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Can Cannabis Harm Your Fetus?

Project CBD submitted this public comment, composed by Adrian Devitt-Lee, to California’s Office of Environmental Health Hazard Assessment ( OEHHA ), which administers the Proposition 65 Program. Approved as a 1986 ballot measure, Proposition 65 requires the state to maintain and update a list of chemicals known to cause cancer or reproductive toxicity.

Project CBD adamantly maintains that current scientific research does not support the designation of cannabis, THC , cannabis extracts, or cannabis smoke as a developmental toxin under Proposition 65.

  • There is insufficient evidence that maternal cannabis use causes low birth weight or long-term adverse developmental outcomes.
  • No negative effects are attributable to cannabis exposure when tobacco and alcohol use are accounted for.
  • Designating cannabis and THC as reproductive toxins under Proposition 65 would misdirect public health and harm reduction efforts away from known teratogens, like alcohol and tobacco.
  • Although cannabinoids are not intrinsically toxic, they may amplify the toxic effects of alcohol, nicotine, and other teratogens. Thus, public health messages should be tailored towards pregnant women using multiple substances.

Introduction

Labeling cannabis, cannabis extracts, cannabis smoke, or THC as reproductive toxins is not justifiable from high-quality scientific evidence.

The concerns surrounding cannabis in pregnancy have far outpaced scientific data showing ill effects. These fears are engendered by poorly designed studies that fail to account for exposure to well-established teratogens, substances that can lead to embryo malformation like tobacco and alcohol, as well as confirmation bias and misunderstandings of statistics.

In nearly every primary study that argues cannabis use during pregnancy is harmful, the authors admit that results are confounded by other drug use. But rather than designing better studies, these repetitious faults are allowed to accumulate, creating a body of research that feels like it demonstrates that cannabis is dangerous in pregnancy. In fact, proper analysis of the currently published data indicates the opposite.

“In nearly every primary study that argues cannabis use during pregnancy is harmful, the authors admit that results are confounded by other drug use.”

The consensus of meta-analyses actually provides some (albeit weak) evidence that cannabis does not lead to negative outcomes in pregnancy, as highlighted in a 2016 publication from the American College of Obstetricians and Gynecologists: “Although these data do not imply that marijuana use during pregnancy should be encouraged or condoned, the lack of a significant association with adverse neonatal outcomes suggests that attention should be focused on aiding pregnant women with cessation of substances known to have adverse effects on the pregnancy such as tobacco,” not cannabis. 1

Why are only meta-analyses considered as “high-quality” evidence?

This public comment only considers meta-analyses, a type of study that attempts to draw firm conclusions from the weight of published evidence. Meta-analyses are considered the highest standard of evidence in medical research, although they are limited by the quality of the publications they analyze.

There is a high rate of false-positives in scientific research, 2 due primarily to misinterpreted statistics and publication bias (a tendency to both ignore contradictory data and preferentially publish positive results). This can sometimes be corrected by a meta-analysis, which may be able to detect confounding variables even when the primary research is not able to. It is related to Simpson’s paradox, 3 wherein aggregate analysis demonstrates the opposite effect of many small studies.

In the context of cannabis, nearly all studies of cannabis and pregnancy are confounded by the use tobacco or alcohol. Primary research, admittedly, often finds harmful effects in the cannabis group. But aggregating many studies in a meta-analysis allows the true culprit (tobacco) to be properly controlled, and so the ostensible harms associated with cannabis disappear.

Evidence regarding adverse pregnancy outcomes

Three meta-analyses on cannabis and pregnancy outcomes have been published. They focus primarily on the effect of cannabis and tobacco on birth weight, as well as preterm birth and other indicators of babies’ health. The most recent meta-analysis, published in 2016 by Connor et al. 4 , analyzed 31 separate studies. Comparing nearly 8,000 infants born from cannabis-using mothers to over 120,000 control babies, they conclude that “the association between maternal marijuana use and adverse pregnancy outcomes may be attributable to concomitant tobacco use and other confounding factors and not marijuana alone”. 5 Unlike most of the primary sources they considered, their study was pre-registered, which is known to dramatically reduce the risk of false-positive results. 6

Tobacco and cannabis are often used by the same groups of people. Since tobacco is a well-known teratogen, it is necessary to consider the possibility that higher rates of tobacco smoking among cannabis-using mothers could account for the risks often seen in primary research.

When Connor et al. first analyzed the data without accounting for tobacco use, they did, in fact, find an association between cannabis use and both low birth weight and preterm birth. There was a 40% increase in the risk of these two complications. But when they stratified their analysis based on tobacco use, the risk attributable to cannabis dropped to around 10% and lost its statistical significance. The authors also looked at a number of secondary measures of harm, such as spontaneous abruption (when the placenta detaches from the uterus). Once again, no negative effects were attributable to cannabis when tobacco use was accounted for.

The quality of a meta-analysis depends on the consistency of the primary research it considers. If the data are produced by widely different methods, a simple meta-analysis may not be appropriate. Heterogeneity is a statistical measure of whether the methods and results fail to be uniform; less heterogeneous data will be more consistent, and the ensuing conclusion of the meta-analysis will be more reliable. The publications used by Connor had significant heterogeneity, suggesting underlying differences in the studies’ populations. But this heterogeneity was eliminated by simply accounting for tobacco use, implying that tobacco is a factor which fundamentally biases much of the primary research on cannabis in pregnancy.

