COLORADO Department of Public Health 8 Environment Larry Wolk, MD, MSPH Executive Director and Chief Medical Officer Duties of advisory committee - Systematically review scientific literature mm 0 Come to consensus on population health effects of marijuana use RelatedlaoMarijuana . - Develop pUbllC health statements 0 Come to consensus on translation of science into - Recommend public health related poWdes - Recommend public health surveillance 1 activities Identify research gaps important to public health- ACOLORADO 1 ?hm Marijuana use among adolescents Substantial Moderate Limited Insuf?cient Less high sdroaL Impaired cognitive Less ?nely hour IQ Lower futon.- in?ation abilities and to earn after Mef lQicures academic cottage aiming? pedal-mama? after 28 d-I?r? E, (by; abstinence . Pig-duck disor?rr in Depression or 5 5mm; in add?md (daily or anxiety after 73' aduurnod near-daily uses-s} adolescence J: 5 suicicm Mam or amt: Can Mop marijuana marijuana use and addiction' after 3601mm:- Alto-Ml or tobacco 3 use and addic?-on' 8 after adder-em '3 D?m illicit drug a use and an addiction' after adolescence Treatment for Quitting audio-ma a man'juana MEI addictim' can cognitive and mu! radix-Imam lualth arm AcomRAoo Surveillance activities Target Pop. Problem Monitoring Young Children Accidental Poisoning UC/Childrens Research Project Colorado Hospital Association (CHA) Data Rocky Mountain Poison and Drug Center Calls Child Health Survey(CHS) - risk factors Youth Increased Use/Abuse Healthy Kids Colorado Survey (aka YRBS) Poisoning, Overdose, Abuse Colorado Hospitalization Data Rocky Mountain Poison and Drug Center Calls Accidents/Trauma Colorado Hospitalization Data Colorado Trauma Registry Adults Increased Use/ Abuse Behavioral Risk Factor Surveillance System Influential Factors for Healthy Living Survey (TABS) Poisoning, Overdose, Abuse Colorado Hospitalization Data Rocky Mountain Poison and Drug Center Calls Accidents/ Trauma Colorado Hospitalization Data Trauma Registry Pilot Surveillance (Ski?Related Injuries) Contaminated Products Food-borne Illness Surveillance related to Edibles Rocky Mountain Poison and Drug Center Calls Pregnant! Birth Defects, Pregnancy Risk Assessment Monitoring System (PRAMS) Breastfeeding Developmental Disabilities Active Surveillance (Birth Defects Registry) 0 Adult marijuana use 3620%# 18% 16%? 14% - 12%_ 10%~ 8% 496* Prevalence (96) Colorado: 18-25 0% I 1 1 2006 2007 2008 2009 2010 2011 Produced by EEOHT, CDPHE 2017: 2014-2015 NSDUH 2006-2014 .. 2012 2013 2014 2015 4 Adult marijuana use by age 40 I 2014 I 2015 36- 32? 28 .. 27.5 6.1 24a 20* 19.8 18.3 Prevalence 16-4 12.4 11.3 18-25 26-34 35-64 65+ Data Source: Behavioral Risk Factor Surveillance System prevalence estimates for 2013 and 2015. ACOLORADO .. Maruuana use rates high school students Colorado Current Use Colorado Ever Use 60? 55? 50? 45? 40* 35? 302005 2007 2009 201 1 2013 201 5 Produced by EEOHT, CDPHE 2017: HKCS 2005-2015 YRBS 2005-2015 5 United States Current Use - United States Ever Use Prevalence Youth Marijuana Use Past 30-day marijuana use, 12-17 yea rs old, 2005/06 to 2014/15 40.0% 35.0% 30.0% 25 0% 20.0% 1 5.0% me ??12.66? . -- . was" 93 may 1 111* 1151a reporting use in past 30 days E9 . ea . 5.0% 7% 5.7% 6 7% mos 5?5 -. 119: 1.29; was 0.0% 2005/00 2036/0! 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 1. indicates a statistically signi?ca nt difference from 2015 with at least a p<.05 Source: Substance Abuse and Mental Health Services Administration, National Survey on Drug Use and Health. URL: .. 0 Student marijuana use by grade level 35 I2013 I2015 27.8 30 - 2615? a3117?Jr-?ad I I 6th 7th 8th 9th 10th 1 1th 12th Grade Produced by EEOHT, CDPHE 2017: HKCS 2013-2015 ASCOLORADO a Student substance Use rates high school 60- 55# 50? 45- 40- 35- 302005 2007 2009 201 1 2013 2015 Marijuana - Alcohol - - Tobacco Prevalence (96) Produced by EEOHT. CDPHE 2017: HKCS 2009-2015 0 Student perception of risk Perception of Great] Moderate Risk of Marijuana Use, Before and After Legaiization, 3th Grade 75.096 - -. .. 73.0% - . .. 71.0% . . . 69-0% . - 57.0% 65.0% - . 53.0% . - 61.0% 59.0% 57.0% 55.0% - - Colorado I Pre RML - Post RML Source: Cerd?, M. et a I. (2017). Association of State Recreational Marijuana Laws with Adolescent Marijuana UseJAm Pediatrics, 1 71, 142-149, Table 2. Signi?cant difference p<.001 Methods of marijuana use high school students currently using 2011 :2013 .2015 10? 88.9 90? [35.08633 30? 7o- 60- 50- 4o~ 30? 20v Prevalence Smoked Ate Vaped Other Types of Marijuana Use Produced by EEOHT, CDPHE 2017: HKCS 2013-2015 ASQOLORADO II. 4" - . .. . Marijuana offenses 1n schools 2,500 2,000 1,500 500 Number of offenses reported 1,000 l? Elementary/secondary school College/University i 2012 2013 El 2014 i 2015 Source: Colorado Bureau of Investigation, National Incident-Based Reporting System database. Note: "Elementary/secondary school'I means that the offense occurred within an elementary or secondary school. "College/University" means that the offense occurred within a college or university. In 2012 there were 43 offenses where the type of school could not be determined. AcmonAoo School expulsion rate Total and drug expulsion rate, per 100,000 students 350 300 -- 3 5 -?h?1.expulsion rate ._Drug expuISIon rate 50 7' -- .. 2004- 2005- 2006- 2007- 2008- 2009- 2010 2011 2012 2013- 2014- 2015- 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 -Tola expu 510n rate 299 313 283 270 255 260 234 235 171 145 123 108 - - Drugcxpulsionralo ASCOLORADO Dropout Rate Colorado dropout rate 5.0% 11.593 .. 4.5% 4.0% 3.5% in BE P4 a! 1. 