WA House COG - Committee Meeting
(January 25, 2022) - HB 2035 - Public Hearing

WA HCA - Prevention Research Briefs
[ Event Details ]

Prevention interests spoke favorably of a bill to form a “behavioral health prevention and equity impact framework” at WSLCB, but the appearance of unbalanced representation raised concerns.

Here are some observations from the Tuesday January 25th Washington State House Commerce and Gaming Committee (WA House COG) Committee Meeting.

My top 4 takeaways:

  • WA House COG Counsel Peter Clodfelter briefed the committee on HB 2035, "Establishing a behavioral health prevention and equity impact framework for the Washington state liquor and cannabis board" (WSLCB, audio - 4m, video).
    • Clodfelter went over the bill analysis:
      • “Establishes a framework for the Liquor and Cannabis Board (LCB) to consider behavioral health prevention and equity principles in strategic planning, decision processes, budget development, and when taking significant agency actions.” 
      • “Requires the LCB to:
        • (1) develop a prevention and equity impact implementation plan;” 
          • This would be incorporated into agency strategic planning with the intent to “increase equity and mitigate behavioral health impacts of agency actions, as well as metrics to track and measure agency accomplishments.”
        • “(2) create an equitable community engagement plan;”
          • This would be about engagement with “overburdened communities, vulnerable populations, communities of color, youth, families and the prevention communities as the LCB evaluates new and existing activities and programs.”
        • “(3) conduct a behavioral health prevention and equity impact assessment when taking significant agency action.” 
          • Formal assessments would be undertaken when “adopting rules, developing interpretive and policy statements, and submitting agency request legislation”; agency staff could designate other actions which would require assessments as well.
      • “Establishes the Behavioral Health Prevention and Equity Impact Council (Council) to advise the LCB on incorporating behavioral health prevention and equity impact principles into agency activities.
      • Establishes the Washington Behavioral Health Disparities Map, which must be developed and maintained by the Department of Health in consultation with the Council and others.” 
        • The map would aggregate data on “the location of alcohol, tobacco, cannabis, vapor product licensees, as well as information about cannabis advertising, as well as available data on the prevalence rate of mental health and substance use disorders” and data “from the Healthy Youth Survey” (HYS). The map would not track data on tobacco, vapor, or alcohol advertising.
      • “Requires consultation with federally recognized Indian tribes.”
    • A fiscal note published after the public hearing showed WSLCB expected implementation of the bill would require part of a full time equivalent (FTE) in 2023, and one and a half FTEs in subsequent years at a cost of $378,420. The additional staff would assist the agency Policy and Rules team by preparing assessments. Additionally, the bill offered the “Washington State Institute for Public Policy (WSIPP) as an option to assist the Department of Health” in development of the Behavioral Health Disparities Map, which could cost $69,183 between 2023 and 2025 due to staffing costs in the event “WSIPP would be assigned the role.”
  • The bill was warmly received as judged by public testimony, with five people lauding the potential positive impacts, and 33 individuals signed in ‘pro’ on the legislation.
    • Representative Lauren Davis, the primary sponsor, described behavioral health as “my life’s work,” noting her position as Strategic Director for the Washington Recovery Alliance. “But this work is often painful, there’s profound suffering,” she said before quoting Frederick Douglass: “it’s easier to raise strong children than to repair broken men.” Davis observed that “instead of spending all of our collective effort pulling people out of the river right before they cascade off of a waterfall, we ought to look upstream and find out why people are falling in the river in the first place” (audio - 4m, video).