Low birth weight and long-term effects

The first meta-analysis of cannabis’s effect on developmental outcomes was published in 1997 by English et al. 7 They analyzed ten studies, considering only publications that accounted for tobacco use among pregnant mothers. The results are quite similar to Connor et al.: they found cannabis was associated with a 9% increase in the risk of low birth weight, which was not statistically significant. 8

English et al. highlight that there is a bias towards false-positive results. For example, one study did not report numbers for cannabis because there was no harmful effect; thus, this result showing safety could not be included in their analysis. It is notable that even though this publication bias promotes false-positive results, the meta-analysis was negative – it showed no statistical effect of cannabis. They concluded that “there is inadequate evidence that maternal cannabis use, at the levels of consumption typically reported, causes low birth weight.”

The final study on this topic, a 2016 meta-analysis published by Gunn et al., 9 is upfront about its limitations. “Determining a cannabis-only effect [on the fetus] was not possible … it is unknown if the effects found in this manuscript are related to cannabis or are a by-product of alcohol and tobacco use,” they caution. 10 Their publication analyzes 24 studies and does attribute some harm to cannabis (a mean 109 gram decrease in birth weight, seventy-seven percent increased odds for low birth weight, higher risk of anemia, and other complications).

Unlike the studies by Connor and English, however, this report does not attempt to disentangle the known toxicity of tobacco from the postulated effect of cannabis. As a result, Gunn’s analysis does not clearly demonstrate reproductive toxicity attributable to cannabis use. The researchers explicitly acknowledge this: “By conclusion, the effects of cannabis on maternal and fetal outcomes remain generally unknown.” 11

Tobacco toxicity

A 2017 report by the National Academies of Sciences, Engineering, and Medicine stated that there is evidence for a statistical association between cannabis and low birth weight. 12 Their conclusion, however, was based exclusively on the aforementioned study by Gunn et al. It is unclear why Connor’s meta-analysis was not considered.

No negative effects were attributable to cannabis when tobacco use was accounted for.

In summary, accounting for tobacco use among pregnant women improves the quality of reviews and eliminates any ascertainable harms due to cannabis. The available research provides some evidence against the notion that cannabis causes pregnancy complications. All three meta-analyses conclude that harms cannot be attributed to cannabis, though they don’t definitively prove that no such harms exist. More research is warranted, but current scientific results do not support the designation of cannabis, THC , cannabis extracts, or cannabis smoke as developmental toxins under Proposition 65.

Project CBD could only find one other meta-analysis that assessed how prenatal exposure to cannabis affects development in humans. 13 The study sought to predict the likelihood of future conduct problems. Only three studies on cannabis were included in the analysis. If cannabis caused an effect it was too small to be statistically detected. The researchers “report no clear effects of [in utero] cannabis” exposure on conduct problems. 14 Hence, there is not sufficient evidence to suggest that cannabis causes long-term adverse developmental outcomes.

Commentary on preclinical research

If researchers are worried about the harmful effects of cannabis in pregnancy, it is clearly unethical to intentionally expose pregnant women to cannabis. Preclinical research is an alternative to the cross-sectional and longitudinal studies on which the above meta-analyses are based. Despite many limitations, preclinical studies have shed light on an important direction for human research and harm reduction. Although cannabinoids do not seem to cause adverse developmental outcomes, they might amplify the toxic effects of alcohol, nicotine, and other teratogens.

Preclinical studies on mice and rats consistently indicate that activating the endocannabinoid system exacerbates fetal alcohol syndrome. 15,16 Cannabinoids normally regulate cell death. In the combined presence of fetal growth factors and inflammatory molecules, cannabinoids may activate endogenous systems used to kill cancer cells. 17 This leads to cell death and a magnification of teratogenic effects in preclinical models. In the absence of inflammatory chemicals like nicotine, however, cannabinoids do not appear to be intrinsically toxic.

This possible adverse synergy with known teratogens does not justify designating cannabis or cannabinoids as developmental toxins under Proposition 65, especially in light of the clinical data cited above. It does, however, suggest that public health messages should be tailored towards pregnant women using multiple substances.

Preclinical considerations also highlight the need to base conclusions on well-designed studies that properly account for tobacco and alcohol use. If not, the potential synergy between cannabis and true toxins may be misinterpreted as an effect of cannabis itself.

Harming mothers and newborns

Claims regarding the potential dangers of cannabis use in pregnancy are part of a prohibitionist backlash against the increasing societal acceptance of cannabis as a safe medical and recreational substance. Unsubstantiated dangers are promulgated under the guise of caution, rather than in the interest of public health. But research into harm reduction shows that the stigmatization and criminalization of pregnant drug users worsens the lives of both the children and their parents.

Misplaced fears are not inconsequential. Designating cannabis and THC as reproductive toxins under Proposition 65 would misdirect public health and harm reduction efforts away from known teratogens, like alcohol and tobacco. It would erect yet another barrier to scientists trying to research the medical value of cannabis and cannabinoids. And it would amplify the single greatest harm that cannabis can cause to mothers and infants: intervention from Child Protective Services.

Adrian Devitt-Lee, Project CBD ’s chief science writer, is a graduate from Tufts University with a degree in mathematics and chemistry. He is employed as a research chemist at the University College of London.

Sources:

