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A new government-commissioned report urges more marijuana-related guidance from Congress and federal agencies such as the U.S. Centers For Disease Control and Prevention (CDC), finding that the “the federal government has been noticeably missing from this dialogue” as more states across the country have legalized cannabis for medical or adult use.
The 341-page document, published on Thursday by the National Academies of Sciences, Engineering, and Medicine (NASEM), takes a broad look at the U.S. marijuana market, describing cannabis availability and assessing various regulatory frameworks. It also lays out a number of policy recommendations around health and safety matters, research, criminal justice and social equity.
“States have received little federal guidance on how to proceed regarding the health impact of cannabis on the public and communities,” it says. “Other than two memoranda deferring to states”—guidance that was rescinded under the Trump administration—”the federal government has been noticeably missing from this dialogue.”
In fact, the federal government’s position on cannabis has actually set back state-level attempts to protect safety, the NASEM report asserts.
“Because cannabis is illegal federally, the federal government has had minimal involvement in cannabis policies within the states,” it notes. “The limited federal guidance on cannabis has focused on its sale—not on public health. Further, federal policies have complicated the efforts of state governments to develop cannabis policies that protect public health.”
Generally, the new report encourages federal agencies to adopt a more hands-on approach to cannabis health matters than they have so far. For example, it calls on CDC to develop both targeted public health campaigns and establish “best practices for protecting public health” in states that have legalized marijuana.
“These should include best practices in marketing restrictions, age restrictions, physical retail and operating restrictions, taxation, price restrictions, product design, and measures to limit youth access, among other strategies,” the guidance says.
Predominantly the NASEM recommendations focus on how to best publicize and manage health risks around cannabis—a role authors say is sorely needed but so far hasn’t been embraced by government officials.
“There is an urgent need for a coordinated public health approach to cannabis policy in the U.S.,” said Steven Teutsch, who chaired the committee that wrote the report. “Our report shows that cannabis policy often focuses on regulating sales and revenue first, and protecting public health second.”
“Now is the time for the federal government to create guidance for states that have legalized cannabis in the interest of protecting the public’s health,” added Teutsch, who is also a senior fellow at the University of Southern California’s Center for Health Policy and Economics.
To that end, the NASEM report calls for the removal of federal limits that prevent certain officials from even researching the impact of cannabis legalization: “Congress should remove the White House Office of National Drug Control Policy’s restrictions on studying the legalization of cannabis,” it says.
Among the report’s other specific recommendations, NASEM also advises that CDC begin centrally tracking state-level marijuana information more closely with “an adaptable public health surveillance system for cannabis, capturing a range of data from cannabis cultivation and product sales to use patterns and public health impacts.”
It also advises a shift in marijuana research priorities to focus more on public health outcomes related to legalization, including efficacy of tests to determine cannabis impairment and health effects of new and emerging products.
Another of the report’s recommendations says Congress should take action to close what NASEM calls “loopholes” in federal law around hemp-derived cannabinoids, which exploded onto the market—even in states where marijuana remains illegal—following the 2018 Farm Bill’s legalization of hemp.
“The report recommends Congress change the definition of hemp to make it clear that no form of hemp-derived THC or semisynthetic intoxicating cannabinoid is exempt from the Controlled Substances Act,” a press release from NASEM explains, “so they are regulated in the same manner as other intoxicating cannabis products.”
Federal lawmakers are beginning to consider a number of possible actions to rein in largely unregulated sales of intoxicating hemp-derived cannabinoids. This week, for example, Sen. Ron Wyden (D-OR) introduced a new bill that would create a federal regulatory framework for hemp-derived cannabinoids, allowing states to set their own rules for products such as CBD while also empowering the Food and Drug Administration (FDA) to ensure that certain safety standards are met in the marketplace.
NASEM’s recommendations also advise an array of state-level actions aimed at promoting health and standardization in the industry, for example requiring training and certification for marijuana retail staff setting quality and purity standards for cannabis products.
Training of retail staff would involve aspects such as the health impacts of cannabis consumption, prevention of sales to minors, warnings about impaired driving, information on high-potency products and other details.
Notably, the report also calls for automatic expungement of state-level criminal records for past cannabis offenses. “States that have legalized or decriminalized cannabis,” NASEM’s press release says, “should implement criminal justice reform and automatically expunge or seal records for low-level cannabis-related offenses.”
The guidance also recommends that state officials at the National Governors Association and National Council of State Legislatures develop model legislation around cannabis policy, which would in turn incorporate the best practices the group says should be developed by CDC.
Another concern detailed in the report is what authors described as inadequate limits on corporate lobbying by the marijuana industry, which NASEM says has thwarted efforts to regulate pesticides or cap THC potency in some states.
“Further complicating matters are documented conflicts of interest, such as revolving-door practices in regulatory bodies (e.g., Colorado) and financial entanglements (e.g., Washington, Ohio),” the document says. “These examples highlight the current lack of safeguards against industry influence, allowing lobbying and conflicts to impede the development of robust public health protections.”
The NASEM report also acknowledges that most states have social equity programs as part of their cannabis laws. Of states where adult-use marijuana is legal, 22 out of 24 have measures intended to aid those harmed by cannabis policing, for example through criminal justice reforms, technical assistance and workforce training, community reinvestment and other programs.
“While these initiatives are well intended,” the report says, “implementation challenges must be addressed to ensure that they are meeting their stated goals and not having unintended consequences.”
To that end, NASEM recommends state regulators regularly evaluate and revisit—”and if necessary, revise”—marijuana social equity policies “to ensure that they meet their stated goals and minimize any unintended consequences.”
As part of that process, it notes that policymakers “should meaningfully engage affected community members when developing or revising these policies.”
