Medical & Legalized Marijuana: The Colorado Experience

Peer Assistance Services, Inc. 2014

Medical & Legalized Marijuana: The Colorado Experience

Chris Knoepke, MSW, LSW, ABD

May 7, 2014


Peer Assistance Services, Inc.

Founded in 1984


Peer Assistance Programs

•Colorado TASC

•Workplace Prevention Services

•Prescription Drug Abuse Prevention Program

•Peer Health Assistance Programs– Nursing, Pharmacy, Dentistry, Veterinary– Mental Health Boards (Social Work, Psychology,

Counselling, Addiction Counselors, MFTs)

•Screening, Brief Intervention, and Referral to Treatment (SBIRT Colorado)





History in CO: Medical Marijuana (Amendment 20: 2000)

• Passes with 54% support to include MMJ in State Constitution

• Patients with recognized conditions may buy/possess 2 oz of MJ at any time and/or cultivate 6 plants (3 mature) without State criminal penalty

• Identified “caregivers” could cultivate plants for up to 5 patients


Amendment 20 Expansion (2007-2009)

• 2007: Denver District Court Judge ruled that 5:1 patient to caregiver ratio was decided in a way which violates open meeting requirements

• 2009: Various statements made by US DOJ, including the Attorney General & his Deputies, indicating that raids on MMJ dispensaries occurring in CA would not be continued or expanded


MMJ Patients & Dispensaries: A Viable Business

• Dispensaries: 0 in 2000, 532 in 2012

• MMJ Cardholders: 4,800 in 2008, 108,000 in 2012

• Dispensary Advertising


Physician Practice Variation

Remember that there are more than 14,000 practicing physicians in Colorado and just over 108,000 registered MMJ cardholders. How many cards have been recommended by Colorado’s top “pot doc”?


MMJ: Recognized Conditions in Colorado

• Cancer

• HIV

• Muscle Spasms

• Cachexia

• Seizures

• Chronic Pain

• Glaucoma

• MS


Workplace MMJ Considerations

• Drug Free Workplace Policies: Employers not required to accommodate use (continued in Amendment 64 & legal marijuana in 2012) – Discipline & termination for failed tests– Denial of unemployment claims– Lawful Off-Duty Activities Statute C.R.S. §24-34-

402.5


CO MMJ in the Workplace: Legal History

• Benoir v. Industrial Claims Appeals Office

• Coats v. Dish Network

h/t Denver Post


Amendment 64: Article 18, Section 16 of the Colorado State Constitution

(2012)


Colorado as the Petrie Dish for Fully Decriminalized Marijuana

“Clearly we are charting new territory, other states haven’t been through this process…

recreational marijuana is really a completely new entity, but really the bills we’re signing today

really do lay out this new territory,”

Gov. John Hickenlooper, 5/28/13


How A64 Was Sold to Colorado



What’s Actually Addressed in Amendment 64…

• Adults (>21 years of age) can possess up to 1 oz of marijuana without State criminal penalty

• Individuals may grow up to 6 plants to support personal use (cultivation rules apply)

• Paraphernalia no longer illegal

• Retail marijuana facilities are licensed and established – including all points of production chain


And What Wasn’t…

• The Fact that MJ Remains a Schedule I Controlled Substance Under Federal Controlled Substances Act

• Specifics of Regulation/Taxation of Sales

• Relationship Between Cultivation/Distribution/Sales Entities


Taxes/Fees Associated with Legal MJ in Colorado

• Standard 2.9% sales tax

• 10% special sales tax

• 15% excise tax (written into A64 – on cultivation)

• Fees on MJ business licenses (enforcement)

• Local special excise/sales taxes (Boulder & Denver = 5%)

$

$

$

$

$

$


Differences from MMJ Rules

• No additional sales/excise taxes collected on MMJ (which could be up to 30% of value in recreational MJ)

• Sales of up to 2oz (instead of 1) at a time

• No sales to out-of-state residents (limit of 1/8oz in recreational MJ)


Prevention on the Road: DUID-MJ

• House Bill 1317 established legal limit of 5 nanograms/ml of detectable THC in blood

• Blood tests would follow existing protocols used in other drug testing procedures

• Implied consent exists, as with alcohol, but limits of physical law enforcement coercion are not clear

• 5 ng/ml not considered a “per se” standard, so someone who has been cited could argue in court that they were not impaired at the time


Department of Justice – Current Stance

• Memo to US Attorneys from AG Holder in late 2013 implied not to prosecute Federal MJ laws - provided states illustrated efforts to:– Discourage use among youth– Mitigate health impacts– Prevent involvement of organized crime


Effects on the Workplace

“nothing in this Section is intended to require an employer to permit or to accommodate the use. . .of marijuana in the workplace or to affect the ability of

employers to have policies restricting the use of marijuana by employees.”


