Rede Group - Public Health + Youth Prevention Marijuana Summit - 2021 - Keynote
(September 28, 2021)

Tuesday September 28, 2021 8:15 AM - 9:00 AM Observed
Rede Group - Logo

Hot Topics in Cannabis Policy and Public Health: from novel cannabinoids to proposed federal legalization

https://www.ph-mjsummit.com/

Observations

CANNRA Executive Director Gillian Schauer shared her personal view of the current state of cannabis policymaking nationwide before addressing associated public health topics.

Here are some observations from the Tuesday September 28th Public Health + Youth Prevention Marijuana Summit hosted by Rede Group.

My top 3 takeaways:

  • Schauer’s keynote speech covered her view of the national legalization landscape as well as equity and restorative justice.
    • Schauer chose to forego the “A to Z on cannabis policy,” remarking that she’d given that overview “for a few years at this conference, I thought it would be more valuable this year to focus on ‘Cannabis Legalization Version 2.0’ or beyond.” She would then speak to contemporary issues she’d encountered officials dealing with, including “novel cannabinoids and THC isomers...THC concentration, [and] federal legalization.”
    • Legalization Landscape. Calling the growth in reforming U.S. cannabis laws “exponential,” Schauer described the increase in states legalizing the plant for medical or adult use since 2014. “Whereas in 2015, we had, I think, 18 states with comprehensive medical use and only four with adult use. Now, we have 18 states and territories with comprehensive adult use, and 13 or so with comprehensive medical use.” She noted only Idaho, Nebraska, and South Dakota had no laws legalizing cannabis for adult or medical uses.
      • Schauer talked about the increase in legal jurisdictions in the “2020/2021 cycle” and what “makes some of these states a bit different in terms of their approach to policy than what we’ve seen before.” She termed this “Cannabis Legalization 2.0,” but conceded that “we could argue that this is 3.0...now, we’re in the third wave, maybe.”
      • Following “a lot of copy and paste” of cannabis laws, Schauer saw a “breakout from the mold” and a “change to how policy’s being made.” Legalization by way of “legislative policy” was “much broader now, than the Cole Memo era.” Schauer said the 2013 memo provided federal guidance to state leaders on “how to proceed with legalization given that cannabis was federally illicit.” She considered it “natural for policy makers in the early states to focus on” establishing “brand new” legal markets, and doing so “without having the feds knock on their door...but a lot has happened since then.”
      • Early states to legalize, like Washington, enacted laws Schauer stated “were not as strong as we might have hoped, in terms of protecting youth from accidental ingestion.” She believed the legalization of cannabis “in and of itself is insufficient to bridge the gap of disparities that we had been seeing, that had, I think, motivated many voters to approve these policies.” Schauer highlighted a 2015 Denver Post article finding “despite legalization, people of color were still being disproportionately targeted for cannabis...related activity,” saying it “necessitated some different approaches.”
      • “In 2018, hemp was legalized at the federal level,” said Schauer, “a big game changer” which had impacted “the way that policy making is happening.” Additionally, a wave of vaping associated lung injuries (VALI) in 2019 led to “a shift in how policy was being viewed,” she added.
      • States legalizing cannabis more recently had “an increased focus on social equity and restorative justice, on public health and safety, and on increased parity of regulations across medical programs, adult use programs, and with hemp,” Schauer commented. Governments were increasingly likely to modify their cannabis laws without ballot or initiative action by voters, she indicated, saying “this past year has been flush with legislative approaches, and I have observed that legislative approaches to legalization can allow for many more stakeholders at the table.” Schauer said this resulted in greater “dialogue about what legalization should look like” and “much more comprehensive policy up front.”
    • Equity and Restorative Justice. According to Schauer, greater attention to this issue had a significant public health impact. “We know that any time somebody has had involvement with the criminal justice system, it forever changes their health trajectory, their health outcomes,” she stated, adding that this even applied to “the health outcomes for that family and the same is true of communities.” Schauer felt that two leaders in this space were “Danielle Perry in Illinois, Cat Packer” in Los Angeles, but noted others had “given this a lot of thought.” What had emerged was “a three pronged approach,” she commented, that was “not just about equity in the market.” 
      • Regarding market equity, Schauer noted a pattern of policymaking aiming to ensure, “to be blunt, that licenses and the profits from this new industry aren’t just going to a bunch of White men.” There was progress on “creating more equity in the market,” she said, with “room for continued improvement.”
      • On “expungement and decriminalization,” Schauer said, “that needs to be an automatic process...we can’t depend on people, nor should we put the burden on people, to file for expungement.”
