State retail marijuana monopoly — Stanford Professor Keith Humphreys 

Here is an edited transcript of part of Stanford Professor Keith Humphreys’s appearance on North Carolina Attorney General Josh Stein’s Webinar series on medical cannabis  in North Carolina: 13’16” mark of https://www.youtube.com/watch?v=aXRI3txu-R4.

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[A] goal a lot of people have is equity — if they want to create an industry, they want to make sure that all groups can participate equally.   One point about that is that if you go forward with any type of legalization, medical or recreational, to consider the option of a state retail monopoly — and you will know what those are because you live in North Carolina.  I grew up in West Virginia; we had a state retail monopoly in alcohol.  North Carolina does as well.

In general retail monopolies (that’s where the industry still produces the product; the state sells it) have a better record of hiring diverse employees than do private companies. I mean that’s one of the striking things I’ve noticed.  I live out here [in California] next to a lot of venture capital firms that finance this industry.  They talk a lot about racial equity but it’s remarkable how almost uniformly white the people who run that industry are.  But state retail monopolies do better than that and that might be a way to promote more equitable employment 

The second point is that our experience with alcohol, of which we have a lot, is that retail monopolies reduce consumption and related problems.  The states that have ABC stores have lower rates of youth binge drinking, automobile accidents involving alcohol, and so on.  So if you decide to go forward a retail monopoly could give you some public health protections as you move the system out across the state.

The last point is that the incentives of profit retailers are to promote a lot and have two for one sales and hype the product and so on, but you don’t have that in a state retail monopoly, so that’s another way to — if you want to go forward — not have some of the costs that come when the when a drug gets linked to the pursuit of profit.

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And here is the unedited transcript of the entire session, with Dr. Humphreys followed by Dr. Steve Wyatt, a board certified psychiatrist and the current chairman of the North Carolina Psychiatric Association’s Addiction Psychiatry Committee, and Eric Sweden, a DWI Program Specialist at the North Carolina Department of Health And Human Services:

on april 8th we’ll address racial equity issues so thank you all for being here

today um before i continue um ellen are there any logistical issues

that we need to mention to folks who’ve joined us for the webinar today

hi everyone um you will see the q a feature available on your zoom if you have any

questions um for the speakers as the session goes on please go ahead and drop your question and answers in there

you can also use the chat feature but we’re going to be pulling questions for that section from the q a function so if you have something specific for them

please place it in there thank you all so much for being with us thank you very much ellen

well i’m very pleased to have a wonderful lineup of speakers today um i’m going to just briefly introduce

all three of them at the beginning and then we will each of them will speak for about 15 minutes and then we’ll leave

about 10 minutes at the end for q a so our first speaker keith humphreys is

the esther ting memorial professor at stanford university and a former white house drug policy advisor in both the

bush and obama administrations he’s testified to congress on multiple occasions and has served as a member of

the white house commission on drug free communities the veterans administration national

mental health task force and the national advisory council of the u.s substance abuse and mental health

services administration dr humphries will be

followed by dr steve wyatt he is a board certified psychiatrist

with an additional certification in addiction psychiatry steve is an adjunct professor of

psychiatry at the university of north carolina and the current chairman of the north carolina psychiatric association’s

addiction psychiatry committee and then the third speaker will be eric

sweden he served for 21 years with the raleigh police department where he retired last year as a lieutenant

eric now works as a dwi program specialist at the north carolina department of health and human services

he is a dwi detection and standardized field sobriety test instructor as well

as a drug evaluation and classification program instructor through the national highway traffic safety administration

and the international association of chiefs of police and on top of all that is a state certified and nationally

registered critical care paramedic so without further ado i will turn things over to

keith humphries keith take it away thanks very much steven very nice to visit with all you

um could we have my slides put up please all righty that looks great

so i’m going to talk about what medical cannabis so as some people call it marijuana it’s called law but in science

we usually say cannabis what it can do and what it can’t do

we advance please thank you so first disclosures i want you to know i don’t have any past current or planned

financial connections to the cannabis industry i i say that because it’s important i also just

some word to the wise is you should be curious about that with everyone who gives you advice on this issue there’s a

lot of money on the table and you have a right to know where people are coming from i also want to say i have no interest in

telling you how to vote i do care about north carolina my parents live there my aunt lives there my sister went to

college there met her husband there spent a lot of time in your beautiful state and i really do like it but i don’t live there

you will live under whatever laws you pass i will not so i’m certainly not going to tell you you should do this or you shouldn’t do

that i really see my role here is telling you what the evidence is so that you can know uh how to get

whatever it is that you decide democratically that you want to do because the worst thing that could happen and it has happened in this area

is people pass a policy hoping for one thing and then they get the opposite of what they what they wanted so that’s my

that’s the spirit i’m going to be uh speaking with you today go to the next slide please

