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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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