        • In 2019, two cannabis-specific conviction reforms were enacted in Washington state, Governor Jay Inslee’s Marijuana Justice Initiative and SB 5605 allowing vacating of cannabis misdemeanor convictions. In September 2019, Cannabis Observer was told by the governor’s communication staff that his initiative had been successfully used 26 times.
      • Considering community reinvestment “the most ground shifting for public health,” Schauer said this amounted to “reparations from the criminal involvement that’s happened in the past.” Two states leading on this were California and Illinois, she noted, saying that the former had made a Community Reinvestments Grant Program which would “be giving $50 million each year” in grants, most to “qualified, community based, nonprofit organizations” assisting in public health priorities like:
        • “Job placement”
        • “Mental health” and “Substance use disorder treatment”
        • “System navigation services”
        • “Reentry”
        • “Linkage to medical care”
        • Schauer commented that she liked that the program mandated that “allocations must be grounded in science and data, and they must advance whole person trauma informed care.” Additionally, funded programs needed “to be responsible to communities that have been disproportionately impacted by the prior criminalization of cannabis.”
        • Via the event chat, Youth Forward Executive Director Jim Keddy commented, “I have been working with state agencies to develop the cannabis funded grant programs in California. It’s a much bigger revenue stream than just the one mentioned- there are three other grant programs including a $50-80 million annual program for youth prevention, focused on reinvesting in communities of color." Schauer thanked Keddy for the clarification, reading that he’d “engaged youth in bringing input to the state agencies.”
      • Schauer said Illinois’ Restore, Reinvest, and Renew (R3) Program allocated “25% of their net tax revenues,” amounting to “$10 million in 2020,” to disproportionately impacted communities “for civil/legal aid, economic development, reentry, violence prevention, and youth development.” She found that the money was disbursed by a “community-based, participatory approach, which I think is also really important.”
      • Two other states legalizing “this past year” focused “not just on equity, but on this restorative justice/reparations/community reinvestment piece,” Schauer observed.
        • New York would “be dedicating 40% of their adult use cannabis tax revenue” towards “job placement, adult education, mental health treatment, substance use disorder treatment, housing” and other community programs she said “tended to be underfunded in public health.” Projections were that upwards of $100 million would be invested in the program, Schauer added. 
        • Virginia would “dedicate 30% of tax revenue to a cannabis equity reinvestment fund” to be administered “by a multi-member board.”
      • Schauer concluded that if policy in these three areas were “implemented well...this stands to be a huge boost for a lot of public health areas that impact disparities” which had “needed funding.”
      • Schauer was asked about the California “community-based decision for grant funding” and how similar funding mechanisms were overseen in other states, curious whether they were “funneled through public health.” She replied that many states were still in the process of setting up their reinvestment programs, but California utilized “a community-based approach and a lot of local engagement.” Public health officials hadn’t managed the grant money in Illinois, either. In that state, a “group that’s comprised of a variety of different stakeholders” who reported directly to their governor were handling the funds. “And I think the goal of that community-based participatory angle is really to try to make sure that the funds are being invested in ways that truly help disproportionately impacted communities,” Schauer said, indicating that public health representatives were “at the table.”
  • The final area Schauer spoke to was public health and safety, arguing that states were getting better at addressing contemporary issues pertaining to cannabis policy.
    • Advertising. Saying that early states to legalize cannabis had used “audience criteria that was based from the alcohol industry’s efforts to sort of police their own advertising,” Schauer described how this meant that “71.6% or more of the audience had to reasonably [be] expected to be 21 years of age or older for advertising to occur.” She then put it another way, saying that close to 30% “of an audience for advertisements could be underage.”
      • Schauer highlighted states that had raised their cannabis advertising standards to assist “a variety of youth prevention outcomes.”
      • Limits and bans on types of advertising had increased with cannabis, Schauer told attendees, pointing to the state of Montana where draft rules on advertising will restrict cannabis from “billboards, TV, radio, or newspaper ads.” New Mexico and Virginia laws would have similar bans on cannabis ad outlets or time, she mentioned. “Warnings on advertisements have also increased, particularly warnings that note that this is an adult-only product,” said Schauer.
