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PreventionIn the Age of Medical Marijuana ©
Marcie Seidel, OCPS
Prevention Action Alliance
Leading healthy communities in the prevention of substance misuse and the promotion of mental health wellness
✓ Formerly Drug Free Action Alliance
✓ Started in 1987
✓ Certified Prevention Agency, Statewide, 501(c)(3)
The Ohio Medical Marijuana
Control Program
House Bill 523
Legalized September 8, 2016
Medicalmarijuana.ohio.gov
Source: HB523
Medicalmarijuana.ohio.gov
TOLL-FREE HELPLINE
The Ohio Medical Marijuana Control Program Toll-Free
Helpline responds to inquiries –
• From patients,
• From caregivers,
• From health professionals regarding adverse reactions
to medical marijuana,
• Provides information about available services
• Additional assistance as needed.
1-833-4OH-MMCP (1-833-464-6627)
Source: HB523
Ohio Medical Marijuana Program
Prevention in a Changing Environment
Today’s Objectives
Understanding Ohio’s Law
Medicalmarijuana.ohio.gov
Potential Impact
Prevention Strategies
Source: HB523
OHIO MEDICAL MARIJUANA
▪ Seed to sale system▪ Uses Tracking System▪ State Issued I.D. Card▪ 18 years or older – minor patients have a designated caregiver▪ No smoking▪ Required to give information to consumers▪ Only patients, caregivers and employees in the dispensary▪ No drive-thru windows or home delivery▪ 500 feet from prohibited facility
Source: HB523
DATES REQUIRED BY LAW
Effective date of OhioHouse Bill 523.
Establishes the basic framework for Ohio’s
Medical Marijuana Control Program.
Cultivator Rules Adopted. Ohio law requires the Ohio
Department of Commerce to adopt
cultivator rules by this date.
Ohio law requires the Ohio Medical Marijuana Control Program to be
fully operational by this date.
8 September 2016 6 May 2017 8 September 2018
Source: HB523
Dispensaries / Patients and Caregivers / New Forms
State of Ohio Board of Pharmacies
Cultivators / Processers / Testing Laboratories
Ohio Department of Commerce
Physicians / New Qualifying Conditions
State of Ohio Medical Board
STATE ENTITES RESPONSIBLE
MedicalMarijuanaAdvisory Commission
Source: HB523
Rule Making Process - complete
✓ Rules Introduced – come before Medical Marijuana Advisory Committee
✓ Common Sense Initiative – required to complete a Business Impact Analysis (BIA) and submit it and the proposed rules to the CSI office
✓ Public Hearing – As a part of the Joint Committee on Agency Rule Review (JCARR) process, the Ohio Medical Marijuana Control Program holds a public hearing between 30-41 days after the rules have been filed with JCARR
✓ JCARR Hearing – this hearing is the final opportunity for comments – but it only address the following 6 issues within JCARR’s jurisdiction
The rule process is complete – much public input in the processSource: HB523
CULTIVATOR APPLICATIONS
Medical Marijuana Control ProgramOhio Department of Commerce
• Level 1 - 50 thousand square feet or less – can expand another 25,000 sq. ft. 12 total
✓ Level II - 6 thousand square feet or less – can expand another 3,000 sq. ft.12 total
✓ Level II applicants were selected and announced on November 3, 2017✓ Level I to be announced by December 1, 2017✓ Blind scoring, if a tie, the one with the highest score in operations prevails
Source: HB523
CULTIVATOR – Level IILevel II Cultivator Provisional License Recipients
Score - 178.92 Fire Rock Ltd. (Columbus, Franklin County)Score - 178.92 Fire Rock Ltd. (Canton, Stark County)Score - 178.92 Fire Rock Ltd. (Akron, Summit County)Score - 176.76 FN Group Holdings LLC (Ravenna, Portage County)Score - 172.00 Mother Grows Best LLC (Canton, Stark County)Score - 168.76 OhiGrow LLC (Toledo, Lucas County)Score - 168.76 Ancient Roots LLC (Wilmington, Clinton County)Score - 160.56 Ohio Clean Leaf LLC (Dayton, Montgomery County)Score - 160.56 Ohio Clean Leaf LLC (Carroll, Fairfield County)Score - 157.08 Ascension BioMedical LLC (Oberlin, Lorain County)Score - 156.60 Agri-Med Ohio LLC (Langsville, Meigs County)Score - 154.56 Paragon Development Group LLC (Huber Heights, Montgomery County)Score - 151.28 Hemma LLC (Monroe, Butler County)Score - 148.92 Galenas LLC (Akron, Summit County)Score - 143.08 Farkas Farms LLC (Grafton, Lorain County)
Can receive only 1 provisional license so must choose location.
