UW ADAI - Symposium - 2022 - Cannabis Use by Young Adults
(September 16, 2022) - Summary

A presentation on consumption habits among young adults in Washington described negative health effects, poor academic outcomes, and suicidal thoughts attributed to cannabis use disorder.

Here are some observations from the Friday September 16th University of Washington Addictions, Drugs, and Alcohol Institute (UW ADAI) 2022 Symposium on “High-THC Cannabis in Legal Regulated Markets.”

My top 3 takeaways:

• Representative Lauren Davis established her history of working with UW professor Jason Kilmer as she introduced him (audio - <1m, video).
  • Warmly greeting “the amazing Dr. Jason Kilmer who I actually used to work with when I was a UW employee back in the day,” Davis acknowledged his role as a UW Associate Professor in Psychiatry and Behavioral Sciences, calling him, “frankly, just a national expert in collegiate substance use, among other things.”
    • Davis was formerly the UW School of Social Work Director of Campus Programs and a Senior Policy Analyst for the Forefront Suicide Prevention program at the university from January 2014 through 2016.
  • At time of publication, Kilmer chaired the College Coalition on Substance Misuse, Advocacy, and Prevention (CCSAP). His research was cited in the Washington State Institute of Public Policy (WSIPP) report on Measuring Youth Cannabis Use in Washington State. 
  • Kilmer was also a member of the Prevention Research Subcommittee at the Washington State Health Care Authority (WA HCA) which published a “consensus statement” on concentrates in 2020. The statement was presented to legislators that September, and subsequently used by Davis in lobbying for a bill she sponsored seeking to restrict the items.
  • His brother, U.S. Congressman Derek Kilmer, voted to pass H.R. 8454, the Medical Marijuana and Cannabidiol Research Expansion Act, on July 26th.

• Kilmer’s presentation, “Cannabis Use by Young Adults: Trends and Considerations,” centered on data from the Washington Young Adult Health Survey (WYAHS) pertaining to consumption patterns by youth and young adults, including concerns over cannabis use disorder (CUD) and suicide prevention (audio - 20m, video, presentation).
  • On July 26th, Kilmer gave an in-depth briefing to the Washington State Liquor and Cannabis Board (WSLCB) about the 2021 WYAHS results alongside Healthy Youth Survey (HYS) data before taking questions from members.
  • Thanking Davis “from the bottom of my heart,” Kilmer lauded her for having “done so much around suicide prevention or on mental health issues with the Washington Recovery Alliance.”
  • Each year, WYAHS collected “data from a new cohort of 18 to 25 year olds” and having completed eight cycles “we have over 16,000 young adults that we've been able to get in snapshots,” Kilmer explained, including “just shy of 13,000 young adults [surveyed] over six time points.” He reviewed  consumption patterns from 2014 to 2021 by people between the ages of 18 and 25 (“the group that uses most frequently”) acknowledging that consumption was increasing “yet most people aren't using.”
  • Kilmer took attendees through cannabis withdrawal symptoms defined in the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) which also broadened the criteria of CUD. Formerly called ‘cannabis dependence’ and before that ‘cannabis addiction,’ he remarked that 2013 revisions to criteria showed that “endorsing at least two past year” CUD symptoms had “gone up significantly.” Some students reported to Kilmer that “they're using for things that they see as a good thing, but could actually be signs of withdrawal”:
    • “Irritability, anger, or aggression
    • Nervousness or anxiety
    • Sleep problems
    • Changes in appetite or weight
    • Restlessness
    • Depressed mood
    • Physical symptoms like sweating, headaches, nausea, vomiting, or abdominal pain”
    • Beyond CUD, the symptoms tracked with a number of mental health challenges research had shown college students faced before cannabis legalization. The National Alliance on Mental Illness noted that “1 in 20 U.S. adults experience serious mental illness each year” and that “50% of all lifetime mental illness begins by age 14, and 75% by age 24.”
  • Because public health officials “do so much on college campuses about mental health and if people are declining consults or referrals and saying ‘I kind of want to take care of this myself by using what I heard can work,’ that's a very different thing than someone getting a medically supervised prescription or suggestion,” said Kilmer. He expounded on other patterns and offered analysis:
    • Trends in WYAHS results were graphed at the yearly, monthly, and weekly levels, both for those who couldn’t legally purchase cannabis, (ages 18-20) and those who could (ages 21-25). This showed “a statistically significant increase” in consumption by the latter age group “in any past year use, at least monthly use, at least weekly use, and at least daily.” Kilmer also interpreted issues around perception of use by peers: in 2019 “we literally had one in five young adults saying ‘I think the typical person my age uses cannabis daily’” even though “only 21.6% used at least weekly, meaning most don't use weekly.”
    • As far as accessing cannabis, 18-20 year olds reported “a decreasing trend in getting it from friends and getting it from someone with a medical marijuana card” in favor of “giving money to someone to get it for them, getting it from parents with their permission, and…we saw for the first time anything other than a zero stealing it from a store or dispensary.” For young adults 21-25, access from licensed retailers had been increasing, while access through other sources had decreased.
      • WSLCB Enforcement staff reported retailers had a 95% compliance rate stopping attempted minor access to licensed cannabis stores in May 2022, and none had been allowed in stores during premises checks in August. The only minors publicly accused of stealing cannabis from licensed retailers did so in a series of armed robberies in the first several months of 2022 that turned deadly.
    • Regarding driving after consuming cannabis, “in 2014, it was almost half of young adults that had used in the past 30 days who also said ‘I've driven within three hours of use.’ Fortunately, we're seeing a statistically significant decrease in that” though the “prevalence of driving within three hours of use is still very high.”
  • Kilmer endorsed the cognitive concerns related to cannabis use which had been raised just before his remarks by Washington State University (WSU) Assistant Professor of Psychology Carrie Cuttler. He argued that studies had found “28 days after stopping daily cannabis use you see no significant differences in these cognitive abilities compared to a control group of people who don't use at all.” 
    • Kilmer cited research he said supported the hypothesis that “the more frequently students use cannabis the lower their grade point average tends to be, the more classes they skip. When followed over time, the less likely they are to still be enrolled, and the less likely they are to graduate on time.”
    • He was further troubled by U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) survey results revealing an increased risk of suicidal thought among those exhibiting CUD.
  • Offering his suggestions on improving CUD prevention, screening, and treatment policies, Kilmer brought up 2021 research on “Lower-Risk Cannabis Use Guidelines (LRCUG) for reducing health harms from non-medical cannabis use: A comprehensive evidence and recommendations update.” He emphasized some of the study’s recommendations around lower-risk consumption because he felt “there is no universally safe level of cannabis use, if you want to avoid the harms, abstain.”

