Outline

1. Cannabis and the WorkplaceKathleen Thompson, PhD, MSW, RSW, BA (Hons)Saskatoon InnSaskatoon, Saskatchewan

2. Outline • Legalization Timeline • Canada Day 2018 • Global Decriminalization / Legalization Movement • Policy Approach • Science of Cannabinoids • Health Effects from Cannabis • Impairment in the Workplace • Substance Misuse • Addictions Model Harm Reduction Health Promotion Kathleen Thompson, PhD

3. Research Affiliation Canadian Consortium for the Investigation of Cannabinoids (CCIC) • Dr. Mark A Ware • Vice-Chair of the Canadian Task Force on Marijuana Legalizationand Regulation (2016) • Researchers and health care professionals • Endocannabinoid system and therapeutic applications • Cannabis Regulatory Research Group (2016) • Global consortium of accredited peers • Public policy practitioners • Linked in: Kathleen Thompson, PhD • Academic, peer-reviewed • U of R: meta-analysis Fostering Critical Thinking Council of Canadians with Disabilities Kathleen Thompson

4. Cannabis Quotes • “I have found in my study of these patients that cannabis is really a safe, effective and non-toxic alternative to many standard medicines.” • Philip Denney, MD • Co-founder of Medicinal Cannabis Evaluation Practice • “The American Nurses Association (ANA) recognizes that patients should have safe access to therapeutic Marijuana/cannabis. Cannabis or Marijuana has been used medicinally for centuries. It has been shown to be effective in treating a wide range of symptoms and conditions.” • “When I was a kid I inhaled frequently. That was the point.” • - Barack Obama Kathleen Thompson, PhD

5. Damaging Historical Portrayals https://www.youtube.com/watch?v=sbjHOBJzhb0 Kathleen Thompson, PhD

6. Outcomes of the War on Cannabis • Organized crime / informal economy • Lost income tax revenues / formal economy • Stigmatizing for people with serious illnesses; damaging for families and communities • Poor people are hurt the worst by the war on cannabis • 2/3rds of drug arrests in Canada in 2013 were about cannabis • Lack of quality control (mold, pesticides, THC / CBD profile) • Cannabis users might feel they experience food poisoning… • Lack of reliable medical and scientific information available to date on the medical benefits of cannabis • Complicated realities facing medical doctors across Canada • Challenging reality for employers and for human resource practitioners Office of the Correctional Investigator (2014-2015). Annual Report of the Office of the Correctional Investigator. Ottawa: Office of the Correctional Investigator. Kathleen Thompson, PhD

7. Definitions • Disability –Any previous or existing mental or physical disability and includes disfigurement and previous or existing dependence on alcohol or a drug • Discrimination – An action or a decision that treats a person or a group negatively for reasons such as their race, age or disability • Impairment – …the appearance of impairment at work is described as: “(e.g. odor [sic] of alcohol or drugs, glassy or red eyes, unsteady gait, slurring, poor coordination)” • Safety sensitive positions –…one which “if not performed in a safe manner, can cause direct and significant damage to property, and/or injury to the employee, others around them, the public and/or the immediate environment”. Positions involving safety sensitive decisions would also be included.

8. Consumption Methods • Cannabis is traditionally inhaled as a dried herbal product, either alone or as a concentrate mixed with tobacco (a joint) • Vaporizing cannabis is more economical and more effective • The flower of the cannabis plant can be made into a variety of products, including: • oil (hash oil) • hash (compressed resin) • concentrates (shatter) or • foods and beverages containing extracts of cannabis • Cannabis can also be ingested by pill form or in food, or absorbed through the skin via creams, salves, or skin patches. Kathleen Thompson, PhD

9. Cannabis is very popular globally • World Health Organization • Cannabis is the most commonly used substance in the world • 181.1 Million Citizens Globally Annually • No other drug is used by more than 1% of Canadians each year • Decriminalized in 20 nations now • Legal in Uruguay and in 8 States (Colorado, Oregon, Alaska, Washington, Maine, Nevada, Massachusetts, District of Columbia) Increasing acceptance Decreasing stigma Kathleen Thompson, PhD

