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

2. 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

3. 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

4. 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

6. 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

7. SBIRT Model

8. 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

9. 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

10. SBIRT Colorado

11. Methods  Procedures & Measures 1. 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

12. Results  8,748 (8%) patients screened positive for marijuana  Odds of screening positive accelerating in early 2009 (interaction with patient age)

15. 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%

16. 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

17. 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)

18. 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

19. 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

20. Limitations  Rapid change in marijuana landscape  Multiple factors likely impact increased marijuana use  SBIRT 2 phase screening process may have missed marijuana users  Generalizability

21. 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

22. OMNI Institute 899 Logan Street, Suite 600 Denver, CO. 80203 www.OMNI.org tel: 303.839.9422 or 800.279.2070 fax: 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.