Recapping the 2019 North American Cannabis Summit

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Via the Boston Globe:

I was honored to serve last week as the emcee of the equity-themed 2019 North American Cannabis Summit in Los Angeles, an important gathering of non-industry marijuana stakeholders organized by Massachusetts-based Advocates for Human Potential.

When I wasn’t reminding people where to find their bagged lunches, I kept an ear to the ground for conversations and presentations that might interest our loyal TWIW readers. Here are a few big-picture takeaways and themes:

1. Almost no one is still debating legalization

Even among public health experts who harbor serious reservations about doing so, the legalization (or at least decriminalization) of marijuana at the federal level is increasingly seen as an inevitability, with attendees only disagreeing over when exactly that will happen. The conversation instead is quickly moving toward how to regulate cannabis commerce (where, admittedly, there is less agreement).

2. We need more — and better — data

Throughout the summit, public health and medical researchers bemoaned the fact that marijuana research is lagging far behind policy and reality.

To wit: Many studies use cannabis supplied by the University of Mississippi, the only federally-authorized marijuana cultivator in the United States. Unfortunately, the place grows, well, pretty crummy weed, at least by street/consumer standards. In a series of studies on the medical efficacy of cannabis as a treatment for pain and other ailments presented at the summit by Dr. Igor Grant, the director of the University of California’s Center for Medicinal Cannabis Research, the most potent variety topped out at 8 percent THC — far weaker than most strains sold at regulated dispensaries, which are generally in the 15 to 30 percent potency range.

While many studies have found marijuana does indeed have potential as a medicine, the potency mismatch makes scientists reluctant to offer pronouncements about whether patients buying much stronger products at a dispensary would experience the same ratio of benefits to side effects found in studies.

A related problem: Getting government approval to conduct marijuana research requires navigating a veritable alphabet soup of different federal agencies. Dr. Grant showed us an eye-opening chart to illustrate that fact:

Even the local DEA office has to sign off; Dr. Grant described how one California-based DEA agent visited his study site — a temporary classroom-trailer on a concrete pad equipped with ventilation and filtering equipment so study subjects could consume cannabis in it — and objected because he thought someone might hitch the trailer and drive off with it (even though the marijuana itself was stored in a safe).

Yes, that’s right: to study cannabis, you have to convince a DEA agent that desperate criminal stoners in California, which is known for its scarcity of cannabis, won’t steal giant wide-load trailers and drill through safes to get their hands on a small quantity of 4-percent-THC government-grown weed.

But seriously, by the time you include the pre-submission stage (designing a study, getting internal approval, and drafting an application), it could easily take two years from having an idea for a study to getting results. That’s awfully slow in the context of the rapidly-evolving and -growing cannabis industry.

Another issue, discussed by a panel that included representatives of federal agencies such as the Centers for Disease Control and Prevention and the National Institute on Drug Abuse, is that collection of data on marijuana consumption is extremely limited. Among the problems are inconsistent methodology, government agencies operating in silos, inflexible surveying systems that make it hard to add new questions as the commercial pot market evolves, and limited funding and staffing.

One suggested solution: suck up more data from state marijuana agencies, which operate seed-to-sale tracking systems that capture lots of granular information about how many, where, and which types of products are sold at regulated marijuana stores.

3. Researchers are frustrated about the press overstating the conclusions of their work

Rosalie Pacula of RAND Corp.’s Drug Policy Research Center and Dr. Ziva Cooper of UCLA’s Cannabis Research Initiative complained that their groundbreaking work on the association between the availability of medical marijuana and improved opioid outcomes was badly oversimplified in the popular media — helping prompt New York State to add opioid addiction as a qualifying condition to get a medical card there.

Pacula and Dr. Cooper aren’t necessarily opposed to that policy, but explained in great depth that there is pretty limited evidence marijuana could help address the opioid crisis — and that evidence only addresses certain aspects of what is a complex problem. In other words, marijuana doesn’t seem to hurt, but it’s no silver bullet. They pressed us to ask more precise questions about how marijuana might help:

Could doctors prescribe cannabis instead of opioids to new pain patients, reducing overprescription of pharmaceutical opioids? (Answer: They’re unlikely to do so.)

Does the availability of medical marijuana reduce opioid prescriptions in a state? (Answer: Prescriptions have fallen in states with medical marijuana, but that might have happened regardless of cannabis. And there hasn’t been a corresponding drop in the number of opioids distributed, which could be real or a methodological artifact due to inconsistencies and changes in how the government tracks the pills.)

Could marijuana help those currently addicted to opioids quit? (Answer: maybe.)

Could marijuana be used to supplement opioid treatment and make tolerance and addiction less likely? (Answer: marijuana seems to boost the painkilling effects of lower doses of opioids, but there’s contradictory evidence on how adding marijuana affects the development of opioid tolerance. And it’s unclear whether marijuana stops opioid patients from transitioning to illicit opioids such as heroin.)

Of course, all that nuance gets turned into a headline that screams, “COULD MARIJUANA SOLVE THE OPIOID CRISIS?” The ensuing narrative sucks up all the oxygen, Pacula complained, making it hard to talk publicly about the many other, better-proven solutions: safe injection sites, increased regulation of prescribing practices, Good Samaritan laws, widespread naloxone availability, and so on. Good point.

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