History repeats: Marijuana tax revenue dedicated to prevention shifted to general fund

Over the years, this blog has included posts about tax revenue earmarked for teen substance use prevention being diverted to the state general fund. Prior to the passage of Initiative 502 which created the legal commercial marijuana system in our state, prevention advocates warned that the initiative's dedicated funds for prevention could and would be moved to fund other things as soon as the legislature was legally able to. And legislators did.

The Seattle Times editorial board recently wrote about it after a Seattle 16 year-old died because he "likely jumped from a balcony in a panic after smoking pot for the first time."The editorial describes the broken promises that, not surprisingly, are similar to previous broken promises for tobacco and liquor revenue earmarks:

Based on the revenue coming in or forecast through 2018, the state Department of Social and Health Services should have had $113 million for programs “aimed at the prevention or reduction” of substance abuse among middle and high schoolers — kids the age of Warsame. Instead, the agency is budgeted to receive only about half that amount.

Similarly, the state Department of Health should have had $77 million to operate a marijuana-education hotline and a statewide public-education campaign regarding marijuana for youths and adults. Instead, the Legislature earmarked less than one-third that amount — $24 million — and the marijuana-information hotline hasn’t materialized.
 

Source: Seattle Times, May 17, 2016

In communities, this means that while access to marijuana increases, as children are exposed to marijuana advertising, and marijuana use becomes normalized, young people aren't receiving messages to counteract marijuana marketing, not all middle schools are implementing tested and effective prevention programs, and not all parents are learning skills for supporting healthy decision making among their children. It means that, once again, legislators and those who promised Washingtonians that marijuana legalization would be good for substance use prevention are failing to do their part to help our teenagers stay drug free.

What is substance use prevention?

The annual National Prevention Network (NPN) meeting was held in Seattle last fall and the University of Washington's David Hawkins gave a keynote address about substance use prevention. As our state expands prevention programming, particularly activities for preventing youth marijuana use, his keynote address provides a good reminder about what works and what does not.

Before a great deal of prevention research was done, many substance use prevention programs were used that have since proven ineffective. The last thirty years of research have made a significant difference in understanding what is most effective.

For example, while it may seem intuitively correct that providing information about drugs would be a straight-forward way to prevent young people from starting to use drugs, such a strategy actually increased drug use in some studies.

Locally, the UW's Social Development Research Group studied the effects of risk and protective factors on youth drug use. They found that protective factors can reduce youth drug use even in the presence of many risk factors.

Protective factors include the communication of clear standards in families, at schools, and in the community. When families, schools, and communities express clear standards against teenagers using drugs, youth are less likely to use drugs.

Individual prevention programs that encourage family bonding, teach skills that teenagers need to be able to avoid or refuse drugs, and provide parents with information about giving their children opportunities and recognition for pro-social behaviors have been found to be effective.

Communities have a role to play in prevention, too. Policies such as the minimum legal drinking age, taxes, and restrictions on where and when legal drugs are sold are proven methods for preventing youth drug use.

So, which prevention activities should be implemented in communities? Whichever ones address the problems specific to a community. Prevention activities are not one-size-fits-all. Know your community and what factors are putting teenagers at risk and what factors are protecting against drug use.

The entire keynote presentation may be viewed by clicking here.

Juvenile justice holds kids accountable

When Prevention WINS members talk about the need to enforce laws dealing with minors in possession of drugs and alcohol, some community members are alarmed and think that the coalition wants to put teenagers in jail.  This couldn't be farther from the truth.  King County has a robust juvenile diversion program that diverts teenagers from jail and into programs meant to help them.

In the video below, a King County Prosecutor talks about the diversion program and about how it has reduced the number of juveniles in detention facilities.



He notes that "the vast majority, if not all" of teenagers who come into contact with the juvenile justice system have a substance abuse problem.  This is another reason why substance use prevention programs targeting middle school students are so important.  It is also why policies that limit youth access to drugs and therefore prevent youth use of those drugs is important.  Preventing youth substance use can prevent juvenile crime.

Different communities will have different prevention activities to address teen medicine abuse

Last week, two posts told the stories of community coalitions that conducted successful campaigns to prevent teen medicine abuse.  Well, I have one more.