1. Conner SN , Bedell V, Lipsey K, et al. Maternal Marijuana Use and Adverse Neonatal Outcomes: A Systematic Review and Meta-analysis. Obstet Gynecol. 2016 Oct. doi: 10.1097/ AOG .0000000000001649
2. Ioannidis JP . Why most published research findings are false. PL oS Med. 2005 Aug. doi: 10.1371/journal.pmed.0020124
3. Rücker G, Schumacher M. Simpson’s paradox visualized: the example of the rosiglitazone meta-analysis. BMC Med Res Methodol. 2008 May. doi: 10.1186/1471-2288-8-34
4. Conner SN , Bedell V, Lipsey K, et al. Maternal Marijuana Use and Adverse Neonatal Outcomes: A Systematic Review and Meta-analysis. Obstet Gynecol. 2016 Oct. doi: 10.1097/ AOG .0000000000001649
5. Ibid.
6. Warren M. First analysis of ‘pre-registered’ studies shows sharp rise in null findings. Nature News. 2018 Oct. doi: 10.1038/d41586-018-07118-1
7. English DR , Hulse GK , Milne E, et al. Maternal cannabis use and birth weight: a meta-analysis. Addiction. 1997 Nov. doi: 10.1111/j.1360-0443.1997.tb02875.x
8. Ibid.
9. Gunn JK , Rosales CB , Center KE , et al. Prenatal exposure to cannabis and maternal and child health outcomes: a systematic review and meta-analysis. BMJ Open. 2016 Apr. doi: 10.1136/bmjopen-2015-009986
10. Ibid.
11. Ibid.
12. Chapter 10, National Academies of Sciences, Engineering, and Medicine. 2017. The health effects of cannabis and cannabinoids: Current state of evidence and recommendations for research. Washington, DC : The National Academies Press.
13. Ruisch IH , Dietrich A, Glennon JC , et al. Maternal substance use during pregnancy and offspring conduct problems: A meta-analysis. Neurosci Biobehav Rev. 2018 Jan. doi: 10.1016/j.neubiorev.2017.08.014
14. Ibid.
15. Subbanna S, Shivakumar M, Psychoyos D, et al. Anandamide- CB1 receptor signaling contributes to postnatal ethanol-induced neonatal neurodegeneration, adult synaptic, and memory deficits. J Neurosci. 2013 Apr. doi: 10.1523/ JNEUROSCI .3786-12.2013
16. Basavarajappa BS . Fetal Alcohol Spectrum Disorder: Potential Role of Endocannabinoids Signaling. Brain Sci. 2015 Oct. doi: 10.3390/brainsci5040456
17. Szilagyi JT , Composto-Wahler GM , Joseph LB , et al. Anandamide down-regulates placental transporter expression through CB2 receptor-mediated inhibition of cAMP synthesis. Pharmacol Res. 2019 Mar. doi: 10.1016/j.phrs.2019.01.002

Copyright, Project CBD . May not be reprinted without permission.

Should cannabis products include warning labels for pregnant women? Project CBD responds to call for public comment by California’s Office of Environmental Health Hazard Assessment

Marijuana Use During Pregnancy and Child Abuse

Although still illegal everywhere in the United States under federal law, Colorado and Washington have decided not to prosecute marijuana use or production at the state level. Despite this lack of enforcement, women who use marijuana during their pregnancies are being charged with child abuse shortly after giving birth. On this episode of Lawyer 2.

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Featured Guests
Sabrina Fendrick

Sabrina Fendrick currently serves as the Director of Strategic Partnerships for NORML the Washington DC-based National Organization for the Reform.

Carla Lowe

Carla Lowe is the founder of Citizens Against Legalizing Marijuana (CALM). She has been a volunteer anti-drug activist since 1977.

Your Hosts
Bob Ambrogi

Bob Ambrogi is a lawyer, legal journalist, and the publisher and editor-in-chief of LexBlog.com. A former co-host of Lawyer.

J. Craig Williams

J. Craig Williams is admitted to practice law in Iowa, California, Massachusetts, and Washington. Before attending law school, his.

Episode Notes

Although still illegal everywhere in the United States under federal law, Colorado and Washington have decided not to prosecute marijuana use or production at the state level. Despite this lack of enforcement, women who use marijuana during their pregnancies are being charged with child abuse shortly after giving birth. On this episode of Lawyer 2 Lawyer, hosts Bob Ambrogi and J. Craig Williams interview Sabrina Fendrick from the National Organization for the Reform of Marijuana Laws and Carla Lowe from Citizens Against Legalizing Marijuana. Together they discuss conflicting studies and beliefs regarding the benefits, harms, and prohibition of marijuana. Tune in to learn more about Fetal Alcohol Syndrome and Neonatal Abstinence Syndrome as well as the differences between THC, tobacco, and alcohol for pregnant women.

Sabrina Fendrick currently serves as the Director of Strategic Partnerships for NORML the Washington DC-based National Organization for the Reform of Marijuana Laws. In 2010, she founded the NORML Women’s Alliance and served as Director of Women’s Outreach to develop multiple female-focused awareness campaigns to educate women, and empower them to speak out on behalf of progressive cannabis policies. Today Fendrick remains dedicated to increasing women’s involvement throughout all aspects of the legalization movement, including parenting and child custody issues.

Carla Lowe is the founder of Citizens Against Legalizing Marijuana (CALM). She has been a volunteer anti-drug activist since 1977. Carla co-founded Californians for Drug-Free Youth and Californians for Drug-Free Schools. In addition, she chaired the Nancy Reagan Speakers’ Bureau of the National Federation of Parents for Drug-Free Youth. Lowe is a mother of five grown children, grandmother of nine, and former high-school teacher.

Special thanks to our sponsor, Clio.

Transcript

Sabrina Fendrick: Alcohol has shown to have fetal alcohol syndrome. There have been no conclusive studies to show mental health to negatively affect a child.

Carla Lowe: It’s been known for at least 40 years that marijuana can kill or permanently damage or harm a fetus.

Sabrina Fendrick: It’s almost criminal to not all a woman to have that opportunity to keep herself and her child healthy.

Welcome to the award-winning podcast Lawyer to Layer, with J. Craig Williams and Robert Ambrogi, bringing you the latest legal news and observations with the leading experts in the legal profession. You’re listening to Legal Talk Network.

Robert Ambrogi: Hello, and welcome to Lawyer to Lawyer on the Legal Talk Network. This is Bob Ambrogi coming to you from just outside of Boston, Massachusetts, where I write a blog called Law Sites, and also a blog called Media Law.

Craig Williams: This is Craig Williams coming to you from sunny Southern California. I write a legal blog called May It Please The Court.

Robert Ambrogi: Just a quick note before we get started with today’s program. We want to remind our listeners that the Legal Talk Network is conducting a survey to learn more about you, our listeners. We want your feedback. Is there something you’d like to hear more of, or a product you’d like to learn more about on the Legal Talk Network. Let us know. Visit the legaltalknetwork.com/survey. Take just a few minutes to fill out the survey. We thank you in advance for doing that. We appreciate your feedback, and we want you to know that select listeners who complete the survey will be interviewed for an upcoming Legal Talk Network special report. So visit legaltalknetwork.com/survey, and give us your feedback on more of what you’d like to see here.

One other housekeeping matter, I guess, before we finish today’s show, but it’s housekeeping we like to do, which is to thank our sponsor Clio, the online practice management program for lawyers. You can find out more about Clio at www.goclio.com.

Craig Williams: Bob, on a previous show we discussed the arrest of a Tennessee woman because she used methamphetamine during her pregnancy. What happens when the drug is marijuana and you live in a state that’s legalized it? Although it’s still against federal law, women in Colorado and Washington are turning to marijuana products to relieve discomfort while they’re pregnant. As a result, some of them are being brought up on child abuse charges shortly after they deliver.

Robert Ambrogi: We’re going to explore this topic today with two guests who come at from different perspectives. First of all, we would like to welcome to the show Sabrina Fendrick. Sabrina Fendrick is the director of Strategic Partnerships for NORML, a Washington DC based national organization for the reform of mental health laws. In 2010 she founded the NORML Women’s Alliance and served as director of women’s outreach to develop multiple female focused awareness campaigns to educate women and empower them to speak out on behalf of aggressive cannabis policies. Today she remains dedicated to increasing women’s involvement throughout all aspects of the legalization movement, including parenting and child custody issues. Welcome to Lawyer to Lawyer Ms. Fendrick.

Sabrina Fendrick: Hi. Thank you for having me.

Craig Williams: Bob, in addition, we have joining us today Carla Lowe. Ms. Lowe is the founder of Citizens Against Legalizing Marijuana, or known as CALM. She has been a volunteer anti-drug activist since 1977. Carla co-founded Californians for Drug-Free Youth and Californians for Drug-Free Schools. In addition, she chaired the Nancy Reagan Speaker’s Bureau of the National Federation of Parents for Drug-Free Youth. Ms. Lowe is the mother of five grown children, a grandmother of nine, and a former high school teacher. Welcome, Carla Lowe.

Carla Lowe: Thank you. Thank you for inviting me to join you.

Robert Ambrogi: Let’s start today by finding out a little bit more about our guests and the organizations they work with. Of course, we should, as a beginning to our discussion, remind everyone that although Colorado and Washington have legalized marijuana at the state level, marijuana remains illegal everywhere in the United States under federal law. I’m sure most of our listeners are well aware of that fact. But Sabrina Fendrick, let’s start with you and just ask you to tell us a little bit about NORML and about its position on pregnant women using marijuana.

Sabrina Fendrick: NORML, the National Organization for the Reform of Marijuana Laws, was founded in 1970 and has been working to end marijuana prohibition and replace it with a legal framework to control and regulate the marijuana market for the last several decades. We focus on … We represent all consumers and patients, including women, and advocating for their rights, as well as, in terms of pregnancy, challenging negative stereotypes, including the notion that because prenatal exposure to tobacco and alcohol have shown to have significant risks on newborns that marijuana must have similar effects. Studies have shown that not to be the case. We also believe that it undermines women and children’s health and threatens women’s reproductive rights. These are unsubstantiated, overzealous arguments that wrongly presume neglect making behavior and creating it as a criminal act. We believe in defending all adult consumers and the responsible use of cannabis.

Craig Williams: Carla, same question essentially to you. Tell us a little bit about CALM and it’s position on pregnant women using cannabis.

Carla Lowe: We organized CALM four years ago as a political action committee, we’re all volunteers, when we realized that the legalization issue was going to make the California ballot, and we needed to be able to speak out differently than we have done for 37 years as 501c3 groups, going way back to the late 70s when we founded the very beginning of the basic parent movement that saw what marijuana was about and what it was doing to our kids. That’s why we organized. As you know, in California, the legalizers tried to pass legalization four years ago and they failed. We beat them.

In 1996 when the issue first was on the ballot to then make marijuana a “medicine,” giving the citizens the right to determine what’s a medicine, we were not organized then. We were up against then billions of dollars, which we know we always are. When it came now, then fast forward to where we are today, we are organized and networking with parents and law enforcement and community leaders throughout the state of California and throughout the country to fight the further proliferation of marijuana, because we know what it’s doing to our kids.

Robert Ambrogi: I want to ask Sabrina. Sabrina, I know you’re in Denver today. Are you based in Colorado or are you based in Washington DC?

Sabrina Fendrick: I just moved out here from Washington DC, to open our Denver office.

Robert Ambrogi: Oh, great. Okay. What is happening with this issue in Denver, I know that I’ve been able to read of at least one case where a woman who used marijuana while she was pregnant actually faced some charges after she gave birth to the child. Is that a case you’re familiar with at all? Can you tell us a little bit about that case, and have there been others like that?

Sabrina Fendrick: Are you referring to Colorado in the last two years?

Robert Ambrogi: My understanding was that it was a woman by the name of Amber Buster, and that she used marijuana medicinally to treat morning sickness, and that after she gave birth she faced charges relating to child abuse, and that those were, that she was … I don’t believe they were criminal charges. I believe they were administrative charges of some kind and those charges were not pursued against her after she obtained legal representation and fought that a little bit.

