Scott M. Gagnon, MPP, PS-C

Transcription

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2 About the presenter

3 Scott M. Gagnon, MPP, PS-C Director of Operations, AdCare Educational Institute of Maine, Inc. Chair, Smart Approaches to Marijuana, Maine SAMHSA, Center for Substance Abuse Prevention National Advisory Council Trainer, New England Addiction Technology Transfer Center Blog Contributor Bangor Daily News State/Regional/National Marijuana Science Presenter National Prevention Network Community Anti-Drug Coalitions of America Rx Abuse Smart Approaches to Marijuana Summit New England School Nurses Association

4 What we ll cover The Maine story from Medical to Legal Why policy matters the science Where do we go from here?

5 First, some data

6 2016 NSDUH: HIGHLIGHTS About 1 in 10 Americans (10.6%) aged 12+ reported using an illicit drug in the past 30 days (28.6 million people). The illicit drug use estimate for 2016 continues to be driven primarily by marijuana use and the nonmedical use of prescription pain relievers: 24.0 million people aged 12+ were current marijuana users, defined as using one or more times in the past 30 days (up from 22.2 million in 2014) 3.3 million people aged 12+ reported current nonmedical use of prescription pain relievers Source: Behavioral Health Trends in the US: Results from the 2016 NSDUH

7 HHS FINDS MARIJUANA USE INCREASING Department of Health and Human Services found that marijuana use among all Americans 12+ significantly increased in 2016 compared to in 4 amongst young adults Perception of risk, rapidly falling. Currently, only 37% of 12-to-17 year-olds find smoking marijuana at least once a week to be harmful, compared to 55% in 2005 and 45% in 2011.

8 Of the 28.6 million people who reported current illicit drug use on the NSDUH in 2016 Marijuana and Hashish 24.0 Pain Relievers 3.3 Tranquilizers 2.0 Cocaine 1.9 Stimulants 1.7 Hallucinogens 1.4 Inhalants 0.6 Heroin 0.5 Sedatives 0.5 Millions of People

9 Marijuana Use Disorder (NSDUH) Defined as if they met the DSM-IV criteria for abuse or dependence In 2016, 4.0 million people over the age of 12 experienced a marijuana use disorder (MUD) in the past year Adolescents 12 17: 584,000 Young adults 18-25: 1.7 million Adults 26+: 1.7 million

10 Highest rate of youth use in U.S. Colorado 11.1 Vermont 10.9 Alaska 10.6 Rhode Island 10.2 Maine 10.0 New Hampshire* 9.4 Oregon 9.4 Massachusetts 9.2 Maryland 9.2 Washington 9.2 Source: NSDUH ( ) Past 30 day use year olds

11 Marijuana Policy in Maine A little bit of the backstory

12 Decriminalization Marijuana has been decriminalized in Maine since the 70 s. Up to 2.5 ozs decriminalized Possession was a civil violation, equivalent of a speeding ticket

13 Medical Marijuana Law legalizing possession of marijuana for medical purposes passed in 1999, by citizen s initiative Allowed possession of up to 2.5 ozs every 2 weeks Law legalizing medical marijuana market passed in 2009 by citizen s initiative Allowed the opening of 8 dispensaries Allowed for medical marijuana caregivers who could grow and supply marijuana from up to 6 mature plants per patient, up to 5 patients Required physician signing off on a recommendation Allowed for minors under the age of 21 to be issued a recommendation

14 The March Towards Legalization 2013 Present Day

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16 2016: Question 1

17 Chambers of Commerce Prevention/Treat ment/recovery Law Enforcement DA s Medical Associations Public Health Hospitals Faith Organizations Behavioral Health Business/Emplo yers

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23 Big Marijuana/Corporate Cannabis

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25 Media

26 Question 1 Yes No

27 Question % % Yes No

28 Question 1 377, ,768 Yes No

29 3, %

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31 Maine Marijuana Legalization Act (aka Question 1): Personal Possession: 2.5 ounces of marijuana or concentrates Home grows allowed, up to 6 mature plants* Gifting allowed* Retail licensing of marijuana cultivation, testing, manufacturing, and sales Social Clubs* Lowest Marijuana Excise Tax in 10%*