thank you so um there’s benefits and there’s risks to medical cannabis like there are to most

drugs um in general the way we approve medications for use in the

united states when you go to your doctor or prescribe something is that they have to go through a randomized clinical

trial which is rigorous experiment they have to have studies showing that they’re safe generally and that they have a

therapeutic effect they work for some condition and these are tightly controlled and very carefully monitored

um medical cannabis not entirely but mostly has not been approved and evaluated that way a lot of it’s come in

by people just voting to have it in a lot of it’s been based on individual experience a lot of it’s been based on

correlations uh but not necessarily experiments so that the data is a lot

weaker relative to what it would be like how an antibiotic comes in you should know that coming in

i also need to know that there are public health considerations when we understand what works so you know one

person could have a story that let’s say you know they had a condition and they they use a lot of cannabis and they feel

much better and they really want to speak about that and that could be true for them

but when you approve a medication it does in fact go out to lots of other people so you also have to think about

not just with anyone at all benefit ever but would anyone be harmed and that’s particularly important with controlled

substances because we know we may look at opioids we know they’re useful we also know that some people are harmed by them so we have to think about who might

be harmed as well as who might be helped next slide please

so we uh do have some cannabis-based medicines already that have been very rigorously tested and which work and

which doctors can use in either our country or other countries it’s a medication called marinol so synthetic

thc which is used for chemotherapy induced nausea approved by fda epidialex

is just recently improved i worked them out a bit in our state california but it’s a cbd based medication for

various types of seizure disorders and travis syndrome and then in in the us i’m sorry in

canada and britain and probably something in the us there’s a medication called sativex which is a mixture of thc and thc which is used for spasticity and

multiple sclerosis and all these things work it’s great it’s great if we get medications out of canvas we will probably get more it’s an interesting

plant there’s a lot of different components to it so there’s no reason to be afraid of canvas-based medications i mean just uh you know we there are other

plants that have generated you know medications salicylic acid which is you know aspirin exists in nature uh

opiate exists in nature so it’s just part of the process by which uh you know we learn through science how to turn

things into medicines and that’s certainly good next slide please um

now i do want to say at the same time we’ve had a lot of promises made about the effects of of cannabis that

are not true uh that are have been lucrative for some people but have not actually based on facts so for example

we maps put billboards like this up all over the country saying that if you legalize marijuana

regulation near medically you would reverse the opioid crisis and this was based on a just a

correlational state level study that early on some of the early legalizing states had lower than expected opioid

deaths and we would not approve any other medication this way i mean just to give you an example states that

where people eat less ice cream have fewer drownings all right that’s a correlation but that’s because you know if you’re a

coastal state where it’s hot people go swimming a lot they’re more likely to drown but they’re also more likely to eat ice cream doesn’t mean that ice

cream protects or causes drowning but this is the kind of data that was out there and it’s been pushed very aggressively around the country

next slide please as it turned out by the way a research

group the team i was a part of led by dr chelsea shover went back and looked at this particular correlation the dark

black line in the middle of the dotted lines is the the best estimate of the correlation between opioid overdoses and

the legalization of medical cannabis and when the initial study was done which is 2009 it was below the zero point meaning

it was a negative correlation but over time it’s actually turned positive so more recently legalization states

have higher rates of opioid overdose now dr chauver is a serious scientist she didn’t say aha i’ve now proved that

cannabis causes opioid overdoses nothing so silly as that instead just saying like you know correlations at the state

level you know they don’t mean anything and we would certainly not approve any other medication on that basis

next slide please ptsd is another area where some very

strong claims have been made as mentioned i’ve done a lot of work in the va i’m from a family of veterans i care about veteran health very much uh but

this is the most recent meta-analysis of uh military veterans experience ptsd

and cannabis and the conclusion there i’ll just read it is the balance of the evidence associated cannabis use with

negative health outcomes with consistent positive associations with other substance use psychiatric disorders and

self-harm suicidality so it’s another area where there’s been a lot of promises made but the evidence is just not there

next slide please some other things that have been advertised by cannabis producers include

that cannabis will cure covet 19 it’ll cure heroin addiction you should stop taking there’s been advertisements

you should stop taking suboxone which is an fda approved medication and take cannabis instead uh that you

don’t need insulin you need cannabis for diabetes that it can cure cancer i was really disturbed to hear from an oncology

friend of some patients dropping out of chemotherapy because they’ve heard that cbd oil will remove their cancer

and then in prenatal health there’s been a couple studies done that if a woman calls a what’s called a blood

tender in california and asks about you know cramping or other sort of unpleasant

experiences during pregnancy that about 80 percent of the time they’re recommended to smoke cannabis through their pregnancy

which most likely harms the developing fetus cognitively and this is a case where