Sabrina Fendrick: I’m not familiar with that case in particular, but she is not alone in that particular practice with Child Protective Services. Pregnant women, when they give birth, or if the doctors or nurses feel there is a need to do a drug test they can, whether or not the mother gives permission. If they find positive traces of a drug that they can inform Child Protective Services and have the child removed, or open a case whether civil or criminal, like you said mostly civil, as to whether or not the mother is acting in a neglectful or abusive manner.

Robert Ambrogi: How does that pair with Colorado’s legalization of marijuana? How do law enforcement authorities treat those kind of conflicting laws?

Sabrina Fendrick: There have been some issues with that, actually. A couple of months ago the State House introduced a bill to redefine the definition of child abuse and neglect, because it is so broad and ambiguous that one could determine that marijuana use, because it is a schedule 1 drug on a federal level, could be deemed child abuse, child neglect, while on the other hand state law says that it is legal and should be treated equally as alcohol. Neither of those bills passed, but they were highly controversial, and there were a lot of challenges and supporters for it. It was not an official on our side, because it wanted to increase the scope of what was included, so that if they deemed it worthy they could include marijuana as reason to remove a child.

Carla Lowe: It’s been known for a least 40 years that marijuana can kill or permanently damage or harm a fetus. Even when the THC … I think we need to talk about what this drug. We really should be calling it THC, tetrahydrocannabinol, which is the active ingredient that gets people high. It’s unique characteristic is that it’s fat soluble. That’s the number one problem with it. It cannot dissolve in the fluids in the body. It, unlike almost any other drug, is fat soluble. It can only dissolve in another fatty tissue in the body. The fattiest tissues are the brain and the sex organs.

We have known that even the 1% THC, which was around 40 years ago, or 37 years ago when I got started on this issue. Today the marijuana, the THC is somewhere between 18%, 20%, 25%. It’s a totally different drug. It was known then that fatal brain damage could be done to a fetus two weeks after conception, even before the mom knew that she was pregnant. If the baby didn’t die, there was damage done to the fetuses. I saw with my own eyes at the University of Davis, which is next to Sacramento, I saw before my own eyes the research that was being done on the Rhesus monkeys by Dr. Ethel Sassenrath. Any of your listeners can document any of this or verify it. I saw with my own eyes the babies that were born of the THC, 1% THC moms, listless, apathetic, no motivation. They were totally different from the other babies in the cages next to them.

At that time, I was substitute teaching all over San Juan School District where the first of my five kids was going to school, and I noticed, this was 37 years ago, and I noticed a handful of kids in every class where I was substitute teaching. They were listless. They were apathetic. They were nice kids, but they weren’t involved. All of a sudden I realized that one of those kids was living in my own home, and I didn’t know. So I will never, never, never accept the fact that marijuana does not affect the fetus, and then the child as he develops.

Sabrina Fendrick:I think that this is a perfect example of the overzealous arguments that are conflating behaviors and socioeconomic status with other toxic substances that are being …

Carla Lowe: It’s facts. It’s science.

Sabrina Fendrick: To talk about the monkey study, which was done incorrectly in the 70s, that basically choked monkeys, pumped only marijuana smoke into their face, giving them no oxygen to breathe and essentially shut down their brain due to a lack of oxygen, not due to marijuana.

Carla Lowe: I was …

Robert Ambrogi: Carla, you’ll get a chance, but let her respond to Carla.

Sabrina Fendrick: I would also say that several studies have shown that marijuana does not have a negative correlation with children, one included a 2008 University of Pittsburgh School of Medicine Study. They published findings assessing the effects of prenatal marijuana exposure in 60 children. They said, “There was significant nonlinear relationship between marijuana exposure and child intelligence.” They also said that heavy marijuana use during the first trimester did not have any other additional effects.

One of the more famous studies that has been cited by the National Institute of Health, among other research papers, is Melanie Dreher’s “Prenatal Marijuana Exposure and Neonatal Outcomes in Jamaica,” published by the University of Massachusetts and the American Academy of Pediatrics, which also found no significant difference in birth weight, and actually found substantial benefits to children who were born. The better quality of alertness was higher. Their motor and automatic systems were robust. They were less irritable. They were less likely to demonstrate any imbalance of tone. I could go on. There was another study by the University of Bristol. All of these studies are qualitative and not quantitative. You can argue either side of this.

Carla Lowe: Of course.

Robert Ambrogi: Let me just break real quick. Carla, you’re going to get the first word when we come back, but we do have to just break right here for a few words from our sponsors, and we will be right back and right back to you, Carla, at that point.

Kate Kenny: Hi. My name is Kate Kenny from Lawyer to Lawyer, and I’m joined by Jack Newton, President of Clio. Jack takes a look at the process of moving to the cloud. Now how long does it take to move to the cloud, and is it a difficult process.

Jack Newton: No. With most cloud computing providers, moving your data into the cloud is something that takes just minutes, not hours or days to do. You can get signed up and running with most services in just a few minutes. Even if you have an existing legacy set of data that you want to migrate to a web-based practice management system like Clio, there’s migration tools and migration services that we’re able to offer to each that process. Most firms can be up and running in the cloud in less than five minutes, and can have their data imported in a matter of hours or days.

Kate Kenny: We’ve been talking to Jack Newton, President of Clio. Thank you so much, Jack.

Jack Newton: Thank you, and if you’d like to get more information on Clio, feel free to visit www.goclio.com. That’s G-O-C-L-I-O.com.

Craig Williams: Welcome back to Lawyer to Lawyer. I’m Craig Williams, and with us today is Sabrina Fendrick from NORML and Carla Lowe from CALM. Carla, before the break you wanted to respond to Sabrina.

