Medical & Legalized Marijuana: The Colorado Experience

2. Medical & Legalized Marijuana: TheColoradoExperience Chris Knoepke, MSW, LSW, ABD May 7, 2014

3. Peer Assistance Services, Inc. Founded in 1984

4. 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)

8. 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

9. 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

10. 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

11. 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”?

12. MMJ: Recognized Conditions in Colorado • Cancer • HIV • Muscle Spasms • Cachexia • Seizures • Chronic Pain • Glaucoma • MS

13. 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

14. CO MMJ in the Workplace: Legal History • Benoir v. Industrial Claims Appeals Office • Coats v. Dish Network h/t Denver Post

15. Amendment 64: Article 18, Section 16 of the Colorado State Constitution (2012)

16. Colorado as thePetrie 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

17. How A64 Was Sold to Colorado

19. 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

20. 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

21. 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%) $ $ $ $ $ $

22. 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)

23. 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

24. 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

25. 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.”

26. 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

27. Issues Around Professional Services • Banking • Legal Services

28. Clinical Issues • Routes of Administration (“Edibles”) • Universal Screening (SBIRT) • Including assessing simultaneous use of marijuana with alcohol, prescription medications

29. 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

30. Edibles, Potency Testing, and Quality Control

34. 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)

35. 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

36. Local Rule: Some Areas With Recreational Pot Shop Bans Greeley Montrose Longmont Blanca Broomfield Buena Vista Burlington Castle Rock Cherry Hills Village Crawford Crested Butte Dacono Del Norte Englewood Fairplay Foxfield Greenwood Village Gunnison Hudson Johnstown Limon Parker Superior Thornton Westminster Windsor Woodland Park Castle Pines Colorado Springs Grand Junction Durango Jefferson County Douglas County

37. 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

38. 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)

39. 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)

40. Thank You! Contact Us: 2170 S Parker Road #229 Denver, CO 80231 www.peerassist.org 303-369-0039 cknoepke@peerassist.org