1. The Story of Lewiston, Maine Presented by: Scott M. Gagnon, MPP Substance Abuse and Tobacco Prevention Services Manager Healthy Androscoggin

2.  Importance of community norms and values  Developing messages that resonate with target audiences  Organizing a successful marijuana education panel or town hall  Engaging and getting covered by the media

4.  Population: 107,609 (US Census, 2010)  Mix of rural and urban  55% of population lives in urban Lewiston/Auburn (aka L/A)  Primarily Caucasian population (93%) Lewiston – 86%  Large Franco-American population  Growing population of refugees (Somali/Somali Bantu) in L/A  15.5% of population is 65+  Population in poverty (14.8%) above Maine average

5.  Population 36,400 (2013 estimate)  48% of the population of French ancestry  29.9% identify with French-Canadian ancestry  11.2% are “New Mainers”; immigrant populations of Somali, Somali Bantu, Sudanese, Djibouti, etc.  16% of population over age of 18 are Veterans  Religious community with over 18 churches

6. Coalition Introduction Began in 1995 as a grassroots group (Tobacco-Free LA)  Evolved to HA in 2001 with expanded goals  Nutrition  Physical Activity  Lead Poisoning Prevention  Tobacco  Substance Abuse Project Unite! Project Unite! is the multi-sector, community based task force within the Healthy Androscoggin coalition that advises the substance abuse prevention strategies. Vision: The communities of Healthy Androscoggin are the healthiest in Maine. Mission: Empowering people and improving the public health of the communities of Healthy Androscoggin, through ongoing planning, community action, education and advocacy. communities of Healthy Androscoggin, through ongoing planning, community action, education and advocacy.

7. Project Unite! Organization Chart

8.  Youth Tobacco Use  Underage Drinking  Youth and Young Adult Marijuana Use  Youth and Young Adult Prescription Drug Abuse  Youth Tobacco Use  Underage Drinking  Youth and Young Adult Marijuana Use  Youth and Young Adult Prescription Drug Abuse Four Priority Areas 2013 Past 30-Day Use of Four Priority Substances* Middle SchoolHigh School Tobacco (Cigarettes)4.3%10.7% Alcohol6.3%23.6% Marijuana6.9%18.9% Prescription Drugs3.3%4.7% Maine Integrated Youth Health Survey, 2013

9. AndroscogginMaine Past 30 Day Use7%4% Easy to Obtain24%18% Parents accepting of use7%5% Low perceived risk of harm from regular use 36%29% Maine Integrated Youth Health Survey, 2013

10.  Androscoggin County had the largest percentage of all counties in most measures  About 1 out of 8 Androscoggin County middle school students reported ever using marijuana.  Over 1 out of 5 Androscoggin County middle school students who use reported starting before age 11.  Percentage of females reporting past 30 day use of marijuana is larger than percentage of males.

11. AndroscogginMaine Past 30 Day Use19%22% Easy to Obtain56% Parents accepting of use15% Low perceived risk of harm from regular use 53% Peers accepting of regular use50%53% Maine Integrated Youth Health Survey, 2013

12.  About 1 out of 5 high school students in Androscoggin have used marijuana in past 30 days.  Of those who have used, 1 out of 4 used before the age of 13.  Big increase in percentage of students who see no risks from regular marijuana use.  Over half of high school students in Androscoggin believe there is no/slight risk from regular marijuana use.  Percentage of males reporting past 30 day use of marijuana is 10 points higher than percentage of females.

13.  Bills introduced to legalize recreational marijuana were voted down in 2013 and 2014  Another bill expected to be introduced in 2015.  Three cities targeted for November 2014 ballot.  York  South Portland  Lewiston  Expectations for bills that could strengthen, or weaken, existing medical marijuana regulations.  Statewide voter referendum eyed for November 2016  Marijuana Policy Project  Legalize Maine

15.  SAMHSA-approved Drug Free Communities Objectives  Impact Parental Attitudes and Knowledge around youth marijuana use ▪ Strategy 1: Community education to increase parental knowledge of the risks of youth marijuana use. ▪ Strategy 2: Increase knowledge and skills amongst professionals who work with parents and youth. ▪ Strategy 3: Provide support to local governments and school boards with policies addressing medical and recreational marijuana

16.  Disseminate state and national materials  Develop localized materials with local data  Support local government and other entities around policy (City of Lewiston e-cig policy)  Educational opportunities for educators, health, behavioral health, and other professionals.  Social Marketing  Convene Marijuana Town Hall

17.  Objectives funded by Maine Office of Substance Abuse and Mental Health Services (SAMHS)  Increase communications to the public about the risk and harm of marijuana use ▪ Use SAMHS-developed materials to provide educational sessions for residents ▪ Disseminate information and/or materials to residents.

