The Problems with Medical Marijuana Program and 18-20 Patients

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One Chance to Grow Up, with origins from Smart Colorado, has focused on the impact of marijuana legalization on kids. This focus has included tracking statistics on youth use, accessibility and perceptions of harm.

We believe the Colorado Medical Marijuana (MMJ) Program is a pipeline to our high schools and underage use of high potency marijuana.

As of February 2021, there are 3,979 Coloradans that have access to medical marijuana via the Medical Marijuana Program.  This number is 12.5% greater than February 2020 (3,536) prior to the COVID-19 pandemic.

An 18 YO, who is often still in high school and has friends still in high school, can obtain a MMJ card without parental notification. The card enables an 18 YO to purchase double the amount of marijuana (2oz) , including significantly more highly potent THC concentrates and marijuana edibles. The legal age for recreational use of marijuana is 21.

Since October 2020, One Chance/Smart Colorado has made a series of information requests to the Colorado Department of Public Health and Environment.

Based on CDPHE’s responses, as well as from the publicly available monthly statistics of the medical marijuana registry, we are able to identify the following concerning trends.

  • Hundreds of teens register for a MMJ card when they turn 18. There are approximately 70X more 18 years olds with a MMJ card compared to 17 year olds. In February 2021, there were so few 17 YO with a MMJ card that CDPHE suppressed the data while the number explodes to 744 18 YO with a MMJ card
  • Medical marijuana tele-medicine (permitted under pandemic executive order in March 2020) resulted in increase in 18-20 YO patients at a rate 58% higher than among the entire registry for an absolute increase of 10.6% between March 2020 and February 2021 (total registry increased 6.7%)
  • 2 in 5 18-20 YO patients (1,549 of 3979) list the subjective, unverifiable qualifying condition of severe pain as their only qualifying condition in February 2021
  • 74 providers wrote a recommendation for a 18-20 YO patient with only the subjective, unverifiable condition of severe pain as their only qualifying condition
  • 42 providers have written more than 50 recommendations for the vulnerable 18-20 YO population in the past 2 years
  • Providers who wrote 50 or more recommendations for 18-20 YO are more likely to prescribe for severe pain than physicians who wrote less than 10 recommendations (83% v. 53%)
  • Only 1 in 3 providers who write marijuana recommendations have recommended it to an 18-20 YO patient in the past 2 years (144 of 423)
  • 40 18-20 patients have extended plant counts, 1% of the 18-20 YO  
  • Less than 10 providers wrote recommendations for extended plant counts for 18-20 YO
  • Over 1,800 recommendations were written for severe nausea among 18-20 YOs over a two year period and only 51 for cancer. While marijuana can be a treatment for nausea caused by some conditions such as cancer treatment, it can also be a cause for nausea with cannabis hyperemesis syndrome, a condition increasingly diagnosed in our hospitals.

Although it is clear that only a portion of providers who recommend medical marijuana recommend it for the vulnerable 18-20 YO segment, it is vitally important to offer these providers continuing medical education and support regarding the latest science on today’s marijuana and risks to teens and young adults.

As the MMJ Program is presently regulated by CDPHE, it is impossible to gain assurance that the providers who are recommending a drug to these vulnerable 18-20 YO are fully equipped to assess the risks before making the recommendation. Are they experts in their field? Do they know how marijuana impacts the developing brain? Do they have an ongoing relationship with their 18-20 patients to monitor for signs of abuse?

Confidentiality is written into Amendment 20 around providers, so CDPHE denied our request for the following information:

  • The identity of recommending providers
  • Practice areas of these providers
  • Business addresses of these providers

Amendment 20 was written as a defense against criminal prosecution. It did not contain a structure for commercial sales. The laws governing medical marijuana stores were enacted years later. The provider confidentiality rules are outdated and misapplied in the context of commercial sales of medical marijuana. Physician confidentiality/anonymity is NOT standard for the prescribing of Schedule II drugs with a high potential for abuse and should not be standard for recommending medical marijuana.

April 15, 2021