December 26, 2013


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Dr. Nora Volkow, NIDA Director, discusses the results of the 2013 Monitoring the Future survey during a teleconference on December 18, 2013. Monitoring the Future tracks annual drug abuse trends of 8th, 10th, and 12th-grade students, including attitudes and perceived risk of specific drugs of abuse. Dr. Volkow is joined by R. Gil Kerlikowske, Director, Office of National Drug Control Policy, and Lloyd D. Johnston, Ph.D., Principal Investigator, Institute for Social Research, University of Michigan.


Jack Stein
Director of the Office of Science Policy and Communications
National Institute on Drug Abuse


Nora D. Volkow, M.D.
Director, National Institute on Drug Abuse

R. Gil Kerlikowske
Director, Office of National Drug Control Policy

Lloyd Johnston, Ph.D.
Principal Investigator, Institute for Social Research, University of Michigan

Location: Teleconference

Time: 10:00 a.m. EST
Date: Wednesday, December 18, 2013

Transcript by My Meetings by Verizon.

Coordinator:  Thank you for standing by. All lines will be in listen only until the question and answer portion of the call. At that time, to ask a question to press Star then 1.

Today's call is being recorded. If you have any objections, you may disconnect at this time. Thank you, you may now begin.

Jack Stein: Good morning everybody. This is Jack Stein. I am the Director for the Office of Scientology and Communications here at the National Institute on drug abuse. Welcome to this teleconference - specifically focused on the monitoring the future 2013 findings.

Before we begin, I just want to note that supporting documentation for the teleconference including press releases, visuals, graphs and an overview of findings can be found on the NIDA Web site which is at

Simply click on news and events tab. And then select the block specific to MTF to be guided to the page. That page will have contact information for the press offices for each of today's speakers.

And if you wish to set up individual interviews, you can contact the press office to do so. We will be operating as follows; I'll be introducing three key speakers who'll be providing some brief introductory remarks.

And then we will open up the lines for individual questions. First will be speaking will be Dr. Nora Volkow. She is the Director for the National Institute on Drug Abuse.

Following her will be Mr. Gil Kerlikowske who's the Director for the Whitehouse Office of National Drug Control Advocacy. Followed by that will be Dr. Lloyd Johnston from the University of Michigan who is the Principal Investigator for the (unintelligible).

So with that, I would like to turn things over to Dr. Volkow from National Institute on Drug Abuse.

Dr. Nora Volkow: Well good morning. I want to welcome you all. And I thank you for your attention in the survey that we do on an annual basis to get an idea of what are the factors of drug use among youths in schools systems.

And at the time, to get a sense of their perceptions - this would be the risk of the drug and the access to this drug. This year actually offered some very good surprises in the positive side. And then actually it also alerts of some area where we need to keep paying attention.

I want to start with a positive. Because I think it's a very good way of starting the morning. They are - we're seeing still - continue to see significant decreases in the patterns of illicit drug use.

And this is extraordinarily important because the drugs that are most frequent abused by teenagers or by adults - by that matter - are the legal drugs -- alcohol and tobacco. And in the case of tobacco, cigarette smoking - the decreases have been actually quite large and for more than 50% decreases over a ten year period.

And they continue to go down. And that is across all of the ages. With alcohol, that decreases is also significant over a longer time period. They are slower. But they are actually on the right direction.

We're also seeing some very positive indicators. This would be the abuse of opiates and analgesics which are prescription medications that contain opiates and which we had seen for many years to be very high in particular the group of drugs under hydrocodone like Vicodin.

We have seen numbers around 10.5% of (unintelligible) use among 12th graders. Well this year we saw a pretty significant decrease to 5.3% of 12th graders which is over a couple of years we have basically been able to bring the prevalence rate of that abuse of that medication for almost half.

The other medication that had before followed with opiates and (unintelligible) is Oxycontin. Again levels that we have not been able to see go down at 4.5% on 12 graders for past year. This year we actually have, I think, something like 3.9%. So also significantly lower.

Another very exciting finding this year of positives was synthetic marijuana which we for the first time in monitoring the future recorded new drug. And so when we saw 11.5% of 12 graders saying that they had abused it last year.

We were of course very concerned. Because it was a very fast out take of a drug much more potent than marijuana because of its effects on the cannabinoid receptors and therefore associated with more adverse effects. It was at 11.5 last year. This year it is 7.9.

