WA House COG - Work Session
(September 15, 2020)

Tuesday September 15, 2020 10:00 AM - 12:30 PM Observed
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The Washington State House Commerce and Gaming Committee (WA House COG) considers issues relating to the regulation of commerce in alcohol, tobacco and cannabis, as well as issues relating to the regulation and oversight of gaming, including tribal compacts.​

Work Session

  • Cannabis potency policy considerations.
  • Cannabis-related scientific research.

Observations

The Washington State House Commerce and Gaming Committee convened its fall work session to hear perspectives on cannabis “potency” from WSLCB, committee staff, and industry representatives along with updates from the Cannabis Science Task Force and state university researchers inclusive of public health and prevention community efforts to correlate ingestion of high-THC marijuana with adverse … Continued

  • Access Cannabis Observer’s segmented audio, the archived TVW livestream, and all presentations below. We’ll have Observations to share in the coming days.

House lawmakers heard invited testimony on “Cannabis potency policy considerations” from the Washington State Liquor and Cannabis Board (WSLCB), legislative staff, and two cannabis trade groups.

  • The Washington State House Commerce and Gaming Committee (WA House COG), the primary cannabis policy committee in the House, convened a work session around tetrahydrocannabinol (THC) concentrations in the state’s legal cannabis products.
    • Legislative work sessions are convened to ground lawmakers in broader policy topics as opposed to addressing specific bills. Subject matter experts are invited to share perspectives and public comment is not permitted. Work sessions may be scheduled at any time, but the committee assembly days in the fall leading up to legislative sessions can be signals of policymaking to come.
    • WA House COG members had been interested in cannabinoid concentrations in legal products since a public hearing on January 30th for HB 2546, which proposed a cap on THC concentration. The bill’s sponsor, Representative Lauren Davis, gave passionate testimony on her concerns about “cannabis-induced psychosis” correlated to THC concentration. While HB 2546 was not advanced during the legislative session, at the hearing Davis deemed it the “beginning, not the end” of a dialogue on cannabis and the brain (audio – 7m, video).
    • Chair Strom Peterson welcomed committee members and participants before explaining the format for the virtual session (audio - 2m, video).
      • WA House COG members observed in attendance:
        • Representative Strom Peterson, Chair
        • Representative Shelley Kloba, Vice Chair
        • Representative Drew MacEwen, Ranking Member
        • Representative Kelly Chambers, Assistant Ranking Member
        • Representative Melanie Morgan
        • Representative Alex Ramel
      • Several WA House COG members did not speak during the session and may have been absent. Cannabis Observer submitted a public records request to confirm the participant list.
        • Representative Brian Blake
        • Representative Bill Jenkin
          • Jenkin ran unsuccessfully in his district’s state senate primary and will not be returning to the Legislature - though he remains a WA House COG member until January 2021.
        • Representative Steve Kirby
        • Representative Brandon Vick
        • Representative Jesse Young
  • WSLCB Enforcement Chief Justin Nordhorn led a presentation on Cannabis Potency Policy Considerations, "providing some general information about potency,” background on laws and rules, as well as WSLCB’s processes and concerns around regulating cannabinoid concentrations (audio - 18m, video):
    • WSLCB staff:
    • Nordhorn began by saying that “most of the times people are referring to the total THC level in the cannabinoid profile” when they talk about ‘potency.’ He said other cannabinoids like cannabidiol (CBD) “play a particular role” in a product’s profile, but WSLCB regulators focused on “the quantities of each of those main ingredients...THC-A, THC, CBD-A, and CBD.”
    • Nordhorn described “the acid form” found within “the raw form of the plant.” He emphasized the carboxylated molecules were “not intoxicating” and abundant THC-A was the reason eating raw plant material would not cause a psychoactive high.
    • The presentation showed the following formula used by regulators to determine total THC/CBD concentrations after testing:
    • Nordhorn conveyed cannabinoid testing was not pass/fail and shared perspective on how testing was conducted, including in other states. He claimed “there’s different dynamics that have been reported on the value” of testing for additional cannabinoids. He added there wasn’t an “across the board” testing methodology for legal cannabis states but that the state’s Cannabis Science Task Force potency workgroup was attempting to “develop that standardized methodology...to be consistent across all testing facilities” aimed at increasing “consumer confidence.”
