Marijuana discussions in recent years typically have focused on the positives and negatives of legalization. But the health system change-focused organization Advocates for Human Potential (AHP), along with the National Council for Behavioral Health and the Addiction Technology Transfer Centers (ATTCs), is seeking to elevate science and best practices in public health and government at a time of policy change that has moved toward expanded decriminalization and legalization.
“We’re having a much-needed conversation about how you manage the culture and change at the state level,” Linda J. Frazier, director of addictions initiatives at AHP, tells Addiction Professional.
Frazier adds, “We’re still waiting to see how the Trump administration will deal with cannabis at the federal level.” With marijuana still on Schedule I of the Controlled Substances Act, the Drug Enforcement Administration (DEA) technically could still ban the drug in states that have legalized recreational and/or medical use.
AHP is holding a National Cannabis Summit with the National Council and the ATTCs at the end of August in Colorado, a state with a far-reaching marijuana legalization initiative. Regardless of the approach the Trump administration takes, says Frazier, there is still a great need for “getting the science out there, and creating a forum for the best practices.”
The forum should not be a discussion of the pros and cons of recreational or medical marijuana, AHP insists. Industry will be represented on topics that AHP deems appropriate, such as regulatory issues on tracking marijuana plants and safety issues in a cash business model, says Frazier. This is why having the meeting in Colorado made sense, she says, in that many of the state officials familiar with the regulatory apparatus will be on hand.
Starting the conversation
AHP is “agnostic” when it comes to marijuana legalization, says Neil Shifman, AHP's founder, president and CEO.
“We’ve put up boundaries associated with the industry—that’s why we decided to have no exhibits,” Shifman tells Addiction Professional. “We don’t want to promote the industry per se—we want to start the conversation.”
AHP became interested in the marijuana issue because “there is a hunger for good, accurate information,” Shifman says. The National Institute on Drug Abuse (NIDA) should be the supplier of such information, but it is in a difficult position because marijuana remains a Schedule I drug, making research difficult. “Recently I was at a conference in which this topic was brought up by people you would think are national experts, but people were spouting opinions instead of facts,” Shifman says.
He believes just having the conversation—out in the open—is key. “We have to change the paradigm,” he says. “We can’t talk about it if people are viewed as criminals. We can work through a number of problems, such as underage issues or driving under the influence issues.”
Potential medical applications
In addition, Shifman says, it’s possible that marijuana ultimately could be found to help people with opioid use disorders. “We don’t know—but we have to find out, because we’re losing people who are dying,” he says. He is also concerned about racial injustice, with people of color far more likely to be arrested for marijuana issues.
“We need to know what the science says, and what the science needs to find out,” says Frazier, a clinical nurse. “Most providers are telling patients that they have to be clean and sober, but what if marijuana helps people with addictions?” Many providers, for example, do not let people who use marijuana remain in buprenorphine treatment, she says. (The Joint Commission and the Substance Abuse and Mental Health Services Administration do not recommend that opioid treatment programs test patients for marijuana.)
Impacts on youth
Colorado already has the experience of seeing the impact of legalization on youth, says Frazier. Prevention programs are important, she says.
But impaired driving is another issue. It’s easy to test the blood alcohol level using breath tests, but “we don’t have a good answer in terms of drugged driving,” says Richard Landis, AHP senior director for strategic planning and business development. “We found out quickly that there are many studies on individual drugs but no national dataset,” Landis tells Addiction Professional. “There’s no way to look at this on a state-by-state level, or even within a state.”
Instead of emphasizing arresting people because they are caught driving under the influence, Landis believes a better objective would be to educate them on how prescription and recreational drugs affect their driving. In Washington state, for example, where recreational marijuana is legal, there is a program that urges people not to drive if they smoke marijuana.
“The point is to have a conversation,” Landis says. “If you know a prescription medication can affect your driving, you need to know what is a safe amount to take before driving.”
In the search for a biometric test for marijuana, it may be a mistake to focus more on the test and not on the amount smoked and the resulting driving impairment, says Landis. AHP is proposing a study of a game that a driver can use to measure impairment before driving.
Industry outpacing science
What has been happening is that marijuana, as an industry, has been moving faster than the science, says Shifman. “The marijuana movement has overwhelmed the practitioner and the scientific community and the policy people,” he says. “It caught us all off guard.”