these are put forward as if they were medicine but they had no

one has ever made that test but at the same time a bud tender is not liable for the advice they give medically if the

doctor gives really bad advice they could lose their license but a blood tender isn’t licensed onto the next one please

so the key point i would make how do you how do you differentiate the hype from what is real and how do you make a

system that is safe is just to remember that medicine has go back to these things medicine has

status and trust because of its rigorous standards so if we want to have a good medical cannabis system where we get medications

that work we want to have the same standards we would for other types of medicine it’s kind of like if you’re a parent and you

have an adolescent child you may have had the experience of hearing adolescents say i want all the rights and privileges of adulthood but i

don’t want the responsibility but rights privileges and responsibilities should go together

so if you go forward you want to make sure you you have standards you would impose on other areas of medicine so that

people are safe for the next slide please

some people feel that even if there’s not a lot of evidence for some of the medical cannabis claims that it’s a good way to

get recreational legalization through the back door and this was actually done in california where medical cannabis was passed and

then the criteria for getting it became so loose that pretty much anyone could get cannabis through the medical system

and some people would argue that well look legalization of cannabis promotes social justice

so it’s okay to that deception is all right it’s okay to say it’s medical even though you’re really doing back door legalization so i’ve just

asked you to consider if that’s your view to remember that if we create a medical system that’s

really faux medical we are telling sick people that some stuff is medical that may not be

and i don’t think that is actually just the second point is that that form of legalization will probably increase

racial economic disparities and arrests and the reason for that is if you have a medical system that’s a nod in the wink

recreation system the people who are most likely to have the wherewithal to get to a doctor get the right paperwork get the card are people who are are

better off people who have more education more income it might be easier for for white

individuals and people of color and so you’re really legalizing for the better off people and that can make

disparities worse rather than better that’s a risk of doing this this type of

uh sort of backdoor recreational legalization through the medical system next one please

um i would point out some say but arrests are terrible they feel strongly that they do more harm than good

i just point out there’s a simpler way than creating a medical system if that’s if that’s the main concern which is just

decriminalizing the possession of of cannabis so in california we uh passed a

law that if you had an ounce of cannabis or less it would no longer be a misdemeanor it

just became a civil infraction like a ticket with a parking ticket and it was an 86 drop in those arrests

for both adults and youth so there is a way if that’s the goal there is a sensible way forward it

doesn’t you don’t need to go through all the rigging world establishing a medical system for that you could actually just decide to do this

and have a pretty dramatic change pretty quickly next slide please

so another goal a lot of people have is you know equity if they want to create an industry they want to make sure that

uh you know that all groups can participate equally so just say one point about that is that

um if you go forward with any type of legalization medical or recreational to consider the option of a state retail

monopoly and you will know what those are because you live in north carolina i grew up in west virginia we had a state retail monopoly and alcohol north

carolina does as well in general retail monopolies that’s so the industry still produces the product

state sells it has a better record of hiring diverse employees

than do private companies i mean that’s one of the striking things i’ve noticed i live out here next to a lot of venture capital firms that finance this industry

they talk a lot about racial equity but it’s remarkable how almost uniformly white the people who run that industry are

but state regional monopolies do better than that and that might be a way to promote more equitable employment

second point is that our experience with alcohol which we have a lot is that retail monopolies reduce consumption

related problems the states that have abc stores have lower rates like youth binge drinking automobile accidents

involving alcohol and so on so if you decide to go forward a retail monopoly could give you some public health

protections as you uh as you move the the system out across the state

the last point is that the the incentives of profit retailers are to

you know promote a lot and have two for one sales and you know hype the product and so on but you don’t have that in a

state retail monopoly uh so that’s another way to to if you want to go forward not have the

uh some of the costs that come when the when a drug gets linked to the pursuit of profit

last slide please okay so here’s what we know um we we already have multiple cannabis

medicines that have been very well tested and have shown to be effective and are fda approved and we’re probably going to have more that’s great it helps

sick people that’s very great at the same time there’s a lot of hype in this area a lot of therapeutic claims

are pretty poorly evidenced and it’s uh you don’t want to get snickered

second there is potential for harm in communicating to sick people the canvas has been carefully evaluated like other medical drugs if we if you call a system

medical the average person is going to assume that it’s been well tested and that they’re safe just like they would

be if they’re going to their doctor so i wouldn’t tell you what to do which way to go but i just say if you do it

make it real so that people can trust what it is they’re getting i point out that uh you know in states

that have tried to make recreational legalization through the medical system by having a super

uh loose system uh it has increased uh disparities and also potentially puts

sick people at risk by thinking something is medical when it isn’t and the last point is um there are other

policies available if the goal is to lower rest or promote health and equity in hiring i mentioned decriminalization of

possession as well as the establishing of a retail monopoly those are your goals those are ways to pursue them