    • Nordhorn reviewed some testing challenges, including the assertion that certificates of analysis (COAs) should only be good for a year. After that “sunset,” Nordhorn felt regulators “should really be looking at how has that potency changed for that particular product” as, similar to “other agricultural products,” there was “degradation or deterioration and it will change that molecular structure.”
      • The linked slide states “CR-102 of WAC 314-55-102 adds 1 year sunset on COAs”, a reference to the long-running WSLCB rulemaking project on Quality Control Testing and Product Requirements. A preliminary search of the currently filed CR-102 did not turn up a reference to this change, so this is likely a proposed requirement which would be spelled out in a supplemental CR-102 scheduled for introduction at the September 30th WSLCB board meeting.
    • Nordhorn told the committee “there are more complexities when you’re talking about cannabis” testing when compared to alcohol. Cannabis was tested for twice as many Active Ingredients and had more modes of ingestion. The interplay between THC and CBD mattered, he indicated, since the latter had an agonistic effect on the former and blocked THC receptors in the human endocannabinoid system
    • Nordhorn reviewed concentration levels, consumption methods, and market share for various cannabis products:
    • Regarding concentrates, Nordhorn indicated there was no cap for cannabis concentration but infused edibles had a serving size of 10 milligrams of THC with a limit of 100 milligrams, or ten servings, per package.
    • Turning to the 502 market, Nordhorn reported that sales of useable marijuana had decreased as concentrates increased but that both trends had “leveled off.” Retail sales had increased by 42% from 2019 to 2020 and Nordhorn speculated that the State may be pulling greater market share away from illicit cannabis sources due to the coronavirus pandemic.
    • Lawmakers had several questions for Nordhorn and Poolman:
      • Chambers asked about the CSTF (audio - 1m, video).
      • Ramel asked for clarification around total THC in concentrates (audio - 3m, video).
      • Peterson wanted to know more about legal cannabis labeling in other states (audio - 2m, video).
  • Washington State House Office of Program Research (WA House OPR) Counsel and longtime WA House COG staffer Peter Clodfelter briefed the committee on his State Law Comparison: Cannabis Potency Regulation. He expanded upon information Nordhorn provided while focusing on “how potency is used as a factor in cannabis regulations in states with adult-use...commercial cannabis markets.” He also spoke to “legislative proposals to limit the potency of marijuana products in these adult-use states” as well as “state laws and rules that limit the potency of medical marijuana products and some related legislative proposals in that area” (audio - 10m, video).
    • Clodfelter conveyed the 10mg THC serving size constraint on infused products in Washington was common across adult use states and medical cannabis patients were typically allowed access to items with more THC per serving. He indicated Oregon had 5mg servings up to a 50mg package, but allowed 10mg capsules.
    • Clodfelter reviewed trends in testing, labeling, and taxation of cannabinoid concentrations in other legal states, showing THC/CBD testing and labeling were very common. He observed other states “defining THC very broadly as to include all the possible THC that could be in the product.”
      • Clodfelter found that Michigan’s cannabis-infused products could be lawfully sold provided they didn’t exceed the 10mg THC limit by more than 10%.
      • Of the jurisdictions reviewed by Clodfelter, only Illinois factored THC concentration into their cannabis excise tax when retail stores began opening at the beginning of 2020.
        • 20% tax for all cannabis infused products
        • 10% tax for other cannabis products with THC content of 35% or less
        • 25% tax for other cannabis products with THC content over 35%
        • Illinois’ governor announced July 14th that the state had collected $52 million in revenue over the first six months of recreational sales, $34.7 million of which came from the excise tax. 25% of revenue collected would be “Reinvested in Communities Hit Hardest by Failed War on Drugs.”
    • While no state specified a maximum THC concentration for useable cannabis or concentrates, Clodfelter identified several attempts to legislate the subject including HB 2546 which he acknowledged "did not advance out of committee."
      • Vermont was considering legislation which would establish two caps: a 30% THC limit on usable cannabis and a 60% limit on concentrates. 
    • Various states had concentration laws and rules around medical cannabis.
      • North Dakota and Delaware had THC limits for medical cannabis patients under the ages of 19 and 18, respectively.
      • New Jersey limited medical cannabis to 10% THC, while Ohio limited medical cannabis to 35% THC for useable cannabis, and 70% THC for concentrates.
      • Arizona and Florida considered but didn’t adopt THC limits for their medical cannabis programs.
    • At the conclusion of Clodfelter’s report, Kloba inquired about Illinois’ excise tax for cannabis and that state’s medical market (audio - 1m, video).
