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Tasty THC: Promises and Challenges of Cannabis Edibles RTI Press Occasional Paper November 2016 Tasty THC: Promises and Challenges of Cannabis Edibles Daniel G. Barrus, Kristen L. Capogrossi, Sheryl C. Cates, Camille K. Gourdet, Nicholas C. Peiper, Scott P. Novak, Timothy W. Lefever, and Jenny L. Wiley RTI Press publication OP-0035-1611 This PDF document was made available from www.rti.org as a public service of RTI International. More information about RTI Press can be found at http://www.rti.org/rtipress. RTI International is an independent, nonprofit research organization dedicated to improving the human condition by turning knowledge into practice. The RTI Press mission is to disseminate information about RTI research, analytic tools, and technical expertise to a national and international audience. RTI Press publications are peer- reviewed by at least two independent substantive experts and one or more Press editors. Suggested Citation Barrus, D.G., Capogrossi, K.L., Cates, S.C., Gourdet, C.K., Peiper, N.C., Novak, S.P., Lefever, T.W., and Wiley, J.L. (2016). Tasty THC: Promises and Challenges of Cannabis Edibles. RTI Press Publication No. OP-0035-1611. Research Triangle Park, NC: RTI Press. http://dx.doi.org /10.3768/rtipress.2016.op.0035.1611 This publication is part of the RTI Press Research Report series. Occasional Papers are scholarly essays on policy, methods, or other topics relevant to RTI areas of research or technical focus. RTI International 3040 East Cornwallis Road PO Box 12194 ©2016 RTI International. All rights reserved. Credit must be provided to the author and source of the Research Triangle Park, NC publication when the content is quoted. No part of this publication may be reproduced in any form by 27709-2194 USA any electronic or mechanical means without permission in writing from the publisher. RTI International is Tel: +1.919.541.6000 a registered trademark and a trade name of Research Triangle Institute. E-mail: [email protected] http://dx.doi.org/10.3768/rtipress.2016.op.0035.1611 www.rti.org/rtipress Website: www.rti.org Contents About the Authors i Acknowledgments ii Abstract ii Introduction 1 Medicinal Cannabis Use 1 Overview of Edibles 2 Promises of Edibles 2 Challenges of Edibles 5 Regulation of Edibles in States That Have Legalized Recreational Use 9 Conclusions and Recommendations 11 References 11 Legal Citations 17 About the Authors Daniel G. Barrus, BS, is a laboratory Camille K. Gourdet, JD, MA, is a public Scott P. Novak, PhD, is a senior research technician in the Pharmacology group of health research policy analyst in the Center public health analyst in RTI’s Behavioral RTI International’s Center for Drug Discovery. for Health Policy Science and Tobacco Health Research Division. His current Mr. Barrus conducts nonclinical behavioral Research at RTI International. She has worked work focuses on characterizing the pharmacology and toxicology research. with the US Food and Drug Administration’s epidemiological trends and identifying the Center for Tobacco Products evaluating state at-risk populations for prescription drug Kristen L. Capogrossi, PhD, is a research and local tobacco control policies, and has abuse and co-occurring illicit drug use. economist in RTI’s Food, Nutrition, and served as project manager on two internally Obesity Policy Research Program. Dr. Timothy W. Lefever, MA, manages funded nationwide surveys to gather the Capogrossi conducts economic analysis of RTI International’s Neurobehavioral opinions of adults around the country about nutrition policy, food safety regulation, food Laboratory. Mr. Lefever has been marijuana use and legalization and the types production and marketing, and related areas conducting preclinical behavioral research of e-cigarette products adolescents use using econometrics, simulation modeling, for over 13 years and has been testing the most often. statistical analysis, and other methods. effects of cannabinoids in these models Nicholas C. Peiper, PhD, is a research extensively during the past 5 years. Sheryl C. Cates, BA, a senior research policy epidemiologist in RTI International’s analyst in RTI’s Food, Nutrition, and Obesity Jenny L. Wiley, PhD, is a leading expert Behavioral and Urban Health Program. His Policy Research Program, has more than 25 in behavioral pharmacology. Dr. Wiley research concentrates on the etiology, years of experience conducting consumer designs and supervises a program of in correlates, and consequences of psychiatric behavior research related to nutrition vivo research at RTI International, including disorders, with a particular focus on early and food safety. She conducts studies to the synthesis and development of intervention for adolescents and young assess consumer use and understanding of candidate medications and