thanks very much for your time and i look forward to the questions

thank you so much keith really appreciate it um we will now turn to our

second speaker dr steve wyatt and steve the floor is yours

that looks good

steve i don’t know if you’re talking but we can’t we can see your slides but we can’t hear you

uh there we go there you go thank you and um thank you steve and

thanks to the attorney general’s office to allow me as a representative of the ncpa

the national the north carolina psychiatric association to give

the a description of our position paper on cannabis

i have no disclosures and i’m going to frame my talk on that

position paper so i’m going to speak on decriminalization of cannabis the evidence supporting cannabis and the

treatment of psychiatric illnesses importantly the impact on adolescents and then

say a few words on the importance of monitoring thc and cbd concentrations dosing and also provider

patient education and lastly i’ll speak to some legislative recommendations

so the north carolina steve um do you want to turn your camera on

um we will mostly see your slides but we will get to see you speaking there you yeah whoop

there you are thank you so much all right uh and um

so

the north carolina psychiatric association is in favor of decriminalization of cannabis

um the potential for harm for uh criminalization certainly outweighs the

potential for uh the risk to individual actual

individuals at the same time we fully understand that the product is um

particularly in daily use can be associated with significant harms i will say that in north carolina we have seen

an increase in the number of individuals that are smoking marijuana and and also

the number of people entering treatment for cannabis use disorder

the problems can does exist that some of those individuals are successful in

getting into recovery and then get back into the community and the you know the

social determinants of health the difficulties that they experience because of the criminality

can really outweigh the difficulties that they

can participate in the difficulties of remaining in recovery so this is something that we’re

very clear on that we’re in favor of decriminalization in looking at the evidence supporting

cannabis and the treatment of psychiatric illnesses uh dr humphries

talked about this already somewhat but the in terms of ptsd there is no conclusive

evidence that cannabis is helpful in the treatment of ptsd there has been evidence of reduction in nightmares and

and yet no real improvement in sleep onset that’s to be able to fall asleep and stay asleep successfully it is sleep

that’s one of the symptoms of ptsd that’s that contributes to the worsening of an individual’s disease

cannabis also puts some individuals at greater risk of worsening of their symptoms

the intoxication alone can can result in them being

uncomfortable with their situation in a way that they start to not be able to think through it clearly

their back can be against the wall which can contribute to violent behavior and

there’s a very clear association between alcohol and other drug use and ptsd and

cannabis has been shown to to um participate in the worsening of that

lastly suicidality suicidality typically we think of the worst and the

the real severe part of suicidality in successful suicides lasts for about

an hour it’s it’s that period of time where a person is just so overwhelmed that they go ahead and and act on their

suicidality and any form of intoxication contributes to that and in this highly

vulnerable population uh to suicide it’s uh it’s clear that cannabis can make

that worse so clearly cannabis is not a treatment of ptsd

at the same time we do understand that the product has been used to relieve symptoms

through intoxication for some individuals but this should be something that the the

provider really talks to the patient about and helps them understand that

the risks of using the product and staying away from you know regular use

that could really cause a worsening of symptoms that it’s not a it’s not a

specific treatment for the disease in terms of bipolar disorder there’s

actually a worsening of depression that’s been associated with the use of cannabis and the emergence of psychotic

episodes associated with the depression so depression the psychotic symptoms

associated with bipolar come both during periods of mania but also uh during

depression and it is those those experiences that are that are most troubling they’re they’re clear

indications of a of a more severe disease and this is particularly too true in

adolescence where they’re trying to figure out this these mood swings families are trying to figure out is it

is it individuation or is it an actual disease and adding cannabis to

it only muddles the problem and brings on potential psychotic symptoms

uh earlier in their disease and it is the earlier onset that actually

contributes to the worsening of the disease there is potential greater risk also of suicidality which

again is is a terrible aspect of more severe untreated or poorly managed

bipolar disorder this clearly is not a treatment for their disease

in terms of anxiety there has been limited evidence that

there’s improvement with cannabinoids excuse me cannabidiol that’s cbd

associated with improving symptoms of anxiety patients should be counseled on how to

use these products most effectively if they’re going to and if the person is

going to continue to use cannabis then there should be some

counseling of the fact that if if they’re going to use a cannabis product that they would be

using cbd but really we can only do this if we can have some assurance of the

purity of the product that’s that’s the real problem is so often cbd

that’s available in in the state right now there’s not a close uh

scrutiny over that purity and that’s both in pure in impurities that are in

the compound but also greater amounts of thc

there’s truly and and dr humphries brought this up inadequate trials for or against

non-pharmaceutical cannabinoids in treating psychiatric illnesses and this

is associated with the difficulties that the federal government has put on this clinical research now it’s

blossomed pretty significantly in the last two or three years but it’s still a schedule