  • Washington CannaBusiness Association (WACA) members presented Priority: Public Health and Safety in Cannabis, spotlighting existing research and potential policy impacts of further regulation of cannabinoid concentrations (audio - 5m, video):
    • WACA speakers included:
    • As he introduced the panel, Peterson asked about reducing cannabinoid concentrations in products, in particular vapor items: “what’s the additive...that fills that void?”
    • Christophersen credited I-502 for envisioning how a “safe and fully regulated marketplace” would be safer than the illicit market which remained pervasive elsewhere. 
      • She said the “vape crisis is a good example of how we as a state sort of exceed and stand out” at proactively protecting consumers from dangers of unregulated products. Christophersen highlighted a Yale School of Public Health study of vapor product use which found “Higher rates of e-cigarette and marijuana use in U.S. states did not result in more e-cigarette or vaping-related lung injuries.” She suggested the study lent credence to the idea that Washington’s legal vapor products may have “crowded out the use of these informally sourced [vapor] liquids.” Nonetheless, she felt the industry remained in its infancy and called for “more research in the cannabis space.”
    • Douglass dove deeper into research on what we know about potency in cannabis,” a “snapshot” of the scientific community’s understanding of “cannabis, cannabis products, and human health” (audio - 4m, video).
      • A 2019 study in the medical journal The Lancet claimed that THC concentrations above 10% “modestly increased the odds of a psychotic disorder.” Douglass said that THC level would include “almost all the cannabis found” in 502 stores. He noted the study didn’t look at cannabis concentrates and was more representative of a “correlative effect and not necessarily a causative effect.”
      • Another study from researchers at Harvard Medical School in 2018 concluded that “an increased familial morbid risk for schizophrenia may be the underlying basis for schizophrenia in cannabis users and not cannabis use by itself.” Douglass conveyed speculation that cannabis use in those circumstances may be “a form of self treatment...for existing underlying symptoms.”
      • Douglass revisited the Yale research study on Vapor Associated Lung Injuries (VALI), asserting it showed “the highest per capita rates” of exposure in states “that did not have regulated cannabis systems” in contrast to “some of the lowest incidences in states that did have regulated cannabis.”
      • The final study, published in 2019 in Scientific Reports, observed “greater symptom relief for many ailments” with “high potency” useable cannabis. Douglass asserted that “in regulated cannabis states you have lower use of medications, and lower prescription rates for things like opioids, benzodiazepine, and SSRIs [selective serotonin reuptake inhibitors].”
      • In closing, Douglass explained that “myself, and a number of Washington scientists like me, voted in favor of Initiative 502 because it explicitly promised to fund cannabis research” which was hindered under cannabis prohibition. He said WACA and scientists would stand “arm in arm” to support continued research, but the current data wasn’t conclusive on whether “cannabis concentrates or high-potency marijuana cause harm. We’re just beginning to grapple with that.”
    • Goldman considered possible policy ramifications of regulation of THC concentrations (audio - 4m, video).
      • Extracted by either solvents or “heat and pressure,” cannabis concentrates were unlike alcohol, Goldman said, since "cannabis oils can't be diluted with water." Instead, they required an oil-soluble additive to “blend” - most of which had some risks when inhaled, as was discovered when vitamin E acetate became a widely used diluent in unregulated marketplaces. Statutes which encouraged dilution to lower cannabinoid concentrations would likely cause consumers to inhale more diluents.
      • Turning to HB 2546, Goldman shared his belief that the bill would have “unintended consequences” like requiring “potentially harmful” additives and encourage consumers to use more cannabis to achieve expected effects. This could be especially damaging for patients acclimated to high-THC products which minimize administration, he indicated. Goldman further warned that some consumers could consider excessive adulteration to be “contamination” of cannabis products and reason to buy from outside the 502 system.
      • Aside from studying any connection between cannabis and mental health, Goldman honestly wondered, “if science does say that we should reduce THC consumption for better mental health, how do we do that safely?”
    • Before fielding questions, Christophersen concluded that both legislators and the industry had an interest in public health, reducing Washington’s illicit cannabis market, and expanding cannabis research (audio - 1m, video).
      • Peterson asked about current labeling requirements (audio - 2m, video).
      • Kloba wanted to better understand how labeling related to consumer education (audio - 5m, video).