32 What Happened After Q1 Passed? Possession, home grows, and gifting went into effect January 30 th, 2017 Committee on Marijuana Legalization Implementation First Implementation bill, LD 1650, was vetoed by Governor LePage and sustained by Maine House. Work on implementation restarted with LD 1719 with goal of improvements to win Governor s approval or enough votes to override a veto. LD 1719 passed both houses, was vetoed by the Governor, but veto was overturned by both houses LD 1719 passes

33 The Gifting Loophole

34 What s in LD 1719?

35 LD 1719 aka Legalization Implementation Puts regulation in same state department that oversees alcohol Created 5 license types: retail, cultivation, nursery cultivation, testing, and manufacturing Eliminated social clubs Reduced home grow planet limit from 6 to 3 mature plants per adult (municipalities can create parcel cap) Closed the gifting loophole

36 Public health provisions 1,000 foot buffer between retail marijuana facilities and schools Requires the state to collect public health data and report out to legislature annually Sets direction for packaging/labeling requirements to minimize promotion to youth Required input from Maine CDC on labeling and advertising regulations 6% of tax revenues must go to public education and prevention

37 2018: LD 1539 and HUGE changes to medical marijuana

38 Dramatic changes to Maine s medical marijuana laws List of approved conditions eliminated Patient limit for caregivers eliminated Requirement for patients to designate a dispensary or caregiver, eliminated Personal possession limit for marijuana increased from 2.5 ozs to 8 lbs. Yes, 8 pounds Allows caregivers to open storefronts

39 Why it matters Overview of the science of marijuana and impact on health

40 Marijuana and Addiction Those who are addicted experience withdrawal symptoms: Irritability Anxiety Insomnia or sleep disturbances Appetite Disturbance Depression Most studies suggest that withdrawal symptoms start on the first day of abstinence, and usually peak within the first 2 to 3 days of quitting, with the exception of sleep disturbance. Withdrawal symptoms are usually over after 2 weeks, but this depends on how dependent someone is on cannabis before trying to quit. Source: National Cannabis Prevention & Information Centre. (2011) Cannabis Withdrawal: Factsheet 24. Accessed at: 40

41 Adolescents who use marijuana are at greater risk of Risky sexual behavior which can lead to STIs or unplanned pregnancy Academic problems (e.g., dropout, increased absences) Legal problems, delinquency Driving under the influence of MJ more than doubles the risk of an accident Increased likelihood of suffering mental illness such as depression, anxiety, psychosis, or other mental illness Lowered educational and occupational aspirations Budney, Roffman, Stephens, & Walker. (2007); UW ADAI Fact Sheet: Marijuana & Adolescents, 2013.

42 Adverse consequences of marijuana use: NIDA Research Report: Marijuana (2015) ACUTE (Present during intoxication) Impaired short-term memory Impaired attention & judgment Impaired coordination & balance Increased heart rate Anxiety, paranoia Psychosis (uncommon) PERSISTENT (Lasting longer than intoxication, but may not be permanent) Impaired learning and coordination Sleep problems LONG-TERM (Cumulative effects of repeated use) Potential for addiction Potential loss of IQ Increased risk of chronic cough, bronchitis Increased risk of schizophrenia in vulnerable people* Potentially increased risk of anxiety, depression, and amotivational syndrome* *Often-reported co-occurring symptoms/disorders with chronic marijuana use; unclear whether marijuana is causal or associated.

43 Endocannabinoid system Cannabinoid receptors Anandamide 2-AG (2-arachidonoyl glycerol)

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45 The human brain is not fully developed until age 25. The teen brain is more vulnerable to the negative effects of marijuana use. Infants are especially vulnerable when marijuana is used during pregnancy and breastfeeding Source: NIDA Research Report Series: Marijuana Abuse (rev. July 2012) 45

46 Intervening variables, Normalization, and Youth

47 Intervening Variables Low Perception of Risk/Harm Access & Availability of Marijuana in the Community Pricing & Promotion of Marijuana Policies & Enforcement Lack of Awareness of Impacts of Marijuana on youth and communities Community Norms favorable to youth substance use

48 Normalization

49 Community Norms Parental Apathy Parental Modeling Using in front of children Using with adolescents Proliferation of marijuana commercialization & normalizing messages Head shops & marijuana-themed or tie-in products* Vaping rooms* Marijuana-themed festivals & events* Medical marijuana storefronts *These were all present in Maine, before, legalization.