I share this last one as an example of how prevention campaigns are different depending on the local community.  The coalition profiled in the video below implemented prevention activities that are different from the coalitions profiled in the other videos.  The stories highlight that every community is going to have different responses to teen medicine abuse, and other teen drug abuse problems, depending on what their local data tell them, who is involved in the coalition, and the capacity of coalition members to do something.

Underage Marijuana Use Prevention Toolkit now available online

An Underage Marijuana Use Prevention Toolkit was recently launched by the Washington State Division of Behavioral Health and Recovery to help educate people about the new law and the risks associated with adolescent use of the drug.  The toolkit is available online and includes several posters, including these two.

Since no current funding exists for a full scale educational campaign, DBHR is relying heavily on community-based organizations, including coalitions and their partners, to use the toolkit to educate parents, youth, and the wider community about the new law and how marijuana impacts adolescent health.  

Multi-pronged approach to teen drug use prevention

Last Saturday was National Drug Take-Back Day during which people could safely dispose of unused prescription drugs in an environmentally-friendly manner at local police precincts.  This is one activity that is part of a national strategy for preventing youth substance use.

Effective youth substance use prevention strategies need to include multiple activities targeting multiple risk factors conducted by multiple organizations.  This was made clear during a recent House of Representatives committee meeting about prescription drug and heroin abuse.


Many factors contribute to prescription drug abuse
The first person to testify was Joseph Rannazzisi from the Drug Enforcement Administration.  His testimony highlights the multiple factors contributing to prescription drug abuse:

The problem of prescription drug abuse has increased exponentially in the last 15 years due to a combination of excessive prescribing, drug availability through friends and family, Internet trafficking, rogue pain clinics, prescribers who prescribe pharmaceutical controlled substances without a legitimate medical purpose or outside the usual course of professional practice, pharmacies that dispense illegitimate prescriptions, and supply chain wholesalers and manufacturers that fail to provide effective controls and procedures to guard against diversion—all of which fueled illicit access at the expense of public health and safety.

Prevention activities address multiple factors
Rannazzisi goes on to describe a “holistic approach” to prevent diversion of prescription drugs and reduce availability for abuse.

Non-medical drug use cannot be addressed through law enforcement action alone. The Office of National Drug Control Policy’s 2011 Prescription Drug Abuse Prevention Plan, a multi-pronged approach that includes education, tracking and monitoring, proper medicine disposal, and enforcement is a science-based and practical way to address this national epidemic.

Preventing teen drug use prevents adult substance abuse problems
Michael Botticelli from the White House Office of National Drug Control Policy emphasized that most adults with substance abuse problems started using drugs before they became adults.

We also know that substance use disorders, including those driven by opioids, are a progressive disease. Most people who develop a substance use disorder begin using at a young age and often start with alcohol, tobacco, and/or marijuana. 

Multi-pronged prevention strategy
He then discussed the White House’s plan for preventing prescription drug abuse:

The Plan focuses on improving education for patients and healthcare providers, supporting the expansion of state-based prescription drug monitoring programs, developing more convenient and environmentally responsible disposal methods to remove unused medications from the home, and reducing the prevalence of pill mills and doctor shopping through targeted enforcement efforts.

Remarks from Daniel Sosin, representing the Centers from Disease Control and Prevention, supported previous testimony and outlined what his agency doing.   Nora Volkow from the National Institutes on Drug Abuse provided information about how prescription drugs and heroin affect the brain.

Westley Clark from the Substance Abuse and Mental Health Services Administration discussed prevention efforts conducted through his agency.  Among them:

SAMHSA also supports the “Not Worth the Risk, Even If It’s Legal” education campaign, which
encourages parents to talk to their teens about preventing prescription drug abuse. Another
educational program, “Prevention of Prescription Abuse in the Workplace,” is designed to
support workplace-based prevention of misuse and abuse of prescription drugs for employers,
employees, and their families.

More about the predictors of youth marijuana use

In the previous post, I provided an overview of a recent presentation about how marijuana availability and norms are strong predictors of youth use of the drug.  The information was based on a presentation given during a recent symposium at the University of Washington.

