A Conversation on Lessons Learned from Marijuana Legalization in Four States: Washington, California, Oregon, and Colorado

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1 A Conversation on Lessons Learned from Marijuana Legalization in Four States: Washington, California, Oregon, and Colorado

2 Presenters Sarah Mariani, CPP Behavioral Health Administrator Department of Social & Health Services Washington Division of Behavioral Health & Recovery Joe Eberstein, CCPS Program Manager San Diego County Marijuana Prevention Initiative (MPI) Center for Community Research, Inc. Luci Longoria, MPH Health Promotion Manager Public Health Division Oregon Health Authority Jenny Wood Director Community Prevention and Early Intervention Programs Colorado Office of Behavioral Health

3 Marijuana Legalization by State 9/14/2017 Source: National Conference of State Legislators. 3

4 What is legalization? Marijuana Legalization can refer to legalizing any or all of at least twelve different activities. 9/14/2017 Source: RAND Corp: Considering Marijuana Legalization in Vermont, Jonathan Caulkins PhD, January 16,

5 Research: Level of Confidence in Adverse Effects of Marijuana Retail Marijuana Public Health Advisory Committee is responsible for reviewing scientific literature on health effects of marijuana translating into public health messages. Insufficient evidence Mixed evidence Links between use & lung cancer Limited evidence Links between use & heart attack Moderate evidence Negative effects of maternal use during pregnancy Substantial evidence Negative effects of adolescent & young adult use 5

6 Timelines and Laws

7 7/2/2017 Marijuana Legalization 7

8 Washington Marijuana Timeline Nov Medical Use of Marijuana Act (I-692) Jul SB 5073 passed but partially vetoed Nov Legalization of marijuana for recreational use(i-502) Jul Retail stores opened. Retail licenses issued (508 as of 8/30/17) Jul First distribution of funds Sept Tribal Compacts 2015 Cannabis Patient Protection Act Jul Advertising Laws Changed Jul Medical integration Allows for : Billboards with only name, location, logo, directions 8

9 Laws, Regulations and Rules in WA Earmarked funds for prevention, treatment, education No home grow allowed (only adult use state) Advertising Restrictions No Delivery allowed Public Use Prohibitions Preemption allowed - Local Zoning/Bans Edible required warning, childproofing, max dosage levels Tied House Laws - Three tiered system Taxes highest in the country, but prices keep dropping Cash Business Changing 10% fee levied for cash tax payments Cannot infuse with alcohol or tobacco 9

10 Brief History Colorado Legalization Medical Marijuana, 18+ years and MMJ card o 2000: Amendment 20 o 2009: Commercialization of Medical Marijuana Retail Marijuana, 21+ years o November 2012: Amendment 64 o Marijuana Enforcement Division created to oversee rules o January 2014: Retail establishments open o January 2017: Marijuana Social Clubs Bill passes

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12 Colorado Adult Campaign on the Laws Colorado Department of Public Health leads the Good to Know Campaign Purpose: Increase knowledge about retail marijuana laws for all Colorado Adults and Visitors 21+ Safe, legal and responsible use of marijuana

13 Colorado Marijuana Use Laws You Must be over 21 to purchase, possess or use retail marijuana Use it on private property or a licensed marijuana social club Federal land is under federal law Keep it in Colorado Don t drive high Keep it sealed in your car Source You can only buy and hold so much at a time Only buy from a licensed Colorado dispensary There's a limit to how much you can grow Only medical patients can buy medical marijuana in Colorado Don't share marijuana with those under 21

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15 Schedule (1) Drug Schedule (1) Drug: No medical value High propensity for abuse and addiction August Sessions, an avowed opponent of marijuana legalization, sent letters to Oregon, Alaska, Washington and Colorado the first four states to legalize recreational marijuana -challenging the states oversight of the nascent pot industry.

16 California 20 years worth of pot laws 1996: CA voters approved Prop 215, also known as the Compassionate Use Act, and became the first State to give the right to use marijuana for medical reasons, with a doctor s recommendation. 2001: The U.S. Supreme Court ruled there was no medical exception to federal marijuana laws, and that it was still illegal to sell or distribute marijuana, even when state laws, like Prop 215, allow it. 2004: The Medical Marijuana Program Act (SB 420) required the CA Dept. of Public Health to develop a voluntary program to register and issue cards to medical marijuana users and their caregivers and mandated county participation. 2008: Then-Attorney General Jerry Brown established the Guidelines for the Security and Non-Diversion of Marijuana Grown for Medical Use. required that the industry operate on a not-for-profit basis and that patients either cultivate their own or work with a caregiver within a collective structure. 2010: Governor Arnold Schwarzenegger reduced marijuana possession to an infraction.

