Cannabis In Colorado Research Articles

The impact of recreational cannabis legalization on youth: the Colorado experience.

Over the past two decades, cannabis policies have liberalized in the United States, culminating in the legalization of recreational cannabis in Colorado and Washington state in 2012. This review will focus on the impact of recreational cannabis legalization in Colorado. While the prevalence of past-year and past-month cannabis use has remained relatively steady among adolescents post-legalization, the prevalence of young adult use has continued to rise. Cannabis products with increased potency have become more prevalent and widely used. There are concerns that the use of products with increased potency will increase risk for cannabis use and comorbid mental health disorders, particularly cannabis-induced psychosis and suicidal behavior, although more research is needed to fully understand the impact of high-potency products. Since the legalization of recreational cannabis, numerous additional public health concerns have emerged: unintentional overdoses requiring acute care visits, electronic vaping-associated lung injury, increased motor vehicle collisions related to cannabis consumption, and higher rates of cannabis use during pregnancy. Lessons learned from the first decade of cannabis legalization emphasize the need for research efforts to provide evidence-based guidelines, inform prevention strategies, and implement selective interventions for at-risk populations including youth, individuals with comorbid mental health disorders, and individuals who are pregnant.

Accounting and the territorialization of markets: A field study of the Colorado cannabis market

This study examines the role of an inventory tracking and accounting system in the creation of a new market for legal cannabis in the US state of Colorado. Inspired by the empirical setting and the work of Deleuze and Guattari, we illuminate different processes associated with the management of flows (of people, aspirations, and things) into, out of, and within the market. Our findings contribute to our understanding of how accounting is implicated in the territorialization of new governable entities. We show how accounting, as a market device, is involved not only in performing economic and other theories, but in populating market spaces with certain elements and not others. Finally, we suggest that our analysis has policy and regulatory implications related to phenomena of contemporary interest such as traceability of global supply chains and the social and economic consequences of tracking and tracing systems.

Changes in Emergency Department Encounters for Vomiting After Cannabis Legalization in Colorado

Cannabis hyperemesis syndrome is an emerging clinical issue associated with cannabis use. Legalization of cannabis has led to an increase in vomiting-related illnesses in health care settings. To examine whether legalization of cannabis in Colorado has been associated with increases in vomiting-related emergency department (ED) visits. A cross-sectional design was used to assess the increase in ED claims for vomiting reported to the Colorado Hospital Association between January 1, 2013, and December 31, 2018, in counties that had no prior cannabis dispensaries before legalization compared with those that did. A total of 820 778 patients seeking care through Colorado EDs were included in the analysis. The number of medical and recreational cannabis dispensaries per county per quarter. County per capita rate of vomiting-related ED claims per quarter. Vomiting-related ED health care encounters increased from 119 312 in 2013 to 153 699 in 2018 (29% increase). Over this period, 203 861 patients (25%) were aged 0 to 18 years; 114 201 (14%) were aged 19 to 25 years, and 502 771 (61%) were aged 26 years or older; 510 584 patients (62%) were female. Additional recreational dispensaries were associated with increased vomiting-related ED visits (incidence rate ratio, 1.03; 95% CI, 1.01-1.05), but counties with high baseline medical dispensary exposure experienced smaller increases in vomiting-related ED visits than counties with no baseline medical dispensary exposure (incidence rate ratio, 0.97; 95% CI, 0.95-0.99). Counties with a high number of medical marijuana dispensaries had increases at a 5.8% slower rate than counties with none. The findings of this study suggest that cannabis legalization in Colorado is associated with an increase in annual vomiting-related health care encounters with regard to exposure to these markets. It may be useful for health care clinicians to be aware of cannabis hyperemesis syndrome and inquire about cannabis use when appropriate.

Post-Legalization Drug Communication: Examining a Colorado Cannabis Campaign

Colorado legalized marijuana use for recreational purposes by adults over 21 in 2012. Our goal is to examine the first major communication campaign (called Good-To-Know) mounted by the state government with the objective of informing the public regarding regulatory and safety precautions surrounding newly legal use. Methods: We assess the content of campaign’s central messaging qualitatively by comparing its major themes in terms of criteria developed from the literature and the campaign’s own goals. Results: With minor exceptions (lack of audience segmentation; limiting the focus to generating knowledge) Colorado’s Good-To-Know campaign rates well when assessed against specific criteria for effective drug communication campaigns as well as its own goals. Conclusions: We conclude that although there were minor limitations to this campaign, policy makers and activists should think proactively about messaging content in states where legalization is imminent. And that more research on legal drug use messaging needs to occur.

