Marijuana Legalization Preventing
Community Impact:
“The Power of Prevention”
Yolanda Cordero, MPA
Chief, Prevention Services
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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.
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Strategic Prevention Framework
Five Step Planning Process:
1. Assessment
2. Capacity
3. Planning
4. Implementation
5. Evaluation
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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• Repealed MCRSA and amends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.
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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”
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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?
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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.
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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
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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
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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
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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”
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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!
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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
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Increased advertising
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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
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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
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Proliferation and Overconcentration
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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
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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
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Marijuana Media Efforts
Marijuana youth use prevention
campaign
Listening Sessions
Youth Outreach for focus
groups & engagement
Launch Date
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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
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CDPH’s Public Information Campaign
Additional Information DPH Cannabis Compliance and Enforcement Program:
Phone: 626-430-5635; Email: [email protected]
DPH – Substance Abuse Prevention and Control,
Prevention Services:
Phone: 626 293-2950; Email: [email protected]
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
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