ANCHORAGE HEALTH DEPARTMENT
MARIJUANA ON-SITE CONSUMPTION
POLICY RECOMMENDATION
The Anchorage Health Department cannot recommend for or against legalizing on-site consumption of edible marijuana products at licensed dispensaries.
Policy
Due to a lack of evidence regarding the effects of on-site marijuana consumption on public health outcomes, the Anchorage Health Department cannot recommend for or against pursuing legalization of on-site consumption.
The Anchorage Health Department cautions that the adverse health and public safety outcomes related to over-consumption or irresponsible consumption of marijuana are a public health concern. Given that legalization of marijuana is associated with increased marijuana use and addiction among adults,i any policy that may increase access to or availability of marijuana should be evaluated with a complete understanding of the potential adverse health effects of marijuana consumption.
Justification
Alaskan and Anchorage residents consume marijuana at a higher rate than the national average: an estimated 16.6% of Alaskan adults 18 and older consumed marijuana in the past month in 2016-17, compared to 9.5% of all adults nationally. Among the 12-17 year age group, an estimated 8.8% of Alaskans consumed marijuana in the past month, compared to 6.5% of youth nationally.ii While 20.0% of students in Anchorage traditional high schools report consuming marijuana in the past month (similar to the national rate of 19.8%), 49.6% of students in Anchorage alternative high schools report past month marijuana use.iii
Nine and a half percent of Anchorage high school students report first consuming marijuana before the age of thirteen, a number statistically significantly higher than the 6.8 percent of high school youth nationwide. This rate is higher among alternative high school students (26.4%), Alaska Native students (19.4%), and Black/African American and Pacific Islander/Native Hawaiian students (10.2%) in Anchorage.iv
Additionally, 71.0% of Anchorage high school students report that their parents think it’s wrong or very wrong for them to use marijuana. In contrast, 82.5% believe their parents think it’s wrong or very wrong to have one or two drinks of alcohol per day, and 85.4% believe similarly about using prescription pain medicine without a prescription or differently than prescribed.v This indicates that marijuana may be perceived among youth as a more socially acceptable substance than alcohol or prescription medications.
As with the consumption of any substance, marijuana use and misuse can result in several negative health outcomes:
Addiction
An estimated 9% of those who try marijuana develop dependence and about 4.3% of Americans have been dependent on marijuana at some time in their lives.vi People who use marijuana before the age of 13 are four to seven times more likely than those who use as adults to develop a marijuana use disorder.vii This is important, given that the percentage of Anchorage high school students that report first use of marijuana before the age of 13 is statistically significantly higher than the national average. The most common form of addiction among Alaskan youth is marijuana use disorder.viii
Cognitive Functioning
Marijuana use directly affects the brain, specifically the areas responsible for memory, learning, attention, decision making, coordination, emotions, and reaction time.ix Early marijuana use may significantly increase the risk of subsequent poor school performance, and research indicates significant associations between marijuana use and lower grade point average, less satisfaction with school, increased rates of school absenteeism, and poor school performance.x Research has shown that people who start smoking marijuana heavily in their teens and had an ongoing marijuana use disorder lost an average of 8 IQ points between ages 13-38.xi
Other Health Effects
Smoking marijuana can cause lung and breathing problems and increased heart rate, and using marijuana while pregnant is linked to lower birth weight and increased risk of both brain and behavioral problems as well as issues related to attention, memory, and problem-solving in babies and children.xii Increasing evidence suggests that regular marijuana use can lead to the development of Cannabinoid Hyperemesis Syndrome, which causes nausea, vomiting, and dehydration, and may be under-diagnosed in emergency departments.xiii In some users, long-term or frequent marijuana use is linked to increased risk of psychosis or schizophrenia.xiv
There is no evidence regarding the public health impacts of legalizing on-site consumption of marijuana, due largely to the fact that this is a new policy that has been implemented in very few locations. Alaska was the first state to legalize on-site consumption of marijuana at licensed dispensaries.
