natal Legal Marijuana: Medicine, Recreation or Plant? Larry Wolk, MD MSPH Executive Director and CMO October 2015 1
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natal CDPHE Role Medical Marijuana Registry Medical Marijuana Research Retail Marijuana Education Marijuana Surveillance Laboratory Certification 3
Medical Marijuana Registry 2
Medical Marijuana Registry Role Issue Medical Marijuana Registry cards Maintain database of registered patients Review petitions for adding debilitating medical conditions to the medical use of marijuana regulations Administer grant programs for clinical and observational research related to potential therapeutic uses of marijuana 5
The Registration Process Step 1: Patient is examined by a Colorado licensed M.D. or D.O. in good standing, After examination. Physician completes Physician Certification Form with plant/oz recommendation Step 2: Patient completes the application for registration card and signs it in front of a notary. Caregiver acknowledgement completed, if one is designated. Step 3: Submit application by certified mail for proof of mailing. Step 4: Paperwork is evaluated. Step 4-Approved Step 4- Rejected: Referred to payment processing and notice of rejection is sent to patient. Complete App Includes: Application Physician certification dated within 60 days. $15 application fee or fee waiver. Copy of valid CO ID or waiver documentation Step 5: All funds received by the Registry are nonrefundable. Check or money order are made payable to CDPHE. Cash is not advised. Credit cards are not accepted at this time. Step 6: Cards are printed once an application is approved and payment has been processed. Cards are mailed standard first class mail to the address on the application. Processing Time: Patients are encouraged to allow 45 60 days for the entire process, including physician exam. It takes no longer than 35 days for an application to be processed once received 6
Current Registry Statistics As of June 2015 Current Status of Registry 301,677 total patients have applied for a registration card since 2001 113,585 active patients are currently on the Registry 1,579 physicians have recommended medical marijuana since 2001 800 physicians have recommended medical marijuana to one or more patients in the last year 16.4% of active patients have an increased plant count Note: Statistics change frequently based upon patient change requests and are updated on our website on a monthly basis. https://www.colorado.gov/pacific/cdphe/statistics-and-data
Current Registry Statistics As of June 2015 Current Status of Registry 32,049 active patients have designated a medical marijuana center 4,609 active patients have designated a caregiver 6,523 active patients have an increased plant count AND have designated a caregiver or medical marijuana center The Registry currently has 22 FTE The Registry processes an average of 15,000 pieces of mail per month Note: Statistics change frequently based upon patient change requests and are updated on our website on a monthly basis https://www.colorado.gov/pacific/cdphe/statistics-and-data
Medical Marijuana Research 9
Summary of Evidence re: Medical Benefits Cannabis has some fairly well documented medical benefits: Chronic neuropathic pain Multiple sclerosis Chemotherapy induced nausea & vomiting Wasting syndrome (cachexia) with AIDS Clear need for clinical trials for most of the conditions for which cannabis already officially accepted as effective, as well as for many other conditions of interest: PTSD Epilepsy Inflammatory bowel disease Cancer Other neurologic and psychiatric conditions Opiate dependence and withdrawal 10
Medical Marijuana Research Grant Program Senate Bill 14-155, Concerning Grant Funding for Medical Marijuana Health Effects Studies Legislative Intent: that the Department gather objective scientific research regarding the efficacy of administering marijuana and its component parts as part of medical treatment. The grant program shall fund observational trials and clinical trials. In order to ensure objectivity in evaluating research proposals, the grant program shall establish a scientific advisory council. $10 million over 5 years from medical marijuana cash fund 11
Grants Approved by Board of Health 1. Observational study of MJ for IBD in adolescents/young adults 2. Observational study of MJ for PTSD 3. Observational pharmacokinetic study of high CBD oils for pediatric epilepsy 4. Observational study of high CBD oils for pediatric epilepsy 5. Observational study of quality of life from using MJ in children with CNS tumors 6. Observational study of MJ for sleep disorders 7. RCT of MJ (4 potencies THC & CBD) for PTSD in veterans 8. RCT of CBD for tremor in Parkinson s Disease 9. RCT of MJ versus oxycodone for chronic spine pain 12
