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

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

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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

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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

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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

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SBIRT Model
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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

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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

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SBIRT Colorado
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Methods

• Procedures Measures
• Brief screen questions (tobacco, alcohol, drug
  use)
• 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
• Any medical marijuana use ASSIST

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Results

• 8,748 (8) patients screened positive for
  marijuana
• Odds of screening positive accelerating in early
  2009 (interaction with patient age)

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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

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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

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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)

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Discussion

• Severity of use
• Severity of use increased over time
• Males gt Females
• Younger gt Older
• Consistent with national trends
• Majority of national treatment admissions are
  for males individuals lt age 30

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Discussion

• Healthcare providers likely serving increasing
  numbers of patients using marijuana
• lt 5 of CO physicians authorize medical
  marijuana
• Lack of rigorous regulations around manufacture,
  distribution and dosage
• Universal screening opportunity to intervene

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Limitations

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

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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

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• 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.