Colorado’s Chief Medical Officer Advocates Marijuana Education

On Monday morning, CBC radio host Matt Rainnie interviewed Dr. Larry Wolk, Chief Medical Officer for the Colorado Department of Public Health, for Rainnie’s daily Prince Edward Island show “Island Morning.”

Like all Canadian provinces, PEI is working to establish its own rules for the sale and consumption of cannabis, which is expected to operate under full federal legality by the summer of 2018. Provincial officials have discussed the possibility of province-run retail shops, as Ontario is doing, but have yet to take decisive action on the question.

Like many Canadians, Rainnie’s “Island Morning” listeners have a lot of questions and fears about legalization. Wolk, who has been Colorado’s Chief Medical Officer throughout the state’s three-year adult-use era, was happy to answer questions and clear up myths about Colorado’s experience.

Here at Leafly, we found Wolk’s interview to uncommonly rational, calm, clear-headed, and evidence-based. So we transcribed it, edited it lightly for grammatical clarity, and present it here in order to spread his observations and experience.

CBC: What have you seen since recreational cannabis has been legal in Colorado? Dr. Larry Wolk: “The short answer is we have not seen much. We have not experienced any significant issue as a result of legalization. I think a lot of people think when you legalize you are going from zero to some high-use number, but they forget that even when marijuana is not legal, one in four adults and one in five kids are probably using on a somewhat regular basis. What we’ve found since legalization is that those numbers haven’t really changed.”

What was your concern heading into recreational cannabis legalization? “I think the concern was that by legalizing marijuana, we should certainly see an increase in adult use, and maybe that would leak into our youth. [There was also a concern that] youth would somehow gain greater access, and/or feel entitled to go ahead and use in greater numbers.

“We just haven’t seen that pan out. We have seen a little bit more calls to the poison control center, but maybe parents of children are a little bit more forthcoming—now that it’s legalized—to make those calls.

“More people are going to the emergency room for marijuana visits, but most of those people are actually from out-of-state. They are tourists coming to ski, or coming to take advantage of all that Colorado has to offer. I say ‘all’ now because we have certainly seen an increase in tourists who partake and end up in the emergency room, or end up hospitalized, because they’re not as familiar with the products or education programs that we have around the state, which warn people and educate people about those products.”

The legal age in Colorado is 21, right? “It is 21 for the retail, or the recreational marijuana. It is 18 for the medical program, which we have had for about 15 years now.”

What is the right age to legally consume cannabis? Is it 21? “That is an interesting question. I have talked to different people in different Canadian provinces about that, because I think biologically the correct age should be 25. But practically speaking, we know a lot of young adults are already using marijuana. If we want to capture that use, for a lot of reasons, we can do surveillance, we can do education, even capture the tax revenue and go ahead and have those programs in place for enforcement, then practically speaking 21 is the appropriate age. I think 19 maybe could be a little too young because of developing-brain issues, but if that is the legal drinking age, and you already have a high prevalence—I don’t know your prevalence here, but it may make sense to align it with the drinking age.”

What do you think about selling cannabis in liquor stores? “I think it is a bad idea, because the co-use of marijuana and liquor is a bad idea. Marijuana in itself [can cause impairment.] Alcohol in itself can cause impairment. [When they’re consumed together] those effects are just not additive; they are exponentially increased when somebody chooses to co-use both substances. Selling both from the same establishment…is just not something we would support.”

What about drugged driving? “We have actually seen an overall decrease in DUI’s since legalization. So, the short answer is: There has been no increase since the legalization of marijuana here. We have seen an increase in marijuana-positive blood tests amongst drivers involved in fatal car accidents. But, blood test is not a good moniker for impairment. We can’t tell if those drivers were impaired. They could have used marijuana a month ago and those metabolites could be still showing up in their blood stream. The other thing is, it is easier to test for alcohol in a roadside test. Many police officers will tell you their protocol is to test for alcohol first, and if they are positive for alcohol, they stop testing at that point. So it is hard to get a sense for how much marijuana is impacting DUI’s.”

How difficult is cannabis enforcement? “In Colorado, we do not allow public consumption. Yet you will go to places or be in particular areas in the state and you will know it is being consumed publicly. Which makes it that much more difficult if someone is consuming an edible or a vapor product, because it makes it much less easy to detect.

I think law enforcement has a tough job. On the one had there is some relief they don’t have to bring people in, or charge folks with misdemeanors as the result of using marijuana. On the other side there is some angst over people maybe taking advantage of the system here.

This is one of the ways I think Canada will have the advantage over the United States. We are doing it state by state, so we have a grey area problem. People can grow marijuana legally, and then move it out the back door—take it and sell it in states where it is not legal.

If we had a national legalization similar to what Canada is doing, it would make the black or grey market far less active, [because there would no longer be such high] demand in neighboring states.”

How important is education about cannabis? “Very important. We have some pretty strong numbers showing that people recognize the statewide campaigns that we have developed. With that then, maybe there is a [growing] recognition among adults about how to follow the laws, and how to store it safely to keep it away from kids.

It appears that teenagers make decisions to consume marijuana for reasons other than legalization—like they do with other risk behaviors. [In Colorado], we had a statewide campaign targeted at teens. They don’t want to hear about it affecting their developing brains. They don’t want to hear about how it impacts what’s next. So, the campaign is all about how using marijuana may impact your ability to graduate high school, impact getting your driver’s license, [make it more difficult to] maintain a relationship or get a job. The numbers look very good in terms of the impact of the campaign.

For adults, we have a much lighter campaign than we started with. One of the mistakes we made early on is, we tried to use a campaign with life-size lab rat cages, saying ‘Don’t be a lab rat.’ That portrayed jail cages, and we ended up alienating the population we were trying to educate and help. So we had to completely scrap that idea and work on something that was more appealing, something likely users would listen to rather than immediately shut off.”

Do we know if cannabis legalization is leading to higher uses of hard drugs? “We are not seeing those kinds of increases. We are certainly seeing an increase in heroin-related deaths, but those are similar to the national increases, so [our heroin-related death rate] is not out of line with the national rate of increase. I think we have yet to answer the question of whether or not legalizing marijuana helps reduce the consumption of those harder, more addictive drugs, or acts as a gateway. The jury is still out.”