Public Health & Legalization: Burlington Forum Brings More Questions [Full Video]

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(October 31, 2015 - Eli Harrington)

After a big week in Vermont cannabis news, thanks largely to the anti-legalization kick-off in Montpelier, the VT news media showed up in force at the UVM Medical Center for an event coordinated by the Vermont Public Health Association on the evening of Thursday, Oct. 29 at the UVM Medical Center.  The event was described in press release as: what are the potential health impacts of marijuana; what lessons can be learned from tobacco policy?

Watch/Read: VT Digger coverage  |  WCAX coverage | WVNY coverage 

vtdigger public health story

Thanks to RETN's support for community television and education, Vermontijuana was able to film the presentation in it's entirety...the video quality leaves lots to be desired, but especially with health issues, Vermontijuana feels it's crucial that Vermonters physically unable to attend the forum themselves have equal access to information.  Thank you again to RETN, the Vermont Public Health Association and the VT Department of Health (esp. Shayla Livingston, MPH and John Searles, PhD).  The full video below is only edited for visual clarity and to cut out any venue tech issues or time spent passing the microphone...Vermontijuana editorial notes under the jump.

As a group whose name has such serious medical and societal implications, it's worth wondering about the VT Public Health Association and how their perspectives might be informed.  The nonprofit org has a small budget, local leadership with serious professional creds, and (refreshingly) isn't just regurgitating information from the widely-criticized Rocky Mountain High Intensity Drug Trafficking blah blah blah group.  Their motto is staked on neutrality: "an independent voice for a healthier Vermont" and their core approach is, "data-driven". To be clear, they do not yet have a formal stance on legalization of marijuana (0:02:00).

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Some of the language the group uses is similar to anti-legalization groups like Smart Approaches to Marijuana (SAM), and a current VTPHA board members is a past coordinator of SAM-Vermont.  Starting off the presentation talking about the need to consider the hypothetical risk of unintended consequences set a somewhat pessimistic tone; however, the fact that they've not yet taken an organizational position means they're seriously considering the issue and likely also have legalization advocates among them.  

Many of the members are prevention and family health specialists, and public health is about the big picture, so if you work in drug treatment and wonder, "based on what we know, will legalization make Vermont more healthy?", you can understandably and simplistically answer "no" pretty quickly and join the prohibition party.  

However when it comes to public health, advocates (especially medical patients) want cannabis further unleashed for research, treatment and therapeutic purposes, not because changing the status quo is going to make healthy Vermonters even healthier, or help with society-level health problems.  So how much time should officials spend considering potential impacts of marijuana, or talking about the lack of data?  

Thinking about public health RE: marijuana, here are a few other questions, some of which were addressed at the event, and some of which could use more examining:

How many Vermonters are using currently?

  Past year usage by Vermonters, left side is 18-25 yr olds, right side is 26+ years old...

Past year usage by Vermonters, left side is 18-25 yr olds, right side is 26+ years old...

A LOT.  In fact, in the year of 2012-13, 47% of 18-25 year olds used cannabis, 15 points higher than the national average (32%).  In that same time period, 14% of adults 26+ used, which is 5 points higher than the national average (9%) - (30:07).  The past 30 day use rates for youth are 24% of the population, which is down a few points overall in recent years, but still has VT teens higher than their national counterparts.  


How much is this illegal usage affecting public health outcomes in VT already?  

vt health infographic

This is where the data is less developed and needs more studying (lots of new research where legalization has happened) and more time.  It's easy for advocates to say that there have been no cannabis overdoses in the state of Vermont, and they'd be right.  The American Lung Association acknowledges that smoking cannabis is harmful to lungs but says more research is needed.

When compared to public health information about alcohol, tobacco, and Rx drug use, cannabis is a molehill to a mountain; however, cannabis isn't always the primary or even secondary substance being tested and reported, so there's likely more to the story.  The presentation showed that there does appear to be an association (not causation) between young people using alcohol (including binge drinking) and marijuana together, which isn't necessarily surprising if you've ever been to a party in VT.

"Our smoking rate in teenagers, kids is probably about 13 percent," Dr. Chen said. "Our marijuana rate is about 37 percent. One is regulated, one is illegal. I think there's, if you do it right, there's ample room for improvement."

Dr. Chen made it clear he is not taking a stance on legalizing marijuana in Vermont, going on to say tobacco use is the leading preventable cause of death in the United States. via WVNY story

How do health impacts of marijuana use compare to tobacco and alcohol?  

Again, it's not even close to being as harmful, but there's lots of statistical information and nuance currently missing due to the illegal paradigm of marijuana use, and there's no big tobacco money to fund more research.  VT Health Commissioner Dr. Harry Chen, who was present at the forum and asked about usage statistics (do we know cannabis stats for people who vape/eat vs. smoke?) was asked about tobacco in his interview for the WVNY story by Alex Rose.

What lessons have worked/failed with alcohol/tobacco policy when it comes to public health and how can they be implemented with a blank canvas for marijuana policy?

similar usage?

The national expert from the Tobacco Control Legal Consortium participated via phone and shared some interesting comparisons between tobacco and cannabis, some of which make sense, and some of which were a stretch, and based on anecdotes and not data.  When she spoke about driving issues, it seems like it's more about fear of cannabis than lessons learned from tobacco--not a lot of energy going into preventing driving under the influence of nicotine.  When the legal expert spoke about similarities in usage, the presentation showed brownies and bongs (ever heard of tobacco brownies?), but didn't talk about dangerous oral tobacco ingestion (ever heard of 'dipping/chewing' marijuana like a baseball player does with tobacco?) or get into detail about the explosion of e-cigarettes, which come in fruity flavors and are very popular among youth, whose use rate has tripled.

There were clearly some valuable examples that relate to cannabis and reducing overall usage: advertising restrictions, pricing controls, and public smoking policies, but having some clear examples and stats (such as Uruguay where advertising regulated cannabis is completely illegal and tourists can't purchase) and better highlighting differences and more accurately decoupling similarities would have been more beneficial to the audience, especially coming from a local (or at least, in-person) voice.

Overall, the event was a timely foray into the cannabis fields by local public health officials who are working hard to collect and analyze accurate data in time to inform the legislature in January.  It was informative and has stimulated some conversation (which will hopefully be helped by the full, uncensored video), but also a transparent acknowledgement of what is still unknown (a lot) and the research being done in real-time by officials racing to produce and analyze enough credible data to responsibly inform the legislature.  

The question for policy observers as the debate continues to grow is how groups like this are informed and how the discussions are balanced between the limited statistical data and anecdotal information, by those on all sides of the issue.

Knowing that local experts can be limited by legal statutes in research abilities and not necessarily aware of all research being done in other states and countries, Vermontijuana encourages readers to watch the entire presentation and share feedback via email, facebook, twitter, or on reddit.

The next public event is a hearing hosted by the Vermont State Senate Government Operations Committee (the most likely gateway for an initial bill), which takes place all day, from 10am to 4pm on Tuesday, November 3, 2015 at the Vermont State House in Room 10.