  • The Washington SunGrowers Industry Association (WSIA) launched the final industry presentation, The "Potency" Driven Market: A Cannabis Farmer's Perspective, offering remedies to move consumer opinion away from THC as a “proxy for quality” (audio - 10m, video):
    • WSIA representatives:
      • WSIA Executive Director Crystal Oliver
      • Jade Stefano, Puffin Farm Co-Founder and CEO, and WSIA Board Member
    • Oliver told the committee that “while THC concentration is used in state and national definitions to differentiate marijuana from hemp, it’s not the only cannabinoid present in cannabis that interacts with the endocannabinoid system and receptors.” Oliver indicated that “terpenoids such as limonene, myrcene, or pinene” had a “pharmacological effect on the brain” beyond impacting cannabis flavor in a process referred to as “the entourage effect.” Oliver said she had yet to see evidence of “linear correlation between intoxication/THC” that could ignore other factors.
    • Mentioning HB 2546’s hearing in January, Oliver dinged the research cited in the bill’s original text. While it “alleged a cause-and-effect relationship between cannabis and psychiatric illness” based on self-reported illicit cannabis use, the study did not consider factors such as actual THC concentration nor the fact that “those with psychiatric illnesses typically use all intoxicants at a greater rate than the general public.” Accordingly, she felt the study---cited with intent to legitimize HB 2546---pointing to a substance use trend in a population with mental health issues was “not really a surprising find.”
    • Oliver spoke to other studies, maintaining that no causation had been sufficiently shown while raising other concerns over taxing or limiting cannabis concentrations. She highlighted a report from Spain which “found no relationship” between cannabis and psychotic experiences once accounting for “covariables” and concluded that “the relationship established between psychotic experiences and cannabis is complex and is mediated by relevant variables.” Oliver agreed with others who called for “more research of the regulated marketplaces to better understand this,” inserting an oblique reference to the fact that many studies were dependent on surveillance of unregulated marketplaces.
    • Oliver felt the role of consumer education had been insufficiently considered to address potency concerns. She believed the construction of Washington’s legal market had encouraged consumers to value THC concentration over other quality factors. Oliver said growers in pre-legalization cannabis cultures would “verbally communicate attributes and distinguishing factors,” didn’t typically perform standardized testing, and were therefore less reliant upon THC concentration to convey value. Under the legal market, “farmers were no longer permitted to sell directly to consumers” leading buyers to rely on packaging and labeling that focused on a few cannabinoids found in a sample from “a five pound lot.”
    • Accordingly, some producers found that cannabis cultivars which had “sold well on the illicit marketplace no longer sold well on the regulated marketplace because they had a lower THC concentration.” Oliver said this led retailers to pressure producers to mark down the price of lower THC products, further motivating growers to stop producing certain cultivars entirely, a process which “negatively impacted the diversity of strains and cultivars” available in legal stores.
    • Another factor which concerned Oliver was the lack of an organic-equivalent designation from the Washington State Department of Agriculture (WSDA). Though there were various “private sector” standards, a lack of consistency had made it “challenging to educate the consumer base that these are, sort of, the organic equivalent,” she attested.
    • Oliver remained concerned that potency taxes or limits would reinforce the concept that cannabinoid concentrations were a “proxy for quality” and would incentivize widespread use of “cutting agents” with their own generally unknown health impacts. She emphasized the “lack of standardization and confidence in Washington’s labs and traceability systems” wasn’t helpful. And banning high THC concentrates would drive consumers to unregulated markets in search of desired products, motivating illicit actors to create and profit in more dangerous and unaccountable settings.
    • Oliver offered ideas to diminish consumer focus on THC concentrations:
      • Allow direct sales to consumers by cannabis producers so that “farmers can educate consumers on their growing techniques.”
      • Reform WSLCB’s testing and labeling requirements “to allow for multiple tests per harvested lot which would allow THC and CBD to be reported as a range rather than as a single number.” This would provide consumers with “a more accurate and representative number to make their buying decision on.”
      • Require WSDA to complete its organic-equivalent certification similar to California’s OCal standard.
    • Following up, Ramel asked for Oliver’s views on the relation of THC concentration to psychosis (audio - 2m, video).
  • Peterson closed out the first part of the work session by thanking participants and reminding everyone WA House COG was “in the information gathering phase” and “if and when any future legislation comes, we want to make sure that we keep these lines of communication open” (audio - 1m, video).