Effect of Washington State and Colorado's cannabis legalization on death by suicides

In the U.S., death by suicide is a leading cause of death and was the 2nd leading cause of death for ages 15-to-34 in 2018. Though incomplete, much of the scientific literature has found associations between cannabis use and death by suicide. Several states and the District of Columbia have legalized cannabis for general adult use. We sought to evaluate whether cannabis legalization has impacted suicide rates in Washington State and Colorado, two early adopters. We used a quasi-experimental research design with annual, state-level deaths by suicide to evaluate the legalization of cannabis in Washington State and Colorado. We used synthetic control models to construct policy counterfactuals as our primary method of estimating the effect of legalization, stratified by age, gender, and race/ethnicity. Overall death by suicide rates were not impacted in either state. However, when stratified by age categories, deaths by suicide increased 17.9% among 15–24-year-olds in Washington State, or an additional 2.13 deaths per 100,000 population (p-value ≤0.001). Other age groups did not show similar associations. An ad hoc analysis revealed, when divided into legal and illegal consumption age, 15–20-year olds had an increase in death by suicides of 21.2% (p-value = 0.026) and 21–24-year olds had an increase in death by suicides of 18.6% (p-value ≤0.001) in Washington State. The effect of legalized cannabis on deaths by suicide appears to be heterogeneous. Deaths by suicide among 15–24-year-olds saw significant increases post-implementation in Washington State but not in Colorado.

Abstract P250: The Impact of Recreational Cannabis Legalization on All-cause Hospitalizations and Acute Cardiovascular Event Hospitalizations in Colorado

Background: Cannabis may have adverse consequences for cardiovascular health. Colorado decriminalized cannabis on November 2012 and retail sales of cannabis began in January 2014. We examined whether the overall rate of hospitalizations and hospitalizations for acute cardiovascular events (ACE) increased in Colorado after legalization. Hypothesis: We hypothesized that the rates of all-cause hospitalizations and ACE would increase post legalization of recreational cannabis. Methods: The State Inpatient Database (SID) for Colorado, available through Healthcare Cost and Utilization Project was analyzed using interrupted time-series methods to assess whether increases in sales of marijuana affected the rates of overall hospitalization and hospitalization for ACE, post legalization of cannabis. The time analyzed included January 2008 through September 2015. We ended the data of analysis on October 1 2015, because ICD-10 codes were implemented in October 2015. The primary outcome, rate of hospitalizations, was measured by total unique inpatient admissions within the SID for each monthly time period. The secondary outcome, ACE, was identified using ICD-9 diagnostic codes for myocardial infarction (410), stroke (430, 431, 433, 434, 436), and ICD-9 procedure codes for coronary artery bypass surgery (36.1x), and percutaneous coronary intervention (36.0x, 0.66). In the interrupted time series regression models we accounted for seasonality and consumption of cigarettes and alcohol using a proxy of sales tax collected each month for cigarettes and alcohol. In the ACE models, we controlled for seasonality, sales of cigarettes and average monthly air temperature. We also examined the effect of legalization on the same outcomes in men and women and different age subgroups. Results: While overall rates of hospitalizations decreased somewhat over the study period, there was no statistically significant difference in hospitalizations rates, neither in the regression intercept (for immediate change) (p=0.94) or slope (p=0.97), after the legalization of recreational cannabis. Similarly, ACE rates decreased over the time frame, but there were no significant changes in rate intercept (p=0.80) or slope (p=0.71) post legalization. The subgroup analyses by age category and gender for hospitalizations and ACE also showed no significant differences in rates pre and post legalization. Conclusions: We found no evidence that overall hospitalizations and hospitalizations for ACE increased due to legalizing recreational cannabis in Colorado. A limitation of our study was that Colorado had already implemented a medical marijuana program in 2000. Recreational legalization may not have led to a significant increase in users. Future studies should examine the link between legalization and cardiovascular events in other states with a different trajectory of legalization.

Results from the Colorado Cannabis Users Survey on Health (CUSH), 2016

Patterns of cannabis consumption among regular users within a legalized environment have not been explored in detail. We aimed to conduct a survey among regular cannabis users to collect detailed information on frequency of use, methods of use, amounts consumed, and adverse health effects experienced. Data was collected via the Cannabis Users Survey on Health, a self-administered, anonymous online survey. Participants were adults (age 21+), residing in Colorado, who used cannabis at least once in the past month. Survey administration occurred June through October 2016. Of 1297 participant responses, 65.1% used cannabis at least once daily and smoking was the most common method of use (83.1%). Cannabis flower was the product most frequently purchased (n = 1006) and in the largest average amount per month (10 g). Adverse health effects were experienced by ~ 40%; most prevalent was paranoia (20.8%). The Cannabis Users Survey on Health provided data needed to inform public health on patterns of cannabis use in Colorado. Surveillance of adverse effects is needed to assess severity. High prevalence of daily use and smoking are concerning for long-term health effects. Continued data collection will allow public health to better assess the effects of increased cannabis availability on use patterns and health.