The presentation ended with a closer look at how new state marijuana laws may affect levels of risk for marijuana use among teenagers.  UW researchers predict that both availability and norms will change.  They point out that parenting behaviors, including parent use, may change.

When looking at increased marijuana availability among youth, researchers not only point to stores and the likely commercialization of marijuana similar to the commercialization of other legal drugs and consumable goods.  They also predict that more adults who are parents will use marijuana, making the drug available in the home.  With the proliferation of non-smoked forms of marijuana, public use of these hard-to-detect products may result in increased availability among youth.  

Since marijuana-infused foods have become more available through the medical marijuana system, it is expected that they will become more available in the I-502 system, as well.  If adults in a household keep marijuana-infused ice-cream in the freezer, how will it be differentiated from regular ice-cream and away from kids?   

The presentation concluded with discussion about implications of increased availability and norms favorable to marijuana use and what can be done.  Strategies to reduce home and social access were discussed.  Communities will need to monitor norms around use.  Availability and norms may be increasingly important risk factors that those of us who work to prevent youth drug use will need to address in our communities.  

Prevention programs most effective when offered early and part of a comprehensive strategy

The Prevention Hub website recently posted a review of research about the effectiveness of substance abuse prevention programs.  The two main findings were that multiple prevention programs implemented simultaneously are most effective and that prevention needs to start early.  Here’s an excerpt from the report:

On the evidence to date, the most promising interventions for reducing several risk behaviours simultaneously are those which address multiple domains of risk and protective factors, perhaps because they match the multi-faceted nature of the causes of risk behaviour. Such interventions largely aim to bolster young people's resilience, supported by promoting positive parental/family influences and/or healthy school environments which foster positive social and emotional development.

Timing is likely to be very important, particularly in relation to periods of transition in young people's lives. Programmes were commonly implemented at ages 11–12, during transition into adolescence, or at ages 13–14, when risk behaviours, or experimentation with them, may already have started. The Seattle Social Development Project was the only identified programme implemented in the pre-adolescent early years of primary school. Its success, especially in reducing sexual risk behaviour, suggests that intervening in early mid-childhood can have an impact on later risk behaviour. It may not be too late to intervene during teenage years, but addressing underlying determinants of risk behaviour early in childhood may have a greater impact than only intervening in adolescence.

Learn about prevention policies that work

Free webinar: The Coalition Influence: Strategies to Implementing Sustainable Tobacco Prevention Policies
Thursday, March 14, 2013
11:00 a.m. to 12:30 p.m.

At the end of the webinar, participants should be able to:

• Describe some of the challenges to implement tobacco prevention policies and how to overcome those challenges
• Understand the importance of youth engagement in reducing the burden of tobacco use
• Understand the importance of local media influence in reducing the burden of tobacco use
• Implement strategies to use the influence of creating new social norms to reduce tobacco use prevalence and acceptance
• Implement collaborative strategies that encourage sustainable partnership building

Click here to register.

Improving school performance by improving mental health

The Spring 2012 edition of Better: Evidence-Based Education focuses on healthy bodies and healthy minds.  The topic for this edition was chosen because "physical and mental health can make a difference to student test scores . . . A host of simple evidence-based changes to the way we parent and school our children can boost their physical and mental health, which in turn will help them to learn."

Several of the articles discuss preventing youth substance abuse, a risk factor for school failure.  This edition of Better features Life Skills Training, an evidence-based curriculum that is taught at Eckstein Middle School (part of the Prevention WINS coalition); includes an article entitled, "Addressing school effects on drug use"; and provides information (from the University of Washington's Social Development Research Group) about how parents can help prevent problem behaviors.

Child & Adolescent Psychiatry group concerned about marijuana policy

While the American Academy of Child and Adolescent Psychiatry's recent statement is about medical marijuana, not marijuana legalization, some of the information it contains can inform the legalization debate.

The American Academy of Child and Adolescent Psychiatry (AACAP) is concerned about the negative impact of medical marijuana on youth.  Adolescents are especially vulnerable to the many adverse developmental, cognitive, medical, psychiatric, and addictive effects of marijuana.  Of particular concern to our field, adolescent marijuana users are more likely than adult users to develop marijuana dependence, and their heavy use is associated with increased incidence and worsened course of psychotic, mood, and anxiety disorders.  Furthermore, marijuana's deleterious effects on cognition and brain development during adolescence may have lasting implications.

