Dr. Nicole Tartaglia can sense when the question is coming.

The Children’s Hospital Colorado pediatrician has worked with children on the autism spectrum for almost 15 years.

“I’ll ask if they have any other questions,” Tartaglia said. And there’s a pause before one of the caregivers blurts out the question they’ve been holding back since stepping into the room: Could marijuana help my child?

“From a basic science perspective, there are a lot of reasons to hypothesize why it would be helpful,” Tartaglia said.

At its most basic level, autism is a spectrum of disorders that affect brain development, and researchers like Tartaglia suspect that cannabidiol, more commonly known as CBD, could help correct some of the dysfunction in a child’s system that causes symptoms like irritability, speech impairments, anxiety and seizures. But there’s been “very limited research” into how effective CBD products are — leaving doctors and families to navigate these decisions with anecdotal stories gleaned from friends and internet groups.

That’s where Colorado’s Marijuana Tax Cash Fund, an account filled by tax revenue from the sale of medical and recreational cannabis, can help. The Colorado Department of Health and Environment offers money from that fund to researchers who want to investigate the therapeutic uses of marijuana in rigorous, random control trials. In November, the agency awarded Tartaglia and her team $1.35 million for a three-year study on how CBD affects children and adolescents with autism spectrum disorder.

“I really feel that as a state we have a responsibility to give back to our Colorado community, as well as the national community, and answer these important research questions,” Tartaglia said.

Her grant is just one of more than 60 different ways state lawmakers spend Marijuana Tax Cash Fund dollars across the state. Most of the money goes out through competitive grants, and unlike the BEST or Public School funds, lawmakers gave themselves broad authority to decide how to spend MTCF dollars.

The fund is the largest pool of marijuana tax revenue in the state. Colorado collected $251 million during fiscal year 2017-2018, and 49 percent of that went into the Marijuana Cash Tax Fund. Three funds that support K-12 education received a collective $98 million, $16.7 million went to local governments and $12.4 million went into the general fund.

State law technically allows the General Assembly to appropriate its tax fund money for any purpose, but state legislators created a set of “allowable purposes” such as mental health treatment, marijuana research and law enforcement training and to provide services to school-age children. Each year, lawmakers tinker with the cash fund by running bills to create new grants and by adjusting how much marijuana money, if any, goes into programs they created in previous years.

In 2018, for instance, they set aside $1.48 million that local police districts can apply for if they lost money because of a series of reforms the state made to civil forfeiture laws. (Civil asset forfeiture is when law enforcement seizes money and property that’s suspected of being tied to a crime, sometimes before anyone is charged.)

Early literacy grants show results

One of the tax fund’s success stories is the early literacy grants. They last for three years and give local school districts the money to choose from a list of approved materials, coaches and teacher training programs designed to raise reading scores for kids in kindergarten through third grade.

“We made almost a 10-point increase since before the grant, which is really pretty fabulous,” said Cary Palumbo, the executive director of elementary education for Pueblo City Schools.

Palumbo was the principal at Ben Franklin Elementary when the state awarded her nearly $262,000 for the 2017-18 school year. It was a huge opportunity, she said. The school serves students who come from lower-income families; nearly 82 percent of her kids received a free or reduced-cost lunch that year. And the state had been threatening to close Franklin just a few years earlier because of poor student performance.

Palumbo bought a coaching package from a company called Growing Educations Practices with her school’s grant money, which included a “mini-academy” for teachers during the summer, one-on-one coaching, data analysis, monthly school visits and lesson plans.

When the kids left school in the spring, 86 percent of them were reading at their grade level or above.

“It’s the highest scores we ever had,” Palumbo said. “I even looked in the archives. It’s the highest in the history of the school, as far as I know.”

And the kids didn’t fall victim to the summer slide — the loss of skills that sometimes happens during a child’s summer break.

“The lack of a slide is even a bigger deal,” Palumbo said. “They normally lose 15 to 20 percent of the skills. It’s like starting over year after year.”

In her new role with the district, Palumbo sent the grant application to all her elementary schools and encouraged them to apply. She admitted, though, that it’s a little weird that a person smoking a joint in Denver right now could be partly responsible for teaching her students the alphabet next year.

