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Medical & Legalized Marijuana:
The Colorado Experience
Chris Knoepke, MSW, LSW, ABD
May 7, 2014
Peer Assistance Services, Inc. 2014
Peer Assistance Services, Inc.
Founded in 1984
Peer Assistance Services, Inc. 2014
Peer Assistance Programs
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Colorado TASC
Workplace Prevention Services
Prescription Drug Abuse Prevention Program
Peer Health Assistance Programs
– Nursing, Pharmacy, Dentistry, Veterinary
– Mental Health Boards (Social Work, Psychology,
Counselling, Addiction Counselors, MFTs)
• Screening, Brief Intervention, and Referral to
Treatment (SBIRT Colorado)
Peer Assistance Services, Inc. 2014
Peer Assistance Services, Inc. 2014
Peer Assistance Services, Inc. 2014
Peer Assistance Services, Inc. 2014
History in CO: Medical Marijuana
(Amendment 20: 2000)
• Passes with 54% support to include MMJ in
State Constitution
• Patients with recognized conditions may
buy/possess 2 oz of MJ at any time and/or
cultivate 6 plants (3 mature) without State
criminal penalty
• Identified “caregivers” could cultivate plants
for up to 5 patients
Peer Assistance Services, Inc. 2014
Amendment 20 Expansion (20072009)
• 2007: Denver District Court Judge ruled that
5:1 patient to caregiver ratio was decided in a
way which violates open meeting requirements
• 2009: Various statements made by US DOJ,
including the Attorney General & his
Deputies, indicating that raids on MMJ
dispensaries occurring in CA would not be
continued or expanded
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MMJ Patients & Dispensaries: A
Viable Business
• Dispensaries: 0 in 2000, 532 in 2012
• MMJ Cardholders: 4,800 in 2008, 108,000 in
2012
• Dispensary Advertising
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Physician Practice Variation
Remember that there are more than 14,000 practicing
physicians in Colorado and just over 108,000
registered MMJ cardholders. How many cards have
been recommended by Colorado’s top “pot doc”?
Peer Assistance Services, Inc. 2014
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MMJ: Recognized Conditions in
Colorado
Cancer
HIV
Muscle Spasms
Cachexia
Seizures
Chronic Pain
Glaucoma
MS
Peer Assistance Services, Inc. 2014
Workplace MMJ Considerations
• Drug Free Workplace Policies: Employers not
required to accommodate use (continued in
Amendment 64 & legal marijuana in 2012)
– Discipline & termination for failed tests
– Denial of unemployment claims
– Lawful Off-Duty Activities Statute C.R.S. §24-34402.5
Peer Assistance Services, Inc. 2014
CO MMJ in the Workplace: Legal
History
• Benoir v. Industrial
Claims Appeals
Office
• Coats v. Dish
Network
h/t Denver Post
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Amendment 64:
Article 18, Section
16 of the Colorado
State Constitution
(2012)
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Colorado as the Petrie Dish for Fully
Decriminalized Marijuana
“Clearly we are charting new territory, other
states haven’t been through this process…
recreational marijuana is really a completely new
entity, but really the bills we’re signing today
really do lay out this new territory,”
Gov. John Hickenlooper, 5/28/13
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How A64 Was Sold to Colorado
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Peer Assistance Services, Inc. 2014
What’s Actually Addressed in Amendment 64…
• Adults (>21 years of age) can possess up to 1
oz of marijuana without State criminal penalty
• Individuals may grow up to 6 plants to support
personal use (cultivation rules apply)
• Paraphernalia no longer illegal
• Retail marijuana facilities are licensed and
established – including all points of production
chain
Peer Assistance Services, Inc. 2014
And What Wasn’t…
• The Fact that MJ Remains a Schedule I
Controlled Substance Under Federal
Controlled Substances Act
• Specifics of Regulation/Taxation of Sales
• Relationship Between
Cultivation/Distribution/Sales Entities
Peer Assistance Services, Inc. 2014
Taxes/Fees Associated with Legal
MJ in Colorado
• Standard 2.9% sales tax
• 10% special sales tax
• 15% excise tax (written into A64 –
on cultivation)
• Fees on MJ business licenses
(enforcement)
• Local special excise/sales taxes
(Boulder & Denver = 5%)
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Differences from MMJ Rules
• No additional sales/excise taxes collected on
MMJ (which could be up to 30% of value in
recreational MJ)
• Sales of up to 2oz (instead of 1) at a time
• No sales to out-of-state residents (limit of
1/8oz in recreational MJ)
Peer Assistance Services, Inc. 2014
Prevention on the Road: DUID-MJ
• House Bill 1317 established legal limit of 5
nanograms/ml of detectable THC in blood
• Blood tests would follow existing protocols used
in other drug testing procedures
• Implied consent exists, as with alcohol, but limits
of physical law enforcement coercion are not
clear
• 5 ng/ml not considered a “per se” standard, so
someone who has been cited could argue in court
that they were not impaired at the time
Peer Assistance Services, Inc. 2014
Department of Justice – Current
Stance
• Memo to US Attorneys from AG Holder in
late 2013 implied not to prosecute Federal MJ
laws - provided states illustrated efforts to:
– Discourage use among youth
– Mitigate health impacts
– Prevent involvement of organized crime
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Effects on the Workplace
“nothing in this Section is intended to require an
employer to permit or to accommodate the use. . .of
marijuana in the workplace or to affect the ability of
employers to have policies restricting the use of
marijuana by employees.”
