marijuana legalization preventing community impact · medicinal vs. non-medicinal cannabis in...

Marijuana Legalization Preventing

Community Impact:

“The Power of Prevention”

Yolanda Cordero, MPA

Chief, Prevention Services

1

County of Los Angeles-Department of Public Health

Substance Abuse Prevention and Control

Prevention Framework

Strategic Prevention Framework (SPF)

Institute of Medicine (IOM)

classification

SAMHSA’s Center for Substance

Abuse Prevention (CSAP) Strategies.

The use of these frameworks are required by the State

Department of Health Care Services.

2

Strategic Prevention Framework

Five Step Planning Process:

1. Assessment

2. Capacity

3. Planning

4. Implementation

5. Evaluation

3

PRIORITY AREA 3:

Underage Alcohol

Drinking and Binge

Drinking

PRIORITY AREA 2:

Reduce underage

marijuana use

PRIORITY AREA 1:

Prescription and Over-

the-Counter Medication

Misuse and Abuse

PRIORITY AREA 4:

Methamphetamine and

other illicit drug use

FOCUS

AREAS

California’s legal background

• “Compassionate Use Act”

• Approved by California voters

• Allowed qualified patients with a valid doctor’s recommendation to possess and cultivate cannabis for personal medical use

1996: Prop. 215

California’s legal background

• “Medical Cannabis

Regulation and

Safety Act”

• Adopted by

California Legislature

• Established the first

regulatory framework

for medical cannabis

2015-16: MCRSA

California’s legal background

• Legalized nonmedical or

adult-use cannabis

possession, cultivation and

use (limits apply)

• Established regulatory

framework for adult-use

cannabis

• Required State of California

to license commercial adult-

use cannabis businesses by

Jan. 1, 2018

Nov. 2016: Prop.

64

California’s legal background

• “Medical and Adult-Use

Cannabis Regulation and Safety

Act”

• Adopted by California

Legislature as a cleanup bill

• Repealed MCRSA and amends

AUMA to include regulations

for medical cannabis (MCRSA +

AUMA = MAUCRSA = one

regulatory framework)

June 2017: MAUCRSA

Medicinal vs. non-medicinal

cannabis in California

• Medicinal Cannabis: Recommended by a doctor for medicinal purposes like chronic pain and can be purchased at cannabis retail outlets

• Non-Medicinal Cannabis: No longer requires a doctor’s recommendation. Adults 21 and over can purchase cannabis at licensed retail outlets as early as January 2018.

9

What is cannabis?Cannabis is a plant which

contains several active

ingredients, THC and CBD

from the cannabis plant.

Some common names for

cannabis include: “Broccoli”, “Dope”, “Grass”,

“Herb”, “MJ”, “Marijuana”,

“Mary Jane”, “Pot”, or

“Weed”

10

Flowers Concentrates Infused Products

Green, brown, or gray mixture

of dried and shredded

leaves, buds, stems, seeds,

and flowers

Compressed resin, “hash,”

that resembles wax or oil

Use of either plant, hash oil or

concentrates in edibles and

drinks

In a pipe, water pipe (bong),

flavored papers, or joint

Inhaled through a device

that heats the liquefied

concentrate into mostly

odorless vapor

Eaten as ingredient in baked

goods, candies, and sodas

Average THC content is 15%,

with range of 8 to 22%

Extracts can have a THC

content of up to 90%

THC concentration varies

per item with no regulation

on dosage

Infused Products

Use of either plant, hash oil or

concentrates in edibles and drinks

Eaten as ingredient in baked

goods, candies, and sodas

concentration varies per item with no

current regulation on dosage

The amount of tetrahydrocannabinol (THC) - the main

psychoactive ingredient in cannabis - can vary in edible

products which makes it harder to control how much THC is

consumed. The amount of THC in homemade edibles can vary even more.

How is cannabis used?

14

Form Type How it Works

Smoking Joint, blunt, pipe,

bong

User inhales smoke from burned cannabis.

Cannabis smoke is similar to tobacco smoke. It’s

harmful to your lungs.