1.5% I 1.0% 4 0.5% 0.0% - 1 - - 2004 2005 2005-2006 20062007 2007 2008 2008-2009 2009-2010 2010-2011 2011-2012 2012 2013 2013-2014 2012,2015 Source: Colorado Department of Education. ALCOLORADO School Health Professionals funding - School Health Professional Grant (SHPG) was expanded by the Colorado legislature in 2017 from $2 million to $12 million to fund an additional 150 school nurses, school school counselors and school social workers - This grant program was created to: - Increase the presence of school health professionals in secondary schools to provide substance abuse education to students who have substance abuse or other behavioral health needs . Implement substance abuse prevention education and provide evidence-based resources to school staff, students, and families - Reduce barriers for enrolled secondary students who are at risk for substance abuse. ECOLORADO 4. Department of Education ACOLORADO 15 . Pmson control calls compared to alcohol Number of Human Marijuana Exposure Callsf Compared to the Number of Human Alcohol: Exposure Calls to Rocky Mountain Poison and Drug Center from January 1, 2000 to December 31. 2015 in Colorado Marijuana Exposures Alcohol Exposures 8000 - 7800 - 7600 a. 7421 7404 7400 7200 7000 - 6800 6762." a 6751 6600 - 3' an 6598? 6400 .6353?: 6 393 6200 - 6000 - 600 400 - 331 239 200 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 No. Exposures Calls CDPHE 2016 THuman marijuana exposure calls to were determined by the presence of the generic code Madluana - 0083000 from the National Poison Data System and questionable exposures were validated with a records review. 1Human alcohol exposure calls to were determined by the presence of the generic code Ethanol maternal-0019140 from the National Poison Data System. Poison control calls .by age Calls to Poison Control Reporting Marijuana Exposure 150 [25 years and older 150 I 18-24 years old El 9-17 years old 100 I 0-8 years old I Unknown No. of reported marijuana exposures C3 2013 2014 2015 2016 Source: National Poison Data System closed, human, marijuana exposure calls in Colorado. . control call volume by type of product 2014~2016 250? 225 203 200a 199 175* 150? 127 125- I I I 100? I 75? I I No. Marijuana Exposure Calls 50Edible Marijuana Smokeable Marijuana Other Marijuana Produced by EEOHT, CDPHE 2017: 2000-2016 ASCOLORADO ER admissions and hospitalizations visits with marijuana codes Emergency Department Visits 3,000 - 0 2,000 1639 . 1,000 . ?6.18 [7?0.1 97% 151Hospitalizations Produced by EEOHT, CDPHE 2017: CHA 2000-Sept 2015 AcomRAoo . . 0 Emergency room admISSIons Substance Related ED Visits in Colorado, 2011-2014: Exposures. Diagnoses. Billing Codes, or Poisonings. 4250 - 3 I 3750 Marijuana 1000 (2011 2012 2013 2014 CUPHE ?016 codes 305.2, 304.3, 969.6 and E854.1 We used to detennine ED visits with possible marijuana exposures, diagnoses, billing codes or poisonings. visits involving other substances were identified using ICD-9-CM coda: Alcohol .8, 303[.0, 305.0, 425.5. .8. 790.3. .8, .9 Prescription Opioid Dependence and Poisoning (304[.0, 305.5, 965L010, .02, Heroin Poisoning i 13850.0. 965.01): Cocaine Dependence and Poisoning {304.2, 305.6. 970.81. Stimulant Dependence and Poisoning (304.4. 305.7. 970.89. E1354. 2). Marijuana tourists Statewide 130- 160- Out?Of-s tate residents 140- 120- 100- Colorado residents (no. per 10,000 visits) OJ in .2 0 4..- .3 .2 CD a: lull .2 a LLI @pomRAoo 2011 2012 '2013 2014 Year Marijuana and pregnancy use before, during, and after 2014 100e 9o~ 80? 7o 50? Prevalence (96Before Pregnancy During Pregnancy After Delivery plus Breastfeeding Produced by EEOHT, CDPHE 2017: PRAMS 2014 ?hcmonAoo Marijuana and pregnancy use during pregnancy by intention 2014 I Did Not Use Marijuana I Used Marijuana 100* 96'0 90.9 90? so~ 7o?? 60? 50?4 3 4o- 30* 20w 1o- Intended Pregnancy Unintended Pregnancy Produced by EEOHT, CDPHE 2017: PRAMS 2014 Substance use and pregnancy use during pregnancy 2014 100~ 90a 80- 70- 60? 50- 40? 30? Prevalence (96) 20? 12.8 m? 6.4 5,7 Drank Alcohol Tobacco Marijuana Used during Pregnancy Produced by EEOHT. CDPHE 2017: PRAMS 2014 ?comrmoo Fatalities Colorado roadways 140 120 125 i? Can nabinoid positive drivers Fatalities with c-annabinoid positive driver5 I 2013 (b13131) I 2014 2015 2016 Note: A positive test for cannabinoids may be the result of active THC or one of its inactive metabolites and does not necessarily indicate impairment. Source: Data provided by Colorado Department of Transportation, 6(1/2017. 2016 DATA ARE PRELIMINARY AND SUBJECT TO CHANGE .. 0 Safe storage of marijuana . 96 of adults with children who have 90 5 marijuana in or around the home i 80? 70~ 60- 50* 40* 30?3 20" 10- o? 7.9% Prevalence 17.8 Stored Safely Potentially Unsafe Storage Produced by EEOHT, CDPHE 2017: CHS 2015 Secondhand marijuana smoke 83.2 Prevalence Smoked, Vaporized, or Dabbed Produced by EEOHT, CDPHE 2017: CHS 2015 AcomRAoo 96 of adults with children who use marijuana in the home Ate or Drank 0 Education and prevention campaigns Good to Know campaign 1 1% statistically significant increase in knowledge of the laws; statistically significant increases in perceptions of risk across all areas except pregnancy (pregnancy campaign launched a year later). PASSES PASSES - TD BABY. ?if: BABY. LIKE I-7ll TRAFFIC EDSBLES CAN TAKE UP To 4 HOURS. GUDDEKNOW GOODEKNOW A1COLORADO Marihuana en Colorado: Lo Que Debes Entender Spanish language campaign Marlbuann on Colorado Samanber 18 at kl ?ora que la marihuana as legal para Ios adullos on Colorado. as qua nan RI mnrnanln adamadn para hablar can Ins ifwer-aa do an remain sabre esle lama. MarihuanaEnC 0.50m SOB Translation Cl?jaf'i?g SGBREELLA MARIHUAHA . EN colongoa . Marin aorzCO com APRE NBA Youth prevention: A two sided approach Youth . AUthentiC and Centric relatable - Engage adults that . . youth trust Posmve focus <1 9 LIJ - Support these Youth ownershi adults to discuss Easily shared peer- Trusted laws/health effects to-peer Adults AcomRAoo Trusted Adults oampaign: Adults can help reduce youth marijuana use Supportive Teachers: . . Youth who agree that . 3,31%? Wm Par 9'17?" teachers care and eqcourage (agent? Saigagsfo: hel are them are 1.7x LESS likely to . use. 1.6x LESS likely to use. Famirly time?s: Yout avecear amiy - 2 rules are 1.7x LESS likely to Parents' Opinion. use. If a parent feels like it?s wrong, their children are 4x LESS likely to use. AQOLORADO Trusted Adult TV ad rusted Adult materials in TALKING TO THEM SAYING STARTS WITH YOU SAYING GOODEKNOW a is: GOOD KNOW ACOLORADO mum . cardamom lea-HI ?we ?wanna Imam mm luau um "drum-pnum-m ?Manhunt!? dint-1h Hm ?muonjm?ol?? ?nah: um. bl 0mm u?mh human-uln- ghMumrlIQIMIh-mhuadhmm Mlui??uhm ril- mm 0" MIMI hill-um nonmmw Whip-churnin- lint-mill! '10:!th Mullen" ?all. ?may! urn-nun lm?Il??l?m? .