Here are some observations from the Tuesday November 8th Washington State Liquor and Cannabis Board (WSLCB) Board Caucus.
My top 4 takeaways:
- Public Health Education Liaison Mary Segawa introduced University of Waterloo School of Public Health Sciences Professor and University Research Chair David Hammond, who talked to the board about cannabis market trends in the state.
- Segawa highlighted how Hammond’s research “focuses on population level interventions to reduce chronic disease, primarily in the areas of tobacco control, obesity prevention, and substance use policy.” She mentioned his role as principal researcher for the International Cannabis Policy Study (ICPS), telling the board that Hammond could offer “Washington data from this research” (audio - 2m, WSLCB video, TVW video).
- Hammond established that Canada had legalized “non-medical cannabis in 2018, and so a lot of the questions about evaluation and market trends are similar to what we have up here.” He planned to speak not only to “understanding what the overall impact of legalization might be, but to try and understand some of the policies and regulations that are implemented in legal markets.” Hammond stated that cigarettes had “always been legal, but the way we regulate them today is much different than 50 or 100 years ago. And so hopefully we can learn how best to regulate cannabis in the public interest over a much sooner timeline.” His work tried to address “the right retail density, should we have standards for products, what's the best labeling or restrictions on advertising and promotion.” He promised to add comparisons to Canadian policies as their officials had “taken a different approach than all the other states and it gives us a chance…to look at some alternative policies and regulations” (audio - 2m, WSLCB video, TVW video).
- ICPS researchers had conducted “repeat cross-sectional surveys" annually in order to collect “more detailed data than many of the national surveys or state surveys” covering “policy specific measures,” said Hammond. Asking the same question over time helped trendlines, he indicated. Hammond presented data in a Washington-specific report surveying “just over 7,000 people” aged 16-65 between 2018 and 2021 (audio - 2m, WSLCB video, TVW video).
- Additionally, the state had provided “a bit of extra funding to try and boost some samples, and we have been producing reports for Mary and others on your end,” he commented. Hammond relayed that ICPS surveys would help contextualize questions around:
- “Consumption and different product modes”
- “Different indicators of problematic use, things that we'd rather not see from a public health perspective”
- “Policy specific measures like…are people seeing advertising/promotion? How much are they paying, where are they buying their cannabis?”
- “Can we estimate the size of the illicit market?”
- Hammond stated that the survey looked at policies across jurisdictions to investigate whether “it matter[ed] if some states have more restrictive retail policies, or some allow more advertising than others.”
- Patterns of Use - Hammond acknowledged that “you'll look at some of these numbers and prevalence, and say ‘boy, that's high,’ and part of it is because we've actually concentrated our surveys among the ages where cannabis use is most prevalent. We also have higher prevalence in those age groups, which in some ways is a bit of a bonus when we're trying to look at consumer trends” (audio - 3m, WSLCB video, TVW video).
- Responses to ICPS showed “modest increases [in overall use] fairly stable over the past four years,” Hammond remarked, “obviously some [coronavirus] pandemic effects in there.” He pointed out this rate was “a little bit lower than the US average.”
- “But one of the things we certainly ask in our sample is ‘how many consumers identify as a medical user,’ and so we find that about 25% of past 12 month consumers in Washington State say ‘yeah, I self-identify primarily as a medical cannabis user,’” explained Hammond. He further divided responses based on cannabis policy (“illegal, medical, and legal states”) and found that “consumers in Washington are a little less likely than some other states to self-identify as a medical marijuana user,” he said, with “nine percent” claiming that “they have current authorization in the past 12 months as a medical cannabis user.” Though below the national average, that level was “actually typical for some of the more mature or established legal markets,” Hammond argued.
- Looking at what products were popular among Washington consumers, Hammond stated ICPS surveys showed purchases “similar to what we've seen overall in the U.S.” including “a little bit more of a decrease in dried flower.” This was a pattern he’d seen in other jurisdictions, and “in most states we've actually seen dried flower decrease a little bit more.”
- Hammond then brought up how “across most jurisdictions [there were] large increases, even in the last four years, in the number of consumers that are using edibles.” While vapor product popularity had been expanding, Hammond’s statistics found “a serious lung disease epidemic in 2019…kind of took the wind out of the sails, but in most places we've seen vape oil sort of recover from that.” Otherwise, he pointed out that “most other forms whether it's oral, oils, or topicals, or hash, they've all been increasing.” He asserted patterns of use were indicative of “an increase in most other forms, many” having “higher, more concentrated THC [tetrahydrocannabinol] levels.”