17 More Laws! 2011: San Diego County amended the existing Medical Marijuana Collective Facilities Ordinance to specify zones of operation. 2014: The City of San Diego adopted an ordinance allowing four dispensaries in each of the municipality s nine council districts. 2014: CA approved Proposition 47 (11/5/14) which reduced the penalties for many drug possession charges from a felony to a misdemeanor. 2015: CA adopted a series of regulatory policies by combining three proposed legislative bills (AB243, AB 266 and SB643), to establish the Medical Marijuana Regulation and Safety Act (MMRSA) to establish regulatory system from cultivation to transportation of medical marijuana and identifies 19 state department roles and also acknowledges and allows local control. November 2016: Prop 64 (AUMA) Adult Use of Marijuana Act - Recreational Use AB 64, (trailer bill) reconciling the Medical Cannabis Regulation and Safety Act and the Adult Use of Marijuana Act/Prop 64 was introduced with the intent to reconcile the regulatory structures for medical and recreational marijuana use. Set up an INDUSTRY!

18 California Key Policies Prop 215 Medical Use: Age of use is dependent upon Doctor Recommendation. In 2015 CA enacted - MCRSA (3 Bills) comprehensive state regulatory framework for medical use Prop 64 Adult Use of Marijuana Act (AUMA): 21 and over possession, cultivation for personal use as well as regulatory framework for profit industry! BMCR now the Bureau of Marijuana Control Governor Browns Trailer Bill creating consistency and uniformity between Proposition 215 and AUMA a clear regulatory structure for both and eliminating discrepancies.

19 New CA Bureau of Marijuana Control BMCR now Bureau of Marijuana Control lead agency in developing regulations for medical and adult use and responsible for licensing retailers, distributors, testing labs and micro businesses. CA Dept. of Public Health - Office of Manufactured Cannabis Safety responsible for regulating manufacturers of edibles for both medical and non use. CalCannabis Cultivation Licensing, a branch of the CA Dept. of Food and Agriculture - develop regulations to license cultivators for both medical and non, track and trace program to record seed to sale through distribution. Municipalities should act now by adopting local policies regulating or banning, cultivation, manufacturing, retail sale, transportation, storage, delivery and testing. The minimum age of a purchasing patient is 21-years-old. The rules then state that if you re 18 or younger, you can only enter a licensed dispensary with a doctors recommendation and your parent, legal guardian or primary caregiver. Who is enforcing this?

20 Points of Consideration: Licensing responsibility is on the State agency to determine whether the applicant has necessary local authorization. No clear limit on cultivation sites. Over concentration of licenses are not a factor when considering new licenses. Age?

21 Allowable Amounts Allowable Recreational Use: 28.5 grams of marijuana in non concentrated form 8 grams concentrated Medical: Under Prop. 215, patients are entitled to whatever amount of marijuana is necessary for their personal medical use. However, patients can be arrested if they exceed reasonable amounts and they can be cited or fined for exceeding local laws.

22 Oregon marijuana timeline 1998 Measure 67 establishes Oregon Medical Marijuana Act 2014 Measure 91 legalizes marijuana for recreational use October 1, 2015 Limited retail sales of marijuana through dispensaries July 2017 Launch Stay True to You, Youth Prevention Pilot Campaign December 31, 2016 Retail marijuana sales in medical marijuana dispensaries ends 2013 HB 3460 allows medical marijuana dispensaries and establishes registry August 2015 SB 460 allows early sales of non-medical marijuana through dispensaries June 2016 Limited retail sales plus (included edibles) October 2016 Begin retail marijuana store licensing April 2017 Stay True to You Pilot Campaign Final Evaluation

23 Revenue Allocation

24 2017 Oregon marijuana resource allocation 5% Alcohol & Drug Abuse Prevention, Intervention, and Treatment $10.1 About $1 million of this amount will go towards prevention (non-treatment) $202.8 Total Distributions Source: Oregon Economic and Revenue Forecast Report (released August 23, 2017)