The "medicalization" of smoked marijuana has distorted the perception of the known risks and purported benefits of this drug. Since certain states began permitting dispensing of medical marijuana, adolescents' perceptions of the harmful effects of marijuana have decreased and marijuana use has increased significantly.  There is also emerging evidence that adolescents are accessing medical marijuana for recreational use.  Therefore AACAP urges more scientific evaluation and a risk:benefit analysis by interdisciplinary experts to determine whether there is any medical indication for marijuana dispensing given the potential harm to adolescents.

In summary:

• Adolescents are especially vulnerable to adverse consequences of marijuana use.
• Medical marijuana dispensing is associated with reduced perception of marijuana-related risks and increased rates of marijuana use among adolescents.
• AACAP thus opposes medical marijuana dispensing to adolescents. 

Adolescent marijuana use is harmful and any proposed law that would make marijuana more acceptable to use and easier to get needs to be scrutinized to make sure it won't negatively affect teenagers.  Future legislation regarding medical marijuana in our state should include tighter regulations to ensure Washington teenagers are not accessing medical marijuana for recreational purposes.  

Surgeon General calls for multi-component prevention efforts

Last week, the Surgeon General was in town and participated in a Town Hall Meeting on youth tobacco use.  She shared a fact sheet about Preventing Tobacco Use Among Youth and Youth Adults.

A Prevention WINS coalition member also participated in the Town Hall Meeting and when I asked her what I should share with blog readers she said, "The calls to action that I heard were to regulate flavored tobacco products (grape blunts, chocolate mini-cigars), increase taxes to deter youth use, and for the FDA to continue to assert their authority."  

"I think that coalition members should know that Seattle students have higher rates of alternative forms of tobacco than cigarettes.  That means more kids are using hookah or swisher sweets than smoking cigarettes.  We have done a great job educating folks about the dangers of cigarettes…so now kids just use the other products."

The Surgeon General's fact sheet ends with recommendations that can inform all substance abuse prevention activities.  She calls for "comprehensive, sustained, multi-component programs".

• Prevention is critical.  Successful multi-component programs prevent young people from starting to use tobacco (and other drugs) in the first place and more than pay for themselves in lives and health care dollars saved.
• Strategies that comprise successful comprehensive tobacco control programs include mass media campaigns, higher tobacco prices, smoke-free laws and policies, evidence-based school programs, and sustained community-wide efforts.  (These strategies are effective for preventing other youth drug use, as well.)
• Comprehensive tobacco control programs are most cost-effective when funding for them is sustained at levels recommended by the Centers for Disease Control and Prevention.  

Prescription drug abuse in the news

Over at Teenology 101, they discuss teen mental health, pain and prescription drug abuse.  They refer to a new study that shows that young people who take opiates like Oxycontin for chronic pain are more than twice as likely to become addicted to the drugs if they have a mental health condition

Sunday's New York Times included an article, Risky Rise of the Good-Grade Pill, about teenagers who abuse prescription medications meant to treat ADHD so that they may focus on studying to get good grades.  The Times' Room for Debate section features differing opinions about prescribing medications for ADHD and their link to drug abuse.

Over at the JoinTogether blog, a Congressman from Kentucky writes about his efforts to prevent prescription drug abuse.

The MSNBC website includes and article entitled, "Opiate addiction: How prescription painkillers pave the way to heroin."

The National Drug Control Strategy puts a focus on prevention prescription drug abuse.  In response to a prescription drug abuse problem designated as an epidemic by the Centers for Disease Control and Prevention, the White House is implementing of the Prescription Drug Abuse Prevention Plan.

Locally, the Take Back Your Meds campaign continues to advocate for a statewide medicine return program.

National Prevention Week May 20-26

National Prevention Week is a new annual health observance that will celebrate the work that community organizations and individuals do year-round to help prevent substance abuse and promote mental, emotional, and behavioral well-being.

