Influential state pot study flawed, researchers say

A chorus of doctors, social workers and academics have criticized a state marijuana study completed this legislative session.

An assessment of the public health risks if Vermont were to legalize marijuana was released mid-January by the Department of Health. The 84-page report offered policy recommendations, a summary and conclusions drawn from available research.

The marijuana bill died in the House this spring.

Some studies that the health department used are unreliable or placed out of context, researchers said. Two doctors from University of Vermont Medical Center, a Johns Hopkins Medical School doctor and a social worker all wrote to lawmakers pointing out issues they saw.

The scope of the health department's assessment seemed to only focus on negative impacts, and didn't put the legalization discussion in the context of Vermont's opiate crisis, they noted.

The scope, to Kalev Freeman, a molecular biologist and emergency room doctor at UVM Medical Center, as well as the medical director at a local marijuana dispensary, was too negative and too narrow.

"They missed it," Freeman said. "The HIA was isolated. When they take that narrow approach they miss the likely impact on public health which I think would probably be positive.”

When officials from the health department presented their study, they warned that there was much still to learn about cannabis.

Shayla Livingston, facilitator of the report and a public health analyst at the Department of Health, said that this health impact assessment was tricky because when they were writing the health impact assessment the bill they needed to assess didn’t exist yet.

“We had to do it before there were a lot of specifics in the bill,” Livingston said. “That was kind of a curveball.”

Often, it's hard for American researchers to study cannabis due to marijuana's status as a schedule one drug, putting it in a danger category alongside heroin, LSD and cocaine.

The assessment wasn't supposed to cover medical marijuana, or decriminalization because both are already law — a health impact assessment isn't meant to study the effects of an existing law, Livingston said, a point that was hard to let go of for some of the people working on the assessment.

“It was hard for some of them to not include parts about medical marijuana and decriminalization, because much of the science is firmer,” Livingston said.

Criticism began moments after health department officials presented their assessment to the senate health and welfare committee.

Malik Burnett, a doctor from Johns Hopkins Medical School who submitted testimony, phoned into the committee room after health department officials presented the assessment. Burnett initially praised the work of the department, but noted that a relevant study was omitted.

"The Department of Health’s report discusses an increased odds of crashing with increasing blood THC levels," Burnett wrote. "A more recent study conducted by the National Highway Traffic Safety Administration (NHTSA) published in February 2015, refutes this assertion."

The NHTSA study, which looked at over 3,000 crashes in the Virginia Beach area, found that when it comes to determining who is more likely to crash, age, gender, ethnicity and alcohol use were much more reliable indicators than cannabis.

In another example, the health department relied on a 2013 study to write that cannabis-related car accidents tripled from 1999 to 2013.

That study is most likely too small to generalize the findings to Vermont, noted UVM undergraduates working in the school’s legislative research service. As well, the authors of the 2013 study note they can only check for drug use, not impairment.

In other words, long after the effects have worn off, traces of cannabis can be found in a person up to one week after they use the drug.

However, those findings didn’t factor into the health department's recommendation around using marijuana and driving. The 2013 study was included as a section on the background of research into marijuana and driving, Livingston said.

“We quote one thing from the Brady and Li study, that is it,” Livingston said, referring to the assessment's limited inclusion of the refuted cannabis-related accident study.

The health department’s assessment ultimately recommended to lawmakers that they make a legal limit for THC intoxication while driving, like alcohol, build a reliable THC testing infrastructure for drivers and promote a public education strategy.

Who guided the assessment?

To figure out what the health impact assessment was going to cover, school guidance counselors, academics, three medical doctors and at least 12 state employees — 25 people in all — met over the course of six months and developed a framework for the assessment.

“There are other large reports, from the state department, from RAND, from the WHO,” Livingston said. “This study has basically the findings as every other report.”

The health department’s assessment was never intended to be a document that advocated one side or another, Livingston said. Rather, it was an objective look at the impacts, per its name. When selecting people to guide the assessment, everyone involved with the project was asked to leave their personal biases at the door.

“We said ‘if that’s not a process you can participate in, we’re going to ask you not participate,'” she said. Nobody from the original group took that invitation, she said.

“No, it wasn’t a group of completely detached individuals,” Livingston said. “It is about the people who are working with people who could be affected."

For doctors, cannabis-based medicine could be key

For Freeman, understanding the public health impact of cannabis-based medicine is deeply important and the state's health impact assessment fell short.

Doctors have long been searching for a mid-way drug to alleviate chronic pain, he said. And their options are limited — for mild pain, forms of over-the-counter anti-inflammatory drugs like ibuprofen or acetaminophen are commonly used.

For much more serious situations, think before surgery or in the case of trauma, opioids like hydrocodone and morphine are definitely appropriate, Freeman said.

"If you break your leg, and your bone is sticking out of the skin, thank goodness we can give you morphine. That's what it's for," he said. "But for chronic pain, opioids don't work. Because they're habit forming."

New research points to cannabis-based medicines as a replacement for opioids, Freeman said. A meta-analysis, or an analysis of many studies, including reliable randomized studies, published in the Journal of the American Medical Association found that cannabis-based medicine could be a viable alternative to treat chronic pain.

"This should be looked at by the Department of Health as part of the solution to the opioid epidemic," Freeman said.

Opiates present a problem that deeply frustrates medical professionals, Freeman said.

"How do we as a society and as health care professionals treat people's pain and suffering, stop them from being addicted to the very substances we use to treat them?" Freeman said. "There has to be something else out there."

This article was first posted online Aug. 1, 2016. Contact Cory Dawson at the office (802) 651-4826, on his cell (802) 338-0316 or via email at cdawson2@freepressmedia.com. Follow him on Twitter at @Dawson_and_Co

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