Transcript 2015 Conf. Presentation (A4) Marijuana

Marijuana Use and Healthcare Facilities
Lisa Barker, CCRC, MPH
Manager, Marijuana Health Monitoring Program
Environmental Epidemiology, Occupational Health and Toxicology Branch
Timeline
Hash Oil Photo by Vjiced available under CCA-SA from Wikimedia Commons
Marijuana Products
Those meant to be smoked or vaporized
Edibles
•
Tinctures and ointments
Colorado Marijuana Use
CO BRFSS 2014
Medical vs Retail: Differences
Who Can Use
Medical:
Colorado resident diagnosed with a debilitating medical condition,
who receive a recommendation for use for qualified condition:
1. Cancer
5. Severe pain
2. Glaucoma 6. Severe nausea
3. Positive status for HIV or AIDS 7. Seizures
4. Cachexia 8. Persistent muscle spasms
Retail: Any
individual age 21 or older
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Medical vs Retail: Differences
Who can assist
Medical: Primary caregivers are authorized to assist medical marijuana
patients in the medical use of marijuana. A primary caregiver must
be 18 years or older and have “significant responsibility” for
managing the well being of the patient including being involved in
basic or instrumental activities of daily living.
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Medical vs Retail: Differences
Amount You can Possess
Medical: Up to 2 ounces product.
Up to six plants with three flowering at one time (this restriction
can be lifted with a physicians recommendation of up to 99 plants
for one medical marijuana card holder)
Retail: Up to 1 ounce.
Up to six plants with three flowering at one time
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Medical & Retail: Similarities
Where can it be consumed
Consumption: Marijuana cannot be consumed openly and publicly
Smoking: Prohibitions in the Clean Indoor Air Act
• Indoors –prohibited with limited exceptions, such as designated smoking areas for
nursing home and assisted living residents
• Outdoors –prohibited within a radius of 15 feet of the front or main doorway
leading into a facility.
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Medical & Retail: Similarities
Intoxication
For the purposes of a DUI or DWAI, a drug content of 5 nanograms
or more of delta 9 THC per milliliter of blood is a permissible
inference that the person is under the influence
Driving soon after using marijuana doubles the risk of a motor vehicle crash.
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You Should Know
Before performing safety-sensitive activities, wait…

…at least 6 hours after smoking marijuana with > 35 mg THC (if more wait longer). A
typical joint contains between 60-115 mg THC.

…at least 8 hours after eating or drinking marijuana with > 18 mg THC (if more wait
longer). The standard serving size for a retail marijuana edible is 10 mg.