      • Davis said Gabor Maté, “renowned addiction medicine physician,” had isolated factors “that will frequently result in a youth, or an adult, developing substance use disorder”:
        • “A susceptible organism”
        • “Stress”
        • “The introduction of an addictive substance”
      • Davis suggested to address these factors:
        • “Intervene early” on those with a history of “mental health challenges” or trauma
        • Teach “stress tolerance skills” to youth so they have coping mechanisms “other than drugs and alcohol” 
        • Prevent youth “access and exposure to addictive substances” 
      • To further existing efforts on this final point, Davis authored HB 2035, saying of those who “first drink alcohol before the age of 14, 50% will develop alcoholism” as compared to 9% of those first drinking after they turned 21. She noted negative “effects of high-potency cannabis on the developing brain” and that cannabis concentrates specifically were to blame for “a silent epidemic of psychosis, cannabinoid hyperemesis syndrome, and cannabis use disorder among young people in Washington State.” Davis further claimed the state had a “long and tragic history of concentrating the sale of addictive substances in communities of color.” She stated this had been true for tobacco and alcohol sales previously, “and it’s true today for cannabis sales.”
      • Asserting that “our communities of color and our low income communities face the greatest exposure to sales and also advertising for addictive substances,” Davis believed they also “face the greatest barriers to treatment.” She declared that HB 2035 was “modeled after the HEAL Act,” passed in 2021, which required “state agencies to take an environmental justice and health equity approach to significant agency action.” According to Davis, her legislation would require an evaluation any time the agency had a policy involving “the sale, use, and advertising of alcohol, cannabis, tobacco, and vapor products.” She thanked her colleagues from “the prevention community” for endorsing her proposal.
      • Chair Shelley Kloba asked whether the Behavioral Health Disparities Map would still need to be created. Davis affirmed that it would need to be built (audio - 1m, video).
      • Kloba also inquired about HYS “locational data” and whether survey participants were anonymous. Davis replied that anonymized data was gathered “at the school building level” (audio - 1m, video).
    • Mike Graham-Squire, Washington Association for Substance Abuse and Violence Prevention (WASAVP) Co-Vice President (audio - 2m, video)
      • Graham-Squire was of the view that "the LCB's mission cannot be accomplished without implementing” HB 2035. He acknowledged the agency had served as “a leader on prevention issues in the past,” noting “their current efforts to regulate delta-8[-tetrahydrocannabinol] and other synthetically-derived cannabis products.” He thought the agency needed “a leadership role on both prevention and equity issues” beyond established processes, since decisions could “lead to increased outlets, increased access, increased advertising, increased social acceptance, and more youth-appealing products.” Graham-Squire expected those decisions would result in “increased underage use, addiction, premature death, mental health disorders” which disproportionately impacted “communities of color, low income communities, and the LGBTQ community.” Graham-Squire indicated other organizations had used health equity impact assessments “for years,” such as the Washington State Board of Health (SBOH) and the Healthy King County Coalition. He added that “the prevention community looks forward to working with LCB to implement this bill.”
      • Kloba pointed to the committee’s involvement in legislation creating the  Washington State Legislative Task Force on Social Equity in Cannabis (WA SECTF) and efforts to “remedy some of the devastating effects of the war on drugs, particularly in communities of color who were more impacted.” Saying it had been “a mistake” not to consider social equity earlier when the state established its cannabis market, and that lawmakers were “working through some bills that would give…an extra leg up for folks who are from…minority communities, disproportionately impacted communities.” Kloba asked Graham-Squire how he imagined “coordination” between an equity effort that could lead to more cannabis businesses, and concerns HB 2035 “clearly addresses” (audio - 3m, video).
        • Graham-Squire said there needed to “be a balance” contrived through “deep analysis and a lot of discussion with the community.” He suggested that if additional cannabis retail licenses were to be approved “to create equity with the retailers, then let’s look at where those are located, those don’t necessarily have to be located in communities that have been most impacted by the war on drugs,” and instead could be allotted in places “least impacted.” He assumed adding the assessments to LCB processes would result in “more successful outcomes.”