- IITAIIJIN My?: onmluanlmm l- ast about.? I?ll. Flu. ?I'm neu-vuvuoumw-uo- . mihmtull??lmwumuugnl law-any ?huurunumucmmuh?mm .. - . -7 um hambm?muh?nmu?-?a?un tun-mp1? 7muou'rmzm . Lulu-m Dag-hat mono? ?marinara a var-arm ?Pm-mu tm?thy-I-tn?uo mm}! mum ?ll-MM mamum ?mum-mum AGES 17-20 RESP Til: mum: will Hum-incl? ?minim mil-I1 Fl"l""?um! no h! ?n ?mm Mann ninth-1min mvcauumm a. mun; IE7 . IIUI at In". ?lm - mm ?mum? ?mull: um? ?In. attain-Lad Ilmd?akummw-lml WM mrovwnwom b?m .m'mu ?mm" "new a mammals! GOALS ?lama-?ninth ?iwlht?n. mum an? null awn?puma?, connExunw ?.7533: Sums-rum Protect What?s Next youth prevention campaign PROTECT NEXT . magi ALCOLORADO Reaching youth PROTECT NEXT [Ii ADVENTURES Go on the adventum of a ileum: mm Protect WMt's Next Ramp up your rock ctr-bang o: heme an Imus pm by Icamng how to Signuplodayandchedthack . . In: BROUG HT TO YOU BY Mlle lg Pmmumn - "rr d'l pun-nominal- 1m rm mun-war - ?FIND YOUR GET IT.- PROTECTWHATSN EXT.COM ALCOLORADO Protect What?s Next ad Protect Whats Next- Ask Out Your Crush . if?? 9? ii. 31' . 0 Medical Marijuana Registry Patient Characteristics March 2017 . Total number of patients is 89,410 . Total number of minor patients (under the age of 18) is 290 'Ge'n?dei? Average Age__ Percentage on Registry Male 43 62.90% Female 47 37.10% Age Group Number o?Patients Egg?age-on j'lTop Reported: Condition 0-10 166 0.19% Seizures 11-17 124 0.14% Severe Pain 18-20 2,982 3.34% Severe Pain 21 -30 18,680 20.89% Severe Pain 31 -40 18,708 20.92% Severe Pain 41-50 14,736 16.48% Severe Pain 51-60 16,030 17.93% Severe Pain 61 -70 14,674 16.41% Severe Pain 71 and . Older 3,310 3.70% Severe Pain Medical Marijuana Registry patients by year Average ii! of Patients ld?m103 52a. 1.13..??53 name a - . . 103,9{0000'. I ?5 I i emu217 50-1 na 1020 1.?37 I 2am zoo: 2on3 zoo-1 zoos zoos 2007 200:3 zoos 20w eon 2m: 1013. 2:314 201: 21:11: ?rear 2010 - Significant increase due to passage of HB-1284 and SB 10-109 2011 - Data reflects application processing backlog 2012 - Elimination of backlog, steady incline continues 2014 - Retail patient numbers continue to increase 0 Medical Marijuana Registry minor patients by year Average 111 of Patients under the age of 18 4502009 2010 2011 2012 2-013 2014 2015 2015 Year Questions? AHCOLORADO COLORADO Department of Human Services Reggie Bicha, M.S.W. Executive Director Public Education and Youth Prevention Strong and Effective Regulatory Enforcement Regime Marijuana Priorities Protecting Public Health (including availability of treatment) C) C) C) Marijuana Tax Cash Fund CDHS has collectively received about $66 million in Marijuana Tax Cash Fund dollars since FY 2014-15. Funded programs include: - Substance use disorder treatment and detoxification services (includes 38 new treatment programs and 5 new prevention programs) Behavioral health crisis system Youth programs Behavioral health (co-occurring Staff training disorders) treatment services - Youth mentoring - Jail-based behavioral health services - Criminal justice diversion programs Acommapo 2 Regulations and Enforcement Impact of marijuana on child welfare system - Prior to July 1, 2017, Colorado?s child welfare data system did not track the use of specific drugs. - As of July 1, CDHS now tracks data on substance use by type of drug to further our understanding of how substance abuse issues affect families. - Anecdotal evidence and review of county case records indicate that opioid use is affecting Colorado families and putting a strain on child welfare agencies. Meanwhile, marijuana usage alone has had minimal impact on child protection. 0 Regulations and Enforcement Mari juana-related child welfare regulations - When a child tests positive for THC at birth, counties can ?screen in? a referral to child welfare if the act threatens the health or welfare of the child. - Testing positive for THC at birth use of marijuana by a caregiver alone may result in screening-in a referral. - This was the case even before the legalization of medical/ recreational marijuana in Colorado. Acomsuoo ,4 Regulations and Enforcement Marijuana and Youth Services (formerly Youth Corrections) Juvenile marijuana arrests fell 23 percent between 2012 and 2015. - Increase - then fall in marijuana offenses reported in elementary/ secondary schools 2012:1,766 2013: Data not available 2014: 2,363 2015:1,809 000 Source: Colorado Juvenile Justice and Delinquency Prevention 3?Year Plan OLORADO $6 0 Education and Prevention Behavioral Health .1 Children Youth and Families . . Grants/funding to . State supports 54 counties for community-based marijuana prevention substance abuse prevention programs . 8 programs received state funding for . At least five new marijuana prevention prevention programs programs in SFY 2017? created since 2014 18 ACOLORADO 5 SPEAK Now STATEWIDE SOCIAL MARKETING Target Audience: Parents/ caregivers of persons aged 9-40. . Focus on providing resources to create speak J) awareness about/ interest in talking with children about the risks of substances. - Speak Now works to increase the percentage of parents and caregivers who have talked with their children about alcohol, marijuana, prescription drugs, and other drugs. COLORADO Department of Human Services 7 0 Treatment Volume Over Time - The number of pe0ple served has increased, partially due to expanded tax revenue. - Individuals that received substance use treatment 30000 25000 20000 15000 10000 -- -- -- .- ?5 5000 2011-2012 2012-2013 2013-2014 2014-2015 2015-2016 a Public Health Treatment - Trends - Marijuana treatment admissions stable since 2008* - Juvenile treatment admissions with marijuana as primary drug fell 34 percent between 2009 and 2015.** - Alcohol makes up largest share of treatment admissions.