• Three questions from attendees elicited comments from Kilmer on youth access, product theft from retailers, and suicidal ideation for young adults.
  • “Given the conversation that we've had and the restrictions that the retailers have about selling to youth, we also heard some information about perhaps theft of products as being one venue of access for youth. How do you suggest that we address the problems of youth access?” (audio - 2m, video)
    • Kilmer’s perspective was that “parents have to be part of…prevention” as surveys were indicating 18-20 year olds’ access was increasing partially from “parents, with their permission.” He felt parents were “operating off of an old script and your parent says ‘I used when I was younger; I turned out fine.’ They used different stuff.” Kilmer hoped parents were “aware of how truly influential they are” and “aware of impacts on mental health and academic outcomes.”
  • Cannabis Observer founder Gregory Foster asked, “You indicated that the [WYAHS] data that you presented for 2020 and 2021 showed a theft from dispensaries or stores as a means of obtaining cannabis products and that that increased from zero to low levels…the question is if that survey distinguishes between cannabis products obtained from regulated retail stores versus hemp derived intoxicating products” from stores lacking cannabis licensure or age restrictions on their premises (audio - 1m, video)
    • Kilmer responded that the increase in thefts were “significant largely because it had been zero every other time point,” but the survey “did distinctly ask about retail stores.”
    • Cannabis Observer was not able to locate the survey to report how this particular question was framed to respondents. We asked because the timing closely matches more widespread availability of products like delta-8-tetrahyrdocannabinol (delta-8-THC or D8) and corresponding consumer interest in the products.
  • “Is there any research suggesting that the risk of suicidal thoughts among cannabis consumers is higher among 21 to 25 year olds?” (audio - 1m, video)
    • Feeling that this could be “an important research question,” Kilmer wasn’t aware of “anything with the focus solely on that older part of the young adult age group.”

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