Source: HB523
CULTIVATOR – Level ILEVEL II CULTIVATOR PROVISIONAL LICENSE RECIPIENTS
Score - 179.28 Buckeye Relief LLC (Eastlake, Lake County)Score - 173.44 Grow Ohio Pharmaceuticals LLC (Newton Township, Muskingum County)Score - 173.28 OPC Cultivation LLC (Huron, Erie County)Score - 172.72 Riviera Creek Holdings LLC (Youngstown, Mahoning County)Score - 167.64 Pure Ohio Wellness LLC (Springfield, Clark County)Score - 167.08 Columbia Care OH LLC (Mt. Orab, Brown County)Score - 165.48 Terradiol Ohio LLC (Canton, Stark County)Score - 161.28 Standard Wellness Company LLC (Gibsonburg, Sandusky County)Score - 161.28 AT-CPC of Ohio LLC (Akron, Summit County)Score - 159.80 Cresco Labs Ohio LLC (Yellow Springs, Greene County)Score - 153.08 Parma Wellness Center LLC (Parma, Cuyahoga County)Score - 142.04 Harvest Grows LLC (Hamilton Township, Lawrence County)Score - 142.04 Harvest Grows LLC (Cleveland, Cuyahoga County)
Can receive only 1 provisional license so must choose location.
CULTIVATION
✓Prevents someone from holding more than one cultivator license in Ohio✓Can’t transfer license to another person without following a process for
approval✓Renewal of licenses yearly✓Must be a least 21 years old to work✓ Limits on pesticide and fertilizers✓Packaging and labeling requirements✓Must do weekly inventory✓Cultivator cannot sell directly to patient
Source: HB523
CULTIVATION updates
• 70 grower applicants have requested appeals hearings to voice their concerns about the selection process – will take months due to number. 185 applicants
• Lawsuit in Franklin County Court of Common Pleas about Minority set-aside provision
• Another is planning a ballot initiative to legalize completely
• SB 264 (2017-2018) Track MEDICAL MARIJUANA (Coley, B.) To require the Auditor of State to conduct and release a performance audit of the Medical Marijuana Control Program, to prohibit the Department of Commerce from issuing final cultivator, processor, or laboratory testing licenses until performance audit recommendations are implemented, and to declare an emergency.
• Attorney General – Third Party Evaluator Source: HB523
FORM AND METHOD
Child Resistant PackagingPackaging Standards in 16C.F.R. 100.15 – Poison Prevention Packaging
Tier I medical marijuana - THC content of 23% or lessTier II medical marijuana - THC content of more than 23% to no more than 35%
Legal Forms of Use:
✓ Oral: Oil, Tincture, Capsule, Edibles✓ Topical: Patches, Lotions, Cream, Ointments✓ Vaporization: Metered Oil, Solid Preparation ✓ Vaping: Plant Material
✓ If new forms, they must be approved by the state board of pharmacy Source: HB523
PROCESSORS
✓ Up to 40 processors to start – more can be added if needed after 9/9/2018
✓ 104 Applications being evaluated now – Award in June 2018
✓ Cannot be within 500 feet of prohibited facility
✓ Ensure that a consistent supply of medical marijuana is available
✓ Not more than thirty days elapsing between shipments
✓ Can provide sample jars to dispensaries for patients to smellSource: HB523
TESTING LABORATORYThe director of the Department of Commerce or the director's designee may issue to an institution of higher learning that meets all of the following conditions:
(1) The institution is public and is located in the state of Ohio; and (2) The institution has the facilities and resources necessary to conduct testing
2- public IHE applicants: Hocking College, Central State University – award in May 20187- private testing laboratory applicants: re-interpreted one year from when any marijuana business license application is accepted, or June 2018 in order to have enough capacity to meet the anticipated demand – they will be award in June 2018
