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

[ Event Details ]

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).

Information Set