- Board Chair David Postman wondered if Hammond classified the types of edibles people were buying and had “a sense of how much of that would be candy versus others.” Hammond asserted that ICPS had data categorizing edible types and would follow up with Segawa to pass it along (audio - <1m, WSLCB video, TVW video).
- According to Hammond, the responses revealed that the majority of consumers used “more than one product…only 25% said, ‘oh yeah, I've only used one product,’ most of them use two, three, four, five products. And so we have this really flexible sort of poly use and I think that's important to recognize that consumers aren't really siloed” based on product type. He also found this flexibility of product type was more common in the U.S., attributing part of the gap to legal markets with “more manufacturing, processing of different products” where it wasn’t just more consumption, but consumption of “multiple products, often over…the course of a day or a week or a month” (audio - 4m, WSLCB video, TVW video).
- Turning to trends from the pandemic, Hammond’s data indicated “about seven out of 10 say it didn't have any impact. A small number say they stopped, a little bit higher number, four percent, say they started using because of the pandemic. But more commonly, people said ‘I used a bit less’ or the most common answer was ‘I used a bit more.’” He said this was consistent with other national surveys on the topic, and “wasn't so much that people started or stopped being a consumer. It's that some used it a little less; more commonly people…they’re at home more, they weren't at work and so…many of them consumed more.”
- Comparing Washington state responses with other jurisdictions, Hammond observed that “we used to see more differences between states” based on cannabis legality, but “those differences have largely narrowed for things like dried flower,” as well as for edibles and vapor products. Responses indicated use of “solid concentrates, wax, shatter,” and others appeared to be “a little bit higher in Washington state, 33% compared to an average of about 27% in U.S. legal states.” Similarly, “cannabis beverages” were more popular in Washington, so Hammond thought “that's because…you don't see many beverages on the illegal market” as the items necessitated “a bit more manufacturing and storage and things and…we see that's higher among the more mature legal markets.”
- Considering what type of cannabis flower products were being sold, Hammond mentioned that respondents were purchasing more joints, and among those “who tell us that they bought flower, about a third say ‘yeah, last purchase I bought pre-rolls.’” He’d found states were selling less “loose flower and more processed in terms of pre-rolls, especially in the adult legal market and we're seeing that more of those pre-rolls are infused” with cannabis concentrates that resulted in products with THC in “high 30s, 40%.” Popularity of these “more potent products” had aligned “very well with what we're seeing with sales data in different jurisdictions,” he added.
- Board Member Jim Vollendroff asked when ICPS began “tracking the sale of infused products, so what was it before it was 25%, and are you still tracking that so we can watch that trend?” (audio - 1m, WSLCB video, TVW video)
- Hammond responded that the survey had begun looking at infused product types in 2021 because researchers were endeavoring to “to figure out why people are paying so much money for some of these pre-rolls.” He was aware of varying classification between states when it came to “whether they break these out or not.” Hammond said he would follow up with 2022 data once it had been reviewed and organized, but considered infused pre-rolls to be “a qualitatively different product.”
- Hammond reported that “consumers have a very hard time reporting what is a THC…or CBD [cannabidiol] product” making it difficult to track in surveys. He then talked about delta-8-tetrahydrocannabinol (delta-8-THC), “which a lot of youwill be familiar with,” as survey responses showed “three percent of all of our respondents telling us that they've ever used a delta-8-THC product. I don't have the time to get into it today but that is certainly going to be subject to over-reporting because we actually asked it in kind of a creative way where we asked about” multiple other cannabinoids (audio - 1m, WSLCB video, TVW video).
- Sources - When it came to sourcing cannabis, Hammond shared that the most common methods of access for Washington consumers was retail stores or social gifting by friends or family. He added that he’d begun studying home cultivation of cannabis in the U.S.as well as in Canada, finding that it was “a touch higher in legal states." Washington law didn’t allow this, and Hammond was seeing that “even among legal states [Washington had] a very high proportion of people buying from stores, lower from social sources…and you can see home grows a touch lower in Washington than some of the other legal states” (audio - 4m, WSLCB video, TVW video).