So this is, of course, very good news and probably reflecting attention of the media on the adverse consequences that may have changed the attitudes towards it.

Now on the other side, so the negative, the worrisome side, the worrisome side relates to the use of marijuana. We continue to see slow increases in the abuse of marijuana grows all of the three ages -- 10, 12 and 8th grade.

And the indicators that we have of marijuana though, the one that had attracted me the most attention. And not because it had increased from last year to now is the regular use of marijuana. It's 6.5% among 12 graders and 4.4% 10th graders.

These are very high numbers considering that these are kids at school. So we are not entering into these numbers though the drop out or that may have missed school which are much more likely to be the case for marijuana abuser.

Reasons of concern, our lessons are very sensitive, are more sensitive to deleterious effects of drugs of using the brain because the brain is developing. And in particular the cannabinoid receptors which are actually the ones that are simulated by marijuana are intimately involved in the development and the quantitative of the brain.

So interfering with process is likely or could result in changes on the way that the brain functions. Second, we know that the marijuana use of marijuana interferes with learning and memory. These kids at school are going to be unable to properly learn if they are using marijuana regularly. And that will translate into the deterioration of their academic achievement.

And finally, we know from entomological studies that the earlier you start using a drug, the greater the risk of addiction. And in the case of marijuana the studies are showing that the earlier you start - not only the entire rates of addiction to marijuana itself but actually to other drugs of abuse.

So marijuana is an area of concern. And there are also concerns this have been decreases in the perception of risk from these drugs. Another area of concern that I do want to put in the table because it actually has been creeping in the past years. And it has attracted some level of attention is the abuse of stimuli by teenagers.

Twelve graders this increased last year to 8.7%. And these drugs are used not just to get high and have fun, but they are actually used by a kid with the perception that they will improve their performance. So they tend to take it just prior to exams.

So these are to me, the most salient numbers that are coming out of the survey. There are other datasets. And you will hear from them. But I think on one hand we see the positives on the legal drugs. On the other hand, it also address that we need to pay attention to the significant increases that we are observing in marijuana that we need to address. Thanks very much for your attention.

Jack Stein: Thank you Dr. Volkow. Our next speaker will be Mr. Gil Kerlikowske from the office of National Drug Control Policy. You back there?

Gil Kerlikowske: Good. Well, thank you Dr. Stein very much and Dr. Volkow. We appreciate the work that you and everyone at NIDA does and particularly your leadership in protecting America's youth.

I want to take a moment to acknowledge Dr. Lloyd Johnston as a distinguished research scientist at the University of Michigan's Institute for Social Research and the principal investigator of monitoring the future.

This is an important study every year. Lloyd, you have been doing this for a long time. And I really want to personally thank you for your decades of work on the survey.

What I'd like to provide some context about the importance of today's survey results. President Obama has outlined his vision of an America built to last - a nation where an educated skilled workforce has the knowledge, energy and expertise to compete in the global market place.

Yet for too many Americans that vision is limited by drug use which not only limits the potential of the individual but jeopardizes families, communities and neighborhoods. Moreover, thanks to decades of research and study, much of it through NIDA, we know that substance use particularly among young people has serious consequences.

Scientific research indicates that young people are more vulnerable to the negative consequences of drug use. Their brains are still developing. And conditions for their success later in life are being cast in these important formative years.

While this year's survey contained some good news regarding declines in the use of pain relievers and synthetic drugs, it also contains information concerned - should concern every parent, teacher and employer across the nation. And it pretends more serious challenges in the years to come.

Today's results regarding marijuana are disappointing. As Dr. Volkow has pointed out, over the past decade the perception of risk among high school students of regular marijuana use has dropped dramatically.

Making matters worse, more teens are now smoking marijuana then smoke cigarettes. Well this isn't a recipe for raising a healthy generation of young people who are prepared to meet America's challenges.

And yet it should not come as a surprise. Science clearly demonstrates that marijuana is not a benign substance. Among other consequences, it hampers academic performance. It impairs driving. It impacts productivity.

And for some to say that it is less dangerous than other substances is a ridiculous statement. Today for the first time in the history of the survey, there is evidence suggesting that regulation schemes that have been promoted by the marijuana legalization lobby are not succeeding in preventing the diversion of marijuana into the hands of young people as was promised to the voters.

