While cannabis remains illegal under federal law, states have regulated cannabis for nearly 30 years. But policymakers have had few evidence-based policy tools to inform them. More than two-thirds of the states and territories regulate cannabis for medical use and more than 20 states and territories allow for nonmedical adult use. Michael Sofis, Ph.D., director of research for the Cannabis Public Policy Consulting, is one of the few researchers looking at the policy issues of concern to lawmakers. His firm does extensive surveying around public policy affecting cannabis. On this podcast, he discusses some of the surprises from his findings, the questions states are trying to answer and explains why the cannabis black market still does a brisk business even in places where it’s legal. You can learn more about the policy issues surrounding cannabis during the session “Growing Fields of Data: Public Health and Cannabis Policy” at NCSL’s Legislative Summit Aug. 3 from 1:30-2:45 p.m. at the Colorado Convention Center in Denver. NCSL tracks and assists legislators with their questions about many policy topics, including state regulation of cannabis. NCSL takes no position on individual state cannabis policies. The federal Controlled Substances Act lists cannabis in Schedule I, with heroin, LSD, ecstasy and other products considered to have the highest potential for abuse with no currently accepted medical use in treatment in the United States. This podcast is supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $563,000 with 100% funded by CDC/HHS. The contents were created by NCSL and do not necessarily represent the official views of, nor an endorsement, by CDC/HHS, or the U.S. Government.
Ed: Hello and welcome to “Our American States," a podcast from the National Conference of State Legislatures. This podcast is all about legislatures, the people in them, the policies, process, and politics that shape them. I am your host, Ed Smith.
MS: I’m someone who came from the National Institute of Drug Abuse. That’s my training. I did not come to cannabis like oh this is going to be great. I came to it assuming it was going to be negative and harmful for the most part. And I have like through my own data like science suggests your data are what your data are and it’s not showing me that.
Ed: That was Michael Sofis, the director of research for the Cannabis Public Policy Consulting Firm, a firm that does extensive surveying around public policy affecting cannabis. While cannabis remains illegal under federal law, states have regulated cannabis for nearly 30 years. The policymakers have had few evidence-based policy tools to inform them. More than two-thirds of the states and territories regulate cannabis for medical use and more than 20 states and territories allow for non-medical adult use. With that in mind, I wanted to talk with Sofis about what his research has found. He is one of the few researchers looking at the policy issues of concern to lawmakers. He discusses some of the surprises from his findings, the questions states are trying to answer and explains why the cannabis black market still does a brisk business even in places where it’s legal.
You can learn more about policy issues surrounding cannabis during the session “Growing Fields of Data – Public Health and Cannabis Policy” at NCSL’s Legislative Summit Aug. 3 from 1:30 to 2:45 p.m. at the Colorado Convention Center in Denver.
Here’s my discussion with Dr. Sofis.
Dr. Sofis, welcome to the podcast.
MS: Hi. Thanks. I appreciate it. Glad to be here.
Ed: Well thanks for coming on the show and to start, could you talk about your cannabis policy research and why it might be of interest to lawmakers?
MS: Yes. So, our work since we collect data from tens of thousands of people across the United States, across many, many states and within states with over 200 different cannabis outcomes. So, these are things ranging from, you know, how much are you using, grams or the frequency or the potency, the methods of use. We are talking market outcomes, public health outcomes, you know. Things like cannabis use disorder, psychosis. Other things like that. And then we bring in other data from state policies that we, you know, we basically program into one big database. So, these substate policies and regulations and then we essentially look at these surveys four times a year and we evaluate what happens, what happened and then what will happen when. And that’s just like okay is adult legalization passed but happens when the excise tax is this much. What happens if you add two more licensees per capital in State “X”. What we do is we model these sorts of policy outcomes using statistics and predicted modeling and it allows us to basically say okay. What are all the good things that happened if you engage in or implement policy “X”. You know does CBD go up or down? Do you know the percentage of regulated cannabis go up or down? What happens to social equity? You know is the social equity program looking are there more applicants or less or no change? Right. And just literally kind of adding this together and making a commonsense interpretation of is the public, is society in general benefitting clearly from this policy. And then you can kind of go from there in terms of whether or not it gets implemented. That’s really what a lot of our research is focused on is kind of evaluating what’s happening there. Essentially when these certain things are. Let’s say they take policy “X” or policy “Y”. Let’s say it’s like half of the number of dispensaries allowed in the State. We can model what kind of impact that is and then broadly these long-term forms to specific States and sometimes specific counties or localities. And then you know maybe even the U.S. at large in terms of what best courses of actions are to maximize outcomes for folks.