- Evaluating the sourcing of cannabis was done “a number of different ways. So, we infer it from where they've purchased it. We also asked people straight up ‘was your last purchase from a legal or illicit store?’ We ask people ‘hey, of all the products you've bought what percentage are illegal or legal?’ And is there some misreporting here? Absolutely there is. But what we've seen in places like Canada where we've tracked it from the start is that it does align fairly well with changes in the actual legal retail sales data.” When it came to purchasing from retailers, “Washington state is as high as we've seen in any legal state…it's bang on about 90%.”
- Questions on sourcing were also asked based on product type, Hammond remarked, revealing that the legal sales “percentage is much lower for solid concentrates. It's higher for things like cannabis beverages,” suggesting “we do need to get past just thinking about dried flower and we need to think about why some people are buying some of these products from a legal source more so than illegal.” He added that responses showed the pandemic made people more inclined to purchase cannabis from a legal store, but this wasn’t verified, and it could be “people's impression that it probably helped more than hindered in terms of encouraging legal sales.”
- Prices - The survey relied on self-reported costs, but “we work really hard to try and get as much detail as we can,” Hammond said. The “sales weighted price per gram of dried flower at last purchase” led him to believe that “people are reporting a lower price per gram in Washington State” of around $7.88, or “a dollar and a half less than we see in some other legal states.” He added that the report included comparisons between states with recently-created cannabis markets and the “mature” markets in Washington, Colorado, or Alaska (audio - 1m, WSLCB video, TVW video).
- Postman wondered how common it was for prices to decline in mature cannabis markets. Hammond said that trend was common, though “Oregon has the lowest price regardless.” He commented that “a lot of that decline happens in the first five years. In Canada we've seen, like, a halving of the price, it's remarkable.” Postman asked for Hammond’s opinion for that pattern, who speculated “the transition to legal sources has been almost linear…three quarters of the market is now legal in Canada after four years.” He added that competition among businesses was a factor, since the country had “far fewer opt-outs” among local jurisdictions and “we have…legal online sales in all of Canada… so it's pure competition” (audio - 1m, WSLCB video, TVW video).
- Vollendroff inquired about the “future of the prices,” to which Hammond said his expectation was that Canada’s cannabis lobbyists would seek to “reduce the level of tax, which is about C$1 gram for flower.” As provincial governments were in charge of distribution and, “in some cases they’re government run stores,” he expected that “there’s still going to be the vigorous competition whether the tax is reduced or not.” His view was “big companies are having a very hard time getting market share because of our very strict advertising and promotion regulations” (audio - 1m, WSLCB video, TVW video).
- Board Member Ollie Garrett asked “when you say competition…is it a different conversation on where we hear there's oversupply?” Hammond said oversupply had been an issue in Canada, but “there's a bit of a different situation in the U.S. where oversupply in a legal state raises the likelihood of diversion to other states” where cannabis was prohibited. As Canada had legalized nationwide, “we don't have that same concern or issue,” he acknowledged, although “it's been so volatile the government in some places restricts the retail stores, and some it's just kind of free market.” Hammond summed it up as “the government, they just overshot, frankly” (audio - 1m, WSLCB video, TVW video).
- Hammond stated “a key question is what's the price differential between legal and illicit sources.” ICPS survey respondents in Washington answered that the price of illicit cannabis had gone up significantly but, “because we have relatively few people purchasing from an illegal source, that's subject to a fair amount of variation.” Generally, he reported that the “illicit price reported to us is lower. It remains lower than the legal price, but in some of the oldest markets [including Washington] it's a little higher, which is very interesting to me and..it suggests that” those still using the illicit market to access cannabis could be “below the minimum legal age. Maybe they live in a jurisdiction with no stores in which case there's actually a price premium.” Hammond believed “the legal sales price is competing very effectively with the illicit sales price in the most mature markets like Washington state” (audio - 1m, WSLCB video, TVW video).
- Garrett wondered whether their data showed the ages of those purchasing from unlicensed sources. Hammond replied that “we have the ability to answer it; we just haven't looked at it.” Anecdotally, he expected Garrett was correct, offering “if kids are buying a joint they're gonna pay a premium for it” since it was “harder for them to access” (audio - 1m, WSLCB video, TVW video).