“Here’s the thing: If it has to be legal, education might as well be the beneficiaries of that,” Palumbo said. “I’m not going to say that it doesn’t bother me. But when I see the good things happening for kids, that’s the one way I can, in my own mind, justify it.”

Pueblo City Schools isn’t the only district to show success from its early literacy grants. Nearly one in four kindergarten students at Aragon Elementary school in Fountain started last year with a “significant reading deficiency,” Colorado DOE spokesman Jeremy Meyer wrote in an email. “By the end of the year, only 4 percent were in that category.”

Similarly, the Moffat County School District saw the percentage of their kindergarten through third-grade students who read well below their grade level at the beginning of the school year drop from 31 percent to 21 percent.

Colorado’s Department of Education awarded slightly less than $4.4 million in early literacy grants for the 2017-2018 school year. That’s about 20 percent of the money the department gets from the Marijuana Tax Cash Fund. The rest went to grant programs for school health professionals, drop-out prevention, marijuana education materials and school bullying. The total amount the state spends on education is about $7 billion — which means MTCF contributes about 0.3 percent of overall funding.

Even if every single marijuana tax dollar the state collected went to education, it would amount to only 3.6 percent of the annual education budget.

Marijuana tax dollars, though small when compared to the overall cost of Colorado’s government services, do have one outsized impact: Pushback from voters when public entities try to raise taxes.

“We have recreational marijuana in Colorado, and we tax it,” Moffat County School District Superintendent Dave Ulrich said he hears frequently. “How could it possibly be that the school is underfunded?”

His district receives money through the early literacy program, and he’s happy to have it. But it’s a one-time influx of money for a specific purpose. The grants are not ongoing sources of revenue, and some of the programs require local taxpayers to raise a certain amount of matching funds.

Keeping youth out of trouble

Another reason it can be hard to see the impact of Marijuana Tax Cash Fund dollars is because millions backfill existing programs that would have otherwise been cut. The fund supports at least five programs that were previously funded by a settlement with tobacco companies. These include programs for drug and alcohol abuse, mental health services for adult and juvenile offenses, and several local public health agencies.

“We have gotten that $100,000 diversion grant for years and years,” said Lori Mueller, the executive director for YouthZone.

Colorado’s Ninth Judicial District contracts with YouthZone, a Glenwood Springs-based nonprofit, for its juvenile diversion services. These are six- to 12-month programs for kids between the ages of 10 and 17 who commit low-level crimes and don’t have a criminal record. The programs keep the kids out of juvenile detention centers and hopefully from committing crimes in the future.

YouthZone has won awards at the state and local level for decades, but the amount allocated by lawmakers has stayed relatively flat. The only new marijuana money YouthZone has received since voters legalized recreational cannabis is a $28,000 grant to help kids who use marijuana.

YouthZone uses that grant to pay for a few days of community service where kids clean cages at the local animal shelter, build homes with Habitat for Humanity or assist local maintenance crews.

Mueller would love to do more to curb youth marijuana use; 50 percent of the kids who come through her door use the drug regularly, she said.

The total amount awarded for the Tony Grampsas Youth Services Program for the prevention of youth marijuana use in the 2018-19 fiscal year was $1.37 million — almost the same amount as the grant Tartaglia received to study cannabidiol treatments in children with autism spectrum disorder.

CDPHE did get an additional $9.4 million for its substance abuse prevention programs.

The path to answers for parents

Tartaglia’s patient trial is tentatively scheduled to start during the summer of 2019. She plans to spend the first part of the new year finalizing the source of her CBD and waiting for the federal Food and Drug Administration to give her the green light.

She’s optimistic the data she collects will give her better answers to the questions parents ask her at the end of their appointments. Will CBD help with anxiety? Could it help my daughter communicate better? Will it stop his seizures?

“People hear a lot of positive, anecdotal experiences on Facebook groups or support groups,” Tartaglia said. “We hear those stories, and we use that to build our hypotheses, but we need to make sure it’s done in a rigorous and placebo controlled way.”

This trial, the doctor is sure, will be marijuana money well spent.