      • Schauer said that social media had proven "a more challenging arena" to predict an ad’s audience. New Jersey and Connecticut prohibited “location-based device ads” for people on internet enabled devices near cannabis businesses “unless you’re 21 years of age or older.” Cannabis advertising was common on social media sites, she added, including not just from companies but “social media influencers as well.” Third party advertising was also a concern of Schauer’s, as states typically only restricted licensed cannabis entities under their ad requirements. Connecticut was an exception, applying cannabis ad rules “to anybody who’s advertising cannabis or cannabis paraphernalia for any reason.”
    • Packaging and Labeling (PAL). Schauer believed states were giving more attention to PAL requirements.
      • Some states were adopting “plain and uniform packaging” or “opaque packaging” that allowed “for a branded element.” She stated this format was “not enticing to youth.”
      • “Putting the universal symbol on all products” was common, which “helps people know that this product contains cannabis.”
      • “Inclusion of a poison center phone number and/or a drug information website is another thing that we’re seeing,” which can be “valuable for adverse events.”
      • “Labeling for total THC,” not just delta-9-THC, but isomers “that can also be impairing and...contribute to the overall psychoactive and psychotropic potential.”
      • “Manufacturing details, in the wake of” VALI as consumers had a greater interest in “more education and information about their products.”
      • Learn more about WSLCB PAL rules and standards.
    • Post-VALI. Schauer said states were increasingly requiring “more regulatory authority over additives and excipients” in vapor products as well as authority over hardware devices.
      • The U.S. Centers for Disease Control and Prevention (CDC) found vitamin E acetate to be “a contributor, but...they couldn’t rule out other contributors.” She said a number of ingredients in vapor items lacked a “well rounded out safety profile” while others “we know are probably likely to be harmful.”
      • State officials were gradually taking more control over ingredients and additives, Schauer explained. This meant quicker action if a similar public health situation occurred in the future, she remarked, “to get the harmful component out of the marketplace,” which also meant strengthening recall procedures. Regulating device temperature or heating elements was another approach Schauer said “may, or may not, be adopted by adult use states,” as well as rules over “less regulated, or unregulated products that may be coming from the hemp marketplace.”
      • Washington lawmakers passed a bill in 2020 increasing WSLCB authority over cannabis products, including vapor items, which agency staff implemented through rulemaking that year.
    • Public Education. Focusing on education, “prevention, and data monitoring” was common among states that had most recently legalized cannabis, stated Schauer.
      • “In New York, 40% of the tax revenue” went into “public education and treatment, including for a youth-focused public education campaign, a statewide campaign on health effects of cannabis and treatment.”
      • “Connecticut established a program at the Department of Public Health to collect data...and they will be putting 25% of their tax revenue to a prevention and recovery fund.
      • “Virginia has the majority of their tax revenue going to fund pre-[kindergarten] for at-risk kids,” as well as a treatment and prevention fund.
      • Schauer considered the situation an improvement as public health entities sometimes lacked money “even to collect basic data.” She indicated that some legal cannabis programs had “public health and safety advisory committees” and are using the collected data to report back to state officials. She called attention to research investment by officials in Michigan to study post traumatic stress disorder (PTSD) “and cannabis use.” Schauer claimed public health advocates’ involvement with regulators brought science “to the forefront.”
    • Social Consumption. Schauer suggested that medical cannabis patients faced particular challenges as consumption was mostly legal in one’s residence “and if you don’t own your own home” safe consumption was “problematic.”
      • Social consumption was also top-of-mind for officials looking at cannabis tourism, she commented, but policymaking was a “challenge” and public health stakeholders could participate in “a much more constructive way." Schauer pointed to policies under development in New Mexico, New York, and New Jersey to “allow for some form of on-site or consumption establishment” as areas where public health advocates should get involved to help “mitigate” potential impacts on venue employees “and for consumers and for bystanders.” She said that Connecticut officials mandated a report “of written recommendations” on cannabis and “whether to authorize on-site consumption or consumption at events.” 
      • Schauer believed that public health officials’ experience with tobacco laws gave them insight on “increased evidence coming out that secondhand cannabis smoke looks like it has similar constituents and may cause some similar health harms.”