Similar bills are advancing in Colorado and Oregon,xv and a bill licensing “cannabis cafes” in Massachusetts was put on hold in 2018 due to concerns related to “increased marijuana access by persons under the age of 21, theft and diversion to the black market.”xvi California allows local jurisdictions to authorize on-site consumption of marijuana at state-licensed retailers: as of 2019 most cities have prohibited “cannabis lounges,” but West Hollywood, San Francisco, Oakland, Alameda, and Palm Springs allow on-site consumption.xvii West Hollywood and Alameda limit the number of permits for retail sales and on-site consumption,xviii and Palm Springs limits the density of retail outlets.xix
Complications and Unknowns
The evidence around marijuana use and traffic accidents is mixed. Marijuana use by drivers is associated with a significantly increased risk of being involved in motor vehicle crashes.xx A 2018 report from the Insurance Institute for Highway Safety found that in states that had legalized retail sales of recreational marijuana there was a 5.2% increase in police-reported crashes compared to states that had not legalized retail sales.xxi However, another study indicates that three years after recreational marijuana legalization, motor vehicle fatality rates in Washington and Colorado were not statistically different from similar states without recreational marijuana legalization.xxii Similarly, an analysis by economists found that legalizing recreational marijuana had no causal effect on traffic deaths.xxiii Conversely, another recent study found that legalization of medical marijuana was associated with a decrease in traffic fatalities.xxiv
References
i Wen, Hefei, et al. The Effect of Medical Marijuana Laws on Marijuana, Alcohol, and Hard Drug Use. The National Bureau of Economic Research
2014. NBER Working Paper No. 20085. https://www.nber.org/papers/w20085
ii Substance Abuse and Mental Health Administration. 2016-2017 National Survey on Drug Use and Health: Model-Based Prevalence Estimates (50 States and District of Columbia). 2017.
iii Alaska Department of Health and Social Services. “Alaska Youth Risk Behavioral Surveillance System.” YRBSS Dataset, http://ibis.dhss.alaska.gov/query/selection/yrbs/YRBSSelection.html; Centers for Disease Control and Prevention. Trends in Prevalence of Marijuana, Cocaine, and Other Illegal Drug Use National YRBS: 1991-2017. Centers for Disease Control and Prevention Division of Adolescent and School Health. 2018.
iv Alaska Department of Health and Social Services. “Alaska Youth Risk Behavioral Surveillance System.” YRBSS Dataset, http://ibis.dhss.alaska.gov/query/selection/yrbs/YRBSSelection.html
v Ibid.
vi Budney, Alan J et al. “Marijuana dependence and its treatment.” Addiction science & clinical practice vol. 4,1 (2007): 4-16.
vii Winters, Ken C, and Chih-Yuan S Lee. “Likelihood of developing an alcohol and cannabis use disorder during youth: association with recent use and age.” Drug and alcohol dependence vol. 92,1-3 (2007): 239-47.
viii Substance Abuse and Mental Health Administration. 2016-2017 National Survey on Drug Use and Health: Model-Based Prevalence Estimates (50 States and District of Columbia). 2017.
ix Filbey, Francesca M., et al. “Long-Term Effects of Marijuana Use on the Brain.” Proceedings of the National Academy of Sciences, vol. 111, no.
47, 2014, pp. 16913–16918.
x Lynskey, Michael, and Wayne Hall. “The Effects of Adolescent Cannabis Use on Educational Attainment: a Review.” Society for the Study of Addiction, vol. 95, no. 11, Nov. 2000, pp. 1621–1630.
xi Meier, Madeline H et al. “Persistent cannabis users show neuropsychological decline from childhood to midlife.” Proceedings of the National Academy of Sciences of the United States of America vol. 109,40 (2012): E2657-64.
xii National Institute on Drug Abuse. “Marijuana.” NIDA, www.drugabuse.gov/publications/drugfacts/marijuana.
xiii Galli, Jonathan A et al. “Cannabinoid hyperemesis syndrome.” Current drug abuse reviews vol. 4,4 (2011): 241-9; Sun, Shusen, and Anthony E Zimmermann. “Cannabinoid hyperemesis syndrome.” Hospital pharmacy vol. 48,8 (2013): 650-5.