one drug which means there’s no that’s that had been determined that there’s no

medicinal use of this drug and and so it has been difficult to to

do these these studies however it is interesting that

we have now established medical marijuana in 36 states around the country and we’ve seen no significant

improvement in any psychiatric illnesses in those states in terms of adolescence which is a

really important part of what we’re discussing the acute effects of cannabis

impaired learning in pure memory attention and motor coordination and in some and again

this is anecdotal but clearly you know it’s very evident that some people will

smoke this product and become very anxious paranoid and have cannabis induced

psychosis it is regular use by adolescence that’s that’s most damaging

and relatively they they can have worsening of their

psych social functioning that is reduction in academic performance or involvement in extracurricular

activities do continuing to do some of the things that they used to enjoy and a earlier onset of psychiatric

symptoms and again this is this this truly makes schizophrenia worse makes bipolar

disorder worse uh prior to the to the young person actually having full brain deliver

brain to the uh development uh doesn’t allow them to to be able to

um understand what’s happening to them as clearly as if these illnesses come on

later if there’s uh there is a three-fold increase in in these

earlier onset with individuals that are using daily and nearly a five-fold increase in

people that are using high potency products on a daily basis as a result of the neurotoxic effects of

regular use cognitive impairments are seen most prominently in those under 25

while the brain is still developing and there’s the potential for this extension

extending into adulthood depending again on the age of onset the earlier they start the worse the problem potentially

is going to be and and the regularity of their use there’s greater potential for subsequent

nicotine alcohol and other drug use that’s worsening

the patient’s long-term health and social well-being this is really associated with them starting to

experiment with using a drug to find pleasure and and starting to um

associate with a peer group that is that is using nicotine and other drugs so uh

it’s not necessarily the gateway drug that anyone that uses marijuana is going to go on to have an opiate use disorder

but it it is clearly associated with the advent of the the

experimentation and the use of other drugs there can be confounding reasons for this evidence though a consistent

factor is regularity of of use at a younger age the national academies of science

engineering medicine evidence regarding health effects on of cannabis have shown

only modest effects in the improvement of pain it is thought about as being a third line medica

substance uh for pain it has in trials been shown to have primarily only

a reduction in pain for neuropathic pain and and this has really only been short term

and helping to in in induced sleep so they’re relaxed enough

they have enough reduction in their pain that it has improved sleep initiation

patients have reported reduction in spasticity and multiple sclerosis we haven’t seen this objectively but

patients have reported it and so it’s it’s been clear uh and then as dr humphrey said there are uh there are

medications now that have been approved by the fda from duret um

leno gusto syndrome and tuberculosis sclerosis really childhood on

severe child childhood epilepsy problems and then two other problems to

induce to help with chemotherapy induced nausea appetite

stimulation associate and wasting conditions i will say in the legislation

that’s currently being looked at it lists a whole variety of of problems

including hiv and i have to say that’s that’s where we’ve you know there’s evidence of improving wasting conditions

around hiv but this was this was years ago in terms prior to us really having

good medications to help people from moving on to developing aids and and

this really devastating disease and the idea that someone would have hiv come

into a physician’s office say you know i have hiv i should be eligible for one of these cards that’s the thing that we’re

trying to avoid because it can it can worse worsen their their other problems they may be

experiencing the recommendations that we have around thc cbd concentrations are associated

with the fact that we know that you do need a certain amount of thc in uh

in the compound that is cbd thc for there to be effective pain

uh relief however um studies have shown that it if it goes above 10 percent we

lose that we it’s it’s no longer as effective and it starts to contribute to

some of the other problems that people experience uh and and unfortunately

on the street and in dispensaries around the country we’re looking at uh levels in the 18 20 or above

concentrations of thc that uh that are that are not effective so we we really

hope that there’ll be um some consistent product regulations that will

help control this we also believe that there should be clear

products certification and dosing available to providers so we we know

what it is that what’s available and what’s what we should be advising patients to be using um that providers

obviously should be well educated to understand the effective concentrations in dosing

there is a universal standard in medicine to do no harm and we need to warn patients against self-diagnosis

that in the community there would be these ideas that friends and family would say

out of cannabis is going to be helpful for this that or the other thing and neglect getting a good evaluation by a

physician and on medications that have been approved by the fda medical treatment should be recommended

i should not be recommended to be inhaling any combustible substance

including cannabis which has clearly shown to have significant respiratory

problems not unlike tobacco products the exception we make to these considerations would be the use of any

form of cannabis by an individual currently in palliative care lastly the north carolina

we recommend that north carolina control the retail outlets

as similar to what dr humphries has said and this could be this could allow store

uh personnel to be educated and the maintenance that they’re educated to be education to be monitored that

we’d be able to maintain um an understanding of the important they would be maintaining the understanding

