CBD and THC - Meet Your New Neighbors
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
CBD and THC – Meet Your
New Neighbors
Darrin Grondel
Vice President, Government Relations and
Traffic Safety – Responsibility.org /
National Alliance to Stop Impaired Driving
Amy Miles
Director of Forensic Toxicology, National
Resource Toxicologist – WI State Lab of
Hygiene, UW School of Medicine and
Public Health
1
Session Objectives
• Discuss the national perspective and rules around CBD, THC and
isomers
• Outline the toxicology of CBD, THC and isomers and adulterants
• Explain Computerized Assessment and Referral System (CARS) to
identify substance abuse and mental health issues
2
Darrin – national
perspective
3
What do we know about Cannabis?
480 Chemical Compounds Cannabigerol CBG
66 – 113 cannabinoid compounds Cannabichromenes-CBC
Delta 9 – THC (1964) Cannabinodial CBDL
now Delta 8, 9, 10, 11,? Cannabicyclol CBL
Cannabinol CBN (1899) Cannabielsoin CBE
Cannabidiol CBD (1963) Cannabitriol CBT
Cannabidivarin CBDV
http://learnaboutmarijuanawa.org/factsheets/cannabinoids.htm
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3736954/
4
SIGNS AND SYMPTOMS of MJ
IMPAIRMENT
THC/CBD and similar
compounds bind with
receptors (CB1 and CB2)
in the brain and other
parts of the body
affecting the function of
the hippocampus (short-
term memory),
cerebellum
(coordination) and basal
ganglia (unconscious
muscle movements).
• Marijuana is a lipid (fat) soluble and tends to stay in the brain
• Alcohol is water soluble - blood Reference - http://www.brainwaves.com/
5
https://cbd.market/cbdblog/cbd-oil-legality-in-usa
6
Hemp vs. Marijuana?
• Morphological characteristics of the plant (macroscopic,
microscopic, smell, etc.) are exactly the same.
• A person cannot tell the difference by looking at or smelling
the plant.
• The only way to differentiate is through laboratory testing to
determine THC concentration.
• How does the user know what they are consuming – the
packaging!
https://www.endoca.com/
7
Regulation of CBD
• Is CBD legal in the U.S? Agricultural Improvement Act – the 2018 Farm Bill allows for CBD from Hemp – Sativa Plant
• Federal - Food and Drug Administration has not approved CBD for any disease or condition
• Exception - Epidiolex – Purified form of CBD – Seizures - Lennox-Gastaut syndrome or Dravet syndrome, and tuberous
sclerosis complex.
• Prescribed by a medical provider and medication guide due the impacts
• The Federal Food, Drug and Cosmetic Act (FD&C) addresses unapproved products with product claims it treats, diagnosis,
mitigates, treats or cures various diseases.
• Is it legal in your State? Check your state laws as they differ (https://www.ncsl.org/research/health/state-medical-marijuana-
laws.aspx)
• Some states legalized for CBD products that are approved by the Food and Drug Administration (FDA), so is this a
safeguard for the state?
• Some include both FDA approval and
Regulation
• Manufacturing process of CBD products has not been assessed by the FDA
• “A regulatory standard for labeling accuracy of CBD does not exist” (Geoffrey et al, 2021)
• No third-party regulatory process nationally or at state level to verify product ingredients, contaminants, or quality.
• FDA sent out five warning letters in December of 2020 to companies who are illegally selling unapproved CBD
products in violation of the FD&C.
• Impaired Driving – the FDA found that CBD can cause sleepiness, sedation, and lethargy, based on their research
with Epidiolex. Remember, if stopped and taking CBD products with THC concentrations, the THC could be
detected.
9
Regulation – Labeling – Adulteration
• Horth, R. Z. et al, Acute poisonings from a Synthetic Cannabinoid - Utah 2017- 2018
• Clear case of why we need regulation, accuracy in labeling and concerns of adulteration
• 52 people identified
• Branded as “YOLO CBD Oil”
• “Nine product samples (including one unopened product purchased by investigators from a store and brand
reported by a patient) were found to contain a synthetic cannabinoid, 4-cyano CUMYL-BUTINACA (4-CCB), but
no CBD.”
• Symptoms – altered mental state, nausea or vomiting, and seizures or shaking, anxiety, unconsciousness.
