Regulation, prevalence and impacts of cannabis consumption in the US


Depending on when and where you listen to this podcast, you may be legally allowed to possess cannabis for your own recreational enjoyment. Or it may land you in jail.  That’s not just a difference between one liberal countries laws and another conservative nation, that’s the difference between New Mexico and it’s neighbouring state of Texas.


Dr Michael Sofis of Cannabis Public Policy Consulting discusses the organisations research into applications and complications around drug legalisation in the US


Read more at the CPPC website


Image credit: Konektus Photo/Shutterstock





The following transcript is automatically generated


00:00:00 Will Mountford 

Hello I’m Will, welcome to researchpod. 


00:00:09 Will Mountford 

Depending on when and where you listen to this podcast, you may be legally allowed to possess cannabis for your own recreational enjoyment, or alternately, it may land you in gaol. 


00:00:21 Will Mountford 

That’s not just a difference between one liberal countries of laws and another conservative nation. That’s the difference between New Mexico and its neighbouring state of Texas. For towns like Farwell that straddle that state line. 


00:00:35 Will Mountford 

Well, that’s complicated. 


00:00:38 Will Mountford 

Today I’m speaking with Doctor Michael Sofis of Cannabis public policy consulting about the organisation research into attitudes, applications and impacts around drug legalisation in the US, and just how complicated it can get. 


00:00:55 Will Mountford 

Michael, hello 


00:00:57 Dr Michael Sofis 

Thanks for having me. 


00:00:59 Will Mountford 

By way of introduction, could you tell me and all the folks at home a bit about yourself and your research, and what led you through academia to the position that you hold now? 


00:01:08 Dr Michael Sofis 

Yeah, so I got my PhD in 2018 behavioural psychology and did a lot of research on behavioural economics decision making, particularly as it relates to substance use and kind of how people make decisions surrounding substance use. And that led me to a postdoctoral fellowship at Dartmouth College working essentially. 


00:01:28 Dr Michael Sofis 

For the National Institute on Drug Abuse, researching cannabis specifically, and looking at impacts of, you know, legalisation on various cannabis harms, cannabis use patterns, harms and benefit. 


00:01:40 Dr Michael Sofis 

That’s and then in turn that kind of led me to really ask some interesting questions. At least I think they’re interesting in terms of the idea that in what contexts and how does legalisation of cannabis and specifically, you know, particular policies or aspects of legalisation, impact public health, harms and market. 


00:02:00 Dr Michael Sofis 

Outcomes public health benefits of cannabis use in the real world, not initially from an academic standpoint only, but from a working with state governments in my current role at cannabis public policy consulting and I’m working with conjunction with my team with these actual states who are or have legalised cannabis and helping them sort through and better understand what the impacts of legalisation. 


00:02:23 Dr Michael Sofis 

Are what they will be ahead of time, and then how they can sort of use that sort of magic crystal, magic ball if you will, to better help society at large. 


00:02:33 Will Mountford 

It’s serious research and it deserves to be taken seriously. 


00:02:37 Will Mountford 

Do you feel like there is the esteem that goes into your research, considering how societally impactful it could be if treated properly? 


00:02:46 Dr Michael Sofis 

Yeah, you know, it’s interesting. So in academia, it’s at least as rigorous as any other type of substance use or any other sort of health. 


00:02:53 Dr Michael Sofis 

Or social issue? 


00:02:54 Dr Michael Sofis 

In some ways I would as someone who’s bias, who does this research, I would say that it’s in some cases it it requires additional rigour because it’s more difficult because cannabis is. 


00:03:06 Dr Michael Sofis 

Very complex, both in terms of the legality, but in terms of the there’s a lot of harms and there’s some benefits and that’s not really common, right for studying tobacco. 


00:03:16 Dr Michael Sofis 

Pretty one sided right? There’s not a lot of benefit both for individuals, groups, society countries, health insurance systems. You pick it, it’s pretty negative. 


00:03:24 Dr Michael Sofis 

Most cannabis is just so different. I do think, yeah, that’s the opposite of what I’ve experienced, although I will say it doesn’t have the. I think because of that complexity it’s a little more challenging. 


00:03:35 Dr Michael Sofis 

From a financial standpoint, to find revenue and funding from government and other sources just because it’s not just a clean cut that there’s no sort of clear cut agenda, it’s not as. 


00:03:46 Dr Michael Sofis 

Sexy as, say, you know, for some tobacco ’cause I can prevent cancer. I can do all these things, and there may be aspects that are similar like that with cannabis, but there’s also all these benefits. 


00:03:57 Dr Michael Sofis 

And so saying I’m gonna give you the right answers about what’s going to happen or what does happen with cannabis isn’t necessarily a easy sell for a lot of folks that makes sense. 


00:04:12 Will Mountford 

Looking at where things are at the moment and where they’ve come from in the recent past of what’s the state of legality in America? 


00:04:21 Will Mountford 

You’ve mentioned the differing legality across the many States and you know there’s 50 states to choose from. Imagine it’s a tough landscape to come up with a holistic view. 


00:04:31 Will Mountford 

So if we could start with the top down and work into some details from there. 


00:04:36 Dr Michael Sofis 

Yeah, I mean there’s about 2/3 of U.S. states that have some form of legalised medicinal and or adult use cannabis, although it even that sort of how you define the line there for medicinal is really. 


00:04:51 Dr Michael Sofis 

Difficult. It’s a lot of states in the South, a little bit in this sort of self, kind of the western part of the Midwest that have what’s called low THC medicinal use. 


00:05:00 Dr Michael Sofis 

So extremely, extremely low potency THC, that’s only that’s allowed, or CBD that’s allowed for cannabis use, but there’s 12 or 13 at this point. 