Retail Marijuana Education 13
Retail Marijuana Prevention and Education Campaign (SB 14-215) Ensure that all Colorado residents and visitors understand the parameters of safe, legal and responsible use of retail marijuana. 14
Prevention and Education Campaign (SB 14-215) 1. 18-month campaign: health effects of marijuana & parameters of legal use 15
Prevention and Education Campaign (SB 14-215) 2. Ongoing education and prevention campaign: Retailer (tourists at point of sale) Latino/Hispanic Audience Youth Prevention Fact Sheets 16
Prevention and Education Campaign (SB 14-215) 3. Maintenance of website portal: colorado.gov/marijuana 4. Alignment of messaging across state agencies Addressing agency concerns Partnering with other state agencies to provide resources and training to complement prevention work 17
Prevention and Education Campaign (SB 14-215) 5. Evaluation of the campaigns Baseline statewide, targeted-population surveys complete Follow-up statewide survey following Good to Know campaign currently in the field Annual assessments each year to monitor change Will review data from other sources to monitor trends 18
Monitoring Potential Health Effects and Changes in Use Patterns 19
CDPHE and Retail Marijuana (C.R.S. 25-1.5-111 & SB-13-283) Surveillance Role SB 13-283 "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. 20
Retail Marijuana Public Health Advisory Committee (SB 13-283) The Department shall appoint a panel of health care professionals with expertise in cannabinoid 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. 21
Duties of Advisory Committee Systematically review the scientific literature Come to consensus on population health effects of marijuana use Develop public health statements Come to consensus on translation of the science into simplified language Recommend public health related policies Recommend public health surveillance activities Identify research gaps important to public health 22
Marijuana Use Among Adolescents Substantial Moderate Limited Mixed Other illicit drug use and addiction after adolescence Impaired cognitive abilities and academic performance after 28 days abstinence Lower IQ after short abstinence Anxiety after adolescence Psychotic symptoms or disorders like schizophrenia Less high school graduation Less likely to earn college degree Depression after adolescence Increased MJ use and addiction after adolescence Suicidal thoughts or attempts Alcohol or tobacco use and addiction after adolescence Quitting lowers risk of cognitive and mental health effects
Target Pop. Problem Monitoring Young Children Accidental Poisoning UC/Childrens Research Project Colorado Hospital Association (CHA) Data Rocky Mountain Poison and Drug Center Calls Child Health Survey(CHS) - risk factors Youth Surveillance Activities Increased Use/Abuse Healthy Kids Colorado Survey (aka YRBS) Adults Pregnant/ Breastfeeding Poisoning, Overdose, Abuse Accidents/Trauma Increased Use/Abuse Poisoning, Overdose, Abuse Accidents/Trauma Contaminated Products Birth Defects, Developmental Disabilities Colorado Hospitalization Data Rocky Mountain Poison and Drug Center Calls Colorado Hospitalization Data Colorado Trauma Registry Behavioral Risk Factor Surveillance System (BRFSS) Influential Factors for Healthy Living Survey (TABS) Colorado Hospitalization Data Rocky Mountain Poison and Drug Center Calls Colorado Hospitalization Data & Trauma Registry Pilot Surveillance (Ski-Related Injuries) Food-borne Illness Surveillance related to Edibles Rocky Mountain Poison and Drug Center Calls Pregnancy Risk Assessment Monitoring System (PRAMS) Active Surveillance (Birth Defects Registry) 24
Percent reporting use Young Adult Marijuana Usage Rates Past 30 day marijuana use, 18-25 year olds 35.0 30.0 25.0 20.0 15.0 10.0 5.0 0.0 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Colorado 19.4 20.5 21.3 23.8 21.7 18.9 21.0 21.2 21.8 23.4 24.2 26.4 27.3 26.8 29.0 United States 14.2 13.7 14.6 17.3 17.2 16.6 16.4 16.4 16.4 16.5 17.4 18.4 18.8 18.9 18.9 Source: Substance Abuse and Mental Health Services Administration, National Survey on Drug Use and Health.
Percent reporting use High School Marijuana Usage 30.0 Rates Colorado High School Students Past 30 Day Marijuana Usage 25.0 22.7 24.8 22.0 20.0 15.0 14.9 16.9 17.4 19.3 19.7 10.0 5.0 0.0 2005 2009 2011 2013 HKCS 30 day marijuana Sources: Colorado Department of Public Health and Environment, Healthy Kids Colorado Survey; Substance Abuse and Mental Health Services Administration, National Survey on Drug Use and Health. NSDUH 30 day marijuana Note: The 2007 HKCS survey did not meet the necessary response rate to be eligible for weighting so it is not presented here.
