getting it right from the start’s mission · • from 2009 to 2016, marijuana use among northern...

Getting it Right from the Start’s Mission

To collaboratively develop and test models of optimal marijuana policy with the goal of reducing harms, youth and problem use. Models are based on the best scientific evidence and protection of

public health, social equity and safety.

Why focus on local?

• California’s Prop 64 legalizing recreational marijuana passed 11/16 and became effective 1/1/18

• A statewide ballot initiative with scant attention to public health concerns

• But it left broad leeway for local control• Window of opportunity to get it right (or

at least better)

The project is working in California through:

QualitativeResearch

Model Laws

LegalAnalysis

Building engagement

for action TechnicalAssistance

Marijuana - Not

But Also Not

Cannabis

• Approximately 4.0 million Americans met criteria for cannabis use disorders in 2015.

• 1.2 million of first time users in 2016 werebetween the ages of 12 and 17

Tetrahydrocannabinol (THC) Psychoactive

Ingredient in Marijuana

Source: Slide - S. Weiss, NIDA and 2016 National Survey on Drug Use and Health, SAMHSA

SOURCE: University of Mississippi; University of Michigan, 2014 Monitoring the Future Study Slides: S.Weiss NIDA

Changing Landscape of Increasing Potency and New Routes of

Administration

a

0.0

60.0

40.0

20.0

80.0

100.0

Smoking In Food In Drink Other

Non-MMJ StatesMMJ States

0

10

5

15

20

95 00 05 10

∆-9 THC

12th grade Past Year Users

Marijuana has

significantnegative health impact,

especially when heavy users start

young

Why Worry? • Small number of proven beneficial uses

• Substantial evidence of harm:• Low birth weight• Increased schizophrenia and

psychoses• Increased motor vehicle crashes• Respiratory illness• Early onset of use and frequency

associated with problem use

• Growing evidence:• Cognitive, academic and social

effects, overdose injuries, heart disease and others

Source: National Academies of Science, Engineering, and Medicine, 2017e

Rising Marijuana Use in Colorado Post Legalization

Youth Ages 12 to 17 Years Old

College Age 1 8 to 25 Years Old

Adults Age ≥ 26 Years Old

Rocky Mountain HIDTA Report www.rmhidta.org Supplement: The Legalization of Marijuana in Colorado: The Impact, Volume 4 (March 2017); S. Weiss NIDA; SAMHSA.gov, National Survey on Drug Use and Health 2014 and 2015

Use and Heavy Use Rising: 42% of Current Users are Daily or

Almost Daily UsersNumber of Days Used Marijuana

in the Past Month

1 to 2 Days24%

3 to 5 Days18%

6 to 19 Days25%

20 or More Days 33%

2002 201522.2 Million Past Month Users of Cannabis in 201514.6 Million Past Month Users of Cannabis in 2002

1 to 2 Days22%

3 to 5 Days16%

6 to 19 Days20%

20 or More Days 42%

Source: SAMHSA, 2015 National Survey on Drug Use and Health (September 2016).

Trends in Washington State Post-Legalization

• Falling Prices – median price per gram fell from $25 to $10 between 2014 and 2016

• % Market share of high potency flower with more than 20% THC increased by 48.4% since 2014, now 56.5% of retail expenditures on flower

Rapidly Declining Tax-Inclusive Price for Cannabis Flower Post Legalization Washington 2014-2016

Cannabis and Brain Development:The Most Vulnerable Periods are

during Pregnancy and Adolescence

Prenatal Adolescent

Source: Slide – S. Weiss NIDA

Declining Perception of Risk During Pregnancy

Source: Roberson et al. Hawaii J Med Public Health. 2014

Marijuana Use in California Pregnant Women Rises

Slide – S. Weiss NIDA

• From 2009 to 2016, marijuana use among Northern CA Kaiser insured pregnant women increased from 4% to 7%

• 22% of pregnant females younger than 18 years and 19% of pregnant females aged 18 to 24 years screened positive for marijuana use in 2016

Source: Young-Wolff et al, JAMA 2017

The Brain Continues to Mature into Early Adulthood

Slide – S. Weiss NIDA

0

0.2

0.4

0.6

0.8

1

1.2

1.4

High School Completion

Degee Attainment

Depression Welfare Dependence

Adju

sted

Odd

s Ra

tios

0

5

10

15

20

Cannabis Dependence

Other IllicitDrug Use

Suicide Attempt

Less than Monthly

Monthly or MoreWeekly or More

Daily

Frequency of Cannabis Use Before Age 17 and Adverse Outcomes at

30 years (n=2500-3700)Consistent and dose-response associations were found between frequency

of adolescent cannabis use and adverse outcomes

Source: Silins E et al., The Lancet September 2014

Use of High Potency Products Increases Risk of Psychosis

Source: Slide – S. Weiss NIDA

The biggest determinants of health impact of legalization on your

community will be:

How many people the industry gets to use cannabis, how intensely, and at

what age?

How many people still go to jail for cannabis?

Legalization – the Regulatory Spectrum

Free rein to the power and might

of American Entrepeneurship and innovation

Grudging toleration

Economic 0pportunity with some constraints

Start modestly and cautiously

Our Approach

Commercial free-for-all

Our Approach: Cautious LegalizationReduce illegal market and drug related

incarceration

.

What we are focusing on

• Model local ordinance on cannabis retailing and marketing

• See website www.gettingitrightfromthestart.org

• Model local ordinance for taxation

Promote economic justice but recognize that this particular economic opportunity comes at a cost that may include negative

social impacts in youth, like not graduating or lower IQ.