10. A massive marketplace… • ~140,000 Canadians have legal cannabis prescriptions (10%) • 15% of non-prescription holders currently consume • = 25% of Canadians • 15% of Canadians indicate they would consumer cannabis in a legalized market • 25% + 15% = 40% • Last year, 90% of Canadian adults purchased alcohol Existing Consumption Estimated Consumption Kathleen Thompson, PhD

11. A Global Movement 7,500 Attendees Canadian Cannabis Business Week - Vancouver . Uruguay, Netherlands (adult use allowed), Argentina, Bangladesh, Cambodia, Canada, Chile, Columbia, the Czech Republic, India, Jamaica, Jordan, Mexico, Portugal, Spain and Germany (legal or tolerated), UNGASS Kathleen Thompson, PhD

12. Pre-Conference Science Workshop • Plant Anatomy • Cannabinoids and Terpenes • Therapeutic and Clinical Research • Extraction: Methods, Formulations • Testing: Regulations, Labeling & Liability • Plant Pests, Pathology and Disease 10,000+ attendees! • Alaska, Colorado, Oregon Washington – already legal • California, Maine, Massachusetts, Nevada – next • Legal or medicinal in 26 states • 52% of the United States population now has legal access Kathleen Thompson, PhD

13. Health and Cannabis The Science of Cannabinoids Kathleen Thompson, PhD

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15. https://www.honeycolony.com/article/endocannabinoid-deficiency-the-boost-you-need-for-balanced-health/https://www.honeycolony.com/article/endocannabinoid-deficiency-the-boost-you-need-for-balanced-health/ Kathleen Thompson, PhD

16. The Science of Cannabinoids • Tetrahydrocannabinol • The most abundant cannabinoid present in cannabis. • THC is responsible for the for cannabis’ most known psychoactive effects. • Treatment for PTSD and high anxiety. • THC is a mild analgesic, or painkiller, and cellular research has shown that it has antioxidant activity • Cannabidiol • CBD had tremendous medical potential • This is particularly true when the ratio of CBD to THC is applied to treat a particular condition. • Reduce CNS Inflammation • Cancer • Epileptic seizures • Schizophrenia THC CBD Source: Keystone Labs (2016). THC and CBD, Edmonton: Keystone Labs.

17. Cannabis Testing • Cannabinoid profile • Terpenes • Composition of cannabinoids • THC -tetrahydrocannabinol • THCV –tetrahydrocannabivarin • CBD –cannabidiol (pain, MS…) • CBDV –cannabidivarin (seizures) • CBG –cannabigerol (anti-bacterial) • CBC –cannabichromene (inflammation) • CBN –cannabinol (sedating) • Contaminants • Pesticides • Mold • Residual solvents • http://keystonelabs.ca/ Keystone Labs Edmonton, Alberta Kathleen Thompson

18. Terpenes - Strain Science Most common: • Alpha-Pinene • Beta-Pinene • Myrcene (musky) • Limenone (citrus) • Caryophyllene (pepper) • Linalool (floral) https://www.leafly.com/news/cannabis-101/terpenes-the-flavors-of-cannabis-aromatherapy Kathleen Thompson

20. The Future: Cooking with Cannabis In the kitchen… Picture: Medical Marijuana Association Kathleen Thompson

21. The Health Effects of Cannabis and Cannabinoids: The Current State of EvidenceNational Academies of Sciences, Engineering and Medicine review of 10,000 studies • Conclusive Evidence • strong randomized trial evidence to support or refute claims - chance of bias ruled out • Substantial Evidence • Strong evidence of an effective or ineffective treatment from several good-quality studies • Moderate Evidence • Therapeutic effects with some evidence to support or refute health endpoints • Good- to fair-quality studies • Limited Evidence • Weak evidence to support effective or ineffective treatments • Support findings from fair-quality findings or mixed findings favoring one conclusion • Significant chance of bias Conclusive or Substantial Moderate or Limited Kathleen Thompson, PhD

