Thank you all for joining me this afternoon. I'm Katie Mueller and I am the Senior Program Manager at the National Safety Council. I'm not sure why that's not in. There we go. Okay. Perfect. Great. And I'm here to talk a little bit about cannabis and the challenges that legalization is posing as we have this unregulated framework throughout the United States. So I'm not going to monitor the questions on the app until at the end. So if you're putting those in there and those of you who are listening online just know we'll get to those at the end. I can still see them but I'm gonna not go back and forth. All right. So we're going to talk a little bit about legalization and what the regulatory picture is looking like for states that have had this undertaking and looking at some public health concerns that have arrived out of these these states and talk about some best practices that have emerged. The National Safety Council, we are the leading organization for workplaces and we are really listening to our members and have done some surveying on how they are addressing cannabis use in their workplaces. So I'll be sharing that data with you and then really looking at some solutions that we are undergoing both research and putting them to market at the National Safety Council to address this health concern. So I don't have any official disclosures today but I do like to tell people that I'm not a physician, I'm not a scientist, I'm not an attorney here to give legal advice but I am from Oklahoma and if you are practicing or have practiced in Oklahoma, have clients in Oklahoma, you know that we don't regulate very many things and so we have a very open market and for cannabis specifically and so we have a lot of lessons I feel that we have learned as we have became one of the conservative states that is now known as the Wild West of weed. Very proud. All right so like I said I'm from the National Safety Council and our mission is to save lives from the workplace to any place. So you may be familiar with our training offerings or our transportation initiatives. I'll talk a little bit about how the work that we're doing in cannabis really links to those areas but we're a hundred and twenty year old organization focused on health and safety. So we do not take a position for against the legalization of cannabis so that's very important for everybody to understand. Really my job at the National Safety Council is to ask you know regulators and policy makers to prioritize safety when they are legalizing and regulating cannabis. So I have a video hopefully this will play. Nope. We don't have sound. Hold on. If we don't have sound that's okay we can skip it. Nope. Okay that's fine. Just telling you a little bit about National Safety Council and our priorities as an organization. Like I said before you may be familiar with our workplace trainings. We also have a research division and really pride ourselves on evidence-based training and solutions. We have about 50,000 member organizations representing over half a million employees at the National Safety Council. So we are monitoring really closely what's happening in cannabis employment and both the risks to employees who are working in the cannabis space but also you know consumers as they look at products and what products are on the market how they're regulated and how states are addressing all of these various issues. But we we are recognizing and understand that the cannabis industry is here to stay and you know we don't have the federal oversight that we have with a lot of other industries and so we're really challenging that industry to prioritize safety in addition to supporting all of those jobs. So when you look at cannabis legalization from a national standpoint there are a lot of sources of information for this. This map is from the National Conference of State Legislatures which is what I use on the policy side and the darkest color 17 states plus DC have legalized adult use or recreational marijuana. In 2021 Connecticut, New Mexico, New York and New Jersey passed legislation to legalize and South Dakota has the ballot initiative that was struck down by their Supreme Court. So their status is still not fully legal. In the lighter green to bring that total to 35 states including DC, Guam, Puerto Rico and the Virgin Islands have approved comprehensive publicly available medical marijuana cannabis programs. And in that lightest green there you'll see you'll see Texas and a few other country a few other states that have the low CBD or low THC CBD laws. In 2020 Mississippi also had a ballot initiative and it was overturned so you'll see that their color is a little bit light with an asterisk there. Only Idaho, Nebraska and Kansas have no laws to address the medical use of marijuana but they are are covered under the industrial hemp or farm bill as we call it in the policy world. So we'll talk a little bit about that and kind of the implications of how states have approached regulation and as legalization has been allowed in their states. So the National Safety Council is headquartered in Illinois and which is also home to Cresco Labs which you may be familiar with Cresco they are a manufacturer of cannabis and cannabis products and they just purchased Columbia Care which was a medical medical cannabis provider as well and so we are you know looking at what is happening in the states economically and understanding kind of you think that cannabis policy is complicated cannabis tax policy is even more complicated. So we're continuing to follow those but we understand that states are prioritizing these these businesses because they are because as they are become legal they are an influx of funding into the state and so I think it's really interesting to see how states that have legalized are prioritizing the tax