of the importance of controlling the sales and the particularities of the products being sold we also recommend

which i think is somewhat unique that uh that this be uploaded into the north

carolina controlled substance

prescription monitoring csr controlled substance reporting system reporting system thank you um and this

would this would um they would report on what dosing quantity and percentage of thc to cbd is

sold this would allow the patient’s health care provider

registered with the prescription monitoring program to have ready access

to this information in the same profile as other controlled substance medications and those submitting the

information at the point of distribution would not have access to patient medical information we also hope that tax

revenues made available by the state to the state through the sale of these

products would in part be used for prevention treatment and research uh

and collection of population data including uh public health impact on

general and importantly impacts on adolescents and

so we we support decriminalization we’re hopeful that

that these products are well studied and that we can make appropriate recommendations to patients

if if it’s made available as some medication in the state and that

cannabis clearly is is a growing problem in the state and there’s concern

that establishing medical marijuana could result in the public’s and particular adolescence reduction in

understanding the potential for harm associated with cannabis so thank you

very much thank you dr wyatt we now turn to our third and final

speaker eric sweden who’s going to talk a little bit about some of the law enforcement implications

of cannabis eric

looks good and there we go

and can you see me now yes here we are um first thank you for giving me the

opportunity to speak briefly about some of the challenges that we are currently seeing and may

expect to see in detecting and testing cannabis impaired drivers

for most who don’t know department of health and human services actually plays a significant role in the education and

testing of impaired drivers here in north carolina to help keep north carolinians safe

north carolina is for north carolina department of health and human services is the agency that’s responsible for

credentialing breath and alcohol testing and chemical analysts

currently we credential just over 7 000 breath alcohol analysts and 200 blood

analysts in our state on average we’re looking at about 46 000

breath tests and 11 000 blood tests and that’s for

drugs and alcohol dhhs also maintains over 400 breath test

instruments at 193 physical locations uh and we are also responsible for the

oversight of eight blood labs so with north carolina dhhs

responsible for training education of law enforcement we need to look at there’s 23 000

law enforcement officers at least 23 000 law enforcement officers in the state of north carolina and we are the agency

that’s responsible to drive this training and education out across the state

while keeping an eye on some national trends and impaired driving as well as collisions that are a result

of impaired driving we’ve really ramped up our training across the state

when we look at the different levels of training that we provide to our law enforcement officers

the first and most basic is standardized field sobriety testing sfst

this is a 24-hour training program that gives officers the basic tools

to detect impairment roadside

the tests that they perform that the officers perform include horizontal gaze nystagmus which is a look at the eyes

walk and turn in a one leg stand test which are our psychophysical tests officers must successfully complete this

24-hour training class before they can actually move on to an advanced

class over the last five years we have conducted 354

basic standardized fields of body tests and of over 23 000 police officers in

the state we’ve trained right at 43 4400

we also currently have 220 instructors across the state through the 100 counties

the next level which is going to be important for drug impaired driving is an advanced

roadside impaired driving enforcement class this 16-hour class builds on those

foundations and provides officers with additional information and an additional

testing for impairment specific to drugs officers must complete this 16-hour

program in order to move on to the next level for a ride we’ve conducted over 120

classes over the last five years and trained about 1200 officers

for this class we have 23 off uh 23 instructors statewide

so this is a little difficult to push out across the state and we’ll talk about that just a little

bit more in a minute the drug evaluation and classification program is a two-week class where we

train officers to conduct a standardized and systematic process to determine if impairment exists if

impairment does exist is it a medical condition is it due to alcohol or is it due to drugs and if it’s due to drugs

what category or categories of drugs is this person impaired on

officers who attend this training our highest level of training in the state must submit an application to the state

to be considered this application is for an officer who has more than two years of law enforcement experience

they need to have completed the standardized field sobriety test as well as the advanced roadside impaired

driving enforcement class they need to be a chemical analyst for testing of breath

they also need to provide a letter of reference from a currently certified

drug recognition expert a letter of reference from an assistant district attorney in their jurisdiction

as well as a letter of support from their agency

over the last five years we’ve conducted 10 of these drug evaluation and classification programs and north

carolina currently has 166 active drug recognition experts with

three drug evaluation 23 drug evaluation and classification program instructors

um dhhs is the agency responsible for the oversight of all dwi programs to include the dec

program which certifies the drug recognition expert and that person is

certified under our full-time state coordinator the programs that we offer

are supported by the national highway traffic safety administration the international chief association of

chiefs of police um we at dhhs make sure that we drive our programs

offers that we offer to law enforcement based on science and research and and not things that maybe

we have just done in the past specifically to the topic at hand we’re

looking at cannabis and thc tetrahydrocannabinol so when we look at

some of the data that has been pushed out from the national institute for occupational safety and health part of

