State prevention efforts criticized


In one of the neatly maintained, brick buildings lining a street on the campus of the Colorado Mental Health Institute at Fort Logan in southwest Denver is a hive of offices where about 60 state employees focus on the prevention and treatment of mental health problems, including substance abuse and addiction.

Their work in the Office of Behavioral Health is cut out for them in Colorado, home to some of the highest drug-use rates in the nation and one of the country’s worst track records for public funding of mental health care, especially for youths. The state almost entirely bankrolls the office’s efforts to prevent substance abuse and addiction with an $8.3 million federal grant.

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How much did Colorado budget in fiscal 2014-15 for the office’s substance prevention work? About $34,000.

“Let’s just say this state talks a good game about wanting to prevent problems but ultimately aligns its priorities much more closely with the interests of industries whose profits come from addiction and use of a harmful drug,” said Bob Doyle, executive director of the Colorado Tobacco Education and Prevention Alliance and chairman of Smart Approaches to Marijuana, a policy group opposed to marijuana legalization.

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“It is especially obvious that the state of Colorado is prioritizing marijuana and the marijuana industry over public health and welfare and basically ignoring many effective prevention strategies and professionals,” he said.

Money funds messages

Indeed, the Office of Behavioral Health, which is the only state office specifically charged by statute with the development, coordination, supervision and evaluation of statewide efforts to prevent drug abuse and addiction, hasn’t received a dollar this fiscal year to support efforts aimed at preventing marijuana use.

Instead, money for marijuana prevention and education initiatives has been channeled to the Governor’s Office of Marijuana Coordination and to the Prevention Services Division of the Colorado Department of Public Health and Environment, which provides information on its website about “marijuana and your health” under the heading “Retail Marijuana” — the state’s preferred term for recreational marijuana.

Unlike the OBH, where every staff member is a certified prevention specialist holding an internationally recognized credential, employees at the helm of Colorado's marijuana prevention and public education efforts have comparatively little training and work experience in substance prevention and issues related to substance treatment. None is a certified prevention specialist.

But there’s a more important difference: Unlike these better-funded prevention groups, the OBH does not invite drug industry executives to help it develop and execute prevention strategies or lead community meetings.

“We have learned early on (in) substance abuse prevention from tobacco and alcohol that the industry has no place with direct prevention,” said Stan Paprocki, who retired March 1 as the OBH’s director of community prevention programs.

Paprocki has more than 28 years of professional experience in substance prevention and treatment and recently wrapped up supervision of a federally funded, five-year, $11 million campaign aimed at reducing underage alcohol consumption, especially among Latino youths, in Adams, Denver, Pueblo and Weld counties. The OBH’s work was so effective that it met its five-year goal to reduce binge drinking among Latino youths in three years.

Paprocki said it didn’t occur to him or his colleagues to ask alcohol industry executives to consult on the campaign.

But working with marijuana industry executives has been a consistent method employed by the CDPHE and governor’s office when developing prevention and public awareness campaigns. The latter issued this edict when searching for a creative team to produce its three-week, $2 million “Don’t Be a Lab Rat” campaign: “Offerer will demonstrate ability to navigate and thoughtfully address the potential of involving representatives from the pharmaceutical and marijuana industry as part of a collaborative effort toward a successful campaign.”

Promotion or prevention?

The resulting initiative was developed with input from marijuana industry representatives and from health care providers who urged state officials to distance themselves and the work from industry involvement. They presented state officials with published, peer-reviewed studies showing that industry involvement in prevention campaigns has been associated with increased substance use rates.

“We know what works. We know that media working with interventions that change environments and speak to personal drug use prevent use. But that’s not what industry wants to do,” said Harold Holder, a world-recognized researcher in substance prevention science and the former director of the Prevention Research Center of the Pacific Institute for Research and Evaluation.

One element of the campaign was a 30-second video focused on teens getting high in a car. The spot has no voiceover. Viewers instead must read a brief message alluding to debated brain research that is transposed over footage of youths who appear to be having a great time as they smoke pot.

“It was all just so stupid because there was no clear prevention messaging,” said William Crano, a professor of psychology at Claremont Graduate University in California who specializes in the development of media to support scientific, evidence-based drug prevention initiatives.

Crano knows a thing or two about angering bureaucrats who develop anti-drug messaging without full regard for its effectiveness. He was an early and outspoken critic of the federal government’s memorable — but ineffective — “This Is Your Brain On Drugs” campaign of the 1980s.

“I quickly became a pariah with our Office of National Drug Control Policy and the drug czar,” Crano said with a laugh. “But what I care about is effective messaging that changes behaviors and attitudes to prevent drug use.”

Research shows effective drug prevention campaigns are not made up only of media, such as websites, billboards and television commercials. Successful campaigns also include an array of regular and consistent education carefully developed for specific audiences and community interventions that limit access to, and availability of, a substance in various ways, including price, Crano said.

He has even sharper words for Colorado’s recently released “Good to Know” campaign — which also was crafted with significant input from marijuana business owners.

Supervised by the Colorado Department of Public Health and Environment, “Good to Know” so far is telling people not to avoid marijuana use but, rather, to use the drug responsibly. The tactic mirrors the alcohol industry-driven “Drink Responsibly” campaigns that have been shown to increase alcohol use, Crano said.

“It’s an old and dirty trick the alcohol industry loves — and pays many millions of dollars for because it’s obviously working for their bottom line,” he said

“The message isn’t prevention; it’s about creating acceptance of alcohol use, which drives up sales. So, Colorado isn’t preventing marijuana use. It’s now in the business of promoting it.”

Many of the state’s addiction treatment providers, substance prevention professionals and advocates working in their communities to reduce drug use and abuse also say the CDPHE and the Governor’s Office of Marijuana Coordination have given marijuana industry representatives too much influence. Among them is JoMcGuire, a Colorado Springs-based consultant who specializes in helping employers maintain drug-free workplace policies and serves on the national board of the Drug and Alcohol Testing Industry Association.

In August, McGuire attended a CDPHE event headlined “Marijuana Workshop for State and Local Public Health,” during which a lawyer for the marijuana industry and a physician who recommends marijuana spoke. She was particularly surprised by the bud tender who lectured the safe, regular use of highly potent THC concentrates.

“None of what these marijuana- industry representatives said was supported by one shred of responsible science, and it was absolutely stunning to me that our state health officials gave these people such a place of authority and legitimacy,” she said.

“It’s one thing if CDPHE officials want to better understand the industry by meeting with people and taking their own notes, but it is very much another and beyond ridiculous for them to make marijuana industry leaders keynote speakers who get to dominate the floor and drive the agenda.

“It’s like inviting Philip Morris executives to help us learn how to use tobacco and develop our next anti-smoking campaign.”

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