      • Retail outlet density was the subject of a “research brief” titled Location Matters: Access, Availability, and Density of Substance Retailers published in early January by the Washington State Health Care Authority (WA HCA), the agency tasked with standing up and appointing the 15 members of the advisory council envisioned in the bill. The brief was the product of “cooperative effort between members of the Washington State Prevention Research Sub-Committee, Washington State University’s IMPACT Research Lab, and the Division of Behavioral Health and Recovery” according to Margaret Kuklinski, Director of the University of Washington Social Development Research Group (UW SDRG). Two other briefs were also published as part of the effort, which former UW SDRG Director Kevin Haggerty said, “brought prevention professionals from around the state together to summarize important scientific information for policymakers to consider when making public health policy decisions.”
    • Linda Thompson, Greater Spokane Substance Abuse Council (GSSAC) Executive Director (audio - 2m, video)
      • Thompson told the committee she’d worked with WSLCB staff for “over 30 years” on behalf of GSSAC, after she’d heard from a parent when “a bar went in next door to the school that her children went to.” Subsequently she’d found the business location was approved because buffer distances had been set 500 feet “from the front door.” Thompson said this inspired her interest in helping to “make equity part of what we do in placement” of cannabis and alcohol retail locations licensed by WSLCB.
      • She reported having found that in some areas, like the Spokane "east central community," resident “lifespan[s were] 13 years shorter than on the upper south hill of Spokane.” Thompson believed HB 2035 would “bring those discussions to the table” after privatization of alcohol sales and cannabis legalization. She remarked that faster results were needed as it took “60 days to get a billboard down that was appealing to our children, and it was replaced the next day with a billboard for that marijuana retailer.” Ideas like a new council consulting with agency leaders would improve “the health and safety of our communities,” Thompson believed, since officials already had “so much work to do with so many systems.”
      • Thompson offered public comment to the WSLCB board about prevention concerns in August 2020.
    • Madeline Wozniak, Washington Chapter of American Academy of Pediatrics (WCAAP) and Seattle Children's Hospital Physician (audio - 3m, video)
    • Megan Moore, Community Liaison for Kitsap Public Health District and Prevention Voices, and Washington State Public Health Association (WSPHA) Board Member audio - 2m, video)
      • Testifying that she was “representing myself,” Moore reiterated that the legislation was “copied from the HEAL Act” and would “contribute one piece to the holistic picture of equity at the LCB.” She noted that legislators had focused on “social equity” in cannabis, “especially as it pertains to equity in licensing and criminal justice, which is rightfully so. However, there hasn’t been much conversation in this committee about ‘health equity’” which had the goal of giving everyone “access to a healthy life.” Moore cited outlet density and licensees near “areas where children congregate” as having health impacts, along with “handing out free cannabis and beer after vaccination.” She claimed that a message youth received in these circumstances was that “substances are the accepted way to deal with their trauma.”
      • She’d found that prevention advocates had been listened to by the agency, “especially over the last two years, we’ve had a great relationship.” Yet, Moore found behavioral health prevention interests were still frequently “acting in a reactionary way to a policy that gets their attention.” Moore felt disproportionately impacted groups would benefit by having WSLCB staff proactively include organizations such as hers when they contemplated health equity.
      • Moore offered public comment to the WSLCB board critical of temporary allowances for licensees in October 2020.
    • Bob Cooper, Washington Association for Substance Abuse and Violence Prevention (WASAVP) Lobbyist (audio - 2m, video)
      • Cooper deemed the bill “good and it’s necessary" until equitable behavior was “ingrained in how government works.” Acknowledging that “equity, though, is a buzzword," he felt equity wasn’t about “making sure [people] have the same resources, it’s making sure that [everyone] can get to the same result.” Cooper found that “by design or by default,” licensees whom the agency regulated “disproportionately” targeted “poor people and non-White communities.” He insisted HB 2035 was “a good start…although I think there is some work that needs to be done.”
      • Cooper voiced confidence the proposal would cost “maybe less than you think,” since there were “a variety of equity analysis tools already out there.” He insisted that without passage of the bill, the state would “continue to externalize the costs to poor, non-White communties.”
    • Luke Fincher signed up to speak in favor of the bill but wasn’t available when called upon.
