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Factors Affecting the Regulatory Context of Marijuana and Cannabinoids in the Workplace Technical Letter Report

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Factors Affecting the Regulatory Context of Marijuana and Cannabinoids in the Workplace Technical Letter Report PNNL-27050 Factors Affecting the Regulatory Context of Marijuana and Cannabinoids in the Workplace Technical Letter Report November 2017 KM Branch EP Kennedy ME Lerchen* AC Dalton *Corresponding author Prepared for the U.S. Nuclear Regulatory Commission under an Interagency Agreement with the U.S. Department of Energy Contract DE-AC05-76RL01830 PNNL-27050 Factors Affecting the Regulatory Context of Marijuana and Cannabinoids in the Workplace Technical Letter Report KM Branch EP Kennedy ME Lerchen* AC Dalton *Corresponding author November 2017 Prepared for the U.S. Nuclear Regulatory Commission under an Interagency Agreement with the U.S. Department of Energy Contract DE-AC05-76RL01830 Pacific Northwest National Laboratory Richland, Washington 99352 PNNL-27050 ABSTRACT Studies clearly demonstrate that the use of marijuana (Cannabis sativa and other related Cannabis species and hybrids) and cannabinoids from other sources have negative impacts on an individual’s fitness to perform safety- or security-sensitive functions. The discovery of the endocannabinoid system (i.e., cannabinoid receptors, their location, and function within the human body) in the 1980s, and the subsequent characterization of that system provided a framework for examining the role and function of cannabinoids. That framework prompted an increase in research on the effects of substances that activate or inhibit the endocannabinoid system, including marijuana and synthetic cannabinoids, which led to a greater understanding of the potential benefits and adverse effects of such substances. This new understanding has heightened interest in the potential medical uses of cannabinoids, development of pharmaceutical cannabinoids, and re-examination of previous research on cannabinoid metabolism, elimination, and the relationship of effects to dose and time. It has also facilitated development of unregulated and illicit drug markets for synthetic cannabinoids (e.g., Spice and K2). The complex biochemical and physiological effects of marijuana use make it difficult to identify workplace policy adaptations that would allow marijuana use while also effectively ensuring that safety- and security-sensitive workers are fit for duty. In addition, a number of states have passed laws decriminalizing possession and use of marijuana for medical purposes and a smaller number have decriminalized recreational use. Because many State laws are now inconsistent with Federal law, and allow use and possession of marijuana, it is unclear whether individuals possessing marijuana in those States should be assumed untrustworthy and, therefore, unsuited for safety- and security-sensitive work. This report discusses the evolving understanding of the role of cannabinoids in human physiology; changes in State laws decriminalizing possession and use of marijuana; and how some Federal agencies are proceeding with assessment and clarification of their policies (i.e., in regard to possession, sale, and use of marijuana; testing for cannabinoid use; and the use of prescription cannabinoids). iii PNNL-27050 SUMMARY This report identifies and discusses factors affecting regulation of marijuana and cannabinoids in the workplace, with a special focus on programs regulating their use by individuals performing safety- or security-sensitive functions. Cannabinoids are compounds that activate one or more of the receptors in the human endocannabinoid system, potentially producing psychoactive effects. Cannabinoids can be extracted from marijuana (i.e., Cannabis sativa and other species) or can be synthesized (e.g., synthetic cannabinoids for pharmaceutical or prescription use and those, such as Spice and K2, available in the unregulated and illicit drug markets). Overwhelming evidence indicates that the physiological, psychomotor, and cognitive effects from the consumption1 of marijuana and cannabinoids from other sources could cause impairment incompatible with safe and reliable work performance. As marijuana continues to be persistently available and the variety and availability of pharmaceutical and other synthetic cannabinoids continues to grow, it is a persistent and increasing challenge to prevent individuals who may be impaired from marijuana or cannabinoids from other sources from performing safety- or security-sensitive functions. In addition, implementation of workplace drug-testing programs and fitness-for-duty (FFD) regulation is further complicated by the evidence of medical benefits from some cannabinoids, the availability of approved prescription cannabinoid pharmaceuticals, and State laws decriminalizing possession and use of marijuana. An