revenue from from their state programs and states that put investment into public education or public health or even better prevention right. So we see some states doing a better job of that than others. In here just another example of the industry growth that we've seen over the last few years eight out of ten of the most populous states in the US have legal cannabis for adult use. So that means many many many Americans have access to legal cannabis and they spent about 18 billion dollars on cannabis products in 2020. So talking a little bit about legalization in this because we don't have the federal framework right states are kind of not kind of they're putting together this patchwork of regulations and one of the huge issues that we saw come to fruition very early in states with the legalization is how they were labeling their products. You know as you can see all different types of labeling are taking place from instructions to warning labels, ingredient contents labeling, none of that is prescribed and so states are coming up with their own way to do this. The variation is is risky for consumers because they may or may not understand what they're taking. I also would be remiss to say not to say that cannabis today is not cannabis of 1960 and 1970. The THC limits are much much higher and limits are there even limits we don't know. So but what we're what individuals who are ingesting or you know taking cannabis of some kind the THC levels and CBD levels are much higher than what we have seen in the past. So all that to say we think at the National Safety Council that proper warning labels labeling and instructions are should be a priority. There are a few organizations who are proposing what's being called a universal symbol for cannabis products and there's a group called the Doctors for Cannabis Regulation and many other stakeholders like ASTM and some universities who are working on this are proposing this symbol to be the universal symbol. They're also working with UCPS and others who were invested in this process. It is it is named the International Intoxicating Cannabis Product Symbol or IICPS. Montana is the first state to formally adopt this as their symbol for their products and ASTM is looking at making this the international consensus standard in which they will ask you know put forth for manufacturers to utilize. So there are a lot of cooks in the kitchen when we talk about cannabis regulation right very similar to some of the work other work that you all do. When we talk about CBD and THC infused food and beverage we have the Food and Drug Administration of course we have the DEA who's constantly monitoring what's happening with legal and illegal sales and production. We have the USDA involved in regulating hemp. Obviously they have you know been charged with that with the farm bill and they are then right their state partners are regulating some of that industry in the states. Obviously HHS is very concerned and creating their own regulations. DOT obviously the regulations for drivers and funds to address impairment. My background is in transportation policy and so I watch this very closely work with our partners at NHTSA very closely. SAMHSA obviously very involved and has a stake as well which we work with them very closely as well. So just like regulating other products it's going to be a very complicated process and we continue to monitor what happens on the federal level all the time. So I know some of you are probably MROs and you're very familiar with FMCSA's regulation of DOT drivers and you know familiar with the clearinghouse or if you are a service provider or an intermediary who is responsible for entering that information into the clearinghouse. DOT created this clearinghouse of driver information and started mandating that drivers enter employers enter their information in there for drivers. We found this very useful and even in the very first year and a half of the clearinghouse there were over 56,000 violations and if you look at the violations really really closely a lot of them are marijuana. And so not just adult and medical use marijuana but synthetic marijuana. I know you guys are probably familiar with more than most of the audience that I talked to about the dangers of synthetic marijuana but the regulated market is making the manufacture of synthetics really interesting because some of the products can be made legally and then they're infused and all kinds of complicatedness. So you know we just are really interested in this and we work with other partners like the NTSB and things whenever there are cases that involve drivers in crashes. All right so in other products I'm going to talk a little bit about product regulation with you because we have a great project here at the National Safety Council talking about product dangers and product regulations. But cannabis testing laboratories are really disadvantaged because they don't have the lack of multi-laboratory validated test methods right. There aren't accepted test methods for things which are available for nearly every other agricultural commodity that humans or pets consume. And so really every the laboratories that are involved in production and manufacturing are left to develop their own standards and their own test methods. There are groups like ASTM and AOAC who are working to develop and validate these methods but those of you whose work who have done valid you know method validation it takes time and unfortunately we're not there yet. So that's one of the areas that we need to know more about. We need to know more about the impairing substances and we need to know more about those isomers and how the brain reacts. The youth access issue there's some published information that's coming out of legalized states that show an increase in youth access and