Health Faculty National Drug Research Institute A Multi-source Investigation of Issues Arising from the Implementation and Evolution of a Commercial, Non-medical Cannabis Market in Colorado Todd Subritzky This Thesis is Presented for the Degree of Doctor of Philosophy of Curtin University November, 2019 1 Declaration To the best of my knowledge and belief, this thesis contains no material previously published by any other person except where due acknowledgment has been made. This thesis contains no material which has been accepted for the award of any other degree or diploma in any university. Human Ethics The research presented and reported in this thesis was conducted in accordance with the National Health and Medical Research Council National Statement on Ethical Conduct in Human Research (2007) – updated March 2014. The proposed research study received human research ethics approval from the Curtin University Human Research Ethics Committee (EC00262), Approval Number # HRE2016-0230 Signature: Todd Subritzky Date: 20/11/19 2 Abstract In November 2012, voters in Colorado used a direct democracy initiative to legalise a commercial cannabis market for pleasure - thereby ending 95 years of prohibition in the State. When the first stores opened 13 months later, following a complex and intense pre-implementation period for regulators, Colorado became the first jurisdiction globally to implement a regulated, adult-use cannabis supply chain from seed-to-sale. It was reported as an historic occasion that presaged a grand social and economic experiment in drug legalisation. This thesis has the overall objective of examining issues arising from the implementation and evolution of the world’s first fully commercialised cannabis market in Colorado. It aims to provide early qualitative insights from the pre- implementation phase and the first five years post implementation. The research is conducted primarily from a harm reduction perspective that includes evidenced based recommendations founded on real-world experience. This is a multi-source investigation and a qualitative descriptive methodology is embraced to examine the corpus of data. This corpus includes hundreds of pages of government documents related to the pre-implementation phase, a sample of 969 mass and niche media articles (2014 – 2016), and interviews in the field with 32 key stakeholders in 2016 and 2017 including senior government officials, industry executives, and front-line public health representatives. Document analysis, thematic analysis, thick description, and both inductive and deductive coding techniques are used to analyse the data and report findings. A major finding of the thesis is that while regulators implemented a functioning system within tight deadlines that established a predictable funding mechanism and that the ‘sky had not fallen in’ immediately post-implementation, the scheme faced major challenges including the conflict with continued federal prohibition, a growing influence of the cannabis industry, and immature cannabis product testing regimes that limited the effectiveness of the regulation to provide a safe product for consumers. 3 Multiple recommendations relevant for other jurisdictions considering the legalisation of cannabis are presented in the final chapter of the thesis. Because it examines a first of its kind legal cannabis market, the study will be of interest to a wide variety of stakeholders including public health researchers, policy and lawmakers, drug policy reform advocates, and the general public both in the US and internationally. It may be of particular interest to regulators in countries such as New Zealand, who have a similar population to Colorado and will vote on legalising cannabis in 2020, Australia where ACT (like Colorado) has legalised small amounts of cannabis (although not a commercial market) in contradiction of federal law in late 2019, or other states in the US considering non-prohibition cannabis models. 4 Acknowledgements For the most part, the past years of this research project have been an enthralling and immensely satisfying period of my life. People often say that to complete a PhD there are two required conditions, namely, a topic that you are genuinely fascinated by and engaged supervisors. I was fortunate to have both elements. Indeed, I am privileged to have been afforded this opportunity, one that I hope to have honoured by seizing. I suppose, as a response to an impending mid-life crisis, doing a PhD is an altogether predictable activity. Perhaps, though, it is not for the feint hearted or thin skinned, you are going to be challenged from the outset, which was the point in my case. My journey would not have been possible without the assistance, guidance, wisdom, and support of a number of people. First, in general to the Coloradan people with their wonderful hospitality, but specifically to the interviewees who freely gave of their time and openly discussed the issues, thank you. The thesis has benefited greatly from your experience. Second, to my supervisors Professors Simon Lenton and Simone Pettigrew, both world class academics in their own rights but also quality human beings, as the Danish say, tusind tak (a thousand thank yous). Everything they have said has been for the purpose of improving the thesis and I have been extremely fortunate to have this level of guidance throughout. As one of the world’s foremost minds on cannabis policy, both as an academic and government advisor, the wisdom and knowledge of Professor Lenton in particular has been an invaluable asset and I am grateful for that. Third, to Dr David Baker you have been an inspiration and your friendship, support, and advice have been indispensable and very much appreciated – long may that continue. I wish you well in your new role at Liverpool University. Fourth, to Professor Beau Kilmer, thanks and acknowledgements for introductions to several study participants, which led to yet further introductions. This access to the highest levels of government in Colorado strengthened the thesis. Fifth, Jo Hawkins and Paul Jones at NDRI have consistently gone above and beyond to assist me. Sixth, many thanks to Dr Nyanda McBride, who as thesis chairperson has always responded promptly to my enquires. Finally, to my family, while it has been a wonderful and challenging journey for me, I suspect it has leaned towards the latter for you. To Mum, who always believed in me and provided a spring in the step when it was needed, thanks. My daughter Jade was the inspiration to be the best I could be, which I hope in turn will inspire her as she heads into a second decade and out into the wider cosmos. 5 Navigating this ‘hybrid thesis’ This is a hybrid thesis. Each results chapter consists of a research article with a structure typical in peer-reviewed journals. Throughout the course of the author’s PhD candidacy, eight papers related to the research topic were submitted for publication in high-quality international journals and a peer-reviewed book chapter. At time of writing, these papers had been cited over 140 times according to Google Scholar. Five of the papers are research articles and are included in the results section of this thesis. I have obtained permission from the copyright owners to use any of my own published work (e.g. journal articles) in which the copyright is held by another party (e.g. publisher, co-author). For reader convenience, each result chapter also includes a brief footnote that places the specific paper into the context of the overall thesis objectives. The three additional articles included two commentaries and an editorial. These are presented in Appendix F of the thesis as supporting material that emerged from the research program but were considered outside the scope of the thesis objectives. The thesis has been written in line with Curtin University Guidelines for a PhD ‘hybrid’ thesis (Curtin University, 2019), with a strong focus on presenting a coherent body of work and assisting the reader by eliminating unnecessary repetition. To improve readability and avoid repeating text, edits have been made where appropriate to the original journal articles (such cases are clearly indicated in the text). For example, references from all papers in the results section have been moved to the references section of the thesis. In addition, in three cases (chapters 7-9) the method sections of published papers have been edited out to avoid repeating material that was presented in Chapter 5. Furthermore, recommendations that emerged from the results have been moved from individual results chapters to the overall discussion of the thesis. This allowed for the thesis to be presented as an integrated body of knowledge despite differing from the traditional structure of a typeset thesis. 6 Chapters 1-5 set out the thesis objectives, outline the research context, and describe the research methodology in the usual manner. Chapters 6-10, which contain published and submitted research articles and a book chapter, constitute the results section of the thesis. Chapter 11 is presented in this thesis as a “Discussion” in the same way as a traditional thesis whereby the results chapters are synthesised and discussed alongside study limitations and future research directions. Supporting material is presented in the Appendices of the thesis. It is advised that the reader use the side navigation pane to navigate the thesis. Table 1 below contains information about publications in the thesis including full reference, publication status, journal impact factor, and number of times the paper had been cited by November 2019 according to Google Scholar. As the author of this PhD thesis, I hold the first authorship of all research papers. Thesis supervisors who contributed significantly to the research are listed as co-authors on the publications (see Appendix H for written statements of authorship). I have received permission from all copyright holders to reprint journal articles and other outputs in this thesis (see Appendix E for details).