extensive review of the literature identified seven factors setting the scientific and regulatory context for decisions about managing marijuana and other cannabinoid use as it affects the workplace: 1. New understanding of the human endocannabinoid system. Discovery and examination of the human endocannabinoid system have reframed understanding of cannabinoids and the central role they play in human physiology. In particular, new knowledge about the role and function of cannabinoids has provided additional evidence of both the complexity of cannabinoids’ physiological activity and their beneficial and harmful/impairing effects. This reframing has informed interpretation of previous research findings and raised questions that are still unanswered about the interactive effects of the various biologically active components of marijuana, particularly delta-9- tetrahydrocannabinol and cannabidiol. 2. Laboratory and pharmaceutical advances. Increased knowledge of the endocannabinoid system and improved analytical techniques have accelerated the pace of pharmaceutical research on cannabinoids. The U.S. Food and Drug Administration has approved two synthetic cannabinoid products for prescription use and others are in the advanced stages of clinical trials. In addition, a rapidly growing number of synthetic cannabinoids are 1 Consumption includes all the ways that marijuana and other cannabinoids are introduced into the body (e.g., ingestion, inhalation, and absorption through the skin or other tissues). v PNNL-27050 commercially available in the unregulated drug market (e.g., Spice and K2).2 Existing workplace urine test panels for marijuana could detect use of some, but not all, of these products. 3. Sustained, pervasive use of marijuana and increasing use of synthetic cannabinoids. Marijuana has a complex chemical composition that varies considerably across varieties/strains and product forms. Its use is widespread despite its well-documented impairing effects. Available evidence indicates that it is unlikely that marijuana use would cease or significantly decline in the near future, even if prescription cannabinoids or synthetic substitutes are available. In addition, there is increasing use of unregulated and illicit synthetic cannabinoids, especially among adolescents and young adults. 4. Unpredictable dose-response relationships. The pharmacokinetics of marijuana and other cannabinoids are complex and are affected by gender; the intensity and frequency of use; and the composition, form, and manner in which the product is consumed. There is high intra- and inter-subject variability in the intensity and duration of impairment from cannabinoid consumption. Impairment patterns are dependent on numerous factors (e.g., the marijuana strain or cannabinoid product; drug delivery method and amount; and individual metabolic characteristics, including adipose levels, use history and patterns, age, and gender). The relationships among consumption, levels of parent cannabinoids and cannabinoid metabolites in bodily fluids, and effects on performance are consequently not predictable with precision. A better understanding of dose-response for cannabinoids requires research beyond today’s limited and often inadequately characterized and controlled study populations and dose characteristics. 5. Inadequate Tests for Determining Level of Impairment or Time since Last Dose. There is limited correlation between cannabinoid and metabolite concentration in urine or other test matrices with the level of individual impairment or time since last dose. The variability and number of factors that affect the concentration and excretion of cannabinoids and their metabolites have stymied efforts to establish tests for biomarkers that reliably indicate level of impairment or time since last dose. Thus, there is no test method suitable for use in the workplace to ensure that individuals who have consumed marijuana or cannabinoids from other sources during off-work hours are no longer impaired when reporting for duty. 6. Schedule I Status of Marijuana. Marijuana is a Schedule I substance, making its use illegal under Federal law. Both the complex and variable composition of marijuana and the fact that its mode of consumption is often smoking complicate its management as a recreational or medicinal product and are factors in the Federal government’s decision not to reschedule marijuana. These factors, along with ongoing concerns about harmful effects and the potential for abuse, are the main reasons Federal government representatives provide for retaining marijuana as a Schedule I controlled substance. 7. Potential for Rescheduling Marijuana. Despite its Schedule I classification, an increasing number of States have passed laws allowing, or reducing the sanctions against, the production, sale, possession, and use of small amounts of marijuana for medicinal use. In 2 These products receive
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