* Treatment Admissions Calendar Year 2015* I Alcohol - 59% I Marijuana - 14% I Cocaine - 3% I Methamphetamine - 12% Source: Drug/Alcohol Coordinated Data System (DACODS), CDHS Office of Behavioral Health Source: Colorado Juvenile Justice and Delinquency Prevention 3-Year Plan OLORADO @6 0 Treatment Admissions for DUI Primary Drug of Use or Abuse Reported 35.000 3.0.63? 3111]]: 29.133 .655 2103: 25.5.5 25.21:? 25.0w 29,000 5.0m 5,900 EJEE 1.155 1.325 1.304 1.1416 1.512 ?159 ma was 2010 2011 2012 2013 201d 2015 Marijuana primary Alcohol primary Source: Data Provided by Colorado Department of Human Services, Office of Behavioral Health. Public Health Treatment Admissions January 2008 December 2015 8 900.0 ?1 3 800.0 :1 700 0 ?O?Alcoh0 .- 2 .5 600.0 +Marijuana 5000 +Cocaine c; a 4000 .5 300.0 -i+i?Heroin 300.0 +Rx Opioids GI I: 1001) 01) 2008 2009 2010 2011 2012 2013 2014 2015 SOURCE: Drug/ Alcohol Coordinated Data System (DACODS), Office of Behavioral Health Colorado Department of Human Services (CDHS) Public Health Treatment Admissions January 2008 - December 2015 (Alcohol Deleted) 40.0 20.0 53 200.0 ,5 3 180.0 m? 150.0 .. 3 140.0 3. +Marijuana 3 120.0 .3: . a +Cocalne 100.0 .. 3. 13/ -n?Methamphetamine 80.0 . q-r?K Heroin - -9 600 . :1 up 2 1.. 2008 2009 2010 2011 2012 2013 2014 2015 SOURCE: Drug/Alcohol Coordinated Data System (DACODS), Office of Behavioral Health (OBH) Colorado Department of Human Services (CDHS) Acommwo Number of Treatment Admissions Marijuana as Primary Drug 120m 'Dn? 5514' 5591 535?- m1 2000 Inna 2009 2010 2011 2012. 2013 201 4 1015 I17 or under I18 to 20 D21 or over Source: Colorado Department of Human Services, Drug-Alcohol Combined Data System (2016} OLORADO $6 0 Public Health Treatment Trends (2008-2015) Increases . Heroin treatment admissions - Methamphetamine treatment admissions . IV drug use across all drugs Decreases . Treatment admission rate for non- medical use of prescription opioids SOURCE: Drug/Alcohol Coordinated Data System (DACODS), Office of Behavioral Health (OBH) Colorado Department of Human Services (CDHS) Limitations: - Treatment admissions to OBH licensed facilities only - Treatment admissions vary by geography across the state ACOLORADO A co COLORADO Questions? ECOLORADO .w Gov. John Hickenlooper Department of Revenue Barbara Brohl - Executive Director Ron Kammerzell - Senior Director of Enforcement Agenda 0 Overview 0 Structure 0 Results 0 Areas of Focus MOLORADO Overview ACOLORADO 0 Department of Revenue 0 1,500 employees Oversees Enforcement (Auto Industry Division, Limited Gaming Division, Division of Racing, Liquour Tobacco and Marijuana), all Taxation, Lottery and other functions 0 Collects $128 in taxes and fees MOLORADO 0 Colorado Marijuana Framework Economy - Amendment 20 (medical) Amendment 64 (adult-use) Personal/Caregiver Cultivations Amendment 20 medical Amendment 64 - adult-use - Law Enforcement - CO Dept. of Public Health and Environment LEGAL NON-COMMERCIAL Colorado Commercial Market a Two industry segments oMedical oAdult-Use i Licensee-based 0 State licensing 0 Local licensing 0 Regulatory and/ or criminal 0 Stores, cultivations, infused manufacturers, testing facilities Amendent 64 Implementation Task Force Report was delivered mid-March 2013 I Joint Select Legislative Committee convened mid-March 2013 Legislation was passed and signed into law in May 2013 a: Temporary rules promulgated 7/ 1 /13 I Cole Memo 8/29/13 .- Permanent rules promulgated 9/9/13 4- Accepted Phase Applications 10/1 /13 . Issued Phase I Licenses 1/1 /'14 4. Accepted Phase II Applications 7/1 /14 See Section 1 Amendix MED Regulatory Objectives 0 Public health and safety 0 Preventing distribution of marijuana to minors Preventing the involvement of criminal enterprises, gangs, and cartels in the legal marijuana industry 0 Preventing diversion of regulated marijuana to other states and criminal markets 0 Transparent regulatory oversight MOLORADO i? 53 Highly Collaborative Stakeholder Process 0 Use of stakeholder work groups 0 Law enforcement 0 Public health community 0 Governmental officials 0 Medical community 0 Parents? groups 0 Licensed businesses 0 Benefits 0 Higher rate of voluntary compliance 0 Neotiated rulemaking Regulations Protecting Pubiic Safety: Licensed Premises 0 Video surveillance requirements of entire premises 0 Alarm system requirements 0 Industrial grade locks 0 Restrictions on hours of operations See Section 3 of Appendix cw 2?73 Regulations Protecting Pubiic Safety: Activities 0 Seed-to-sale tracking 0 Production management and tiering limits downward 0 Restrictions on purchase amounts 0 Restrictions on edibles No on-site consumption See Section 4 of Appendix - RFID Tag AB 4300?279 quorado High. Religf' 402,19992 OLORADO 0 RFID Placement - ACOLORADO RFID Tags are required to be attached to marijuana packages during transport and, once received, entered into the inventory of the facility receiving the package. .. g. - 5 Regulations Protecting Minors oEnforcement underage compliance Checks oChild resistant packaging I .Extensive labeling uAdvertising restrictions uWaste removal ItIrProduction limits .Restrictions on edibles Edibles Regulation: Phase 1 Promulgated emergency rules July 31, 2014; permanent rules adopted September 30, 2014; became effective October 1, 2014 1 Compliance by February 2015 to allow for implementation 0 Requirements for child-resistant packaging for edible retail marijuana products Limiting the serving size of an edible retail marijuana product to 10mg of THC and limiting the amount of THC on a multiple-serving edible to 100mg Requirements for physically demarking multiple-serving edible retail marijuana products to show individual serving sizes Incentives for the production of single-serving edible retail marijuana products Labeling including explicit serving size, number of servings and total THC r? 0 Edibles Regulation: Phase 2 an Effective October 1, 2016 Attractiveness to children: 0 Prohibition on ?candy? or ?candies? Pre-manufactured products prohibited (no gummy bears) 0 Additional labeling requirements 0 Purchase amount equivalency Universal Symbol Universal Symbol I Beginning October 1, 2016, each marijuana package