Looking at the last two years combined, 34% of marijuana using high school seniors living in states with medical marijuana laws, say that one of the ways they obtained the drug is through someone else's medical marijuana recommendation.

The good news is, that despite increasing rates of youth drug use, we know we're not powerless against this challenge. And education is our most powerful tool. We'll put simply, prevention saves lives and it cuts costs. Research demonstrates that if we can prevent young people from using drugs and alcohol through their teenage years, the likelihood of them developing substance use disorders, drops dramatically.

So today, I am continuing to call upon all of us to recommit to bolstering education, prevention and involved parenting. The young people represented in today's study are making decisions that are going to affect their future and the future health of the next generation of our leaders, innovators and citizens.

At this critical moment in their development, they deserve full support to make healthy decisions to choose a life that is not hindered by drug use. And for parents looking for resources or tips on how to talk to young people about drug use, we encourage you to visit the partnership at or NIDA's Web site at

Well let me close by saying a word about our path forward. Now I've said many of times before, law enforcement is always going to play a vital role in keeping communities safe. And at the end of the day, however, we cannot arrest our way out of any drug problem.

And the Obama administration has a drug policy reform plan that treats our nation's drug challenge as a public health issue not just a criminal justice issue.

It puts forth a series of alternatives to a war on drugs - to the war on drugs enforcement centric approach on one hand and legalization on the other. These alternatives include expanding prevention, early intervention, treatment, smart on crime reforms that are based on evidence and science rather than ideology or dogma.

This is what 21st century approach to drug policy looks like as we work to build a nation that is healthier and safer. Thank you.

Jack Stein: Thank you, director. Our last speaker is Dr. Lloyd Johnston from the University of Michigan - Dr. Johnston.

Dr. Lloyd Johnston: Thank you, Jack. Thank you all for tuning in. This is the 39th National Survey in the series - began in 1975. And it's a pleasure to announce it with Dr. Volkow and Director Kerlikowske. And thank you Dr. Kerlikowske for your kind comments.

Just to tell you a few things about how the study's done. This year we had about 42,000 students and 389 secondary schools both public and private. And they are representative of students in each of the three grades we study -- 8, 10 and 12 -- in the coterminous United States.

They fill out self-administered questionnaires in a normal classroom for about one class period. And these surveys are conducted by University of Michigan personnel. So the youngsters know that their answers won't fall into the hands of anybody in their school.

The samples as I mentioned are representative of students in each grade. One notable fact to me -- having studied these behaviors over the years -- is the number of drugs that continue to arise on the scene. Our questionnaires have gotten longer, it seems, because there are so many drugs that we ask about. I think we ask about over 50 classes and subclasses of drugs now.

And unfortunately, not a great many leave the scene although some have like PCP. So there's always a concern about the new threats and the danger that we don't know enough to caution people about those threats. And I think we've some of that recently in three of the newer drugs -- synthetic marijuana, bath salts and salvia.

Synthetic marijuana as you've heard is in sharp decline this year in youths. And it started from a pretty high level. The second most widely used drug among the older teens after marijuana itself.

So there's a lot of reports from the poison control centers about adverse consequences up to and including suicide. So I think it's important that we've seen a turnaround on that case. And the FDA scheduled a number of the ingredients to these drugs. And that undoubtedly helped create the turnaround.

Bath salts showed a very sharp increase this year. Maybe the sharpest we've ever seen and the proportion of youngsters who see the dangerous. So I think the word has gotten out largely through the media that bath salts are not something to fool with.

And fortunately, the rates have remained quite low at 1% or less in each of these grades which I think is very good news. You'd like to see it go to zero, of course. But there are still horror stories that come out in the press.

Finally, salvia was introduced into the study in 2009. And then since then we have seen a continuing decline in all three grades. And it continued again in 2013. This is a drug in the mid family that is often smoked.

So those are some good developments about newer drugs. Now some of the established drugs are also declining. Dr. Volkow mentioned some of these inhalants. Gasses are sprayed. The youngsters inhale or huff - have been going down in all three grades. And the decline continues this year. I think that's good news especially for younger teens who are the ones most likely to be using inhalant drugs.