00:05:10 Dr Michael Sofis 

Or roughly around there for adult use states, but there’s no state is exactly the same, and that’s kind. 


00:05:17 Dr Michael Sofis 

Of the challenge here, and that’s people really struggle with in media, in government in almost all parts, even in science to some extent, but in particularly in other areas besides science and academia, people struggle with the idea of even a basic what a correlation is and when it can be applied in on it. 


00:05:38 Dr Michael Sofis 

And you start in terms of impacts of something or the relationship between variable X&Y and then when you throw in. 


00:05:44 Dr Michael Sofis 

35 different state structures in terms of these policies and how they ought to relate is a real issue. 


00:05:50 Dr Michael Sofis 

That’s partly why we created this policy simulation lab, so that we can literally pick apart and look at how every single different change, whether it’s one state, allows advertising to those under 21 that other states don’t. Right? And. 


00:06:04 Dr Michael Sofis 

What have you that there’s a limit on how many licensees or how many cannabis stores like legal stores there can be per in the state, right, all these different policies and we we use that to sort of. 


00:06:15 Dr Michael Sofis 

Breakdown one by one, but also sometimes at the same time how these various policies impact outcomes. And so, yeah, I think the laser land right now is sort of things are a little bit all over the place. 


00:06:27 Dr Michael Sofis 

I think one of the only things that most folks agree on right now is that there needs to be a safe banking act of some kind, which is really. 


00:06:35 Dr Michael Sofis 

There’s a overall societal benefit, but there’s. 


00:06:38 Dr Michael Sofis 

It’s a lot of resignation. I think that federal legalisation is is a good ways off, unfortunately. 


00:06:45 Dr Michael Sofis 

In the US, which I think most folks at various aspects whether believe at least on that we associate with believe and I think the evidence would suggest is going to be, would be positive. It’s a mixed world out there right now. In terms of cannabis.


00:06:59 Will Mountford 

Now we’ll get into some of that grey zone in a minute. You mentioned 35 states that had some kind of structure for whatever state of legalisation drugs are currently in. 


00:07:11 Will Mountford 

When did legalisation move from a social campaign to a social social reality in those first few states? Was it something that took a long time to kind of come together? 


00:07:23 Will Mountford 

Has there been a rapid increase in the last 1520 years or so has it been? 


00:07:28 Will Mountford 

Fast growing has it been kind of a. 


00:07:31 Will Mountford 

Slow moving project, what’s the inertia behind? 


00:07:35 Dr Michael Sofis 

So states like Maine and California had some very interesting sort of laws, medical laws that are a little bit more nuanced, I think, than the ones we see today. 


00:07:44 Dr Michael Sofis 

Even in like the late 90s and early 2000s, but not until I want to say it was either 12 or 13 at Colorado was, you know, I think the 1st. 


00:07:54 Dr Michael Sofis 

Maybe in the world like sort of recognise state or country that legalised the broad scale adult use of cannabis. 


00:08:02 Dr Michael Sofis 

States like Washington, Oregon were pretty close behind. You saw after that for the next four or five years are pretty decent. 


00:08:10 Dr Michael Sofis 

Uptick in medical laws and a lot of states said, well, this is something that I’d like to talk about a little more later, but. 


00:08:20 Dr Michael Sofis 

Medical, great. Medical safe. It’s medical, right? Medical sounds great. It sounds like amazing, right? Oh my God. Like that’s forced. 


00:08:27 Dr Michael Sofis 

Medical better. Like I remember I was on a plane once going to a conference talk about cannabis and this lady was sitting next to me asking me about. 


00:08:34 Dr Michael Sofis 

And she goes, well, I think medical is fine, but not recreational. And it’s just very interesting. 


00:08:38 Will Mountford 

I I mean, it comes in this very familiar pill bottle. It’s got the pharmacy logo 1I recognise this shop. 


00:08:44 Will Mountford 

I recognise this brand. 


00:08:46 Dr Michael Sofis 

Yeah, exactly, exactly like, it’s just like, it’s literally exactly association there. So anyway, yeah, a lot of states did that quickly. 


00:08:52 Dr Michael Sofis 

Like you’re sort of New Mexico is there’s like several other states very rapidly and then you started to see the. 


00:08:58 Dr Michael Sofis 

Was kind of often referred to as the second wave which is where like of of the adult you used, right. So the Michigan’s, the Massachusetts of the main these sort of States and they. 


00:09:09 Dr Michael Sofis 

Took Colorado and Washington were, you know, especially Colorado where had to sort of do this stuff on the fly, right? 


00:09:16 Dr Michael Sofis 

There was quite literally nothing to refer to and so there was a little bit of improvement where states like Massachusetts and Maine, you know, had the ability to sort of. 


00:09:26 Dr Michael Sofis 

Take some obvious wins and some obvious things that maybe they could avoid from Colorado and such, but it was still very was challenging. 


00:09:34 Dr Michael Sofis 

And so there was a lot of kind of, I think in general there’s always been sort of a copy and paste approach with a lot of these things because there’s just no one really studying in detail how these policies truly impact. 


00:09:45 Dr Michael Sofis 

Outcomes and so then you know now we’re sort of getting into maybe we could be considered a third wave which is you know these the Arizona is the New Jersey, Connecticut’s the New York. 


00:09:55 Dr Michael Sofis 

That New Mexico for adult use that either have already in the last six months or will in the next 6 to 12 months your Virginias. 


00:10:04 Dr Michael Sofis 

Which is a good five or six states that are going to be Vermont, actually kind of technically already did. 


00:10:10 Dr Michael Sofis 

I think so a lot of that third wave of adult use states where in like in a year and a half or so we’ll have about 18 ish states with adult use. 


