Marijuana Legalization Preventing Community Impact: The Power of Prevention

Marijuana Legalization Preventing Community Impact: The Power of Prevention Yolanda Cordero, MPA Chief, Prevention Services County of Los Angeles-Department of Public Health Substance Abuse Prevention and Control 1

Prevention Framework Strategic Prevention Framework (SPF) Institute of Medicine (IOM) classification SAMHSA s Center for Substance Abuse Prevention (CSAP) Strategies. The use of these frameworks are required by the State Department of Health Care Services. 2

Strategic Prevention Framework Five Step Planning Process: 1. Assessment 2. Capacity 3. Planning 4. Implementation 5. Evaluation 3

PRIORITY AREA 1: Prescription and Overthe-Counter Medication Misuse and Abuse PRIORITY AREA 3: Underage Alcohol Drinking and Binge Drinking FOCUS AREAS PRIORITY AREA 2: Reduce underage marijuana use PRIORITY AREA 4: Methamphetamine and other illicit drug use

California s legal background 1996: Prop. 215 Compassionate Use Act Approved by California voters Allowed qualified patients with a valid doctor s recommendation to possess and cultivate cannabis for personal medical use

California s legal background 2015-16: MCRSA Medical Cannabis Regulation and Safety Act Adopted by California Legislature Established the first regulatory framework for medical cannabis

California s legal background Nov. 2016: Prop. 64 Legalized nonmedical or adult-use cannabis possession, cultivation and use (limits apply) Established regulatory framework for adult-use cannabis Required State of California to license commercial adultuse cannabis businesses by Jan. 1, 2018

California s legal background June 2017: MAUCRSA Medical and Adult-Use Cannabis Regulation and Safety Act Adopted by California Legislature as a cleanup bill Repealed MCRSA and amends AUMA to include regulations for medical cannabis (MCRSA + AUMA = MAUCRSA = one regulatory framework)

Medicinal vs. non-medicinal cannabis in California Medicinal Cannabis: Recommended by a doctor for medicinal purposes like chronic pain and can be purchased at cannabis retail outlets Non-Medicinal Cannabis: No longer requires a doctor s recommendation. Adults 21 and over can purchase cannabis at licensed retail outlets as early as January 2018. 9

What is cannabis? Cannabis is a plant which contains several active ingredients, THC and CBD from the cannabis plant. Some common names for cannabis include: Broccoli, Dope, Grass, Herb, MJ, Marijuana, Mary Jane, Pot, or Weed 10

Flowers Concentrates Infused Products Green, brown, or gray mixture of dried and shredded leaves, buds, stems, seeds, and flowers In a pipe, water pipe (bong), flavored papers, or joint Average THC content is 15%, with range of 8 to 22% Compressed resin, hash, that resembles wax or oil Inhaled through a device that heats the liquefied concentrate into mostly odorless vapor Extracts can have a THC content of up to 90% Use of either plant, hash oil or concentrates in edibles and drinks Eaten as ingredient in baked goods, candies, and sodas THC concentration varies per item with no regulation on dosage

Infused Products Use of either plant, hash oil or concentrates in edibles and drinks Eaten as ingredient in baked goods, candies, and sodas concentration varies per item with no current regulation on dosage The amount of tetrahydrocannabinol (THC) - the main psychoactive ingredient in cannabis - can vary in edible products which makes it harder to control how much THC is consumed. The amount of THC in homemade edibles can vary even more.

How is cannabis used? Form Type How it Works Smoking Vaping Dabbing Eating or drinking Topical Joint, blunt, pipe, bong E-cigarettes, vape pens, vaporizers Dab, wax, shatter, budder, hash oil Beverages and food items including candy or desserts that have cannabis added to them Lotions or oils with cannabis additions User inhales smoke from burned cannabis. Cannabis smoke is similar to tobacco smoke. It s harmful to your lungs. User inhales burned THC extract. Vaping tools aren t checked for safety. The health effects of vaping aren t currently well-known. User heats THC extract from cannabis and inhales vapor. THC extract is a concentrated form of cannabis. This can be dangerous because it s more potent than regular cannabis. User consumes edible (food items). Cannabis effects are more delayed because cannabis is digested like food. It s harder to regulate how much THC is consumed with edibles because the effects aren t felt right away. User rubs products onto the skin. These products are believed to treat pain without a cannabis high. 14

What Prop. 64 does not change A number of marijuana-related activities remain illegal under Prop. 64 and law enforcement may continue to charge the most serious marijuana-related violations: Providing marijuana to a minor (under 18) Manufacturing marijuana using a volatile substance without a license Attempting to smuggle marijuana across state lines, as felonies. As with alcohol, driving while impaired by marijuana or with an open container of marijuana remains illegal. Marijuana may not be consumed in public

Data Trends 17

24.0 Million Americans admitted to using marijuana within the last month! (NSDUH, 2016) o Marijuana is becoming more acceptable in the society o More prevalent among men than women! Marijuana use has increased (NIDA) o Commonly used by many adolescents and young adults Marijuana potency has increased! (higher concentration of THC is the chemical responsible for most of marijuana's psychological effects) Marijuana related medical emergencies have also increased! Source: NIDA: Marijuana https://d14rmgtrwzf5a.cloudfront.net/sites/default/files/1380- marijuana.pdf

Marijuana Use among Youth 19

Current use of marijuana is higher among Latino males than Latino females and higher than average across LA County! Source: CDC YRBS Youth Online Available at https://nccd.cdc.gov/youthonline/app/results.aspx?lid=lo

Percentage of Youth (Grades 9-12): Who Used Marijuana Once or More, in the Past 30 Days Los Angeles County Average vs. Latino Students Source: CDC Youth Online Available at https://nccd.cdc.gov/youthonline/app/results.aspx?lid=lo

Community Needs Assessment Survey (2017) SAPC research team compiled existing survey questions on prescription drug and marijuana use (e.g., NSDUH, CHKS, MTF) in the following domains: Risk perception Perception of access/availability Attitudes toward use Patterns of use Motivation for use Consequences of use 24

Strongly Agree or Agree 2017 LAC SAPC Community Needs Assessment Survey LATINO POPULATION 71% 67% 72% 75% 63% Latino White Black API Other 71% of Latinos reported they would seek professional help if felt they had a problem with marijuana! Source: Los Angeles County Department of Public Health, Substance Abuse Prevention and Control: Community Needs Assessment Survey, 2016-2017

Demographics of Sample Participants 3,742 Age (years) 1,997 582 1,259 1,101 Gender Transgen Male 3,435 (39%) Female 5,139 (59%) 26

2017 LAC - SAPC Community Needs Assessment Survey LATINO POPULATION Total surveyed 9,487 { Latinos 4,265 (45%) } About 64% of Latinos surveyed reported having easy access to cannabis in their neighborhood About 30% felt that cannabis was a problem in their neighborhood! 77% of Latinos felt State law should prohibit advertising of marijuana products in public places! Source: Los Angeles County Department of Public Health, Substance Abuse Prevention and Control: Community Needs Assessment Survey, 2016-2017

Geography of Participants* Service Planning Area (SPA) Supervisorial District (SD) SPA 1 190 (3%) SPA 8 SD 5 773 (12%) 1,235 (19%) SD 1 SPA 2 1,645 (25%) 973 (15%) SPA 7 958 (14%) SD 4 944 (14%) SPA 6 995 (15%) SPA 4 1,057 (16%) SPA 3 1,345 (20%) SD 3 1,081 (16%) SD 2 1,703 (26%) SPA 5 316 (5%) *69% of participants provided their current residence zip codes. 28

Los Angeles County (2017) Needs Assessment Survey: Youth Ages 12-17 11% reported using marijuana about 10 days in the last 30 days! Mean age of initiating marijuana use was 13. Over half of youth surveyed reported having easy access to cannabis. 72% used marijuana with friends 49% reported having gone to school under the influence of marijuana. Over 30% felt occasional use of marijuana was harmful. Source: Los Angeles County Department of Public Health, Substance Abuse Prevention and Control: Community Needs Assessment Survey, 2016-2017

2017 LAC SAPC Community Needs Assessment Survey LATINO POPULATION Among Latinos who used marijuana, 94% reported they smoked it, 55% used edibles, and 29% vaped cannabis. N= 9487 N= 4265 Source: Los Angeles County Department of Public Health, Substance Abuse Prevention and Control: Community Needs Assessment Survey, 2016-2017

Rates of Emergency Visits due to marijuana increased for all genderrace/ethnicity groups in Los Angeles county, particularly among African Americans (280.6%) followed by Latinos (112.6%). Source: Office of Statewide Health Planning and Development (OSHPD). Emergency Department and Inpatient Discharge Data Sets 2006-2015. California Department of Public Health (SAPC Health Outcomes and Data Analytics )

From 2005 through 2015, the rate of emergency visits related to marijuana increased by 740% among Latino women; the increase among Latino men was 423%! Source: Office of Statewide Health Planning and Development (OSHPD). Emergency Department and Inpatient Discharge Data Sets 2006-2015. California Department of Public Health (SAPC Health Outcomes and Data Analytics )

Hospitalizations due to Marijuana, LAC, 2005-2015 Source: Office of Statewide Health Planning and Development (OSHPD). Emergency Department and Inpatient Discharge Data Sets 2006-2015. California Department of Public Health (SAPC Health Outcomes and Data Analytics )

From 2005 to 2015 the rate of Primary Marijuana related Hospitalizations increased by 38% with the largest increases among African Americans (280.6%), and Latinos (112.6%)! Source: Office of Statewide Health Planning and Development (OSHPD). Emergency Department and Inpatient Discharge Data Sets 2006-2015. California Department of Public Health (SAPC Health Outcomes and Data Analytics )

Los Angeles County Substance Abuse Treatment Admissions by Race/Ethnicity, Fiscal Year 2015-16 26, 029 N=55,985 Among all treatment admissions, 47% were Latino! Annual Review of Patients in Publicly Funded Substance Use Disorder Treatment Programs in Los Angeles County, 2015-2016 Fiscal Year. Health Outcomes and Data Analytics Unit, Clinical Services and Analytics Branch, Substance Abuse Prevention and Control, July 2017.