Carla Lowe: What I really care about doing in this program is letting people know what the drug marijuana is. Common sense says you don’t smoke a medicine. It’s never been a medicine. You will never smoke a medicine. Marijuana cannot be prescribed by any doctor in the United States. Our daughter is a physician. They can only recommend it. In 1977, Keith Stroup said, “First we have to get marijuana accepted as a medicine. It will be the red herring we need in our quest to see marijuana legalized.” It’s been a hoax from day one. To talk about giving moms marijuana. The most critical time in their life is when they’re pregnant with a child. To ever consider that she wouldn’t be held accountable for child abuse, I think is unconscionable.

The person who needs to be held accountable is the physician who recommends that she uses it. I daresay there’s not a doctor around who doesn’t know that cannabis, as your guest said, it is a schedule 1 controlled substance under federal law. As soon as it’s released to a different schedule and doctors can prescribe it, we support all the fast track research that’s being done on some of the cannabinoids. There are 400 chemicals in cannabis. Surely there’s some hope for some, but not in a smoked form.

Robert Ambrogi: Carla, what should happen to the mother who uses marijuana while she’s pregnant? Should she face criminal charges? Is that your position?

Carla Lowe: Well, I would certainly hope that when she got the facts, she would stop immediately, and hopefully it wouldn’t be past the dangerous timeline in the development of the fetus. What should happen to her? I would think she needs to be held accountable. I think it’s criminal to knowingly, now I’m saying knowingly, take a substance that can do this damage to an unborn child. Common sense would say mothers are taught not to smoke. Every sign on every restaurant, you walk in and under the smoking, no smoking, and may be dangerous to mothers, blah, blah, blah.

We know about the fetal alcohol syndrome. We know about the neonatal abstinence syndrome, which they’re really looking at now in the newborns. The science is there. I just want your listeners to really do the research for themselves. I’m concerned about that. I’m concerned about if the kids, the babies do survive that they get into school and become teenagers. If they haven’t been smoking marijuana, that’s when they’re starting in junior high. The kids are dropping out of high school. We need to talk about the social costs of marijuana use today.

Robert Ambrogi: I don’t know the answer to this, and I’m surprised I don’t, but do mothers who drink alcohol, are they treated the same way as mothers who consume marijuana while they’re pregnant? Or does the law distinguish between those things?

Carla Lowe: Alcohol is a legal substance to use. That’s the difference. Marijuana is not.

Robert Ambrogi: But we know that alcohol causes, as you just mentioned, fetal alcohol syndrome.

Carla Lowe: Right.

Robert Ambrogi: We know that for sure. There’s no question.

Carla Lowe: And it’s water soluble. It’s water soluble. It doesn’t even stay in the body. You know I drink a glass of …

Robert Ambrogi: The reason it doesn’t stay in the body is because it is a poison and the body wants to get rid of it as soon as possible. The reason cannabis does stay in the body longer is because we have hundreds of cannabinoid receptors

Carla Lowe: Right.

Robert Ambrogi: Already in our body and in our brain, and the body wants to hold on to the benefits of that, of THC as long as it can. Exactly like you said, alcohol has shown to have fetal alcohol syndrome. There have been no conclusive studies to show marijuana to negatively effect a child. To go to your point about smoking marijuana, there are several ways to consume and ingest marijuana, including eating it in edible form.

Carla Lowe: Of course.

Robert Ambrogi: You can also vaporize it. There are patches you can put on.

Carla Lowe: That’s 100%. That’s right. That’s 100%, almost 85% to 100% pure THC, once vaporized. I think that your listeners need to know that also.

Robert Ambrogi: Actually, there’s a pill that the federal government has approved called Marinol that is also

Carla Lowe: Metanol.

Robert Ambrogi: 100% THC, which to your argument is a legal substance that is given to people with nausea in cancer, AIDS, and several other ailments like that. But if a mother who

Carla Lowe: And cannot …

Robert Ambrogi: Who has severe, severe morning sickness cannot hold down, cannot eat anything, has no nutrients, can’t even swallow a pill to help with her pain and suffering, the only thing that is going to help her keep down her food that will provide nutrients to the baby is marijuana.

Carla Lowe: You know I just …

Robert Ambrogi: Either through edibles or through vaporizing or patch, like I already mentioned. It’s almost criminal to not allow a woman to have that opportunity to keep herself and her child healthy by enabling herself to consume something to hold the rest of her nutrients and minerals down.

Carla Lowe: I agree. Marinol has been around a long time. Doctors use it very sparingly. My daughter, as I said, is an internist. She never uses it, because there are other safer, more effective drugs that are available on the market. But again, edibles and vaporizing, that is just unconscionable when someone is pregnant. I probably was as sick as anybody has ever been during pregnancy five times, violently ill. There’s no way my doctor would have ever said to take anything with THC in it. I think we need to also look at what this is doing when the kids do reach adolescence. That’s another major concern of ours. We know the damage that the THC is doing on the brain. There are studies, and they cannot be refuted. IQ is lower, as much as 8 points in the study group for kids who have been smoking cannabis. The science is overwhelming, and I would say that I will be happy to come … Let me finish.

Robert Ambrogi: But what we’re talking about here, what we’re talking about here is the effect …

Carla Lowe: On the fetus. I’m just saying that [crosstalk 00:22:03].

Robert Ambrogi: On the fetus, and the unique circumstances in Colorado. I’m curious, Sabrina, what the law is in Colorado regarding doctors prescribing this.

Carla Lowe: They can’t prescribe it.

Craig Williams: Well, maybe it’s not even necessary.

Carla Lowe: Excuse me, they cannot prescribe. They can only recommend. Please don’t say prescribe.

Robert Ambrogi: Well, that’s what I’m asking. I don’t know the answer to that.

Sabrina Fendrick: You’re not allowed to prescribe a schedule 1 drug, so she is right. You can only recommend it. That is a freedom of speech between a doctor and a patient.

