By R. Scott Rappold
WebMD Health News
Reviewed by Hansa D. Bhargava, MD
Oct. 31, 2016 -- Pueblo, a town of 110,000 people in the prairie of southern Colorado, has had many identities over its 175 years.
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Frontier trading post. Agricultural hub. Steel manufacturing capital of the West.
Since Colorado voters legalized marijuana in 2012, the first state to do so, Pueblo County has become home to more than 100 recreational pot businesses, from massive grow operations to stores where anyone over 21 can walk in and buy some weed. The mild climate is good for growing, and the local regulatory climate is friendly for marijuana businesses.
But while the industry has been good for the economy, some question how healthy it has been for the community. A citizens group, concerned about the impact of legalization on teens and overall public health, has petitioned to shut down the industry here. On Nov. 8, Pueblo could be the first community in Colorado to reverse legalization through a popular vote.
It's a date that may be a watershed moment in the history of cannabis. Five states -- Massachusetts, Arizona, California, Nevada and Maine -- are poised to join Alaska, Colorado, Washington, Oregon, and Washington, D.C., in legalizing recreational marijuana use. Recent polls suggest it could succeed in all five.
Meanwhile, the debate in Pueblo provides a cautionary tale that 3 years into this experiment, the jury is still out on how beneficial legal recreational pot has been for Colorado.
Teen Use Rising
Paula McPheeters was driving her son home from school in 2014 when he asked about the recreational marijuana store that had opened a mile away. The Drug Abuse Resistance Education (DARE) program had taught him that pot was bad. How could they sell it in a store?
McPheeters, who had voted against legalization, decided to do something about it. She co-founded Citizens for a Healthy Pueblo, the group that gathered signatures to get the ban on the ballot.
"The health and safety of our community is more important than the marijuana industry," says McPheeters, a community college administrator. "What recreational marijuana has brought ... is a tacit approval of drug use, advertising, full-page ads for marijuana use, and a store less than mile from my child's school. I don't think anybody voted for that."
She points to surveys that show Pueblo County has the highest rates of teen marijuana use in the state, with 32.1% of high school students reporting using within the past 30 days, compared with 21.2% statewide. Among middle school students, 22.8% reported using in within the past 30 days.
In Washington, the other state to legalize pot in 2012, there has also not been a big change in teen use. A recent study showed there was virtually no change in the proportion of teens who reported it was easy to access marijuana in 2010: 55%, compared with 54% in 2014.
Supporters of the ban in Pueblo also say marijuana has worsened Pueblo's homeless problem and is a factor in the dramatic increase in illegal home grow operations being busted in the county. Illegal growers, they say, are "hiding in plain sight."
Doctors at Pueblo's two hospitals share the concerns. Both Parkview Medical Center and St. Mary-Corwin Medical Center have issued public statements in support of the ban.
Steve Simerville, MD, is director of St. Mary-Corwin's neonatal intensive care unit. He says that before legalization, it would have been extremely rare to see an infant born with THC, the psychoactive ingredient in marijuana, in their systems. This year, 10% of babies born there have tested positive, meaning the mother not only used marijuana, but used it fairly recently before the birth.
"We've known for years, since the '70s, that babies exposed to marijuana have diminished school performance, are more likely to drop out, more likely to experiment later in life," says Simerville.
Doctors don't test every newborn, but rather verbally screen the mothers. Simerville says 25% to 50% of women and infants are tested, and that 25% to 50% of those who are tested come up positive. He believes the prevalence of marijuana stores and their advertising have convinced pregnant mothers that pot is a safe way to control the nausea and other side effects of pregnancy.
As a pediatrician who also works with teens, he supports kicking the industry out of Pueblo simply to reduce availability.
"If there's a recreational marijuana ban in Pueblo County, where are you going to get your recreational marijuana? You're going to get it from a dealer or you're going to get it from out of the county," he says. "Is it going to go away? No, but my exposure or ability to get exposed is going to become more difficult, and it's going to protect some teenagers."
The hospital's emergency department has seen an increase in patients for whom marijuana was noted as the patients' primary diagnosis, from 768 in 2015 to 839 in the first half of 2016.
In March, the Colorado Department of Public Safety released a comprehensive analysis of legalization's impact. It found:
- Marijuana use has gone up among older Coloradoans since legalization, from 21% in 2006 to 31% in 2014 among people ages 18-25, according to data from the National Survey on Drug Use and Health from the Substance Abuse and Mental Health Services Administration.
