 Welcome. My name is Dr. Catherine Antley and today we're recording another episode in the science of effective prevention. And today it is my honor and pleasure to welcome a very special guest from Colorado, Don Reinfeld. Don Reinfeld is the executive director of Blue Rising Together, and she's going to be on our show. And this is an organization which has worked for many years on issues which make it difficult to grow up in Colorado. In the past they've focused on gun violence but more recently they're focusing on the harms and educating and warning the public about the harms of high potency THC cannabis marijuana. Before I give the platform to Don to tell us all the wonderful things she's been doing in Colorado, I want to do two very pretty quick clips. One is Dr. Chris Rogers, who's a psychiatrist and medical director of a large psychiatric hospital. And the other is the attorney general of Colorado so we'll get both the medical perspective and the legal perspective, and then we'll hear Don's story. As has been discussed, the rise in teenage youths of high THC concentration marijuana is a critical public health challenge. It demands action. And it's important what's being done today. It is a model for the nation. Just consider the latest report from the Colorado Department of Health Public Health and Environment in their Healthy Kids Colorado Survey. They surveyed the use of doubting which has been discussed when accessing high THC potency. You went from 4.3% of students in 2015 to over 20% in 2019. This is an alarming rise and this House Bill 1317 represents an important critical response to this threat. The substance abuse trend in response task force, which I chair and Matt Bock was with me today, head of our office community engagement, his vice chair, has focused on this issue with leadership from parents, from public health advocates identifying this troubling trend. This legislation meets that trend and addresses the fact that our medical marijuana laws have enabled teen access, diagnosing marijuana, as we come out of work to address this public health challenge. And we're fine at the regulatory program for overseeing legal matters. We need to do so in a way that protects kids. I'm the medical director of child and adolescent services at the Medical Center of Aurora, the largely non-publicly owned psychiatric hospital in the state. Here among inpatient psychiatrists with a front row seat to the emerging epidemic of cannabis abuse and addiction that threatens to swallow the lives of a whole generation of Coloradans. On our adult inpatient unit, it's hard to keep count of the number of psychotic and suicidal patients they're admitted with THC on board. And regardless of the data or clear evidence of how cannabis contributes to their illness, person after person refuses to accept that marijuana could be bad for them. How could it be? They have been taught to believe this is a harmless plan, a medicine that is good for anything from headaches to cancer to anxiety. It's natural, without side effects, without risk of addiction. This is the lie that is ruining the lives of far too many people in our state. The story on our adolescent unit is even more tragic, as we repeatedly treat kids too psychotic to know what's real, who they can trust or where they are. The rates of adolescent psychosis have grown steadily since legalization and in almost every single case is linked to the use of high THC and potency concentrates. Products known as dabs or wax or shatter that are made in the lab like distilling down the most psychoactive component of the marijuana plan and concentrating it into what is better described as a hard drug than the weed people voted for in amendment 64. Kids as young as 11 or 12 are using blow torches and glass ribs to use to smoke these highly addictive and harmful chemicals sometimes every night just to go to sleep. We have very little research to try and understand what this does to the developing brain, but as any child psychiatrist who treats these kids can tell you, we don't need a randomized control trial to see how dangerous and often tragic the effects are. We do know there's a clear risk between developing depression or even committing suicide related to an earlier age of first use as well as the potency of products. This means a 12 year old trying to marijuana concentrate is at far greater risk of developing a mood disorder or even eventually killing themselves than a 30 year old experimenting with a joint of flower. Unfortunately, it's far too easy for these 12 year olds to get access to these products and not from the black market or a shady drug dealer. They're getting them from friends at school or older siblings, many of them have medical marijuana cards themselves and ready access to as much shatter dab or wax as they could ever want. It's time for this to change. House Bill 1317 will provide stronger safeguards to keeping cannabis products out of the hands of Colorado's kids. Having reasonable limits on daily purchases of these highly addictive substances makes good sense. Maintaining adequate guidelines for providers to uphold when recommending cannabis, especially the young brain or young kids is a no brainer. We need a more robust tracking mechanism to better understand who is using medical cannabis products, how much and in what form. In Colorado should be leading the way in researching high quality THC