Craig Williams: Are doctors recommending this?

Sabrina Fendrick: I don’t think that they would publicize that information. But I am aware of people that have used it with their doctor’s knowledge to help with their morning sickness, and to help keep their food and nutrients down. However, even though it is, there is medical marijuana that can be, a doctor can recommend it, they are still subject to Child Protective Services issues. We see that all over the country, including California and other states with medical marijuana. However, more and more cases are being won that the use of medical marijuana is not grounds for abuse or neglect. That’s more so in the case with adolescent children. But it’s something that does occur because a doctor wants to keep their patient comfortable and healthy. If that’s the only thing that will work, then that’s what they are going to prescribe.

Also, to a point is that humans have been using cannabis in pregnancy for thousands of years across the world, including Egypt and China, and they continue to do it to this day in Jamaica. But this is something that has long been a tradition. Forty years ago these parents conflated the issues of harder drugs and a lack of proper education and harm reduction education, and singling out marijuana as the single issue, which has completely warped our entire society’s view on the medicinal benefits of marijuana and neglected to acknowledge the severe, severe social consequences of prohibition.

Carla Lowe: Let’s talk about the social consequences of the use of marijuana in the states that have legalized marijuana either for a “medicine” or in legalization, and look at the rise in traffic accidents. Look at the rise in crime. Look at the rise in dropouts in high school students. I’m a former teacher. I follow the education LF and dropout rate closely. The social costs are overwhelming. We know it’s 10 to 1 …

Sabrina Fendrick: Well, in Colorado, actually, a study just came out that showed crime dropped. The adolescent use of marijuana in Colorado is way below the national average. There has actually not been a rise in direct correlation with simple marijuana use and car crashes. There is always another circumstance.

Carla Lowe: No, no, no.

Sabrina Fendrick: Most of the time, there is alcohol involved. If you’re going to be protecting children and advocating for anything, I would suggest it would be for alcohol, because those have actual proven consequences to children and to our society.

Carla Lowe: The proven consequences are equally glaring for marijuana. The problem is, is that marijuana concern is not popular politically currently with the administration. It’s not popular politically with the media. I submit that were “our side,” and I’m going to just say that in quotes, able to get its message out like your talk show today, if the people really understood what this drug is, and in particular what it’s doing to our kids, yes, the unborn is a primary concern, that those who survive and get to adolescence. It’s criminal.

Craig Williams: Carla, I’m just curious. How do you distinguish alcohol and marijuana, and how the law treats those? Would you want to see alcohol outlawed as well? The health effects, the safety effects, the automobile accidents related to alcohol impairment, shootings related to alcohol impairment. The statistics are horrible for the consequences of alcohol use in our society. Do you see those as parallel, or do you see one as different than the other.

Carla Lowe: No, I don’t see it. I’m concerned about alcohol. Alcohol is a legal drug that can be used responsibly. It’s not fat soluble. It doesn’t stay in the body for periods of time, the half life being one week. We smoke a joint today, all of us sitting here, if we were all in your studio, we smoke a joint today, and we come together a week from now, have a blood test, and we’ve got 50% of the THC in our system. Alcohol, we have nice drink, a couple glasses of wine, and in a few hours we’re fine. Of course not, alcohol can be used responsibly. It’s not good for kids to use. I’m not a prohibitionist. I’m a realist, and I know what marijuana is. Thirty-seven years. I don’t know how long your other guest has been in the trenches, but I’ve got some credentials, and I know what I’m talking about.

Sabrina Fendrick:It’s somewhat intellectually inconsistent to say that one can responsibly use alcohol while an adult can’t responsibly use marijuana. I think there’s a conflation and confusion between use and abuse. Because something is illegal does not mean it’s right. Segregation was a law for a very long time, and people just accepted it as per “health reasons.” We now know that obviously that was a hugely unjust law, and we are now conflating marijuana with these similar issues.

Carla Lowe: I think people, I think the science is on our side. At the time when science reverses it’s findings, I’ll be the first to say, if my daughter can prescribe smoking marijuana, I certainly wouldn’t stand up and keep fighting. I’ll certainly be dead by then. It will not happen in my lifetime. We will never see smoking marijuana. There are other … Listen, I’m a … I have friends whose children have major seizures. I’m on the fast track team to see the cannabinol or the cannabis oil be released for research that has zero THC. I supporting all that fast track. All of us in prevention, across the country, hundreds and hundreds and hundreds of thousands of parents and concerned people, are all in support of that. We’re not crazy.

Sabrina Fendrick: We’ve already seen that prohibition doesn’t work. Children have greater access to marijuana under prohibition than they ever would. The reason that they consume less alcohol, which is at an all-time low, and tobacco, which is also at an all-time low, is because those are legal, regulated, age-controlled substances that encourage responsible use and what’s called harm-reduction education. An abstinence-only policy creates absolutely no legal restrictions, does not encourage any kind of responsible adult use, and simply provokes the youth to rebel in that particular fashion.

Robert Ambrogi: You both make very valid points, and unfortunately we’re getting near the end of our program. Obviously, neither of you are going to agree with each other during this program, but we really appreciate the thoughts that you’ve shared with us and the insights. We do want to give each of you an opportunity to just kind of give us your closing thoughts on this topic before we wrap up the program, and we would also invite you to let our listeners know how they can follow up with you, find out more about the work that your organizations are doing. Sabrina Fendrick, let’s start with you and get your final thoughts.

Sabrina Fendrick: Well, I would just say that one can simply look at the evolution of the arguments of prohibitionists and people trying to keep marijuana illegal. In the 1930s, they were talking about reefer men, as in how marijuana was making black people go crazy and rape white women. Then you move fast forward and in the 70s they would say that marijuana is a gateway drug, and you smoke one hit of marijuana, you’re going to be a heroin addict on the street in an hour. Then you come forward today and there’s talk about THC levels, which is something that most people don’t understand. It’s a scare tactic. It’s rhetoric, but it’s simply talking points.