and each individual edible product was required to be marked with a the Colorado Universal Symbol. Beginning December 1, 2016, retail (adult-use) stores and medical centers could only sell marijuana marked with the Universal Symbol. Medical Retail (adult? Marijuana use) Marijuana MOLORADO 0 7) Examples of Packaging Universal Symbols in '5 CNATUQE A COLLECTION OF Sm Tm 12?: 3425191. L114 KFEP 8. "55 OLORADO . i g. "i 33:: FIT-Y I1. a, . .42- ., Exampies of Edibie Universe! Symbois Edibles Regulation: Phase 3 Oct 1, 2017 Changes - Prohibition on production or sale of edible retail marijuana products or edible medical marijuana infused products in the shape of humans, animals, or fruit ?commaoo Structure MOLORADO MED Structure a Business Individual Licensing (See Section 2 of Appendix) 0 Business I Initial applications I Renewals I Change of ownerships 0 Individual licensing I Owners I Managers employees I Field Enforcement (See Section 6 of Appendix) 0 Criminal investigations 0 Complaint investigations 0 Compliance monitoring data analytics Underage compliance Background Licensing Business structure . Criminal background checks 0 Government obligations Financial agreements Sources of funding Compliance history Business associations 0 Coordination with local licensing authority Licensing recommendation to State Licensing Authority OLORADO $6 0 . - 0 As of 7/ 1/2017, there are 3,011 business licenses approved across the state. Medical Licenses 'RetaiI'LiCEn?es . Centers/Stores Cultiuations I Testing Facilities Transporters Operators Totals MED Occupational Licenses/ Badges are required for anyone working within Colorado ?5 marijuana industry. As of 7/1 /2017, there are 34,459 Active Occupational Licensees HEIJICMJ RETAIL RETAIL RETAIL ONLY Lic Exp: 8/15/11 3/15/14 ADPOLORADO - a. Field Enforcement Primary Activities 4- Compliance inspections an Initial inspections :3 Routine inspections 1:21 Risk based inspections Complaint investigations c: Solvability factors a: Underage compliance operations a Liquor model :3 Under 21, residency, registered patient a Criminal investigations :1 Issuance of criminal summonses for underage compliance violations :3 Joint law enforcement operations See Section 6 of Appendix Product Testing 0 Potency Homogeneity 0 Residual solvents Microbials 0 Pesticides MOLORADO Marijuana Taxation I Uses 0 School construction (BEST) 0 Marijuana-related purposes I Oversight and enforcement I Youth prevention I Substance abuse prevention and treatment I Public education campaigns Taxes - $459.5 Million through May 2017 0 Total tax collected in FY13-14 0 Total tax collected in FY14-15 0 Total tax collected in FY15-16 0 Total tax collected in FY16-17 (through May 2017) See Section 9 of Appendix MOLORADO i" 3 Regulatory Violations Penalties .- Retail Marijuana Code, Rule 1307 o- Public Safety Violations I Suspension up to $100,000 fine per violation and/ or license revocation I Violations Associated with Cole Memo Priorities C: License Violations I Suspension up to $50,000 fine per violation and/ or license revocation I General violations not affecting consumer safety or public safety License Infractions II Suspension up to a $10,000 fine per violation I Minor regulatory violations Assurance of Voluntary Compliance (AVC) Administrative Holds See Section 7 of Appendix AgcowRADo MED Staffing Operating Budget Resources Appropriated by Legislature for MED 38 FF Criminal Investigators 30 Compliance Investigators 31 FTE Administrative Support 0 4 Management Series 0 2 FTE Communications and Marketing 3 Legal Assistant 1. - 108 Appropriated (through Budget) . FY 2016-17 MED Budget: r? TAX Staffing Operating Budget I Resources Appropriated by Legislature for TAX 12 FTE Field Auditors 3 FTE Tax Examiners 1.5 Special Agents 1.5 FTE Tax Compliance Agents 1 Tax Examiners 0000 FTE: 19 appropriated (through FY16-17 Budget) 0 FY 2016-17 TAX Budget: @comRAoo Ongoing Taxation Activities o100% Business Audit Every Three Years iTax Compliance Agents enforce collections on retail marijuana businesses with tax delinquencies. ?nCriminal Tax Special Agents investigate cases of criminal marijuana tax evasion. :Tax Examiners provide customer service for marijuana tax businesses and assist them with account and filing issues. .Mandatory Electronic Filing MOLORADO Areas of Focus 0 Edibles 0 Federal Regulatory Assistance 0 Pesticides 0 Banking Diversion COLORADO Reports Studies Amendment 64 Task Force Final Report, 3/2013 MED Market Size and Demand Study, 7/2014 House Bill 14-1366 Marijuana Edibles Work Group Report, 1/2015 Marijuana Equivalency in Portion and Dosage Study, 8/2015 Annual Report Thank You i For more information: Please visit the DOR MED website at - pacific/enforcement/ marijuan aenforcement COLORADO Department of Public Safety Stan Hilkey Executive Director CDPS is the primary state law enforcement entity of the executive branch of state government. Role: Prevent diversion and other illegal marijuana activity through: - Enforcement 0 Policy - Legislative participation - Gathering and disseminating intelligence - Coordination Partnerships: Challenges: - Governor?s Marijuana Working Group 0 No overall state police or investigative - Law Enforcement Working Group agency with original jurisdiction in - State?s Sheriffs enforcement - Chiefs of Police - No statewide data system - Federal agencies - Data practices prior to legalization - Rocky Mountain HIDTA - Starting point on data after 0 Other states legalization - National Fusion Center Network 0 Local control - 22 judicial districts - 64 counties 0 272 cities and towns Violent Crime Rates: Colorado?s total violent crime rate is 17 percent lower than the national average. atoms . 403.5' - 33 3.1 331? 333-? 3 g- - 8 300 333?? 3119 32421.! H?l? 304.6 30531> 100 2010 2311 2012 2013 2014 EHIE --I-- Colorado ?I?United States Data sources: Colorado Bureau of Investigation, Crime in Colorado; Federal Bureau Of Investigation, Crime in the United States. National rate for 2016 is an estimate based upon a 5.3% increase in violent crime over the ?rst six months Of 2016. A COLORADO Mari juana-related Violent Crime in Denver - Denver has 43% of state licensees, making it a reasonable sample. - In 2015, marijuana-related crime in Denver accounted for about 0.5% of all crime. 