    • Delta-8-THC. Schauer remarked that the compound and other “novel cannabinoids” were scheduled to be discussed later that day, and involved cannabinoids “derived from hemp.” This left products in “a legal gray area federally,” she said, calling them “psychotropic and impairing.” The “widely available” items skirted testing and labeling rules, she added, pointing to a CDC health advisory sent out on September 14th which identified 660 cases reported to poison control centers nationwide involving the compound. This made delta-8-THC and other novel cannabinoids “a particularly concerning policy area for public health.”
    • THC Concentration. “Many of you may have seen bills about THC concentration in your legislature this past session,” Schauer established, expressing dismay that they had been more about cannabis concentrates “and not concentration.”
      • Saying the “complex” policy topic had been studied by officials in Colorado as well as by the Washington State Prevention Research Subcommittee in 2020, she noted that they studied cannabis items with a THC concentration over 10% - or, “basically all products.” Schauer claimed that cannabis consumers were “more likely to be diagnosed with a psychotic disorder” than “non-consumers” and that “there’s evidence of a dose-response relationship in terms of negative health impacts.” 
        • She said Colorado officials found all of their cannabis products were high-THC---over 10% THC---but data on cannabis concentrates specifically was “limited.” Schauer read from their conclusion that, “Our ability to make unbiased, evidence-based statements on the potential health effects of marijuana products containing high THC concentration is limited until further scientific research can be conducted.” 
        • Schauer pointed out that the Washington research statement was more “a consensus building report” and had “less of a concrete approach to review the science,” but found that “THC content of cannabis products contributes to health effects in a dose response manner.” Researchers found the risks of cannabis use were “likely to disproportionately affect marginalized populations who may choose more high potency products because of a lower cost in certain markets.”
      • Schauer reported that there was “mixed evidence in terms of the effects of use of...concentrated THC products on dependence” but such products were more likely to include “residues and contaminants that can be harmful to health.” Additionally, she’d seen evidence that cannabis consumers “may self-titrate to achieve the desired level of THC regardless of the THC that’s actually in the products they’re consuming.”
      • Studies “often lack a consistent definition of what is a high concentration THC product,” Schauer claimed, and didn’t account for “compensatory uses.” She felt the goal of public health leaders on this issue should be “to reduce exposure to higher levels of THC, particularly when the brain is still developing.”
      • Schauer reviewed potential policy options around THC concentration:
        • “Require serving sizes”
        • “Label doses or servings in all products”
        • “Limit the total THC in the total purchase amount”
        • “Cap THC in cannabis products”
        • “Restrict or ban certain classes of products entirely”
        • “Tax based on THC”
          • She remarked that Canada and New York utilized tax schemes with this feature.
          • In 2019, WSLCB led a Potency Tax Work Group to meet a legislative mandate to “determine the feasibility of and make recommendations for varying the marijuana excise tax rate based on product potency,” producing a final report on the subject which found a tax based on THC concentration was not feasible at that time.
      • Regulators needed to take care not to “fuel the illicit market, or to create a new one” as Schauer found it “much wiser to have products on the regulated market.” She was also wary of setting “a new industry standard” that incentivized creation of products of a certain strength as it would promote the inclusion of “excipients, flavors, and other additives” in cannabis products. Schauer concluded there was no “easy answer” to the topic.
    • Federal Legalization. Mentioning the Cannabis Administration and Opportunity Act (CAOA) discussion draft in the U.S. Senate, Schauer quickly briefed on the bill’s effects and requirements and the CANNRA response to the draft.
      • The CANNRA response was to ask federal authorities to “set a floor, not a ceiling” to enable “states continue to be able to innovate” and remain “responsive to situations that arise.” The organization also requested standards on PAL, “lab testing, ingredients, and additives,” she explained, and called upon federal officials to work alongside states that had been “at the forefront of setting those standards.” Schauer reported that CANNRA members made recommendations on taxes, data monitoring, research and “initiatives to promote equity” as well. She pointed out that the CAOA included “a community reinvestment grant program.”
      • Schauer hoped that public health stakeholders would “take a seat at the table and keep it.” She advocated working with a variety of stakeholders because “the more stakeholders I speak with, the more my mind is opened to different approaches and opportunities.” Schauer encouraged public health leaders to avoid making “perfect the enemy of the good” and look towards “incremental improvement.”

Engagement Options

Webinar

Registration Required

Information Set

  • Public Health + Youth Prevention Marijuana Summit - 2021 - General Information [ InfoSet ]