This week, the National Institute on Drug Abuse (NIDA) hosted its International Forum, which brought together researchers from across the globe to discuss the science of substance use, including cannabis, and related research.
One of the panels this year was focused solely on cannabis. The session, titled International Cannabis Policy and Implications for Research, was moderated by Gillian Schauer, executive director of the Cannabis Regulators Association (CANNRA). Speakers included Hanan Abramovici, a senior science advisor for Health Canada; Ivana Obradovic, deputy director of the French Monitoring Center for Drugs; and Daniel Radio, secretary general of the National Drugs Commission in Uruguay.
In an overview of the landscape of high- and low-THC cannabis in the United States, Shauer highlighted how far cannabis legalization has come, reaching what she calls “version 2.0 or 3.0.” State regulators and lawmakers are less laser-focused on a fear of federal intervention, which loomed large when Colorado and Washington were the first jurisdictions in the world to legalize cannabis for adult use a decade ago.
“We’ve moved beyond that. There are now so many states that have done this that I don’t think regulators are concerned about the federal government coming and shutting things down. And we have a lot of events that have refocused regulation,” Shauer said.
Those events include the vaping-related lung injuries that popped up across the country in 2019 and renewed focus on quality control and packaging and labeling.
“We’ve also had data in the last decade that have shown that legalization alone is insufficient to repair the harms of the war on drugs, that legalization has to be done purposefully with a focus on social equity and restorative justice,” Shauer said. “And we’re seeing some of the recent adult use states take a very different approach there to emphasize that.”
Shauer pointed to the “arbitrary” nature of what separates what we know as hemp, which is a cannabis plant with .3% THC or less and is federally legal, and what we know as cannabis, which is federally illegal but available in dozens of states in either medical or adult use shops.
“The .3% is a bit of an arbitrary line, and I want to just state upfront that that’s one of the areas that we don’t have a lot of science on. And so our very policy architecture in the U.S. has been based on something that’s not necessarily scientifically supported,” Shauer said.
Shauer also covered how different types of agencies in various states have taken up the regulatory and licensing requirements for cannabis, leading to differences in inspection and compliance schemes.
“These look different across all states. I like to say ‘if you’ve seen one state, you’ve seen one state.’ I know, internationally, there’s a tendency to want to go look at Colorado and then you’ve seen the U.S. market. But, I’m here to tell you that every state has done this a little bit different,” Shauer said.
Abramovici, of Health Canada, gave an overview of Canada’s path to adult use legalization in 2018 through legislation that prioritized public health and safety. He also covered the “mix” of different retail models from province to province, including an entirely public model, like in Quebec, to hybrid models, like in British Columbia, to entirely private models. Finally, he laid out the two-phase approach of legalization in Canada, starting with flower and cannabis oil for ingestion, and a year later including products like edibles, extracts, and topicals.
While Abramovici said it’s “still early days” after legalization, and data collection has been upended by Covid-19, so far, data “tells us that the rate of cannabis use among youth and the age of initiation has not changed, which is good.”
“One of the surprises, let’s say, that we’ve found in the course of legalization or regulation of cannabis, is that cannabis poisonings from accidental ingestion of edible cannabis have increased. And notably among children under the age of five,” Abramovici said.
Radio, of Uruguay, had spotty audio when speaking, but discussed how regulators and public health officials have been “managing the risks and reducing the harms” since Uruguay became the first country in the world to legalize cannabis for adults in 2013.
Obradovic, of France, began her presentation by outlining that five member states out of 27 in the European Union “are introducing or planning to introduce new approaches to regulate cannabis.” Those are: Switzerland, Germany, Luxembourg, Malta and the Netherlands.
“Over the last 20 years, the general trend in national laws in Europe has been decriminalization, except in France, which appears as one of the most conservative countries currently,” Obradovic said.
Public sentiment in France and many EU countries hasn’t swayed lawmakers, it seems.
“Cannabis issues are covered in the media on a very regular basis. We also have a significant body of reports and academic expertise that has been challenging national drug policy,” Obradovic said. “And over the last couple of decades, the issue of legal change was discussed in every presidential election campaign.”
As part of its information gathering, the French Monitoring Center for Drugs spearheaded a qualitative study that focused on six jurisdictions in North America, “mixing early adopters and later movers in the US and three very different provinces in Canada in terms of regulation choices,” Obradovic said.
“We are paying special attention to policy-specific measures, price and taxation, licensing rules and so on, and the related outcomes in a comparative perspective,” she added.
While data are analyzed, some results have already been published. Broadly, while the country has a medical cannabis pilot program underway, there’s reluctance to change the status quo beyond that, Obradovic said. To illustrate the point, when CBD shops started to pop up in 2019, the French government was one of the “leaders” in the European Commission that tried to prohibit CBD and classify it as a controlled substance, Obradovic said.
“But, the pace of new legal initiatives recommending cannabis reform has accelerated, and the arguments for legalizing are evolving, now integrating economic considerations,” Obradovic said.
Even among countries that have legalized, research hurdles remain. Abramovici, from Health Canada, pointed out that not all hospitals and emergency departments report cannabis-related data to a centralized data surveillance hub.
“So, some of that data is missing or some of that data is kind of fragmented amongst different agencies. And it’s kind of hard to have a cohesive, generalized overall pan-Canadian picture of emergency department visits and hospitalization,” Abramovici said. “There is no granular information on the type of products that people are consuming. So what’s the product? What was the dose? Where was it bought? That type of information is typically not collected, and if it’s collected, it’s poorly collected. So we have some barriers there.”
But, legalization has been the catalyst to some positives with regard to data collection in Canada.
Initially, before legalization, there wasn’t a clearinghouse pan-Canadian survey on the knowledge, attitudes and behaviors of Canadians regarding cannabis.
“That was the spark to create the Canadian Cannabis Survey, which is the flagship survey,” Abramovici said, to measure knowledge, attitudes and behaviors among those who consume cannabis.
“We have, now, five or six years of data. And so that’s really been really, really key in our policy research,” Abramovici said.