Marijuana Use and Healthcare Facilities

Lisa Barker, CCRC, MPHManager, Marijuana Health Monitoring Program

Environmental Epidemiology, Occupational Health and Toxicology Branch

Timeline

Marijuana Products

Those meant to be smoked or vaporized

Edibles

• Tinctures and ointments

Hash Oil Photo by Vjiced available under CCA-SA from Wikimedia Commons

Colorado Marijuana Use

CO BRFSS 2014

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 AIDS7. 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 vs Retail: Differences

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

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Medical & Retail: Similarities

Driving soon after using marijuana doubles the risk of a motor vehicle crash.

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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You Should Know

•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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Impact on Facilities

• Interactions with other medications

•Second hand smoke

•Accidental poisonings with edible marijuana products

• Impairment resident falls incapacitated employees

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Other Potential Impacts

https://mjmarketwatch.files.wordpress.com/2013/10/cibdex.jpg

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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For Consideration

Marijuana In Colorado CDPHE Roles and Responsibilities

CDPHE Internal Governance

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 Primary investigatorUpdated grant amount

University of Colorado Anschutz  Medical Campus

Do Adolescents and Young Adults with Inflammatory Bowel Disease Benefit from Use of Marijuana?

Edward J. Hoffenberg, University of Colorado School of Medicine at the Anschutz Medical Campus, Children’s Hospital Colorado

$1,191,329***

University of Colorado Anschutz  Medical Campus

A Randomized, Double-blind, Placebo-controlled Crossover Study of Tolerability and Efficacy of Cannabidiol (CBD) on Tremor in Parkinson's Disease

Maureen A. Leehey, Department of Neurology, University of Colorado School of Medicine at the Anschutz Medical Campus

$1,028,981**

University of PennsylvaniaSchool of Medicine

Treating PTSD with Marijuana: Clinical and Functional Outcomes

Marcel O. Bonn-Miller, Dept. of Psychiatry, University of Pennsylvania, and VA National Center for PTSD

$1,181,127***

University of Colorado Anschutz  Medical Campus

Cannabidiol (CBD) and Pediatric Epilepsy

George Sam Wang, Department of Pediatrics, University of Colorado School of Medicine at the Anschutz Medical Campus and Children’s Hospital Colorado

$576,350***

University of Colorado Denver Anschutz  Medical Campus

Medical Marijuana in the Pediatric Brain Tumor Population(palliative care)

Nicholas Foreman, Dept. of Pediatrics, Pediatric Neuro-oncology, Children’s Hospital Colorado

$1,041,256***

University of Colorado Anschutz  Medical Campus

Use of Medicinal Cannabinoids as Adjunctive Treatment for 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

$631,835**

Multidisciplinary Association for Psychedelic Studies

Placebo-controlled, Triple-Blind, Randomized Crossover Pilot Study of the Safety and Efficacy of Four Potencies of Smoked Marijuana in 76 Veterans with Chronic, Treatment- Resistant Post Traumatic Stress Disorder (PTSD)

Marcel O. Bonn-Miller, University of Pennsylvania and VA National Center for PTSD

$2,156,000***

University of Colorado Anschutz  Medical Campus

A Double Blind, Placebo-Controlled Cross Study Comparing the Analgesic Efficacy of Cannabis versus Oxycodone

Emily Lindley, Dept. of Orthopedics, University of Colorado School of Medicine at the Anschutz Medical Campus

$743,122**

National Jewish HealthColorado Cannabis Cohort: Efficacy, Safety, and Usage Patterns of Medical Marijuana for Sleep

Russell Bowler, National Jewish Health $450,000*

 TOTAL

  $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

● 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

Future Directions for Health Monitoring Program

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

www.cohealthresources.org

• Free to order

Youth Prevention

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?Lisa.Barker@state.co.us

Randy Kuykendall, MLSDivision Director, Health Facilities and Emergency Medical Services

Randy.Kuykendall@state.co.us

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