I think if you take a step back and you do look at all of the research, including the Federal medical marijuana program that’s going on that is continuously dispensing government-grown marijuana to federal patients, there is clearly medical benefit that has been proven and acknowledged both anecdotally and in real research overseas in Israel. The truth is coming out, and society is starting to realize that our crazy laws are not effective. It’s not keeping children away from marijuana. It’s not endorsing responsible use. It’s giving all of the money to criminals and underground enterprises and wasting so many law enforcement resources that could actually go towards real crimes with real victims, such as alcohol car accidents and rape and real child abuse.

It’s just a matter of looking at all of the information in an objective manner, look at it side by side. But you can find more information on NORML.org, and in regards to information on women and pregnancy, NORML.org/women. We have all kinds of information on parenting and responsible cannabis use as a parent, best of practices. Cannabis consumers are humans as well that have the same rights as everybody else, including alcohol consumers.

If you look at alcohol prohibition, that was an experiment that lasted only 10 years, because they realized quickly afterwards that the consequences of prohibition vastly, vastly devastated society, and the benefits of reform were the appropriate steps to take. Children had access, overwhelming access to it. There was no regulation in that aspect. The alcohol, just like marijuana under prohibition, and you can see it with the K2 and Spice was made with dangerous products in unregulated forms that was having devastating consequences on children and our families. You could just look at the parallels and look at the research. You’ll understand that marijuana reform and marijuana legalization are the just and moral direction to go in this country for that policy.

Robert Ambrogi: Thank you very much. Carla Lowe, your final thoughts today.

Carla Lowe: Very simply, the marijuana that we’re talking about today is really THC, tetrahydrocannabinol. That’s the potency issue in the marijuana that we’re concerned about. Not 35, 37, 40 years ago when it was 1%, and all of the research was done then that’s now being confirmed. The difference is, today’s marijuana, THC, is 20, even 25 times stronger than it was then. It is fat soluble. It does stay in the body for great lengths of time. It’s fat solubility issue is key in the fact that it effects, and will only dissolve the brain and the sex organs, particularly concerned about its impact on the developing fetus and/or adolescent.

Further, nobody drinks, really, I don’t think, to get drunk, but very few people smoke pot not to get high. I’ve never known anybody who doesn’t smoke pot to get high because it feels good. Because it feels good is not one of the criteria for a medicine. Cannabis, under federal law, is a controlled substance, schedule 1. It’s never been found safe or effective, and it’s addictive. I would just encourage your listeners to consider what it’s doing to our teenage population and to society in general. Would you really want your physician to be pot high? Do you want a pot smoker driving your kids to school in the morning. Do you want the pot smokers, they’re called dopers because marijuana makes you dopey. Do you want more of them on the highway? Do we want more people in our prisons? Do you want people … Do you know that the greatest number of people admitted to ER for mental health problems are marijuana users.

Go and look at the facts. Our website, again I say, we’re just all volunteers. We’re not funded by millions and millions of dollars as NORML is. I’ve known NORML for 37, 38 years. They’re backed by billionaires. We’re just moms and dads who would love your help in fighting this important fight. The future of our country depends on it. Marijuana diminishes the potential of our kids. Go to CALMca.org, and you will see how our website, we have links to other great organizations. We’re preventionists for the good of our country. Thank you so much for letting me have this great discussion with the lady from NORML.

Robert Ambrogi: Thanks for being with us.

Craig Williams: Thanks for being with us.

Robert Ambrogi: Now we would come to the point in our show where we would each share our closing thoughts. Craig, you get to go first today.

Craig Williams: I’m tremendously disappointed at the argument on the side against marijuana just focused on what are essentially, seems to me to be scare tactics and outdated information that was pretty much taken care of with a significant number of studies that Sabrina mentioned, and harkens back to the language that we heard when prohibition was put into place. Obviously, drugs are meant to make people feel better, especially the narcotics and the morphine, and some of the other drugs that are given when people are having significant problems, so that argument doesn’t sound logical to me.

I recognize that any drug can be abused, but so can alcohol. But in moderation, some of the drugs provide significant benefits. If marijuana provides benefits to people that need it for medical purposes, California’s approved that, and to me it seems like it’s a worthwhile thing. But as far as the topic that we started to talk about, whether or not women should be arrested for using marijuana. If it’s abused, I would say yes, just like alcohol. If alcohol is abused and a child gets fetal alcohol syndrome, then that mother should be dealt with on a treatment basis, as much as a mother should be dealt with that abuses marijuana or any other type of drug. But if it’s used as a benefit, then I think it’s fine.

Robert Ambrogi: Craig, I pretty much see it as you do. The one thing I’m certain of is that criminalization is not the way to deal with this issue. There may be questions. I’m not a doctor. I’m not up on the research regarding the effects of marijuana on the fetus, or of any other drug on the fetus. But I think clearly the way to address this issue is not by criminalizing any kind of a conduct. The answer needs to be through smarter laws, through consistent laws, through laws that let doctors and patients make informed decisions about this, and not laws that threaten prosecution or criminalization for something that may be a medical issue and a medical decision. I think we’re in agreement on this one, Craig. That’s where I come down on it.

That about does it for today’s show. I’d like to thank each of you for taking the time to be with us today and sharing your thoughts on this. It was a really interesting discussion, and happy you could be with us today.

Well, that brings us to the end of our show today. I’m Bob Ambrogi. Thanks a lot for being with us and listening today. Join us next time for another great legal topic. When you want legal, think Lawyer to Lawyer.

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