What cannabis policies are U.S. federal agencies prioritizing? What do they see as the potential impacts of its legalization and use? Although many states have legalized cannabis, many public health implications have not been fully evaluated, and a group of federal agency representatives recently met to discuss these and other questions in a recent National Academies of Sciences, Engineering and Medicine (NASEM) committee meeting focused on Public Health Consequences of Changes in the Cannabis Policy Landscape.
With a goal of attaining input for the committee’s study intended to address those public health consequences, the meeting included three agency presentations – from the Centers for Disease Control and Prevention (CDC), the NIH National Institute on Drug Abuse (NIDA), and the NIH National Cancer Institute (NCI) – along with general discussion and public remarks. Following are some key points from the three presentations:
CDC has developed a six-element cannabis strategic plan that is complementary to and collaborative with other federal agencies, but focused on its particular strengths and directed toward health and social effects, and populations at increased risk of negative health effects. The plan includes:
- Monitor trends including incentivized states to implement the BRFSS Marijuana Module, cognitively testing survey questions with National Center for Health Statistics, and exploring marijuana supplement in Pregnancy Risk Assessment Monitoring System (PRAMS)
- Advance research with a special supplement on cannabis surveillance and applied research with the American Journal of Public Health (AJPH), and publications on cannabis-involved emergency department visits, cannabis sales during the pandemic, and reasons for use
- Build state, tribal, local, and territorial capacity through a 2021 American Public Health Association meeting with states on cannabis surveillance, a National Conference of State Legislatures case study report on cannabis legalization practices, and a Resource for Action
- Support health systems and providers through a health advisory on delta-8 THC products and adverse events, a National Council for Mental Wellbeing toolkit for youth substance use prevention, and provider and patient fact sheets on cannabis and chronic pain
- Partner with public safety, schools, and community coalitions and provide technical assistance to Drug Free Communities coalitions
- Increase public awareness through an updated CDC Marijuana website and fact sheets
The NIDA presentation discussed and focused on a recommendation for a standard unit of measure for THC. In 2019, a paper was published on the topic, stating, “On the basis of experimental and ecological data, public health considerations and existing policy, we propose that a standard THC unit should be fixed at 5 mg THC for all cannabis products and methods of administration.” While it is “far from perfect,” NIDA saw it as a start and issued a Notice requiring the use of the standard THC Unit (STU) of 5 mg for human studies (NIDA, NCI, NHLBI, NIMH).
Why? Because a standard unit of measurement can help:
- Achieve comparability across research studies, including epidemiological and observational studies.
- Determine whether there are “safer” levels of exposure*, i.e., less likely to lead to serious adverse outcomes (*This would not apply to women who are pregnant, children/adolescents, or those at high risk for mental illness
- Determine what levels of exposure cause or contribute to adverse outcomes, including cannabis use disorder (CUD), mental illness, psychosocial impairments, hyperemesis, etc.
- Identify meaningful CUD treatment outcomes—e.g., reduction-based endpoints vs. abstinence
- Determine appropriate doses/formulations for medical vs. adult use
- Train physicians, patients, budtenders and others involved with cannabis distribution
One area of focus of the NCI presentation was the oncological knowledge gap. Although 80% of oncologists surveyed have discussed medicinal cannabis with patients and 46% have recommended it in the past year, 29% do not feel they are sufficiently knowledgeable about medicinal cannabis. Where are the knowledge gaps? Questions include:
- How and why are cancer patients currently using cannabis?
- What are the benefits/harms of cannabis use among cancer patients?
- Does cannabis use alter cancer risk (e.g., interacting with other substance use known to cause/increase cancer risk)?
Meanwhile, some key questions patients are asking are:
- Can cannabis help: Do studies show that cannabis can improve my symptoms; and can cannabis help to treat my cancer?
- Is it safe: What are the risks; and is cannabis safe to use with opioids?
- Is it available: What are the laws in my state, and what types of products are available?
Despite the lack of federal legalization, states are continuing to move forward, so such discussions and research are vital to improving the knowledge of medical staffs as well as manufacturers and distributors of cannabis products – and consumers. Included in this article is just a brief glimpse of the three-hour session; a video recording of the full meeting is available on the NASEM webpage along with a link through which stakeholders can provide feedback on the project.