the cdc it says that cannabis can impair coordination distort perception cause difficulty in

problem solving and critical driving tasks when we look at the national institute

for drug abuse it reports that thc can slow reaction times and reduce the

ability of the driver to make decisions in this aspect is where we need to have

the training for law enforcement brought up because as you can see when

an impaired driver has a delay in recognizing the road hazard then a delay deciding and what action to

take to avoid the hazard and then a delay even slight and moving their foot from

the gas to the brake can result in a collision property damage injury fatality um

just at a speed of 45 miles an hour in one second that car has moved 66 feet

for every second that person delays recognizing a hazard or making a

decision as to what actions to take

when we look at highway safety and we look from dhhs

perspective to bridge public health and public safety we need to look across

coast to coast that’s what’s going on nationally between 2000 and 2018 that

percentage of car crashes involving deaths due to cannabis have doubled so from 4.8

to 10.3 now while these numbers might be low in and of itself remember that this

number is a person between four and six percent increase in

crashes attributed to cannabis as measured by the insurance collision claims and then over seven

year period between 2007 and 2014

that percentage of nighttime weekend drivers tested positive for thc increased from 8.6 to 12.6

and that’s a large increase when we’re looking across the board specific to north carolina this is um

and this is directly towards us just last year in 2021

the north carolina state crime lab found 50 percent almost 50 percent

of its dwi blood cases involve thc the national trend towards

combining thc with either other substances and specifically alcohol

is increasing horrex damage producing and injury producing

in an alarming rate so we’re looking at a detection of impaired driving

currently there is no reliable roadside test device available for law

enforcement officers to determine the presence of thc similar to ones that they use in the

street for alcohol they use a preliminary breath test device to determine if the impairment

they’re seeing roadside is consistent with an alcohol concentration and that doesn’t exist

while there are some devices that are out there on the market none have passed a fry or dauber

hearing in any state it’s for that reason that the roadside

psychophysical tests are paramount for the detection of drug impaired drivers

basic standardized field sobriety tests are limited in what the officers can

find for impairment those tests can that are conducted have an eye test for hgn

but they also have that walk and turn and the one leg stand test

the advanced training class that 16 hour advanced roadside impaired driving

includes additional information human behaviors but also psychophysical

tests for officers to determine impairment the finger to nose test

a modified romberg balance test and a lack of convergence tests

are information specific to drug impaired driving

and they will also give the officer more information

for common signs and symptoms of drugs

and categories of drugs in this case specifically due to impairment

providing the drug evaluation and classification program to more officers will also assist in utilizing both

clinical and general indicators of impairment it’ll also rule out medical conditions that show impairment

but then show the impairment due to substances other than alcohol all of these tests and training for

officers are simple tests and they’re easy to administer by that officer by that trained officer

roadside with the exception of the drug evaluation and classification program which is going to have to take

be taken inside for just a little bit these are relatively easy to administer on the side of the road

all the tests that we conduct are validated there is science and research

behind it and it shows accurate and reliable indicators of impairment

the research papers that we do have all been peer-reviewed and blood tests is currently the

preferred method of testing for for cannabis

currently and going forward with only eight blood labs and 200 blood

analysts in north carolina the increase of drug impaired drivers

may increase the burden on those labs as we move forward

so what are we looking at for training needs currently there there is an issue roadside and going forward

we expect that to continue it’s necessary for us to provide our law

enforcement officers with the training that they don’t currently have but they will need to keep our highways safe

as i said we’ve already stepped up training across north carolina in standardized field sobriety test classes

and advanced roadside impaired driving in classes and the drug evaluation and

classification program we have been working with north carolina training and standards

commission and they have they have put the excuse me standardized field sobriety

tests into basic law enforcement training with their curriculum change for blet 2023

so beginning in 2024 we’re looking at all the officers having

that basic training currently we’re looking at a cost of

seventeen hundred dollars per standardized field sobriety test class the advanced skill set is what’s needed

for the record for the recognition of drug impaired drivers those classes are running about a

thousand dollars per class these are host classes and don’t include travel or

per diem for for state instructors we also need to look at increasing the number of drug recognition experts

across north carolina we currently have 166 in 100 counties

and sometimes we’re going to fall short with that the drug evaluation and classification that two-week school

runs on average at about 50 000 that class

is all-encompassed so that class really includes training materials instructors per diems

across the state and then with only 23 instructors we we are looking at

increasing the number of instructors across the state for 23 instructors most of who have other jobs full-time as law

enforcement we’re looking to increase those about three years ago we changed from

two instructor schools a year to three instructor schools a year in order to meet that need

and steve that is what i have for you here’s my contact information the next slide will give all the references to

the materials that we’ve presented here in the last couple of minutes

thank you so much eric really appreciate that informative overview and just so all of

the folks who are listening in today know all of the slides as well as a recording

