Trends in Detection Rates of Risky Marijuana Use in CO Healthcare Settings

Acknowledgements

» SBIRT Colorado is a statewide initiative of the Office of the Governor, funded by SAMHSA, administered by DBH, managed by Peer Assistance Services

» Authors: Melissa Richmond, Katie Page, Laura Rivera, Brie Reimann, Leigh Fischer

» Thanks to: DBH, Peer Assistance, SBIRT team, Dr. Fred Pampel

Introduction

» Marijuana Use and Abuse

» 17.4 million users nationwide (2010 NSDUH)

» 32% increase in marijuana treatment admissions 1996-2006 (2009 TEDS)

» 9% of all users and 25-50% of daily users become dependent (NIDA)

» Other consequences

Marijuana Policy» National Marijuana Policy

» 16 states have legalized medical marijuana» States with medical marijuana laws have

higher rates of marijuana use

» Colorado Marijuana Policy» Legalized medical marijuana in 2000» Rapid growth of marijuana industry since 2009» Uses a dispensary system requiring physician

approved medical marijuana cards

Implications of Legislative Changes

» Substance use prevention research:

» Availability, price, advertisement, social norms

» Implications for healthcare providers

» Opportunities to use data from prevention and treatment programs to assess changes

» Colorado SBIRT

SBIRT Model

Specific Aims

1. Examine trends in rates of patients screening positive in healthcare settings for risk-prone patterns of marijuana use in CO

2. Assess trends in severity of use at time of screening among marijuana users

3. Examine if trends in use or severity of use differ by age and gender

Methods

» Participants» 108,907 patients were screened in 12

healthcare sites (Jan 2008 – August 2011)»Mean age 44.2 years (SD 17.7; range 18-85)»53% Female»59% identified as White, 28.4% as Hispanic,

& 8.7% as Black

SBIRT Colorado

Methods

» Procedures & Measures1. Brief screen questions (tobacco, alcohol,

drug use) 2. Health Educator administered ASSIST (WHO)

» Prior use and negative consequences “During the past 3 months, how often has your use of cannabis lead to health, social, legal, or financial problems”

» Scored 0-39» 4+ on cannabis scale = at least moderate risk

3. Any medical marijuana use = ASSIST

Results

» 8,748 (8%) patients screened positive for marijuana

» Odds of screening positive accelerating in early 2009 (interaction with patient age)

Results

» Odds of screening positive increased over time (nonlinear)

» Odds of a positive screen were 60% lower for females than for males

» Controlling for time and gender, for every 10 years older patients were, odds of a positive screen decreased by 38-40%

Results

» Severity of Use Among Users (1+ on the ASSIST)» Linear increase over time» Less severe use with age» Less severe use for females than males» 1.6% of the variance in severity was

explained by the model

Discussion» Increases in positive marijuana screens over

time correspond to changing landscape

» Consistent results across 2 scoring methods» Probability of positive screen increased over time

for all individuals

» Young males had highest probability of positive screen

» Older adults» Greater proportional increases at low threshold

(4+ Assist)

Discussion

» Severity of use» Severity of use increased over time

» Males > Females

» Younger > Older

» Consistent with national trends» Majority of national treatment admissions are

for males & individuals < age 30

Discussion

» Healthcare providers likely serving increasing numbers of patients using marijuana

» < 5% of CO physicians authorize medical marijuana

» Lack of rigorous regulations around manufacture, distribution and dosage

» Universal screening: opportunity to intervene

Limitations

» Rapid change in marijuana landscape

» Multiple factors likely impact increased marijuana use

» SBIRT 2 phase screening process may have missed marijuana users

» Generalizability

Future Directions

» Further research on best practices for healthcare providers

» Universal screening protocols as a way to address risk-prone use

» Continued changes to marijuana policy

OMNI Institute899 Logan Street, Suite 600Denver, CO. 80203

www.OMNI.orgtel: 303.839.9422 or 800.279.2070fax: 303.839.9420

Richmond, M.K., Page, K., Rivera, L.S., Reimann, B., & Fischer, L. (in press). Trends in Detection Rates of Risky Marijuana Use in Colorado Healthcare Settings. Substance Abuse.