then there's some that have shown that with legislation comes a little better handle on youth access. So we're continuing to watch that and put you know we have other partners who are working in the youth area that help us kind of amplify, again we don't take a position either way but we really just ask legislators and regulators, stakeholders and policy makers to prioritize safety for everyone including the youth that are able to access these products. And then of course the workforce health impacts. We want to understand how marijuana is affecting the workforce. I know that you guys that are MROs are interested in you know are they impaired, are they not impaired and then how do we test, what's the best test method, all those kinds of things. But again you know one of the things that we are looking at, we have a scientific advisory board who advises us on cannabis related, alcohol and cannabis related issues and Delta 8 is one of the issues that seem to be popping up in every conversation that we have because there are a wide variety of Delta 8 products on the market and these include you know vapes, edibles, all kinds of different things. But because those test methods are still being developed, products that may be tested for contaminants or other things aren't necessarily tested for the levels of Delta 8 that we would like to see nor do we understand kind of the impairing effects, we don't understand all of the impairing effects of Delta 8 or Delta 8 in combination with other things like CBD or Delta 9 or alcohol, all these things. So but we do know that there have been an increase in poisoning and unintentional overdose when it comes to Delta 8 and so we're continuing to monitor those things as well. In September of last year the FDA and CDC did issue a public health advisory warning for Delta 8, really amplifying that, the health risks associated with consuming it. And as we have seen kind of what happens you know, states, some states have started to ban the substance or have started to regulate it a little bit closely or more closely. And I don't know why that, I apologize for the font on this slide, it looks strange and it's the only why it's strange. But I know I saw a poster about the vape issue and we are again, we are getting ready to release a study or one of the toxicologists that works on our aided committee is getting ready to publish a study on the impacts of vaping and it's another issue that we're very well aware of. One of the things that I hope to gain from our product regulation study is really monitoring the states that are regulating vitamin E acetate and some of those things that are causing the lung injuries, you know, unintentionally again, because we don't have the laboratory standard test methods and the laboratory SOPs that we need, they don't have the limits that they have when they're manufacturing other products. So unfortunately what happened was they were increasing that vitamin E acetate in order to, you know, get their concentrates to thicken and in turn it, you know, had some deadly health impacts. All right and we're continuing to hear and see some impacts of the combined effects of alcohol and cannabis use. This is a complicated subject, right, because we can't test for cannabis like we can test for alcohol and the jury is still out in a lot of those test methods as well as the effects and how long the impairment lasts, those kinds of things. But what we're seeing is consistent evidence that multisubstance impairment does increase when cannabis is used versus when it's used alone. Again, alcohol is the most commonly detected drug in serious and fatal car crashes with marijuana coming in second or cannabis coming in second. So we're watching that really closely and really hoping to see an increase in research now that we can have, we have cannabis more readily available in the research field as well. All right, so here are just some studies that we're using to demonstrate the risks of multisubstance impairment and really develop some evidence-based policies and practices around mitigation of these things and really develop some interventions that can work for states that are legal as well as, you know, really amplifying that health risk message. All right, so some of the states who have done, who have been at this legalization thing for a while are starting to aggregate some data on the impacts of what they're seeing. And I will tell you that there's a lot of information about impacts. You can look, if you're looking for criminal justice or if you're looking for public health, if you're looking for prosecution and adjudication, the data is there. The problem is, is that the data sources vary considerably based on what you're looking for, and that exists really greatly in the area of traffic. And so it's difficult for these states to draw a conclusion on what's happening as a whole because the lack of historical data, right? When Oklahoma legalized, one of the things that I asked for was I said, can we please get a baseline of where we are on marijuana-involved fatal crashes before we get to this point, right? Because states don't have that baseline data. And so I want to caveat that, this information with that, but some of the things that Colorado is seeing obviously is decrease in arrests because it's decriminalized, right? And so they can have it on their person to a limit. That in turn reduces court filings. But one of the interesting things that I read in the Colorado Impact Study from this year was probationers, people who were on probation testing positive for the substance. And you know, that just really brings home the need for continuing education about, you know, just because we have legalization doesn't necessarily mean that we're reducing recidivism and all of these kinds of things. So in Youth Act, not surprisingly, youth access is up again, but kind of the impacts of that are yet to be known. And we continue to look at states and utilize their data to inform what we're doing. One of the things that I always encourage people like yourself who have the ability in your state to advocate for data linkage systems. We need data linkage systems between emergency room department information, traffic data. We need medical examiner's information. We need health department data. All of that data linkage is so important in the area of prevention, but again, really building evidence-based programs to deter these public health impacts. So next I'm going to talk a little bit about what NSE is doing in the workplace space. Last year we fielded a survey of about 1,500 employers and really asked them about cannabis use and their policies to address cannabis use in the workplace. And one-third of the respondents reported actually observing someone in the workplace consuming or using cannabis. So that was really interesting and not surprising. You know, Quest just came out with their new DTI. If you've seen it, I apologize, I didn't have time to put those results in this. So my slides coming up are from last year's data. But cannabis continues to be the most detected substance in workforce drug testing. So that's all just to say that it is, again, not going away and we're going to have to develop evidence-based policies to address it. All right. We at the National Safety Council feel really strongly about it being unsafe to be under the influence of cannabis while working in a safety-sensitive position. Research is clear. Again, it's not really clear to the level of impairment, but it is clear that cannabis does impact psychomotor skills and cognitive ability. Now it's really left up to the employer to determine how important that is for the task and the job that that individual is doing. But we really support, you know, if companies are going to eliminate or not disqualify individuals who test positive for marijuana in pre-employment, if they're going to do that, we really support putting those people in non-safety-sensitive operational positions. All right. Again, this is the slide that is a little bit out of date, but there wasn't much change. There was like 4% change, I believe, from last year. But marijuana positivity is, you know, greatly increasing. And what you see here, the darker is urine and the green color is oral fluid and the yellow is hair. I know that's hard to see. So increase in marijuana positivity across all testing categories. So I think that that really is the take-home here. And again, we're at the highest level of detection ever. This is another visualization of, again, last year's positivity rates by testing reason. So if you see the dark blue is for cause and then pre-employment, I believe, is purple. So that's the lowest one. And one of the things that was interesting that I heard from Quest this year was even noting all of those companies that are removing marijuana testing from their panels, marijuana is still the most detected substance, right? So that's even taking out the ones that aren't testing for it. So, we talk to employers a lot about what it means to recognize and respond to an employee who may or may not be impaired. And, you know, as the state laws are evolving, I know that some of you are probably more familiar with them than I am, there are different levels of what employers can do to a person. Or for a person who is using cannabis for whatever reason. But it's consistent in the law that employers are not permitted to, they're not required to allow someone who is impaired to continue to work. The intervention is kind of up in the air, but, you know, there are the level issues and the testing method issues. But I think that the states are going to continue to have to continue to navigate that until we have federal regulation. So the million-dollar question, right, what constitutes cannabis impairment? Again, what we know is that THC does cause changes that are critical for those driving and other safety-sensitive tasks, thinking, judging, evaluating, depth perception, motor skills, those kinds of things. And you know, I'm not going to talk to you all about levels of detection and the window of detection and all of that, but you know that. And so we really do need more science about what it means, what does cannabis impairment mean, and how do we test for it? So since 2015, the National Safety Council, we have advocated for utilizing oral fluid testing for DOT compliance. And just recently, the DOT issued proposed rulemaking on that. And so it will be interesting to see when those rules come down, but again, we are supportive of that and we were supportive of that when HHS changed it for the general workforce. So we talk to, like I said, I talk to employers all the time about what they need to consider whenever they're developing policies to address marijuana in the workplace. And you know, my number one thing is consult your attorney first, you know, because depending on what state you're operating in, if you're operating in multi-states, you may have multi-state regulations to follow. So that's really a challenge for larger employers. And you know, what is lawful off-duty use? You know, New Jersey just decided that their police officers can consume off-duty. And so I think that that's going to be an interesting implication, again, coming from the public safety sector. It's a challenge for me to understand how that all works. But you know, the broad application of disability law in New York and things like that are also really hard for employers to navigate. So whenever we get, you know, our HR professionals and individuals who aren't working in law, they're not working in science, I tease them, I say, it's like