WA HCA - Webinar - Impacts of Marijuana Legalization in Washington
(September 29, 2020)

• Washington State Health Care Authority (WA HCA) Prevention Policy and Project Manager Christine Steele was joined by WA HCA Prevention Research and Evaluation Manager Tyler Watson to present interpretations of “many studies” to an unclear audience. No direct visibility was provided as to the quantity or identity of observers, nor the intended audience(s) for the high-level overview provided of very particular interpretations of data drawn largely from the post-legalization period in Washington, but also often dated several years.
• There were some interesting observations, revealing “using” of language, and some surprising failures of fact  - such as a belief that consumers were paying a 25% excise tax due to “industry lobbying” (the excise tax was raised to 37% in 2015).
• The slidedeck was well-annotated with references to data sources and studies. Cannabis Observer will request meeting materials associated with the event to tell more of the story.

Here are some observations from the Tuesday September 29th Washington State Health Care Authority (WA HCA) webinar on “Impacts of Marijuana Legalization in Washington.”

My top 3 takeaways:

• Prevention officials with WA HCA opened the event with an explanation of their goals for the webinar and background on the state’s cannabis legalization policy.
  • In addition to purchasing health care for Medicaid eligible Washington residents and public employees, WA HCA procures funding for the development and implementation of substance use treatment and prevention programs with the intention of "integrating physical health and behavioral health services for better results and healthier residents."
  • WA HCA staff and other public employees on the call:
    • Christine Steele, WA HCA Prevention Policy and Project Manager
    • Tyler Watson, WA HCA Prevention Research and Evaluation Manager
    • Sabrina DiGennaro, Washington State Department of Social and Health Services (DSHS) Department of Behavioral Health Research (DBHR) Prevention Fellow
    • Alicia Hughes, WA HCA Strategic Development and Policy Supervisor
    • As Cannabis Observer reported in the event’s initial update, “No direct visibility was provided as to the quantity or identity of observers, nor the intended audience(s) for the high-level overview provided.”
  • Steele said they were going to offer impressions of the “result of many studies and collaborations with people studying the impact of [Initiative] 502.” She noted that she was "overseeing the Dedicated Marijuana Account (DMA) at” WA HCA (audio - 3m).
    • Learn about WA HCA’s allotment from the DMA, according to the 2020 supplemental biennium budget.
  • Watson began the presentation with a background on I-502, alleging that the excise rate was "going to be 37%" but “due in part to industry pressure that got lowered” to 25% (audio - 2m).
    • An initial 25% excise tax assessed across all tiers of the supply chain was consolidated by lawmakers in 2015 to a 37% excise tax collected from consumers by retailers. For more information, see details at the Washington State Liquor and Cannabis Board (WSLCB) and the Washington State Department of Revenue (DOR).
• Presenters offered analysis of particular emerging trends around cannabis use such as increased access and social acceptance, driving after use, increased use by senior citizens, as well as COVID-19 impacts on use and underage “exposure.”
  • Looking at reported youth use according to the state’s Healthy Youth Survey (HYS), Watson provided “bigger picture evidence” on Marijuana Use Trends (audio - 11m).
    • Watson reviewed HYS statistics of cannabis use among school-aged youth, noting age of first use and use in the last 30 days from 2006 to 2018 had stayed “about the same.” He added that the data suggested some youth were beginning cannabis use “at a later age.” Watson pointed out that the Washington State Office of the Superintendent of Public Instruction (OSPI) tracked expulsions and suspensions of students due to cannabis and found “no observed changes” before and after I-502’s implementation.
      • Learn about WSLCB’s role in HYS and other prevention efforts.
    • Watson said use rates in young adults aged 18 to 25 “hadn’t seen a lot of change” beyond a “small uptick.” He stressed that “half of young adults are not using marijuana at all.”
    • Steele shared slides about “very clear” increases in overall use among adults as well as first use by seniors 55 and older. She said that information from the National Survey on Drug Use and Health (NSDUH) found “from 2002 to 2014, the proportion of adults aged 50 to 64 who reported marijuana use in the past year has more than tripled.” Steele noted this trend happened against a backdrop of medical marijuana legalization around the country in addition to the start of recreational cannabis legalization in Washington.
  • Staff then talked about Marijuana Access Trends (audio - 6m).
    • Watson reviewed HYS data on perception of “easy access to marijuana” amongst school aged youth from 2006-2018 in addition to young adult perceptions of accessibility according to the Washington Young Adult Health Survey. He indicated that “each grade level has actually seen a decline in reported easy access after 2012” which he felt represented an “interesting trend.” Among young adults, Watson said that “more than three quarters now report purchasing from retail stores.”
    • Steele then looked at retail cannabis sales around Washington and rising annual excise tax revenues which provided $454 million to the State in 2020. Turning to county-level sales information between 2018-2019, she drew attention to “the counties that border Idaho, where marijuana remains illegal, are seeing higher rate sales per 1,000 people than other nearby counties.” She discussed the growth in county sales over time.
  • Watson and Steele next went over Marijuana Perception Trends, with an emphasis on youth and adult views of cannabis “harm” and “normalization” (audio - 6m).
    • Watson indicated that both HYS and the Young Adult Health Survey showed a decreasing perception of harms from cannabis use among their respective cohorts. Watson said school aged youth were “seeing less of a risk over time” and that young adults had a prevailing view of cannabis as ”a normal thing to be doing." Moreover, there was a “contrast...the perceived risk of alcohol use has actually been increasing.” Watson also found it interesting that young adults assumed “a typical peer, someone their age, is using marijuana, at least once per year.” Yet the survey estimated that 54% of the age group was “not using at all, not even once per year.”