products. We certainly leading the way in their sales. We have a long way to go to help the kids in my hospital, but House Bill 1317 is a great place to start. Whole country is watching Colorado as other states look to legalize cannabis. Let's lead the country into a sustainable responsible future. We can all be proud. Thank you. So Dawn, my first question to you is, you know, how, how did you end up that was the press conference last last spring, I guess, how did this come about how did you, how did you realize that there was a problem and how did it get your attention. Thanks, Catherine, it's wonderful to be here today. And it's so nice to hear the quotes from both Phil wiser and Chris Rogers. So basically, we started working on this in Colorado, I run an organization called blue rising. And we started, as you said earlier, working on gun violence prevention issues after the Sandy Hook shooting. And that's kind of where I learned a lot of organizing skills and I also learned the power of parents wanting to make change out of things that they saw that was wrong and how really parents coming together is an unstoppable force. So we started organizing around high potency THC because as a parent myself I have teenagers, and I saw in my community, how high potency THC was having dramatic impacts amongst teens, and that the legislators at the capital, most of whom did not have teenagers, many either have no children or little children or much older children really were totally disconnected from how the policies that they were passing at the legislature were impacting their local communities. So having worked in the space for a while we just started reaching out to legislators, organizing, and kind of saying this isn't what you think it is, and your policies are actually having a really dramatic effect on teens. Yep. So in Vermont, you know, over and over and over again for the last, you know, seven years folks have told us, this is going to be good because now the marijuana is going to be locked behind the store, the store front doors right, and it's not going to get out and so what part of that didn't work out for you. Our laws about medical marijuana have been very laxed in Colorado, it's extremely easy for an 18 to 20 year old to get a medical card. That actually is changing now that the law we passed is just started to be effective in January. But basically an 18 year old living at home on still on their parents insurance could easily get a med card with a five minute doctors appointment. Actually they often don't even take five minutes and get a card that would then let you purchase whatever you wanted in a store. And there's really no regulatory guidelines or framework to put products on the market. So if a marijuana company creates something, they can just put it on the market. They don't have to prove it safe. They don't have to prove it's effective for any medical treatment whatsoever. If they can make it, they can put it in on the market, and they can also claim its medicine. There's no regulatory framework that they have to prove this is good for this condition and why. And so what happened is kids were able to just purchase whatever they want, they were allowed to purchase up to 40 grams of concentrate per dispensary per day. So 40 grams is like 40 bags of high potency concentrate shatter, and they're usually in in flavors like Girl Scout cookies birthday cake pineapple express you name whatever flavor might appeal to you. And that's what the shatter and shatter is in. So kids were very easy able to get it, it's inexpensive, and they would just sell to each other or, or it would be given to them is just incredibly easy for kids to get. The schools when we first started our effort and with our lobbyists we started reaching out to different groups. We met with the Association of school board superintendent so excuse me, and they said to us, there will not be one school district in the entire state that does not support this because they were so overwhelmed with the problems of kids dabbing high potency THC, and then all of the mental health effects that were coming from that that honestly. There was so much support from organizations like in the education community, and the medical community to join on to this very large effort that really kind of ran the political spectrum. The organization blue rising has always been on the Democratic side of things. And, you know, one of the things that I feel like is a Democratic bedrock in our philosophies is following science. So Democrats believe in following the science on COVID on vaccinations on climate change. And the argument that we made was if you believe in following science, then you need to follow science, and that includes industries that you've gotten too cozy with. And that's what happened we said we need to follow the science on high potency THC, regardless of what this industry that's actually out to make profit from addiction. We need to follow the science and protect the public health. So that's what we work to do here in Colorado. We passed our bill in Vermont, we had a couple of mentions of psychosis, they limited the THC to 30 and 60 30 for flower and 60 for concentrates. And, you know, we have had folks. who've been impacted and so they know very well, the impact of who wrote that bill. So I think that had some impact into and and and we had firsthand testimony as well. But now there's