Ed: So, if we talk specifically about public health and safety kind of questions, looking at your data and the analysis you’ve done, what kind of questions do you think legislators might have that these data could answer?
MS: The most common ones I’ve seen is something like the proceedings. Ahm at least at the federal level. But I think also at the state level having talked to many legislators and policy folks is what does legalization do you know kind of “legalization” right cause obviously it’s a little more complex than that. But what does that do on do to these outcomes? Does it increase youth use? Does it increase cannabis use disorder? Does it increase psychosis? And then you know sometimes the more complex ones like okay well there is higher potency because of legalization. How does that in turn impact right doses of health outcomes? That’s usually the kind of questions that we get that are strictly sort of focused on public health.
Ed: So, when you regulate any industry, you are balancing between what is going to be in the best interest particularly in terms of the health and safety of the citizenry and not stifling economic development and that’s certainly the case with marijuana. When you look at policymakers, how can they use this data science to inform those decisions where they are not really tamping down the market unnecessarily still making sure that they are looking out for the health and safety of their citizenry.
MS: Yeah, I think when you have when you collect all this data together and you have you know thousands of thousands and thousands of people and you are doing it four times a year so you are getting seasonal regular updates on this. And looking at states and looking at substates and substate areas in the whole country what it allows you to do is basically figure out simulating these sorts of outcomes. Let’s say for example. I’m going to give you an example. Like in Rhode Island, we did this for a conference recently where we simulated the number of dispensaries per capita because they do have an actual license cap. There are only so many licensee stores, dispensaries, depending on your state that can actually be present you know or active in their adult use market that’s going to be emerging here. What we did was we said OK well happens you know if you have one, two, three, four, five all the way up to you know I think it was like 45 or 50, which for Rhode Island being as small as it is is quite a few. And said OK, well, basically what we found was you know once it got to like 13 or 14, the actual effect on the percent of regulated use which is important because illicit use and illicit like sales is associated with a lot of negative outcomes not just in terms of like safety and crime outcomes in addition to health-related outcomes. But also, for the industry to succeed, you know, it’s also important for that regulated use percentage to be up right. And so, we saw that it would up and up and up and then it just flattens out. Like just beautifully flattens out to where you add a store, and you are not getting anything when it comes to breaking down that into the illicit market anymore. And so, then it becomes well why do that. Right. As a state, they are going to pay more money in administrative costs and fees, and it is going to be more complicated. And then it’s most likely that if you keep pushing and pushing when you are not getting any good outcomes with that, you are eventually going to hit more negative health outcomes if you just keep adding stores and dispensaries. So that’s a good example I think of where you can kind of maximize where no one is really losing. Everyone is basically winning there.
Ed: Yeah, that’s really interesting that it would just max out at a certain point. And as I mentioned in our earlier conversation here in Colorado it is I think we’ve got more pot shops than Starbucks at this point. So, for policymakers, what would be the best if you were to name a few of the data sources or analyses that policymakers should want to look at on a regular basis you are saying you are doing this analysis four times a year. What should the regulators be looking at? What are the real key indicators for them to keep an eye on?
MS: See that’s a fantastic question. I mean I’m biased because to my knowledge no one else is measuring this much data this frequently at this large of a level. And so, the tough part is is if you measure an outcome itself. Let’s say it’s I don’t know. Cannabis psychosis cases or youth risk or even just like market health of market outcomes. You know things. OK, the market is doing great. Whatever. Anytime you take one of those outcomes or even multiple at a time, that by itself kind of means nothing because it’s. For example, there are a dozen of news stories where people will. There was a recent in the New York Times to where it was inferred that increases in potency. Ahm there was increases in accidents like sort of maladaptive outcomes related to like youth use or like you know issues with product use and things like that. It is just instantly linked to legalization because of course States have legalized more over time. But that’s a huge leap that more often than not it is just wrong. It has no impact in many cases. And in a lot of cases, it has, it some cases it has the opposite impact people think. In other words, it’s actually lower risk of some of these negative outcomes. In more legal states, states that have adult use for example and so I think it’s really what they need is they need to understand relationships between outcomes between policies and outcomes. And ideally, they are not just looking to track those. They are looking to predict them ahead of time with working with folks like us that when they can actually figure out okay this is very likely going to go up a lot. But if we can implement this policy or reduce the excise tax or whatever you know whatever is the appropriate outcome. And then what we try to do is help them actually implement it. We started as a purely consulting firm working with States and building like the legalization and legal team and really standing up a legal market. We then help them you know get stakeholder consensus and you know talk to the public and all these different stakeholders that are involved and actually help enact or implement that policy. So, it’s sort of meant to be like a full-scale solution.
