Our question this week comes from Guy Page, who wonders in Vermont: "As you may know, Vermont is considering similar legislation (to legalize marijuana). The connection between youth access and legalization is, of course, a matter of concern. Understanding that Alaska and Vermont are two very different places, could you please point me to some hard, or even semi-hard, data on how youth access has been affected?"
There's a lot going on in this question, so I'll try hard not to fly into a full-on stats-nerd Hulk-out over here.
First of all, because licensed sales have not yet begun in Alaska, any understanding of the public health impact of legalization here will necessarily be incomplete so far. That's the case for adults and youth. And even pets.
Because legalization and regulation have yet to manifest, our understanding of what's changed at this point isn't just half-baked, it hasn't even been put in the oven yet. It's kind of liquid at this point. Like an un-set crème brulee, maybe?
Read more Highly Informed: Seeking answers to Alaska's cannabis questions
Dr. Jay Butler, director of the state's Public Health Division and chief medical officer of the Alaska Department of Health and Social Services, said in a phone interview that we don't yet have much idea yet about what the impacts of legalization in Alaska are, and aren't likely to have a reliable picture for at least three or four years after licensed sales start.
"It may take some time for the market to mature and stabilize -- use patterns may vary if there are wide swings in supply and price early on," he wrote in an email. "That has been observed in some other areas after legalization. Therefore, it may take a period of several years before we will really know very much about the effects of legalization on use, the health of Alaskans, and the health care system in Alaska."
Known unknowns
But what about a baseline? Will we know if anything has changed for Alaskans?
Butler said that work is being done now to make sure that in three or four years, his division will be able to know more about what, if anything, may have changed in the years after licensed sales begin. But it's too soon to know now.
According to Butler, " the best visibility that we have" on youth cannabis use, though not necessarily access, comes from the Youth Behavior Risk Survey, a poll every other year about a variety of personal health issues taken anonymously by Alaska students in grades 9-12 after parents give permission. The same test is taken by students across the country, including students in Vermont, although Alaska is among a small number of states that require parental consent.
The most recent year of YBRS results come from 2013, when DHSS reports that participants were "1,247 students from 43 high schools selected to represent all public high schools (excluding boarding schools, alternative schools, correspondence and home study schools, and correctional schools) in Alaska." Information and results from many years are available online.
Results and details of the 2015 survey will be released on Nov. 16, according to DHSS, and it's something Highly Informed will likely follow up on.
In past years, the multiple-choice YBRS survey has asked about four marijuana-related things: The number of times have kids used pot; their age when they first used it; how many times they've used it in the last 30 days; and how they would rank the relative health risks if someone were to "smoke marijuana once or twice a week."
Butler said of the survey questions, "Those are fairly blunt instruments. (The survey) doesn't get into the details of usage or assess heavy use, which is where we might have the greatest concern from a public health perspective."
In the 2015 survey, a new question has been added about method of consumption: "During the past 30 days, how did you usually use marijuana?" The six answer choices include a set of common smoking methods, a list of foods, a list of beverages, and vaporizing.
When it comes to public health research, and making inferences from statistically valid surveying, language can be critical. For example, from answers to that question, we might infer things about teen access to commercial edible products, but picking one of those choices may not necessarily mean the teen had access to commercial edibles, maybe just homemade ones. But some uncertainty is the nature of surveying and statistical analysis.
Relative health risks associated with smoking, eating and vaporizing aside, access to infused foods is a primary concern when it comes to kids in legal states. The idea being that candy or sweets are more appealing and easier for young people to use (intentionally or accidentally) than, say, a honey blunt the size of Nancy Reagan's calf. Based on numerous studies, researchers believe that the earlier people first use cannabis, the greater their vulnerability is for a host of other risk factors, including their probability of becoming a heavy or dependent cannabis user.
Room for improvement
Butler said that despite the survey data's known limitations, it is valuable tool for assessing risk, and the best one we've got at this time. It's useful for comparison and benchmarking he said because it is standardized and has internal checks to keep data useful, it has numerous years of results, and is part of a coordinated national survey effort.
That all means that such survey results are not an absolute measure of use rates, just a useful snapshot. And though they don't measure youth access to cannabis at all, the odds are good that if a teen has used pot, he or she has some kind of access to it. Plus, survey results are far better for getting an idea of use rates than measuring something like the decibels of stoner rock coming from notorious teenage woodland hangouts. Except for times when survey returns don't measure up to internal standards for reliability, results from any state's YRBS can be compared with themselves across time, with other states, and with national averages.
According to highlights of the 2013 survey, for instance, 19.7 percent of Alaska teens surveyed reported using pot in the last 30 days, compared with a national average at 23.4 percent. And that use rate appears to be declining in Alaska. The survey compilers say that the downward trend was statistically significant between 2013 and 2003, when 23.9 percent of respondents said they used in the last 30 days.
No matter where drugs and alcohol are available, legal or not, young people having access to them is a concern. But in legal pot states, the issue is being watched very closely. In Colorado, the state with the longest track record with a legal recreational marketplace, teen use rates have appeared to decline. Officials there have only begun asking marijuana-specific questions of adults participating in its behavioral risk survey since 2014, after retail sales began. Time and multiple data sets are essential to perceiving trends, so we'll have to wait for a better picture from Colorado.
When it comes to getting more detailed data in Alaska about youth cannabis use or new questions about access, Butler said that any changes to the YRBS would have to be approached carefully so as not to interfere with the national program's data. He also said that discussions are ongoing with public health officials in other legal states about ways to get a finer-grained picture of the issue and maybe even get together to standardize methods for better comparison. But all that is still early-stage.
But really, asking kids may not end up being the best way to gauge their access to legal cannabis after all. Colorado has started asking as part of an adult survey whether parents secure their cannabis products at home, and more than 70 percent said they keep it locked up. Does that mean kids can't buy illegal pot in the school parking lot, or find it some other way that doesn't involve their parents stash? Not necessarily. Conversely, access to pot doesn't necessarily translate into use in all cases.
Despite caveats like these for understanding the data, results like these, whether in Alaska or not, are a piece toward better understanding the effects of this huge change in drug policy. Hopefully, in their efforts to understand, public health officials won't have to choose one sort of survey over another.
Have a question about marijuana news or culture in Alaska? Send it to cannabis-north@alaskadispatch.com with "Highly Informed" in the subject line.