Lawmakers learned about the cannabis-related work of academics affiliated with the Collaboration on Cannabis Policy, Research, and Outreach (CCPRO) at Washington State University (WSU) including studies on rodent brain development and human cannabis use during and after pregnancy.

  • After a briefing from regulators and trade association representatives on Cannabis Potency Policy Considerations, the Washington State House Commerce and Gaming Committee (WA House COG) work session agenda was turned over to “Cannabis-related scientific research.”
  • Michael McDonell, Associate Professor at the WSU Elson S. Floyd College of Medicine, led the university’s presentation as chair of CCPRO, a group which included researchers “primarily focused on health” as it related to cannabis use (audio - 9m, video):
    • CCPRO “consists of more than 70 researchers across the WSU system” who “work on the cannabis policy landscape, determining short and long term health effects of cannabis use, including addiction, impact on the opioid crisis, pain, stress, anxiety, depression, and other public health issues, plus public safety and criminal justice issues, and agricultural issues.”
    • McDonell identified four “pillars” of CCPRO’s work:
      • Improving Health and Well-Being
      • Public Policy and Safety
      • Economics
      • Agricultural Research
    • And expanded on CCPRO’s goals:
      • “Support and coordinate the cannabis work at WSU.”
      • “Make sure [WSU] policies are consistent with both federal law and state law.”
      • “Be an interface...for working with other government agencies, legislators, the industry, as well as other cannabis stakeholders.”
    • McDonell took committee members through a presentation on CCPRO’s priority research areas, its funding and collaborative efforts, as well as the opportunities and challenges which lay ahead for the organization.
    • Turning to cannabis and mental health, McDonell told the committee he led the “statewide evaluation of our first episode psychosis program (FEPP)”---WA HCA’s New Journeys program---which he said had been “very successful.” He described evaluators’ work at “understanding the impact of cannabis...on first episode psychosis” before saying “I want to be very clear about what the science does say, because there’s a lot it doesn’t say yet and we need more research.”
      • McDonell agreed with earlier remarks from cannabis trade group representatives that some research inconclusively linked cannabis use and psychosis, “however, what we do know…[is] that potency of THC [tetrahydrocannabinol] is correlated with psychotic symptoms and is associated with hospitalizations for people who have psychosis, for people who have schizophrenia.”
      • McDonell also commented that “high potency or frequent use” of cannabis “also strongly correlated with the...how early on in your life you get psychosis.” He stated, “the earlier you're diagnosed with a psychotic disorder or a problem with psychosis, the more likely you're going to have a very bad outcome for you across your lifespan.”
        • The National Institute of Mental Health (NIMH) Recovery After an Initial Schizophrenia Episode program (RAISE) FAQ answering the question “Why is early treatment important?” states: “It is important to reduce this duration of untreated psychosis because people tend to do better when they receive effective treatment as early as possible.”
        • The NIMH FAQ also provided a definition of “the word psychosis: “The word psychosis is used to describe conditions that affect the mind, where there has been some loss of contact with reality. When someone becomes ill in this way it is called a psychotic episode. During a period of psychosis, a person’s thoughts and perceptions are disturbed and the individual may have difficulty understanding what is real and what is not.  Symptoms of psychosis include delusions (false beliefs) and hallucinations (seeing or hearing things that others do not see or hear). Other symptoms include incoherent or nonsense speech, and behavior that is inappropriate for the situation. A person in a psychotic episode may also experience depression, anxiety, sleep problems, social withdrawal, lack of motivation and difficulty functioning overall.”
      • Mentioning a 2019 study in the medical journal The Lancet which was put forward in HB 2546's preamble to lend academic legitimacy to the bill and had been criticized by industry representatives, McDonell called it “a very well done, case-controlled study” and the “best way that we can do research and try to establish some sort of a strong, scientifically rigorous relationship between two variables.” McDonell asserted there was “no way we’d ever be able to do a study where we gave people at risk for schizophrenia high potency THC on purpose. That’s just not something that we can do.” He believed that study created “the most compelling evidence that what they defined as high potency THC, 10% and above, has a very strong association when we control for many of the factors that my colleagues highlighted, when we control for history of family, or genetics sort of things...we see a very large increase...in the prevalence of psychosis correlated with cannabis.”
      • McDonell repeated his earlier remark that more research was needed and the CCPRO “stands ready to do the research,” particularly around psychosis and cannabis.
      • Learn more about New Journeys and read WA HCA’s legislatively mandated initial status report on the program from March 1st.
  • Ryan McLaughlin, an Associate Professor with the WSU Department of Integrative Physiology and Neuroscience, presented “Toward A More Translationally Relevant Model of Cannabis Use” regarding cannabis use in animal studies and how it may be "virtually impossible" to determine causal relationships between the plant and psychosis (audio - 10m, video).
    • McLaughlin echoed others’ calls for greater research as he explained his study of how "cannabis use affects the brain and affects behavior." However, “it’s virtually impossible to establish cause/effect relationships or directionalities of these relationships” regardless of “how many correlative studies you might have.”
    • Instead, McLaughlin observed, researchers often turned “to animal models to do this work.”
      • McLaughlin developed a “novel, innovative approach” of administering cannabis to animals that “tries to tackle this translational gap that we see in the field of cannabis” where scientists don’t “use actual cannabis products” but go with “injections of synthetic drugs or pure THC which...is very, very different from cannabis.” McLaughlin noted this was problematic due to the interplay of THC with other phytocannabinoids as well as the fact that “the effects of the drug can vary dramatically according to the route of administration.”
      • His process also recognized the impact of “forcing a drug on an animal who is unsuspecting versus allowing it to consume the drug of its own volition.” Type of cannabis, mode of ingestion, and choice were “very important considerations in the pre-clinical animal field,” McLaughlin testified. He criticized the “crude cannabis extract” provided by the federal government through the University of Mississippi and added that his team had “received a compound that is up to almost 70% THC with trace amounts of these other phytocannabinoids.”
    • McLaughlin reviewed the hardware used to administer diluted cannabis vapor to mice. He said that researchers had “worked for several years to validate this model...that animals will show conditioned drug-seeking for cannabis vapor and that they are motivated to respond for it.” McLaughlin explained the main purpose was to model “developmental cannabis exposure” and hoped results from rodent tests could be used to address policymaker questions around underage cannabis use by looking for changes in rodent brains over time. “We’re finding some really interesting data showing that there are some effects...dependent on the type of extract being used,” he remarked, while other impacts depended on “whether you’re a male or a female.”
    • McLaughlin said another area of “major interest” for those he worked with was the “effects of maternal cannabis use on offspring” by allowing pregnant rodents to self-administer cannabis vapor “throughout pregnancy” and studying the effects on the offspring. He explained that this provided data on Behavioral and Biological Predictors of Problematic Cannabis Use which would “try to get at, sort of, neural correlates of cannabis use disorder which has been fairly elusive in our field to date.”
    • Finally, McLauglin called attention to research he'd collaborated on with his wife, psychology researcher Carrie Cuttler, to “to examine the effects of an acute stress manipulation on subjective stress and salivary cortisol in chronic cannabis users compared to non-users” which revealed a “blunted stress response under intoxicated conditions compared to non-cannabis users.” McLaughlin hoped an additional grant from NIH would allow his team to “use our animal model to look at whether cannabis use in our model, with all other factors controlled for, does in fact produce a blunted endocrine response to stress.”
  • CCPRO’s final presenter was Celestina Barbosa-Leiker, Vice Chancellor for Research at WSU Health Sciences Spokane, who shared I-502 funded research on “Cannabis use by pregnant and parenting women” (audio - 9m; video).
    • Leiker testified that “over the past two decades we know that past month cannabis use in pregnant women has increased.” She stated, “70% of pregnant and non-pregnant women believe that there is slight or no harm in using cannabis a couple times a week while pregnant” and “overall perception of harm resulting from cannabis use has decreased since legalization.”
    • Leiker said that “quite a few studies” over the last 30 years had shown cannabis use during pregnancy to be associated with health impacts while THC content in cannabis “has greatly increased in the past 20 to 40 years.” She stated it was known that THC “crosses the placenta during pregnancy and during breastfeeding” before delving into specific studies.
      • Leiker was among scientists who looked at women’s perceptions of risks and benefits of cannabis use during pregnancy and postpartum as it related to breastfeeding and parenting. They spoke with 19 pregnant/postpartum daily cannabis users, “primarily white women,” leading to another ongoing study with “American Indian pregnant women.” Leiker spoke to several themes researchers derived from the women surveyed.
        • Continued use for medicinal purposes: “Many women were reporting using for nausea and morning sickness, but even more so to manage pain, for anxiety and stress, and to get a better night’s sleep.”