0 Violent crime around licensed marijuana establishments: - In 2015 2016 combined, there were 10 marijuana-related violent crimes reported at licensed marijuana business locations. There were a total of 21,089 violent crimes in Denver in those years - Violent crime in the non-licensed (non-industry) area: - In 2015 2016 combined, there were 54 marijuana-related violent crimes outside the regulated industry. There were a total of 21,089 viblent crimes in Denver in those years - There has been no noticeable increase in violent crime related to marijuana since the Denver PD started tracking it as a category in 2012. 2012 .2013 2014 2015 2016 Industry violent crime 4 7 10 7 3 Non-industry violent crime 23 32 37 32 22 Note: Violent crime includes robbery, aggravated assault, and simple assault. The 2016 data only includes the first 10 months. Crime Marijuana, URL: denver-crime-marijuana, Retrieved 2/27/2017 f) Marijuana Diverted Out of Colorado Colorado Qriginated Marijuana Seizures 2000 1726 1790 1800 1593 1600 1502 1400 1200 . . ?-K lograms 1000 Incidents 800 600 510 1160 363 356 400 200 ., 0 2014 2015 2016 2017 {est Source: El Paso Intelligence Center. National Seizure System (2017]. 2 Notes: Average seizure size range between 2.3kg to 3.9 kg, with standard deviations remaining consistent across all years. - Estimate for 2017 based on doubling first six months of incidents and kilograms (178 incidents, 751 kilograms). National Seizure System (NSS) Data prior to 2014 is not comparable due changes in the reporting. The RMHIDTA began entering seizure data into the NSS beginning January 1, 2014 and that resulted in a spike in seizures being reported. There has not been a discernible upward trend in seizures since retail sales began in 2014. AcomRADo Enforcement Effort Snapshots National Seizure System - :Colorado cases - '?lpounds . Iplants Source: El Paso Intelligence Center, National Seizure System (2015 to date) Colorado Courts Data - 17,955 marijuana-related charges filed in courts, Title 18 *Colorado Courts, 2015 to date. Open Source Media Single Agency Data 34 cases over a 2 V2 year - 2016, Pueblo County period 0 41 arrests 22,400 plants seized 0 6,000 plants 29,110 pounds of product 100+ dried product seized" a 5 BHO labs 193 arrests Source: Open source Colorado media accounts. *pounds and plant counts may be double reported Source: Data from Pueblo County Colorado Sheriff 1- Highlights: Enforcement Efforts Data Challenges 0 C3 Four Divisions of CDPS Engaged Division of Homeland Security, Colorado Information Analysis Center (Colorado?s Fusion Center) Dedicated Marijuana - Ongoing analysis of organized Cuban gang activity in- . state: origin, structure, etc. Analyst and Intelligence - Smuggling routes, methods and types of concealment Function 0 Connecting agencies to front and back end of diversion . . cases (IN and OUT of State) Four Prlorlt'ies: - State-to-state coordination, with emphasis on other legalization states and bordering states - Intelligence products on first responder safety in marijuana grow operations g. - Analysis of top destination states and top types of product - A5515tance to law enforcement seized involvement in national - Analysis of diversion methods: Highway, USPS, FedEx production UPS - Coordination with National Fusion Center Network ACOLORADO E, Intelligence Assessments (From -There Is not a significant amount of marijuana being diverted by owners or workers of licensed facilities in relation to the amounts leaving Colorado. oThe main means of diverting marijuana from the legal market is by looping. which primarily occurs in the medical marijuana space due to reduced taxation on medical marijuana versus retail marijuana. - In the unregulated medical market, the primary drivers of diverted marijuana are illicit grows and extended plant counts. (Recent legislation was intended to address this problem.) -These illicit grows have transitioned from primarily outdoor grows to primarily residential, indoor grows. Organized crime related to marijuana has transitioned from Mexican cartels to Cuban organized crime groups that utilize residential grows. - Most of the diversion that does not have an organized crime nexus is facilitated by extended plant counts or overgrown medical marijuana. (Case reviews E: Interviews with investigators, Patrol Officers and Interdiction officers) Four Divisions of CDPS Engaged Colorado State Patrol - Highway Safety - Impaired Driving - Smuggling, Trafficking lnterdiction Section and Criminal Investigations Branch 0 Training - DRE, ARIDE, and MJ 101 0 Research - Oral Fluids and Green Lab ACOLORADO 8 Colorado State Patrol, Continued . . . While marijuana is a factor in impaired driving, the impairing substance most often cited by the State Patrol is still alcohol. Alcohol on its own accounted for almost 80% of impaired driving arrests in 2016. Marijuana, alone or in combination with other drugs, was involved in about 17% of DUI citations in 2016. In the first six months of 2017, there has been a 21% decline in marijuana-related DUI compared to this time in 2016. 5,000 I 5.1.111]. I Marlluana onlv Marijuana 8; alcohol I: Marijuana other drugs Ll Other (Was um I Alcohol on 111?! LEGO um I 2014 (Tota .5305} 2015 lTolal=4,898) 2016 C3 DUI Data Improvements In 2017, the legislature passed a law aimed at improving our grasp of DUI data in Colorado. There will be an annual report that brings together data from the courts, toxicology labs, and probation to give a comprehensive account of the current information available to determine what substances people are testing positive for in DUI cases. This will also allow for reporting on how many drivers meet or exceed the 5 ng/ml limit for Delta 9 THC that has been established as a ?permissible inference? for impairment. Impaired Driving Training The total number of drug recognition experts has increased 17% from 2013 to 2016. Certified Drug Recognition Experts 303 2? 