22. Pain Relief • Half of medicinal cannabis use is for pain • Up to 90% of reported use in the US and in Europe • Fibromyalgia, arthritis, spinal cord injury and MS, HIV, trauma • Pain research is mostly focused on cannabinoid compounds as opposed to herbal cannabis • Pain relief of smoking is important to study • People with head pain metabolize THC twice as fast Ware, M.A. (2014). Medicinal Cannabis and Pain, PAIN Clinical Updates, 22(3), 1-7. Distribution of CB1 receptors (www.ccic.net) Kathleen Thompson, PhD

23. Therapeutic Conclusions • Substantive Evidence • Chronic pain • Chemotherapy-induced nausea and vomiting • MS • Moderate Evidence • Improving sleep outcomes (apnea) • Fibromyalgia • Chronic pain • MS • Limited Evidence of effectiveness • HIV/AIDS • MS • Tourette Syndrome • Improving anxiety symptoms (social anxiety) • Improving symptoms of PTSD • Limited Evidence of a statistical association • Traumatic brain injury Substantive or Moderate Limited Evidence Kathleen Thompson, PhD

24. Therapeutic Conclusions (cont.) • Limited evidence of ineffectiveness for: • Dementia • Glaucoma • Reducing depressive symptoms for individuals with chronic pain or MS • No or insufficient evidence to support or refute conclusions that cannabis or cannabinoids are effective for: • Cancers • IBS • Epilepsy • Huntington’s • Parkinson’s • Abstinence • Schizophrenia Limited Evidence More research is needed! Kathleen Thompson, PhD

25. Moderate Evidence – statistical association • Cannabis use and impairment in the cognitive domains of: • Learning • Memory • Attention Kathleen Thompson, PhD

26. Additional Cannabis Concerns • Is Cannabis a gateway drug? • No, the gateways are lack of education and opportunity • Gateway theory has been debunked (Task Force) • What about addictions and cannabis? Kathleen Thompson, PhD

27. Comparative Dependency Data • Studies indicate the majority of cannabis users do not go onto harder drug use • Gateway theory is that early exposure to cannabinoids in rodents decreases the reactivity of brain dopamine reward centers later in adulthood and ‘primes’ the brain for enhanced drug responses • Cross-sensitization • Long term probability and predictors from first time use to dependence: • 67.5% - Nicotine 20.9% - Cocaine • 22.7% - Alcohol 8.9% - Cannabis • Poverty and poor social environment is a gateway to heavy drug use • Long term health implications of cannabis use is similar to not flossing Meier, M.H. et al, Associations between cannabis use and physical health problems in early midlife: A longitudinal comparison of persistent cannabis versus tobacco users, JAMA Psychiatry, 37(70, 731-740. Lopez-Quintero, Perez de losCobos, Jose, Hasin, D.S et al (2011). Probability and predictors of transition from first time use to dependence on nicotine, alcohol, cannabis and cocaine, Drug Alcohol Dependency, 115(1-2), 120-130. Kathleen Thompson, PhD

28. Cannabis as a harm reduction tool • Cannabis is commonly used to help people with substance misuse problems step down: • Cocaine • Alcohol • Nicotine Whoopi Goldberg and medicinal marijuana http://whoopiandmaya.com/ Economist (May 28th-June 3rd 2016). The ecstasy and the agony: American take too many painkillers. Most other people don’t get enough. P. 14. Kathleen Thompson, PhD

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30. Human Rights – Addictions Model • Addictions are a significant issue in our communities • Power of the abstinence model • AA is the most effective addictions model in the world and helps many with alcohol and other addictions, such as gambling • We are focusing on the evidenced-based medicinal aspects of cannabis • The abstinence model is not evidence based or trauma-informed • Trauma-informed care is a powerful, evidenced-based tool • It is a human rights violation to deny non-toxic relief to people medically and legally able to use medicinal cannabis for evidenced-informed symptom relief The Lancet Commissions (2016). Public health and international drug policy. The Lancet. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)00619-X/abstract Kathleen Thompson, PhD

31. Cannabis Policy Considerations Kathleen Thompson, PhD

32. Public Health and Safety Focus Legalization of Cannabis in Canada is Occurring • Canada Day 2018 – The Cannabis Act (Bill C45) • Criminal Code Changes A significant pressure facing governments and businesses is managing the risk and the public perception of risk related to cannabis use and misuse Access to Cannabis for Medical Purposes Regulations (ACMPR) Kathleen Thompson, PhD

