How high is too high when it comes to cannabis usage in Washington state?
The answer might come from a bill that’s been introduced in this year’s legislative session.
HB 2546, sponsored by Rep. Lauren Davis, D-Shoreline, along with 21 secondary sponsors, calls for a new THC limit on recreational sales of cannabis concentrates to match the 10-percent limit already imposed on infused edibles.
Sen. Jesse Salomon, D-Shoreline, is the prime sponsor of the Senate companion bill.
The limit would not apply to product sales to medically endorsed patients.
According to the bill: “Only marijuana retailers who hold a medical marijuana endorsement … may sell marijuana concentrates with a THC concentration greater than 10 percent THC. Marijuana concentrates with a THC concentration greater than 10 percent may be sold only to qualifying patients and designated providers who are entered into the medical marijuana authorization database and who hold a valid recognition card.”
Products containing higher concentrated levels sold at state-licensed stores include vape cartridges and dab extracts.
Denise Walker, a research associate professor at the University of Washington and director of the Innovative Programs Research Group, works to develop and evaluate interventions, which includes cannabis use involving teens and cannabis-dependent adults.
Walker said a measure like Davis’ is “absolutely long overdue.”
Not everyone agrees.
There are early signs of opposition from industry advocates. Some fear giving up any ground won with I-502 (the initiative to legalize recreational marijuana) in 2012 would lead customers back to the black market and unregulated products containing dangerous substances made from home labs — along with the threat of explosions from do-it-yourself extractors.
The measure is up for a public hearing later in January with the Commerce and Gaming Committee. Already, a change.org petition against the bill had more than 19,000 signatures as of Friday.
“What is the other 90 percent going to be?” wrote one of the petition’s signers. “If anything this would make companies add fillers and other crap that is way unhealthy. Is there a law so alcohol can ONLY be 5 percent?…”
“This bill was made by people who still have no idea what weed is,” wrote another signer.
Davis begs to differ on that point.
The 10 percent limit
If you ask Davis about where the measure came from, she is ready with a long list of research examples as well as anecdotal experience.
“My concerns about a cannabis/psychosis link in young people began six years ago when two 16-year-old boys in my life were diagnosed with early onset psychotic disorder linked to heavy cannabis use,” she told The News Tribune in response to questions via email.
She said her concerns grew over time.
“I work professionally in the field of mental health and substance-use prevention, treatment and recovery. I began hearing from directors of inpatient psychiatric units who described their units being full of adolescents with cannabis-induced psychosis and young adults receiving schizophrenia diagnoses many years before typical onset due to heavy cannabis use,” Davis said. “They wondered why no one was talking about this crisis.
“Upon speaking with emergency department physicians, I learned that they were treating these adolescents who were presenting with acute THC-induced psychosis. And many such patients are not safe or stable enough to return home after receiving treatment in the ED, so they are being admitted to inpatient psychiatric units.”
Data on numbers of cases treated within CHI Franciscan and MultiCare health systems were not immediately available, representatives of the two health systems told The News Tribune last week.
The bill references a 2019 study published in The Lancet journal. The research found that, among those studied, daily use of cannabis led to increased odds of psychotic disorder compared with those who never consumed it, “increasing to nearly five-times increased odds for daily use of high-potency types of cannabis,” according to the study.
“Differences in frequency of daily cannabis use and in use of high-potency cannabis contributed to the striking variation in the incidence of psychotic disorder across the 11 studied sites. Given the increasing availability of high-potency cannabis, this has important implications for public health,” the report said in its interpretation of the findings.
The study looked at 901 patients with first-episode psychosis at 11 sites across Europe and Brazil and 1,237 population controls from those same sites across Europe and Brazil.
The proposed 10 percent THC potency limit for concentrates, Davis said, is a way to at least offer some guardrails in a market that voters in 2012 couldn’t imagine.
“I elected to introduce the bill with a 10 percent potency limit on concentrates because that is consistent with the state’s THC limit on edibles, as well as the tipping point for a population increase in schizophrenia cases as evidenced in The Lancet study,” Davis said. “Ten percent is the beginning, not the end point, for negotiations on concentrate potency.”
Davis said she was shocked when she first learned edible products were limited to a THC potency of 10 percent and “the dried flower is biologically limited to about 30 percent, but there is no limit on the potency of cannabis concentrates,” which she said could run as high as 70-99 percent in state-licensed stores.
In 2019, concentrates make up 37 percent of the state’s cannabis sales, according to Davis.
The bill isn’t taking away high-potency products from those with medical endorsements using it to control pain or other medical issues.
“I know that cannabis, particularly CBD, can be helpful in curbing the symptoms of certain medical conditions,” she wrote.
The Washington CannaBusiness Association told The News Tribune in response to questions about the proposal that it was concerned and had met with Davis.
“Dramatically reducing the THC-content of legal products is only likely to return the manufacture and sale of such products to the illicit marketplace, undermining a core public health motivation for maintaining a regulated marketplace,” the cannabis industry group said in an emailed statement.
