A group of some of the top regulators, researchers, and policy makers focused on cannabis in the U.S. and abroad is convening for the second time this week.
The National Academies of Sciences, Engineering, and Medicine’s Committee on the Public Health Consequences of Changes in the Cannabis Policy Landscape met for the first time in September. The first day of sessions this week, which took place on Wednesday, focused on state and local policy and regulation, while Thursday’s sessions will have a more international lens.
The questions to be explored throughout this week’s meetings are far-ranging. “What are the unanticipated consequences of early cannabis policies, and how can we learn from them to improve safety and minimize negative public health consequences?” for example. And, “What can federal, state, and local governments learn from other countries about cannabis policy?”
In a session focused on “the changing landscape of cannabis policy,” during which state cannabis regulators primarily spoke, the conversation often returned to the implications of the regulatory patchwork across states with legal access to cannabis, for medical or non-medical use.
During her presentation, Gillian Schauer, executive director of the Cannabis Regulators Association (CANNRA), looked at legalization-to-implementation timelines, and the importance of recognizing the role of legal access.
“Legalization does not equal legal retail access. And in fact, what we usually see is a delayed market opening,” Shauer said. “What happens in that lag time, where a product is legal but there’s nowhere to get it, is you may see illicit sources increase after legalization before the market opens.”
Shauer also looked at the implications of the state-by-state patchwork approach to regulation, through the lens of advertising. For example, in the early days of legalization, advertising policies more closely resembled those for alcohol, which required roughly 70% of the audience to be 21 or older. Put another way, Shauer said, 30% of the audience could be underage. That started to shift, Shauer said, when states like Connecticut and New York set the audience requirement for 21 plus at 90%. Meanwhile, Maryland has no outdoor advertising, and Montana has banned all advertising except electronic advertising.
Shauer turned to the policy wrinkles created by cannabinoid hemp products, the “biggest confounder” of cannabis legalization. While hemp was legalized with the 2018 Farm Bill, the products on the market today more closely reflect the intoxicating cannabis market, but aren’t regulated similarly. Shauer said it was a “misnomer” to study cannabis policy from state to state “without considering the fact that every state has access to these products and they’re much more accessible to people in a lot of instances.”
“Regulation of cannabinoid hemp is nascent and many states don’t have anything in place. There are many states that have tried to put something in place and are being sued for what they’ve tried to put in place and have had injunctions granted,” Shauer said. “Those products are still out there. So, the regulatory landscape for hemp in every state looks extremely different from the regulated landscape for cannabis.”
Next, a panel brought together several cannabis regulators: Adria Berry, executive director of the Oklahoma Medical Marijuana Authority; Nicole Elliott, director of the California Department of Cannabis Control; Amy Moore, director of Missouri’s Department of Health and Senior Services; Michele Nakata program manager at the Hawaii Office of Medical Cannabis Control and Regulation; and Will Tilburg executive director of the Maryland Cannabis Administration. The panel also included Beth McGinty, from Weill Cornell Medicine, and Schauer.
Nakata’s overview of Hawaii reflected the slow-and-steady approach the state has taken to cannabis policy reform, which has legal medical cannabis.
“I would say that being very restrictive has been a very good thing, as a regulator. It makes it a lot easier to do our jobs, especially with limited resources,” Nakata said. “However, I do recognize that it’s been a challenge not only for the industry but also for patients with regards to access. So there’s a lot of things that we are looking forward to fixing.”
Hawaii lawmakers are expected to return to adult use legalization next year, too.
“Right now, we’re trying to ramp up and be prepared for that,” Nakata said.
Elliot spoke about the landscape in California and the role of localities.
“We have a significant amount of competition in this market. Locals are still engaged, but as you can see from that map,” Elliot said, referencing an opt-out map, “the uptake of participation is not robust, if you will, and we continue to have a persistent illegal market.”
During a discussion about equity, Moore said that “there needs to be some element of financing,” or funding available for applicants.
But programs themselves could also use more funding, too, said Berry, adding that with more resources, the state would build up their research center because most of their funding has been funneled toward compliance.
“We would do some more proactive research, we would do more medical community engagement and education,” Berry said. “I’ve been kind of forced into the choice of spending most of our funding on the compliance and enforcement efforts the past couple years to get our arms wrapped around some of the issues we had here in Oklahoma. So, that means that we haven’t been able to spend as much time on the science and the research and the medicine of it.”
Tilburg said that Maryland needs more workforce training ahead of an expected surge in the number of people employed in the cannabis industry. In Maryland, he said, they’re anticipating a jump from 6,000 to 30,000.
“Putting money into workforce development, particularly for those that are impacted – returning citizens – to ensure that they have opportunities,” Tilburg said, is necessary, adding that Maryland has a “very diverse workforce but it’s most diverse at the entry level position.”
“Having that workforce development would be focused on leadership so that communities of color, communities that were most impacted by the war on drugs, have the ability to have access to those same leadership roles that others have,” Tilburg added.
During a later session on “industry approach to the wide variation in cannabis policy,” a “A Safe and Sustainable Cannabis Industry” panel brought together: Michael Cooper from the National Cannabis Industry Association; Daniel Fabricant, president of the Natural Products Association; Micah Sherman from the National Craft Cannabis Coalition; Ross Gordon policy director at the Humboldt County Growers Alliance; and Carrie Harne, vice president of U.S. government and regulatory affairs the U.S. Pharmacopeia.
Much of the discussion during this panel focused on topics like product safety, integrity of cannabis testing and the labs testing products, as well as compliance. The elephant in the room, of course, is that in lieu of national and global standards, states have stepped in with different rules. But there was a tone of inevitability at the meeting – that legalization was coming to the United States.
Harney, of the U.S. Pharmacopoeia, said that USP has experience setting standards, from food to innovative medicines. So, in that sense, cannabis doesn’t present an issue in creating uniform standards.
“When we think about cannabis, similar principles apply from a standard setting perspective that we use for all of these other product categories,” Harney said, including areas like purity and strength. “Those can be applied in this space as well. So it is possible from our perspective to have uniform quality standards for cannabis.”
Daniel Fabricant, president of the Natural Products Association, pointed to the fish industry and gave fish oil as an example of a product with variability in the “oils and the fats that people want.”
Good Manufacturing Practices, or GMPs, “can account for natural variability as well as contaminants,” Fabricant said. “I don’t think it’s impossible. I think one challenge is everyone – and sometimes the states – like their methods better, their tests better. I think in those instances, though, you’ve got to look to a broader schematic that really covers the spirit of continuous improvement.”
Thursday’s panels will bring together researchers from Canada, Spain, Chile, Australia, and Uruguay.
A panel titled “Protecting Public Health and Social Equity with Legal Cannabis” will include Kevin Sabet, founder of Smart Approaches to Marijuana, Cat Packer, director of drug markets and legal regulation at the Drug Policy Alliance, Lynn Silver, a researcher, pediatrician, and senior adviser at the Public Health Institute, and Peter Grinspoon, an internist and medical cannabis specialist Massachusetts General Hospital.