150 10} 50 21116 2007 2MB 2009 1010 2011 1012 2013- 1014 2015 ACOLORADO Four Divisions of CDPS Engaged Division of Criminal Justice - Dedicated data analyst/ researcher - Published data report (attached) - Criminal justice research arm of executive branch 0 State administrative agent for JAG funding and other federal grants Division of the Colorado Bureau of Investigation 1 State?s toxicology laboratory Investigative assistance if requested (no dedicated marijuana tax fund resources - under consideration) Toxicology research to inform DUI strategies Incentivizing local law enforcement to more toxicology testing r3 "Afi- Recent Successes. . . HB17-1220 Addresses: - Limits residential grows to 12 plants statewide - Abuse of medical patient plant count - Exceptions of up to 24 for patients/ caregivers if - Reverts ability to ?hide in plain site? using they obtain a waiver, or if growing on a registered large indoor grow operations commercial property Direct intent of curbing DTOs - Local control maintained HB17-1221 Addresses: - Eliminates grow cooperatives - Large, unregulated cooperative grows in - Establishes reimbursement grant program for residences local law enforcement - Provides financial assistance to local law enforcement impacted by residential grow Operations 133227-1315 . . l' . 'd ll . Addresses: reates crimina Justice-WI ata co ection on . Gaps in knowledge about DUID DUI and DUID cases in Colorado. . - Informs future public policy, legislation - Yearly report to legislature on findings . and effort regarding DUID All three bills address the majority of provisions in the Cole Memo. AICOLORADO 0 AV Marijuana Safety Awareness and Educatidn COLORADO Department of Transportation Impaired Driving Shailen P. Bhatt, Executive Director Colorado Department of Transportation Safety Awareness and Education Campaign - Mari jUana and Driving Research -Target Audience Focus Groups - Thought there were different penalties (alcohol v. marijuana) - Lack of understanding of DUI law g. when, who) 0 Thought marijuana was safer than alcohol when it came to driving - Would not respond well to government finger-wagging Campaign Tactics 0 Paid advertising -- TV, digital, billboards, social media PR campaigns - Gain earned media Partnerships with Marijuana Industry Group (MIG) and dispensaries Approach Users do not want to feel criminalized CDOT takes a neutral stance rooted in education of the laws and dangers Awareness phase of the behavior change spectrum CDOT strives to connect with users and establish trust MOLORADO C) C) C) Colorado Department of Transportation Safety Awareness and Education Campaign - Marijuana and Driving Timeline 2014 - Educate that driving high can result in a DUI - $120,000 (federal funds) 0 Name: Drive High, Get a DUI - - Achievement: 46% message recall of ?Drive High, Get a tagline - Earned media - 1.2 billion impressions 2015 - Continue education about DUI laws - $450,000 (state marijuana tax funds) - Introduced tactics to engage marijuana users - Hotboxing Car - Introduced point-of-sale outreach - End Game and Collateral Material - Achievement: 200 million impressions on ambient tactics; 35 million on paid media - End Game Arcade - Thousands of people are exposed to message daily ?gcomRADo 2 Colorado Department of Transportation Safety Awareness and Education Campaign Marijuana and Driving Timeline 2016 Educate about the danger of driving high 0 $450,000 (state marijuana tax funds) 0 Name: Dangerous Combinations - new ads; introduction of Slow Speed Chase - Good news: 91% of marijuana users now know you can get a DUI driving high. - Bad news: 30% of marijuana users think they are safe to drive high and over 50% admit to doing so in last 30 days - - Achievement: 17 million impressions; 3 million video plays; CTR was very high with 0.33% compared to the average of 0.15% - 0.20% 2017 - Motivate people to take action $450,000 (state marijuana tax funds) Name: 320 Campaign Plan for a Safe Ride Tactics - 17 Wrapped vehicles; Crashed Edible Tagline - ?Plan a Ride Before You?re High? Partners: Lyft; Dispensaries; Red Rocks; 420 on the Block Incentive: discounts C) C) C) Colorado Department of Transportation Safety Awareness and Education Campaign Marijuana and Driving 2016-2017 Ads HITS LEAD TO HITS . was" Aim GRINDING ONE CAN CRASH THE OTHER DRIVE HIGH ACOLORADO Colorado Department of Transportation Safety Awareness Campaign Marijuana and Driving 2017 Campaign s?r H. 0 ?Drug Recognition Expert (DRE) Program Since 2014: - The Highway Safety Office has conducted 6 DRE training sessions. 0 Training 118 Colorado Peace Officers from agencies statewide - Training 24 instructors - Special emphasis is given to underrepresented parts of Colorado. ALOLORADO E, Recognition Expert DRE) Program As of 2016: 662 Colorado law enforcement officers have completed DRE training. - There are 227 active DREs. - 82 law enforcement agencies have DREs. - The Colorado State Patrol has the most DREs (61 ACdvonced Roadside Impaired Driving Enforcement (ARIDE) Since 2014: The Highway Safety Office has conducted 57 Trainings. - Training 1,134 Colorado Peace Officers from Agencies Statewide - Training 24 Instructors - Special emphasis is given to underrepresented parts of Colorado - Additional ARIDE trainings are conducted statewide by other agencies. AcomRADo 8 Questions? COLORADO Department of Regulatory Agencies Marisol Larez, Interim Executive Director Ronne Hines, Director Division of Professions and Occupations Chris Myklebust, Commissioner Division of Banking Division of Financial Services . Physician Regulation DORA is responsible for regulating physicians who recommend medical marijuana. A physician who provides a patient with a medical marijuana certificate is required to do so ?in the context of a bona fide physician-patient relationship." Colo. Const. art. The Dept. of Public Health Environment (CDPHE) regulates the medical marijuana registry, keeping a record of physicians making medical marijuana recommendations. AcomRADo 1 Colorado Medical Board Pursuant