Vaping E-cigarettes, vape

pens, vaporizers

User inhales burned THC extract. Vaping tools

aren’t checked for safety. The health effects of

vaping aren’t currently well-known.

Dabbing Dab, wax, shatter,

budder, hash oil

User heats THC extract from cannabis and inhales

vapor. THC extract is a concentrated form of

cannabis. This can be dangerous because it’s more

potent than regular cannabis.

Eating or

drinking

Beverages and food

items including candy

or desserts that have

cannabis added to

them

User consumes edible (food items). Cannabis

effects are more delayed because cannabis is

digested like food. It’s harder to regulate how much

THC is consumed with edibles because the effects

aren’t felt right away.

Topical Lotions or oils with

cannabis additions

User rubs products onto the skin. These products

are believed to treat pain without a cannabis high.

15

What Prop. 64 does not change

A number of marijuana-related activities remain illegal under Prop. 64

and law enforcement may continue to charge the most serious

marijuana-related violations:

• Providing marijuana to a minor (under 18)

• Manufacturing marijuana using a volatile substance without a license

• Attempting to smuggle marijuana across state lines, as felonies.

• As with alcohol, driving while impaired by marijuana or with an open

container of marijuana remains illegal.

Marijuana may not be consumed in public

Data Trends

17

24.0 Million Americans admitted to using marijuana

within the last month! (NSDUH, 2016)

o Marijuana is becoming more acceptable in the society

o More prevalent among men than women!

Marijuana use has increased (NIDA)o Commonly used by many adolescents and young adults

Marijuana potency has increased! (higher concentration

of THC is the chemical responsible for most of marijuana's

psychological effects)

Marijuana related medical emergencies have also

increased!

Source: NIDA: Marijuana https://d14rmgtrwzf5a.cloudfront.net/sites/default/files/1380-

marijuana.pdf

Marijuana Use among Youth

19

20

Source: CDC YRBS Youth Online Available at https://nccd.cdc.gov/youthonline/App/Results.aspx?LID=LO

Current use of marijuana is higher among Latino males than Latino females

and higher than average across LA County!

Source: CDC Youth Online Available at https://nccd.cdc.gov/youthonline/App/Results.aspx?LID=LO

Percentage of Youth (Grades 9-12):

Who Used Marijuana Once or More, in the Past 30 Days

Los Angeles County Average vs. Latino Students

Percentage of Youth (Grades 9-12):

Who Used Marijuana Once or More, in the Past 30 Days

Los Angeles County Average vs. Latino Students

23Source: CDC Youth Online Available at https://nccd.cdc.gov/youthonline/App/Results.aspx?LID=LO

SAPC research team compiled existing survey

questions on prescription drug and marijuana use

(e.g., NSDUH, CHKS, MTF) in the following domains:

• Risk perception

• Perception of access/availability

• Attitudes toward use

• Patterns of use

• Motivation for use

• Consequences of use

24

Community Needs Assessment Survey (2017)

Source: Los Angeles County Department of Public Health, Substance Abuse

Prevention and Control: Community Needs Assessment Survey, 2016-2017

2017 LAC SAPC

Community Needs Assessment Survey

LATINO POPULATION

71% of Latinos reported they would seek professional help if felt they had a

problem with marijuana!

71%67%

72%75%

63%

Latino White Black API Other

“S

tro

ng

ly A

gre

e” o

r “A

gre

e”

26

Demographics of Sample Participants

3,742

582

1,2591,101

1,997

Age (years)

Male3,435 (39%)

Female5,139 (59%)

Transgen…

Gender

Source: Los Angeles County Department of Public Health, Substance Abuse

Prevention and Control: Community Needs Assessment Survey, 2016-2017

2017 LAC - SAPC

Community Needs Assessment Survey

LATINO POPULATION

• Total surveyed 9,487 { Latinos 4,265 (45%) }

• About 64% of Latinos surveyed reported having easy

access to cannabis in their neighborhood

• About 30% felt that cannabis was a problem in their

neighborhood!

• 77% of Latinos felt State law should prohibit advertising

of marijuana products in public places!