- When it came to the reasons people were purchasing from illicit sources, Hammond said a third of Washington consumers reported believing “legal cannabis [was] more expensive, [although] most actually think it's less expensive.” He considered other justifications to be relatively uncommon among cannabis consumers overall, “only about one in 10 feel that legal cannabis is lower quality… a negligible amount see an advantage for illicit cannabis in terms of safety or convenience.” Hammond relayed that “the bottom line is that price is…the main reason that some consumers” favor unlicensed cannabis sources. Anonymity and “loyalty to my dealer” were also given as reasons people weren’t shopping at retailers, he added (audio - 2m, WSLCB video, TVW video).
- Packaging and Labeling - Remarking that “we've been doing lots of work about labeling of ten or five milligrams servings for edibles and what people understand,” Hammond said, “we see very, very low levels of what I call ‘THC literacy’” (audio - 2m, WSLCB video, TVW video).
- Few consumers knew “the typical THC amounts of their products; most get confused and give us milligrams when they should be telling percent,” he explained, while three quarters “say I don't know what the THC levels are…they'll tell you it’s sativa, or indica, or something.” Of those who answered, “about half of them give us a number that doesn't exist,” he stated.
- More encouragingly for Hammond, “Washington consumers are more likely than consumers in other jurisdictions to say ‘yeah. I see the warnings for cannabis products.’ It's about 25% of everyone we ask.” Additionally, “when you sort of drill down and just look at those that have consumed in the past 12 months. It's about 41%,” he remarked. Hammond was interpreting “that mandated information you have is reaching a lot of people. It's not reaching everybody, and there's a lot of consumers that report not even seeing it at all. But…you're doing better” than other jurisdictions. He felt the research showed that “the bigger you make a warning that, the more understandable you make it, the more people use it and pay attention to it.” Canadian labeling practices included “more comprehensive warnings than any US state and…we have shown that those warnings are actually most effective relative to those in any of the US states,” added Hammond.
- Postman sought clarification on how labeling was deemed to be effective, “Does that mean people don't use it, or do they use it responsibly?” Hammond responded that “we start with noticing, if you don't see it, you can't use it…and then we ask people can you tell us what messages are on packages.” After that, “then you can look at…health knowledge,” he suggested, “how does it inform…what they believe the risk might be.” Though it was possible to “stretch out beyond that” to study consumption patterns, “that's a bit of a trickier methodological issue,” so his survey focused on “the front end saying ‘do they notice it, can they remember it, and is it associated with health knowledge?’ And generally speaking you see that to be the case” (audio - 2m, WSLCB video, TVW video).
- Advertising - Hammond described how advertising was “a concern a lot of folks have with the legal market. The concern, of course, is that it reaches young people and we have lots of evidence from other areas, whether it's e-cigarettes, or tobacco, or alcohol…seeing promotions is an important risk factor for young people.” In Washington, he said the most common places respondents said they were seeing cannabis advertising was “billboards and posters, outside stores, inside stores, and then you have” social media and other online advertising (audio - 3m, WSLCB video, TVW video).
- The “biggest difference we see between illegal and legal states, it's the stores and billboards. Whereas we see fewer differences for social media and digital sources” as he noted that “crosses borders.” Hammond brought up that Canada had “very strict rules, very little advertising and promotion is permitted.” After evaluating the advertising rules in various legal cannabis states, he said, “what we're seeing from our surveys and how much advertising they're seeing, and we do see a really consistent, strong correlation where…the looser the rules the more people see, and generally speaking younger people report seeing as much or more advertising than, than other consumers.” Hammond saw this as “evidence that the strength of the rules matter.”
- WSLCB opened an Advertising Rulemaking Project on August 31st, though Hoffman described it as delayed due to staffing vacancies on October 11th. New Policy and Rules staff were scheduled to be introduced at the Tuesday November 15th board caucus.
- Social Norms - Wrapping up, Hammond communicated that the survey “ask[ed] a classic question about whether people think that society approves or disapproves of marijuana and…Washington State is bang on average,” with approval of cannabis between states at “similar levels of approval regardless of the legal status of cannabis.” Looking at approval of cannabis by age “the youngest people are right at the top but in Washington state they're a little bit lower,” he remarked, though overall “very stable over the past four years” with only “some little bumps up and down” (audio - 3m, WSLCB video, TVW video).