to Title 12, Article 36, of the Colorado Revised Statutes, the Colorado Medical Board ensures the public?s health, safety, and welfare. Licensure of Regulation of qualified licensed applicants physicians C) C) C) Complaints - Process and Challenges CDPHE Complaints By law, complaints may not include patient identifiers Requires subpoena of redacted records - inability to obtain records due to lack of specificity of the subpoena Subpoena enforcement ACOLORADO 3 Taking Disciplinary Action Must find violation of the Practice Act Policy 40-28 adopted by the Colorado Medical Board describing parameters of an adequate evaluation for therapeutic use of medical marijuana Types of Actions Restrict a license Suspension Revocation Summary suspension MOLORADO C) C) C) Physician Licensees Physicians Recommending I Total CMB Licensees I Physicians recommending 750 ACOLORADO 5 Disciplinary Actions by Colorado Medical Board CMB Disciplinary Actions Total 119- I Other CMB Licensee Discsiplinarv Actions I Recommendation Discipline rv Actions C) C) C) Collaboration with Law Enforcement Leads to Results DORA and the Colorado Medical Board worked in collaboration with local, state, and federal regulators and law enforcement seeking to support the work of the State within Colorado?s current constitutional requirements to eliminate the medical marijuana grey market by enforcing practice standards to protect patients. AcomRADo Results of Collaboration Results of Collaboration 5 summarily suspended (7/2015) with final action as follows: - 1 revocation - appeal pending - 1 stipulation- 1 year suspension, permanent restriction, re-education - 3 litigation pending (2 are stayed pending CCA action for Board exceeding authority by summarily suspending license) - all remain suspended ANGOLORADO 9 Continued Efforts for Public Safety DORA is developing a campaign to raise awareness and increase complaints DORA is partnering with local law enforcement DORA will be hosting forum to identify regulatory gaps DPO received 1 to investigate medical marijuana cases COLORADO A co COLORADO Questions? A Gov. John Hickenlooper Banking Cannabis in Colorado - Colorado?s banking regulators prioritize public safety and the safety and soundness of the banking and financial services industries. - Focus on monitoring and enforcement - Oversight of state-chartered banks and credit unions that facilitate the transfer of cash into the Federal Reserve System (FRS) - The regulatory regime works with financial institutions to monitor the financial activities of marijuana related businesses (MRBs) and to create a documented audit trail. COLORADO . C) C) (3 Audit Trail - Has generated case evidence and other valuable information that has been used by law enforcement agencies and federal regulatory authorities. - Has facilitated the transfer of hundreds of millions of dollars into the FRS that would otherwise exist outside of the nation?s banking system. - Outside the monetary system, vast amounts of cash would exist without any means of tracking its whereabouts or future purposes. - The United States has the most robust banking system in the world and it?s a powerful and necessary remedy to ensure public safety and to ensure that money generated is not diverted to criminal enterprises. AcomRADo Focus on Compliance - We communicate to financial institutions the duty to comply with federal guidance. - Regulatory authorities do not convey a message that banking the cannabis industry is ?permission? to engage in activities that are illegal at the federal level. - Over time, we have strived to achieve a temporary solution that respects Colorado law without ignoring the fact the marijuana is illegal on a national level under the Controlled Substances Act (CSA). - Banking the cannabis industry has only achieved success through Colorado?s cooperation with federal banking agencies. This relationship is made possible by the ongoing valuable guidance provided by the Department of Justice and MOLORADO Cooperation with Federal Agencies - Cooperation has served to solidify our commitment to a robust regulatory regime. - Colorado delivered outreach concerning marijuana banking and training in coordination with federal banking jurisdictions that include branches of the San Francisco, St. Louis, and Kansas City Federal Reserve Banks. - Coordinated regulatory expectations between federal and state agencies that includes the State of Colorado, the FDIC, the NCUA, the Fed and the OCC (which regulates the na?onalbanksy 0 Not an official policy but is meant to provide inter- agency education and to formulate a consistent message for regulated institutions through periodic safety-and- soundness examinations. AcomRADo Cooperation with Federal Agencies - Agencies coordinated regulatory efforts with financial institutions to provide traditional banking services to the cannabis industry while providing a robust audit trail for use by law enforcement via suspicious activity reports (SARs) and bank records obtained via subpoena. - Coordinated with the Federal Reserve?s regulatory authorities to share our history and professional experience regulating MRBs with a number of non-Colorado state- regulatory agencies and with financial institutions to help them create best practices and to establish priorities concerning federal guidance. 0 One such example is to encourage states to create a robust licensing and tracking system before offering banking services to the cannabis industry in order to comply with federal guidance. COLORADO $0 0 0 Helping Law Enforcement Punish Bad Actors 1. Suspicious Activity Reports (Marijuana Limited Marijuana Priority Marijuana Termination) provide targeted documented records for law enforcement concerning suspicious banking activity (Please refer to Q1 2017 Marijuana Banking Update). 2. This information has been used by law enforcement and used in coordination with the subpoena process, has resulted in law enforcement agency stings and arrests. Bank records have been used as evidence in these cases. ACOLORADO A co COLORADO Questions? COLORADO A Gov. John Hickenlooper