Emergency room admissions per 100,000 population ER Admissions 1,200 Emergency room admission rate (per 100,000), by substance 1,092 1,000 974 996 800 600 400 246 200 0 179 148 115 127 138 110 61 74 2011 2012 2013 Alcohol Marijuana Prescription opioids Methamphetamine Source: Data provided by Colorado Department of Public Health and Environment. Note: Indicates drug s involvement in first three IDC-9 diagnosis codes..
Rates of Hospitalizations (HD) and Emergency Department (ED) Visits with Possible Marijuana Exposures, Diagnoses, or Billing Codes in the First Three Diagnosis Codes per 100,000 HD and ED Visits by Time Period in Colorado. * * * NA NA N b =1,211 N=12,328 N=16,428 N=7,080 N=5,014 N=1,191 Prior Legalization of Medical Marijuana Medical Marijuana Legalized Medical Marijuana Commercialized Retail Marijuana Legalized
Poison Control Statewide Substance-related Calls to Poison Control 1600 1400 1200 1000 890 800 600 868 858 916 840 913 991 951 912 Alcohol 153 400 157 131 196 165 131 200 201 161 182 138 117 72 72 78 238 31 51 60 29 45 70 61 107 54 98 130 136 0 2006 2007 2008 2009 2010 2011 2012 2013 2014 Source: Rocky Mountain Poison and Drug Center. Other drugs Methamphetamine Marijuana Note: "Other drugs" includes cocaine/crack, heroin/morphine, and club drugs.
Retail Marijuana Testing Facility Inspection Program 30
Retail marijuana testing facility inspection program: Coordinates inspection of retail marijuana testing facilities; Reviews all documentation and practices relating to laboratory methods, staff qualifications, and quality assurance; Ensures that testing facilities meet the rules promulgated by the Department of Revenue (DOR) and are competent to carry out specific scientific tests; Provides recommendations to DOR about suitability of the testing facilities for certification; and, Provides scientific consultation and recommendations to the DOR in regards to laboratory testing as it pertains to public health and safety. 22
As of May 26, 2015, nineteen Retail Marijuana Testing Facilities have been licensed by DOR. Eleven of those have been granted provisional certifications. Testing Category Potency Microbials (Bacteria, Fungus) Residual Solvents Number of Labs Currently Certified 10 3 6 *Inspections are ongoing 23
Marijuana Offenses, by Month and Legal Status Source: Colorado Bureau of Investigation, National Incident-Based Reporting System data.
Marijuana Offenses by Location Source: Colorado Bureau of Investigation, National Incident-Based Reporting System data. Note: In 2012 there were 43 cases where the type of school could not be determined.
Driving Under the Influence Colorado State Patrol DUI Citations 1800 1600 64 203 1400 1200 1000 44 152 49 156 43 163 44 169 48 147 800 1432 600 400 1074 1253 1113 893 940 200 0 Q1 2014 Q2 2014 Q3 2014 Q4 2014 Q1 2015 Q2 2015 Alcohol only Total Marijuana Citations Other drugs Note: Citation type is classified according to the trooper s impressions of the reason for impairment. Total Marijuana citations include marijuana alone, marijuana plus alcohol, and marijuana plus other drugs. Source: Data provided by Colorado State Patrol, 7/9/2015.
Traffic Fatalities Source: Colorado Department of Transportation, Fatality Analysis Reporting System (FARS) data.
Traffic Fatalities Source: Colorado Department of Transportation, Fatality Analysis Reporting System (FARS) data.
Drug suspensions per 100,000 students Total suspensions per 100,000 students School Discipline Total suspensions and drug suspensions per 100,000 students 600 16,000 500 Drug suspension rate 14,000 12,000 400 10,000 300 Total suspension rate 8,000 200 6,000 4,000 100 2,000 0 2004-2005 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010 2010-2011 2011-2012 2012-2013 2013-2014 Drug suspension rate 443 437 414 400 391 506 551 534 500 538 Total suspension rate 13,445 13,267 13,618 12,796 12,632 11,542 11,094 10,454 9,301 8,396 0 Source: Colorado Department of Education.
Expulsions per 100,000 students School Discipline Total expulsions and drug expulsions per 100,000 students 350 300 250 200 Total expulsion rate 150 100 Drug expulsion rate 50 0 2004-2005 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010 2010-2011 2011-2012 2012-2013 2013-2014 Total expulsion rate 299 313 283 270 255 260 234 235 171 145 Drug expulsion rate 77 74 69 71 65 90 91 84 71 61 Total expulsion rate Drug expulsion rate Source: Colorado Department of Education.
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Questions? 24