High Profile DFWP: Von Miller and the NFL’s CBA

• A bit different in that the drug policy is collectively bargained

• Nonetheless, suspended over violations of what’s effectively a DFWP


Issues Around Professional Services

• Banking

• Legal Services


Clinical Issues

• Routes of Administration (“Edibles”)

• Universal Screening (SBIRT)– Including assessing simultaneous use of marijuana

with alcohol, prescription medications


Edibles & Routes of Administration (ROA)

• THC-inclusive products– Cookies, chocolate, butter, “candy-like” items

• Novice Users

• ROA issues– Time to effect– Time until “clean” urine/blood


Edibles, Potency Testing, and Quality

Control




Brief Screen Question Positive Screen CriteriaDrinks per week:How many drinks do you have per week?

If female or a male over the age of 65 = More than 7 drinks

If a male age 65 and younger = More than 14 drinks

Drinks per day:When was the last time you had 4 or more drinks per day? (Asked of all females and males over the age of 65)

OR

When was the last time you had 5 or more drinks per day? (Asked of males age 65 and younger)

If female or a male over the age of 65 = 4 or more drinks in one day in the past three months.

OR

If male age 65 and younger = 5 or

more drinks in one day in the past three months

How many times in the past year have you used marijuana? If one or more times = YesIn the past year, have you used or experimented with an illegal drug or a prescription drug for nonmedical reasons?

If = Yes

Do you currently smoke or use any form of tobacco? If = Yes

Other positive screen criteria For those age 18 – 20

Any alcohol use

For pregnant women Any alcohol use


What We Know About Simultaneous Use: SBIRT 1 (pre-dates Amendment 64)

• % of past-90 day marijuana users who also screened positive risk for:– Alcohol 43.1%– Tobacco 71.9%– Stimulants 6.8%– Cocaine 7.7%– Opioids 5.6%

• Non-cardholders were significantly more likely than Cardholders to screen at-risk for:– Alcohol (45.9% vs. 31.7%, c2(1, N = 1470) = 18.81, p < .001)– Tobacco ( 75.9% vs. 54.8%, c2(1, N = 1470) = 49.82, p < .001)– Stimulants (7.6% vs. 3.6%, c2(1, N = 1470) = 5.77, p < .05)


A Note on Youth, Access, & Accidental Ingestion

• Prevention of use among youth a focus– Educational campaigns, websites, TV ads

• Mixed data on use by teens (Increasing? Decreasing?)

• Anecdotal reports of increased ER visits for small children & pets from accidental ingestion– Edibles– Childproof packaging


Local Rule: Some Areas With Recreational Pot Shop Bans

GunnisonHudsonJohnstownLimonParkerSuperiorThorntonWestminsterWindsorWoodland ParkCastle PinesColorado SpringsGrand JunctionDurango

Jefferson CountyDouglas County

GreeleyMontroseLongmontBlancaBroomfieldBuena VistaBurlingtonCastle RockCherry Hills VillageCrawfordCrested ButteDaconoDel NorteEnglewoodFairplayFoxfieldGreenwood Village


How Prevention Programs May Respond in the Future

• Co-Opt Models/Approaches from Alcohol– Programs which emphasize prevention at the

family/household/individual level– Education (both youth and adults, safety, routes of

administration, universal screening, mechanisms of youth access, etc.)

– Marketing (approaches from tobacco?)– Focus on health/social consequences rather than

legal• Teen drinking analogies


How Prevention Programs May Respond in the Future

• Advocacy Opportunities– Regulations (local and Statewide, distance from

schools, etc.)– Models of taxation/industry (ad valorem, on

cultivation rather than point of sale, vertical business integration)


So… about that tax money…• First $40 million annually in excise taxes to

create new public school construction fund

• Estimates vary, but first year projections include possibly another ~$85 million in revenue, possibly to fund– Treatment programs

– Prevention/education campaigns aimed at youth (maybe adults)

– Research into health impacts of MJ use

– Increased regulatory budget (also supported by licensing fees)


Thank You!

Contact Us:

2170 S Parker Road #229

Denver, CO 80231

www.peerassist.org

303-369-0039

[email protected]

Documents

Medical & Legalized Marijuana: The Colorado Experience