Literature Review Topics Advisory Committee Marij uana Use During - PDF document

6/ 29/ 2015 Objectives • Brief review of CDPHE Retail Marij uana Public Health Advisory Committee Marij uana Use Among Marijuana Pediatric Exposure Prevention: Adolescents and Young Adults and Findings A Summary of the Evidence and Resources • Provide an overview of Pediatric Exposure for Colorado Health Care Providers Prevention Clinical Guidance Document Development and Content. Tracy Foo MD, MPH Marij uana Clinical Guidelines Coordinat or Colorado Depart ment of Public Healt h and Environment • Describe the marij uana education resources June 2015 available from CDPHE for health care providers. CDPHE: Marijuana and Public Health Marijuana Use by Colorado Youth • Monitor health effects of marij uana use • Quest ions on marij uana use added t o: • Healthy Kids Colorado S urvey BRFS S , PRAMS , YRBS / Healt hy Kids Colorado survey • Administered in Fall 2013 to over 40,000 middle and • Dat a collect ion/ analysis, including Colorado ER and high school students. hospit alizat ion dat a, Rocky Mount ain Poison Cont rol dat a • Ret ail Marij uana Public Healt h Advisory Commit t ee • Middle school: • 8.8% reported ever trying marij uana • Medical Marij uana Registry and Research Grant Program • 5.1% reported marij uana use in past 30 days • Retail Marij uana Education Team • High school: • Prevent ion campaign • 36.9% reported trying marij uana one or more times • Clinical guidelines • 19.7% reported marij uana use in past 30 days • Yout h prevent ion Retail Marijuana Public Health Literature Review Topics Advisory Committee • Marij uana Use During Pregnancy and • 13 members representing public health, multiple Breastfeeding medical specialties, epidemiology, toxicology • Review the scientific literature currently available • Neurological and Mental Health Effects on health effects of marij uana • Effects on Youth and Unintentional Poisonings • Developed a lit erat ure review process including rat ing qualit y of each st udy • Marij uana Dose and Drug Interactions • Translat e science int o public healt h messages • Recommend public healt h relat ed policies, surveillance • Extra-pulmonary Effects and Inj uries act ivit ies and research gaps • Monitoring Health Concerns Related to Marij uana in • Respiratory Effects and Lung Cancer Colorado: 2014 The clinical guidance content in this presentation is draft language. The final document will be available this summer. 1

6/ 29/ 2015 Findings Summary: Health effects in adolescents and young Examples of Public Health Statements adults Substantial Moderate Limited evidence Insufficient Mixed evidence evidence evidence evidence • Regular marij uana use by adolescent s and young adult s is Other illicit drug Impaired cognitive Lower IQ after Anxiety after associat ed wit h impaired learning, memory, mat h and use and addiction abilities and academic short abstinence adolescence after adolescence performance after 28 reading achievement , even 28 days aft er last use. days abstinence • These impairment s increase wit h more frequent Psychotic Less high school Less likely to earn Depression after marij uana use. symptoms or graduation college degree adolescence disorders like schizophrenia • Marij uana use by adolescent s and young adult s - even Increased MJ use and Suicidal thoughts occasional use - is associat ed wit h fut ure high-risk use of addiction after or attempts adolescence alcohol, t obacco, and ot her drugs like cocaine, ecst asy, Alcohol or tobacco use opioids and met hamphet amine. and addiction after adolescence Quitting lowers risk of • S t art ing marij uana use during adolescence or young cognitive and mental health effects adult hood is associat ed wit h fut ure marij uana addict ion. Examples of Research Gaps: Marijuana Clinical Guidelines • Evaluat e effect s of occasional marij uana use vs. regular/ heavy • S B 14-215: Contract for the creation of clinical use guidelines as a resource for health care providers when they recognize that a person is at risk from • More st udies wit h varied t ime periods of abst inence t o assess marij uana use or exposure. t he durat ion of cognit ive impact of marij uana use • To develop evidence-based guidance for Colorado • Evaluat e effect of marij uana use on males vs. females health care providers to talk with patients about • Compare fact ors associat ed wit h init iat ion of use by marij uana exposure adolescent s in st at es wit h different legal st at us • Challenges: limitation in evidence, avoid • Assess causalit y rat her t han only report ed associat ions overstating the available evidence Guidance Document Guidance Development Process • Encourages providers t o t alk wit h parent s/ pat ient s about • Review Retail Marij uana Public Health Advisory marij uana along wit h ot her subst ance use. Committee findings summaries • Many st at ement s have associat ed middle school reading level • Healthcare Provider S urvey language t o use wit h parent s/ pat ient s. • It is not int ended as a read t hrough document . • Engaged multiple, diverse stakeholders • Ideally, providers will familiarize themselves with the information • Guidance Development Committee and use the document as a reference when needed. • Providers can choose what information that they want to share with • Focus group input their patient based on the patient type/ situation. • It is also not int ended t o replace your facilit y’ s policies or • Formatting and pilot testing guidelines. • colorado.gov/ cdphe/ marij uana-clinical-guidelines The clinical guidance content in this presentation is draft language. The final document will be available this summer. 2

6/ 29/ 2015 Pediatric Exposure Prevention Guidance 2 Pediatric Guidance Documents: • S creening questions • Discussions with parents/ guardians, • Talking points: S afe storage, safe environments, including age specific talking points to health effects, medical marij uana use with parents/ guardians of children • S econdhand smoke age 0-8 and 9-20 • Breastfeeding • Discussions with adolescents/ young • Mandatory reporters adults age 9-20 • Parenting and safety: driving • Accidental Ingestion/ Using Too Much • Common myths about marij uana • Resources for health care providers and patients Key Points DISCUSSIONS WITH • Screen for marij uana use at all visits PARENTS • Talk about potential risks of marij uana Discussion with parents: use by youth Age specific talking points to use with • Talk about marij uana safety with parents parents of children age 0-8 and 9-20 and youth Talking to parents: Safe Storage Screening Questions for Parents Language for parents of children 0-8: Language for all parent s: • Remember t hat kids can get int o all kinds of t hings t hat you assume Now t hat marij uana is legal in Colorado, we would like t o t alk are out of reach or not of int erest . • Like household chemicals or bleach; marij uana, alcohol and some wit h you about it t o help you keep kids safe. medicat ions are dangerous f or children. • Keep all pot ent ially harmf ul subst ances in a locked area, out of sight How do you st ore subst ances t hat may harm a child in your and out of reach of children. home? S uch subst ances include alcohol, marij uana, t obacco, • Lock boxes or locked cabinet s are examples of saf e st orage prescript ion drugs, over t he count er medicines, cleaning opt ions. product s or ot her pot ent ially harmful chemicals. • If you don’ t have a locked area, make sure product s are out of reach and out of sight of children. Does anyone smoke in your home (marij uana or t obacco)? Does • Keep in mind, saf e st orage f or young children may not st op older anyone in your home use any ot her form of marij uana, such as children or t eens. vaping, edibles or t inct ures? Does anyone else who cares for your child use marij uana or have it in t heir home? The clinical guidance content in this presentation is draft language. The final document will be available this summer. 3