00:10:21 Will Mountford 

Whilst that’s all coming through in terms of approval, I imagine in terms of the penalties within those states where maybe in neighbouring states it has been legalised for personal use or distribution. 


00:10:34 Will Mountford 

If that is something that can be quickly addressed, how is that being approached from a law enforcement perspective, considering that this is perhaps a substance that up until very recently they were arresting people for, and now someone in the exact same situation with the exact same amount of the exact same substance on them isn’t breaking any laws? 


00:10:56 Dr Michael Sofis 

That’s a really good question. To be honest with you, I that is probably one of the biggest gaps in knowledge that currently exists because the it’s difficult to measure. 


00:11:07 Dr Michael Sofis 

States are often in a difficult position in terms of who is actually responsible for that. In other words, there might be a cannabis. 


00:11:16 Dr Michael Sofis 

Control Commission that is sort of broadly responsible for helping to form regulations and policies in to a certain extent enforcing things. But exactly how that’s enforced and who carries that out and. 


00:11:28 Dr Michael Sofis 

Is challenging and to be honest, we just. 


00:11:30 Dr Michael Sofis 

Really don’t know. 


00:11:31 Dr Michael Sofis 

How often it’s occurring, I can say from sort of personal experience like in consulting with states, that there is definitely at least. 


00:11:39 Dr Michael Sofis 

Efforts to not, but to back off, to avoid some of the issues as much as possible of the like. Things like the war on drugs too, and things like that. 


00:11:48 Dr Michael Sofis 

I do think that it but it’s it’s really to be seen and I don’t have that on that. I can really speak to say how exactly how well it’s going, but it’s difficult, right, because it’s. 


00:11:58 Dr Michael Sofis 

I think states want to enforce it. 


00:12:00 Dr Michael Sofis 

To be fair. 


00:12:01 Dr Michael Sofis 

But they also don’t want to overdo it based on past harms that have been done to particularly underrepresented groups. 


00:12:08 Will Mountford 

No, is a perfectly acceptable answer to that question. So. 


00:12:12 Will Mountford 

Explaining and exploring all the ways that that is kind of yet to come through for the places where it’s on the cusp of legalisation. You mentioned Vermont and the Virginias in terms of maybe a grey market. 


00:12:25 Will Mountford 

Where ownership is moving either from medical exemption to legalised ownership, is there any knowledge of that transition market if that’s something that comes up in your research. 


00:12:36 Dr Michael Sofis 

Yeah, the grey or diverted markets, you know, there’s all sorts of little complexities like extremely prevalent for there to be. 


00:12:46 Dr Michael Sofis 

In medical you know this is kind of a case in point where if you have a medical state that a broad scale medical use state they will as doesn’t have low THC restrictions. 


00:12:57 Dr Michael Sofis 

You’ll see that in our data. We see that a lot of people are using, maybe even really the majority of people who are actually medical patients are using cannabis. 


00:13:07 Dr Michael Sofis 

For recreational reasons, they’re self reporting that and so it does, kind of. 


00:13:11 Dr Michael Sofis 

Make you kind of, you know, maybe even like in some cases like 80 or 90% of people are using recreationally and medically. 


00:13:18 Dr Michael Sofis 

And then there’s a lot of people that there’s still a decent prevalence of folks that are using medicinally and they’re getting it from like illegal operations, whether it’s online, in person, store, there’s some. 


00:13:31 Dr Michael Sofis 

Caregiver markets that are very like. 


00:13:35 Dr Michael Sofis 

It’s very grey and a lot of times it’s probably illegal, but it’s it’s so close that it’s put states in challenging situations. 


00:13:44 Dr Michael Sofis 

So it’s, yeah, that’s increasingly prevalent, but I think that’s kind of the point of where adult use can come in is it is a solid implementation of adult use and it’s written well as in statute. 


00:13:55 Dr Michael Sofis 

And things like that it you can really help, I think, curb some of that. And that’s important because illicit use is associated with a lot more harms and there’s really not a lot of benefit to society at all for more of that, essentially. 


00:14:14 Will Mountford 

Where do the cannabis public policy consulting at CPCI think is the proper acronym? When do you guys come onto the scene then, and what kind of role are you fulfilling now? 


00:14:27 Dr Michael Sofis 

So we work with state governments, local governments, nonprofits and even some for profit kind of cannabis ancillary businesses. So not necessarily that we don’t work. We’re not like for against legalisation. 


00:14:40 Dr Michael Sofis 

We don’t directly work with industry, but so we can stay sort of neutral and unbiased as much as. 


00:14:47 Dr Michael Sofis 

Possible, but we really help states provide data based predictions, simulations about what is and what will happen if they do certain things with their policies and then kind of have this consulting warm handoff that then take helps these states do community outreach and stakeholder outreach and in local communities. 


00:15:07 Dr Michael Sofis 

And ask people what they need and what they want and sort of bring it all together with that data based approach. That’s then we we also work in other areas with. 


00:15:16 Dr Michael Sofis 

Couple, you know, for profit companies trying to create technical solutions for to for example things like cannabis impairment like in driving things like getting bad, really illicit products that are dangerous off of illegal shelves and stores. Things like that are sort of what we’re really trying to. 


00:15:36 Dr Michael Sofis 

To do as well and work with folks that have for profit, but that are focused on helping and doing public health related have public health at least associated missions and I think that’s. 


00:15:48 Dr Michael Sofis 

I guess in a nutshell we we sort of are a little bit all over the place but really trying to help solve the cannabis legalisation issues in the US essentially. 


00:15:57 Will Mountford 

To follow up on the database approach that you mentioned there, I’ve got two aspects that I’d like to follow up in terms of cannabis use. 