But the answer to your question, we think it is about understanding these relationships between a policy and multiple outcomes of interest. But doing so beforehand so they can take measures to actually prevent it or improve it.
Ed: Well, I think you make a great point that the dearth of research in this area has been vast compared to the amount of activity that has gone on at the state level in terms of legalization. What do you think at the federal level, what would help them to understand this policy which whether it’s legal at the federal level or not is nonetheless a significant presence in the society and a lot of state regulators looking out for health and safety?
MS: That’s a really interesting question because it is really about the behavior of those individuals right and what motivates or impacts or really influences them. The thing I would say personally, and I think from our company is that we are seeing increasingly that adult use is associated with both when you compare states that have it a person doesn’t just do med and even within the states that have adult use, adult use is. So, folks that are using adult use versus say folks that are using you know getting from a dealer or other sources right is associated with lower cannabis use disorder and lower driving under the influence. There was a big another paper that came out recently showing something almost identical to what I’m saying, and it was you know driving under the influence. It was you know the lowest was in not use states, then medical states and it was the highest in states where it was illegal.
They are starting to come out with this data where you know there’s been these sorts of conceptions for a long time right where you know I think President Biden at one point came out when he was running for president saying oh you know medical is fine, but recreational is. And you know just no founding for that sort of evidence and if anything, we are seeing the opposite--that when it is mainly in an adult use market or implemented in an adult use market, it’s I think we are starting to see it turn the corner where it might even be safer in some contexts. One thing I’m trying to do because I know there is a lot of talk like Republicans are going to be sort of moving into office potentially, there is a lot of predictions of that is I’m trying to connect the market outcomes. I just did like an analysis for a state client. OK, this is going to be every dispensary was like I forget like 24 or 25 new jobs, and they are going to get paid like on average according to our data like this much and then you start multiplying that and that has profound implications for local. And you know, you start adding the economic outcomes and it’s associated with okay we are not seeing anymore harms. Maybe that could convince them that this might be a net net win.
Ed: Well certainly the economic effects are they are significant. I mean it depends on when you look at Colorado, I can’t remember exactly how much money it was, but the amount of money when you look at it seems to be enormous. But then when you look at what percentage of the state budget revenue is so you can get people arguing either way on it. But you are right. I mean if the research tends to point towards better outcomes with legalization as well as some economic benefit, that’s an interesting data point for people to consider. Let me ask you about this study you did in Maine for the Office of Cannabis Policy. I read that and I was fascinated by it. Just the kinds of things you were looking at and I wondered what it was the state was most interested in.
MS: Yeah so, I think with Maine, they were really interested in understanding sort of public health outcomes and market supply and demand across various sources. They really wanted to know how much illicit cannabis was being purchased for access in the state. You know ideally sort of how that was relating to public health with outcomes. And actually, one of the more like I think convincing displays that I’ve ever seen is that you know more illicit use is associated with for every gram of illicit use, you are experiencing more significantly more issues related to like cannabis use disorder, the prevalence of driving under the influence. And even to think days of smoking tobacco as well. And so, I think it’s really important that people understand this is a good example of kind of that net win-win. The market can benefit there by who just knows the market and they have done a good job of doing so there. And then in turn that’s probably helping public health outcomes too.
Ed: Well one of the things in there that I was interested in was talking about the illegal. People who are buying it illegally and Maine seemed to actually be from your research on the lower end. I guess my question is why do people buy pot illegally if they can buy it legally and maybe that’s a stupid question.
MS: Ed, I’m telling you like that is like a brilliant question and you’d be surprised. I almost never have been asked that. I’m not sure if I’ve been asked that more than maybe once ever because people have asked me oh why did they admit to that. I think the more interesting question is why do they do it. So, the obvious reason and we basically is price. So, we essentially said look once we did some (inaudible) and look once it gets to like 10/20, 10/25 per gram for adult use, you are going to see things just. As it gets closer to that, people are going to jump in and switch over to illicit. In the five months since we did that data collection, their illicit has either the price dropped right to 10/25 and now it’s like you know they’ve had to go fantastic first quarter of this year. And so, I think that price is part of it is a big part of it. The other thing we are finding is that folks who are using illicitly there may be something going on with sort of a trust in government or sort of not wanting to be a part of that enterprise. And we think it could have something to do with social equity related you know people who were on drugs. The whole sort of that sort of thing. And I think there is something there where they just don’t trust the government and they don’t want to sort of benefit if you will by purchasing from there. And when we’ve done analyses on these, that is kind of what we saw where you know I told you about that flattened out where if you add licensees to stores, you weren’t really seeing that much after a while. You sort of hit like a what’s called an asymptote where it just flattens out. You don’t see that increase in the percentage of regulated sales. And so here I think part of that is because there is a good chunk of folks that are holding on because it’s part of. You know it could also be cultural things going on, but I think there is some trust, antirust in government. You know it’s antigovernment, but not trusting government in this context for. You know to be honest ahm understandable reasons I think.