28

Geography of Participants*

SPA 1190 (3%)

SPA 2973 (15%)

SPA 31,345 (20%)

SPA 41,057 (16%)

SPA 5316 (5%)

SPA 6995 (15%)

SPA 7958 (14%)

SPA 8773 (12%) SD 1

1,645 (25%)

SD 21,703 (26%)

SD 31,081(16%)

SD 4944 (14%)

SD 51,235 (19%)

Service Planning Area (SPA) Supervisorial District (SD)

*69% of participants provided their current residence zip codes.

Source: Los Angeles County Department of Public Health, Substance Abuse

Prevention and Control: Community Needs Assessment Survey, 2016-2017

Los Angeles County (2017)

Needs Assessment Survey:

Youth Ages 12-17

• 11% reported using marijuana about 10 days in the last

30 days!

• Mean age of initiating marijuana use was 13.

• Over half of youth surveyed reported having easy

access to cannabis.

• 72% used marijuana with friends

• 49% reported having gone to school under the

influence of marijuana.

• Over 30% felt occasional use of marijuana was

harmful.

Source: Los Angeles County Department of Public Health, Substance Abuse

Prevention and Control: Community Needs Assessment Survey, 2016-2017

2017 LAC SAPC

Community Needs Assessment Survey

LATINO POPULATION

• Among Latinos who used marijuana, 94% reported they

smoked it, 55% used edibles, and 29% vaped cannabis.

N= 9487

N= 4265

Rates of Emergency Visits due to marijuana increased for all gender-

race/ethnicity groups in Los Angeles county, particularly among African

Americans (280.6%) followed by Latinos (112.6%).

Source: Office of Statewide Health Planning and Development (OSHPD). Emergency

Department and Inpatient Discharge Data Sets 2006-2015. California Department of

Public Health (SAPC Health Outcomes and Data Analytics )

From 2005 through 2015, the rate of emergency visits related to marijuana

increased by 740% among Latino women; the increase among Latino men was

423%!

Source: Office of Statewide Health Planning and Development (OSHPD). Emergency

Department and Inpatient Discharge Data Sets 2006-2015. California Department of Public

Health (SAPC Health Outcomes and Data Analytics )

Hospitalizations due to Marijuana, LAC, 2005-2015

Source: Office of Statewide Health Planning and Development (OSHPD). Emergency

Department and Inpatient Discharge Data Sets 2006-2015. California Department of

Public Health (SAPC Health Outcomes and Data Analytics )

From 2005 to 2015 the rate of Primary Marijuana related Hospitalizations

increased by 38% with the largest increases among African Americans (280.6%),

and Latinos (112.6%)!

Source: Office of Statewide Health Planning and Development (OSHPD). Emergency

Department and Inpatient Discharge Data Sets 2006-2015. California Department of

Public Health (SAPC Health Outcomes and Data Analytics )

Among all treatment admissions, 47% were Latino!

N=55,985

26, 029

“Annual Review of Patients in Publicly Funded Substance Use Disorder Treatment Programs

in Los Angeles County, 2015-2016 Fiscal Year. Health Outcomes and Data Analytics Unit,

Clinical Services and Analytics Branch, Substance Abuse Prevention and Control, July 2017.”

Los Angeles County Substance Abuse

Treatment Admissions by Race/Ethnicity,

Fiscal Year 2015-16

Among our 20,283 Latino treatment clients, an estimated 32% were treated for

heroin, 29% for methamphetamine, 20% for marijuana, and 13% for alcohol

treatment. A total of 2580 (12.7%) clients were Adolescent.

N=20,283

“Annual Review of Patients in Publicly Funded Substance Use Disorder Treatment Programs

in Los Angeles County, 2015-2016 Fiscal Year. Health Outcomes and Data Analytics Unit,

Clinical Services and Analytics Branch, Substance Abuse Prevention and Control, July 2017.”

Los Angeles County Substance Abuse

Treatment Admissions among Latinos by

Primary Drug Use, Fiscal Year 2015-16

Marijuana admissions constituted 13.9% of all treatment admissions in 2015-16

fiscal year (N=7,760)! Total of 4,153 (63%) of all marijuana-related admissions

were Latino!