the feeling that the recreational shops we're not talking about medical marijuana, our medical marijuana shops have no limit on THC at all. But our in our, our, our medical ones. Theoretically, there's, there's a lot more controls than what you're talking about in Colorado, but we're talking about, you know, it in a very short period of time a few months we're going to open shops recreational shops, the recreational shops will have high put if this bill passes that they're talking about make in Vermont, they're going to have no limit to THC. So why are these shops, why is the industry put all of their money, you know, hired all of the lobbyists and will be here to try to get those those limits lifted. It's all about money, honestly, and it's disappointing as a lifelong Democrat to see Democrats being willing to side with industry and money over public health. And there really is research from around the world. The industry will say, Oh, there's not enough research, blah, blah, blah. It's totally untrue. There is research from around the world that that is calling out the alarms for the damage that high potency THC is having in our communities. And honestly, so often in states across the country we've seen this so much over the last couple of years, the industry is the only one at the table, they, they, they have the most money. And the legislators aren't doing their homework to understand that this is a profit driven enterprise, and the sales tax that states hope to gain from these products is nothing in comparison to the devastation that they wreak upon the next generation of your children. And we have found in Colorado, we have a very high teen suicide rate, and for 15 to 19 year olds in Colorado, 34% of the teens in Colorado that died by suicide have marijuana in their system. We can't definitively say the high potency THC is definitely causing suicide, but there is a relationship there that many research papers have started to highlight, and that in Colorado we are also researching. But this is, it's amazing to see an industry that can put whatever they want on the market without having to prove it safe. So for example, you can go into a liquor store and buy vodka soak tampons, they don't sell them, they're dangerous, but you can go into a cannabis store and buy high potency THC vaginal and anal suppositories. There's been no studies that show those suppositories don't cause cancer, that they could maybe don't cause infertility, nobody knows, but they can be put on the market, they can be told that they're medicine. And, and our legislators are just happily looking the other way, except in Colorado, we are starting to actually like pay more attention to this but around the country and as I watched states legalize without a genuine regulatory framework to protect the public health is really appalling, and it's also terrifying because I know what is in store for the families in these states that do not understand that it is not a joint from the 1970s anymore. Hard drug concentrates that have dramatically changed in their THC potency, whereas in the 70s it might have been three or 2% THC, many of these products now are 80, 85% THC 90. And they're just not the same thing anymore, they're not a plant. They are not an innocuous plant anymore. So the Department of Health had a doctor Professor Jonathan Calkins come and talk to us a few years ago, and a number of the legislators came and attended that. And one of the more remarkable things that he said was, he was talking about the increase in concentration of THC and he said, it's gone up 60% and if you don't want to say 60% it's easily gone up 40%. And if you say, if you take caffeine, like the cup of coffee that we drink in the morning, and we increase that potency of the caffeine by 40 to 60%, it's borderline lethal. And that's not, you know, a point that people are really wrapping their heads around. And I've often thought, you know, what would happen if they passed around 100%, 90% THC and a blowtorch, you know, in these conference rooms where they're passing these laws. And how many of those legislators would be cool with that or, you know, would survive it. Yeah. And how many of them would want their 18 year olds to do it, or 21 year olds. Okay, yeah, or 21 year olds. I mean, I think I feel like that is kind of the, the, the worst part of this whole issue is the lies that have been told to communities across the country and honestly across the world that, that this is medicine, that it's safe. And I'm not saying there isn't a portion of products and THC that might possibly be medicinal, as far as the seizures, the CBD oil, the low potency products. I don't, you know, I don't have a dog in that fight whether whether those, that's not what I'm talking about. I'm talking about the things that are 15 over 15% THC, and especially the stuff in the upwards of 6080 those kind of products. The community has not seen those kind of products created to be consumed the way they are and flavored, and then you add on it this lie, very similar to the Purdue pharma story that oxycontin was not addictive. It's a similar lie now, they say it's not addictive, it's medicine, it's a plant. It's totally wonderful. And it really wasn't until you know the Colorado legislature and honestly we have a wonderful speaker of the house in Colorado a Democrat from Denver, and he's a parent, and he really saw like, in a minute, we