Over and under-regulation in the Colorado Cannabis industry – A data-analytic perspective

With the State of California legalizing recreational cannabis sales on January 1, 2018, the regulatory process is once more in the forefront of cannabis research. Colorado, often held up as a model of legalization policy, was the first state to implement retail sale of recreational cannabis on January 1st, 2014. However, a combination of subsequent under-regulation and over-regulation, inconsistently applied across issues such as retail licencing, chemical testing, cannabis derivatives, municipality approval for growers, and financing, have not only held back the industry in Colorado but also negatively impacted public health, oversight, and have potentially increased the availability of illegal cannabis. We argue that a data-analytic approach to the industry is potentially the most effective way to resolve these concerns, since in the absence of consistent and reliable data, policymakers are apt to satisfy individual policy concerns without considering the industry as a whole. In this paper we present a data-analytic framework for the cannabis industry, offering a theoretically-driven justification for our approach, and describe implications for research on drug and information policy. The framework may serve as a model for other states or countries contemplating cannabis legalisation. As four new states legalised recreational cannabis in 2016, the implications of this research for policymakers has dramatically increased.

Recommendations From Cannabis Dispensaries About First-Trimester Cannabis Use.

To characterize recommendations given to pregnant women by Colorado cannabis dispensaries regarding use of cannabis products for nausea during the first trimester of pregnancy. This was a statewide cross-sectional study in which advice about cannabis product use was requested using a mystery caller approach. The caller stated she was 8 weeks pregnant and experiencing morning sickness. Dispensaries were randomly selected from the Colorado Department of Revenue Enforcement Division website. The primary outcome was the proportion of marijuana dispensaries that recommended a cannabis product for use during pregnancy. We hypothesized that 50% of dispensaries would recommend use. A sample size of 400 was targeted to yield a two-sided 95% CI width of 10%. Secondary outcomes included the proportion endorsing cannabis use as safe during pregnancy, specific product recommendations, and encouraging discussion with a health care provider. Recommendations were compared by licensure type (medical, retail, or both) and location (rural vs urban). Of the 400 dispensaries contacted, 37% were licensed for medical sale (n=148), 28% for retail (n=111), and 35% for both (n=141). The majority, 69% (277/400), recommended treatment of morning sickness with cannabis products (95% CI 64-74%). Frequency of recommendations differed by license type (medical 83.1%, retail 60.4%, both 61.7%, P<.001). Recommendations for use were similar for dispensary location (urban 71% vs nonurban 63%, P=.18). The majority (65%) based their recommendation for use in pregnancy on personal opinion and 36% stated cannabis use is safe in pregnancy. Ultimately, 81.5% of dispensaries recommended discussion with a health care provider; however, only 31.8% made this recommendation without prompting. Nearly 70% of Colorado cannabis dispensaries contacted recommended cannabis products to treat nausea in the first trimester. Few dispensaries encouraged discussion with a health care provider without prompting. As cannabis legalization expands, policy and education efforts should involve dispensaries.

Mental Health-related Emergency Department Visits Associated With Cannabis in Colorado.

Cannabis legalization in Colorado resulted in increased cannabis-associated health care utilization. Our objective was to examine cooccurrence of cannabis and mental health diagnostic coding in Colorado emergency department (ED) discharges and replicate the study in a subpopulation of ED visits where cannabis involvement and psychiatric diagnosis were confirmed through medical review. We collected statewide ED International Classification of Diseases, 9th Revision, Clinical Modification diagnoses from the Colorado Hospital Association and a subpopulation of ED visits from a large, academic hospital from 2012 to 2014. Diagnosis codes identified visits associated with mental health and cannabis. Codes for mental health conditions and cannabis were confirmed by manual records review in the academic hospital subpopulation. Prevalence ratios (PRs) of mental health ED discharges were calculated to compare cannabis-associated visits to those without cannabis. Rates of mental health and cannabis-associated ED discharges were examined over time. Statewide data demonstrated a fivefold higher prevalence of mental health diagnoses in cannabis-associated ED visits (PR= 5.35, 95% confidence interval [CI], 5.27-5.43) compared to visits without cannabis. The hospital subpopulation supported this finding with a fourfold higher prevalence of psychiatric complaints in cannabis attributable ED visits (PR= 4.87, 95% CI = 4.36-5.44) compared to visits not attributable to cannabis. Statewide rates of ED visits associated with both cannabis and mental health significantly increased from 2012 to 2014 from 224.5 to 268.4 per 100,000 (p<0.0001). In Colorado, the prevalence of mental health conditions in ED visits with cannabis-associated diagnostic codes is higher than in those without cannabis. There is a need for further research determining if these findings are truly attributed to cannabis or merely coincident with concurrent increased use and availability.

An overview of health and safety in the Colorado cannabis industry.