• 73% vaped, 17% sublingual
• 67% Recreational, 28.8% Medical,
10Adulterations
CBD products are not regulated and is subject to concerns about product labeling, contaminants, or
adulterations…
(Gurley et al., 2020) research on labeling consistency for cannabidiol (CBD) products examined
25 different commercial samples obtained in the state of Mississippi.
•Only three were within 20% of claimed labeling
•15 were well below stated claims
•Two exceeded claims by more than 50%
•Three exceeded the legal limit of 0.3% THC content
•Four products marketed for vaping were contaminated with synthetic cannabinoids (potential
for acute and chronic health effects)
Gurley, B. J., Murphy, T. P., Gul, W., Walker, L. A., & ElSohly, M. (2020). Content versus Label Claims in Cannabidiol (CBD)-Containing Products Obtained from Commercial Outlets in the State of Mississippi. Journal of
Dietary Supplements, 17(5), 599–607. https://doi.org/10.1080/19390211.2020.1766634
11THC Concentrations over the Years
1973 3%
2008 10%
2019 20%
-
Cannabis flower being sold in stores
30%
12THC Potency Used In
Most Government Studies addressing crash risk
13Toxicology of THC,
THC isomers and
CBD
14CANNABINOIDS • D9 most readily studied of all isomers • D8, D10 quickly becoming prolific as alternative to D9 with limited scientific data • CBD still available, reports of users turning to isomers • Active metabolite of D9 = 11-hydroxy-THC • Route of administration effects metabolite ration profile
Route of Administration
• Oral
• Edibles
• Smoking
• Vaping
• Typical smoking
• Concentrates
• Oils
• Waxes
16Delta-9-THC (parent)
Psychoactive component in THC
Very short half life
11-Hydroxy-THC (metabolite)
Equipotent to delta-9-THC at certain
concentrations
Very short half life
Carboxy-THC (metabolite) *Only
reported analyte for urine*
No psychoactive impairment
Longer half life
17The Feel Good Factory
18Contains 20% CBD Contains 10% CBD
19Delta - 7 Delta - 8
THC Isomers
Delta - 10 ?
20Shutterstock
21Consumer Products
22Regulations?
• No FDA oversight
• “Tested” products are
misleading
• Common adulterants
include synthetic
cannabinoids
2324
• Products contained an excess of 0.3% THC
• Synthetic cannabinoids detected in products marketed for vaping
• “From this small, but diverse, samples of hemp-derived merchandise,
it appears that most product label claims do not accurately reflect
actual CBD content and are fraudulent in that regard.”
25Case Histories
26Cannabis Impairment
Detection Workshops
27Cannabis Impairment Detection
Workshop Handbook:
o New publication from the National District Attorneys
Association’s National Traffic Law Center and
Responsibility.org
o Provides answers on how to host and conduct Green
Labs
o Potential issues highlighted with solutions
o Addresses LE hosted workshops and those conducted
by contractors
o Recently utilized by Maryland State Police for their police
agency-hosted workshop
https://www.responsibility.org/wp-content/uploads/2020/11/FAAR_4090-Cannabis-Impairment-Detection-Workshop-Handbook_V-3-002.pdf
28HOW: Classroom curriculum: Potential topics- • Current products available • Ingestion methods and consideration of duration of effects • THC v. CBD • Different types of high (Indica/Sativa strains) • Polydrug use (cannabis and alcohol) • How cannabis impairs a driver • General indicators of impairment • SFSTs/ARIDE roadside tests and how they specifically point to cannabis impairment • Wrap up / critique
HOW:
Lab/workshop curriculum
Potential Topics-
❖General indicators of cannabis impairment
❖SFSTs/ARIDE roadside tests and how they
specifically point to cannabis impairment
o HGN expectations
o Importance of ARIDE tests
o Frequent users versus occasional users
o Oral fluid as a screening device roadside
tool
o Q & A with consumers
• Direct interaction with users in a
controlled environment at optimal
impairment time
• Medic presentEnforcement (optional)
o To be conducted directly following training (classroom &
lab)
o Saturation patrol and/or checkpoints
o Events in the area (concerts, festivals)
o Important dates (April 20th, July 10th)
Montgomery County stats after first lab:
• Total traffic stops:47 stops
• Total traffic citations: 40 citations
• Total traffic warnings: 47 warnings
• Additional:
• 1 DUID (DRE performed-determined to be under the
influence of cannabis)
• 1 DUI alcohol
• 2 Civil citations for possession of marijuana under 10
grams
• 1 PWID marijuana arrest ($1760.00 seized along with
marijuana)Computerized
Assessment and
Referral System
(CARS)
32High Risk Impaired Drivers
Conviction Focused Approach Individualized Justice Approach
Law enforcement trained only on alcohol Expanded DUID training (ARIDE, DRE, oral fluid)
Test only for alcohol if per set limit reached Test for alcohol and drugs
Multiple prosecutors handle a single DUI case Vertical prosecution
Cases heard in criminal/civil courts DUI and treatment courts
Inconsistent screening & assessment using generic tools Screening & assessment at multiple phases using tools
validated specifically among the DUI population
Emphasis on punishment (fines & jail) as prescribed in Investment in treatment and supervision determined by
statute multidisciplinary team and informed by assessment
Probation generalists Mental Health/SUD probation specialists
Siloed data systems Linked impaired driving data system
Leverage your State DUI Task Force or
Impaired Driving Work GroupsHigh Risk and Repeat Offenders 34
Criminogenic Risk Factors
History of Family/
Anti-social Leisure/
anti-social marital
cognitions recreation
behavior discord
Anti-social
Anti-social Substance School/
personality
associates abuse work
pattern
35Mental Health?
