A major cannabis summit in Nevada brought together regulators, lawmakers, and law enforcement from across the US, all with the common goal of improving cannabis and vaping policies.
The summit was hosted by the Nevada Department of Health and Human Services (DHHS) and Division of Public and Behavioral Health (DPBH), in partnership with the Nevada Attorney General’s Office.
During a keynote called National Policy and Public Health Recommendations, Norman Birenbaum, New York’s Director of Cannabis Programs and inaugural president of the newly formed national Cannabis Regulators Association (CANNRA), joined Brooke Hoots, acting cannabis strategy lead for the CDC Division of Overdose Prevention, and Elyse Contreras, a program manager focused on cannabis health for the Colorado Department of Public Health & Environment.
Birenbaum, Hoots, and Contreras focused on Colorado’s lessons learned, policy recommendations from states that have legalized, and the CDC’s “strategic plan for cannabis, gaps in the science, and the CDC’s plans to address them.”
Legalization discussions in New York are active, as Governor Andrew Cuomo has again included adult use in his budget, and top lawmakers Senator Liz Krueger and Assembly Majority Leader Crystal Peoples-Stokes have reintroduced their own cannabis legalization bill. Birenbaum highlighted some “emerging issues” related to legalization in the Empire State. Among them: home cultivation, water soluble THC, “coordination with medical cannabis and hemp markets,” changes to federal regulations related to cannabis, and banking and financial services.
“We’re entering into this new era of cannabis 3.0 now in Virginia and New York, Connecticut, Pennsylvania, New Mexico, where we’re able to actually use the lessons that we’ve learned like those that we’ve just mentioned in Colorado,” Birenbaum said.
As a result of his work meeting with cannabis regulators around the country—for years, informally, and now formally with the launch of CANNRA—Birenbaum has a unique depth and breadth of perspective on cannabis issues.
Birenbaum laid out some vaping trends, noting that EVALI, the vaping-related illness that caused dozens of deaths in 2019, “significantly shifted the landscape” of vaping rules.
“We are seeing states to be more proactive in identifying what excipients and diluents they will allow, or which are banned. We’re also seeing the use of flavors being highly regulated,” Birenbaum said, adding that he’s also starting to see more requirements for cartridges, and identifiers on the cartridge that indicate whether the product contains THC, CBD, or nicotine.
Another major shift in vaping regulations pertains to testing, not just of the extract or concentrates, but of the vapor itself. Another emerging area for vaping regulation is longer-term stability testing. Birenbaum used the example of Massachusetts, where there was a “very large recall” of vaping products, most of which were later re-released for sale. Stability testing is “a great practice,” Birenbaum said, because vaping products might not initially test positive for certain toxins, but over perhaps six months, “you start to have leaching. And so long-term stability testing has been key, particularly for this product category,” he said.
On packaging and labeling, Birenbaum pointed to an industry that’s maturing, shifting from clearer labels that identify THC serving size to uniform packaging and labeling standards.
“It’s also great for regulatory authorities and offices because now they do not have nearly as many issues approving very disparate SKUs of packaging. This is something that we’ve seen in Canada, and that they’ve utilized with a tremendous amount of success, but something we’ve seen adopted in the state of Rhode Island for their medical program,” Birenbaum said.
Producers of cannabis products in Europe generally adhere to good manufacturing processes, or GMP. That’s not the case in the United States, though that’s changing and becoming more common, Birenbaum said.
“That’s difficult, obviously, because of the conflicts with federal standards of what constitutes GMP and cGMP. But there are third party auditors that will come out and certify facilities that are manufacturing and processing cannabis products,” he said.
Social consumption and delivery licenses are the newest category of licenses, aside from your traditional cultivation and processing and brick and mortar retail distribution, Birenbaum said.
“There are a lot of concerns here in terms of delivery,” Birenbaum said, adding that there are “varying” approaches to the know-your-customer requirements, limits on the products, and cash that can be used by a delivery person. What’s the role of surveillance, both to protect the delivery personnel, but also to ensure that the person who’s receiving the product is qualified and of age and is not going over other limits?
When it comes to on-site consumption, BYO/bring-your-own models could create the risk of consumers bringing unregulated, untested products, which “could create additional cover for the illicit market,” Birenbaum said.
Another issue with on-site consumption? The Clean Indoor Air Act. Many states “do not want to take a step back on that,” so regulators are talking about filtration requirements, and whether consumers should be allowed to smoke at all. But when you ban smoking and vaping, allowing only edibles could create its own issues with accidental overconsumption due to late onset.
During legalization discussions, one of the “highest priorities” for many lawmakers, policymakers, and law enforcement officials is workplace impairment and driving under the influence, Birenbaum said.