- It also increased among those 26 and older, from 5% to 12%.
- Hospital visits for marijuana increased from 803 per 100,000 to 2,413 per 100,000 last year.
- Marijuana, or marijuana in combination with other substances, accounted for 15% of impaired driving arrests, up from 12% the year before.
- Among those ages 12-17, marijuana use in the last 30 days shows a slight increase, although the report points out it's not a statistically significant change from 2009, before legalization. Still, it's in contrast to downward trends in the use of alcohol, cigarettes, and other illicit substances among teens.
But the report failed to make sweeping conclusions on the impacts of legalization.
"It is too early to draw any conclusions about the potential effects of marijuana legalization or commercialization on public safety, public health or youth outcomes and this may always be difficult due to the lack of historical data," the authors concluded.
Heidi Keyes co-founded Colorado Cannabis Tours after legalization, to cater primarily to visitors to Colorado. They get to visit grow operations, marijuana stores, local attractions, art and cooking classes, and pot-friendly hotels, all aboard limo buses where they can puff away.
Three years after legalization, business hasn't slowed. In fact, she has expanded to Oregon and Washington.
"It's not a typical stoner kind of thing. There are business people. There are couples. There are people who are retired and a lot of consumers between 35 and 65. Most of them are professionals as well," says Keyes.
"There are a lot of people coming out of the cannabis closet. They have been users their entire lives, and they felt like they needed to hide it, and they're coming here because they no longer need to hide it."
She believes marijuana is a factor in the tourist boom Colorado has enjoyed. Last year saw a record 77.7 million visitors who spent $19.1 billion and generated $1.13 billion in state and local tax revenue, according to the Colorado Tourism Office. While most came to ski or visit the Rocky Mountains, visitor surveys showed 23% visited Colorado at least in part for marijuana.
Taxes on marijuana sales, meanwhile, generated $88.2 million for state and local governments in 2015, $24 million of which is earmarked for school construction. That's up from $25.3 million in state and local taxes from the year before.
Marijuana sales have already generated more tax revenue this year: $124.9 million as of August.
Back in Pueblo, the industry says it has created 1,300 jobs in the community. Taxes on sales have generated $3 million for local governments, and a new tax on growing operations is expected to generate another $3.5 million annually.
Jim Parco, an economics professor at Colorado College, owns a recreational marijuana store next to his family's farm in Pueblo County. If the marijuana ban, known as Proposition 200, passes, he'll have to fire his six employees. Businesses would have to close their doors by Oct. 31, 2017.
"If Proposition 200 passed, it would financially destroy us and most of the business owners in the community. ... Most of us are locally owned and operated. The hardest thing would be to fire the employees and close the door," says Parco, spokesman for Growing Pueblo's Future, an industry group formed to fight the measure.
"These are not minimum-wage jobs. These are state-licensed, above-minimum-wage jobs, many of which have health benefits. You're going to get rid of those jobs, and in Pueblo, it's a depressed economy. Since the steel industry left 30 years ago, our community has struggled to create jobs and economic vitality," he says.
He calls ban supporters "a vocal group of the minority of the community." Even if it passes, he says, it won't affect marijuana possession or use, nor will it affect the 75 medical marijuana dispensaries in the county.
As for the opposition of the hospitals to marijuana, he believes the medical establishment has revenue to lose with legal marijuana, pointing to research that suggests prescription drug use decreases when marijuana is available.
And he adamantly denies that the industry has anything to do with the spate of illegal grows in the county or minors getting hold of marijuana. He says there have been no cases here of stores illegally selling to anyone under 21.
"It's a controlled substance. Nobody is supporting kids having it. That's why we don't even sell medical (marijuana), because 18-year-olds can get it," Parco says. "I can tell you if kids are getting into it, that's a social problem that happens at home. People can grow. They can get it elsewhere, but they're not getting it from the regulated industry."
At its heart, the debate is about the future of the community and what kind of economy it will support. And McPheeters, with Citizens for a Healthy Pueblo, knows people far beyond Pueblo are watching.
"This isn't the kind of community I want to leave for my kids, frankly. I want them to have better than I had, not less than I had," she says.
"People need to look at Colorado, and especially Pueblo. Why would citizens rally against this industry if it delivered everything as promised? That's a question I would ask the other states (voting on legalization). If it's so great and the streets are paved with gold, why are people now against it? The answer is the harms."
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