- With regard to whether cannabis should be legal, Hammond found “it's up to 70% by our survey in 2021” and “when you compare that with other jurisdictions, you see that Washington is among the highest.” He acknowledged a “trend in legal states…it goes up after states legalize” and “it's even higher in Washington given you've got a longer history” with legalization.
- Following the caucus, agency staff sent out a press release emphasizing certain aspects of the ICPS survey of Washingtonians, including that:
- “Washington leads the nation in cannabis consumers buying from regulated retail outlets rather than the illicit market…90% of the products they purchased were from a retail store.”
- “Smoking ‘useable flower’ peaked in 2020 while most other products such as edibles, oils, and drinks increased in 2021.”
- “Most Washington consumers perceive legal cannabis to be higher quality and safer than the illegal market.”
- Without mentioning Hammond’s uncertainty about the variability of this estimate, WSLCB staff stated, “the average legal cost per gram in Washington was $6.51 compared to $13.58 from illegal sources.” Director Garza was quoted as saying, “We knew then that if the total price dropped to below $12 per gram that the regulated retail market would be able to compete with the illicit market.”
- Julia Dilley, Affiliate Instructor in Epidemiology at UW as well as Multnomah County Health Department and Oregon Department of Human ServicesDivision of Public Health Program Design and Evaluation Services Principal Investigator, went over public health perspectives on cannabis regulatory successes, trends in use, and outcomes.
- At the outset of the caucus, Segawa introduced Dilley, whose “current research focuses on public health effects of law and policy around cannabis, alcohol, tobacco, and other drugs.” She noted Dilley’s work on “a nine year, federally-funded research study of cannabis legalization impacts in Washington and Oregon,” and position as co-chair of “the nationwide Council of State and Territorial EpidemiologistsCannabis Subcommittee, leading efforts to identify the best measures and methods for cannabis related public health monitoring. She will be sharing with us Washington-specific public health data.”
- Dilley spoke about some research findings which “uses Washington home grow[n] data, so to speak, and kind of what we've seen from within the state in the past 10 years.” She mentioned collecting this data through a National Institute on Drug Abuse (NIDA) grant “to study the impacts of cannabis legalization in Washington and Oregon” with the help of state agencies and officials like Segawa “and others at the LCB.” Dilley planned to review “positive regulatory approaches within Washington state…trends and product use among adults and youth within the state, and then third, just touching briefly on some public health outcomes” (audio - 2m, WSLCB video, TVW video, presentation).
- Positive Regulatory Approaches (audio - 5m, WSLCB video, TVW video)
- Praising the comparatively low density of retail outlets, Dilley called it an aspect of how the state “uniquely approached cannabis legalization with a strong public health and safety lens.” She showed data indicating that since retail locations began opening in 2014, “the number of retailers increased over the first four years or so, and then it's been holding steady.” Dilley argued that since “Washington has a lower per capita cannabis retail licensee number...compared to Alaska, Colorado, and Oregon,” she assumed that “may have affected some of what we're seeing in terms of public health outcomes.”
- A positive approach she’d seen in Washington pertained to “child resistant packaging.” In 2017, “there were concerns about child exposures, poisonings, that were being reported to the Washington Poison Center” involving edibles. Dilley said WSLCB “acted to require a single serv[ing] wrapping for edible packages and then to have a label with the poison center phone number on the edibles packaging.” Using a “difference in difference method,” she described looking at Washington and other states’ cannabis reports to poison centers before and after the change. “And what we found was that…this change in the packaging rules in Washington state was associated with a 25% reduction in edible poisoning reports for children under 10, a 51% reduction for ages 10 to 20, and a 23% reduction for adults 55 and older relative to the pre-policy period, and relative to what we would expect to have expected based on what we saw in other states.”
- With regards to advertising, Dilley expected “we know that that can be very visible especially to young people,” but “Washington state didn't have any kind of way to know the prevalence of young people that were being exposed to cannabis advertising.” In 2017, Oregon “added a question about this to our youth survey data similar to” HYS, and “what we saw was that 72% of 8th graders and 78% of 11th grade students said they saw cannabis ads in their neighborhoods in that year. And among kids who had a cannabis retailer within a mile of their school, 85% of 8th graders and 87% of 11th grade students were seeing cannabis ads.” Dilley noted that Washington officials acted to ban sign spinners and billboards with slogans like “I'm so high right meow,” so she felt prohibitions on such advertising methods represented “another positive story.”