One area that’s remained fairly consistent are policies that prohibit cannabis use by safety-sensitive employees, or people who work as bus drivers, pilots, or commercial drivers, for example. In many states now, Birenbaum said, he’s seeing policy defer to employers on “adopting whatever workplace drug use policy they want, as long as it is equitably enforced and put down in writing and not forcing employers to accommodate someone to either use or possess cannabis when they’re on the clock or on the company property.”
Equity is also becoming increasingly crucial during legalization discussions, but there’s little agreement when it comes to definitions and implementation.
“No state really has a silver bullet of how to do this the right way,” Birenbaum said. How does one state define social and economic equity? Do they base that off of revenue being funnelled into these communities? Or is it focused on who is participating in the industry, whether through ownership or employment? “Just because you have a license doesn’t necessarily mean that you have market share,” Birenbaum said.
Another emerging policy issue for cannabis regulators is whether to allow home grown cannabis. Home cultivation is allowed in all adult use states, with the exception of Illinois and Washington, and, in the latter, lawmakers are now considering permitting the practice. (New Jersey’s adult use legislation awaits the governor’s signature, but it also excludes home cultivation.)
“It’s increasingly being removed from legalization proposals. It’s typically likened to beer, homebrewing,” Birenbaum said. “But the public health considerations around growing your own plants are very different,” he added, because home growers use things like HVAC and electrical systems, butane and propane to process cannabis, and some use harmful pesticides. Further, there are wide market differences in the value of home brewed beer versus home cultivated cannabis, Birenbaum said.
Birenbaum also said that it’s “essential” to establish baseline data and ongoing public health monitoring and surveillance around cannabis use, adding that many states just can’t do this, especially before they launch a commercial cannabis industry. States like Colorado and Washington and Oregon are “furthest along” in creating ongoing monitoring and surveillance systems.
“But in large part, most states have failed to establish baseline data. So as we’re putting in place all these regulatory structures, we do not actually know the difference that legalization is having on all these different metrics and all these different policy areas that we’re trying to track because it just didn’t exist,” Birenbaum said.
On that note, Hoots, the CDC’s acting cannabis strategy unit lead, said the CDC created the cannabis strategy unit about a year ago, and its purpose is to act as a “coordinating center” for all the cannabis work at the CDC, which was previously spread out across multiple centers and divisions without a central focal point.
The CDC is currently “updating and expanding” their site with things like cannabis factsheets and the evolving science, and the agency is in the process of rolling out a “marijuana website very soon,” Hoots said.
Hoots focused her presentation on the CDC’s strategic plan for cannabis, which centers on the study and monitoring of health and social effects of cannabis use, with a focus on vulnerable populations like infants and children, pregnant people and postpartum use, workers, those with chronic conditions, and racial and ethnic minorities. The plan was created because of the rapidly changing cannabis policies in the United States.
“In the midst of all of this, public health and science are behind, especially in terms of surveillance, evaluation of policies and health effects and communication to the public, and we really need to get to a place where the public can make science-based, informed decisions for their health,” Hoots said.
The CDC is also monitoring legislative and policy developments related to cannabis, and wants to see existing data sources improve “with additional questions to better track U.S. exposure and health effects. We’d also like to tap into new data sources and surveillance platforms.” The CDC is also participating in and hosting work groups, and joining federal and local responses to emergencies, like the e-cigarette, or vaping, product use-associated lung injury (EVALI) outbreak.
The CDC has an ongoing project during which researchers use social media data to assess cannabis vaping activity, and a partnership with CDC branches to better understand how pregnant people use cannabis, and how that could affect outcomes.
Additionally, the CDC’s future plans in these areas could include, Hoots said, “identifying risk and protective factors for early initiation of cannabis use and eventually updating the National Academy of Sciences Engineering and Medicine report on the health effects of cannabis.” The CDC expects that other future work on cannabis could include “in-depth policy tracking analysis to identify components of a public health framework prior to legislation occurring.”
“We’d like to eventually offer surveillance and policy toolkits to states and support state-based prevention programs,” Hoots said.
Another “pillar” of work for the CDC in the cannabis space is around educating “the public on the known benefits and harms of cannabis,” Hoots said, adding that the CDC is developing a campaign focused on youth who have increased substance use during the COVID-19 pandemic.
The last day of the summit focused on discussing the some 200 strategies that emerged during the event, which will be submitted to Nevada’s Division of Public and Behavioral Health in February. Some of these strategies include a goal of raising the state’s legal age of tobacco sales to 21, and better data collection, education, and labeling of cannabis products.