50 Policies & Enforcement Challenges and barriers for law enforcement Plant counts Documentation Access to information Rapidly changing laws governing medical marijuana Landlord and tenants looking for clarity on what is allowed/not allowed Lack of clarity and leadership from federal government Challenges for employers navigating medical marijuana laws

51 Perception of Risk/Harm Marijuana is safer than Parental/Adult attitudes: At least they re using pot and not [alcohol, tobacco, heroin, etc.] Glamorization in the media and pop-culture Hempfest and other marijuana-centered events promoted as family events Mixed messages on marijuana use and pregnancy/breastfeeding

52 Normalization: This is what it looks like.

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54 Heavily promoted Medical Marijuana Festivals in communities.

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56 JUUL

57 Prevalence of Cannabis Use in Electronic Cigarettes Among US Youth 1 in 11 middle and high school youth use cannabis in an e- cigarette 1 in 3 who ve ever used an e-cigarette, have used cannabis in an e- cigarette Over 2 million youth have used cannabis in an e-cigarette Use of cannabis in vaping devices significantly higher amongst: males, those who ve used most recently, those who ve used other tobacco products, those who ve lived with tobacco users. CDC Research Letter, JAMA Pediatrics, 2018

58 Marijuana Edibles

59 Norms from radio 4:20 Bar Crawl and Roll Your Own

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64 Study: X/fulltext

65 Perception of Harm Down, Use Up

66 Talking Points What you will, or probably do hear. What is the truth?

67 We need more research. We need more research does not mean we don t have research. Here is some of what we know from research: Marijuana is addictive: 1 in 6 youth who try will become addicted Marijuana use interferes with normal brain functions, heavy prolonged use can lead to lasting disruptions (learning & memory, important for academics and careers) Heavy marijuana use is associated with negative mental health outcomes (psychosis, depression, & anxiety) Marijuana use impairs driving and increases risks for fatal car crashes Marijuana use during pregnancy and breastfeeding affects the health and development of infants

68 Marijuana will bring in lots of money None of the projections on the economic benefit to states have taken into consideration the costs. (.e.g. implementation, enforcement, & social costs) SAM studies: Projected revenues for Connecticut if it legalized marijuana: $116 million vs Estimated Costs: $216 million Source: Illinois: Projected revenues: $566 million vs estimated costs: $670.5 million Source:

69 Marijuana is/is not a gateway drug It is true, many who develop heroin, cocaine, and other hard drug addictions, used marijuana early in life. Is is also true that most who use marijuana, don t, go on to develop heroin, cocaine, and other hard drug addictions. The problem with the gateway debate: Implies success if someone only has a marijuana addiction. Reminder: This isn t Woodstock Weed. Much more potent Much more attractive to youth We need to take this seriously even when youth and adults don t develop other addictions.

70 Where do we go from here? What successful approaches for tobacco, alcohol, and Rx can we apply to retail marijuana? For example: Server/Seller trainings for retail marijuana dispensaries Safe storage education for parents (edibles, concentrates, etc.) Impaired driving education/impaired driving details Smoke-free home pledges What are the successes in Utah for youth prevention around other substances? What could you adapt/add on to?

71 Messaging We need to be thoughtful about what and how we message to youth and parents. We have a lot of science, but we can t throw it all at parents and teens. We need to find what is relevant. What are parents open to hearing? What are teens open to hearing? We need to find what is relevant for where they are. Get our foot in the door, and then introduce other messages/science/etc.

72 Tips for Parents Communication with teens is huge! Talk to your teens. Don t need to have the Big Scary Drug talk, short, frequent talks are more effective Demonstrates this is an important issue for you Do your homework (Lot s of great info on NIDA) Listen and acknowledge teens perspective and opinions Don t let it become a debate Talk about what s important to your teen and discuss how marijuana or other drugs could get in the way. 72

73 National Resources National Institute on Drug Abuse: NIDA for Teens: Marijuana Lit from the ATTC Network: Smart Approaches to Marijuana: Americans for Safe Access (Medical marijuana):

74 Contact Info Scott M. Gagnon Follow Me on Website: