Legalization Of Marijuana In Colorado Research Articles

Levels and in-unit stability of 11-nor-9-carboxy-9-tetrahydrocannabinol (9-carboxy-THC) in donor platelets and whole blood: is enough present to have an impact on recipients?

Abstract Objective The safety of the United States donor blood supply has been questioned in the context of recreational marijuana legalization in Colorado and other states nationwide. It is unclear whether cannabis use by donors presents a danger to recipients, either through direct toxicity or socioeconomic ramifications. Our objectives are to both determine if the active metabolite of tetrahydrocannabinol (THC), 11-nor-9-carboxy-9-tetrahydrocannabinol (9-carboxy-THC), is present in donated units in a dosage high enough to impact the recipient and to assess for in-unit metabolism or degradation. Methods We will quantify the amount of 9-carboxy-THC in platelet units donated by self-reported cannabis users through liquid chromatography with tandem mass spectrometry (LC-MS/MS) testing and correlate the assay data with donor survey responses. To gain insight into in-unit metabolite stability, we also will test whole blood units at several time points throughout storage, collected from participants who self-report taking a known oral dose of THC prior to donation. Results Institutional review board approval for a study evaluating marijuana at a children’s hospital presented a challenge, requiring the addition of an organizational risk review and an update to the hospital transfusion consent for approval. Thus, the projected timeline of this study has been extended. Study recruitment flyers and an email screening survey have generated interest from volunteer donors. The email survey was sent to 9,208 donors who had previously donated at least once, from which we received 372 responses (4.04% response rate). Of the respondents, 49 individuals reported daily marijuana use, 33 reported marijuana usage 4-6 times per week, 32 reported usage 1-3 times/week, 30 reported usage 1-3 times/month, 52 reported rare usage, and 167 reported never using marijuana. Overall, out of the survey respondents, over 50% reported at least some marijuana usage, and 31% reported at least weekly marijuana usage. Although this number is small, our prior study found that many were repeat donors. Research visits are currently being scheduled for interested participants. Conclusions This study highlights the challenges of performing marijuana research at a children’s hospital and illustrates why there is a lack of published data evaluating the effects of recreational marijuana legalization. Although completion of this project investigating this controversial topic has been delayed, persistent advocation for this area of interest is opening doors for future studies and will hopefully pave the way to fill our knowledge gaps. The results of this research study will inform decisions regarding donor eligibility and safety of the national blood supply as well as address associated socioeconomic implications.

Marijuana Legalization in Colorado: Increasing Potency, Changing Risk Perceptions, and Emerging Public Health Concerns for Youth.

Marijuana legalization occurred gradually in Colorado through political processes. This review aimed at describing the history of marijuana legalization and correlated shifts in product availability, use patterns, and risk perceptions and describes associated emerging concerns with this process for adolescents and young adults. This review focuses on the history of marijuana legalization and correlated shifts in product availability, use patterns, and risk perceptions. Along with the legalization of marijuana, there has been strong commercialization characterized by the widespread development of dispensaries, new products including edibles and concentrates, and an overall lowering of the "price per serving" of marijuana. While the frequency of marijuana use among adolescents does not appear to have shifted substantially, young adult patterns of use have demonstrated an increase in usage. A substantial shift has occurred in the increasing use of concentrates and high potency products. Emerging concerns related to high potency products include increased acute care visits, prevalence and outcomes of comorbid mental health disorders, cannabis-induced psychosis, driving while high, marijuana-related lung injuries, and increased use during pregnancy. Yet, there are also potential medical uses of marijuana. To date, scientific evidence of the mental or physical effects of high potency products is currently very limited. Clinical issues related to the treatment of marijuana use and comorbid psychiatric disorders in youth are discussed with a focus on how low risk perceptions influence treatment considerations.

52 Impact of National Marijuana Legalization on Delirium Rates and Opioid Use in Acute Burns

Abstract Introduction Cannabis use has been associated with larger total burn size areas, longer hospital stays, and an increased number of operations. Legalization of marijuana in Colorado has led to marked increases in burn injuries. Tetahydrocannabinol (‘THC’) use has been shown to increase psychosis, anxiety, and depression, however, it is unknown how this has impacted rates of ICU related delirium in the burn context. Further, observational studies have shown that marijuana use has decreased opioid-related overdoses, but it is unknown how chronic marijuana use affects opioid consumption in the ICU. Thus, it is unknown how national marijuana legalization has impacted ICU rates of delirium and opioid use. As such, the objectives of this study are to describe trends of marijuana legalization on burns and determine if the amount of delirium and opioid use while in hospital has increased after national marijuana legalization. Methods We conducted a retrospective cohort study of 514 patients admitted to an ABA-verified centre one year prior to national marijuana legalization and one-year afterwards. Inclusion criteria consisted of an acute burn injury admission. Data included demographics, toxicology screening information, hospital rates of delirium, and pain medication use. Statistical analysis consisted of student’s t-test, one-way ANOVA, Kruskal-Wallis, Mann-Whitney U, Fisher’s exact, and χ2 test. P value of < 0.05 was considered statistically significant. Results Out of 514 patients, 422 were included; 203 prior to legalization (‘PL’) and 219 afterwards (‘AL’). Cohorts were similar regarding age, gender, inhalation injury, and smoking history. TBSA, length of stay, police custody, major psychiatric illness, alcoholism, and drug dependence were significantly higher in the AL cohort. Positive cannabinoid screens were similar in each cohort (13.3 versus 13.7%), however in both cohorts a large proportion of admissions did not have a toxicology screen completed (58.4–63.5%). Delirium rates (PL=0.5%, AL=4.1%; p=0.02) and opioid use (PL=48%; AL=52%;X2(1, N=422)=5.7, p=0.02) were significantly higher in the AL cohort. Conclusions National legalization of marijuana is associated with increased in-hospital delirium rates and opioid consumption in the acute burn context. Every effort should be made to ensure toxicology screens are completed on admission with the appropriate use of both opioid and adjunct pain medication regimens. In addition, for those not eligible for a toxicology screen due to delayed arrival time to the burn centre, an in-depth discussion should be completed to elicit drug history.

The Effects of Marijuana Legalization in Colorado: More Neutral than Expected

The Effects of Marijuana Legalization in Colorado: More Neutral than Expected

The Spillover Effect of Recreational Marijuana Legalization on Crime: Evidence From Neighboring States of Colorado and Washington State

An ongoing debate exists about the implications of recreational marijuana legalization to public safety. One important public concern is how recreational marijuana legalization may affect crime in neighboring states that have not legalized. Based on Uniform Crime Report (UCR) data from 2003 to 2017, this study used difference-in-differences (DID) analysis to examine the potential spillover effect of recreational marijuana legalization in Colorado and Washington State, with a special focus on the examination of the changes in the rates of a variety of crimes in the border counties of neighboring states relative to the nonborder counties in these states following Colorado’s and Washington’s legalization. Results provide some evidence suggesting a spillover crime reduction effect of legalization, as reflected by the significant decreases in the rates of property crime, larceny, and simple assault in the Colorado region that includes six neighboring states. Results also suggest that the effects of marijuana legalization on crime in neighboring states vary based on crime type and state.

Fatal crashes in the 5 years after recreational marijuana legalization in Colorado and Washington

Colorado and Washington legalized recreational marijuana in 2012, but the effects of legalization on motor vehicle crashes remains unknown. Using Fatality Analysis Reporting System data, we performed difference-in-differences (DD) analyses comparing changes in fatal crash rates in Washington, Colorado and nine control states with stable anti-marijuana laws or medical marijuana laws over the five years before and after recreational marijuana legalization. In separate analyses, we evaluated fatal crash rates before and after commercial marijuana dispensaries began operating in 2014. In the five years after legalization, fatal crash rates increased more in Colorado and Washington than would be expected had they continued to parallel crash rates in the control states (+1.2 crashes/billion vehicle miles traveled, CI: -0.6 to 2.1, p = 0.087), but not significantly so. The effect was more pronounced and statistically significant after the opening of commercial dispensaries (+1.8 crashes/billion vehicle miles traveled, CI: +0.4 to +3.7, p = 0.020). These data provide evidence of the need for policy strategies to mitigate increasing crash risks as more states legalize recreational marijuana.

The marijuana user in US news media: an examination of visual stereotypes of race, culture, criminality and normification

In the wake of growing legalization efforts, both medicinal and recreational marijuana use in the US is becoming more prevalent and societally acceptable. However, racial, criminal and cultural stereotypes linger in mediated visual portrayals. This study examines the extent to which mediated visual portrayals in mainstream news have been impacted by these recent legalization efforts. Employing a quantitative as well as a qualitative analysis of visual images used to represent marijuana use in mainstream news, this study draws upon the power of visual framing and the construction of social reality to examine how visual symbols and iconic signifiers are used to construct both stereotypical and ‘mainstreamed’ or ‘normative’ depictions of marijuana use. Analyzing 458 visuals across 10 different media outlets across the political spectrum, both before and after legalization of marijuana in Colorado, this study shows how news portrayals perpetuated stereotypes about marijuana users, particularly around criminality and pot-culture iconography. Relatively few depictions of marijuana users in the US are visuals of ordinary, ‘normal’ people or families. This study thus interrogates the relationship between representations of race, criminality and ‘pothead’ stereotypes associated with marijuana use, and how these visual representations differ amongst liberal and conservative news sites, finding that the political ideology of the news outlet largely influences the visual stereotyping of marijuana users. The study concludes by considering both the legal and cultural implications of how mainstream news visually represents marijuana use, considering how persistent decades-old representations were largely perpetuated rather than challenged in light of legalization efforts.

Crime, Laws, and Legalization: Perceptions of Colorado Marijuana Dispensary Owners and Managers

The legalization of recreational marijuana in Colorado has complicated the relationships between local, state, and federal governments. Such challenges have trickled down to proprietors, managers, and employees within the new billion-dollar industry. Dispensary owners and managers often must navigate the implementation of new laws and policies in how they operate their business. The current study surveyed marijuana dispensaries across Colorado to explore owners’ and managers’ perceptions of operating their business while considering federal banking laws and concerns with state laws conflicting with federal laws, particularly in context of the 2016 presidential election.

Unintended Consequences of Legalization of Marijuana in Colorado

Unintended Consequences of Legalization of Marijuana in Colorado

Marijuana business workers most common news source

This study explores newspaper coverage of marijuana legalization in Colorado during the first two months of implementation in 2014. The analysis of 202 news articles marijuana business workers and users account for 29 percent of sources used in articles. The most commonly discussed benefit of legalization is taxation revenue, while arguments against legalization are more diverse.

Marijuana and acute health care contacts in Colorado.

Over 22 million Americans are current users of marijuana; half of US states allow medical marijuana, and several allow recreational marijuana. The objective of this study was to evaluate the impact marijuana has on hospitalizations, emergency department (ED) visits, and regional poison center (RPC) calls in Colorado, a medical and recreational marijuana state. This is a retrospective review using Colorado Hospital Association hospitalizations and ED visits with marijuana-related billing codes, and RPC marijuana exposure calls. Legalization of marijuana in Colorado has been associated with an increase in hospitalizations, ED visits, and RPC calls linked with marijuana exposure. From 2000 to 2015, hospitalization rates with marijuana-related billing codes increased from 274 to 593 per 100,000 hospitalizations in 2015. Overall, the prevalence of mental illness among ED visits with marijuana-related codes was five-fold higher (5.07, 95% CI: 5.0, 5.1) than the prevalence of mental illness without marijuana-related codes. RPC calls remained constant from 2000 through 2009. However, in 2010, after local medical marijuana policy liberalization, the number of marijuana exposure calls significantly increased from 42 to 93; in 2014, after recreational legalization, calls significantly increased by 79.7%, from 123 to 221 (p<0.0001). The age group <17years old also had an increase in calls after 2014. As more states legalize marijuana, it is important to address public education and youth prevention, and understand the impact on mental health disorders. Improvements in data collection and surveillance methods are needed to more accurately evaluate the public health impact of marijuana legalization.

A Review of the Impact of Marijuana's Legalization on Colorado's Industrial Warehouse Lease Rates: How High is High?

We review the evolution of the marijuana industry in Colorado and its implications for real estate. We investigate industrial space pricing and the history of price effects caused by the legalization of marijuana in Colorado. We are the first to investigate how the legalization of marijuana has created an excess demand for real estate space. We show that the lease pricing of industrial grow facilities is well above that of non-marijuana related industrial spaces by referring to examples and reasoning for the lease rate spread. We comment on what the next phase of the marijuana real estate market will be as the industry matures.

An innovative model for integrating substance use treatment in schools

Since legalization of marijuana in Colorado, youth marijuana use increased by 20%, which is 74% higher than the national average (National Survey on Drug Use and Health [NSDUH]). According to this same survey, the top 20 states with the highest rate of marijuana use for youth ages 12–17 years are those that have medical marijuana or have legalized recreational marijuana.

Marijuana Legalization in Colorado -- Lessons for Colombia

In 2012 Colorado became the first jurisdiction anywhere in the world to legalize marijuana possession and use for all adults. The regulated and taxed marijuana industry that arose in Colorado following legalization was also the first of its kind and stands a model for other states considering marijuana law reform. In this brief article I discuss the results of the Colorado experiment; I demonstrate that while Colorado’s regulatory model was largely successful, it also demonstrates the limits of generating revenue through taxing and regulating marijuana. I then discuss the implications of this conclusion for post-conflict Colombia, drawing a comparison to the situation California confronts as it considers legalizing marijuana for adult use.

Public Health Effects of Medical Marijuana Legalization in Colorado.

The public health consequences of the legalization of marijuana, whether for medical or recreational purposes, are little understood. Despite this, numerous states are considering medical or recreational legalization. In the context of abrupt changes in marijuana policy in 2009 in Colorado, the authors sought to investigate corresponding changes in marijuana-related public health indicators. This observational, ecologic study used an interrupted time-series analysis to identify changes in public health indicators potentially related to broad policy changes that occurred in 2009. This was records-based research from the state of Colorado and Denver metropolitan area. Data were collected to examine frequency and trends of marijuana-related outcomes in hospital discharges and poison center calls between time periods before and after 2009 and adjusted for population. Analyses were conducted in 2014. Hospital discharges coded as marijuana-dependent increased 1% per month (95% CI=0.8, 1.1, p<0.001) from 2007 to 2013. A change in trend was detected in poison center calls mentioning marijuana (p<0.01). After 2009, poison center calls increased 0.8% per month (95% CI=0.2, 1.4, p<0.01). Poison center calls also increased 56% (95% CI=49%, 63%, p<0.001) in the period following the policy change. Further, there was one hospital discharge coded as dependent for every 3,159 (95% CI=2465, 3853, p<0.001) medical marijuana registrant applications. The abrupt nature of these changes suggests public health effects related to broad policy changes associated with marijuana. This report may be used to assist in policy decisions regarding the short-term public health effects of marijuana legalization.