25 7/2/2017 WA Marijuana Sales and Excise Taxes Collected $30,000,000 $180,000,000 Marijuana Excise Tax Revenue $25,000,000 $20,000,000 $15,000,000 $10,000,000 $5,000,000 $160,000,000 $140,000,000 $120,000,000 $100,000,000 $80,000,000 $60,000,000 $40,000,000 $20,000,000 Marijuana Sales (shelf-price including 37% tax) $- $- July-2014 August-2014 September-2014 October-2014 November-2014 December-2014 January-2015 February-2015 March-2015 April-2015 May-2015 June-2015 July-2015 August-2015 September-2015 October-2015 November-2015 December-2015 January-2016 February-2016 Month - Year Excise Tax Due March-2016 April-2016 May-2016 June-2016 July-2016 August-2016 Total (Shelf Price) September-2016 October-2016 November-2016 December-2016 January-2017 February-2017 March-2017 April-2017 May-2017 June-2017 Source: WA State Liquor and Cannabis Board Frequently Requested Lists 25

26 WA Funding Disbursements** Agency For I-502* Dept. of Social and Health Services Prevention and reduction of substance abuse Up to 15 % Dept. of Health Marijuana education and public health program Up to 10 % Univ. of Washington Research on short- and long-term effects Up to.6 % Washington State Univ. Research on short- and long-term effects Up to.4 % Health Care Authority Basic Health Trust Fund Account Up to 50 % Office of Superintendent of Public Instruction Contracts with community health centers Up to 5 % Drop-out prevention Up to 0.3 % General Fund Up to 18.7 % *After initial allocations for implementation, surveys, evaluation and a website. **Modified by Legislature in 2015, 2E2SSB2136

27 WA Funding Disbursements - DSHS General HYS/Young Adult Survey Cost Benefit Analysis (WA State Institute of Public Policy (WSIPP) SUD Services Tribal Prevention and Treatment Services Prevention and Treatment Evidence-Based Program/Practices (EBP) Training Youth Treatment Services JJRA Youth Treatment Services (Juvenile Justice Rehabilitation Administration (JJRA)) Parent Child Assistance Program Community Prevention Services - Community Prevention Wellness Incentive and Community Based Organizations Life Skills Training (Office of Superintendent of Public Instruction (OSPI)) Home Visiting (Dept. Early Learning (DEL)) 27

28

29 State Data

30 Colorado Drive High DUI Facts Driving high is a prosecutable offense-even with a prescription for marijuana Established impairment level in Colorado is 5 nanograms of active THC per milliliter of whole blood Drive high with a child in the car= child abuse charges What happens if driver refuses a blood test? 1. Driving privileges immediately revoked 2. Immediately considered a high risk driver. 3. May require mandatory ignition interlock for 2 years 4. May require level 2 education and therapy classes

31 Recreational vs. Retail Why the different name?

32 Colorado Retail and Medical Marijuana Stores

33 Dispensaries vs. Starbucks

34 Source: SAMHSA, Center for Behavioral Health Statistics and Quality National Surveys on Drug Use and Health,

35 Oregon: Current marijuana use among youth over time, Marijuana use has remained fairly stable over time in Oregon and nationally; current marijuana use among Oregon youth is slightly higher than nationally

36 Oregon: Source of marijuana among 11th-grade current users, 2016 The majority of 11 th grade marijuana users report getting their marijuana from friends

37 Oregon: Usual method of marijuana use among youth current users, 2015 The vast majority of youth reported smoking as their usual method of use

38 Current use of marijuana, cigarettes and alcohol among Oregon youth, 2016 Current marijuana use is higher than cigarette smoking among both 8 th and 11 th graders

39 Oregon 8th-graders who think using select substances is harmful, 2014 & 2016 Eighth-graders think weekly marijuana use is less harmful than smoking a pack of cigarettes a day, binge drinking or using Prescription drugs

40 Oregon 11th-graders who think using select substances is harmful, 2014 & 2016 Eleventh-graders think marijuana use is the least harmful of these substances; there were no notable changes in perceived harm among either age group

41 Oregon 8th-graders who think selected substances are easy to get, 2014 & 2016 Perceived easy access to marijuana is similar to cigarettes for 8 th graders, while more 11 th graders perceive marijuana as easy to access compared to cigarettes

42 Oregon 11th-graders who think selected substances are easy to get, 2014 & 2016 while more 11 th graders perceive marijuana as easy to access compared to cigarettes; increases and decreases in perceived access were modest across years

43 Marijuana-related calls to the Oregon Poison Center by quarter, 2013 through September 2016 Marijuana-related calls began a steady increase in 2015, but declined in Q3 2016

