Marijuana and CDPHE. Tista Ghosh, MD, MPH Deputy Chief Medical Officer

Transcription

1 Marijuana and CDPHE Tista Ghosh, MD, MPH Deputy Chief Medical Officer

2 History of Medical Marijuana in Colorado Amendment 20 - November 2000 July 2001 Registry established Ogden Memorandum 10/2009 Commercial production/distribution HB & SB

3 Medical Marijuana Registry Issue registry identification cards Maintain database of registered users Review petitions for adding debilitating medical conditions to the medical use of marijuana regulations Will administer grants program for clinical and observational research related to potential therapeutic uses of marijuana

4 Colorado Medical Marijuana Registry 140, , ,000 80,000 60,000 40,000 20,000 0 Active Patients December 31, ,679 Active Patients 67% Male Average Age = 41

5 Medical Marijuana Research Program Authorized in 2014 Grants program to fund research regarding the efficacy of marijuana part of medical treatment. The grant program shall fund observational trials and clinical trials.

6 History of Retail Marijuana in Colorado November 2012: Amendment 64 passes December 2012: Creation of Task Force on the Implementation of Amendment 64 March 2013: Task Force issues recommendations on marijuana regulation and taxes May 2013: Governor signs bills related to Task Force recommendations September 2013: Colorado Dept. of Revenue (CDOR) adopts Colorado Retail Marijuana Code (HB ) November 2013: Vote on Proposition AA, a 15% excise tax plus 10% sales tax January 2014: Regulations go into effect

7 Retail Marijuana C.R.S. Sec : Specifically-Designated Roles for CDPHE Only section that directly specifies CDPHE. Several duties outlined: a. "Monitor changes in drug use patterns, broken down by county and race and ethnicity, and the emerging science and medical information relevant to the health effects associated with marijuana use.

8 C.R.S. Sec continued b. "The Department shall appoint a panel of health care professionals with expertise in cannabanoid physiology to monitor the relevant information. The panel shall: Provide a report by 1/31/15 and every 2 years thereafter* Establish criteria for 1) studies to be reviewed, and 2) reviewing studies and other data*, and Make recommendations, as appropriate, for policies intended to protect consumers of marijuana or marijuana products and the general public*. *No required duties until we have funding

9 Legal Marijuana and Public Health Monitor health effects Changes in use Poisonings and Accidents Contaminated products Chronic health issues Education and Prevention Adult abuse Adolescent use Pregnant or nursing mothers Product safety and storage Harm reduction Occupational Health and Safety Infused product safety Laboratory practices Waste disposal

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11 Specific Concerns for Legal Marijuana Photo by Vjiced available under CCA-SA from Wikimedia Commons Marijuana contamination literature reports Chemicals: pesticides, formaldehyde, lead, ammonia Other: aspergillus, salmonella, menginococcus High potency marijuana Butane hash oil Increase in unintentional poisonings Prevention among youth Pregnancy/Breastfeeding

12 Progress So Far.

13 Educational Resources

14 CDPHE Monitoring Activities Target Pop. Problem Monitoring Young Children Accidental Poisoning Pilot surveillance project Colorado Hospital Association (CHA) Data Rocky Mountain Poison and Drug Center Calls Child Health Survey(CHS) - risk factors Youth Adults Pregnant/ Breastfeeding Increased Use/Abuse Poisoning, Overdose, Abuse Accidents/Trauma Increased Use/Abuse Poisoning, Overdose, Abuse Accidents/Trauma Contaminated Products Birth Defects, Developmental Disabilities Healthy Kids Colorado Survey (aka YRBS) Colorado Hospitalization Data Rocky Mountain Poison and Drug Center Calls Colorado Hospitalization Data Colorado Trauma Registry Behavioral Risk Factor Surveillance System (BRFSS) Tobacco Attitudes and Behaviors Survey (TABS) Colorado Hospitalization Data Rocky Mountain Poison and Drug Center Calls Colorado Hospitalization Data & Colorado Trauma Registry Pilot Surveillance (Ski-Related Injuries) Foodborne Illness Surveillance related to Edibles Rocky Mountain Poison and Drug Center Calls Pregnancy Risk Assessment Monitoring System (PRAMS) Active Surveillance (Birth Defects Registry)