investigation adults. Dr. Peiper works with Dr. Scott labeling features and response to alternative of neural mechanisms underlying Novak on National Institutes of Health label formats. Her research also assesses substance abuse. She also conducts (NIH)- and SAMHSA-funded grants related the impact of educational interventions independent NIH grant-supported to prescription drugs, injection drug use, on outcomes related to healthy eating and research in the area of cannabinoid marijuana, and psychiatric comorbidity. foodborne illness prevention. pharmacology. Abstract Food products containing cannabis extract (edibles) have emerged as a popular and lucrative facet of the legalized market for both recreational and medicinal cannabis. The many formulations of cannabis extracts used in edibles present a unique regulatory challenge for policy makers. Though edibles are often considered Acknowledgments a safe, discreet, and effective means of attaining the therapeutic and/or intoxicating Preparation of this manuscript was effects of cannabis without exposure to the potentially harmful risks of cannabis supported by RTI International internal funds and by National smoking, little research has evaluated how ingestion differs from other methods Institute on Drug Abuse (NIDA) grant of cannabis administration in terms of therapeutic efficacy, subjective effects, and DA-03672. safety. The most prominent difference between ingestion and inhalation of cannabis extracts is the delayed onset of drug effect with ingestion. Consumers often do not understand this aspect of edible use and may consume a greater than intended amount of drug before the drug has taken effect, often resulting in profoundly adverse effects. Written for the educated layperson and for policy makers, this paper explores the current state of research regarding edibles, highlighting the promises and challenges that edibles present to both users and policy makers, and describes the approaches that four states in which recreational cannabis use is legal have taken regarding regulating edibles. RTI Press: Occasional Paper Cannabis Edibles 1 Introduction 2016). Although specific laws governing cultivation and regulating dispensaries vary across states To provide a better understanding of the implications (Fairman, 2016), most states distinguish between of increased use of edible cannabis products, we medicinal and recreational use of cannabis. describe promises and challenges associated with use of cannabis-infused edibles and critically examine Medicinal use of cannabis involves obtaining a extant research on factors related to their use. We prescription for cannabis from a licensed medical have blended science and regulatory factors in order professional for treatment of a medical issue (e.g., to provide an overview of edibles for the educated pain, muscle spasm, weight loss due to serious illness, layperson and for policy makers. Although some of childhood epilepsy). Unlike medications approved the issues discussed are relevant for other methods through a formal data-driven process by the US Food of cannabis use (e.g., smoked, vaped), we emphasize and Drug Administration (FDA), medicinal cannabis issues primarily related to cannabis-infused edibles. dosage is not specified. Possession of a medicinal Further, our discussion primarily focuses on cannabis card allows purchase, with details dependent consequences of intentional use of edibles in adults. upon state law (e.g., approved conditions and amount allowed to possess). Medicinal Cannabis Use In contrast, recreational use is defined as use that is not for a specified medical purpose, but rather with Marijuana (or cannabis) is the most commonly used the goal of getting “high” (i.e., altering the user’s state illicit drug in the United States, with 9.5 percent of of mind). However, the two groups of users show adults and 23.7 percent of youth reporting use within considerable overlap: self-medication is common the past year 2015 (Hasin et al., 2015; Johnston, among recreational users (O’Connell & Bou-Matar, O’Malley, Miech, Bachman, & Schulenberg, 2016). 2007; Osborn et al., 2015), and adults who use Further, the population of users is increasing, a medicinal cannabis may report prior recreational use finding that is associated with decreased perception of (Bostwick, 2012; O’Connell & Bou-Matar, 2007). harm from cannabis use (Johnston et al., 2016; Miech et al., 2015; Okaneku, Vearrier, McKeever, LaSala, & Perhaps the largest area of difference between Greenberg, 2015) and legalization of medicinal and/ the two types of use is in the disparate regulatory or recreational use by a number of states (Cerda, requirements, including taxation. While medicinal Wall, Keyes, Galea, & Hasin, 2012). As additional and retail cannabis products are similar,
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