Understanding worker health and safety in the rapidly growing legal U.S. cannabis industry is important. Although little published research exists, workers may be exposed to biological, chemical, and physical hazards. This study investigated the Colorado cannabis industry workforce and both physical and psychosocial hazards to worker health and safety. Two hundred and fourteen Colorado cannabis workers completed an online survey after in-person and online recruitment. Participants answered questions about their occupation, job tasks, general well-being, occupational health and safety, cannabis use, and tobacco use. Colorado cannabis workers were generally job secure and valued safety. However, they regularly consumed cannabis, expressed low concerns about workplace hazards, reported some occupational injuries and exposures, and reported inconsistent training practices. Working in the cannabis industry is associated with positive outcomes for workers and their organizations, but there is an imminent need to establish formal health and safety training to implement best practices.

Recreational Cannabis Legalization and Opioid-Related Deaths in Colorado, 2000-2015.

To examine the association between Colorado's legalization of recreational cannabis use and opioid-related deaths. We used an interrupted time-series design (2000-2015) to compare changes in level and slope of monthly opioid-related deaths before and after Colorado stores began selling recreational cannabis. We also describe the percent change in opioid-related deaths by comparing the unadjusted model-smoothed number of deaths at the end of follow-up with the number of deaths just prior to legalization. Colorado's legalization of recreational cannabis sales and use resulted in a 0.7 deaths per month (b = -0.68; 95% confidence interval = -1.34, -0.03) reduction in opioid-related deaths. This reduction represents a reversal of the upward trend in opioid-related deaths in Colorado. Legalization of cannabis in Colorado was associated with short-term reductions in opioid-related deaths. As additional data become available, research should replicate these analyses in other states with legal recreational cannabis.

Cannabis and Pediatric Inflammatory Bowel Disease: Change Blossoms a Mile High.

The trend toward decriminalization of cannabis (marijuana) continues sweeping across the United States. Colorado has been a leader of legalization of medical and recreational cannabis use. The growing public interest in the medicinal properties of cannabis and its use by patients with a variety of illnesses including inflammatory bowel disease (IBD) makes it important for pediatric gastroenterologists to understand this movement and its potential effect on patients. This article describes the path to legalization and "medicalization" of cannabis in Colorado and the public perception of safety despite the known adverse health effects of use. We delineate the mammalian endocannabinoid system and our experience of caring for children and adolescents with IBD in an environment of increasing awareness and acceptance of its use. We then summarize the rationale for considering that cannabis may have beneficial and harmful effects for patients with IBD. Finally, we highlight the challenges federal laws impose on conducting research on cannabis in IBD. The intent of this article is to inform health care providers about the issues around cannabis use and research in adolescents and young adults with IBD.

Colorado Cannabis Legalization and Its Effect on Emergency Care

Colorado legalized the use of medical marijuana in 2000, although it was not truly commercialized in the state until the US attorney general ceased the prosecution of marijuana users and suppliers in 2009. The result was striking: from January 2009 to January 2011, the number of registered medical marijuana licenses in Colorado increased from 5,051 to 118,895 (Figure 1). Figure 1 Number of active marijuana licenses in Colorado. In 2012, Colorado voted to legalize recreational marijuana beginning in 2014, making it the first state alongside Washington to permit recreational use. Several other states have recently legalized the use of medical or recreational marijuana, with other states considering similar measures (Figure 2).1 Given this trend, emergency physicians in training will likely be confronted with increasing volumes of marijuana-related emergency department (ED) visits and may learn from Colorado’s recent experience with increased availability of marijuana products. Figure 2 Marijuana legalization by state (as of May 2015). THE EPIDEMIOLOGIC EFFECT OF LEGALIZATION Although the significant increase in medical marijuana registrations does not prove its increased use, this inference is supported by various survey data. According to the National Survey on Drug Use and Health, the percentage of young Coloradan adults aged 18 to 25 years reporting marijuana use within the past year increased significantly after medical marijuana legalization (35% in 2007 to 2008 versus 43% in 2010 to 2011). Simultaneously, the percentage of adults aged 26 years or older perceiving “great risk” to marijuana use significantly decreased, from 45% to 31%.2 Interstate comparisons also show a higher prevalence of marijuana use in states in which it has been legalized versus those in which it has not. According to National Survey on Drug Use and Health responses from 2011 to 2013, the prevalence of Coloradan adults endorsing marijuana use within the last month was 19% compared with a national prevalence of 12%.3 According to data from the National Epidemiologic Survey on Alcohol and Related Conditions, residents of states with medical marijuana legalization were twice as likely to endorse marijuana use compared with residents of states without legalized medical marijuana.4

Quasi‐legal cannabis in Colorado and Washington: local and national implications

Quasi‐legal cannabis in <scp>C</scp>olorado and <scp>W</scp>ashington: local and national implications