33. Key Steps - Workplace Strategies • Identifying appropriate mechanisms • Provide clear guidance and policies (parties) • Consistently apply policies • Federal White Paper – Canadian Centre for OH&S • Provincial occupational health and safety and human rights legislation sensitivity is required Kathleen Thompson, PhD

34. Workplace Strategies: Risk of Impairment from Cannabis • address the potential for impairment as part of a hazard assessment • establish a concise policy and program on the use of any substance that can cause impairment • determine the actions the workplace can take regarding impairment • implement accommodation practices where necessary, including therapeutic needs and substance dependence • create a supportive, healthy and safe workplace https://www.ccohs.ca/products/publications/cannabis/

35. The Canna-Sensitive Workplace • Zero tolerance policies for safety sensitive workplaces • Similar approach to alcohol or painkillers for non safety sensitive workplaces • Employees: What can I get away with? • Managers: How do I protect the owners and the other employees plus value human rights? • Owners: How do I avoid litigation? Kathleen Thompson, PhD

36. What is cannabis impairment? • Main effects are “contentment, relaxation, sedation, euphoria and increased hunger” - Dr. Carl Hart@drcarlhart • Research on impairment is inconclusive • Someone can test positive days or weeks after use • Cannabis impacts individuals differently THC levels do not correspond with impairment levels “You cannot predict a person’s level of impairment based on THC levels” Kathleen Thompson, PhD

37. Cannabis impairment (cont.) • Effects peak within 5 to 10 minutes and diminish over the next two hours for smoking or vaping • Effects peak within 2 – 4 hours for edibles • Temporary impairment might be the lowering of a person’s level of vigilance or focus • Infrequent users show marked disruptions Kathleen Thompson, PhD

38. Impairment Effects on the Body • dizziness, drowsiness, feeling faint or lightheaded, fatigue, headache • impaired memory and disturbances in attention, concentration and ability to think and make decisions • disorientation, confusion, feeling drunk, feeling abnormal or having abnormal thoughts, feeling “too high”, feelings of unreality, feeling an extreme slowing of time • suspiciousness, nervousness, episodes of anxiety resembling a panic attack, paranoia (loss of contact with reality), hallucinations (seeing or hearing things that do not exist) • impairment of motor skills, and perception, altered bodily perceptions, loss of full control of bodily movements, falls • dry mouth, throat irritation, coughing • worsening of seizures • hypersensitivity (worsening of dermatitis or hives) • higher or lower blood levels of certain medications • nausea, vomiting • fast heartbeat Kathleen Thompson, PhD

39. http://calculator.marijuanacentral.com/how-long-can-a-drug-test-detect-cannabis-usage/http://calculator.marijuanacentral.com/how-long-can-a-drug-test-detect-cannabis-usage/

40. Table 1: Cannabis Use and Approximate Detection Times http://calculator.marijuanacentral.com/how-long-can-a-drug-test-detect-cannabis-usage/ Kathleen Thompson, PhD

41. Imprecise Testing Methods • Testing methods are imprecise and flawed • It is a human rights violation to ask for a test in relation to Persons With Disabilities (PWD) • Providing training to recognize and respond to cannabis impairment is critical • Congratulations to attendees for being proactive! Kathleen Thompson, PhD

42. Mixing Substances increases impairment • Alcohol and cannabis combined leads to greater impairment • Mixing cannabis with CNS depressants can lead to greater impairment (benzodiazepines, barbiturates, opiates, anti-histamines and muscle relaxants) Kathleen Thompson, PhD

43. Conclusions • Act now! Legalization is around the corner • Measuring cannabis impairment is imprecise • Complicated human rights issues at play • Education and training is required • Promote healthy workplace policies • Establish appropriate mechanisms for your workplace • Provide clear guidance • Consistently apply policies Kathleen Thompson, PhD

44. Thank You & Contact Info • Kathleen.Thompson@sasktel.net • Phone: 306-757-0669 (office) • https://twitter.com/tomkatcomm • www.linkedin.com/in/kathleen-thompson-phd • https://www.facebook.com/TomKat-Communications • http://saskvoice.com/ Council of Canadians with Disabilities Kathleen Thompson