✓ Unmarked vehicles, extreme security, cannot stop along the way✓ Every lot tested among other things:
• THC, THCA, CBD, CBDA• Contaminants, heavy metals, fertilizer, pesticides, solvents other CO2
Source: HB523
Dispensaries
DISPENARIES
✓ 60 Provisional Licenses✓ Board of Pharmacy will consider more based on need at least once biennial✓ One can only own a maximum of 5 licenses✓ Can’t transfer licenses✓ Open a minimum of 35 hours a week✓ Can be opened 7:00 a.m. to 9:00 p.m.✓ At least 2 Employees on site at all time✓ No drive-thru✓ Cannot consume on site✓ Cannot be within 500 feet of a school, church, public library, public playground or public
park✓ Cannot deliver
Source: HB523
DISPENARIES
• The dispensary districts were created after considering the following:
✓Established rules and regulations in other state medical marijuana programs
✓Patient populations
✓Consultation with regulators in other states
✓Ohio’s population
✓Existing compliance resources for the State Board of Pharmacy
✓Access to major Ohio roadways
Source: HB523
DISPENARIES Update
10 Northwest Region
18 Northeast Region
17 Southwest Region
15 Southwest Region
Source: HB523
DISPENARIES Erie County
NW District 8 2 Dispensaries
Erie, Huron,Richland, Ashland
Source: HB523
DISPENARIES Update
376 Applications received for 60 licensesAwarded early May 2018
No applications for 3 regions so there will only be 57
Source: HB523
LAW PROTECTING CHILDREN
PROHIBITED✓Resemblance to a cartoon character, child’s fictional character, pop culture
figure✓Resemblance to commercially available candy✓Design or object recognized as appealing to or used by children✓Bears, animals, caricatures or cartoon renderings✓Anything that may target those under 18 years old✓Characterizing flavors used for vaporization✓ No vaping for patients under 18
Source: HB523
EDIBLES
PRODUCT LABELING
✓ Child proof packaging✓ Label on every package with information of cultivator and strain✓ Total weight in grams✓ Where and when tested✓ Complete CBD and THC profile✓ Expiration date – one year from date of manufacturing✓ All ingredients in edibles
Warnings:✓ “This product is for medical use and not for resale or transfer to another person.”
“This product may cause impairment and may be habit-forming.” “This product may be unlawful outside the State of Ohio”.
"Caution: When eaten or swallowed, the effects and impairment caused by this drug may be delayed."
Source: HB523
ADVERTISING
All must be approved through the Board of Pharmacy
✓ Marijuana advertisements cannot:✓ Be within 500 feet of prohibited facility✓ Be targeted to children✓ On billboards✓ On radio or broadcasts✓ On handheld or portable signs✓ Handout flyers or literature in public spaces✓ Displayed on public transit vehicles
Source: HB523
ADS AND PROMOTIONS
✓No cartoon characters✓No apparel, unless for employees✓No merchandise marketed to youth under 18✓No slang – only medical registered name✓False or misleading statements✓Obscene or indecent✓Encourage use for anything other than specified conditions✓No illuminated signs✓No coupons except for indigent or veterans✓No illuminated signs
EDIBLES
PHYSICIAN
✓ Active, unrestricted license to practice medicine and surgery or osteopathic medicine and surgery under section
✓ Access to the new database systems
✓ No disciplinary actions
✓ 2 hour approved continuing medical education
▪ Diagnosing qualifying medical conditions
▪ Treating with marijuana
✓ No ownership in marijuana company
✓ Maintain a complete patient history and medical record
✓ ****Explain risks and benefits of using Marijuana*** Source: HB523
PHYSICIAN UPDATE