Peer Assistance Services, Inc. 2014
High Profile DFWP: Von Miller
and the NFL’s CBA
• A bit different in that
the drug policy is
collectively bargained
• Nonetheless,
suspended over
violations of what’s
effectively a DFWP
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Issues Around Professional
Services
• Banking
• Legal Services
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Clinical Issues
• Routes of Administration (“Edibles”)
• Universal Screening (SBIRT)
– Including assessing simultaneous use of marijuana
with alcohol, prescription medications
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Edibles & Routes of
Administration (ROA)
• THC-inclusive products
– Cookies, chocolate, butter, “candy-like” items
• Novice Users
• ROA issues
– Time to effect
– Time until “clean” urine/blood
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Edibles, Potency
Testing, and Quality
Control
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Peer Assistance Services, Inc. 2014
Peer Assistance Services, Inc. 2014
Brief Screen Question
Drinks per week:
How many drinks do you have per week?
Positive Screen Criteria
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Drinks per day:
When was the last time you had 4 or more drinks per day?
(Asked of all females and males over the age of 65)

If female or a male over the age of
65 = More than 7 drinks
If a male age 65 and younger =
More than 14 drinks
If female or a male over the age of
65 = 4 or more drinks in one day in
the past three months.
OR
When was the last time you had 5 or more drinks per day?
(Asked of males age 65 and younger)
How many times in the past year have you used marijuana?
In the past year, have you used or experimented with an illegal
drug or a prescription drug for nonmedical reasons?
Do you currently smoke or use any form of tobacco?
OR

If male age 65 and younger = 5 or
more drinks in one day in the past
three months
If one or more times = Yes
If = Yes
If = Yes
Other positive screen criteria
For those age 18 – 20
Any alcohol use
For pregnant women
Any alcohol use
Peer Assistance Services, Inc. 2014
What We Know About Simultaneous Use:
SBIRT 1 (pre-dates Amendment 64)
• % of past-90 day marijuana users who also screened positive
risk for:
–
–
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Alcohol 43.1%
Tobacco 71.9%
Stimulants 6.8%
Cocaine 7.7%
Opioids 5.6%
• Non-cardholders were significantly more likely than
Cardholders to screen at-risk for:
– Alcohol (45.9% vs. 31.7%, c2(1, N = 1470) = 18.81, p < .001)
– Tobacco ( 75.9% vs. 54.8%, c2(1, N = 1470) = 49.82, p < .001)
– Stimulants (7.6% vs. 3.6%, c2(1, N = 1470) = 5.77, p < .05)
Peer Assistance Services, Inc. 2014
A Note on Youth, Access, &
Accidental Ingestion
• Prevention of use among youth a focus
– Educational campaigns, websites, TV ads
• Mixed data on use by teens (Increasing?
Decreasing?)
• Anecdotal reports of increased ER visits for
small children & pets from accidental
ingestion
– Edibles
– Childproof packaging
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Local Rule: Some Areas With
Recreational Pot Shop Bans
Greeley
Montrose
Longmont
Blanca
Broomfield
Buena Vista
Burlington
Castle Rock
Cherry Hills Village
Crawford
Crested Butte
Dacono
Del Norte
Englewood
Fairplay
Foxfield
Greenwood Village
Gunnison
Hudson
Johnstown
Limon
Parker
Superior
Thornton
Westminster
Windsor
Woodland Park
Castle Pines
Colorado Springs
Grand Junction
Durango
Jefferson County
Douglas County
Peer Assistance Services, Inc. 2014
How Prevention Programs May
Respond in the Future
• Co-Opt Models/Approaches from Alcohol
– Programs which emphasize prevention at the
family/household/individual level
– Education (both youth and adults, safety, routes of
administration, universal screening, mechanisms of
youth access, etc.)
– Marketing (approaches from tobacco?)
– Focus on health/social consequences rather than
legal
• Teen drinking analogies
Peer Assistance Services, Inc. 2014
How Prevention Programs May
Respond in the Future
• Advocacy Opportunities
– Regulations (local and Statewide, distance from
schools, etc.)
– Models of taxation/industry (ad valorem, on
cultivation rather than point of sale, vertical
business integration)
Peer Assistance Services, Inc. 2014
So… about that tax money…
• First $40 million annually in excise taxes to
create new public school construction fund
• Estimates vary, but first year projections
include possibly another ~$85 million in
revenue, possibly to fund
– Treatment programs
– Prevention/education campaigns aimed at youth (maybe
adults)
– Research into health impacts of MJ use
– Increased regulatory budget (also supported by licensing
fees)
Peer Assistance Services, Inc. 2014
Thank You!
Contact Us:
2170 S Parker Road #229
Denver, CO 80231
www.peerassist.org
303-369-0039
[email protected]
Peer Assistance Services, Inc. 2014