18.  Social Marketing Campaign  Marijuana Town Halls  Chamber of Commerce Brown Bag Presentations  Table Talks  Screening, Brief Intervention, Referral to Treatment (SBIRT) training for medical providers  Drug Impairment Training for Education Professionals  Youth Engagement and Empowerment  Drug Facts Week & In-school presentations

19.  Maine Office of Substance Abuse and Mental Health Services Marijuana Work Group Funding for Healthy Maine Partnerships www.Maineparents.net  Maine Alliance to Prevent Substance Abuse  Marijuana and Public Health Issues  SAM Maine (Smart Approaches to Marijuana) Advocating for science-informed public policy Community presentations on the science of today’s marijuana. www.learnaboutsam.org Governor’s Substance Abuse Services Commission

20.  PowerPoint Slide Bank  5 Key Messages  Pregnancy and Breastfeeding Rack Cards  Maineparents.net  Various PSAs and other materials created by SAMHS and Marijuana Workgroup

21.  Alcohol Enforcement Team  Lewiston/Auburn Public Health Committee  Western District Coordinating Council  Bates College  Kaplan University  University of Southern Maine – L/A  Androscoggin Chamber of Commerce  Gleason Media – Z105.5  Turner Publishing  DFD Russell Medical Centers  Tri-County Mental Health Services  School Districts  Advocates for Children

23.  Community norms are important risk and protective factors in substance abuse  Community and family values are also key  Education  Youth striving and thriving  Healthy development  Healthy workforce  Public safety

24. Community Values Family Values Community Education on Substances Community Norms Environmental Strategies Past success with underage drinking Androscoggin County slashed underage drinking rates – lowest rate in Maine.

25.  Impairment  Health  Future Success  Addiction  Perception of Harm and Normalization

26.  Heavy marijuana use is linked to an increased risk of a motor vehicle crashes.  Nationally, in 2011, 57% of Emergency Department visits for illicit drug use among 12-24 year olds involved marijuana.  Using marijuana weekly or more has also been shown to double a teen's risk of depression or anxiety.  Ashbridge, M. & Hayden, JA (2012) Acute Cannabis Consumption and Motor Vehicle Collision Risk: Systematic Review of Observational Studies and Meta-analysis. British Medical Journal, 344:e356.  Substance Abuse and Mental Health Services Administration, Drug Abuse Warning Network, 2011:National Estimates of Drug- Related Emergency Department Visits. HHS Publication No. (SMA) 13-4760,DAWN Series D-39. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013  Hayatbakhsh, M.R. et al. (2007) Cannabis and anxiety and depression in young adults: A large prospective study. Journal of the American Academy of Child and Adolescent Psychiatry, 46(3):408-17.  Patton, GC et al. (2002) Cannabis use and mental health in young people: cohort study. British Medical Journal, 325:1195-1198.

27.  Studies indicate that problems with attention, learning, memory and processing speeds can be associated with heavy marijuana use during adolescence.  The amount of tar inhaled by marijuana smokers and the level of carbon monoxide absorbed are 3 to 5 times greater than from tobacco smoke.  Marijuana contains more cancer causing chemicals than tobacco.  Meier, MH et. al (2012) Persistent Cannabis Users Show Neuropsychological Decline from Childhood to Midlife. Proceedings of the National Academy of Sciences. 109(40) e2657-e2664.  Jacobus, J., Bava, S. et. al. (2009) Functional Consequences of Marijuana Use in Adolescents. Pharmacology, Biochemistry and Behavior 92(4).  Drugs and Human Performance Fact Sheets - Cannabis / Marijuana ( D 9 -Tetrahydrocannabinol, THC). National Highway Traffic Safety Administration, n.d. Accessed at: http://www.nhtsa.gov/people/injury/research/job185drugs/cannabis.htm.http://www.nhtsa.gov/people/injury/research/job185drugs/cannabis.htm  The British Lung Foundation (2012) The Impact of Cannabis on Your Lungs. Accessed at: http://www.blf.org.uk/Files/8ec171b2- 9b7e-49d9-b3b1-a07e00f11c05/The-impact-of-cannabis-on-your-lungs---BLF-report-2012.pdfhttp://www.blf.org.uk/Files/8ec171b2- 9b7e-49d9-b3b1-a07e00f11c05/The-impact-of-cannabis-on-your-lungs---BLF-report-2012.pdf

28.  Marijuana use in teens has been linked to lower academic performance and reduced job prospects.  Heavy marijuana users experience attention and memory problems which last beyond the time when they are high. Studies indicate these problems can worsen with years of regular use.  Meier, MH et. al (2012) Persistent Cannabis Users Show Neuropsychological Decline from Childhood to Midlife. Proceedings of the National Academy of Sciences. 109(40) e2657-e2664.  Solowij N, Stephens RS, Roffman RA, et al. (2002) Cognitive Functioning of Long-term Heavy Cannabis Users Seeking Treatment. JAMA, 287(9):1123-1131.

29.  Research has established that marijuana is addictive and that it is three times more likely to lead to dependence among adolescents than adults.  About 1 in 6 of those who start using marijuana in their teens develop addiction  Nationally, in 2011, 872,000 persons reported receiving treatment for marijuana use  Gfroerer, JC, Wu, LT., & Penne, MA. (2002). Initiation of Marijuana Use: Trends, Patterns, and Implications (Analytic Series: A-17, DHHS Publication No. SMA 02-3711). Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applied Studies.  Wagner, FA & Anthony, JC (2002) From first drug use to drug dependence; developmental periods of risk for dependence upon cannabis, cocaine, and alcohol. Neuropsychopharmacology 26(4), 479‐488.  Substance Abuse and Mental Health Services Administration, Results from the 2011 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-44, HHS Publication No. (SMA) 12-4713. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012.

31.  Today’s marijuana is far more potent: The average THC content in marijuana has risen from under 4% in 1983 to more than 10% in 2008.  Greater marijuana potency means a smaller amount can make someone higher, faster- and perhaps far more intoxicated than they can handle.  Mehmedic Z, et al (2010) Potency Trends of r9-THC and Other Cannabinoids in Confiscated Cannabis Preparations from 1993 to 2008. Journal of Forensic Science, 55(5):1209-17.  ibid

32. THC: Psychoactive Ingredient 32

33.  Marijuana use, and its impairment of motor coordination and reaction time, doubles the risk of car crashes.  Cannabinoids, the drug class that includes marijuana, ranked as the number one drug found in Maine impaired driving cases (Jan 2009-Aug 2011) when a Drug Recognition Expert was called in.  M. Asbridge, J.A. Hayden, J.L. Cartwright. (2012) Acute cannabis consumption and motor vehicle collision risk; systematic review of observational studies and meta-analysis. British Medical Journal, 344 : e536: DOI: 10.1136/bmj.e536  Brunell, D. (Maine Dept. of Transportation), Pierce, S. (Maine Dept. of Health and Human Services), Drug Recognition Experts. (March 2012) Maine Drug and Alcohol Crash Related Data. [Powerpoint slides]

34.  Don’t barrage your audiences with data  Give them what they want  Listen to their fears and concerns (they are usually in the questions)  We are immersed in this, most in our audiences are not. Keep it simple and straightforward

35. SHOW them that today’s marijuana is not the marijuana of the 60s.

37. Making Drug Use Appealing to Youth

40. Get this out into the community!

41.  Two town halls held in Lewiston in 2014  Town Hall #1 – May 2014  Was part of DFC workplan submitted in March 2013  Goal – educate public on new marijuana data, latest research, and to hear from professionals in the community dealing with issues first hand  Town Hall #2 – October 2014  Request from City of Lewiston and Lewiston/Auburn Public Health Committee  Goal – address emerging questions from the community around marijuana, learn from local experts, and give parents prevention tools.

42.  Opening Remarks  Presentation  Panel Moderated by: Mike Chavez, Maine State Police  Kevin Cowell, D.O., MPH – DFD Russell Medical Centers  Vicky Wiegman, M.Ed, CAS – Lewiston High School  Travis Doboszenski – Tri-County Mental Health Services  Craig Johnson - Lewiston Police Department  Scott Gagnon, MPP– Healthy Androscoggin  Q & A with Panelists  Just One Thing – How will you get involved?