The class of drugs we call hallucinogens -- other than LSD which for the most part is comprised of psilocybin use of shrooms -- also continues to decline in all three grades. And Vicodin as you heard went down sharply this year in 12th grade. Highly significant 2.2 percentage point drop to 5.3%.

So that's good news on a narcotic drug and a legal one with prescription that begins to address the problem that emerged in the late 90s and early 2000. And that is misuse of prescription type drugs.

Needless to say, the declines in cigarette use and alcohol are very important. There are long term declines that continue this year. We saw about a one percentage point drop in the proportion of youngsters in all three grades combined who say that they actively smoke cigarettes.

And that's roughly a one-tenth drop in the number of smokers in the age group. So a very important change and significant this year and it follows a similar change last year. So even though the rates went down more sharply in the late 90s and early 2000s, we're still seeing progress. And I think that's very important.

And with alcohol, we've seen both 30 day use -- that is any use in the past 30 days -- and binge drinking -- five or more drinks in a row -- dropped to their lowest levels in the history of the study.

So we've now seen drops in binge drinking of about six, tenths in 8th grade, four, tenths in 10th grade and three, tenths in 12th grade - so very important and substantial declines since the peak levels were reached in those behaviors.

If you'd like to see more of the detail that we have on tables and figures - and there's a lot - you can look at our press releases. Just go to And right on the homepage there's a connection to the releases. Thank you.

Jack Stein: Dr. Johnston, thank you very much. For anybody who joined the call late, just a once again, to refer you to the NIDA Web site at for supporting documentation relating to monitoring the future. And with that, we have time to open up the lines for questions.

Everybody's lines will be muted except for the individual that in fact, has a question put forth. And we will begin that process right now.

Coordinator: Again, to ask a question depress Star then 1 - one moment. Again to ask a question to press Star then 1. (Jonah Engle), your line is open.

(Jonah Engle): Hi this is (Jonah Engle) from the Beacon. I have a question for Director Gil Kerlikowske. You note rising rates of marijuana use among the youths and decreasing levels of concern about the drug among the population. We've had drug education in schools for at least three decades now. Why do you think that these prevention efforts haven't led to more decrease in marijuana use?

Gil Kerlikowske: We've actually had really sporadic drug education in schools. And in particular, if we look over these last few years, many, many schools along with other programs, have been reduced. It's often times a very short or quick part of maybe healthcare curricula within a school.

But we know from prevention research that it has to be consistent. It has to age specific. And it has to be over a period of years. And I think you could probably count on both your hands the number of schools that have actually taken on in this country, comprehensive, dedicated health related prevention programs.

So I think that's probably one of the reasons. As adults and as of heads of schools and others, we just haven't done a very good job of putting forwards the science and the information the young people need to be able to make a good decision about what they're going to put into their bodies.

Jack Stein: Thank you. I believe there's another question.

Coordinator: (Susan Heview) you may ask your question.

(Susan Heview): Hi thanks for taking my question - (Susan Heview) with Reuters News. We've also seen -- especially last year with elections in Colorado and Washington -- for this growing shift to allow more marijuana use. In what way do you see that trend impacting things here?

Dr. Nora Volkow: Well one of the - there's been a series of reports actually to try to see if there are differences in the prevalence rate of marijuana use among the states that have legalized marijuana recreationally or whether the states that have legalized it for medical purposes. And indeed those states have higher prevalence rates than those that have not among teenagers.

The issue that is difficult to determine if this caused a link. And the reason why one is not simple to disentangle is that those states voted approval for this marijuana because evidently already the perception of those states was different from those that rejected them.

So we don't know what came first. But one of the things that we are doing at NIDA with these changes in policies, we have requested proposals. And we're currently already funding researchers to be able to address what are the consequences of these changes in policy vis-à-vis the prevalence rates of marijuana.

But we're also interested in knowing vis-à-vis the effects on school performance, vis-à-vis the effects on emergency room admissions, vis-à-vis the effects on car accidents.

(Susan Heview): Okay, and how long do you think that will take to figure out?

Dr. Nora Volkow: Well I think that some indicators come faster than others. In particular, for example, that's why we're very interested on looking at the location of achievement. Because increased use of regular marijuana should be able to translate pretty rapidly in changes in performance so being able to track those.

