Cannabis – Matters of Substance

Some time ago there was an anthropologist who lived amongst a North American tribe. He noticed that from time to time the tribe would meet in a circle. They talked and talked and talked –for what seemed like no purpose at all. There was no leader and no agenda. No decisions were made. Although tribe members tended to listen to the elders a bit more – wise men and women- everybody in the circle participated as equals. The meeting went on until it stopped and the group dispersed. The anthropologist didn’t understand until one day the tribe was challenged. What he observed was remarkable. Everybody understood each other so well that they knew what to do. There was no crisis. They could easily move towards action having recognized the beliefs, values and perspectives that reside inside their community. -David Bohm, On Dialogue

We know that strong communities make for healthier citizens. And when our communities nurture human connections, we are better able to face social challenges. But in our day and age, we have stopped investing in community understanding. Polarizations exist and we have stopped talking to each other. Competitiveness and self-interest have made it difficult to truly hear each other. We find it hard to deal with divergent opinion or contested evidence. As a result, our conversations tend to mimic our civic life of disconnection.

So, how do communities build strength and resilience, especially in light of upcoming cannabis policy changes?

Dialogue is a way to create trust and explore new possibilities for a community. It is deeply needed in our divided world. Addressing complex issues such as cannabis legalization requires that we come together as a community and build understanding. Similar to the members of the tribe, we need opportunities to talk with each other in safe environments and create connection. Few of us ever take the opportunity to engage respectfully with people who hold different views. Our social networks are generally made up of people who share our beliefs. Yet when we engage with people who are different from us, we get to see another side of the human story. Even if we do not wholly agree with the new perspective, listening openly and empathically expands our understanding.

What exactly is dialogue?

Ironically, dialogue is more about listening than talking. The sort of listening that is important in dialogue demands our empathy and our genuine curiosity about the experiences of other people—including their assumptions, beliefs and values. When people feel listened to, they also feel validated and respected. The experience of being listened to empathically widens our minds and opens our hearts—and prepares us to listen appreciatively to others with the same kind of engagement and respect, even to people with radically different experiences and points of view.

Unlike other forms of public communication (for example, debates or negotiations), dialogue is not meant to lead immediately to agreement or action. Instead, the hope is that we will come away from dialogue with a new understanding of the subject, of each other and of ourselves. This new understanding enables us to work together more effectively as community members. As a result, our communities become more flexible, and better able to respond to challenges. And as individuals and communities, we develop a greater sense of control over our own lives and well-being.

Dialogue is more than a process or methodology—it is a way of being. It is an art that requires reflective practice. It is the skill of connecting and building bridges between individuals with different views, especially in times of change.

What does dialogue about cannabis look like?

Communities across Canada have expressed divergent opinions and concerns about legalized cannabis. A national partnership was formed to help communities create spaces where people can come together and build understanding of each other, of themselves and of the subject.

Communities are doing everything from conversation cafés to photo voice to walking tours to spark the dialogue about cannabis. With a focus on questions rather than answers, participants are moving towards a deeper space of inquiry together. Dialogue encourages us to be creative and move away from typical large-scale forums that privilege “expert” opinion. While providing information is important, the real challenge is to level the playing field and maximize opportunities for community members to interact, exchange views and acknowledge each other’s values, beliefs and assumptions. Opportunities like this might start to address some of the polarizations we see today and also create a foundation for communities to start working together instead of apart.

Endnote:

Let’s Talk Cannabis is led by the Canadian Institute for Substance Use Research. The partnership includes the Canadian Centre on Substance Use and Addiction, the British Columbia Ministry of Health, Alberta Health Services, the Saskatchewan Ministry of Health, the Thunderbird Partnership Foundation, and the Newfoundland and Labrador Department of Health and Community Service. Due to the difference from other forms of communication, resources were developed to aid communities in understanding and facilitating dialogue.

Kristina Jenei, coordinator, Let’s talk Cannabis project

**Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Canadian Institute for Substance Use Research.

Health Canada reports that the ability to drive or perform activities that require alertness may be impaired for up to 24 hours following a single joint. A report from the National Highway Traffic Safety Administration in the U.S. with expert advice from six toxicologists states that some investigators have demonstrated residual effects in specific behaviors up to 24 hours, such as complex divided attention tasks. The World Health Organization reports “human performance on complex machinery can be impaired for as long as 24 hours” after smoking a moderate dose of cannabis.

The source of the claim of 24-hour deficits from each of these above mentioned reports—just a few of many that exist in literature around cannabis impairment—is based on a single 1991 study by Leirer et al. The findings of this study has received an extraordinary degree of acceptance, but this study has multiple methodological issues, including a failure to randomize conditions, a failure to conduct a pre-test of the methods, and retention of unreliable measures. Let’s take a closer look at some of the problems with this study.