whack-a-mole. You know, you get one thing done and then you got to do something else. And that's really the policy situation that employers are in right now, because of product changes, state law changes, disability implications, medical exemptions, even just the changing product updates in states is mind boggling. So without that measurable concentration, we do need more evidence-based methods to evaluate marijuana impairment in the workplace. So if you're working on that, please continue. It's going to be a need for some time. We are continuing to develop resources at the National Safety Council to help employers navigate these things. And last April, we did a cannabis-specific perception survey that I talked a little bit about earlier, but I'm going to delve into some of the details now. So we really wanted to understand employers' really perceptions about usage and effects of marijuana in the workplace, and talk to them about how their state was legalizing, and was that impacting their employees' job performance or safety on the job? And really understanding what policies they were developing to address this, and what resources that they needed from us and others to formulate safe workplace policies. So this is just kind of the methodology a little bit. I know that's hard to read, because again, it's that weird font. I don't know what happened. But these are some of the key learnings that we found. There really is a gap between what employers say that they're doing, and what information employees are receiving. So a lot of employers think that they're doing a good job at addressing marijuana, but their employees are saying we need more information. So employees are less aware about cannabis policies, and they really do want more clear communication about what the policy is. Next steps, and what good is a policy if you don't enforce it, right? And so that whole dynamic is a challenge for employers. So again, I just think that employees in safety-sensitive positions report cannabis use less, but not zero. Construction is one of the areas that are more likely to report these behaviors. And it's interesting that employers thought that their employees were comfortable talking about this topic, but only 49% of employees said that they would feel comfortable telling their supervisor if they thought their coworker was impaired. So that's really important information as well. We have some toolkits that we utilize talking about how to talk to your employees about this. And employees did seem to understand that cannabis can cause impairment, but it's interesting that they think that recreational use is less dangerous than medical use. And so even though individuals may be monitored more by a physician or someone else, it's still really interesting because without the product regulation, we don't really have a good understanding of what individuals are using even when they do get a recommendation for cannabis. Workplace cannabis policies do need improvement. And so only 19% of employees thought that their companies were doing a good job at this policymaking. So reporting is a really important topic as well because it really is a barrier for us to get that data. And because if you think about incident data, if a company that you work for is reporting an incident, whether it be a fall, a crash, or something like that, they probably are not even noting if that employee was impaired or not. OSHA doesn't require a lot of the data that we wish that they did on their incident reporting forms, and so we're continuously asking for improvement in that area as well. And here's just some more data. We found that 55% of employees in those states that had legal cannabis, again, that had reported on our survey eliminated it from their panel. And I think that that's really interesting. So I love hearing the anecdotal evidence from employees about what they're doing. And we heard a lot of, we don't really hear about that after our first week at work. Or we're not really prepared, but there's not much we can do. So we want employers to understand there are things that they can do, and to decrease their risk and their employees' risk. All right, so I talked a little bit about the health impacts, but kind of some state regulation impacts that we have. The DOL guidance in New York on the disability issue, if you have a cannabis recommendation, you are probably protected on their disability laws. There are some states who are looking at developing workforce impairment experts similar to drug recognition experts in traffic safety, if you're familiar with that. And Connecticut, interestingly, isn't allowing employers to test, have tests that only detect the inactive metabolites for THC. Again, and then cities and states all over the country are removing those panels. So a lot of the news in the last year was the labor shortage and how do we get past that and still test everyone? We're disqualifying people who are qualified to do the job because they're taking a substance that is legal in their state. And so I think it's really interesting to see what's happening here. And Amazon was one of the companies that was really in the news for doing this. And it's that reactionary strategy that we'll have to wait and see what happens, right? Because the decision that they have made may or may not have safety impacts down the road. So what we advocate for at NSE, we have policy positions to back that up. We partner really closely with ACOEM on their safety sensitive definitions. And a lot of the work that goes on in that area, we have policy positions for all of these things. And you can see those at nse.org slash impact if you're interested. And we are continuing to develop these as new research becomes available. So if you have research that you're doing or are familiar with that you think could