Others like addiction and there's been an increase in the number of individuals that are being admitted for addiction to marijuana. That takes longer because it requires longer exposure. So depending on the outcome, it may be sooner or later. But we're giving this a priority currently.

Jack Stein: Thank you. Another question and please again, continue to identify yourself.

Coordinator: (Debra Brushy) line is open.

(Debra Brushy): Yes thank you so much. Based on the results, from this year's survey, do you have any recommendations for clinicians when it comes to some of these increases? Should they be maybe doing more screens or are there any kind of recommendations that you have.

Dr. Nora Volkow: I think that this is a very, very good question and indeed as we are faced with a increasing the use. And we're speaking just about a lesson. But this is translated - likely to translate also in (unintelligible). And the healthcare system can play a very important role in prevention.

And screening for the use of marijuana - asking the question (unintelligible) with respect to abuse because at once where it's rewarding or relaxing property. We're also questioning for the potential whether they are being receiving prescriptions for marijuana for medical purposes is going to be very, very important.

And again, it's something that the healthcare system has not been paying too much attention to. And to address questions, as for example, how does marijuana interact with other medications that may be used. What is the rate of marijuana use, for example, during pregnancy?

I mean some very important questions that are going - that the patients are going to be faced. For which we have very little information because again, we're facing a new change in policy. But the advice there for the clinician is to screen for the use of drugs in general but defiantly, also for including the use of marijuana to possibly for medical purposes.

Man: One issue that we are aware of is that in the medical marijuana states - and that's a growing number of states. We looked at the youngsters who used marijuana in the past year in those states and then in the states that don't have medical marijuana.

We saw a large difference in the proportion of them who indicate that one of their sources of getting marijuana is other people who have prescriptions. And in fact, 6% of them indicate that they have prescriptions. These are high school seniors. So they're 17, 18 sometimes 19.

So it may not be illegal for them to have prescription at that point. But the general point is that this provides a potential avenue for young people to get marijuana. And think that's something about which most people are pretty concerned.

Jack Stein: Great thank you. Another question in the queue?

Coordinator: (David Pittman) from Medpage Today. Your line is open.

(David Pittman): Hi thank you for taking my call. I wanted to follow up about the point that was just made about the medical marijuana states. Is there any - why do you think this is the case that these prescriptions are falling in the hands of high scholars who it may not be intended for? And what can be done to prevent this?

Also additional Dr. (Johnston), if you can sort of give more information on - you say that the respondent in the survey were representative of the schools and the grades - can you be more specific on how you know that is the case?

Dr. Lloyd Johnston: Of the schools aren't drawn to be representative of marijuana laws states or medical marijuana states. They're drawing to be nationally representative. But a fair number of states do have those laws now. And just trying to remember what numbers of cases are.

That case where we're talking about a 1,000 students in the non-medical marijuana law states answering the questions. And about 600 in medical marijuana law states. So it gives you some idea of the proportions. And to answer both the question about do they use someone else's marijuana. And do they have their own prescription?

(David Pittman): More specifically, I mean, who is it that are - is deciding - how is it decided that these are the (unintelligible) on its representative of their respective schools and grades?

Man: It's another representative?

Man: Yes.

Man: They're representative in the sense that I think they're representative of all states. One very large state that represents a lot kids is California. So that probably weighs in more heavily than the other states that have done so. But I think there's a least a dozen states now that have marijuana use but maybe considerably more than that.

(David Pittman): I'm not sure she meant the first question was answered about why exactly this was the case that medical marijuana prescriptions are falling into the hands of high scholars and what if anything can be done to prevent this.

Man: Do you understand that question.

Dr. Nora Volkow: Yes, no I think it is why are they - how do they end up by having marijuana that is from a prescription that was not intended for them. And that is actually very similar to what we see with the abuse of Psychotherapeutics where we asked researchers who have been asking the question, where do they get their pain medications like Vicodin or Oxycontin or their other - also Ritalins that they are abusing.

And most of the marijuana - I mean in this case we're speaking of prescription - comes from actually they - it's given to them by friends or relatives. But approximately 30% of this comes from drugs that we're given through a prescription.

So this actually just the fact that you are just having them available because it was delivered through a prescription makes these kids take it out from the bathroom cabinet or from their home - so one could see a similar situation.