- Trends in Use - Dilley began by explaining how she would share with the board “data from within Washington state which largely tells the same story as Dave mentioned” (audio - 3m, WSLCB video, TVW video).
- Utilizing the state Behavioral Risk Factor Surveillance System (BRFSS) and HYS data, she had found “the percent of adults who use cannabis in the past 30 days, that went up from eight percent in 2012 up to 17% in 2019.” While the question hadn’t been surveyed in 2020, the responses in 2021 appeared “the same as 2019, so it looks like it's increased over time and then maybe leveling off a little bit in recent years.”
- What was more concerning to Dilley was “daily or near daily use, or 20 or more of the past 30 days. That's increased from three percent in 2012 up to seven percent in 2019, and then eight percent in 2021.” While that proportion of cannabis consumers “may be stabilizing…that has also increased.”
- Looking at the types of products consumers preferred, Dilley indicated that surveys “between 2015 and then through 2021” had asked “about what kinds of products people are using.” She reported that smoking cannabis had “declined significantly from 85% in 2015, down to 70% in 2019, and then down now to 65% in 2021.” Over this same period, Dilley shared data that edibles “went up from 27% to 35%, and now 46% in the brand new 2021 data.” Vaping had increased “from 17% then went up to 27% in 2019, but now [had] declined to 20% in 2021.” Additionally, “dabbing did look like it was holding steady and maybe it's dropped a bit, and drinking sodas or teas that are infused with cannabis” remained “stable and low,” noted Dilley
- Considering a “harm perspective approach," Vollendroff wondered if fewer people smoking cannabis could be “a good thing” for their health. He asked if there was “enough research to show…are any of these methods of use better than others?” (audio - 2m, WSLCB video, TVW video)
- Aside from the focus of some researchers on “THC concentration and how that may affect the risk profile of different products,” Dilley thought generally “smoking anything is probably not good for your lungs and…we're concerned about people inhaling any kind of combusted products.” However, she mentioned edibles “can have specific risks associated with them” that could “depend on how the quality of the products…whether they're contaminated with any sort of adulterants, or, and the same could be said for vaporizing.” Dilley felt “it all depends…there are probably different profiles and I think we're learning more and more about that.”
- Looking at youth, Dilley suggested HYS data showed “these dramatic declines relative to 2018,” offering 12th grader responses as an example where “we had 26% of youth in 2018 who had used cannabis in the past 30 days, down to 16% in 2021. That's a big drop, but some of that may be related to…post-pandemic school context effects, and to the change in the survey administration.” For this reason, Dilley encouraged the board to “be cautious about” the unexpected positive trend, but acknowledged that “overall, we didn't see those dramatic inclines that” officials including herself “worried about when cannabis was legalized” (audio - 3m, WSLCB video, TVW video).
- Still, increased use among some groups troubled her. She was “part of a study that looked at youth who are working in part-time jobs” which “measured increases in…those 12th grade youth.” Dilley was also involved in research on the proximity of schools to cannabis retailers which had found “reductions in prevention indicators and increases in cannabis use indicators.” She expected research to continue “but, at least…at the state level [youth cannabis trends] didn't do what we worried that they would do.”
- Until 2021, youth that reported consuming cannabis were made “to choose one answer, their usual way of using,” she said. However, since consuming a variety of products was a pattern in adult consumption, she commented that survey responses around cannabis flower “had declined, over time from 2014 down to 2018. And then you see this kind of complementary increase in these higher THC products, the edibles and vapes to some extent, and then we added dabs in 2018.” Starting in 2021, respondents could select all the product types they consumed “in the past 30 days.” She noted how “10th graders, 67% had smoked it, half had vaporized (51%) and then about a third (32%) used edibles, and about a third (33%) had dabbed it.” Among a declining cohort of cannabis consumers, youth still consuming cannabis were “using some of these higher THC products,” deduced Dilley.
- Postman observed that “vaping is…much higher for this group of 10th graders” than what Hammond had shown for adults, about whom he inferred “the over 21 people aren't vaping that much.” Dilley admitted, “I'm actually a little surprised to look at it and see this for kids. All I can say is…there may be reasons why kids prefer vaping products, you know, maybe that it's easier to conceal.” She further speculated that the popularity of nicotine vaping among youth could mean “kids are comfortable with that type of product” and their “fear or concern about vaping product safety might not be as great as for adults” (audio - 1m, WSLCB video, TVW video).
