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Trends in Detection Rates of Risky Marijuana Use in CO Healthcare Settings
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
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
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
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
Specific Aims • Examine trends in rates of patients screening positive in healthcare settings for risk-prone patterns of marijuana use in CO • Assess trends in severity of use at time of screening among marijuana users • Examine if trends in use or severity of use differ by age and gender
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
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
Results • 8,748 (8%) patients screened positive for marijuana • Odds of screening positive accelerating in early 2009 (interaction with patient age)
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%
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
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)
Discussion • Severity of use • Severity of use increased over time • Males > Females • Younger > Older • Consistent with national trends • Majority of national treatment admissions are for males & individuals < age 30
Discussion • Healthcare providers likely serving increasing numbers of patients using marijuana • < 5% of CO physicians authorize medical marijuana • Lack of rigorous regulations around manufacture, distribution and dosage • Universal screening: opportunity to intervene
Limitations • Rapid change in marijuana landscape • Multiple factors likely impact increased marijuana use • SBIRT 2 phase screening process may have missed marijuana users • Generalizability
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
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.