…to consume another THC-containing product until after the effects from the first edible
serving are known. For new or occasional users, it takes up to 4 hours to reach maximum
blood levels of THC and potentially longer to feel the full effects of consuming a
marijuana edible product.
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Impact on Facilities
•Both medical and retail marijuana are:
• legal at the state level
• illegal at the federal level
• Surveyors cite when:
• use infringes on the rights of residents
• there is a resident safety issue
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Other Potential Impacts
• Interactions with other medications
• Second hand smoke
• Accidental poisonings with edible marijuana
products
• Impairment
resident falls
incapacitated employees
https://mjmarketwatch.files.wordpress.com/2013/10/cibdex.jpg
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For Consideration
If you are planning on developing a policy, consider:
• Developing a process to monitor the level of impairment of employees
and of clients
• Safe storage practices for marijuana to prevent accidental ingestion
• Emergency response for cases of actual or suspected accidental
ingestion or over ingestion
• Facilitating discussions with residents or their families about
interactions between marijuana and other medications
• Consulting legal counsel
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Marijuana In Colorado
CDPHE Roles and Responsibilities
CDPHE Internal Governance
Disease Control and
Environmental Epidemiology
Preventative Services
Retail Marijuana Public
Health Advisory
Committee (SB-13-283)
CDPHE Internal Retail
Marijuana Steering
Committee
Health Surveillance, Medical Literature Reviews,
Outbreak Investigations, Occupational Health and
Safety
Prevention and Education Campaign,
Clean Indoor Air Act
Environmental Health and
Sustainability
Infused Product/Edible Safety (consultative)
Center for Health and
Environmental Data *
Health Behavior Surveys, Data Analysis
Laboratory Services
Laboratory Certification, Contaminant Analysis
Consultation
Hazardous Waste and Waste
Management
Marijuana and Byproduct Disposal Issues
(consultative)
Health Facilities and EMS
Trauma Registry, Guidance for Health Facilities
CDPHE ROLErijuana ROLE
• Issue registry identification cards
• Maintain database of registered users
• Review petitions for adding debilitating medical conditions to the
medical use of marijuana regulations
• Will administer grants program for clinical and observational
research related to potential therapeutic uses of marijuana
Medical Marijuana Research
$9 M scientific grants program authorized by SB-14-155
Program goal: “to provide objective scientific research regarding the
efficacy of marijuana as part of
medical treatment”
56 respondents to RFA –
40 reviewed
Applicant
Project title
University of Colorado
Do Adolescents and Young Adults with Inflammatory Bowel
Anschutz Medical Campus Disease Benefit from Use of Marijuana?
Primary investigator
Edward J. Hoffenberg, University of Colorado
School of Medicine at the Anschutz Medical
Campus, Children’s Hospital Colorado
A Randomized, Double-blind, Placebo-controlled Crossover Study Maureen A. Leehey, Department of
University of Colorado
of Tolerability and Efficacy of Cannabidiol (CBD) on Tremor in
Neurology, University of Colorado School of
Anschutz Medical Campus
Parkinson's Disease
Medicine at the Anschutz Medical Campus
Marcel O. Bonn-Miller, Dept. of Psychiatry,
University of Pennsylvania
Treating PTSD with Marijuana: Clinical and Functional Outcomes University of Pennsylvania, and VA National
School of Medicine
Center for PTSD
George Sam Wang, Department of
University of Colorado
Pediatrics, University of Colorado School of
Cannabidiol (CBD) and Pediatric Epilepsy
Anschutz Medical Campus
Medicine at the Anschutz Medical Campus and
Children’s Hospital Colorado
University of Colorado
Medical Marijuana in the Pediatric Brain Tumor Population
Denver Anschutz Medical
(palliative care)
Campus
Nicholas Foreman, Dept. of Pediatrics, Pediatric
Neuro-oncology, Children’s Hospital Colorado
University of Colorado
Use of Medicinal Cannabinoids as Adjunctive Treatment for
Anschutz Medical Campus Medically Refractory Epilepsy (pediatric epilepsy)
Kelly Knupp, Dept. of Pediatrics, Children’s
Hospital Colorado and University of Colorado
School of Medicine at the Anschutz Medical
Campus
Placebo-controlled, Triple-Blind, Randomized Crossover Pilot
Multidisciplinary
Study of the Safety and Efficacy of Four Potencies of Smoked
Marcel O. Bonn-Miller, University of Pennsylvania
Association for Psychedelic
Marijuana in 76 Veterans with Chronic, Treatment- Resistant Post and VA National Center for PTSD
Studies
Traumatic Stress Disorder (PTSD)
University of Colorado
A Double Blind, Placebo-Controlled Cross Study Comparing the
Anschutz Medical Campus Analgesic Efficacy of Cannabis versus Oxycodone
National Jewish Health
Colorado Cannabis Cohort: Efficacy, Safety, and Usage Patterns
of Medical Marijuana for Sleep
TOTAL
Emily Lindley, Dept. of Orthopedics, University
of Colorado School of Medicine at the Anschutz
Medical Campus
Russell Bowler, National Jewish Health
Updated grant
amount
$1,191,329***
$1,028,981**
$1,181,127***
$576,350***
$1,041,256***
$631,835**
$2,156,000***
$743,122**
$450,000*
$9,000,000
Detailed Report
Google – “Retail Marijuana Public
Health Advisory Committee”
Health Dept tasked with…
1. Monitor patterns of use
2. Monitor health effects
3. Create a scientific advisory panel to review
literature and emerging science
http://www.spins.com/wp-content/uploads/2014/11/medical-marijuana-edibles.jpg
Future Directions for Health
Monitoring Program
● Continue surveillance of currently available data sources.
Collaborate with state, county and local entities to identify
additional sources of data - update reported data at least every
two years.
○ Prevalence data
○ Health effects data
● New topics for Literature Review
○ Cannabis Use Disorder (covered in March)
○ Vaporization and Secondhand Smoke
○ Hyperemesis
○ Intra and Interpersonal Violence
○ Immune Function
○ Oral Health
● Review of current topics - every two years
Health Dept tasked with…
1. Monitor patterns of use
2. Monitor health effects
3. Create a scientific advisory panel to review
literature and emerging science
4. Prevention campaign and education
5. Consultative role: Contamination limits and
laboratory certification, edibles safety, safe
disposal of product and byproducts
Educational Resources
www.colorado.gov/marijuana
Website
www.GoodToKnowColorado.com
Website
Out-of-Home
Print Materials for Order
• Free to order
www.cohealthresources.org
Youth Prevention
Protect What’s Next
o The #1 deterrent
 The most compelling reason not to use marijuana across all
age groups was that it could get in the way of achieving their
goals.
o It’s not what we say, it’s how we say it
 Youth rejected any language that was preachy or presented as a
scare tactic.
www.ProtectWhatsNext.com
Protect What’s Next
https://www.youtube.com/watch?v=W5aCZkXyt7U
Educational Resources
www.colorado.gov/marijuana
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Questions?
[email protected]
Randy Kuykendall, MLS
Division Director, Health Facilities and Emergency Medical Services
[email protected]
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