Marijuana Policy in Colorado

In November 2012, voters in the states of Colorado and Washington approved ballot initiatives that legalized marijuana for recreational purposes. Alaska, Oregon, and the District of Columbia are scheduled to consider similar measures in the fall of 2014, and other states may follow suit in the fall of 2016.Supporters and opponents of such initiatives make numerous claims about state-level marijuana legalization. Advocates believe legalization reduces crime, raises revenue, lowers criminal justice expenditure, improves public health, improves traffic safety, and stimulates the economy. Critics believe legalization spurs marijuana use, increases crime, diminishes traffic safety, harms public health, and lowers teen educational achievement. Systematic evaluation of these claims, however, has been absent.This paper provides a preliminary assessment of marijuana legalization and related policies in Colorado. It is the first part of a longer-term project that will monitor state marijuana legalizations in Colorado, Washington, and other states.The conclusion from this initial evaluation is that changes in Colorado’s marijuana policy have had minimal impact on marijuana use and the outcomes sometimes associated with use. Colorado has collected non-trivial tax revenue from legal marijuana, but so far less than anticipated by legalization advocates.

The implications of marijuana legalization in Colorado.

The legalization of marijuana in Colorado has had complex effects on the health of its citizens. Physicians have the responsibility to present a balanced perspective, identifying both the potential health benefits and risks associated with marijuana use. In this Viewpoint, we discuss the history of marijuana policy in Colorado and the expected and unexpected effects of increased marijuana availability. Other states considering marijuana policy liberalization may learn from the experiences in Colorado.

Fear and Loathing in Colorado: Invoking the Supreme Court's State-Controversy Jurisdiction to Challenge the Marijuana-Legalization Experiment

In this Article, we assert that States may invoke the Supreme Court’s original jurisdiction to challenge marijuana legalization in Colorado and other jurisdictions. The Constitution endows the Court with jurisdiction to adjudicate transboundary nuisance disputes between States. Such suits once comprised a relatively common part of the Court’s docket. The number of these actions fell dramatically following passage of the Clean Air and Water Acts, which relieved the Court of its historic role of establishing and enforcing interstate environmental standards. Colorado’s introduction of marijuana into interstate commerce has reawakened this long-dormant body of constitutional law. Like downstream industrial pollution, the transboundary externalities resulting from Colorado’s introduction of marijuana into interstate commerce fall within the ambit of the Court’s original jurisdiction. In making this argument, we distinguish our theory from the Complaint lodged by Nebraska and Oklahoma with the Supreme Court. Rather than premising their claim on the Court’s transboundary nuisance jurisprudence, Nebraska and Oklahoma seek to “enforce...the Supremacy Clause, Article VI of the U.S. Constitution.” They contend that Colorado’s venture violates the federal Controlled Substances Act and should be enjoined. Their federal-supremacy claim suffers from a myriad of fatal deficiencies: they lack standing to represent the federal government’s interests, they have not plead injury with the particularity required to invoke the Court’s original jurisdiction, and their prayer for injunctive relief runs afoul of the anti-commandeering doctrine. In contrast, we assert that the Court should award damages to a prevailing State, using the Coase Theorem as its guide. The Theorem states that if transaction costs are eliminated “parties will negotiate the efficient solution to private nuisance problems.” Real-world application of the theorem is attained by imposing legal rules that best approximate the way disputes would be resolved in a transaction-cost-free environment. Such an outcome is best effectuated by a rule charging the nuisance with the damages it causes. If compelling a polluter to internalize the cost of his pollution drives him out of business, then his enterprise was not the most economically efficient use of the property and his interests should yield to that of his neighbors. In contrast, if the polluter assumes responsibility for all the costs of his venture and still realizes a sufficient profit to stay in business, then his use of the land is most efficient. If this remedy is applied, the market will determine the success or failure of Colorado’s venture and will serve as a guide to other states in deciding whether it is worth emulating.