need to protect the public health and we need to be focused on science, and he really kind of took this to heart and wanted to make a difference on this issue. And it was a lot of legislators who were really willing to go out on a limb, because they had heard from their own constituents and the parents that we were able to mobilize that this is a real thing. Reef or madness. This isn't, you know, craziness over not liking cannabis. This is high potency THC that is very different from what most people think they are voting on. We find that when even with our own legislators when we first started this effort, when we started showing them what was for sale in dispensaries and how much those products had changed over time. And then as soon as they saw the anal and vaginal suppositories many of the legislators were like, whoa, wait a minute. This isn't what I thought it was and we need some sort of regulatory framework that's in place to protect the public health. And it's, yeah, it's just disappointing, especially when you see democratic states that that have tried so hard to adhere themselves to science to just watch them kind of toss it aside for for money. And it's very sad. I mean, the science is kind of difficult to get your mind around, but there's a lot of research out there and some of the Colorado psychiatrists have done really done a deep dive into it. And I want to go, I want to show I want to share that my screen and show the warnings that you that the, you know, Department of Health in Colorado is now recommending that you display. One of the aspects of the House Bill 1317 that we passed required the state of Colorado to give out kind of a resource guide with every purchase of concentrates to anyone who purchases concentrates. And there was a rulemaking session this was actually with the marijuana enforcement division to look at all the research and come up with what are those warnings and what should they be. So, so the first one that the state of Colorado now this has the seal of the state of Colorado on it. See if I can find it down here. There it is right. Colorado gov. Yes, it's if you scroll up to the first page. Right there Colorado department of marijuana enforcement division. And if you wouldn't mind going back down to scroll down to the warning so we could go over those. So the first warning is psychosis, which is psychotic, psychotic symptoms both delusions and hallucinations, visual and auditory, then it's also mental health problems or symptoms it's very tied to depression and anxiety, cannabis hyperemesis syndrome which is uncontrolled and repetitive vomiting in fact youth call it greening out. And then cannabis use disorder dependence including physical and psychological dependence. High potency THC is addictive. It is not what it was in the 70s when it was not addictive below 5%. The state of Colorado now concentrates are addictive and the state of Colorado is saying that, and if you scroll down just a teeny bit, a little bit right there. The state is also warning that there is moderate evidence and they define moderate as substantial earlier in the document that individuals who use marijuana with THC concentration, greater than 10% are more likely to be diagnosed with psychotic disorder such as schizophrenia. And we have parents in our group whose kids have medically been diagnosed with cannabis induced schizophrenia and it is extremely hard to treat. There is very few medications that work on it. And it's very different from genetic schizophrenia, which we actually have quite a few medications that work on. I remember talking to Sir Robin Murray many many years ago, I think 2013 and he was working he and, and Dr to 40 we're working on a study, and he said I was preparing for a testimony and he said, you can say we're going to we're getting ready to publish there are people who are psychotic and schizophrenic who would would be well. That's for their marijuana use, and that's slayed me. It's such a devastating disease and disorder, not only for the individual but the entire sort of surrounding community that has to take you know that the, that has to take care of the this person it's very very expensive. So you, you're saying it's it's addictive. And we have here is Vermont the print the what we're what the camps control board is suggesting that they put on the, on the labels, and they're saying it may be habit forming. And you know, walking my dog is habit forming. You know, working. You know, spending time with my husband is habit forming, you know, having a nice conversation with you could be habit forming. So we really take issue with with that terminology. And they don't mention psychosis, even though the law, actually the law in Vermont is written. It mentioned psychosis and it says that the head of the cannabis control board is tasked with finding out how much CBD needs to be added to the CHC to prevent psychosis. Now I haven't seen that covered in, you know, in the CCB, or I haven't seen them convene a group of scientists to research this. We're just really impressed with what Colorado has done. I mean, you're a huge state and your resources are, are, you know, you have, think about how many psychiatrists exist but they've just done enormous work. The Vermont Medical Society took a lot of, you know, lead from from them and this is our warning that we passed back in November. Psychosis impaired driving addiction