        • Moderation: Pregnant women said they “were cutting back marijuana use, they were trying to use safer methods, they saw cannabis as a safer alternative to opiods, to ibuprofen, and to other medications.” 
        • Mixed messages: “They were hearing all conflicting messages from healthcare providers, they felt stigma from healthcare providers, and also fears from Child Protective Services (CPS).”
        • Wanting more info: “Every participant, and this was surprising to us, talked about how they were frustrated over the lack of research about cannabis use for pregnancy for the development of the fetus and any effects on their child.”
        • Individuality: “There was a lot of history of trauma...we had participants who had just overcome homelessness all the way to middle class, there were a lot of comorbid conditions. They really talked about how they needed this individual decision.”
      • Another survey was geared toward assessing healthcare providers' perceptions and messaging on pregnant/postpartum cannabis use, with Leiker expressing surprise that “pregnant women are getting their scientific and medical advice from budtenders.” This motivated Leiker’s team to survey retail licensees and their employees as well.
        • Healthcare providers noted a lack of definitive research; their unfamiliarity with cannabis products and lack of training in their medical values; and increased “patient disclosure of use after legalization.”
        • Cannabis retailers considered pregnant/postpartum cannabis use approved by a customer’s doctor a “personal decision” and felt “it wasn’t their job to get in the way of the purchases that the pregnant women wanted to make.”
        • In addition to wanting better informational resources, budtenders often adopted a “harm reduction approach” for pregnant customers where “they would steer her towards low THC products, or even recommend [cannabidiol] (CBD).” Several reported wanting more information than was provided in the Washington State Department of Health’s (DOH) Medical Marijuana Consultant Certification Program.
    • Leiker wanted to “work with patients, healthcare providers, and cannabis retailers to better serve pregnant and postpartum women,” expand research, and “rethink patient education. More of a harm reduction approach I believe is best and not stigmatization.”
      • Representative Melanie Morgan asked about CCPRO’s outreach and engagement with black, indigenous, and people of color (BIPOC) communities (audio - 5m; video).
      • Representative Shelly Kloba shared her views on the state’s funding of cannabis research and how it compared to the original initiative (audio - 2m; video).

Committee members learned about cannabis-related research from academics affiliated with the University of Washington Alcohol and Drug Abuse Institute (UW ADAI) and heard their concerns about concentrated cannabinoid products.

  • Beatriz Carlini, a UW School of Public Health Affiliate Associate Professor, presented information on "High Potency Cannabis" and research on “how they are measured and researched, who are the consumers, health risks and consequences, and a little bit about policies” (audio - 13m, video).
    • Carlini began by saying “high potency” cannabis had been defined as having a tetrahydrocannabinol (THC) concentration “of more than 10%, and that was right before the market forces of legalization redefined that concept.” She accepted that potency-focused cultivation and concentrates were “not invented by legalization, by no means, but was legalization...that brought a possibility of mass production of this manufactured products, cannabis extracts.”
      • Carlini presented data showing low potency cannabis flower had disappeared from retail stores.
      • Carlini contrasted concentrates, which had cannabinoid concentrations “mostly in 60 to 90%” range, which she felt was “entirely a different animal” than the cannabis plant. Carlini testified that extraction of cannabis was “mostly using butane...adding terpenes from other vegetables and other plants, refine and process a little like” commercial food manufacturing but with less research. She believed this process of cannabis product innovation led to new paraphernalia like “dabs and all the different ways of vaping cannabis.”
      • Carlini noted that Washington's extract market share grew from 9% in 2014 to 24% by 2017, and that it was currently “35% of the market” in Washington, representing a “nearly ten-fold increase in sales.” 
        • Some of this growth can be attributed to other factors. As a writer covering the launch of retail sales in Washington for the Marijuana News Network (MJNN), I observed the stores opening across the state throughout 2014 had limited types of products given the small number of licensed processors in operation. At the first retailer to open in Vancouver, I wrote that “the supply issue will be resolved soon enough...we will soon be offering the finest quality weed at a reasonable price, as well as edibles and more.”
        • UW ADAI’s data also couldn’t account for extract sales in gray market dispensaries prior to their prohibition by law in 2015, and closure the following year. I noted one nearby dispensary when writing about Thurston County’s first legal retailer.
    • Increasingly concerned about health impacts of concentrated cannabinoids, UW and WSU staff joined state and community prevention organizations to form a “Cannabis Concentration Workgroup” within the Washington State Prevention Research Subcommittee (WA PRS) in March.