    • Signed in but not testifying (33):
  • Two speakers signed in ‘other’ on the legislation, supportive of its intent but concerned about a lack of outreach to some of the groups most impacted by the bill, while another two people signed in against the measure.
    • Chris Thompson, WSLCB Director of Legislative Relations (audio - 3m, video).
      • Supportive of the bill’s “goals and objectives,” Thompson relayed that agency leaders wanted to keep “public health, prevention, and equity impacts in [the] forefront of our thinking.”
      • He described the efforts of agency staff in this regard:
        • “We hold a series of forums,” Prevention Roundtables, “specifically with the prevention and public health communities” to facilitate connection with senior staff at WSLCB.
        • “Promote participation from the prevention community in our listen and learn sessions which we do as part of rulemaking.”
          • Outreach and engagement was coordinated by the WSLCB Public Health Education Liaison, formerly Sara Cooley Broschart and Mary Segawa at publication time. The person in this role was responsible for communicating substance abuse and youth access prevention strategies at the highest levels of LCB staff, and represented the agency externally on public health issues.
        • “Working diligently on improving the social equity emphasis in our policies and practices through internal social equity work groups, our support of the social equity task force, and other matters.”
      • Thompson noted that HB 2035 was “modeled on the HEAL Act,” SB 5141 from 2021, which implemented recommendations from a state Environmental Justice Task Force. He thought the bill had “a lot of potential,” but “the framework from HEAL needs to be adapted to fit the type of work” done by WSLCB officials. Thompson added that more thought could be given to “recognizing the difference between what we do and, say, the involved agencies under HEAL” which focused on “development of capital projects, funding of direct services to communities - that’s not the type of thing that we do.”
      • Thompson asked for the chance to “work with the sponsor”---which he said had not occurred—to engage on development of the “major legislation.”
    • Micah Sherman, Raven Co-Owner, WSCA Board Member, and WA SECTF appointee (audio - 3m, video, written comments)
      • Sherman appreciated “the intent” of the legislation, but not the methodology being used to achieve it. As a WA SECTF member, he was “unaware of any attempt by this group to interface with that work” in drafting HB 2035, “and I think that alone should make it so that this hearing” was the last one given to the topic without redrafting the bill. Sherman asked Davis to attend future meetings of the task force because “there’s a lot of great information about what’s really going on that’s needed to inform this work.”
      • Sherman then called out “the war on drugs, which is responsible for a great majority of the problems that are being outlined today,” as “a state project to control the behavior of the poor and marginalized. Drugs were not the problem in that war, it was the state action that resulted in the poverty that creates susceptible organisms and stress.” He found it “bothersome” that HB 2035 could have progressed so far “without dealing with poverty first.”
      • Sherman asked for reflection on why “we treat the wealthy different from the poor in the same exact conversation” and asked proponents to “approach these attempts to help people in the same way that we would if it was a wealthy community that we were trying to intervene on.” He concluded by asking the bill sponsors to participate in WA SECTF events.
    • Bailey Hirschburg, Washington chapter of the National Organization for the Reform of Marijuana Laws (WA NORML) Board Member, and John Kingsbury signed in opposed to the legislation, but not testifying.
  • Representative Melanie Morgan, the WA SECTF chair, asked to provide closing remarks on HB 2035 as she was “a little disturbed" to see equity issues championed without inclusion of the disadvantaged communities targeted (audio - 2m, video).
    • “I appreciate the prime sponsor of this bill bringing this forward,” Morgan said, recognizing Davis’s good intentions, but “it feels to me that we’re focused on children of color, yet not one testifier was from the community of color to speak for our own children, which disturbs me.”
    • Wary of the possibility “we’re throwing around the word ‘equity’ and thinking that gives it a pass” to actually engaging “the very community that you’re trying to help,” she commented that she was “with Mr. Micah Sherman" in that WA SECTF members weren’t “properly engaged” on something which was obviously “a social equity issue, I thought that we should be engaged more.”

Information Set