15 Population Surveys PRAMS 2014 During any of the following time periods, did you use marijuana or hashish? 3 months before becoming pregnant First 3 months of pregnancy Last 3 months of pregnancy At any time during pregnancy Since baby was born

16 Enhanced Birth Defects Surveillance Pilot Working with Denver Health to develop standard screening questions on marijuana use (frequency and trimester of use, method of use, etc) Match to Birth Defects Registry Similar to a Fetal Alcohol Syndrome surveillance project Details still being worked out

17 Retail Marijuana Public Health Advisory Committee Laura Borgelt, PharmD Pharmacologist University of Colorado Hospital Russell Bowler, MD, PhD Pulmonologist National Jewish Health Al Bronstein, MD Poison Control Representative Rocky Mountain Poison and Drug Center Colorado School of Public Ashley Brooks-Russell, PhD Health Risk Behaviors Health Heath Harmon, MH Local Public Health Representative Boulder County Public Health Neonatal-Perinatal Sharon Langendoerfer, MD Medicine Denver Health Bruce Mendelson, MPA Drug Epidemiology Denver Office of Drug Strategy Andrew Monte, MD, MSc Medical Toxicologist University of Colorado Hospital Judy Shlay, MD Public Health Surveillance Denver Health Christian Thurstone, MD Psychiatrist/Addiction Medicine University of Colorado Hospital George Sam Wang, MD Pediatrician Children s Hospital Colorado

18 Literature Review Strategy Conduct a search of peer-reviewed journals (mainly utilized PubMed) General search strategy: [ marijuana or cannabis ] + [ pregnant or pregnancy or fetal or infant] + [ health effect of interest] + Review titles and abstracts for relevance Download selected articles and sort by focus While reviewing these, note referenced articles that may be important to add: Opposing findings More specific focus Referenced in multiple articles

19 Literature Review Procedures Rate evidence based on strengths and limitations of each study Low, medium or high quality Substantial evidence: at least 1 high quality finding, plus supporting findings, with no opposing findings at least 3 medium quality findings, with no opposing findings Moderate evidence: a single high quality finding only at least one medium quality finding, plus supporting findings with no opposing findings mixed findings, heavily favoring one conclusion (opposing findings must be low quality)

20 Evidence Review Limited evidence: a single medium quality finding only two or more low quality findings in agreement mixed findings, most favoring one conclusion Insufficient evidence: a single low quality finding Mixed evidence: mixed findings, with neither direction dominating mixed findings, with a medium or high quality study on each side

21 Review of Findings Moderate evidence Limited evidence Insufficient evidence Growth Stillbirth Psychosis symptoms IQ scores in young children Cognitive function SIDS (no association) Depression symptoms Breastfeeding and SIDS Initiation of future marijuana use Mixed evidence Preterm delivery Low birth weight Small for gestational age Academic Ability Attention problems Delinquent behavior Frequency of future marijuana use Isolated simple ventricular septal defects Birth weight Newborn behavior Breastfeeding and infant motor development Birth defects (NTD, gastroschisis)

22 Approved Public Health Messages There is no known safe amount of marijuana use during pregnancy. THC can pass from mother to the unborn child through the placenta. The unborn child is exposed to THC used by the mother. Maternal use of marijuana during pregnancy is linked with negative effects on exposed children. There are negative effects of marijuana use during pregnancy regardless of when it is used during pregnancy. THC can also be passed from the mother s breast milk, potentially affecting the baby.

23 Next Steps Develop Prevention Messaging Continue to collect and analyze surveillance data Report on data/trends as becomes available

24 ?????Questions??????