of the webinar not just today but for all four webinars will be available on the same website that you use to

register for today’s webinar we now have uh about uh seven minutes

for questions and so um jasmine i think that you were trying to keep keep a tab

looks like we’ve had more questions than we’ll be able to answer did you want to

throw out some of the questions we’ve gotten so far sure dr humphries can you share any

major takeaways of the lessons learned in california about regulation of cannabis what does california we should

have done differently from the start oh that’s a great question so one thing is people underestimated the extent to

which a legal system needs enforcement to work so we still have as big a black market

maybe even larger than we had before legalization and just underestimated you know if you want people to in any other

endeavor you know the reason people get licenses is so that they’re licensed to do certain things that are otherwise not

legal and that wasn’t put into the equation second thing is that the

medical to have written the medical law to actually be medical uh where it basically got turned into any condition

that anyone thinks might possibly benefit them well that becomes everything and that they lost control of the system

at that point now for some people that may have been a good outcome uh because they really believe that um you know

complete access to cannabis is the best but if people concerned about public health

would generally be negative about the way we we just totally fail to regulate the

medical side thank you jasmine in states that have decriminalized

cannabis is there data on increased usage rates especially with younger people

can you ask that one more time jasmine i guess that would be for either keith or steve but would you ask that

question one more time in states that have decriminalized cannabis is there data on increased usage rates and especially with younger

people i i say some of that so you know it’s important let’s use the terms uh to just

fix define them okay so decriminalize would mean you don’t have an industry you don’t have legal sales but you are

no longer criminally punishing people just for the active use and the evidence around that around the

world is yeah there’s probably a little more use a little more but not much more

most people don’t track the law that carefully even in criminalization you know arrest even with a lot of rest so

many people use cannabis the relative risk for any person is low so perhaps a little higher but certainly

not a lot higher from decriminalization legalization of any great companies selling it promoting it yeah then you’re

going to get a lot more cannabis use thank you jasmine

dr wyatt can you say more about the evidence of the use of cbd to treat anxiety any clinical trials and if so

were they controlled or what you refer to as the purity of the product is anyone in north carolina testing cbd for

purity and how is that defined i don’t actually have an answer to how

it’s my understanding it’s not there is some control over how the product is made but not necessarily is

every product that’s being sold in north carolina cbd uh do we know the purity of

the of the product and again there’s been there have been reports and uh

there have been reports of you know other substances being in it that could be harmful to individuals

along with uh higher levels of acceptable thc in terms of cbd cbd is an

interesting is an interesting cannabinoid it’s a it actually uh

does not cause significant intoxication it’s not associated with

the um sort of what could be psychotic episodes

it’s uh it actually is is being looked at as a potential

medication for psychotic illnesses because it has some ability to reduce

positive symptoms of schizophrenia or other psychotic illnesses

and and along with that there has been evidence and i could offline i can send

you some evidence of of the fact that it has been helpful for

some anxiety but again this isn’t the thc cbd product this is cbd alone that

we’ve that there’s this evidence it has not there’s to my knowledge

there’s not a company that’s that’s actually applied for the use of this for

anxiety but dr humphries may know differently okay

jasmine next question what are the potential harms of daily cannabis use

uh i pointed out a variety of things uh the the the primary problem really there’s a

few different things that take place and and not only is it

bathing the brain in a in a with a with a substance that changes

a person’s perception uh on it on a regular basis and and i’m talking about

thc at the same time it is associated with more isolation

with it’s not it’s not a drug that people typically see or use as

you know it’s not a stimulant it doesn’t unlike alcohol that can be

very engaging with individuals at least while people are getting intoxicated and that’s that’s another interesting thing

about alcohol that it’s it’s more in joyful or engaging as people are have

rising levels of alcohol in their system and then it becomes more dysphoric it

becomes more uncomfortable as they’re tapering off whatever

level of alcohol marijuana is does not necessarily do that marijuana

is more interceptive drug that people will kind of zone out and and enjoy a

specific something but if they do that regularly there’s less communication

with others that can really impair the individual’s ability to stay

to stay focused to really bounce ideas off another individual in a way that

that helps them from moving into a worsening worsening problem again in adolescence we’ve clearly seen a

reduction in academic performance and involvement in activities that they once

enjoyed and start using a drug to find other ways to find enjoyment

thank you for that and i’m afraid we are out of time as a reminder though this is

um just the beginning of a four-part webinar series next week again we talk about regulatory sales and taxation

issues on the 25th april 1st is growing and processing cannabis and april 8th is racial equity

issues that we just scratched the surface of today so i want to thank all of you who have

taken time out of your busy days to be with us today and i especially want to thank our three fantastic panelists for

uh all of your time and expertise so i hope that everyone has a good friday afternoon and a good weekend

thank you all thank you

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