The rising popularity of cannabis and, more recently, some of its compounds, like cannabidiol (CBD) and Delta-8-THC, has complicated the research community’s understanding of impairment.
That was a repeated theme on Tuesday, during the latest Substance Abuse and Mental Health Services Administration (SAMHSA) Drug Testing Advisory Board (DTAB) meeting. A decade ago, cannabis, which contains dozens of compounds known as cannabinoids, was most often associated with its dominant cannabinoid, delta-9-tetrahydrocannabinol (THC). Even today, while cannabis is legal for adult use in 15 states and Washington, D.C., research is inconclusive when it comes to how, or how much, THC leads to impairment, on the road and elsewhere, and there is no national consensus as there is for alcohol (.08% BAC). And now, researchers are scrambling to account for differences depending on whether the consumed cannabis products also contained CBD, and whether they were consumed via, say, vape or edible.
During his introductory remarks about the “evolving environment,” Ron Flegel, the chair of the Board, said that the passage of the 2018 Farm Bill, which legalized cannabis with .3% THC or less, also known as hemp, “had an effect on the drug testing industry.”
Flegel noted the “increased public acceptability, and definitely availability, of marijuana and CBD products, and the implications for workplace safety and security,” and flagged “as an emerging issue, the Delta-8-THC or other THC isomers.” Flegel added that “the Delta-8 is an impairing substance, and it is being marketed on the Internet dramatically as we speak.”
In short, when the federal government singled out delta-9-tetrahydrocannabinol in defining hemp as the legal form of cannabis, everything else that comes from the cannabis plant, such as CBD or Delta-8, became fair game. Hemp-derived CBD, which does not cause a high, has been on mainstream shelves for years, while Delta-8, which does cause a high, is a much more recent trend, and, as Flegel noted, is so far found most often through online retailers.
SAMHSA’s Division of Workplace Programs, which oversees the Federal Drug-free Workplace Program, has been working with researchers from Johns Hopkins University for nearly a decade to try to better understand cannabis impairment, and invited them to present their most recent findings during Tuesday’s meeting.
Researcher Ryan Vandrey began by providing an overview of the legal landscape of cannabis today, where medical cannabis is available in dozens of states and cannabis is legal for adult use in 15 states and D.C.
“The result of that legalization is that joints and blunts are no longer all we think about when it comes to cannabis,” Vandrey said. “The term ‘cannabis’ now has become an umbrella that covers hundreds of different distinct products. And these products are distinct both in the route of administration in which they’re administered. It varies in the formulation, it varies in the chemical composition. And so the complexities abound in terms of how we understand and how we think about cannabis and cannabinoid products.”
So far, the researchers have found in several published studies, for example, that secondhand exposure to smoked cannabis joints with 12% THC in an unventilated room can lead to detectable THC in blood, and, looking at urine, Vandrey said that they “had a single specimen that was a true positive in accordance with current federal drug testing methodologies.”
They also found that 10 mg of THC vaped is felt more strongly than if smoked. That is reflected in the consumer’s heart rate, which increases more with a vaped product, and in their psychomotor skills, which are more negatively affected.
When it comes to CBD, the team looked at 100 mg CBD (vaped and orally ingested), at 100 mg CBD with the addition of 3.7 mg THC (vaporized), and at a placebo. They found that women more often than men reported a “pleasant drug effect.” Also, they found no “cardiovascular outcomes” with the pure CBD products. And, Vandrey added, they “noted no impact of any dose or formulation in this study on cognitive performance outcomes.”
Forthcoming research from the Johns Hopkins team will examine topical cannabis products and Delta-8-THC dosing.
Prior to the presentation of cannabis studies, Capt. Eric Welsh, the Director of the Office of Drug Demand Reduction in the Department of Defense provided an update on drug testing of Department of Defense service members. In FY 2019, he said, cannabis accounted for 77.8% of all positive tests of service members. Though, overall, cannabis-positive tests are lower today than they were a decade ago, before any state legalized cannabis for adult use.
“People ask constantly if we’re seeing an impact of legalization, decriminalization efforts,” he said. “We actually saw a pretty significant decrease from 2009 to 2014, and now we’re starting to slowly see that climb back up. Whether that’s from decriminalization or not, it’s hard to tell, but it’s something we continue to monitor.”
The DTAB meeting continued into the afternoon, but was closed to the public and the press. On the agenda was an “FDA CBD Presentation,” which included “FDA Staff,” FDA’s Cannabidiol (CBD) Policy Working Group,” and “FDA/Office of the Commissioner (OC)/Office of Clinical Policy & Programs (OCPP).”
After the passage of the 2018 Farm Bill, the Food and Drug Administration was tasked with crafting rules for hemp-derived products containing cannabinoids, including everything from foods and beverages to supplements and cosmetics. That process is ongoing.