help us advocate for better policies in any of these areas, please let us know. And we're always looking for that. In this summer, we're going to be releasing a new policy position on impaired driving, which is a huge policy. Everything from prevention to adjudication all the way through. And so that was a huge undertaking, but we're certainly proud of it. And we're looking forward to publishing that in the summer. So these are our official, I don't know how official is official, but our recommendations for cannabis policies for employers, you know, really consider those, consider a zero tolerance policy for employees in safety sensitive positions. Create that safe reporting structure and please include cannabis in your testing panels. Even if you aren't going to disqualify individuals that test positive, we recommend putting them in a non-safety sensitive position. But just having the policy, I think is the key. And then having a policy that's enforceable. Having that clear messaging to employees is important. Staying up to date on state regulations and creating a fair return to work. If you have employees who have a substance use disorder or are habitual substance users and increase those EAP programs. We recently did a study that my colleague is presenting on tomorrow virtually about EAP utilization during the pandemic specific to substance use and mental health. So if you're interested in that, tune in. And we did see some changes, some positive changes from employees who reported to us in our survey on how they expanded their EAPs during the pandemic. Here's some results from that. Oh no, this is just the background on the study. Sorry, I don't have the results, just kidding. But really identifying opportunities and best practices was the goal that we had of the study. Really looking for people to report, employers to report to us what worked really well. And we saw some really innovative things coming out of that. Things like increase in childcare benefits, elder care benefits, access to things like toiletries and groceries whenever there were supply chain issues. So it was really interesting and we'll continue to monitor that. We are working with SAMHSA on that study. So I talked about how important it was for employers to understand their role here. And supervisors are the most important people who can make a difference in this area. Again, we have to have the top level support, right? But those supervisors are the ones who should be recognizing and responding to impairment in the workplace. And we have a brand new training that just launched in January from the National Safety Council. And it is a comprehensive training based on our broad definition of impairment. So you'll see things in there, not just about drugs and alcohol, but about mental health and just life stressors in general and how employers can recognize those risks, those things that can be risky in the workplace and respond to them. All right, and I am also working on this project, which I have kind of alluded to a little bit, but it is with all the patchwork of regulations going on in the cannabis industry, we saw a need for there to be a resource for policymakers, stakeholders, individuals, scientists, doctors, whoever to, there isn't an aggregated place where you can find cannabis policy regulations. And so we are building a database that we'll launch in September, where you can really look at, this is for product specific regulations. So things like, does the state ban Delta-8? Do they, you know, what panel do they test for metals and residual solvents? Very specific, but we're hoping to provide some guidance for states and really highlight those emerging best practices and build that framework, really high standard for federal regulation. We're collaborating with a lot of other groups on this. And ASTM has a committee that is dedicated to standard setting for cannabis, everything you can imagine from transportation to manufacturing, to advertising. And we're currently working on 50 new standards. They've published 70 and we're involved in that as well. We're involved with AOAC and really looking at some of the more harmful substances and products that we found in cannabis. And of course we're monitoring what NIST is saying about the laboratory quality standards. They have a quality program that we support. ASTM is coming out with a cannabis quality program as well, laboratory quality program. So we are really advocating for those who are involved in the industry to look at those standards setting, those organizations that have set those standards and follow the validated test methods. All right, well, that's the end of my presentation. I know I have some questions here and I'll get to those. And if any of you have questions, I'd be happy to answer them. Feel free to reach out in my email here. Are there any, the first question here, are there any laws, rules limiting tobacco companies entering this industry? I am not, I am not an attorney. So I don't know that if anybody else knows, if anybody is an attorney in here and knows the answer to that, please speak up. But we have seen some crossover. I don't know about tobacco, but we have seen some crossover in alcohol. Some alcohol manufacturer, beverage manufacturers are crossing over and creating some infused beverages. And that's, we're watching that in the beverage work group, but it's really interesting. Some high THC content happening there as well. Someone had a question about technology on there that I'm definitely not the person to answer that. So, but happy to answer any of your questions or email me. Thank you guys for attending. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you.

cannabis legalization

regulation

safety

workplace policies

cannabis use

impairment

state regulations

National Safety Council