On Wednesday, the Senate Caucus on International Narcotics Control held a hearing called “Marijuana and America’s Health: Questions and Issues for Policy Makers.” During the first panel, US Surgeon General Jerome Adams, and Nora Volkow, director of the National Institute on Drug Abuse, spoke about use among youth and pregnant individuals, barriers to research, and vaping-related illnesses.
The hearing was held, in part, Texas Senator John Cornyn said, to help “policymakers to understand the public safety implications of increased marijuana use before we dive in to the admittedly complex and difficult job of changing federal policy” because, he added, “It seems like we’re putting the cart ahead of the horse.”
Cornyn highlighted an advisory released in August by Adams, which Adams described as a “response to alarming rates of marijuana use among pregnant women and young people, widespread and growing access to increasingly potent marijuana through legalization at the state level, and mounting evidence that marijuana use poses a risk to healthy brain development and to public health.”
California Senator Dianne Feinstein opened her statement by sharing, “One thing I’ve learned is that marijuana is much more complex than I thought.”
The National Institutes of Health recently increased the number of grants awarded to cannabis research. “I hope it will continue to do so. This will enable marijuana’s potential therapeutic benefit really to be more understood,” Feinstein said, adding that it is “important” that lawmakers and policymakers learn more about appropriate dosing, potential interactions with other medications, and effects of long-term use.
Adams focused his opening statement on his advisory and the possible harm that young and pregnant people who consume cannabis face, emphasizing that today’s cannabis has become more potent and therefore more risky.
“Marijuana is now everywhere, especially in states that have legalized, and it can be smoked, drunk, eaten, and vaped. As I like to say: it ain’t your momma’s marijuana,” Adams said. “I’ll be the first to admit we need to know more … But I want you to hear me say this: We know enough now to deliver sound guidance to protect the future of our nation’s youth.”
Volkow pointed out that, while research is underway to examine the effects of THC on growing fetuses, one reason that cannabis poses harm to fetuses is that THC “freely crosses the placenta.” She added, “Fetal exposure is associated with significant negative outcomes, including fetal growth restriction, lower birth weight and preterm delivery.”
Volkow pointed out research that suggested that adolescents who regularly consume cannabis exhibit a “subsequent sensitivity to the rewarding effects of other drugs, which would be one reason why those who would use marijuana at a young age are more vulnerable to addiction later in life, not just to marijuana, but also to other drugs.”
Volkow added that cannabis that is higher in THC “can trigger acute psychotic episodes.” Later, Adams compared cannabis’ average potency in the 90s to a light beer versus a glass of vodka today.
Feinstein seemed surprised, asking: “I don’t think people know that. How do we get that out?”
Cornyn said that he saw some “parallels, perhaps,” between cannabis and tobacco, adding, “I even went back with my staff staff and found some advertisements by the tobacco industry where they would tout the health benefits of smoking.”
Adams agreed, “Cocaine was thought to be an effective medicine and harmless. Once upon a time, opioids were thought to be good for whatever ails you.” He continued, “Not that I am in any way, shape, or form comparing marijuana to those substances. But from a policy point of view, I think the lesson we should have learned was that we have to make sure the science is leading the policy and that the tail isn’t wagging the dog.”
Volkow noted hyperemesis syndrome, which causes intense cyclical vomiting. The syndrome was previously unknown, and didn’t emerge until 2006, after cannabis became more potent, Volkow said.
One of the repeated themes of the first part of the hearing was: well, there’s a lot about cannabis yet to be learned. Cornyn asked, “are there impediments, legal or otherwise, to the study of the health effects of marijuana?”
Adams answered, “Well, I’ll start off just by saying that [Secretary of Health and Human Services Alex Azar], the president and I have all stated publicly we need to make it easier to do research,” adding that the Department of Health and Human Services is “partnering” with the Drug Enforcement Administration, going “around the country and talking to folks to find out barriers that exist to research.”
Volkow talked more in-depth about the barriers, some of which include: lengthy wait times for DEA registration, which “delays that process enormously.” When investigators need to make a protocol change, they must be submitted for approval, sometimes leading to more delays. Volkow continued that if a researcher wants to study a specific cannabis strain, “It’s probably unlikely that we have it and we’ll have to cultivate that.”
The cannabis grown at the only federally-approved research farm, at the University of Mississippi, offers the bare necessities. Volkow pointed out that researchers are often unable to study what people are actually consuming from the legal market, because the market is ahead of the federal research supply.
For the past several years, Volkow said, NIDA has been trying to develop “an accommodation that would allow researchers to streamline the process.”
Vaping was a strong concern during the hearing, and Feinstein asked if there was enough research to understand the potential impacts of cannabis vapes. “What happens to the lungs when you use it?” Feinstein asked.
Adams said he was “terribly concerned” about the vaping-related lung illnesses, and that HHS has been “mounting an all-hands-on-deck response.” (Catch up on some of Cannabis Wire’s latest coverage of the vaping illnesses here.)
Feinstein then asked if autopsies had been completed on the lungs of the 33 people confirmed dead. Adams responded that autopsies had been done on some, “but not all of them.”
“Well, what’s been learned from the autopsies? What happens to the lungs?” she asked.
“We know that there’s damage to the cells of the lungs, to the tissues of the lungs. There’s a lot of misinformation out there. Some of these cases have been reported to be associated with Vitamin E, and that was the case for some. But it actually looks like an inflammatory injury,” Adams said, trying to find a good comparison.
Lipoid pneumonia, Adams said, has been “found in some of these folks. But in other folks, it’s as if the cells in the tissue are being eaten away. Again, you’re putting toxic materials into the lungs that were never meant to be inhaled.”
Feinstein then asked, directly, “Are vaping devices well enough known? Do they bring on death?” Feinstein seemed to stumble over how to ask the question, reiterating, “if you use a vaping device, are you more apt to die?”
Volkow responded, “Not necessarily, if you are using a device that has quality control.”
Toward the end of the hearing, Feinstein said “we may want to put out a paper as a result of this.” Cornyn added “certainly that’s something we ought to consider.”
“Believe me, we want to continue the conversation,” Cornyn said. “I think the American people deserve the facts, which is what we’re trying to get to here.”
A second panel took place as well, and included university researchers.