00:16:06 Will Mountford 

There’s the breakdowns of physical characteristic, but also by psychological characteristic. If we could start with maybe some of the hard coded stuff there in terms of age. 


00:16:17 Will Mountford 

Location, gender, ethnicity? Who is using what, where and when? 


00:16:24 Dr Michael Sofis 

That’s a good question.. 


00:16:27 Dr Michael Sofis 

In short, everyone that’s 16 and older and some people younger, everyone really using. I mean within reason. 


00:16:36 Dr Michael Sofis 

At least 1/3 folks who are 16 older in the US we’re finding, at least in legal states, which is now the the majority of the US are using cannabis at least month late. 


00:16:49 Dr Michael Sofis 

And this is important because some of the federally funded data sets on substance use, which cannabis is a small part of it, are suggesting things like 13%. 


00:17:01 Dr Michael Sofis 

And now to be fair, those are like 2 years old to happen. So like that’s probably a big part of it, but a big part of it too is that. 


00:17:09 Dr Michael Sofis 

There’s other reasons about, like how these studies are done, etc. But Long story short, it’s 1/3 is I think a pretty fair number and. 


00:17:16 Dr Michael Sofis 

Other folks that have kind of corroborated that, other academics in different ways. But the Long story short is a lot of people are using now. Young folks do. 


00:17:24 Dr Michael Sofis 

Use more and by young I mean you know your 18 to 25 is is probably the highest prevalence and the highest prevalence of cannabis use disorder associated with that. But it’s. 


00:17:36 Dr Michael Sofis 

Cannabis use is increasing and period. It’s increasing in states that have medical, that have adult use, that have completely illegal is you can’t do it, you know you’re a lot. 


00:17:44 Dr Michael Sofis 

It’s it’s increasing everywhere and I think that’s one of the biggest misconceptions is look, more states are legalising. 


00:17:52 Dr Michael Sofis 

And look, cannabis use in the US is going up and it’s just like, oh, oh, that’s cute, ’cause. Like, I wish it was that easy. 


00:18:00 Dr Michael Sofis 

But you would be surprised people like. 


00:18:02 Dr Michael Sofis 

MD’s other people are like, you know, put stuff like this on social media, other sites, other sources like with just utter confidence that this is a great argument. 


00:18:09 Dr Michael Sofis 

And so yeah, anyway, so it’s it’s going up a lot and but it’s not necessarily because of legalisation in some cases. I think it’s actually potentially in spite of it at least. 


00:18:18 Dr Michael Sofis 

In terms of the harms. 


00:18:19 Will Mountford 

Then on the psychological side, in terms of motivations and drivers, you mentioned the cannabis use disorder, but there’s also emotional regulation aspect of things. 


00:18:31 Will Mountford 

Is there any consumer breakdown that can be made to say that we know that college students are using drugs to relax and have a good time compared to maybe an older population who are using it to deal with work stress? 


00:18:47 Dr Michael Sofis 

So 18, yeah, 1825 year olds make up, uh, a crazy portion of it. Like, I think I’ve done some research suggesting it’s like over half of all CD cases are like between 18 and 29 or something along those lines. It’s a very disproportionate amount, which obviously we don’t want that. 


00:19:04 Dr Michael Sofis 

As of in terms of like developing brains, they’re still developing often in that age range, but the other way to look at it too is that OK, well, that means in the rest of the population the prevalence isn’t as high now, with that being said. 


00:19:18 Dr Michael Sofis 

Just like the prevalence of use measures in federal surveys, the prevalence of cannabis use disorder is dramatically underestimated based on the data we’re seeing. Like, dramatically. I mean, our data suggests, right, that. 


00:19:29 Dr Michael Sofis 

About 100 million people in the US, roughly our maybe 80 to 100 million are using cannabis in. 


00:19:34 Dr Michael Sofis 

The past month. 


00:19:36 Dr Michael Sofis 

Conservative conservative estimates, which adjusts 20 to 30% of those people have cannabis use disorder. Our data suggest more, but just to be really conservative, so you’re talking whatever, 20 million to 30 million people in the US are

probably meet criteria. 


00:19:49 Dr Michael Sofis 

For campus order right now in terms of the. 


00:19:52 Dr Michael Sofis 

Psychological motivations for it, I think. 


00:19:55 Dr Michael Sofis 

Coping mode is I’ve. I’ve published at least a paper or two on this. It’s very prevalent, trying to cope with things, and it’s it makes sense, it’s and it bears out. 


00:20:03 Dr Michael Sofis 

In the data, in the science, the. 


00:20:06 Dr Michael Sofis 

There’s a lot of other things, though, and I think what I’ve I literally got this finding two days ago from our national survey data, which is about 6000 people across the US. 


00:20:16 Dr Michael Sofis 

And when you use medical cannabis, the number of like reasons or conditions you use it for that are not approved by someone like a physician, right? 


00:20:27 Dr Michael Sofis 

Is really strongly related to cannabis use disorder, but the number of ones that are qualified that you qualify for that you’ve gotten approved for. 


00:20:36 Dr Michael Sofis 

Does not relate to that. And so it’s important. I think, you know, this kind of comes back to what I was intimating before, which is that, you know, medical uses can be dangerous because the, for the most part, there’s very few qualifying conditions that have a really solid corpus of evidence. It’s, yes, this really is a benefit. 


00:20:53 Dr Michael Sofis 

And there are some, there’s, you know, maybe three to five where, yeah, there’s a few others where it’s promising in terms of the effects, but most of the time it’s at least as bad, if not worse, like mental health wise, right? 


00:21:04 Dr Michael Sofis 

I mean, there’s probably more evidence now suggesting that if you have PTSD or anxiety or depression, using cannabis will eventually make it worse, not better, on average. 


00:21:13 Dr Michael Sofis 

Doesn’t mean there aren’t cases where it might help someone. 


00:21:16 Dr Michael Sofis 

But a lot of states have various mechanisms or qualifying conditions for this and so. 


00:21:21 Dr Michael Sofis 

Honestly like. 


00:21:23 Dr Michael Sofis 

The idea is that one of the things I’m trying to sort of push what we’re seeing in our data. 


00:21:27 Dr Michael Sofis 

And I think some colleagues of mine who do similar research are suggesting similar things is if we think about cannabis like alcohol in the context of just, you got to be careful with it. But if you just use it recreationally normally, there’s obviously medicinal uses for cannabis, which makes it different. 


00:21:42 Speaker 4 

This requires means. 


00:21:43 Dr Michael Sofis 

But outside of those that are like firmly establish if you you need to use if you think about it like alcohol and just in a recreational context, it might actually be a lot safer from a societal standpoint if people stop thinking about it. 


00:21:54 Dr Michael Sofis 

It is such a it’s healthy for everything. So I might as well start treating things, changing prescriptions, little switch out prescriptions and then also like there’s a lot of issues with the perceptions of risk you have done. 


00:22:06 Dr Michael Sofis 

Some studies on this associated with any harm of cannabis are so I did a harms and benefits and on average, most Americans think. 


00:22:14 Dr Michael Sofis 

There’s more benefits than harm. 


00:22:16 Dr Michael Sofis 

And so that’s not great either. And I think the medical side of it has really over and over sold and ironically prevented adult use because, you know, our current President and other high profile governors have come out and said things like oh medical good, often adult use this like, yeah, the worst, but it’s like our debt is actually suggesting. 


00:22:36 Dr Michael Sofis

More like carefully controlled trying to get systems in place where folks are actually getting there.


00:22:44 Dr Michael Sofis 

There are primary care providers and getting access to primary care providers and as a part of their medical cannabis use and then. 


00:22:50 Dr Michael Sofis 

That’s really important and they don’t use side may actually be more helpful in terms of harm, so hopefully that answers your question. 


00:22:57 Will Mountford 

Is there any delineation in your research between cannabis just kind of medical or adult use cannabis, that raw stuff that people are probably most familiar with to any of its derivatives, things like? 


00:23:10 Will Mountford 

CBD, which is in the health shops near where I live. 


00:23:14 Dr Michael Sofis 

Yeah, I mean, people, I think, no, broadly that CBD is different than THC. CBD obviously has almost no risk of harm. 


00:23:21 Dr Michael Sofis 

So if then the day, if someone likes it and thinks it’s helpful for them, there’s not a tonne of evidence that it really is, but there’s some specific context where maybe it can be for certain types of like inflammation potentially. 


00:23:32 Dr Michael Sofis 

A lot of times it’s on a binary yes or no. It’s good for you writing it. It could be like it’s good for 25 or 30% of people. 


00:23:38 Dr Michael Sofis 

It shows it like a small but a nice effect, and then the rest of people doesn’t show anything for the same condition, right? 


00:23:44 Dr Michael Sofis 

And so, yeah, there’s no harms, is it? So people don’t really. So people do know that, I think. 


00:23:49 Dr Michael Sofis 

But they also don’t aren’t willing to. Usually the attitude is, well, I need this percent THC and I need. 


00:23:55 Dr Michael Sofis 

This, you know I need indica or what have you to be able to actually treat this X condition. 


00:24:02 Dr Michael Sofis 

So we’ve done some studies recently where folks are really passionate that like I need this, I have to use this method and I have to use this. 


00:24:10 Dr Michael Sofis 

Potency. And I have to use indica and so on and so forth from my anxiety. But then for my PTSD or my arthritis, right, I have to use this, this, like, you know, more CBD. And there’s just so little evidence that those differential levels have anything to do with it. 


00:24:25 Dr Michael Sofis 

You know, my guess is that it’s because they’re reinforced for using ’cause. It feels good when you have pH. D and it those aspects or characteristics of that pattern get reinforced. 


00:24:34 Will Mountford 

I imagine there’s a aspect of the comfort in the ritual of it as well. I know some people who are the same with their coffee that they want to have the exact control over the grind, over water temperature, over how long it steeps to have ownership of that process and make it theirs. 


00:24:50 Dr Michael Sofis 

That’s a great analogy for sure. 


00:24:57 Will Mountford 

Could you tell us a bit about what happens when people are out in the wider world? 


00:25:04 Dr Michael Sofis 

Yes, that’s a really big question in a tough one. It’s even more so than I think some other drugs. 


00:25:09 Dr Michael Sofis 

It depends. There’s so many different aspects where you feel like you’re just saying the same thing over or cannabis is just it’s more complicated than with other drugs. 


00:25:16 Dr Michael Sofis 

In the sense that there’s a little bit more tolerance, there’s some really conflicting findings right about if I use everyday three times a day, decent THC level, decent anagrams, and I’m really just Inigo and I used before. 


00:25:29 Dr Michael Sofis 

I drive. You know, there’s some evidence that maybe that’s even bizarrely count intuitively, you might drive better right now. 


00:25:35 Dr Michael Sofis 

Usually it’s not. It’s usually just like you might do a little bit worse, but their studies show that you don’t do as worse as someone who write doesn’t usually use cannabis, right? So you have two people, right? Or two groups, people that use all time, people that use rarely. 


00:25:49 Dr Michael Sofis 

And they they use the same amount right before like a a simulation study of a driving simulator study right in a lab setting though the people who there’s some studies showing that OK to the. 


00:25:59 Dr Michael Sofis 

They’ll both do worse than they they do when they’re sober, but they the folks that use all the time might not do as bad relative to their baseline when they’re sober. 


00:26:07 Dr Michael Sofis 

So it’s complicated there, the until it’s really challenging you know just got back from a conference trying to determine impairment. What does impairment mean? What is under the influence mean? 


00:26:19 Dr Michael Sofis 

Impairment in terms of like at the workplace, impairment at when driving and it is honestly kind of a a mess to be quite frank. And there’s just not a lot of great solutions for it right now. 


00:26:31 Dr Michael Sofis 

And so. 


00:26:32 Dr Michael Sofis 

In the US at least right now, it’s just kind of getting wrapped up into other impairment. 


00:26:36 Dr Michael Sofis 

You know, lot of say just wrap it up into other substance use impairment, but there’s also unfortunately a lot of states that have. 


00:26:41 Dr Michael Sofis 

Limit like 0 tolerance for THC, right? And then what’s called per cell laws, so like there’s a certain amount? 


00:26:48 Dr Michael Sofis 

Of THC that they deemed to be sort of implicitly like associated with impairment, which is just crazy. And there’s plenty of really good studies multiple of them at at Johns Hopkins with some colleagues of mine that just show pretty convincingly like this is you are coin flipping right now as to whether this person is actually. 


00:27:06 Dr Michael Sofis 

Impaired and that’s horrible. From a legal and ethical and social equity standpoint. And at work people, there is a bit of a movement to stop testing for THC. 


00:27:17 Dr Michael Sofis 

Some big corporations in the US with 10s or maybe hundreds of thousands of employees in some cases have. 


00:27:23 Dr Michael Sofis 

Move to a away from T testing because of some of this evidence and tried to move a little bit closer to like a actually testing impairment. 


00:27:31 Dr Michael Sofis 

And there are some cool like cognitive apps that can help with that. But it’s the tough question is always how accurate do you have to? 


00:27:38 Dr Michael Sofis 

Be for it to be fair, right? In other words, filing will lose my job. 


00:27:42 Dr Michael Sofis 

’cause I use cannabis and I was what is impaired? Like, is it 10% worse in cognitive performance than normal? Is it 5%? 


00:27:50 Dr Michael Sofis 

What if I didn’t sleep? I mean, if I don’t sleep, I’m a disaster, right? So it’s still we’re still kind of. 


00:27:56 Dr Michael Sofis 

In the. 


00:27:58 Dr Michael Sofis 

In the weeds, if you will, right? 


00:27:59 Dr Michael Sofis 

Now with that stuff. 


00:28:01 Will Mountford 

How long after exposure can THC be picked up at the kind of levels that is going to be? Well, companies are going to be testing for to say. 


00:28:09 Will Mountford 

That this is. 


00:28:10 Will Mountford 

Indicative of exposure or possibly impairment for people who are going to be judging. 


00:28:15 Will Mountford 

It in that way. 


00:28:17 Dr Michael Sofis 

So that’s a fantastic question and again tough to answer because it just. 


00:28:22 Dr Michael Sofis 

Depends on what you’re. 


00:28:24 Dr Michael Sofis 

The issue is what the definition of impairment is, is is challenging. That’s kind of the you need that ground truth, right. 


00:28:32 Dr Michael Sofis 

And so in the alcohol world, even though it’s technically non impairment, your blood alcohol level of .08, right, even though it’s not impairment, it’s been associated enough in research for people to say that’s impairment. 


00:28:45 Dr Michael Sofis 

Cannabis does not have that yet and that’s the challenge. I honestly in terms of what it would mean for impairment and the individual differences, right, that sensitivity, that tolerance. 


00:28:54 Dr Michael Sofis 

Even like things like. 


00:28:56 Dr Michael Sofis 

Fat cells, I mean cannabinoids, are stored in like fat cells. There’s all sorts of weird genetic individual differences that is going to change that time profile. 


00:29:04 Dr Michael Sofis 

But I mean broadly, right? Like and it also depends on the method, right? Or is this the potency, what else you’re doing at the time? 


00:29:11 Dr Michael Sofis 

So you can vary really widely, to be honest with you. Obviously a lot of times you’re going to see it. 


00:29:16 Dr Michael Sofis 

For 1530 minutes. 


00:29:17 Dr Michael Sofis 

If it’s a lot high potency or in a lot of amount and then it could be anywhere from. 


00:29:23 Dr Michael Sofis 

An hour to two hours, 3 hours all the way up to five or six hours with edibles. Take a little more longer to get through. 


00:29:28 Dr Michael Sofis 

You know, there’s a lot of variability there, which again makes it really hard to create policy to, you know, create regulations that are really going to be broadly beneficial. 


00:29:38 Will Mountford 

Are there any professions or fields that you see things being the most tightly clamped down on, or on the other hand, the most permissive for casual use of cannabis within? 


00:29:48 Dr Michael Sofis 

That’s a good question. I mean, I would assume I don’t know, but I would assume work from home would be a pretty good example of remote work, that being pretty particularly someone lives in a legal cannabis state. 


00:29:59 Dr Michael Sofis 

So I think that’s probably a fair assumption. I will say that obviously transportation and I think what folks have in the HR world referred to as safety sensitive positions. 


00:30:11 Dr Michael Sofis 

Again, the definition, the line there, the operator, the operationalization there is is challenging, right? Obviously someone who’s driving in the train or flying. 


00:30:19 Dr Michael Sofis 

Plane is clearly in that sort of role, but what about the forklift operator? OK, well, maybe the forklift operator is, but what about someone driving a golf cart or like what? And then you come back to what is impaired and really I think there’s been a. 


00:30:34 Dr Michael Sofis 

An issue with people also thinking, at least from the HR World 2. 