✓Certificate to Recommend – CTR behind their other medical credentials✓Ohio Medical Board to Approve✓No limit and ongoing process✓Geographically dispersed✓April and May Medical Board meeting approved the first cohort✓ 40-50 applicants, 37 were approved✓Must be trained in marijuana curriculum ✓Must be trained in regulatory software
Source: HB523
QUALIFYING CONDITIONS
✓AIDS ✓Amyotrophic lateral sclerosis ✓Alzheimer’s disease ✓Cancer ✓Chronic traumatic
encephalopathy ✓Crohn’s disease✓ Epilepsy - seizure disorders✓ Fibromyalgia ✓Glaucoma ✓Hepatitis C ✓ Inflammatory bowel disease
✓Multiple sclerosis✓Pain that is either chronic and
severe or intractable ✓Parkinson’s disease ✓Positive status for HIV ✓Post-traumatic stress disorder ✓ Sickle cell anemia ✓ Spinal cord disease or injury✓ Tourette’s syndrome ✓ Traumatic brain injury ✓Ulcerative colitis
Source: HB523
PATIENT
✓Registration Fees: Patient, $50 Caregiver, $25✓Bona fide relationship with doctor and has a qualifying condition✓Register with Ohio State Board of Pharmacy after receiving recommendation✓Proof of an Ohio citizen✓Must renew annually✓Can purchase a 90 day supply in 90 days✓Must carry registration card any time they have it with them✓Must be in original containers
Source: HB523
CAREGIVER
✓ Must be 21 years old – unless a minor’s parent, then at least 18
✓ Patient can have no more than 2 caregivers
✓ Caregivers can have no more than 2 patients
✓ Can purchase no more than a 90 day supply in 90 days
Source: HB523
Control and Support
✓ Seed to sale tracking
✓ New software system for physicians, dispensaries, patients
✓ Use the Current OARRS – dispensaries must enter information with 5 minutes of sale
✓ State’s Compliancy Team is in place
✓ Robust Security at all location
Source: HB523
Ohio Medical Marijuana Program
Prevention in a Changing Environment
Medicalmarijuana.ohio.gov
Community Impact
Things to Think About
Community Concerns
Police, Fire, EMS, Increased ER Visits• Medical Marijuana is an all cash business• Security is a primary concern• Managing hazmat concerns from chemicals, CO2• Managing fire concerns, electrical strain & high heat• Housing values• Institutions that ban federally illegal drugs• Schools – administering marijuana to patients
Things to Think About
1. COMMUNITY ATTITUDES AND BELIEFS2. DRUGGED DRIVING3. DIVERSION OF DRUG4. YOUTH ACCESS5. ACCIDENTAL OVERDOSES - CHILDREN6. INCREASE USE – ADULT & ADOLESCENCE7. RISK OF INCREASING MENTAL HEALTH CONCERNS8. SAFETY – WORK ENVIRONMENT
What your community can do
• Increase zoning distances• Restrict zoning in residential area• Restrict advertising in city limits• Implement comprehensive city licensing program• Impose ban on medical marijuana related entities
Zoning Ordinances are your friend
Ohio Medical Marijuana Program
Prevention in a Changing Environment
Medicalmarijuana.ohio.gov
Prevention Strategies
Prevention
Prevention EducationEnvironmental Prevention - C.A.M.P.
AlternativesCommunity-Based ProcessInformation DisseminationProblem Identification and Referral
Supplemental strategies support the implementation of the 2 main strategies –not prevention if used alone
COMMUNITY Attitudes & Beliefs
Although these laws, for the most part have not targeted the adolescent population, they have created an environment in which marijuana increasingly is seen as acceptable, safe, and therapeutic.
COMMUNITY Attitudes & Beliefs
Cannabis is an addictive substance that should not be
treated as an ordinary commodity in the
marketplace
Community Attitudes & Beliefs
SOCIAL NORMS
IS IT ACCEPTALBE OUTSIDE OF THERAPEUTIC USE?
The perception of marijuana being harmful is falling among youth
* 2017 Monitoring the Future
COMMUNITY Attitudes & Beliefs
Cannabis sale and consumption should not be normalized!