Keep marijuana from becoming too inexpensive and increasing youth

access

Correct false perceptions of harmlessness and fight “social

normalization”\

Learn from tobacco and alcohol experience, including need for high

taxation

Prevent market practices that will increase consumption and attract

youth

Fully use local authority, innovate & learn

Retail Pricing

• Price will be a major determinant of youth use in spite of < 21 prohibition

• Vast evidence from tobacco, alcohol and youth

“Washington is allowing the potency and price of legal cannabis to be shaped by the market; remember, this is a choice. Potential policy levers for controlling potency include potency-driven taxes, price floors linked to potency, or THC limits. Although these may be challenging to enforce and no evidence yet exists on what threshold constitutes a ‘safe’ potency, risk-averse jurisdictions considering or implementing non-medical legalization may nonetheless want to discourage consumption of high-potency products until more is learned about their health effects.”

Source: Smart et al, Addiction, 2017

Taxation

• Taxation is allowed locally in CA, and will affect price and reduce youth use

• Globally recognized as one of the most effective tobacco control policies

• Raises money

Tough tax questions• Who should we tax?• How much should we tax?• How should we tax? • Are there products we should tax less or more?• How do we balance promoting the shift to the

legal market with not making cannabis so cheap it increases use and harm?

• How should we use the proceeds? – Let’s get started

Note: The legal information provided in this model ordinance does not constitute legal advice or legal representation. For legal advice, readers should consult an attorney in their state

What should tax funding go to?

Since it comes on the heels of decades of unequal enforcement and large scale social consequences of the War on Drugs, tax funds should:

Be strategically dedicated to undoing the complex web of social and health factors that perpetuate substance abuse, exacerbate its consequences in people’s lives, or diminish freedom, safety, health, well-being, ability to find jobs or to live a dignified life.

A Dedicated Tax

Part 1: Create healthier communities that prevent substance abuse

Assuring sustained funding to community-based prevention including:• Prevent cannabis consumption by youth, during pregnancy or in

excessive or harmful ways; • Prevent other forms of substance abuse or addiction; • Prevent other leading causes of illness, injury and premature

death in the community• Promote wellness and reduce inequity in health conditions• Flexibility to define priorities over time(Proposed 70%)

• 4,100 hospitalized for overdoses in 2016

• Nearly 2,000 deaths

• Demands on medical, jail and foster care systems

• Rural CA counties hardest hit

• 3,650 exposed newborns in 2015

Address California’s Opioid Epidemic

• Nurse Family Partnership or home visiting with high risk mothers

• Prevents adverse childhood experiences, like unemployment or addiction that lead to poor health and social outcomes

Start early!

• For every $1 spent to create healthier communities a return on investment of $6.90 could be realized over 11 years, based on a major CDC effort *

• California healthcare expenditures for the top 6 conditions cost $98 billion in 2010.

Investing in Prevention is the Best Deal in Town

Source: Haddix, personal communication 2017

Part 2: Prevent Drug-Related Incarceration and Mitigate Negative Social Impact

Examples:• Support to diversion programs to reduce new drug-related

incarceration • Assist in expungement or reclassification of past marijuana

convictions • Re-entry programs after release from prison to avoid recidivism• Job training programs• Community-based and educational programs especially those

which can help minimize substance-abuse related incarceration; (Proposed 30%)

• Advise governing body

• Recommend priorities for funding

• Make annual recommendations on the spending of tax

• Recommend efforts to evaluate

• Review the fund’s annual report and related records

• Can serve for either special or general tax

Special Tax Community Advisory Board

Community-based organization, including CBO serving low-income people

Residents of communities disproportionately affected by drug-related incarceration

Community clinics School nurse or school-based mental health professional Public health professional Expert in addiction/substance use prevention & treatment Community Physician County health officer or designee. No cannabis industry reps

Suggested Composition of Board

Products: Is this what we want sold in our communities?

Why higher taxes on problem products? Two potential paths for problem products:• Prohibit Sale (see model ordinance)• Levy higher taxes as disincentive

Goal: Discourage sale of products• Particularly attractive to youth• More likely to cause harm

Rapid rise in higher potency cannabis flower post legalization in Washington 2014-2016

High Potency Products• Marijuana potency has vastly increased over

past 30 years

• What we thought we were legalizing is no longer what is sold

• Products now up to >90% THC (shatter for dabbing)

• More psychotic and other unexpected reactions

• Higher taxation recommended by numerous experts

Model local retailing ordinance recommends not allowing sale of:• Flower > 20% THC• Cannabis concentrates > 50%THC

If sale is allowed, use higher taxation (by 1% per 1% over 17% THC) on:• Flower > 17%• Cannabis products > 50% THC• Exclude edibles at 10mg or less per dose• Would make skunk, shatter, wax, butter more expensive

Recommendations on Taxing High Potency

Sweetened Cannapops and Other Drinks

• Zero need for cannabis soda or iced tea

• Mimics “alcopops” (sweetened, fruit-flavored alcoholic beverages) known to attract youth

• Youth consume 47% of alcopops in CA

• Nationwide, minors are twice as likely to consume “alcopops” as are adults

• “Reglamorizes” unhealthy sugar sweetened beverages known to promote obesity, diabetes and tooth decay, now with added pot

Sources: Rosen et al, 2007; Siegel et al 2012

Model local retailing ordinance recommends not allowing sale of Cannabis beverages

If sale allowed, recommend additional; 20% tax on liquid cannabis product containing natural or artificial sweeteners sold in units intended for consumption exceeding one

Recommendations on Taxing Sweetened Beverages

• Create a healthier and more just community

• Promote a safer cannabis market

• Save public dollars going to preventable healthcare, avoidable incarceration, foster care and other social needs

Thoughtful cannabis taxation can help you: