Policy Center, 2008
111

112. Alcohol & Tobacco:
Money Makers or Dollar Drainers?
112
Alcohol
Costs
Tobacco
Costs
$14
billion
Costs
Revenues
$25
billion
$200
billion
$185
billion
Revenues
State estimates found at http://www.nytimes.com/2008/08/31/weekinreview/31saul.html?em; Federal estimates found at
https://www.policyarchive.org/bitstream/handle/10207/3314/RS20343_20020110.pdf; Also see
http://www.tobaccofreekids.org/research/factsheets/pdf/0072.pdf; Campaign for Tobacco Free Kids, see ―Smoking-caused
costs,‖ on p.2.

113. There are 8x as many
alcohol outlets in
poorer, communities of
color than in upper-class
white communities.

114. New Message
A new Big Marijuana industry will target the
most vulnerable, just like Big Tobacco and the
Liquor Lobby have.
We don’t need more arrests in these
communities, BUT we also don’t need more
drugs -- we need job opportunities, health
screening, and proper education – all things
that are compromised when more people
smoke marijuana.

115. 115
Myth 6:
Portugal and Holland
Provide Successful
Examples of
Legalization

116. Neither Holland nor
Portugal have legalized
ANY drug
116

117. In 2001, Portugal changed policy to send users
with small amounts of drugs to “dissuasion panels”
– social worker panels who refer individuals to
treatment, administer fine, etc.
Portugal also implemented robust treatment plan
Portuguese policy
117

118. • Youth use has increased since 2001
• Deaths have gone down
• The impact of is policy unclear, despite extreme
rhetoric
Results are mixed
118

119. The Dutch established the Non-
enforcement Policy in 1976 and saw
the birth of ―Coffee Shops‖
Dutch policy
119

120. • Experienced a three-fold increase in marijuana use
among young adults
• Before Non-Enforcement, the Dutch always had lower
rates of drug use than the US.
• Holland is now #1 country in Europe with marijuana
treatment need
• Scaling back policy
• Coffee Shops Closing
• Cannot sell to non-residents
Results
120

121. What about Jolly Ole‘ England?

122. 122
Myth 7:
Prevention, Interventi
on, and Treatment are
Doomed to Fail – So
Why Try?

123. 123
Policy
Implications

124. The groups pushing for
marijuana legalization have
found a way to make their
issue resonate with everyday
people.
124

125. They have reframed the issue so it is about:
• Voting for compassion for the sick and
dying
• Reducing our prison population
• Stimulating the economy
125

126. Advocates have organized across
US states and around the world
to push their initiatives.
126

127. They have major donors who
fund their work and
messages.
127

128. Spent over $250
Million on
Legalization

129. The National Organization for the
Reform of Marijuana Laws estimates
that Peter Lewis has spent between
$40 million and $60 million funding
legalization of marijuana campaigns
since the 1980s.

130. John Sperling
Over $50 Million

131. They‘ve secured legislative
champions at all levels –
local, state, federal, internation
al.
131

132. They‘ve gotten the attention of
editorial boards and media –
including print, television
and social media.
132

133. Case of Sanjay Gupta:
―Gupta Changes His Mind On
Weed‖
133

134. They‘ve mobilized major
grassroots and student
supporters.
134

135. They are present and active
in every single
academic, think-
tank, UN, and other
international and domestic
discussion on drug policy.
135

136. Most of all: They have
captured the “sensible”
ground, boxing us in as
extremists, old
fashioned, and moralistic.
136

137. What has been the result of
their framing of this issue?
137

138. 138Sources: Gallup http://bit.ly/olrSEQ and GSS
Support for Marijuana Legalization in
the United States Has Reached
Unprecedented Levels
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Year 1975 1980 1985 1990 1995 2000 2005 2010
Do not support legalization Support Legalization

139. National Policy
After 50 years of a movement to
legalize marijuana, 2 states have
now done it – Colorado and
Washington
Marijuana Still Illegal Under
Federal Law and Laws of 48
states
139

140. DOJ Guidance from Holder
Holder did not endorse
legalization
He said that the government would
defer its right to challenge states in
court “right now”
140

141. DOJ Guidance from Holder
He laid out major areas of
importance, including:
- youth use increases
- drugged driving/health
consequences
- advertising for youth
141

142. But has this
already
happened?
142

143. • Passed medical marijuana in 2001
• But no dispensaries until the mid-
2000s
• Between 2006 and
2012, medical marijuana
cardholders rose from 1,000
to over 108,000
• The number of dispensaries rose
from 0 to 532
Colorado post-2009
143

144. Marijuana use among Colorado teens is
currently:
• Fifth highest in the nation
• 50% above national average
Increased teen use
NSDUH, 2013
10.7%
7.6%
Colorado
National average 144

145. Average 5.6% of
students per year
between 2007 and
2009
Distribution to minors
Rocky Mountain HIDTA, 2013
2007-2009 2010-2012
Drug-related referrals for high
school students testing
positive for marijuana
increased
Average of 17.3% per
year between 2010 to
2012
Rose by
over 150%
145

146. In 2007, tests positive for marijuana made up
33% of the total drug screenings, by 2012 that
number increased to 57%
Distribution to Minors
Rocky Mountain HIDTA, 2013 146

147. • Teens who know somebody with a medical
marijuana license are more like than those
who don‘t to report ‗fairly‘ or ‗very‘ easy
access to marijuana
• 74% of Denver-area teens in treatment said
they used somebody else‘s medical
marijuana an average of 50 times
Medical marijuana is easily
diverted to youth
Thurstone, 2013; Salomonsen-
Sautel et al., 2012
147

148. • 29% of Denver high school
students used marijuana in the
last month
• If Denver were an American
state, it would have the
HIGHEST public high school
current use rates in the country
Denver high schools
Healthy Kids Colorado, 2012 148

149. Percent difference between
national and Colorado past-month
teen marijuana usage averages –
2006 and 2011
9.41%
28.73%
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
2006 2011
Rocky Mountain HIDTA, 2013
149

150. In Colorado, fatalities
involving drivers testing
positive for marijuana
rose by 112%.
Increased traffic fatalities
Mu-Chen Li, J.E., et al., 2011; Colorado
Department of Transportation, 2006 150

151. While the total number of car crashes
declined from 2007 to 2011, the number of
fatal car crashes with drivers testing positive for
marijuana rose sharply.
Colorado Dept of Transportation
500
550
600
650
700
750
800
850
2007 2008 2009 2010 2011
Total car
crashes
15
20
25
30
35
40
45
50
55
2007 2008 2009 2010 2011
Crashes
with high
drivers
151

152. In 2011, marijuana-related incidents
accounted for 26 percent of the total ER
visits, compared to 21 percent nationally
Increased ER admissions
Rocky Mountain HIDTA, 2013 152

153. 200%
60%
92%
Under 5 6 to 12 13 to 14
• 200% for kids
under 5
• 60% for kids 6-
12
• 92% for kids 13-
14
Increased ER admissions
Rise in marijuana-related ER visits from
2006 and 2012:
Rocky Mountain HIDTA, 2013 153

154. As the price for marijuana plummets
in legalization states, we can expect
cheap marijuana to be sold in non-
legalization states for a handsome
profit.
• According to the El Paso Intelligence Center (EPIC)
National Seizure System, in 2012, there were 274
Colorado marijuana interdiction seizures destined
for other states compared to 54 in 2005.
Diversion of marijuana
Rocky Mountain HIDTA, 2013 154

155. Two independent reports released in
August 2013 document how Colorado‘s
supposedly regulated system is
not well regulated at all
Poor regulation
155

156. The Colorado State Auditor concluded that:
• The state had not ―established a process for
caregivers to indicate the significant
responsibilities they are assuming for
managing the well-being of their patients,‖ and
that the state ―cash fund‖ was out of
compliance.
Poor regulation
Colorado Office of the State Auditor, 2013 156

157. The Colorado State Auditor concluded
that:
• 50% of ALL recommendations
made by only TWELVE
physicians
Poor regulation
Colorado Office of the State Auditor, 2013 157

158. The city of Denver Office of the Auditor concluded
that:
• The city of Denver ―does not have a basic control
framework in place for effective governance of
the…medical marijuana program.‖
• The medical marijuana records are
―incomplete, inaccurate, inaccessible.‖
• And that many dispensaries are operating
without licenses.
Poor regulation
City of Denver Office of the Auditor, 2013 158

159. 4/20 Rally in Denver
159

160. 4/20 Rally in San Francisco
160

161. Responsible Regulations?
161
• Heavily influenced by CO‘s massive medical
marijuana industry
• Allowing character packaging, edibles, candies
• Can grow much more than you sell
• Advertising allowed in ―Adult Periodicals‖

162. With the DOJ‘s announcement that it will
not enforce the CSA, the reform
group, Marijuana Policy Project
(MPP), announced its plan to get
legalization on the ballot in 10 states by 2017
Legalization on the horizon
162

163. Arizona
California
Maine
Nevada
New Hampshi
Vermont
Maryland
Rhode Island
Hawaii
Alaska
These states include:
Massachusetts
Oregon
163

164. • MPP is currently supporting a petition – the
―Campaign to Regulate Marijuana‖ – to place
legalization on the 2014 ballot
• If passed:
• The manufacture, sale, and possession of up to one
ounce of marijuana becomes legal for adults over
21.
• Creates establishments such as:
marijuana retail stores and marijuana infused-
product manufacturers
Alaska
164

165. • Arizona
• California
• Maine
• Nevada
• Hawaii
• Maryland
• New Hampshire
• Rhode Island
• Vermont
Initiatives supported by MPP are in place to put
legalization on the ballot by 2016 and 2017 in:
Also on the horizon…
MassachusettsOregon Montana
165

166. In all of these states, if the proposed
amendments are passed, the retail sale
and production, and possession of
marijuana will become legal
If passed…
166

167. So What Are Our Choices?
All or nothing?
Legalization (―Regulation‖) vs. Incarceration (―Prohibition‖)
167

168. Not about legalization vs.
incarceration
We can be against legalization but
also for health, education, and
common-sense
Smart approach
168

169. Chair, Patrick J. Kennedy
Launched January 10th 2013
Over 15,000 press mentions
Public Health Board of Trustees
10 state-wide affiliates
169

170. 1. To inform public policy with the science of today‘s
marijuana.
2. To have honest conversations about reducing the
unintended consequences of current marijuana
policies, such as lifelong stigma due to arrest.
3. To prevent the establishment of Big Marijuana that
would market marijuana to children — and to prevent
Big Tobacco from taking over Big Marijuana. Those
are the very likely results of legalization.
4. To promote research of marijuana‘s medical
properties and produce pharmacy-attainable
medications.
Project SAM
170

171. SAM is a national group
with state and local
partners
Kevin A. Sabet, Ph.D., www.kevinsabet.com

172. SAMIA (SAM Interstate Alliance)
State partners who work on state/local
issues
Can be separate 501 (c) (4) or PAC or
simply an informal entity

173. 173

174. 174

175. 175

176. Addressing current policy:
• People should not be stigmatized for their
past use
• No sense in incarcerating users
• People need job and economic opportunities;
by being blocked from them they will re-enter
the illicit market
Smart Approach
176

177. • Robust community-based prevention programs
• community coalitions
• Criminal justice intervention programs
• Probation reforms
• Drug treatment courts
• Non-drug interventions
• Housing
• Education
• Healthcare
Non-legalization reforms
177

178. Recruit Champions
178

179. • Legislators at every level of
government
• Executive branch leaders, at every
level of government
• Media luminaries in every medium
• Business leaders
• Other key influentials (faith
leaders, civic leaders, foundation
leaders, other) 179

180. • Figure out how the marijuana legalization issues
affect them and their constituents/members.
• Discuss these issues in a way that will appeal to
them, their mission and their members.
180
How To Interest Grasstops
Leaders:

181. Frames Win Debates
181

182. How to Frame Our Messages
to Win Back The Public
182

183. Changing the Frame:
• From negative to positive
• From ―old‖ to ―new‖
183

184. Old Message
Marijuana legalization will increase
drug use and workplace related
consequences.
184

185. According to the American Council for Drug
Education in New York, employees who abuse
drugs are:
• 10 times more likely to miss work
• 3.6 times more likely to be involved in on-
the-job incidents
• 5 times more likely to file a workers‘
compensation claim.
185
Facts:

186. 6.5% of high school
seniors smoke marijuana
every day1
, rendering
them virtually
unemployable.
186
1 Johnston, L. D., O'Malley, P. M., Bachman, J. G., & Schulenberg, J. E. Monitoring the Future national survey results on drug use, 2012. Volume I:
Secondary school students. Ann Arbor: Institute for Social Research, The University of Michigan.
Available: http://www.monitoringthefuture.org/data/10data.html#2011data-drugs
Fact:

187. New Frame:
If your community cares about jobs and
employability, you need to care about reducing
marijuana use.
187

188. Old Message
Marijuana use is bad for
memory, motivation and learning
188

189. If you care about academic performance, you
need to care about youth marijuana use.
189
The New Frame

190. Connecting the dots for
elected officials is crucial if we
want results!
190

191. 191

192. There are alternatives…
Smart International
Prevention Treatment Recovery Enforcement Efforts
Kevin A. Sabet, Ph.D., www.kevinsabet.com

193. Parental Involvement in Preventing
Substance Abuse
• In 2012, most youths aged 12 to 17 believed that their parents
would strongly disapprove of their having:
– Alcoholic Beverage (one or two every day) – 90.5%
– Smoking Cigarettes (one or more packs a day) – 93.1%
– Marijuana or Hashish Use (once of twice) – 89.3%
Effect:
– In 2012, past month use of illicit drugs, cigarettes, and
alcohol use were all lower among youths 12-17 who reported
parental involvement.
• 7.6% - Rate of past month illicit drug use with parental
involvement.
• 18.1% - Rate of past month illicit drug use without
parental involvement.

194. Kevin A. Sabet, Ph.D., www.kevinsabet.com

195. Prevention:
Community-based
Planning Multi-Sector approach Reduction in use of …
Alcohol Tobacco Marijuana
Kevin A. Sabet, Ph.D., www.kevinsabet.com
12% 28% 24%

196. Kevin A. Sabet, Ph.D., www.kevinsabet.com

197. Recovery

198. Enforcement:
An untapped opportunity for progress
7 million
Americans in the Criminal Justice System
Nearly a … and a quarter of Federal
third of State prisoners committed their crimes
prisoners … under the influence of drugs
5 million
On Probation or Parole
2 million
Incarcerated
1/3 1/4

201. Enforcement and Treatment
Can Work Together
For every $1.00 invested in Drug Court, taxpayers save
as much as $3.36 in avoided criminal justice costs alone.
Kevin A. Sabet, Ph.D., www.kevinsabet.com

202. Project Hope
Reduction in
missed
appointments
85%
Reduction in
positive
urinalyses
91%
47%
Arrested Used Drugs Skipped
Appointments
Probation
Revoked
46%
23%
15%
21%
13%
9%
7%
Control Project Hope

203. Drug Market Interventions (DMI)
In Rockford, Illinois, property
crime declined by 24 percent.
In Nashville,Tennessee, drug crime
declined by 39.5 percent.
In High Point, North Carolina, the first
site,indicated that the target area
experienced a substantial decline in
violent (30.6%) and drug-related crime
(32.2%).
In all three communities, interviews with local
residents revealed a perceived decline in crime and
disorder,reported improvement in the quality of
neighborhood life, and appreciation for the police.

204. Re-entry
Kevin A. Sabet, Ph.D., www.kevinsabet.com

205. Thank You!
Questions?
Email
kevin@learnaboutsam.org
www.learnaboutsam.org