Ed: Thanks Dr. Sofis. We are going to take a quick break and then come back with the rest of our discussion.
I’m back with Dr. Michael Sofis of Cannabis Public Policy Consulting. One thing that I know was challenging to lawmakers when these cannabis laws first went into effect was the issue of how to determine if someone was driving under the influence of cannabis. Is there an agreed upon standard for determining if someone is under the influence now?
MS: No. I went to a great conference about three or four weeks ago. Basically, multi-day exclusively about this with, you know, leaders in tech. Leaders in research. State regulators. You know the whole kit and caboodle of a ton of you know attorneys, prosecutors and it was a lot of circular conversations because there really isn’t a consensus because. I mean I think there is a general consensus amongst experts that you know tolerance and per say laws are not great. Probably aren’t very effective and I do think a lot of you know the drug addiction experts do a very good job and combine a lot. You know focusing on impairment; not on what THC is in your blood. Cause we know that impairment and THC are actually quite poorly correlated often. And so, it can create negative opportunities you know negative situations in terms of marginalizing those who have already been marginalized you know with being pulled over and things like that and it is just not accurate. Using that as evidence is understandable at the end of a long series of process from when someone would be pulled over all the way to you know if they were processed or at least taken back to be examined in terms of the more biological side of things. But it’s the personal laws of your tolerance are generally I think most would consider not great, but they are kind of already there and so it’s unclear to me how that would get reversed in those States to be honest.
Ed: Well, that’s interesting. So, it really is sort of right where it was.
MS: There is technology emerging. Sort of the great hope, if you will, is the technology that is emerging. So, there’s a couple leaders, I think have the best bet of actually being a highly scientifically validated court admissible you know full fledge approach. And you know one is rapid eye tracking. If you look at studies on DRE’s, the drug recognition experts, the eye related stuff is already the most predictive already. And rapid eye checking you think of it as like multi-millisecond video tracking of the eyes. It’s much more detailed. Many more measures and so there is a lot of building evidence that maybe that could be a really great solution. And maybe even be able to identify THC versus other drugs which obviously would have benefits in the context of a court scenario.
The other one that is really interesting and I’m going to butcher the full name. I think it’s functional mirror infrared spectroscopy. I think I got that right. It’s really fancy nerd for just like a portable FMR like mirror imaging. It’s more or less what it is. The idea there again is like if you are measuring abnormal blood flow in certain parts of the brain at least externally, it is noninvasive. You know neither of these are invasive. They are just to be quick, there are a couple of studies out of Harvard’s Mass General Hospital doing that that are showing promising findings. The idea is that you have to be able to identify this in one trial. With hockey players and concussions right they have a baseline for them at the beginning of the year you get like a cognitive test and then they go back and give them a cognitive test right after they get hit too hard. And they know okay this person probably has an issue here in terms of a concussion. You can’t do that with cannabis because you can’t give the whole population that drives you know cognitive tests so it’s a real challenge in that sense. These more like cognitive and biological measures integrated together have the best potential to actually identify things accurately and quickly and non-invasively.
Ed: Now you have already mentioned a few findings that are king of counterintuitively to a lot of us. I’m just wondering what other interesting or surprising things you’ve found in your research that kind of goes against the popular belief such as the notion that in the adult use states that there seems to be less of these bad outcomes than in the states where nothing is legal.
MS: I think there’s two things here. The first is that and this is actually really important for a lot of stuff we’ve talked about today so far, which is cannabis use and oftentimes if any substance use gives of any type of substance if the use goes up, frequency amount or whatever at a population level, there’s going to be some risks actual risks of harm. It’s kind of intuitive right. But cannabis use is going up across the country. It’s illegal states, med, adult use. It doesn’t matter. It’s a really important point I think people should know. It’s not just with my research. This is you know dozens and dozens of other papers showing this, in federal data sets, other data sets you know showing this. I think it’s important. In other words, just because you regulate. As a regulator and a legislator or any other stakeholder in a state just because you don’t have legal cannabis doesn’t mean people aren’t using it. You know a lot of these states, millions of people are still using illicitly you know in some states at least. Based on our data, using in that fashion is more dangerous you know in general. I think that’s the first thing I would tell some folks may find that intuitive; some might not.
