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
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
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
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
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
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, canvaspublicpolicyconsulting.com, 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 consulting.com.
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