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Legal Marijuana:
Medicine, Recreation or Plant?
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Larry Wolk, MD MSPH
Executive Director and CMO
October 2015
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CDPHE Role
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• Medical Marijuana Registry
• Medical Marijuana Research
• Retail Marijuana Education
• Marijuana Surveillance
• Laboratory Certification
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Medical Marijuana Registry
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• 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
Medical Marijuana Registry Role
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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.
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 4: Paperwork is evaluated
.
Step 4-Approved
Step 4-
Rejected: Referred to
payment
processing and
notice of
rejection is sent
to patient.
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
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Current Status of Registry
Current Registry Statistics As of June 2015
• 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 Status of Registry
Current Registry Statistics As of June 2015
• 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
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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
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• 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
Medical Marijuana Research Grant Program
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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
Grants Approved by Board of Health
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Retail Marijuana Education
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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.
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Prevention and Education Campaign (SB 14-215)
1. 18-month campaign: health effects
of marijuana & parameters of legal
use
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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
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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
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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
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Monitoring Potential Health Effects and Changes
in Use Patterns
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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.”
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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.
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• 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
Duties of Advisory Committee
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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 Increased Use/Abuse
Poisoning, Overdose, Abuse
Accidents/Trauma
Healthy Kids Colorado Survey (aka YRBS)
Colorado Hospitalization Data
Rocky Mountain Poison and Drug Center Calls
Colorado Hospitalization Data
Colorado Trauma Registry
Adults Increased Use/Abuse
Poisoning, Overdose, Abuse
Accidents/Trauma
Contaminated Products
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
Pregnant/
Breastfeeding
Birth Defects, Developmental
Disabilities
Pregnancy Risk Assessment Monitoring System (PRAMS)
Active Surveillance (Birth Defects Registry)
Surveillance Activities
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Young Adult Marijuana
Usage Rates
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
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0P
erc
en
t re
po
rtin
g u
se
Past 30 day marijuana use, 18-25 year olds
Source: Substance Abuse and Mental Health Services Administration, National Survey on Drug Use and Health.
High School Marijuana Usage
Rates
22.7
24.8
22.0
19.7
14.9
16.9 17.4 19.3
0.0
5.0
10.0
15.0
20.0
25.0
30.0
2005 2009 2011 2013
Pe
rce
nt
rep
ort
ing
use
Colorado High School Students’ Past 30 Day Marijuana Usage
HKCS 30 day marijuana NSDUH 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. Note: The 2007 HKCS survey did not meet the necessary response rate to be eligible for weighting so it is not presented here.
ER Admissions
Source: Data provided by Colorado Department of Public Health and Environment. Note: Indicates drug’s involvement in first three IDC-9 diagnosis codes..
974 996
1,092
148 179
246
115 127
138
61 74
110
0
200
400
600
800
1,000
1,200
2011 2012 2013
Eme
rge
ncy
ro
om
ad
mis
sio
ns
pe
r 1
00
,00
0 p
op
ula
tio
n
Emergency room admission rate (per 100,000), by substance
Alcohol Marijuana Prescription opioids Methamphetamine
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.
Nb=1,211 N=12,328 N=16,428 N=7,080 N=5,014 N=1,191
*
* *
NA NA
Prior Legalization of Medical
Marijuana
Medical Marijuana Legalized Medical Marijuana
Commercialized
Retail Marijuana Legalized
Poison Control
45 70 61 54 107 98 130 136
238
29 31 51 60
72 78 72
117
131
201 161 182 138
131 196 165
157
153
868 858
916
840
913
991 951
912
890
0
200
400
600
800
1000
1200
1400
1600
2006 2007 2008 2009 2010 2011 2012 2013 2014
Statewide Substance-related Calls to Poison Control
Alcohol
Other drugs
Methamphetamine
Marijuana
Source: Rocky Mountain Poison and Drug Center. Note: "Other drugs" includes cocaine/crack, heroin/morphine, and club drugs.
Retail Marijuana Testing
Facility Inspection Program
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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.
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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
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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
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.
1074
1432
1253
1113
893 940
152
203
156
163
169 147
44
64
49
43
44 48
0
200
400
600
800
1000
1200
1400
1600
1800
Q1 2014 Q2 2014 Q3 2014 Q4 2014 Q1 2015 Q2 2015
Colorado State Patrol DUI Citations
Alcohol only Total Marijuana Citations Other drugs
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.
School Discipline
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
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
0
100
200
300
400
500
600
Tota
l su
spe
nsi
on
s p
er
10
0,0
00
stu
de
nts
Dru
g su
spe
nsi
on
s p
er
10
0,0
00
stu
de
nts
Total suspensions and drug suspensions per 100,000 students
Drug suspension rate
Total suspension rate
Source: Colorado Department of Education.
School Discipline
Source: Colorado Department of Education.
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
0
50
100
150
200
250
300
350
Exp
uls
ion
s p
er
10
0,0
00
stu
de
nts
Total expulsions and drug expulsions per 100,000 students
Total expulsion rate Drug expulsion rate
Total expulsion rate
Drug expulsion rate
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Questions? 24