4,153

N=7,760

“Annual Review of Patients in Publicly Funded Substance Use Disorder Treatment Programs

in Los Angeles County, 2015-2016 Fiscal Year. Health Outcomes and Data Analytics Unit,

Clinical Services and Analytics Branch, Substance Abuse Prevention and Control, July 2017.”

Los Angeles County Marijuana Related

Treatment Admissions by Race/Ethnicity,

Fiscal Year 2015-16

38

39

Increased advertising

40

41

What We Now Know

Adolescence is a critical

period in brain development.

The brain is still developing

until approximately age 25

Marijuana and the Teen Brain

ADOLESCENT BRAIN DEVELOPMENT

• Underdevelopment of the frontal

lobe/prefrontal cortex make adolescents

more prone to “behave emotionally or with

‘gut’ reactions”

• Adolescents tend to use an alternative part

of the brain– the AMYGDALA (emotions)

rather than the prefrontal cortex

(reasoning) to process information.

The Prefrontal Cortex is responsible

for controlling planning, working

memory, organization, modulating

mood, and is constantly changing

and growing.

The Limbic System is responsible for

controlling emotion and other brain

functions related to our instincts and

memories, such as giving a sense of

reward for engaging in risk.

ADOLESCENT BRAIN DEVELOPMENT

44

The National Institute on Drug Abuse Blog Team. (2014, December 1). Marijuana Use Can Lower

Your Grades. Retrieved from https://teens.drugabuse.gov/blog/post/marijuana-use-can-lower-

your-grades on March 19, 2018.

National Institute on Drug Abuse

45

Proliferation and Overconcentration

46

Prevention Efforts Rethinking Access to Marijuana

County-wide Cannabis Assessment

Survey

Marijuana Education Initiative Pilot

Education, Prevention and

Intervention Work Group

Hosting Cannabis Summit – January

11-12, 2018

Hosting Youth Summit – March 2018

48

Cannabis Prevention Partners

Community-Based Coalitions

City and County Tobacco Programs

Chief Executive Office - OCM

Probation Department

LAUSD, LA Trust Wellness Centers

Environmental Health

LAC Fire Department

49

Marijuana Media Efforts

Marijuana youth use prevention

campaign

Listening Sessions

Youth Outreach for focus

groups & engagement

Launch Date

50

California Bills related to Cannabis:

AB 3067 (Chau) – explicit restrictions on internet

advertising of cannabis products to youth under 21

SB 1451 (Fuller) – imposes minimum penalties on

cannabis licensees that sell to youth under the legal

age

SB 1302 (Lara) – recently amended, but still appears

to allow cannabis delivery regardless of local bans

(Less urgent) AB 2020 (Quirk) – expands definition of

locations where temporary events may take place and

AB 2641 (Wood) – implements permitting process for

temporary events and explicitly preserves local

control

WARNING: Non-citizens should beware about carrying medicalmarijuana through US airports. Although TSA and local police havegenerally been tolerant of medical marijuana in airline baggage inlegal states like CA, this may no longer be the case when dealingwith non-citizens.

STATE VS FEDERAL LAW

County’s Uniform Emblem Program

• Uniform emblem program for licensed cannabis businesses and consumer education campaign– Steer customers away from unlicensed

dispensaries, by allowing them to easily identify licensed ones

– Modeled after the restaurant letter grade program

– Partnerships with LA City, Long Beach, and others

– Partnership with licensed industry and state agencies

53

CDPH’s Public Information Campaign

Additional Information DPH Cannabis Compliance and Enforcement Program:

Phone: 626-430-5635; Email: ccep@ph.lacounty.gov

DPH – Substance Abuse Prevention and Control,

Prevention Services:

Phone: 626 293-2950; Email: ycordero@ph.lacounty.gov

DPH Prop 64 Resource Webpage:

http://publichealth.lacounty.gov/sapc/Prop64/Propositio

n64.htm

LA County Office of Cannabis Management:

https://www.lacounty.gov/marijuana

55