addiction pure out a suicide attempt uncontrolled vomiting which has been actually fatal occasionally kidney failure and whatnot. It's an addiction harm to feed us and nursing babies and, importantly, these events can happen in people who have no previous history of psychosis or mental illness I think that's really important, because there's this profound misperception that anybody who gets who develops an addiction or who develops, you know, psychosis or schizophrenia, quote unquote from marijuana is in fact was going to do it anyway. Yeah, there's a lot the industry really loves to blame people for addiction and mental health issues. We found that you might want to stop screen sharing. We found that there's an enormous amount of blame and shame that the industry tries to use to deflect from that the fact that their products are dangerous. I would like you to say, Oh, we've heard addiction is a choice. Some kids are just bad kids. This is a parenting problem. And really, again, it's, it's very sad to watch, like, not only, you know, communities and states but we are really reliving what just happened with tobacco, what just happened with the opiate crisis. We are taking hook line and sinker, the lies that this industry is is pushing for profit. You know, as states, we've done calls with states and beg them, put money in this bill so that people can afford to save their children. And it is as if, you know, we're crazy. And marijuana is the answer to all problems both physical and financial, and time is just going to have to show these states and as more kids struggle with this issue and you see the devastation that Colorado has been experiencing. And, you know, I feel proud for the most part of the state of Colorado being willing to look now at these issues. And, and, and, you know, I notice you have represented Julia mob lay up there. When we have legislators up that are willing to talk about their own families and the harms that they've experienced, and refuse to be shamed and shamed anymore. That's how we're going to fix this issue. But there will be a lot of lives ruined and destroyed until that happens. Yeah. So I think we should listen to her and then we'll listen. I'd like you to listen to a synopsis of the, of the of what's happening in marijuana it's just a few in Vermont it's just a few minutes long. Thank you Madam chair. So I also would like to speak in support of this bill today. As many of you know I have a son who started smoking marijuana in the eighth grade, and then smoke marijuana consistently and persistently all through the school. And at age 18, he had his first psychotic break. And we did not know what the cause of that was. But during that time, before that happened, we have tried everything in our power to stop his marijuana use. We sent him to psychiatrists to, to therapists. We grounded him. We drug tested him. We punished him. We praised him for the things that he did do. But we couldn't stop the use. Everywhere he went, this product was available and in greater and greater concentrations and potency. And after his first psychotic break, we, we sent him to a hospital where he spent six weeks, and it cost us $60,000. And they didn't fix it. They couldn't fix it. I think he has get so effective disorder with co-occurring substance misuse and he will never recover. And our family is broken as a result. And we will never be made whole. So let's not talk about him today, because it's too late for him. Let's not talk instead about your children and the thousands of other children that are being negatively impacted by the use of marijuana. It's a real thing. And let me just say that hundreds of parents, thousands of parents are being affected by this. And we are done being blamed and shamed into silence. We will be silent no more. And this bill gives us a voice. It says, yeah, we have to look at this. This is on us. This is what we were sent here to do. And I urge you to vote yes. Representative Holtzorf. Cannabis is going to be sold legally, so it must be pretty harmless, right? That is what those that sell it in your town want you to believe, because when people think a substance is relatively harmless, they use it more. This is generally the case in Vermont, which has the highest past month cannabis or THC use in the United States for both adults and teens. While people have been taught that cannabis is a harmless plant, today's high THC products come in many forms, making cannabis up to 40 times stronger than in the past. Doctors know that Vermonters want to be informed decision makers. The Vermont Medical Society reviewed the latest research. What did they find? Cannabis or THC may cause, one, psychosis. There are numerous studies on cannabis, psychosis and schizophrenia. Using greater than 15% THC products daily may result in five times the likelihood of developing psychosis and increased schizophrenia. In some cities, cannabis accounts for nearly half the new psychotic patients. In Colorado, where recreational cannabis was first legalized, emergency room visits have spiked, crowding hospitals, overburdening healthcare facilities, and increasing costs. Two, impaired driving. One in six Vermont teen drivers say they drove under the influence of marijuana last month. Currently, one in five fatal car crashes in Vermont involve THC. Three, addiction. The number one state in the US for substance use disorder is Colorado. Vermont