cannabis and the workplaceford foundation, r01 hl125893, ncc 9-58, f32hl131308, aasm young...
TRANSCRIPT
CannabisandtheWorkplace15November2019
NicoleBowles,Ph.D.,[email protected]
ResearchAssistantProfessorOregonInstituteofOccupationalHealthSciences
OregonHealthandScienceUniversity
Type of Potential Conflict Details of Potential Conflict
Grant/Research SupportFord Foundation, R01 HL125893, NCC 9-58,
F32HL131308, AASM Young Investigator Award
Consultant None
Speakers’ Bureaus None
Financial support None
Other Cannabis Policy Oversight Taskforce
1.2.3.
Overview
•HistoryofcannabisprohibitionintheUnitedStates+Cannabinoidbiology101
•Cannabisuseandemployment• LessonsfromCanada
Overview
•HistoryofcannabisprohibitionintheUnitedStates+Cannabinoidbiology101
•Cannabisuseandemployment• LessonsfromCanada
Historyofcannabisuse
• 2700BCChineseemperorShen Nungdiscoverthehealingpropertiesofcannabis
• 1600-1890sdomesticproductionofhempisencourage
• 1900s-1920Mexicanimmigrantsintroducerecreationalcannabis“marijuana”totheUS
• 1937MarijuanaTaxAct• 1944“LaGuardiaReport”• 1960sCBDandTHCisolatedandidentified
5Imagesource:thcmuseum.org
Definingthecannabinoidsystem
• Receptortargets• CB1,CB2• GPR55,5-HT1A,TRPchannels
• Endogenouscannabinoids• Anandamide:1992,sanskrit for“bliss”• 2-arachidonylglycerol:1995,highlevelsintheCNSthananandamide
• Synthesizinganddegradingenzymes• Exogenouscompounds
• Phytocannabinoids• >100(e.g.,THC,CBD,CBG,CBN)• Possibleinteractionswithterpenes (entourageeffect)
• Syntheticcannabinoids:Nabilone anddronabinol,K2and“spice”
TargetsofPhytocannabinoids
Izzo,AngeloA.,etal."Non-psychotropicplantcannabinoids:newtherapeuticopportunitiesfromanancientherb." Trendsinpharmacologicalsciences 30.10(2009):515-527.
Cannabisuseincreasedacrossthe60sand70s,useisinverselyassociatedtoperceivedrisk
Source:TheMonitoringtheFuturestudy,theUniversityofMichigan8
Imagesource:thecannabisindustry.org 9
Rapidlegalizationinthelastdecade
2018FarmBill:WhatdoesthismeanforCBD?
• SignedintolawDecember2018• Removedhemp(<0.3%THC)andderivativesfromtheControlledSubstancesAct
• PreservesFDA’sauthoritiesoverhempproducts• Nohealthclaimsofadietarysupplement• June2018FDAapprovedEpidiolex fortreatmentofseverepediatricseizures• Basedonapprovalofthisdrug/substantialclinicalinvestigationsofCBD,CBDcannotbemarketedasadietarysupplement
• FoodswithCBDcannotbeintroducedintointerstatecommerce• Exceptioncanbemadefollowingpubliccomments:FDAhasformedCBDPolicyWorkingGroup(publichearingMay31,2019)
• DespitetheseregulationstheFDAnotesafloodofproductsinthemarketwithillegalandunsubstantiatedhealthclaims
Overview
•HistoryofcannabisprohibitionintheUnitedStates+Cannabinoidbiology101
•Cannabisuseandemployment• LessonsfromCanada
QuestDiagnosticsDrugTestingIndex2018
Oregonleadingstateforpercentageofpositiveworkplacetestingforcannabisuse
“WehavealltheseAmericansthatarelookingtowork…Arewealigningour…drugtestingpolicieswithwhat’srightfortheworkforce?”
-LaborSecretaryAlexanderAcosta
QuestDiagnosticsDrugTestingReport2018
“Increasesinpost-accidentpositivityamongsafety-sensitiveworkersshouldserveasawarningtoemployersthatemployeedrugusemayincreasetheriskofworkforceaccidentsorinjuries...
-KimberlySamano,PhD,scientificdirector,QuestDiagnostics
Practicalproblems:Whenwascannabisingested?
Source:Verywell mind/JRWell
Practicalproblems:Howtoassessimpairment?
Ramaekers,JohannesGerardus,etal. Journalofpsychopharmacology 23.3(2009):266-277.
Practicalproblems:Indirectconsequencesofcannabisuse
Bowles,N.P.andShea,S.A.Submitted
0 1 2 3
Short Sleep
Long Sleep
Odds Ratio
Never
1-4 x/month5-15 x/month≥16/month
Legalcannabisandcannabinoids:WhatrightsdoemployeesandemployershaveformedicalorrecreationaluseintheUnitedStates?
CannabisandEmployment:StateLawsState MedicalCannabisAnti-
DiscriminationEmployeeProtection
MedicalCannabisRequiredAccommodation
RecreationalCannabisAnti-Discrimination EmployeeProtection
Alaska
California
Colorado
DistrictofColumbia ✔
Illinois ✔
Maine ✔
Massachusetts
Michigan
Nevada ✔ ✔ ✔
Oregon
Vermont
Washington*Medicalstateswithmedicalcannabisanti-discriminationemployeeprotection:Arizona,Arkansas,Connecticut,Delaware,Illinois,Maine,Minnesota,NewYork,Oklahoma,Pennsylvania,RhodeIsland
CaseReport
• RhodeIsland:Callaghanv.DarlingtonFabricsCorp.,2017• Duringjobinterviewplaintiffwastoldshewouldberequiredtotakeadrugtest
• Plaintiffsharedthatshehadamedicalmarijuanacard,currentlyusescannabisduetoallergytopainmedications,andwouldnotuseorbringcannabistotheworkplace
• Plaintiffwasnothiredsinceshewouldnotcomplywithcorporation’sdrug-freeworkplacepolicy
• Plaintiffsuedandwon
Overview
•HistoryofcannabisprohibitionintheUnitedStates+Cannabinoidbiology101
•Cannabisuseandemployment• LessonsfromCanada
“Increasesinpost-accidentpositivityamongsafety-sensitiveworkersshouldserveasawarningtoemployersthatemployeedrugusemayincreasetheriskofworkforceaccidentsorinjuries
-KimberlySamano,PhD,scientificdirector,QuestDiagnostics
…employerscommittedtocreatingasafe,drug-freeworkenvironmentshouldincorporatestrategiesthatmonitordruguseaboveandbeyondpre-employmentdrugscreening.”
LessonsfromCanada
• Ontario’sHumanRightsCode-Employersmustaccommodatetheuseofmedicalcannabis,andaddictiontorecreationalcannabistothepointofunduehardshiptotheemployer.
• CanadianHumanRightsCommission(CHRC),2017- definessafety-sensitiveposition:“ifnotperformedinasafemanner,cancausedirectandsignificantdamagetopropertyand/orinjurytotheemployee,othersaroundthem,thepublicand/ortheimmediateenvironment.”
• IBEW,Local1620vLowerChurchill,2019NLSC49.Here,theSupremeCourtofNewfoundland:uphelddenialofemploymenttoanemployeeatasafety-sensitiveconstructionsiteduetohismedicallyprescribedcannabis
Movingforwardwhatshouldemployersdo?
• Terminologymatters:Performancedeficitvs.impairment• Definebehaviorthatwarrantsadrugtest• Notethattestingfollowinganaccidentreportareareasonablepartofaninvestigation
• Stateactiontobetakenifimpairedatwork• Aredrugtestnecessarybeforeemploymenteveninsafetysensitivejobs?
• Clearlystateinstanceswhenuseofcannabisintheworkplacewillbeaccommodated(i.e.,breaks,worksocialevents)
MovingforwardwhatshouldOregondo?
• ModifyOregondisabilitylawsothatuseofmarijuanadoesn'tdefertofederallaw
• Employeesaccesstomoreresourcesforaddiction• Ex.Anemployerdoesnothavetoaccommodatesomeone'salcoholismintheworkplace,butmustaccommodateneedfortreatment.
Adamson,SimonJ.,etal."Animprovedbriefmeasureofcannabismisuse:theCannabisUseDisordersIdentificationTest-Revised(CUDIT-R)." Drugandalcoholdependence110.1-2(2010):137-143.
Scoresof8ormore:HazardouscannabisuseScoresof12ormore:Possibleusedisorder
AllparticipantsN=561
MedicaluseonlyN=74
Bowlesetal.Unpublished
Average Δ9-tetrahydrocannabinol (THC) concentration of Drug Enforcement Administration specimens by year, 1995–2014.
Biological Psychiatry, Volume 79, Issue 7, 2016, 613–619
IncreasedTHCpotencyingrowncannabis
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Bowlesetal.Unpublished
Caulkins,JonathanP.,etal."Bigdataonabignewmarket:InsightsfromWashingtonState’slegalcannabismarket." InternationalJournalofDrugPolicy 57(2018):86-94. 29
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Acknowledgements
Research ParticipantsFundingGrant/Research SupportFord Foundation, R01 HL125893, NCC 9-58, F32HL131308, andUL1TR000128, AASM Young Investigator Award
Practicalproblems:Whatisthelevelofimpairment?
Crean,RebeccaD.,Natania A.Crane,andBarbaraJ.Mason."Anevidencebasedreviewofacuteandlong-termeffectsofcannabisuseonexecutivecognitivefunctions." Journalofaddictionmedicine 5.1(2011):1.
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Historyofcannabisuse
• 1937MarijuanaTaxAct• MosesBaca
• Firstarrestfor¼ofanounce• Sentencedto18months
• 1950sstrictersentencesforfirstoffense,2-10years
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Heavycannabisuseisassociatedwithagreaterriskofculpabledriving
Calabria,Bianca,etal.Drugandalcoholreview 29.3(2010):318-330.