This, for us, it's new. And I think that the monitoring in the future this is a new question vis-à-vis the prescription. So exactly does it mimic what we've been seeing in psychotherapeutics, we don't know exactly to what extent it mimics. But one can predict that there's a similar phenomenon as we have seen for psychotherapeutics.

Gil Kerlikowske: Let me go ahead. This is Gil Kerlikowske. And also mentioned, the promise in medical marijuana states to the voters was that there would be regulatory schemes to prevent marijuana from falling into the hands of young people.

In every state, that promise has clearly been broken. And I'll give you an excellent example, in the State of Colorado which was held up by the journalist of governing magazine as the gold standard of regulating medical marijuana. Unfortunately, both an audit by the City of Denver and an audit by the State of California or the State of Colorado essentially said that their regulatory scheme that medical marijuana was unregulated.

So I don't think we should be surprised when we see that alcohol gets into the hands of young people. Prescription drugs which are highly regulated and controlled get into the hands of young people. Why we would've believed that the promise that marijuana would not get into the hands of young people, is a bit beyond me.

Dr. Nora Volkow: And also, you know, in bringing up the comment of Director Gil Kerlikowske. I think how many of these things are actually unpredictable. In the past couple of months there was a paper publishing journal that reported a very significant increase in emergency admissions of infants are children that have basically been intoxicated from marijuana from the use of products that have been sold in Colorado.

And this was - it wasn't really in the radar of anyone because nobody has really seen admissions in emergency room contrary to our kids getting poisoned from marijuana. So excess to these products and if someone has a prescription - if parents have a prescription and they are not careful about it, then this could be one of the consequences.

I think that it does highlight the difficulty of having control of these substances. So where those are the ones that you want to protect children and adolescents.

Jack Stein: Okay, we have a number of other questions in the queue. We'll take the next one please.

Coordinator: (Eve Blad) from Education Week. Your line is open.

(Eve Blad): Yes thank you. I'm curious about if you know if there's a correlation between attitudes about the harmfulness of marijuana and the likelihood that a student would use it because of that attitude.

I'm also wondering if you could explain sort of in a simple fashion a little more about the effects of marijuana use on a developing brain. At what age is a teen, sort of, or an adult out of the woods as far as its effect on their brain development? And what part of the brain is affected? What is that? What does that part do?

Man: Maybe I can speak for the relationship with attitudes and Dr. Volkow can speak more knowledgably about the brain effects. Yes we've seen in various historical periods, a strong correlation between changes in proceed risk for a drug including specifically marijuana and subsequent increases or decreases in use.

And we have a couple paper and latitude on that. But we've seen similar effects with cocaine and also documented the literature and with various other drugs. So it's a fairly strong association (unintelligible) preserved risk has become a leading indicator of problems to come.

You don't get many leading indicators in the social sciences. They're mostly in the economic sciences. But this is one. So we take it seriously.

Dr. Nora Volkow: Now with the brain what - I mean, (unintelligible) cannabinoids and they interact with a wide variety of receptors. Those that have been the most investigated are the cannabinoid 1 and the cannabinoid 2 receptors. And particularly the cannabinoid 1 receptor has extremely high concentrations in the brain apart from the traditional (unintelligible) and inhibitory neural transmitters, glutamate and (unintelligible).

Cannabinoid receptors are the most abundant. So they play a role in multiple process. And their function actually varies as a function of brain development. During the stages from fetal to adulthood the brain is changing very abruptly.

And it doesn't really stop changing completely. I mean until we are - even as adults it continues. But the speed of change - the largest changes are basically terminate around age 21, 22. Now during that period of time, and carries from childhood into adulthood, the levels of cannabinoid receptors change dramatically.

So they are extremely, extremely high during childhood and early adolescence. And then they slowly decline to lower levels until you reach those that are achieving adulthood. And the function of these cannabinoid receptors along with the (unintelligible) cannabinoids is to modulate and regulate among other things the in areas of the brain.

So the brain is really a set of networks neurons communicate with one another and this communication short range and long range. And that pattern and disunity of those communications those fibers are in part regulated by convoy nodes.

And so one of the questions that researchers - because research has been showing that if you do expose animals or even (unintelligible) with emerging technologies in humans during adolescents -- and again I'm referring adolescents to marijuana -- you actually can profoundly affect the connectivity. And the connectivity disruption is not wide spread at some areas where you see it specifically expressed.