Below is a public service announcement created by young adults to kick off National Prevention Week.  Its positive message highlights the ways in which young people can focus on their own talents and inner strength to prevent substance abuse and promote emotional well-being in their community.

National Prevention Week will be held in May, near the start of summer and the perfect time for communities to come together and rally around prevention. Summer is a season filled with celebrations and recreational activities that can potentially be linked to substance use and abuse, such as graduation parties, proms, weddings, boating, and camping excursions. The percentages of marijuana, cigarette and alcohol initiates among youth increase between spring (April and May) and summer (June and July), and the timing of National Prevention Week 2012 will help to raise awareness in youth at this crucial time of year.

Individuals and organizations wishing to observe National Prevention Week can access a plethora of prevention-related resources on the Substance Abuse and Mental Health Services website.

Marijuana: prevention resources and media stories

So much information to share . . .

Web-based resources

-- Marijuana Resource Center: Marijuana is a topic of significant public discourse in the United States, and while many are familiar with the discussions, it is not always easy to find the latest, research-based information on marijuana to answer to the common questions about its health effects, or the differences between Federal and state laws concerning the drug. This Web-based resource center provides the general public, community leaders, and other interested people with the facts, knowledge, and tools to better understand and address marijuana in their communities.

-- Locally, the University of Washington Alcohol & Drug Abuse Institute hosts an online resource -- Marijuana: Science-based information for the public.

-- A National Alliance for Marijuana Prevention was recently launched with the goals of to developing and strengthening collaboration among communities, agencies and federal, state and local governments to support the efforts of organizations to prevent and reduce marijuana use by addressing the factors that increase risk within a community.

-- The But What About the Children? Campaign website demands that policymakers who want to legalize marijuana guarantee that marijuana will not be marketed to young people like alcohol and tobacco are.

Medical marijuana policy analysis

-- A two part series entitled "Clearing the Smoke on Medical Marijuana" discusses medical marijuana policy.  Part 1 looks at how marijuana is classified in the federal Controlled Substance Act and Part 2 discusses the ability for research to be done on the effects of marijuana.

In the media

-- In January 2010, Massachusetts decriminalized the possession of small amounts of marijuana.  A story in a Massachusetts newspaper, "New Law Haunts Schools Local Officials Charge: Marijuana Law is Taking Toll on Teens at Revere High" reports:  Two years later, public safety officials, school officials and youth advocates are saying it has levied a major toll on the school-age generation – who grapple to understand why marijuana is frowned upon at school and smiled upon in the law books.

-- As fewer teens perceive harm in marijuana use, fewer teens also report that marijuana use is distracting while driving, according to a recent national study.  Stephen Wallace of Students Against Destructive Decisions says the findings reflect a “dangerous trend toward the acceptance of marijuana and other substances compared to our study of teens conducted just two years ago…both in terms of the increased use of marijuana and from the perspective that many think this is not a danger.”

-- From "High Season: Teens and Marijuana Use" (Family Circle magazine):  After more than a decade of decline, pot smoking among adolescents is growing once again. According to the University of Michigan's annual survey of 50,000 middle and high school students, 16 percent of 8th-graders have smoked marijuana, 32 percent of 10th-graders, and 42 percent of 12th-graders.

What's behind the increase? "There's been a rapid erosion of anti-marijuana attitudes in our society," says Tom Hedrick, a founding member of Partnership for a Drug-Free America (PDFA). "A lot of what kids hear today is not to worry." Fourteen states have legalized medical marijuana, and this fall Californians will vote on whether to do the same for recreational use. From movies like Hot Tub Time Machine to TV's Weeds to Michael Phelps' marijuana moment, there's a constant message being sent to teens: Everybody must get stoned, and it's all right. No wonder survey results show that only 44 percent of 8th-graders perceive pot as posing a "great risk" to their health, down from more than 50 percent in 2004. "This is the perfect storm that could lead to a tremendous explosion in marijuana use," says Hedrick. "Parents have reason to be concerned."

Locally . . .

-- The Mayor of Seattle in his 2012 State of the City Address pushes for legalizing marijuana. 

-- In December, KCTS 9 Connects aired a show about marijuana legalization.