is currently number two. If cannabis sellers target kids, this increases addiction. In cannabis legal states with laws like Vermont's limiting advertising, ads like this are still found without health warnings. This targeting is especially concerning since current Vermont rules say cannabis drug stores may be located as close as 500 feet from a school and right next to a daycare. Four, suicide attempt. A review of numerous studies concluded that adolescent risk of suicide attempt increased by an average of three and a half times with the use of cannabis even when there is no history of mental illness. Five, uncontrollable vomiting. A new condition known as cannabis hyperemesis syndrome or CHS results in extreme pain and potentially life-threatening, unrelenting violent vomiting due to cannabis use. Rare prior to cannabis commercialization, CHS is an expensive healthcare burden doctors now see daily in busy ERs. Six, harm to a fetus or a nursing baby. Use of marijuana during pregnancy may stunt the growth of the fetus and these children may have higher rates of depression, hyperactivity, and inattention. Vermont doctors recommend a cap on THC of 15%, which is about 10 times as potent as marijuana of the 1970s. In Holland, where cannabis use has been prevalent for years, health and government officials propose classifying products above 15% THC as hard drugs, similar to cocaine and ecstasy. The current Vermont legislation allows for plants with THC as high as 30% and concentrates as high as 60%. The higher the THC, the more addictive and the greater the risk of physical or mental health issues, such as psychosis, addiction, suicide, or self-harm. The Vermont Medical Society recommended that these six warnings be added to cannabis and THC product labels and advertisements. Vermonters want to be informed decision makers. So, we can finish up Dawn if we have a few more words. We just want to be sure everybody who feels strongly about this issue will call their health representative or senator. And the number is 802-828-2228 because right now there's a bill in Vermont that has a lot of support, which lifts the limits that we have, which are 30 and 60% THC to have no limit on the recreational marijuana. Right now we have no limit on medical, so if you have a medical condition, there's no limit, but they want to get rid of the limits that we Vermont did put in last year when we passed the bill. So, if you have concerns or if you want the Vermont Medical Society's warnings, like they are in Colorado, to show up on the packaging, please call as well. Because right now the warnings are going to say it may be habit-forming and it will not mention psychosis, suicidality, or addiction. It's sad to see Vermont legislators really backing away from science and public health. It will be very sad and shameful, honestly, for the Vermont legislature to bow to the demands of a for-profit industry, which is honestly something that usually we hope that Democrats stand with the people and with the public health and science. So it's really disappointing and, like I said, shameful to see them being willing to auction off the next generation of Vermont's kids for profit. So that they are well liked and that they get donations from the cannabis industry, both the national and the industry in Vermont. But it's a sad day to see if the Vermont legislature really turns their back on science and chooses profit and addiction over youth. And that's really what it would come down to. So I hope that doesn't happen in Vermont and I hope at some point that, you know, I feel like Colorado is the cautionary tale. Don't do what we did here. But in Colorado, we are beginning to try and make right and do right by our next generation and change the tide. So, you know, I hope that these other states don't have to go through the agony that our youth have had to go through and our families have had to go through. And we'll just have to wait and see, but hopefully people will learn from our mistakes here, but that would be a bad day for Vermont if they really remove those caps. The CCB is saying if we don't remove the caps that we're going to have black market, illicit market problem. And of course, in Colorado, the promise was that if you commercialized and legalized it, you would get rid of the illicit market. Do you think the illicit market is disappeared from Colorado? Yeah, the illicit market is worse than it's ever been. And it's just, it's almost a laughable joke. Literally, every tax or regulation that the industry faces, they bully people and threaten by saying, Oh, this is just going to make the black market worse than the black market, the black market. Well, you know what? It has made the black market worse all of these products. The black market is out of control in Colorado. And it's just a joke and every law enforcement agency that we have talked to and met with and they testified about this at the Capitol, said that it is not the case. So it is not keeping a potency cap is not going to wildly destroy the state of Vermont through a black market. This, the high potency products will do enough on their own to destroy youth in Vermont. You don't need the black market to do it. I cannot thank you enough. Number one for being concerned for bringing your talents to this issue and, and deciding to spend some time with us in Vermont today. Very important for having me. Sure. Take care.