CannabisandtheWorkplace15November2019

NicoleBowles,Ph.D.,M.S.bowlesn@ohsu.edu

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

28

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.

33

Historyofcannabisuse

• 1937MarijuanaTaxAct• MosesBaca

• Firstarrestfor¼ofanounce• Sentencedto18months

• 1950sstrictersentencesforfirstoffense,2-10years

34

Heavycannabisuseisassociatedwithagreaterriskofculpabledriving

Calabria,Bianca,etal.Drugandalcoholreview 29.3(2010):318-330.