The study’s claim that performance deficits continue 24 hours after using cannabis is not justifiable based on the methods reported. The researchers did not report random assignment of conditions or a crossover design, which is when everyone participating in the study receives all the treatments being investigated (in this case, it would mean all the subjects smoking both the cannabis cigarette and the placebo at different points). These two approaches are essential to reduce the likelihood of bias in a study. In describing their procedures, Leirer always refers to the marijuana condition first. In this type of research design, the marijuana condition is confounded with practice effects (i.e., subjects do better on tasks with more experience). Furthermore, the authors did not report any blinding of researchers, which is the practice of ensuring that researchers and/or participants are unaware of information that might influence their behaviour or decision. This is an important component of high quality studies, and its omission opens up the possibility of researcher bias.

Finally, two measures (far target detection and engine malfunctions) were dropped from the analysis after data collection was complete because they were not reliably recorded. The proper procedure for a study is to decide on valid measures at the onset of the study and to keep them throughout the study, not to drop them after looking at the data. Interestingly, the data for near targets was kept, even though the same procedures were used to collect this data as far targets. At 24 hours, subjects performed worse than any other time point, including 15 minutes after use!

Are there other, better studies? Absolutely. I found eight laboratory studies that examined long-term performance deficits from cannabis use. Three of them (Chait et al., Fant et al. and Ronen et al.) were much higher quality with randomized/counterbalanced and double blind designs and no other major limitations were found. None of these studies found performance deficits that exceeded 4 hours.

Table 1. Studies of hangover effects from cannabis

The claim of 24-hour deficits from a cannabis joint in occasional users is dubious at best. So how did prevailing scientific thought become so distorted?

I have a couple of explanations for why this has happened. First is publication bias. In science, there is a bias among journals to publish findings that are statistically significant and consistent with researcher’s hypotheses. This accepted bias toward publishing studies with significant findings also can be reflected in conclusions that authors of review articles choose to report – that is, there is a tendency to ignore non-significant findings in favour of ones that are significant.

Second, there is a bias toward reporting findings that are consistent with a public-health perspective. The vast majority of research in the illicit drug field is aimed toward describing the harms associated with use and how to prevent, treat or reduce them. If harms of illicit drugs are not found, then the reason to be for focusing on public-health issues cannot be achieved.

Conclusion

In this series, I have compared our knowledge of alcohol with cannabis in relation to driving and Canadian legislation to reduce driving casualties. The safety benefits of the breathalyzer for detecting alcohol impairment are substantial and undeniable. A large body of credible research shows alcohol negatively affects performance in a dose-response relationship and the BAC level from breath tests is an excellent measure of performance deficits. As well, alcohol is eliminated from the body at a constant rate and is water soluble, which means there is a close relationship between alcohol in the blood and performance. Although alcohol can cause long-term effects, such as those due to hangovers, the breathalyzer cannot detect such deficits. For cannabis detection, the story is much different. The blood tests are inconvenient, difficult to administer in a timely fashion and poor relationships between low levels of THC and performance deficits. Impairment at the proposed 2 and 5 ng/ml cut-offs appear to be very low compared to the impairment at 0.05% and 0.08% BAC for alcohol. Using such low cut-offs to compensate for time delay in getting the blood samples is not defensible in light of the variable rate at which THC blood concentrations decline over time and between individuals. Finally, the theory of 24-hour impairment does not provide a rationale for adopting low THC cut-off levels.

Although research does show cannabis impairs performance, we don’t have any valid method of determining these deficits, unless blood tests are administered almost immediately when impairment is suspected, and a much higher level is found. The proposed legislation for cannabis impaired driving does not pass the standard we should expect for Canadian criminal law.

Read our Cannabis and Driving blog series:

Part 1: Proposed federal legislation on cannabis and alcohol impaired driving

Part 2: The safety benefits of alcohol breath-testing: a research summary

Part 3: The safety benefits of THC blood testing: a research summary

Scott Macdonald is the Assistant Director of research at the Canadian Institute for Substance Use Research and a professor in the School of Health Information Science at the University of Victoria. He has been an expert witness in several cases related to drug testing in the workplace. Material from this series is taken from his book, Cannabis Crashes: Myths and Truths, Lulu Press.

**Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Canadian Institute for Substance Use Research.

Tag: Cannabis

Strengthening community through dialogue: Let’s Talk Cannabis

The myth and origins of 24-hour performance deficits from cannabis