43.  Welcome/Introduction (10 mins)  Presentation (20 mins)  Local data  Latest science on marijuana & impacts to health  Prevention tips for parents  Moderated Panel (30-40 mins)  Youth  Medical  Law Enforcement  Education  Behavioral Health  Q & A (20-30 mins)

45.  Moderate attendance but huge local & state media coverage.  Covered by all major news affiliates and state papers.  Stories from medical and behavioral health treatment professionals hit home  Visuals of the edibles were eye-opening and jaw-dropping  New partnerships were forged with panelists

46.  Plan early  If funding is an issue, look for free spaces  May Town Hall was in a public library  October Town Hall was at the middle school  Think about transportation and accessibility  Prevention tips for parents  Get audience engaged.  Promotion, promotion, promotion! (not just ads) – listservs and networks

47.  Make a plan for Q & A  Live mic or screened questions?  Discuss how you will handle “controversy”  And prepare panelists  Don’t get hooked into a debate  Have resources available for concerned audience members Don’t be afraid of controversy, just be prepared for it.

48.  Monitor marijuana coverage in your area.  Who has the “marijuana beat”?  They aren’t covering prevention? Reach out and say Hi!  Relationship building  Meet & Greet, Follow on Twitter  Media list – maintain  It’s a partnership – symbiotic relationship  You want your messages out, they really want to cover marijuana  Reporting isn’t always going to be great, but don’t give up on them.

49.  Don’t forget the smaller papers, public access, college papers  Get coalition members and multiple sectors involved.  Educators sharing academic impacts  Doctors sharing what they see & hear in exam room  Employers sharing workplace safety/productivity issues  Message validation through triangulation  More buy-in as the public hears from more voices.

50. Two out of Three Maine Cities Reject Legalization Ordinances

51.  York – Board of Selectmen refuse to put on ballot  South Portland – Passes 52% vs 48%  Lewiston – Fails 45% vs 55%

52. OneTwoThree/FourFiveAbsentee LePage (R)23.226.936.135.932.3 Michaud (D)66.762.353.955.155.7 Bear Bait Ban68.467.858.959.964.4 Legalize MJ57.855.450.052.642.9 Districts that had strongest support for Democrat and for the bear- baiting ban had the strongest support for marijuana legalization ordinance. Districts with stronger support for Republican showed less support for marijuana legalization ordinance. Districts that had strongest support for Democrat and for the bear- baiting ban had the strongest support for marijuana legalization ordinance. Districts with stronger support for Republican showed less support for marijuana legalization ordinance.

53. 1234567C-V LePage (R) 41.058.029.359.140.062.858.345.6 Michaud (D) 50.934.362.732.950.529.932.945.6 Bear Bait Ban 59.046.463.946.253.344.150.056.1 Legalize MJ 54.241.165.742.656.943.645.436.6 Every district that voted for Governor Paul LePage (R) also voted against the bear-bait ban and the marijuana legalization ordinance. Absentee ballots were against legalization almost 2 to 3, however were split between Gubernatorial candidates and voted in favor of bear-bait ban. Every district that voted for Governor Paul LePage (R) also voted against the bear-bait ban and the marijuana legalization ordinance. Absentee ballots were against legalization almost 2 to 3, however were split between Gubernatorial candidates and voted in favor of bear-bait ban.

54.  The public has questions and concerns  You have the science and research  Meet the community where they are at  Get the community involved!  You can do it!  You can have an impact!

55. www.facebook.com/healthyandroscoggin www.facebook.com/MaineProjectSAM www.facebook.com/healthyandroscoggin www.facebook.com/MaineProjectSAM @ScottMGagnon @HealthyAndro @maine_SAM @ScottMGagnon @HealthyAndro @maine_SAM

56.  Maine Alliance to Prevent Substance Abuse  http://www.masap.org/site/mapsa.asp http://www.masap.org/site/mapsa.asp  Maine Parents – prevention tools for parents  http://www.maineparents.net http://www.maineparents.net  Healthy Androscoggin  www.healthyandroscoggin.org www.healthyandroscoggin.org

57. Scott M. Gagnon, MPP 300 Main Street Lewiston, ME 04240 207-795-2120 Healthy Androscoggin: gagnonsc@cmhc.orggagnonsc@cmhc.org SAM Maine: scott.m.gagnon@gmail.comscott.m.gagnon@gmail.com