44 Marijuana-related calls to the Oregon Poison Center by age, 2014 through September 2016 Marijuana-related calls have increased over time among all age groups; the largest increase was seen among those 21-years-old and older

45 CA Current Marijuana Use: Students reporting using marijuana at least once during the past 30 days 50% 40% 30% 20% 10% 0% 19.2% 20.1% 12.6% 13.4% 4.7% 5.0% th Graders 9th Graders 11th Graders

46 CA Daily Use: Students reporting using marijuana 20 or more days during the past month 30% 25% 20% 15% 10% 5% 0% 2.2% 0.4% 4.0% 5.3% 3.0% 1.5% th Graders 9th Graders 11th Graders

47 CA Perception of Harm: Students Reporting That People Risk Harming Themselves Greatly By Smoking Marijuana Once or Twice a Week* 80% 60% 40% 20% 54.0% 56.0% 44.1% 49.2% 39.5% 47.8% 0% th Graders 9th Graders 11th Graders *Item added to survey in 2007

48 San Diego Treatment Admissions Marijuana is the primary drug of choice for youth ages (12-17) in SD County funded drug treatment and has been for over 10 years. Beats out alcohol for this age group as the primary substance. Treatment providers observing much higher levels of THC in drug tests.

49 Public Health Challenges The most common reasons of seeing marijuana poisoning in the ER: 1. Cannabinoid Hyperemesis 2. Psychosis 3. Chest pain

50 Key Findings: Drug and Marijuana Presence among Drivers Treated for a Motor Vehicle Injury in Emergency Departments or Hospitalized ( ) in California and San Diego County Over a 5-year timespan ( ), marijuana was found in at least half of all drivers hospitalized or treated in emergency departments for a motor vehicle injury (state and county levels) The number of drivers treated for motor vehicle injuries who tested positive for any drug or marijuana has increased since 2010 (state and county levels): o Any drug presence increased 73%, statewide o Any drug presence increased 77%, San Diego County Marijuana presence increased 92%, statewide Marijuana presence increased 60%, San Diego County Source: California Office of Statewide Health Planning and Development, Emergency Department Data, Inpatient Discharge Data Prepared by: California Department of Public Health, Safe and Active Communities Branch, March 2017

51 Washington s Healthy Youth Survey Used marijuana/hashish during the past 30 days? Marijuana Use: Youth, Past 30 Days 40% 6th Grade 8th Grade 30% 25% 10th Grade 12th Grade 26% 20% 18% 17% 10% 10% 6% 1% 1% 0% Source: Washington Healthy Youth Survey , 2004, 2006, 2008, 2010, 2012, 2014, /14/

52 60% 40% Washington s Healthy Youth Survey 8th Grade 10th Grade 12th Grade Risk of Harm from Marijuana Use Regular use has no risk or slight risk. 45% 33% 20% 22% 17% 13% 21% 0% Note: Includes responses where using marijuana regularly has no risk or only a slight risk. Source: Washington Healthy Youth Survey , 2004, 2006, 2008, 2010, 2012, 2014, /14/

53 7/2/2017 WA Youth Adult Perception of Harm 40% % Risk of Harm from Marijuana/Cannabis Use: Young Adults Percentage 30% 20% % 19% 31% 10% 0% Psychological Harm Marijuana Use Physical Harm Source: Young Adult Health Survey

54 WA Adult Risk of Harm Source: DBHR CPWI community Survey/2016

55 WA Treatment Rates for Marijuana 9/14/

56 WA Traffic Fatalities 9/14/

57 Increase in Marijuana Poison Center Calls 9/14/

58 Prevention Strategies and Programs: Keeping Youth Safe

59 Colorado: DRIVE HIGH DUI CAMPAIGN Source

60 CA Youth Exposure - Edibles/Concentrates "I was surprised by the increase of admissions in my unit for cannabis unintentional intoxication among toddlers and by the increase of severe presentation after children had eaten part or an entire cannabis resin stick. Drowsiness Dizziness Seizures Coma Agitation Euphoria Erratic breathing or heartbeat Dilated pupils

61 Proper Public Health Messaging - What are the Risks? Youth exposure risk and 2 nd hand exposure. Edible Protocols and guidelines. Doctors should discuss safe driving windows after recommending marijuana for medicine. Warnings! regarding pre-existing mental health issues. Addiction/Treatment risks. No gimmicks this drug could have serious consequences for youth!