While not a criminogenic need, it is imperative that mental health issues be
identified and treated to adequately address other risk factors.
36Development of CARS
• CARS was developed by a team of researchers from Cambridge Health Alliance, a teaching affiliate of
Harvard Medical School.
– Initial grant funding was provided by NIAAA; Responsibility.org continues to fund CARS research and
implementation.
• The goal was to create an assessment tool specifically for a DUI offender population that fills the mental
health void that exists with traditional instruments.
3738
What is CARS?
Diagnostic
report
generator
Mental
Case Brief
management health intervention
assessment
Referral
database
39What is CARS?
• Diagnostic report generator that gives providers and clients:
– Immediate diagnostic information for up to 20 DSM-V Axis I disorders (onset, recency, persistence).
– Geographically and individually targeted referrals to treatment services based on the
outcomes of the assessment.
Substance
dependence
Intervention
Mental health
issues
40CARS comprehensive mental health screener domains
Panic disorder Social phobia Eating disorders
Attention deficit/hyperactivity Obsessive compulsive
Intermittent explosive disorder disorder
disorder
Depression Generalized anxiety Suicidality
Mania/bipolar disorder Post-traumatic stress disorder Conduct disorder
Oppositional defiant Psychosis Nicotine dependence
disorder
Alcohol use disorder Drug use disorder Gambling disorder
Psychosocial stressors DUI/criminal behavior
41How does CARS work? 42
How does CARS work?
• Individual diagnostic reports have been programmed to provide
information about the mental health disorders for which a person
qualifies or is at risk, as well as a summary of bio-psycho-social risk
factors.
• The CARS tool includes a section on DUI behavior.
– The data obtained from the questions in this section is integrated
with other risk factors to generate an overall DUI recidivism risk
score.
– A graphic is generated as part of the outcomes report that indicates
where an individual is within a range of low to very high risk.
43CARS Report 44
CARS Report 45
Bridging the gap…
• Unlike traditional assessments,
CARS has a built-in referral system.
• CARS has been designed to include
a list of individually-targeted
referrals at the end of each report
based on an individual’s issues and
zip code.
• Before CARS can be implemented,
the referral list must be populated
with treatment services that are
available within that jurisdiction.
46Benefit of CARS • Provides immediate diagnostic information for up to 20 major psychiatric disorders. • Provides geographically and individually targeted referrals to appropriate treatment services. • Generates user-friendly reports at the click of a button. • Informs supervision and treatment decisions. • Runs on free open-source software. • Can be used by non-clinicians. • Applicable in a number of settings. 47
National Roll-Out
CARS was launched for
general use in June 2017.
Available to any court,
probation department, or
program free of cost.
Online web portal for
downloads and training:
www.carstrainingcenter.org
48Contact Information
Darrin T. Grondel
Vice President – Government Relations and Traffic Safety
Darrin.Grondel@Responsibility.org
571-309-7615
Amy Miles
Director of Forensic Toxicology
Wisconsin State Laboratory of Hygiene
UW School of Medicine and Public Health
Direct: 608-224-6247
amy.miles@slh.wisc.edu
/GoFAAR @goFAAR @go_FAAR /faar /GoFAAR
49You can also read