COMMUNITY Attitudes & Beliefs
• Data collection: accurate knowledge of use rates• Provide age appropriate drug education starting
very young• Provide facts – no scare tactics• Environment should not reflect its acceptance
Prevention Strategies
Drugged Driving
• Colorado – traffic deaths doubled for drivers positive with marijuana*
• About 50% of fatal crashes national involved drivers whose blood testes were positive for THC
• Many students believe they are better drivers after using marijuana
• Rocky Mountain High Intensity Drug Trafficking Area October 2017• 2014 FARS
Drugged Driving
• Media Campaigns • A.R.I.D.E and DRE (Drug Recognition Expert) programs• Person under 21 who is MM patient can’t get driver’s
license• Patient should not drive for 6-8 hours after ingesting
Prevention Strategies
Diversion of Drug
ColoradoLarge Scale
✓Felony arrests are up✓3.5 tons of illegal marijuana seized
Personal level✓Diverted to non-patients
• The Legalization of Marijuana in Colorado: The Impact Rocky Mountain High Intensity Drug Trafficking Areawww.rmhidta.org
Diversion of Drug
• Tight Controls in Ohio’s MM Program
Prevention Strategies
Youth Access
• Adolescents living medical marijuana states with a plethora of dispensaries are more likely to have tried new methods of cannabis use, such as edibles and vaping, at a younger age than those living in states with fewer dispensaries.**
** Study from The Geisel School of Medicine at Dartmouth
• People who begin using marijuana before age 18 are 4 to 7 times more likely than adults to develop problem use.
Teens are more likely to use Marijuana
than Cigarettes
Monitoring the Future 2017
Youth Access and use
• SBIRT – [Screening and Brief Intervention Referral to Treatment]
• Parents talk to your children• Set expectations• Set an example• Share factual information
Prevention Strategies
Accidental Overdoses - Children
• Since marijuana legalization, pediatric exposers to cannabis have increased
• Pediatric exposure: drowsiness, lethargy, irritability, seizures, nausea & vomiting respiratory depression, bradycardia and hypertension
• Pediatric Death Due to Myocarditis after ingestion
* Wang GS, Roosevelt G., Le Lait MC, et al
Accidental Child Overdoes
• Child proof packaging• Proper storage• Don’t use around the child
Prevention Strategies
Increase in Use – Adult &
Adolescence
Colorado Youth past month marijuana use for 2015/2016 was 30% higher than the national average
Youth past month marijuana use increased 12% in the 3-year average since Colorado legalized recreational marijuana
Adult past-month use increased 71% in the 3-year average
• The Legalization of Marijuana in Colorado: The Impact Rocky Mountain High Intensity Drug Trafficking Areawww.rmhidta.org
• NSDUH
Increase Use of Marijuana
• Education• Advertising• Pricing• Access and Availability - Monitor for illegal grows• Rules and Laws• Media • Normalization in community• Keep MM business accountable to the law
Prevention Strategies
Risk of Increasing Mental Health
Issues
“Results of meta-analysis provide evidence for a relationship between cannabis use and earlier onset of psychotic illness”
“Likely to increase the risk of developing schizophrenia”
*Meta- Analysis conducted by Australian Researchers – 2011 Archives of General PsychiatryNational Academies of Sciences, Engineering and Medicine
Increase Risk of Mental Health
Issues
Those starting use before the age of 15 are 4 – 7 times more likely to have a dependency at
some point in there life
• Prevent early use• Educate on the dangers
Prevention Strategies
Environment
• Water – 6 to 16 gallons a day for one plant• Indoor cannabis production can be a very electricity
intensive• An indoor grow module for 4 plants can use as much
energy as 29 refrigerators• Mildew, pesticides, mold, herbicides
* Mother Jones
Northwest Power and Conservation Council
Environmental Concerns
• Zoning Ordinances• Enforcement• Illegal Outdoor Grows
Prevention Strategies
Safety – Workplace Environment
• Are almost 4 times more likely to be involved in workplace mishaps*
• Less productive on the job and more likely to miss work**
* NIDA** McCleanInsurance.com
Employers’ Rights
1. Employers are NOT required to accommodate use, possession or distribution.
2. Employers CAN refuse to hire, discharge, discipline and take adverse employment action.
3. Employers CAN establish a drug-free workplace program (including zero tolerance).
4. Employers CANNOT be sued for adverse action taken based on medical marijuana use.
Employers’ Rights
• This law does not interfere with federal restrictions on employment (e.g., DOT).
• NO unemployment will be paid for an employee violating an employer’s drug-free workplace or zero-tolerance policy.
• This law will NOT interfere with Workers’ Compensation:• The Drug-Free Safety Program (DFSP) requirements
remain valid.• Rebuttable presumption is still in place.
• Medical marijuana will NOT be covered by health insurance.
EDIBLES