Los Angeles County Substance Abuse Treatment Admissions among Latinos by Primary Drug Use, Fiscal Year 2015-16 N=20,283 Among our 20,283 Latino treatment clients, an estimated 32% were treated for heroin, 29% for methamphetamine, 20% for marijuana, and 13% for alcohol treatment. A total of 2580 (12.7%) clients were Adolescent. Annual Review of Patients in Publicly Funded Substance Use Disorder Treatment Programs in Los Angeles County, 2015-2016 Fiscal Year. Health Outcomes and Data Analytics Unit, Clinical Services and Analytics Branch, Substance Abuse Prevention and Control, July 2017.

Los Angeles County Marijuana Related Treatment Admissions by Race/Ethnicity, Fiscal Year 2015-16 N=7,760 4,153 Marijuana admissions constituted 13.9% of all treatment admissions in 2015-16 fiscal year (N=7,760)! Total of 4,153 (63%) of all marijuana-related admissions were Latino! Annual Review of Patients in Publicly Funded Substance Use Disorder Treatment Programs in Los Angeles County, 2015-2016 Fiscal Year. Health Outcomes and Data Analytics Unit, Clinical Services and Analytics Branch, Substance Abuse Prevention and Control, July 2017.

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Marijuana and the Teen Brain What We Now Know Adolescence is a critical period in brain development. The brain is still developing until approximately age 25 41

ADOLESCENT BRAIN DEVELOPMENT Underdevelopment of the frontal lobe/prefrontal cortex make adolescents more prone to behave emotionally or with gut reactions Adolescents tend to use an alternative part of the brain the AMYGDALA (emotions) rather than the prefrontal cortex (reasoning) to process information.

ADOLESCENT BRAIN DEVELOPMENT The Prefrontal Cortex is responsible for controlling planning, working memory, organization, modulating mood, and is constantly changing and growing. The Limbic System is responsible for controlling emotion and other brain functions related to our instincts and memories, such as giving a sense of reward for engaging in risk.

The National Institute on Drug Abuse Blog Team. (2014, December 1). Marijuana Use Can Lower Your Grades. Retrieved from https://teens.drugabuse.gov/blog/post/marijuana-use-can-loweryour-grades on March 19, 2018. 44

National Institute on Drug Abuse 45

46 Proliferation and Overconcentration

Prevention Efforts Rethinking Access to Marijuana County-wide Cannabis Assessment Survey Marijuana Education Initiative Pilot Education, Prevention and Intervention Work Group Hosting Cannabis Summit January 11-12, 2018 Hosting Youth Summit March 2018 48

Cannabis Prevention Partners Community-Based Coalitions City and County Tobacco Programs Chief Executive Office - OCM Probation Department LAUSD, LA Trust Wellness Centers Environmental Health LAC Fire Department 49

Marijuana Media Efforts Marijuana youth use prevention campaign Listening Sessions Youth Outreach for focus groups & engagement Launch Date 50

California Bills related to Cannabis: AB 3067 (Chau) explicit restrictions on internet advertising of cannabis products to youth under 21 SB 1451 (Fuller) imposes minimum penalties on cannabis licensees that sell to youth under the legal age SB 1302 (Lara) recently amended, but still appears to allow cannabis delivery regardless of local bans (Less urgent) AB 2020 (Quirk) expands definition of locations where temporary events may take place and AB 2641 (Wood) implements permitting process for temporary events and explicitly preserves local control

STATE VS FEDERAL LAW WARNING: Non-citizens should beware about carrying medical marijuana through US airports. Although TSA and local police have generally been tolerant of medical marijuana in airline baggage in legal states like CA, this may no longer be the case when dealing with non-citizens.

County s Uniform Emblem Program Uniform emblem program for licensed cannabis businesses and consumer education campaign Steer customers away from unlicensed dispensaries, by allowing them to easily identify licensed ones Modeled after the restaurant letter grade program Partnerships with LA City, Long Beach, and others Partnership with licensed industry and state agencies 53

CDPH s Public Information Campaign

Additional Information DPH Cannabis Compliance and Enforcement Program: Phone: 626-430-5635; Email: ccep@ph.lacounty.gov DPH Substance Abuse Prevention and Control, Prevention Services: Phone: 626 293-2950; Email: ycordero@ph.lacounty.gov DPH Prop 64 Resource Webpage: http://publichealth.lacounty.gov/sapc/prop64/propositio n64.htm LA County Office of Cannabis Management: https://www.lacounty.gov/marijuana 55