The other one I would say is we are starting to see stuff that suggests. I kind of alluded to this a little before. Medical cannabis can be more challenging. It can have sort of be more of a double edge sword because there are obviously conditions where it is fantastic. It has very legitimate health benefits you know documented. You know health benefits and other ones where they are showing promising benefits. But there is very, very few people who actually use cannabis as a medical cannabis patient do not also use recreationally. And it’s also extremely common that they use cannabis for other conditions that they haven’t met qualifications for or recommendations for. And so, it becomes this thing where you know when it becomes it’s a medicine, but then it’s also not cause you are using recreationally and it’s an approved medicine and it’s not. They are using their medical cannabis instead of prescribed medications. It becomes challenging right. And a lot of people aren’t going to like a primary care provider or you know a doctor or nurse physician even. It becomes very challenging. We are seeing more harm associated with that and even if you control for like their health conditions in the first place. It’s not necessarily that oh they are not as healthy to begin with even if you loss control for that, that can be an issue. And so, I think it is important people understand that. And that could be part of what we are seeing with adult use being potentially associated with the best outcomes in some cases.
Ed: What’s the next area for research? The next five years. What questions do you want to answer that you haven’t been able to answer yet?
MS: That’s a really good one. I think like the one that has been on my mind a lot is to what extent or is there a single generally speaking. I know this is like impossible to be a perfect version of this but is there generally one format for the most part that is the format to implement in terms of like going from illegal to all the way to legalization of adult use and then a bunch of sub questions. Do you just put med right with adult use? Do you put all at once? Do you make med a subset of adult use? Do you you know how much lag if any do you put between the two right. I mean obviously you know dispensaries per capita and this and that you know there are a bunch of things you can talk about. But I guess what I’m really curious about. Let me give you an example. In Maine right we saw this effect right where for every gram of adult use, you really weren’t seeing relationships with these other negative outcomes. But for every gram of let’s say you were seeing higher likelihood of these negative outcomes right a stronger relationship. And like literally this morning I replicated that finding for the most part essentially with both cannabis abuse disorder and driving under the influence with nine total adult use states suggesting that maybe these states aren’t that different after all in terms of. Once you really collect all the data and you really start isolating things, maybe they are not that different, but I don’t know. You now maybe those adult use states may have something in common. Twenty years from now if we get five states from the Southeast that all have adult use that could look very different and so the question is if and where these states might differ in terms of how these relationships look like. You know will we have to go into a state and do completely different policy simulations or give them completely different advice based on the policy simulations cause people there are different you know or their use is different or the environment is different or what have you. I think that’s kind of one of the biggest like quintessential questions and that has I think profound implications for federal legalization. How much oversight or lack thereof should there be at the federal level and that should largely depend on how consistent generic the data is how different states are or how similar they are.
Ed: Well, that’s interesting cause it’s make sense that it is going to take a fairly long period of time with a lot of groups different population areas in this country to really come to conclusions that are valid. I always like when I have an expert on this show to ask them as we wrap up to tell legislators who are in this space whether they are a legal use state already or whether their state might be looking at that, what are some of the key takeaways? What are the key things that they should look at?
MS: That’s a really good one. Yeah, I think my advice would be like I said making sure that they are getting data, they are looking at relationships in the policies and the data. If I could tell these people or show them that like we are talking about actually reducing harms and potentially having a real shot here if you work with the data here. Maybe even like it’s very likely that you can reduce harms, public health harms of cannabis and make more state revenue and help employment and GDP and literally all of it. Like it’s you know and I’m someone who came from the National Institute of Drug Abuse. That’s my training. I did not come to cannabis like oh this is going to be great. I came to it assuming it was going to be negative and harmful for the most part. And I have like through my own data like science is you know suggest like you know your data area what your data are and it’s not showing me that. You know and I guess I just that’s what I would want them to take it’s not a political it shouldn’t be considered a political like tabu. I mean the numbers are overwhelming for support in both parties in terms of the citizens and like it could be a cross topic issue that I think politicians could benefit from supporting if they take a data driven approach.
Ed: Well, this has just been a fascinating conversation and I know that an awful lot of legislators are very interested in this research. So, thanks so much for taking the time to share this with us. Take care.
MS: Thank you so much Ed.
Ed: And that concludes this episode of our podcast. We encourage you to review and rate NCSL podcasts on Apple podcasts, Google Play, Pocket Casts, Stitcher or Spotify. We also encourage you to check out our other podcasts: Legislatures: The Inside Story and the special series Building Democracy. Thanks for listening.
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