Overall the NASEM report stresses that while there’s indeed a need to gather more information, it’s also time for action.
“While ongoing research is crucial,” it says, “applying the core public health functions—assessment, policy development, and assurance—now will lead to better and more consistent policies for cannabis legalization and improved public health and health equity.”
The report, Cannabis Policy Impacts Public Health and Health Equity, was commissioned by CDC and the National Institutes of Health (NIH), which asked the committee “to recommend a harm reduction approach to cannabis policy and set a policy research agenda for the next 5 years.”
Earlier this year, a NASEM meeting convened state and local regulators from across the country to discuss social equity efforts. It was the third meeting of the Committee on Public Health Consequences of Changes in the Cannabis Policy Landscape following a pair of earlier gatherings to discuss other policy issues.
An earlier meeting, held in November, took up a variety of other regulatory matters around local control, the persistence of the illicit market, gaps that have allowed unregulated businesses to thrive, market trends in countries where cannabis is legal and corporate and celebrity backing of legal marijuana.
The committee’s first meeting, in September, featured representatives of several federal agencies who weighed in on evolving cannabis policies.
Here are some highlights of the recommendations in the new NASEM report:
Congress should refine the definition of “hemp” to state clearly that no form of tetrahydrocannabinol or semisynthetic cannabinoid derived from hemp is exempt from the Controlled Substances Act.
In conjunction with other federal agencies, the Centers for Disease Control and Prevention should conduct research on and develop best practices for protecting public health for states that have legalized cannabis, drawing from tobacco and alcohol policies. These best practices should encompass marketing restrictions (e.g., on advertising and packing), age restrictions, physical retail and retail operating restrictions, taxation, price restrictions, product design, and measures to limit youth access. Other strategies for protecting public health that warrant identification of best practices include reducing cannabis-impaired driving, promoting state retail monopoly, and encouraging cultivation practices that limit contamination of both products and the environment. The best practices should be reconsidered and updated periodically as new research emerges.
The National Governors Association, the National Council of State Legislatures, and other public health stakeholders should develop model legislation concerning best practices related to marketing restrictions (e.g., on advertising and packaging), age restrictions, physical retail and retail operating restrictions, taxation, price restrictions, product design, and measures to limit youth access, as well as strategies for reducing cannabis-impaired driving, promoting state retail monopoly, and encouraging cultivation practices that limit contamination of both products and the environment. Once the Centers for Disease Control and Prevention’s best practices have been developed, they should be incorporated into the model legislation.
The Centers for Disease Control and Prevention, in conjunction with its federal, state, tribal, and territorial partners, should create an adaptable public health surveillance system for cannabis. This surveillance system should include, at a minimum, cannabis cultivation and product sales, use patterns, and health impacts. It should also include all the essential components of a public health surveillance system: a surveillance plan, data collection, data analysis, data interpretation, data dissemination, a link to action, and regular evaluation.
The U.S. Pharmacopeia has established product quality and analytical standards for cannabis inflorescence (flower) and is developing standards for cannabis extracts incorporated into pills and edibles. As these standards are completed, state cannabis regulators should adopt and enforce them to ensure the safety and quality of all legal cannabis products.
State cannabis regulators should require training and certification for all staff at cannabis retail outlets who interact with customers. The training should address the effects of cannabis on humans, prevention of sales to minors, warnings about cannabisimpaired driving, cannabis use in pregnancy, high-concentration or high-potency products, and how to identify signs of impairment. The effectiveness of the training should be assessed and the content updated as new scientific information about the positive and negative impacts of cannabis emerges.
The Centers for Disease Control and Prevention (CDC), in coordination with other relevant agencies, should develop and evaluate targeted public health campaigns directed mainly toward parents and vulnerable populations (e.g., youth, those who are or are likely to become pregnant, adults over age 65) about the potential risks of cannabis; how to identify risky behavior, such as the use of cannabis in combination with alcohol or prescription drugs; and risk mitigation strategies, such as lower-risk use guidelines and safe storage. These public health campaigns should include discouraging unhealthy use, such as the use of cannabis in combination with other substances (alcohol, tobacco, or drugs), and the increased risk associated with the use of high-concentration or high-potency products.
Congress should remove restrictions on the Office of National Drug Control Policy (ONDCP) from studying the impacts of cannabis legalization. The ONDCP should be allowed to support research on the impacts of changes in cannabis policy.
Jurisdictions responsible for the enforcement of cannabis laws should endeavor to regularly gather and report detailed data concerning the use of criminal enforcement tools to enforce cannabis policies. These tools include:
arrests,
sentences,
incarceration (pre- and postadjudication), and
diversion programs (e.g., drug courts, law enforcement–assisted diversion, treatment programs).
State cannabis regulators should systematically evaluate and, if necessary, revise their cannabis social equity policies to ensure that they meet their stated goals and minimize any unintended consequences. Policy makers should meaningfully engage affected community members when developing or revising these policies.
Where states have legalized or decriminalized adult use and sales of cannabis, criminal justice reforms should be implemented, and records automatically expunged or sealed for low-level cannabis-related offenses.
The National Institutes of Health; the Centers for Disease Control and Prevention; state, local, and tribal health authorities; and private entities should support a research agenda focused on:
public health outcomes of different approaches to cannabisregulation,
efficacy of tests used to determine cannabis impairment,
health effects of cannabis use (by product, amount, and frequency) by specific populations,
health effects of emerging cannabis products, and
mitigation of the risks of cannabis use.
“}]] A new government-commissioned report urges more marijuana-related guidance from Congress and federal agencies such as the U.S. Centers For Disease Control and Prevention (CDC), finding that the “the federal government has been noticeably missing from this dialogue” as more states across the country have legalized cannabis for medical or adult use. The 341-page document, published Read More