And in particular, one of the most affected areas is the connections into the hippocampus which is the area that its involved with memory which could in a way perhaps account for why the studies that have looked at intelligence quotations in kids that have abused marijuana during adolescence have reported a declining cognitive abilities. A disruption of the communication of the hippocampus which is involved on everything related to learning could be one of the mechanisms.

So this is one of the major concerns essentially the use of marijuana in adolescents that it will be interfering with the normal orchestration by which the brain develops from inception into the complexity that it reaches as an adult.

Jack Stein: Thank you Dr. Volkow. Just an FYI for those on the phone, if there's more specific interest in this type of discussion, one on one interviews can be arranged via press office. We have another question, I believe.

Coordinator: (Allison Neff) from Alcoholism and Drug Weekly. Your line is open.

(Allison Neff): ...taking my call. I think this is probably for Gil. There's been a lot of discussion about medical marijuana - but what about legalization? The perception that marijuana can be a recreational drug like alcohol and tobacco also being for kids but the top drugs kids use. And, you know, as you just mentioned, we know that the perception of risk is down use is up.

So in terms of legalization, the Federal Justice Department lets this happen in August. So while this was disturbing to many treatment and prevention people, maybe it was too new to be registered in the survey. Do you have any comment on this at all?

Gil Kerlikowske: Sure I'm happy to comment. First of all, I think the memorandum from the Department of Justice is very specific. And I think the very first principal is that they will continue to enforce federal law. But then regarding those two states in particular, Colorado and Washington, they have a series of bars that they will watch very carefully.

And we will be assisting the Department of Justice in that data gathering over areas involving youth use, drugged driving, money that may come from that industry that could be used involving organized crime. So I think that it's an important - it's an important issue and one that clearly these two states are engaging in a very large social experiment and is much of the information that we're beginning to send portends that they're going to have a very difficult time.

Man: It seems improbable that we could have as many states having medical marijuana laws and now two states having full legalization. That wouldn't have an impact on how young people see marijuana. So I'd be quite surprised if the preserved risk had been going up or had been slacked.

In fact it's going down rather sharply. And we have to remember that the effects are not only the direct effects in the state in question. But these discussions as you well know from being in the media are nationwide.

So when two states legalized that was an issue that was carried throughout the country. And youngsters throughout the country were exposed to the discussion and the issues.

Man: Right.

Jack Stein: We have several other questions. And we are getting a little tight on time. So let's move on to the next one please.

Coordinator: (Julian Hater) from the Helen. Your line is open.

(Julian Hater): Yes thank you guys for taking my question. Thank you so much for doing this call. This is defiantly a follow up to these other questions about medical marijuana and legalization. I mean just continuing that effort shouldn't it make sense that as regulatory efforts to medicine marijuana seem to have failed to prevent marijuana from getting to kids, in your opinion.

That legalizing will also lead to that. And kind of, more broadly, isn't this - is there kind of a losing battle here as a larger public opinion seems to be changing that will lead to marijuana. What can you do to combat that?

Gil Kerlikowske: Well this is Gil Kerlikowske. I think that it's important to recognize that for the last several years the president has requested media campaign money for this science to be put forward as it has been for many years about prevention around drug use.

Unfortunately, congress has not funded that in the last two years. We have been working with social media. We've been working with the partnership at to have quality prevention messages that have been tested and retested and evaluated.

And we even know from several peer reviewed articles regarding those prevention messages that they can in fact, that they can be affective. We know that without funding of course it's very difficult then to get that message out. Those that wish to legalize and downplay the concerns regarding marijuana are incredibly well funded.

And we saw that both in Colorado and Washington State with the advertisements that were put forward on every media.

Jack Stein: Do we have another question?

(Operator): (Gabren Watts) from American Psychiatrist Association. You may ask your question.

(Gabren Watts): Hi, yes so it was reported that the synthetic marijuana dropped from 11.5 to 7.9%, roughly a four point drop within a year. What do you think is the reason for this sharp decline in synthetic marijuana?