- Public Health Outcomes - Thinking about broader public health outcomes, Dilley called out increased emergency room visits associated with cannabis use among older individuals “during 2006 up to 2015 and we saw the biggest increases in 2014 to 2015,” along with similar increases in hospitalizations (audio - 2m, WSLCB video, TVW video).
- “Some of that could be due to better documentation,” said Dilley, by “people feeling more comfortable disclosing their cannabis use—and then it shows up in the record—compared to when cannabis…was illegal.” However, she had become concerned that “among people…who are hospitalized with a cannabis related code, we're seeing a greater share of those folks who are older adults. So, ages 51 and older.” In 1998, Dilley stated older adults made up only “2% of all cannabis related hospitalizations,” but they made up “33% in 2014.”
- Dilley brought up “seeing sort of mixed results” in data on “treatment admissions and traffic crashes,” but that in all, she felt laws and regulations on public health “have had an effect in mitigating harms.” Adult use had increased whereas youth use hadn’t, she said.
- She called out “examples of potential challenges ahead includ[e] specifically looking at these products that are coming on to the market, and the increased use of these products, especially with higher THC concentration and…different risk profiles for some of those products,” along with “addressing risks…identified for specific populations.”
- Board members posed several questions to the researchers around youth use, consumption trends, bad regulatory outcomes, and THC literacy among older adults.
- Vollendroff wondered how the decline in cannabis use among Washington youth compared to other legal jurisdictions (audio - 2m, WSLCB video, TVW video).
- For the states with the most developed cannabis markets, Dilley stated that researchers from “the first four states had collaborated to look at all of our youth data together and we did see sort of the same thing…not huge increases.” Another trend she’d seen was “increases in cannabis use among older girls. So, 12th grade girls, 11th grade girls in Oregon” represented a “unique pattern among kids, and we saw that across all the states.”
- Hammond noted that in Canada, "we've seen basically no change" and that youth use was “consistent” with levels just before the nation legalized. He did think that patterns needed to be followed for many years before being judged, “you really need those kids to grow up potentially with promotional images for some time, and then age into the period of initiation before you can really pass judgment. But so far, it's been…encouraging.”
- Referring to generational trends, Postman asked, “if you were born in 2012, cannabis is legal your entire life. Do you think we will see faster uptake of that generation when they hit 21? Are more of those people gonna go and buy cannabis?” (audio - 3m, WSLCB video, TVW video)
- Attributing some of his gray hair to “testifying against tobacco companies…in legal challenges to advertising laws,” Hammond thought that was a “plausible” concern, expecting it would “come down to the strength of the regulation.” Similar to tobacco policy, he anticipated “it will be the nature of some of those regulations and not simply whether cannabis is legal or not…we have managed to protect young people from tobacco marketing infinitely better than we did 50-60 years ago.”
- Dilley remarked that while use changes weren’t significant, “some of those prevention indicators,” like whether youth thought their friends or family disapproved of cannabis consumption, “those indicators look better in Washington state relative to Oregon.” She described Washington as having “more prevention supportive” regulations and “better outcomes among those early prevention indicators.”
- Vollendroff inquired about state regulations which “missed the mark” and subsequent “research that shows that was not a good decision” (audio - 6m, WSLCB video, TVW video).
- Hammond’s impression was that any answer would be “a little bit in the eye of the beholder,” though he thought “we really haven't done much in terms of regulating the products themselves and people's understanding of the products.” In his view, “many cannabis consumers don't know how much to take, they have trouble when they go to a different product form,” especially “naive or new consumers.” Hammond suggested the problem with labeling wasn’t about accuracy of information, but rather “consumers don't know how to use them.”
- In Canada, edibles were restricted to ten milligrams of THC per package, “a lot for a naive consumer to take,” he argued. Greater education on labeling “helps the industry, it helps regulators, it helps consumers…to understand THC better and how it's present in the product in different forms.” Hammond believed that data showed problems related to cannabis flower were comparable to problems related to edibles and that the line of reasoning related back to the question about what method of cannabis consumption might be safest.
- He spoke favorably about Quebec, which had “the most strict regulations of any legal cannabis jurisdiction in the world. They have actually capped every product at 30% THC” and had experienced “almost no change in” cannabis use since legalization. “I'm not saying this to say that we should start banning products. I'm just saying it's starting to ask the question of what I think of as like, legalization 2.0,” which could involve regulations intended to “help consumers to find their way to less harmful products and to take it in the way that suits their needs and minimizes their harm.”