Watch December 9, 2011 on PBS. See more from KCTS 9 Connects.

Free webinar: social marketing, social norms, social media and substance abuse prevention

The Substance Abuse and Mental Health Services Administration is offering a free webinar as part of their series on environmental strategies for substance abuse prevention:

Social Marketing, Social Norms, Social Media, Social What?
December 13, 2011
3:30-5:00 p.m.

The strategies and evidence that support different prevention practices often get confused, severely limiting the effective implementation of these approaches. Learn about the differences between some of the more common and evidence-based prevention strategies, including social marketing and social norms, as well as how new tools like social media fit in to the mix. This webinar will leave you with new tools, a better understanding of your prevention arsenal and the energy to make positive behavior change a reality.

Key topics will include:
-Social Marketing, including branding strategies
-Social Norms
-How to select the right approach
-Differentiating between a tool and an approach
-How to select the right tools for your approach
-How Social Media fits in most effectively

To register, click here. 

Prevention Summit: holistic prevention saves money

Every year, the Washington State Prevention Summit provides youth and adults from around the state with resources and information about substance abuse and violence prevention.  Handouts from some of the 2011 presentations are now available online.  

From my perspective, a common theme among many of the speakers was the importance of prevention activities that address the whole person and the whole community.  For example: 

• During his presentation, Anthony Biglan discussed different strategies for developing nurturing communities including nurturing schools and families.
• Heather Larkin discussed a whole person approach to addressing Adverse Childhood Experiences (ACES).
• Harold Holder described his research around implementing environmental prevention strategies as part of a comprehensive, community-wide approach. 
• Children's own Leslie Walker talked about creating health equity by reducing the fragmentation of services and considering the family, social, and community issues of each teenager needing help.

 Another theme that emerged during the Summit was that, in the long run, prevention saves money.  This is an especially important message during these difficult economic times.  Stephanie Lee from the Washington State Institute for Public Policy provided specific examples during her presentation.  One of the prevention programs she highlighted is Life Skills Training, the prevention curriculum offered at Eckstein Middle School.  Here is the slide from her presentation:

 

 

Prevention WINS awarded AMA Foundation grant

In partnership with Seattle Children’s Hospital, Prevention WINS was awarded a grant from the American Medical Association (AMA) Foundation’s Healthy Living Program.  The $5,000 grant will be used to expand the Prevention WINS social marketing campaign and parent education program for Eckstein Middle School families. The project’s goal is to provide parents with the support they need to prevent substance abuse, including prescription drug abuse, among their children.

The AMA Foundation's Healthy Living Program addresses critical healthy lifestyle issues by providing mini-grants to grassroots community organizations.  This year, the foundation is funding projects targeting youth and addressing the topics of nutrition and physical fitness, prescription drug safety and violence prevention. Prevention WINS is one of 37 nonprofits across the country that received this grant this year.  

Local physicians provide advice about parenting teenage children

Preventing youth substance abuse was among the many adolescent health-related topics discussed during last night's Children's HealthLink special. 

During Part 3 of the show, the three Seattle Children's physicians on the panel stated:

-- marijuana and alcohol are detrimental to the growing brain;

-- parents can teach their children drug/alcohol refusal skills -- role playing is especially effective;

-- parents play an important role in preventing youth substance abuse and should talk to their children early, when they are 11-13 years old, about not using drugs/alcohol.

Earlier in the day, Dr.'s Walker and Breuner appeared on New Day NW and talked about how to keep teenage children safe, healthy and motivated during summer  break. 

NE Seattle underage drinking rates decline

Prevention works! 

Regular alcohol use among students in NE Seattle declined between 2008-2010.  Below are the data comparing 2006, 2008 and 2010 Healthy Youth Survey results regarding regular alcohol use among sophomores at Nathan Hale and Roosevelt High Schools. 

Nathan Hale High School 30-day (regular) alcohol use rates among 10th grade students

• 2006: 38.6%
• 2008: 35.7%
• 2010: 20%

Roosevelt High School 30-day (regular) alcohol use rates among 10th grade students

• 2006: 37.7%
• 2008: 30.1%
• 2010: 24.5%

More on NE Seattle 2010 HYS results to come . . .