00:30:38 Dr Michael Sofis 

What does this mean for these people like they’re concerned about? 


00:30:43 Dr Michael Sofis 

Really some of the same issues the war on drugs about further marginalising people and when someone you know someone drives on the influence, for example, and I think the odds of them having cannabis disorder are way higher than if they do not, right? 


00:30:55 Dr Michael Sofis 

And so they’re strongly linked and I’ve done this across multiple studies, different time points, different states. I mean just the whole 9 yards. 


00:31:03 Dr Michael Sofis 

And so they need, oftentimes they need help, they need treatment or they need assistance of some kind. So it becomes really challenging, like even from a workforce perspective, if you make a good business case that helping these individuals is the better way to go than trying to do punitive programmes. 


00:31:21 Will Mountford 

By comparison to the restrictions that have been brought in against, say, binge drinking or curfews have been placed on bars or pubs to try and limit the amount of the the social harm that comes out of a substance in the environment that it’s in it’s context and it’s. 


00:31:40 Will Mountford 

What kind of situation is cannabis use in in that kind of regard? 


00:31:47 Dr Michael Sofis 

Yeah, that’s. I mean that’s a. 


00:31:48 Dr Michael Sofis 

A really interesting thought. I think it’s a progressive thought and I think it’s. 


00:31:54 Dr Michael Sofis 

At this point, though, I think based on where states are, it’s kind of a luxury to be able to start approaching that. 


00:32:00 Dr Michael Sofis 

In other words, trying to, you know, one of the things that I think would be great, and there’s some. 


00:32:06 Dr Michael Sofis 

States that have done this with more like just driving under the influence in general, but like rideshare programmes for it’s a good example that these sort of harm reduction strategies where States and and I think actually more like, look how it is. 


00:32:18 Dr Michael Sofis 

I think DC Washington DC has this where it’s like they’ll help fund, particularly on holidays and certain like high drinking days. 


00:32:27 Dr Michael Sofis 

Subsidised like an Uber or a Lyft or another type of rideshare company to provide. Like in a lot of cases, even some pieces like free rides come back home from the bars or what have you, and so there’s a lot. 


00:32:38 Dr Michael Sofis 

Of stuff, a lot of confusion and debate about what to be done about the cannabis lounges for the reasons that you’re bringing up, right. 


00:32:45 Dr Michael Sofis 

I think the issue is there’s really not a lot of infrastructure in place to support that in terms of things like incentivizing rideshare. 


00:32:54 Dr Michael Sofis 

Programmes on other harm reduction strategies was just the entire idea of like how cannabis is used in public is so far from even coming close to being sort of standardised or decided on a consist. 


00:33:07 Dr Michael Sofis 

And on at States and localities across the US. So it’s almost like what you’re bringing up is a great point, but it’s almost a few steps ahead of where I think folks are even well able to really consider right now. 


00:33:19 Will Mountford 

And to bring things back to the personal safety and managing one’s well-being with a specific attention to mental health. 


00:33:27 Will Mountford 

You mentioned the dependency disorders, but also the link that there is between post traumatic stress disorders, either as something that people use to soothe their symptoms of the condition or something that could trigger the onset of symptoms. 


00:33:40 Will Mountford 

And equally, on a purely biological level, the presence of anything that is not air in your lungs is going to have some metabolic biological activity to change the function of your lungs. 


00:33:53 Will Mountford 

I mean, I guess ultimately if people are going to be using cannabis, what is the most Safeway to facilitate that? 


00:34:00 Will Mountford 

And are people likely to do that sensible and safe thing? 


00:34:05 Dr Michael Sofis 

These are some really good questions. Come to speak to the physical stuff there’s what are the challenges with like, OK, does cannabis cause this health condition right is you need to do longitudinal studies, right? 


00:34:15 Dr Michael Sofis 

So these are usually at least kind of like 10 year studies, oftentimes ideally 20 or 30. And so with cannabis only very recently coming to the forefront, right, we’re just starting to get some of this. 


00:34:26 Dr Michael Sofis 

First, legitimate studies in when it comes. 


00:34:28 Dr Michael Sofis 

Say things like long how things like heart health, cancer, the ones I’ve seen do suggest like it’s going to increase the risk of those now. 


00:34:35 Dr Michael Sofis 

Exactly how much? How much compared to tobacco or combustible cigarettes? How much based on whether they use XY and Z? Other substance right is still very much in flux right now, but I will say that. 


00:34:49 Dr Michael Sofis 

There’s pretty unfortunately what’s good for individuals. Aren’t you increasingly think cannabis is beneficial? 


00:34:56 Dr Michael Sofis 

Despite the fact that. 


00:34:58 Dr Michael Sofis 

There’s a lot of evidence suggesting it can be harmful, and maybe more so particular as it relates to mental and biological physical outcomes. 


00:35:05 Dr Michael Sofis 

The funny part is, that’s the one side that makes me sound a little bit like grumpy old man. But then there’s the other side, which is I think makes me sound like the opposite, but which is also data based, which is the folks. 


00:35:18 Dr Michael Sofis 

I have just looked also this week, so kind of fresh off the plate. 


00:35:22 Dr Michael Sofis 

In 20 different states, right, we have this big sample 6000 people and just from last April, so like 3 months ago, not even and adult use. 


00:35:32 Dr Michael Sofis 

We shared this in another state in our previous project in in Maine actually and then we should it’s in these 20 states where the more that you use adult use in grammes. 


00:35:43 Dr Michael Sofis 

Is not related to any sort of additional risk for cannabis use disorder and driving under the influence, which are arguably the two most sort of problematic outcomes for adults, arguably as it relates to. 