- Postman believed “we've talked about this with some other researchers” and “I think there's been some reluctance for what I think you described as THC literacy because it assumes it assumes it's okay to use this product.” He argued that “some of the people that are most expert in that science don't necessarily want to help people learn how to do it responsibly.” Postman hoped such views in Washington state were “cresting…and I think we're going to get that kind of, hopefully, collaboration because it's going to take the industry, the regulators, and the experts like yourself to figure out what does that literacy look like with a goal of responsible users, not prohibition.”
- Vollendroff then added his interest around “that senior population” as he had “two older parents, one living with dementia. And periodically, my dad will say things—my mom's the one living with dementia—’Oh, I'm gonna go to a pot store and get…mom some pot’ and I'm like ‘whoa, whoa, let's talk about that.’ But I can see how important it would be for older adults to also get literacy around the various…ways to use it…and implications.”
- Following up on the concept of senior cannabis literacy efforts, Postman recalled how he’d been working in the governor’s office after I-502 passed. After cannabis retailers began to open in 2014, “we heard right away [that] emergency room visits are up and it's not kids. It's…other people my age” whose last experience may have been buying “ditch weed for 10 bucks.” His anecdotal impression of senior conversations around cannabis was “it's different today” (audio - 4m, WSLCB video, TVW video).
- Dilley’s feeling was that this dialogue around products was increasing, after seeing middle-aged and older “naive users who were interested in trying again and got surprised because things were different than they remembered.” In these cases, she’d seen adults “made whatever change they needed” to avoid hospitalization the next time they consumed cannabis. But Dilley remained bothered because “products just continue to evolve so rapidly and…I study this and I can't keep up with what's going on.”
- Hammond emphasized how this was “a legacy of…having an illegal market, not having it pre-regulated” and that cannabis commercialization meant “more highly processed products, more manufactured [products]. That's a function of legalization: you have industry, they offer different products.” He insisted “there's a reason why most smokers, tobacco smokers, in the US don't roll their own cigarettes. We are going to see more pre-rolled…cannabis joints.” Hammond further considered edibles problematic since “there are no physiological cues as you're ingesting it as to how strong it is” while vaping items could “run from zero to one to two percent up to 90% THC.”
- Budtender guidance from officials was something Hammond advised should more directly involve THC percentages rather than broad questions he’d heard from staff like “what kind of night do you want to have?” For alcohol, “you got to make sure that people know that they're drinking a glass of wine versus a glass of vodka,” he said, feeling many people understood this, but for cannabis “labeling and packaging is an excellent opportunity for enhancing that.” Postman readily agreed, wondering about a better partnership with health officials on “how to incentivize that among people.”
- Postman was glad to find that “the news, generally, is fairly positive. I'm glad to see Washington is doing better in a lot of these really important ways than some other states, and that some of the worst cases hasn't come true. But obviously…there's work to do…as the market evolves, our challenges will evolve” (audio - <1m, WSLCB video, TVW video).
- Concluding the event, Segawa offered her thoughts on how public health research could continue to assist agency efforts around medical cannabis patient needs, advertising implications, packaging and labeling rules, and public education (audio - 2m, WSLCB video, TVW video).
- Segawa was grateful for the “wealth of information" provided by Hammond and Dilley, and looked forward to “digging more deeply" into their findings. Research would continue to be an important part of WSLCB policymaking, she said, calling out a “need to look more closely at our medical patients’ needs and how those might be better met. We need to continue to assess our advertising, especially its impact on youth. And as we talked in detail, the packaging and labeling. We need to better understand the effectiveness of our warning statements and especially serving size.” This could be addressed through education or agency regulations, stated Segawa.
- Not discussed was the “influx of hemp derived products and how little we know about those because they don't fall under current regulation,” she noted, voicing concerns that “we're seeing that our consumers don't necessarily understand the difference in these products.” Segawa promised WSLCB and health professionals would continue to watch cannabis trendlines “and where possible support the research that we can have to better inform policy and protect public health.”
- Board members scheduled a final panel for Tuesday November 15th to hear the perspectives of selected industry representatives on the ten year anniversary of I-502.