xiv Di Forti, Marta et al. “Daily use, especially of high-potency cannabis, drives the earlier onset of psychosis in cannabis users.” Schizophrenia bulletin vol. 40,6 (2013): 1509-17; Di Forti, Marta et al. “High-potency cannabis and the risk of psychosis.” The British journal of psychiatry : the journal of mental science vol. 195,6 (2009): 488-91; Di Forti, Marta, et al. “Proportion of Patients in South London with First-Episode Psychosis Attributable to Use of High Potency Cannabis: a Case-Control Study.” The Lancet, vol. 2, no. 3, 1 Mar. 2015, pp. P233–238.
xv Johnson, Evan. “Oregon Lawmakers Weigh Bill Allowing Marijuana Lounges And Cannabis Business Tours.” Marijuana Moment, 28 Feb. 2019, www.marijuanamoment.net/oregon-lawmakers-weigh-bill-allowing-marijuana-lounges-and-cannabis-business-tours/ ; Mitchell, Thomas. “Bill Allowing Social Pot Use and Dispensary Tasting Rooms Moves Forward.” Westword, 9 Apr. 2019, www.westword.com/marijuana/coloradohouse-committee-approves-bill-allowing-marijuana-use-in-hotels-dispensaries-and-other-businesses-11287211.
xvi Associated Press. “Prosecutors Want Massachusetts to Wait on Marijuana Cafes, Home Delivery.” The Cannabist, The Cannabist, 13 Feb. 2018, www.thecannabist.co/2018/02/10/massachusetts-marijuana-social-use-delivery/98692/.
xvii Associated Press. “San Francisco Embraces Amsterdam-Style Marijuana Lounges.” The Cannabist, The Cannabist, 27 Mar. 2018, www.thecannabist.co/2018/03/15/san-francisco-marijuana-lounges/101474/;
“City of Oakland California: Municipal Code.” Municode Library, library.municode.com/ca/oakland/codes/code_of_ordinances?nodeId=TIT5BUTAPERE_CH5.80MEADECADIPE_5.80.025ONCOPE; “On-Site Cannabis Consumption in California: Progress Report.” Canna Law Blog™, 1 June 2018, www.cannalawblog.com/on-site-cannabis-consumptionin-california-progress-report/.
xviii “City of West Hollywood.” Cannabis , City of West Hollywood, www.weho.org/business/cannabis; Alameda County Government. AN ORDINANCE AMENDING CHAPTER 6.108 OF THE ALAMEDA COUNTY GENERAL ORDINANCE CODE TO REGULATE THE RETAIL SALE OF CANNABIS.
2018, https://www.acgov.org/cda/planning/landuseprojects/documents/Retail-Dispensaries-6-108-FinalClean.pdf.
xix City of Palm Springs, CA. “Cannabis FAQ.” Cannabis FAQ City of Palm Springs, www.palmspringsca.gov/city-services/cannabis-relatedbusinesses-and-activities/cannabis-faq.
xx Mu-Chen Li, Joanne E. Brady, Charles J. DiMaggio, Arielle R. Lusardi, Keane Y. Tzong, Guohua Li, Marijuana Use and Motor Vehicle Crashes, Epidemiologic Reviews, Volume 34, Issue 1, January 2012, Pages 65–72.
xxi Insurance Information Institute. A Rocky Road so Far: Recreational Marijuana and Impaired Driving. 2019. https://www.iii.org/sites/default/files/docs/pdf/marijuanaanddui-wp-031119.pdf.
xxii Jayson D. Aydelotte, Lawrence H. Brown, Kevin M. Luftman, Alexandra L. Mardock, Pedro G. R. Teixeira, Ben Coopwood, and Carlos V. R. Brown, 2017: Crash Fatality Rates After Recreational Marijuana Legalization in Washington and Colorado. American Journal of Public Health 107, 1329-1331.
xxiii The National Bureau of Economic Research. Early Evidence on Recreational Marijuana Legalization and Traffic Fatalities. 2018. NBER Working Paper No. 24417. https://www.nber.org/papers/w24417
xxiv Anderson, D. Mark, et al. “Medical Marijuana Laws, Traffic Fatalities, and Alcohol Consumption.” The Journal of Law and Economics, vol. 56, no. 2, 2013, pp. 333–369.
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