    • Looking at older adults, Steele shared that the National Survey on Drug Use and Health (NSDUH) found from 2015-2017 that perceived “great” risk of harm from weekly cannabis use among adults aged 50 and older had also been diminishing. “Marijuana use is on the rise among baby boomers” nationally, she added.
  • After that, the team went through Marijuana Harm Trends, “specifically looking at poisonings, driving, and older adult harms” (audio - 7m).
    • Utilizing information from the non-profit Washington Poison Center (WAPC) 2018 annual cannabis report, Steele highlighted a “166% increase in calls for those aged 12 and under” as well as an “82% increase in...the number of ingestion cases of marijuana in all ages in 2018.” She qualified that for undrage poisoning cases, “the overall number remains low, the biggest volume of cases of poisoning is for those ages 21 through 59.”
      • The increase in cases WAPC identified occurred between 2017 and 2018 following implementation of WAC 314-55-106 which required “Marijuana-infused products for oral ingestion sold at retail must be labeled on the principal display panel or front of the product package with the ‘not for kids’ warning symbol (‘warning symbol’) created and made available in digital form to licensees without cost by the Washington poison center (WPC). The warning symbol may be found on the WPC's website.” Launched by WSLCB and WAPC in February 2017, the requirement established WAPC as the contact number to call in an emergency, emblazoned on the labels of all regulated infused cannabis products in the state.
      • In early 2019, legislators specifically asked WSLCB Director Rick Garza and WSLCB Enforcement and Education Chief Justin Nordhorn about the increase in calls to WAPC. Neither Garza nor Nordhorn identified any cannabis exposures resulting in fatalities. Nordhorn explained the calls represented people reaching out for assistance, not clinical diagnoses of drug overdoses. Garza noted many WAPC calls amounted to “panic attacks” from individuals, and that calls spiked after the Poison Center’s phone number was included on cannabis product labeling (audio – 22m, video).
    • Watson offered his interpretation of trends around youth driving “within three hours” of cannabis use, qualifying that it was a “contentious topic, it was also something that’s difficult to track.” He argued that while the survey utilized a three hour window for impairment following cannabis use, “that can vary a lot.” Waton said that young adult surveys had found the percentage of those driving within three hours of use to be decreasing “but is also still high” at approximately 14%.
    • Steele believed the role of cannabis in state traffic fatalities, as monitored by the Washington Traffic Safety Commission (WTSC), was "significant.” Drivers in collisions with fatalities "within four hours" of cannabis use “plus alcohol or other drugs seemed to be declining each year” even as positive tests for presence of tetrahydrocannabinol (THC) “in some form is increasing annually.” However, alcohol remained “three times more prevalent among drivers in fatal crashes than delta-9 THC.” She noted WTSC’s focus on delta-9 THC rather than “any marijuana presence” as it was the “main psychoactive ingredient.”
      • At publication time, it was Cannabis Observer’s understanding that the WSLCB was assessing whether delta-8 THC should be regarded as a separate isomer, but the agency had not released an official position.
    • Steele also touched on potential harms for older adults, whom she expected may have cannabis experience from "years ago, when marijuana potency rates were much lower." She said cannabis use “could be problematic for those with age-related vulnerabilities.” She recommended "targeting prevention efforts [to] include primary caregivers, the family, and the primary physician” along with greater research of “the interaction of marijuana with other common medications.”
  • Finally, the presenters reported on Emerging Marijuana Topics involving cannabis licensee violations, “poison exposures”, COVID-19 policy allowances, and product use trends (audio - 5m).
    • Violations Issued to Marijuana Licensees. Watson noted the “increase over time” in issued violations prior, drawing attention to a decrease in 2019. He said “about 18%” of violations involved sales to minors, or allowing them into “restricted areas.”
      • Enforcement and Education Chief Nordhorn spoke to the change in violations issued during a work session with lawmakers on September 28th, commenting that “our education is up.”
    • Pediatric Cannabis Exposures. Steele mentioned “poison exposures” reported to WAPC during the early part of 2019, concluding that “more people are, and children are, at home during COVID and it's a good time to reinforce and/or raise awareness of proper storage at home.”
    • COVID-19 Temporary Allowances. Noting excise tax collection had “topped the $50 millon mark” in August, Steele brought up temporary policy allowances like curbside service or allowing minors to be on licensed premises. She said health officials would “continue to watch” and “see how science continues to grow and expand.”
      • While the presentation cited statistics from 502data, at publication time the publicly accessible version of that site did not indicate excise tax collections for August. Whereas the retail excise tax spreadsheet published by WSLCB on October 2nd, three days after this webinar, included expected collections for the month of August totaling $42,591,647.22.
      • Learn more about WSLCB’s temporary COVID-19 policy guidance to licensees from a May 21st webinar.
    • Cannabis Market Share. Steele highlighted broad changes in consumer product type preferences, identifying a decrease in usable marijuana sales compared to concentrates and infused products.
  • Watson distilled several trends and opinions for emphasis (audio - 3m):
    • Increased use by adults “but not among youth”
    • Increased access for adults and tax revenue
    • Decreased perceptions of harm
    • “Hundreds of [administrative] violations per year” 
    • Steele asserted that pediatric cannabis exposures during COVID-19 were “child poisonings” and noted continued research around the correlation of health issues with cannabis potency and vaping.
• Attendees were granted an opportunity to ask questions, surfacing queries about youth cannabis use, information for adults, and source data.
  • Question around survey data on increased frequency of youth use (audio - 2m).
  • Question about the availability of cannabis health information geared towards older audiences (audio - 1m). 
  • Question on analysis of medical vs. recreational data (audio - 1m).
  • Question about whether changes in traffic fatality data were due to I-502’s creation of a per se driving standard (audio - 3m).
  • Steele closed out the session thanking attendees for “learning more about the impacts of legalization in our state” (audio - <1m).