“We support ongoing dialogue regarding regulation of products in the legal marketplace in the context of protecting public health and safety. A fundamental threat to public health is the ongoing development and sale of products by the illicit, illegal market — especially where a regulated system is not in place to offer consumer protection through monitoring, tracking and testing products.”
It noted that the recent national vaping-related health crisis and filler used in illicit products “should be a solemn reminder that a return to prohibition policies is the wrong solution for an existing problem.”
Davis told The News Tribune via email, “I have had three meetings with the cannabis industry and look forward to continuing the conversation. … I appreciate their willingness to learn about and engage on this issue. ”
Davis is not alone in her concern.
“I am glad the Legislature is thinking about this policy,” Walker, the UW professor, told The News Tribune in a brief phone interview Friday. “It also needs to be in conversations and on the table when other states are considering retail marijuana.”
A report published in November looking at cannabis concentrate use among teens in Arizona said, “As findings emerge showing high rates of concentrate use in adolescents, and increased cannabis-related risks associated with use of high-THC cannabis, policy makers might consider putting a limit on THC concentration in cannabis.”
Walker was among the researchers who talked to The News Tribune who emphasized that Washington could use more research on potency levels.
Concentrates “were not even on the mind of voters,” back in 2012, she said Friday. “Those products weren’t available. I do marijuana treatment research. Dabbing was not a thing around that time, and now we have this product and really creating a different type of experience … the real problem is we don’t know.”
Andrew Saxon is a professor at UW School of Medicine and director of the Center of Excellence in Substance Addiction Treatment and Education at VA Puget Sound Health Care System. Saxon told The News Tribune via email that “in regard to the high potency, there is virtually no evidence in any direction.”
“The only study I am aware of is an epidemiologic study from UK which indicated that individuals who reported smoking ‘Skunk,’ high potency cannabis flowers but probably not as high potency as many cannabis flowers available in dispensaries, were more likely to develop schizophrenia than people who didn’t.
“Studies like this one can only show association and not causation,” he wrote, adding that “we really do not know impact of high THC potency, either flowers or concentrates.”
In regard to the effect of cannabis of any THC strength on psychiatric disorders, “Most of the evidence we have is from observational studies, so the evidence is weak,” he wrote.
“Effects on depression, PTSD, anxiety, and psychosis have been looked at. There is no evidence so far that using cannabis is beneficial for psychiatric disorders. There is weak evidence that it is harmful.”
Michael Gerard McDonell, chair of Washigton State University’s Collaborative for Cannabis Policy, Research, and Outreach, leads the evaluation of the Washington’s New Journeys Program, an intervention to treat youths with psychosis. He also works in the field of alcohol and drug treatment research.
“This issue is at the crossroads of my work,” he told The News Tribune via email in response to questions about the potency-limit bill.
McDonell noted two factors in regards to legalization’s effect on cannabis use disorders: increased availability coupled with low price here and in other states “makes it easier for people to become daily or multiple times daily users.”
The second factor he cited is the increased availability of high potency products allows individuals to obtain products capable of delivering higher doses of THC.
“It follows that if THC is the psychoactive component of marijuana, and people can obtain more THC as a result of increased availability and potency, they might be more likely to have a cannabis use disorder,” he wrote.
He added, “We need funding to conduct research on these topics so we can have definitive answers for the public, policy makers and the industry in terms of product safety.
“I just see this as one of many attempts over the last few years, to make adjustments in the spirit of the original initiative — to decriminalize marijuana and allow safe and responsible use.”
“There have been multiple laboratory studies that demonstrate that THC potency is directly related to the severity of psychotic symptoms in normal people,” he wrote. “On the flip side, but relevant, there is increasing evidence that CBD might actually regulate the areas of the brain associated with psychosis. Thus people with psychosis might at times find symptom relief from CBD when they use marijuana — something our patients tell us frequently.”
He added: “This is very preliminary evidence.”
Beyond a potency limit, Davis told The News Tribune she would like to see more money applied to state medical research on usage.
“I am interested in directing more of the state’s marijuana funding to research to collect local data, including admissions to emergency departments and psychiatric units for cannabis-induced psychosis,” she said via email.
Davis says that for now it’s difficult to predict the bill’s outcome this session, but now at least there is attention being paid to the topic.
“Researchers studying marijuana’s effects, psychiatrists and emergency department physicians treating these cases and parents whose children have experienced THC-induced psychotic breaks are keenly aware, and yet there has been little public discourse on the topic,” she told The News Tribune.
“I am grateful that this bill seems to have finally stirred a long-overdue conversation about cannabis, psychosis and the developing brain.”
McDonell also was glad the conversation is happening.
“I think it’s just important for us all to listen to one another, look at the facts, and be willing to work together to come up with common sense solutions around marijuana regulation,” McDonell said.
Public hearing on HB 2546
The bill concerning the potency of marijuana products will be discussed at a public hearing of the House Commerce and Gaming Committee at the state Capitol in Olympia along with two other separate cannabis measures also on the agenda.
When: 8 a.m., Jan. 30
Where: House Hearing Room C, John L. O’Brien Building, Olympia