62 MPI Prevention Strategies: Don t go down in flames discussing weed! Get educated about Pot!

63 As soon as you get home! Compile data add custom module regarding use, access, availability, treatment, ER visits, poison control. Schools - Send a letter to parents stating nothing has changed on school campus! - Drug Free Schools! Train school personnel, nurses, staff regarding marijuana effects, new research. Collaborate with all sectors! Local municipalities can regulate or ban commercial cultivation, access (pot shops), delivery services.

64 Prop. 64 Prevention Toolkit Toolkit Materials: Lease addendum Medical Use on School Property facts. Social Host Laws School Letter Work Place Drug Policy Fact sheet and Info cards

65 Drugged Driving How many hours after using pot is it OK to drive? What is the relationship between THC levels and driving? What recommendations can doctors make for persons taking marijuana for medical reasons regarding safe driving windows?

66 Washington Prevention Strategies and Programs

67 Consistent Messaging of Health Risks Marijuana is addictive Addiction in about 9% of users overall 17% of those who begin use in adolescence 25% to 50% of those who are daily users*. Increased risk of chronic psychosis disorders (including schizophrenia) in persons with a predisposition to such disorders. 9/14/2017 *The effect is strongly associated with initial marijuana use early in adolescence. 67

68 Oregon Public Health Division s role in marijuana legalization is to protect the public s health by: 1 Understand 2 Educate 3 Protect 4 Prevent 5 and minimize the public health impacts of retail marijuana products the public about health issues related to marijuana use children and vulnerable populations from marijuana exposure youth marijuana use Monitor marijuana use, attitudes and health effects in Oregon

69 Stay True to You Oregon Youth Marijuana Use Prevention Pilot Campaign

70 Stay True to You Pilot Campaign Evaluation Results More youth and young adults in campaign pilot areas: Correctly identified social norms around youth marijuana use compared to those in non-pilot areas. Understood the legal consequences of underage marijuana use.

71 Stay True to You Pilot Campaign Evaluation Policy Recommendations Provide support in every community in Oregon to youth, young adults, and parents. Require marijuana businesses to disclose their expenditures on marketing and promotion. Establish a maximum size and number for signs at retail marijuana stores. Prohibit the sale of flavored cannabis products. Protect local control.

72 Oregon marijuana report arijuana/documents/oha-8509-marijuana-report.pdf

73 Oregon Prevention recommendations Partner with various regulatory entities and tobacco prevention Watch for threats to tobacco control successes Stick to evidence-based public health practice Surveillance, surveillance, surveillance!

74 Advertising and Product Development 74

75 Original Advertising Washington Prohibited: Images that might be appealing to children; Not within 1000ft of schools, parks, transit centers, etc. Allowed Depictions of products or plants Sign Spinners Inflatable Arm-Flailing Tubemen Any area not within 1000ft of restricted areas 9/14/

76 76

77 Washington New Advertising Restrictions: Prohibits: Targeting to youth; Targeting to persons residing outside of Washington; Depictions that are likely to appeal to youth; Outdoors Ads that contain any depictions of marijuana plants, marijuana products, or In arenas, stadiums, shopping malls, fairs, farmers' markets, and video game No commercial mascots. Allows for : Billboards with only name, location, logo, directions 77

78 78

79 Requirements for Marijuana Edibles Childproof Packaging Preapproval for all edibles Warning symbols Warning messages Maximum dosage: 10mg THC per serving Products that are especially appealing to children are prohibited No gummies, cotton candy, lollipops, or bright colored products 9/14/

80 Types of edibles What is allowed? 80

81 O r e g o n

82 O r e g o n

83 O r e g o n

84 Current Climate and What s Next

85 Marijuana Perspectives in CO Tourist Industry Housing Edibles Education Behavioral Health Services Lessons learned from previous substance use campaigns (tobacco, alcohol, prescription drugs)

86

87 Medical? Insufficient evidence to prove if marijuana can help with chronic pain and PTSD. Experts warn the use of marijuana for chronic pain could lead to an increase risk of harm such as motor vehicle accidents, psychotic symptoms and short-term cognitive impairment.

88 Need more Research!

89 MPI Website

90 Resources Washington Athena Forum - DBHR - Healthy Youth Survey - Start Talking Now - Liquor and Cannabis Board University of Washington Alcohol and Drug Abuse Institute 90

91 Contact Info California Joe Eberstein, Colorado Jenny Wood, Oregon Luci Longoria, Washington State Sarah Mariani,

92 Questions?

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