Dr. Nora Volkow: Well I think that it's going to be speculative because it's based on what we think is going on. We're not that - we have the data. In the healthcare system, for example, that you saw synthetic cannabinoids have been associated with actually very adverse consequences. There have been already several reports in relatively short period of time of individuals smoking this synthetic marijuana ending up with strokes - severe strokes.

And this has to do with the fact that cannabinoids can produce vasoconstriction. And this has attracted a lot of attention of the media. And there has been, of course, some fatalities. Of course, the display of portraying these negative consequences are also - and by the way, are discussing the (unintelligible).

I think that got a way of making youngsters aware that this is a much more risky drug than it's portrayed. In fact, it sold in the stores as not for human consumption. So it is as potpourri in the sense that it would be a benign compound.

I think that's part of the consequences when you have something that's very, very harmful. It's actually the consequences that appear so rapidly that then these actually leads to the decline in the use of the drugs. And we saw that actually to with ecstasy at one point with all of the adverse effects or with MPC that we saw terrible toxicity immediately killed the drug.

Man: I might add that the American Association of Poison Control Centers lists the following as consequences that they see from people who come in and said they have used the synthetic marijuana; severe agitation, nausea, vomiting, muscle spasms, seizures, tremors, intense hallucinations, psychotic episodes, and suicidal and other harmful thoughts and or actions.

These are pretty serious consequences. And it's not surprising in a way when you consider - and this also true for some of the other synthetic drugs - that these are constantly in motion. Because they're moving around molecules in order to avoid the FDA bans.

And nobody's testing these new versions of the drugs. And really nobody knows what the consequences are including the people who making it. So I think it's very important and I've tried to make this point over years - the youngsters realize that these are not people whom they want to be trusting. A lot of these drugs are made in China.

And even the legal products in China, are often harmful. So I think an important message to get out to kids is that these kinds of drugs - whether these or other ones - are particularly dangerous because they're untested. And nobody really knows what the consequences are until they occur.

Jack Stein: Thank you. I believe we have time for two additional questions.

Coordinator: (Lahar Golapor) from Live Science. You may ask your question.

(Lahar Golapor): Hi yes, thank you. So I saw that the reports found that 20 to 30% of teenagers reported having used marijuana in the past month or so. My question is, is this occasional use concerning too? And if so, why?

Dr. Nora Volkow: Is this occasional use, you say, of concern?

(Lahar Golapor): Yes as much as it is - as much as that the daily use is concerning.

Dr. Nora Volkow: I mean a priority I would say that the more frequent that the use of drugs, the higher the likelihood that you have adverse consequences. Nonetheless, monthly use what we say is once a month of use of marijuana, is actually - I would say that it's not trivial. Because if anything, just being the most conservative perspective, marijuana - there's load of cannabinoid receptors in the hippocampus.

And when someone is intoxicated -- and this is no matter what age -- you really cannot memorize or learn. And as a result of that, if you are a student in high school, you are going to be interfering with your performance. And that will then affect your grades. So you start almost like a domino accumulative effect.

There also other reactions of marijuana that are basically, may have consequences to that are negative. When you are not intoxicated - so when someone is intoxicated there is the sense of relaxation. But as the drugs leaves your body, the anxiety goes up. And so you see an increase in anxiety during periods where the individual is not taking marijuana that are also going to be detrimental.

And it's also associated with dysphoria - again, when the drug leaves the body. So you have these adverse consequences. And the one that Director Gil Kerlikowske mentioned, that we cannot underestimate that when you are taking once a month marijuana, either you are your friend, you may be in a car that someone is intoxicated and driving and that in turn is going to increase the likelihood of accidents.

So I would say that being the most conservative even monthly that the not so frequent as regular is an area of concern. And that is - that's why you want to actually basically a prevention, you want to prevent kids from abusing this drugs.

(Lahar Golapor): Okay thank you.

Jack Stein: And we have time for one last question.

Coordinator: (Don Angles) from Beacon. Your line is open.

(Don Angles): That's okay, my question was answered.

Jack Stein: Okay well, thank you. In that respect we will wrap up today's conference. Again is the NIDA Web site on the monitoring the future page that you'll see on the homepage. You can have contact information for all the press offices for each of today's speakers if you wish to set up individual interviews.

Thank you very much for your time today. And please join me in thanking our three presenters and speakers. So thank you very much.

Coordinator: This concludes your conference call. You may now disconnect. Thank you.