      • The formation of the work group may have been a response to the failure to advance HB 2546, which proposed a cap on THC concentrations in cannabis products. However, Carlini expressed concerns in 2019 as a member of WSLCB’s potency tax work group. She was joined in that work group by WSU Human Development Professor Laura Hill, who was a co-chair of WA PRS at the time, and UW Endowed Professor of Prevention Kevin Haggerty, who was appointed co-chair of WA PRS in January.
      • The WA PRS cannabis work group’s goal was development of a “consensus statement on health risks of high concentration cannabis” which Carlini said would be available to policymakers and the public before November 2020. She said the group “departed” from an approach which would “check if the science really backs what we have been perceiving as work in the community.” Instead, the group planned to assert “that high potency cannabis is more detrimental to health than lower potency, so there is a dose-response relationship.”
      • Carlini said the work group members believed “high potency cannabis use is an issue of equity, disproportionately affects marginalized or vulnerable populations,” another subject discussed in the cannabis potency tax work group.
    • Carlini called attention to research at UW by Caislin Firth, who used data from the Behavioral Risk Factor Surveillance System (BRFSS) to look for common traits among adults who vaped or used higher concentrated cannabis dabs. Firth asserted vape users tended to be male, with higher incomes and college education. Dab users were also likely male, but skewed towards being younger, Latinx, and with less income and health insurance.
    • Although cannabis use among underage populations “has not increased when we look at the general prevalence,” Carlini said that some youth were vaping or dabbing at increasing rates according to the state’s Healthy Youth Survey (HYS).
      • WSLCB Public Health Education Liaison Sara Cooley-Broschart briefed on the HYS’s impact on agency activity in December 2019 and on January 8th
    • Carlini credited the work of Julia Dilley, the Principal Investigator at Program Design and Evaluation Services, a joint office of the Multnomah County Health Department and the Oregon Department of Human Services Division of Public Health, and a Senior Research Scientist/Epidemiologist at UW.
      • Carlini said Dilley and other researchers studied poison center data nationwide from 2015 to 2017, “and they clearly see that the plant material” reports were “stable” but that there were “increasing calls to the poison centers asking for help is concentrated on vape concentrate products and also edibles.” She reported that the majority of poison center calls for cannabis plants involved “co-using” with another substance, but that 82% of calls for concentrates, edibles, and vape products were “calling because they are experiencing negative consequences related to this manufactured product.”
      • Dilley briefed the WSLCB Board in September 2018, was a participant on the WSLCB potency tax work group, and briefed the agency’s HYS work group in October 2019
      • More recently, Dilley was listed as a reference for Center for Toxicology and Environmental Health (CTEH) health scientist Katelyn Hall in the unsuccessful proposal from TerraGraphics, Inc. to consult for the Washington State Task Force on Marijuana Odor. TerraGraphics, perhaps better equipped to help monitor radioactive solid waste burial grounds at the Hanford site, partnered with “CTEH as our subcontractor to provide human health and toxicological expertise for this scope.”
    • Carlini presented other researchers’ “most relevant” reviews of academic studies between 2018 and 2020. At UW, Denise Walker and Jason Kilmer found that “the higher the potency, higher is the chance of developing addiction to cannabis” and “THC concentration increases the chance of cannabis use disorder, particularly among young people.”
    • Echoing a point made earlier by her WSU colleagues on limits to constructing human studies involving the administration of cannabis products, Carlini said there wouldn’t be studies based on “randomizing people to see if they’re going to get addicted later. This is not possible. We’re never going to get that.” Carlini asserted that “the studies are well done, and well controlled, and have sophisticated designs, but they observe people over time. They do depend on what people tell us because that’s the nature of doing research in this area.”
    • Carlini then mentioned psychosis, and McDonell’s literature review which claimed that “the use of higher potency cannabis increased nearly five times the odds of developing psychotic disorders.” Carlini said that “no one is trying to disseminate panic or anything, but [a dose-response relationship] is what the data says.”
    • Carlini concluded by saying “we live in a legalization era where the market runs the show. There are many ways you can legalize cannabis.” She argued that Washington’s market was driven by “product diversification and innovation. That’s how it is for cell phones, for cars” where consumers were encouraged “to want to consume more.” Meanwhile, science and regulation “walks behind” that curve. Carlini dropped an open question: “who owns the burden to prove safety and quality of the products sold?”

Information Set