Anticipated Medical Effects on Children From Legalization of Marijuana in Colorado and Washington State

On November 4, 2012, Amendment 64 passed in Colorado and Initiative 502 passed in Washington State to legalize the possession of small amounts ofmarijuana andmarijuana-related productsbyadults.Possessionbyanyoneyounger than21years and the growing of marijuana without authorization remain illegal in both states. InColorado, adults are permitted topossess up to 1 oz of marijuana or 6 marijuana plants. In Washington, adults are permitted to possess up to 1 oz of marijuana, 16 oz ofmarijuana-infused product in solid form, 72 oz ofmarijuana-infusedproduct in liquid form, or any combination of all 3. The possession of marijuana remains illegal under federal law andmarijuana remains a Schedule I agent under the Drug Enforcement Administration. Themedicaluseofmarijuanaandmarijuana-infusedproducts is legal in 18 states and theDistrict ofColumbia. Sevenadditional states are considering legalization of medical marijuana.Themedicaluseofmarijuanahasbeen legal inColorado since 2009. In this issue, Wang et al1 describe an increase in cases of accidental ingestion of marijuana by children after decriminalization of medical marijuana in Colorado. Marijuana ingested by themajority of the children described in the article was in the form of a food product. The medical marijuana industry provides attractive and palatable marijuana-infused solidand liquidproducts, including cookies, candies, brownies, andbeverages. The legalizationof recreationalmarijuana, especially the solid and liquid-infused formspermitted inWashington, will provide children greater access to cookies, candies, brownies, and beverages that contain marijuana. Ingestion of marijuana results in the absorption of delta-9-tetrahydrocannibinol (THC) and stimulation of cannabinoid receptors in the central nervous system. This produces stimulation with hallucinations and illusions, followed by sedation.2 Toxic reactions are usually mild after acute accidental ingestion but can cause significant sedation in children.3 Respiratory insufficiency and the need for ventilatory support are described in the article. In older children, the stimulatory phase and hallucinations can produce anxiety and panic episodes when not anticipated in an accidental ingestion. The potency of marijuana in the United States has progressively increased over the past 40 years, with THC levels climbing from around 2% to nearly 8%.4 The risk of significant toxic reactions from exposures is more likely today than in the past. Emergencymedicine, pediatric emergencymedicine, and primary carepediatric providerswill be first to seepatients accidentally exposed to marijuana. They may need additional training to recognize andmanage significant marijuana toxic reactions. Signs and symptoms can include anxiety, hallucinations, panic episodes, dyspnea, chest pain, nausea, vomiting, dizziness, somnolence, central nervous system depression, respiratory depression, and coma.5 Similar signs and symptomsoccur in a large variety of diseases andpoisonings. The providers and staff should investigate the availability of marijuana in the child’s environment and use rapid tests to identify the metabolites of marijuana in the urine.6 No antidote exists for marijuana toxic reactions and supportive care should be provided, including control of anxiety, control of vomiting, airway control, and ventilation as needed. The regional Poison Center should be contacted to report the episode andobtain additional advice on evaluation andmanagement. Increased accidental exposure after increased availability of an agent is a consistent lesson in toxicology. Our current increase in laundry-pod ingestion in children is the resultof increasedavailabilitycoupledwithattractivepackaging.7 The ready availability of pain medications led to opioids surpassingmotor vehicle crashes as the leading causeof accidental death in the United States. This profound poisoning problem went unrecognized for nearly a decade and has only recently come to the attention of health care providers and policymakers.8 A recent analysis of PoisonCenter data shows a parallel increase in severe poisonings, emergency department visits, andhospitalizations in children.9 A similar rise in marijuanaexposureand toxic reactions is anticipated fromthe increased availability of marijuana in the child’s environment. Timely analysis of Poison Center data and emergency department recordswill provideanopportunity toquickly recognize and respond. Intervention strategies inWashingtonStatehavebegun to reduce thedeath rate fromopioid exposure. Theseweremodeled on successful interventions in poison prevention and includepublic educationon the risksofopioiduse,providereducation on safe prescribing practices, prescription monitoring programs, and home naloxone hydrochloride programs.10,11 Editorial page 600