00:35:53 Dr Michael Sofis 

Cannabis if you but like, when it comes to like, if you get illicitly, it’s it is it is significantly related and the same thing with medical. 


00:36:03 Dr Michael Sofis 

And so like it’s at least, So what we’re seeing is it’s at least less risky per unit of grain to use adult uses, what is what the implication might be. So we still have to do follow up, we’re going to do another. 


00:36:14 Dr Michael Sofis 

Survey the next month to get follow up data on that, do another round, but like we’re seeing costs and then we’re seeing within states you study right now using California data that generally speaking when you start mixing to the safest folks that are using in terms of severity of use, right, so more or less problematic use. 


00:36:33 Dr Michael Sofis 

Are the folks that are just using recreationally in California? Then it’s medical is like in the middle if you just use medical and then the worst is if you use medical and rec. 


00:36:42 Dr Michael Sofis 

And so generally speaking, you’re seeing even within subjects within that same person within the legal state and then looking at all at the state as a whole across states. 


00:36:52 Dr Michael Sofis 

You’re seeing this same pattern. So again, we’re not for sure yet, but we’re really starting to see some stuff suggesting that. 


00:36:58 Dr Michael Sofis 

Adult use might be the way to go. It might be, you know, if you just normalise this as a part of every like, yeah, I drink a beer, I had some cannabis, whatever, you know, like it inedible, whatever it is. Lady gummy. 


00:37:08 Dr Michael Sofis 

If you just normalise that as opposed to maybe over emphasising the medical, I think we could see at a population level a big reduction in harm, but the issue is that people are not conceptualising. 


00:37:19 Dr Michael Sofis 

Like that. And when I say people, I mean the average U.S. citizen. And unfortunately a lot of politicians are thinking of it that way, including some of the highest folks in the US. 


00:37:30 Will Mountford 

Going back to the top down view, thinking of the political and economic stability of widespread drug use. If someone is impaired beyond the ability to attend work and contribute financially, possibly on a long term basis, then if that is matched with an upward trend of. 


00:37:50 Will Mountford 

Usage generally, then, is that something that on a policy level, people should be wary of? 


00:37:57 Dr Michael Sofis 

So to put it in perspective, the amount that the relative rates of increase I think are actually pretty subtle. 


00:38:04 Dr Michael Sofis 

They’re not like robust. It’s not like we’re just seeing like tripling every couple years or something, right? It’s not anything crazy. I think a big part of it is people. 


00:38:14 Dr Michael Sofis 

Probably didn’t report that they were using it a lot of times in the past and I think a big chunk of it’s that right there were legitimate. 


00:38:22 Dr Michael Sofis 

Consequences and some, many states they’re still there, still are. So it was, you know, legitimate consequences too, if you were to report, if they knew your identity and that you use cannabis, right? 


00:38:33 Dr Michael Sofis 

I think, I think that’s a big part of it, so I do. I don’t think it’s as much, but I think, I think the idea is that if you use every once in a while and just ’cause you’re a past month. Using the past month doesn’t mean it’s it’s like bad, right? 


00:38:45 Dr Michael Sofis 

It takes, and that’s kind of my point is what we’re seeing with the adult use is is I like in my ideal world, I honestly like you always want to have medical use. 


00:38:54 Dr Michael Sofis 

So that you can help philtre folks in with like a a primary care provider and as a part of their larger health plan and our larger health goals. 


00:39:03 Dr Michael Sofis 

And you want to be able to make it, maybe reduce the price or keep it tax free or things like that? 


00:39:07 Dr Michael Sofis 

And I get that. But if I had my druthers, I would want to go straight to adult. 


00:39:11 Dr Michael Sofis 

Use and. 


00:39:12 Dr Michael Sofis 

Have medical be like a subcomponent of that, but really emphasising the adult use side because I think I do think a lot of the harms. 


00:39:21 Dr Michael Sofis 

Are coming from at least some of the harms are coming from sort of these misconceptions, and often driven from a medical folk, overly focused medical side of things. 


00:39:34 Will Mountford 

To try and summarise all of everything that we’ve just talked about, do you have any kind of final thoughts, any roundup or cohesive message that you think someone who’s listening to this should take away? Maybe if they’re in a position to be making decisions on a policy? 


00:39:51 Will Mountford 

Definitely if they’re involved in local or even national government, with everything that people will have learned over the last 30 or so minutes, what should they know and what can they do with that information? And more importantly, where can they find you to find out more about your work? 


00:40:07 Dr Michael Sofis 

First, encourage them to go to our website,, because we have a lot of free reports. 


00:40:14 Dr Michael Sofis 

So some of the stats I brought up today, or I have free reports brought up there, we’re going to be doing a series of three or four of them in the next six months on things like social equity, prescribing medical cannabis, you know, from actual people. 


00:40:27 Dr Michael Sofis 

So our prescribers, recommenders, I should say actual social equity applicants and other licensees, people who were not able to get a licence and we have a whole public health report, workforce report. So there’s a lot of free resources. 


00:40:43 Dr Michael Sofis 

And we have some data simulations we’re showing people they could try to get the sort of get people to understand what’s really going on. 


00:40:49 Dr Michael Sofis 

And I would yeah definitely encourage anyone who is involved in this on in any way that’s you know that they deem is important to to contact us because I think unfortunately we’re the only organisation to my knowledge that actually uses works with states. 


00:41:03 Dr Michael Sofis 

Actively with data and simulations to actually try to inform policy, which is unfortunate to be honest. And so we we work with companies, we’re really trying to sort of bring everyone together to try to help solve this problem. So, so also help really maximise societal benefits of cannabis. So. 


00:41:20 Dr Michael Sofis 

Yeah, that’s what I would probably urge folks to contact us at cannabis public policy  



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