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David Hill: In middle school, R. Lorraine Collins looked around at her friends and became fascinated by the idea of self-control.

Lorraine Collins: I was like, what is going on with the fact that some of the people I know are kind of well-regulated and don't have issues, and then others just constantly run into issues with all sorts of behaviors.

David Hill: That early fascination led her to study psychology with a focus on obesity. As a postdoc, she shifted her focus to alcohol, and then, as a researcher in the early ’90s, to cannabis, at a time when hardly anyone was studying it and medical marijuana wasn't even a thing.

Now a SUNY distinguished professor at the University at Buffalo and director of the Center for Cannabis and Cannabinoid Research, Collins is widely recognized as an expert on the use and abuse of the popular weed. In 2018, she was named to a working group tasked with drafting legislation to regulate recreational cannabis use in New York State. That program began rolling out earlier this year.

Welcome to Driven to Discover, a University at Buffalo podcast that explores what inspires today's innovators. My name is David Hill, and on this episode I'll be talking to Dr. Collins about the pros and cons of cannabis legalization.
So you started out researching the idea of self-control. Where did that interest arise?

Lorraine Collins: It did arise in middle school where I had a good friend who often struggled with food, and I and others around her did not. And so I was curious about that.

David Hill: Now, you began researching cannabis long before most others were even doing so. Tell us, how did that come about?

Lorraine Collins: So I had an NIH grant to look at heavy drinkers, particularly focusing on malt liquor. And we ran a survey study, recruited over 600 young people in the Buffalo area. And, you know, you're looking at your findings, and one of the things that really struck me was that about 50% of our sample reported that they use cannabis on a regular basis. That was completely unexpected. And that launched me into cannabis.

David Hill: Now, as a researcher, you are an advocate for legalizing recreational cannabis. What do you see as some of the positives in making it legal?

Lorraine Collins: So the main positive that I see is safety. When you get an illegal substance of any sort, you do not know what you're getting. And especially these days, with fentanyl being used to cut everything, it's really important that people have products that have been tested, products that they know are safe. In the case of cannabis, how it's cultivated can be really important. You don't want a product with pesticides. You don't want a product that's been sitting around gathering mold. So, safety is very important with regard to the product. And then with regard to the person, I do get concerned that as long as cannabis is illegal, that brings people into contact with illegal activities, criminal activities.

David Hill: What are the pitfalls?

Lorraine Collins: So the pitfalls vary. I mean, one very important one is access for youth. We do not want cannabis to be used by adolescents and even into young adulthood. We know, the research is showing us more and more, the ways in which cannabis can disrupt certain aspects of brain development. Cannabis use and driving is a huge issue for many people. Another issue that I think is really important is, just, access. When you have a legal substance that's easier to purchase, you might get people either who haven't used to experiment or want to try it. And then a real concern are the people who have used and now have easier access and so they use more, because we do know that excessive use of cannabis can lead to cannabis use disorder.

David Hill: What do you think New York State got right with medical marijuana and what did it get wrong?

Lorraine Collins: So New York was, I think, appropriate in being cautious. We had licensed dispensaries, probably not as many as people would like, but there was a process for vetting them. There was a process for making sure that the product was safe.

I think we could have done a better job in training around dispensing cannabis. I'm not saying people weren't trained, but what you have to understand is when people get a medical marijuana card, they are given a prescription, quote unquote, that they take to a dispensary. The prescription doesn't say what or how much or what dose. At the dispensary, the people who work there are the ones who talk to the patient about what might help them. And so it's kind of dispensary by spontaneous conversation and sometimes limited knowledge.

And then as the program has evolved, more and more disorders have been added. And the way in which disorders get added, not just to New York, but to any medical cannabis program, seems to be through advocacy, not through scientific research. And so we do have disorders where I get concerned. A very popular one is PTSD. That's a very complicated disorder to diagnose, and it has multiple components, some of which cannabis might address, but some of which could be exacerbated by cannabis. We know that cannabis can exacerbate anxiety. We know that cannabis can exacerbate depression. And so to give someone who's struggling with those particular disorders cannabis in a semi-regulated way, is cause for concern.

David Hill:: Now what about recreational cannabis? Clearly, the state was smart enough to bring people like you to the table before writing the current law. Did New York State take all of the working group's recommendations?

Lorraine Collins: I think the state was smart to bring people together, and I want to let the audience know that the working group was very kind-of diverse in terms of expertise and areas of focus. So we had people from agriculture, mental health, the sheriffs and state police, a wide range of folks, including researchers like me.

Where things went off the rails in terms of our recommendation was, again, I think embracing advocates’ perspectives as opposed to research perspectives. And one of the ways in which I think New York could have done a better job, for example, is collecting data well ahead of the implementation of recreational cannabis. And so our baseline data with regard to the prevalence of cannabis use, especially in high-risk groups, I don't think is all that great.

Another thing that we advocated is that marketing not include any kind of packaging that was really attractive. We wanted plain packaging, just with the relevant information about dose and safety and a few key variables. And my understanding is that marketing will have a whole lot more in terms of labels.

But the underlying issue that I struggle with as a researcher is the lack of research. I mean, we just don't know enough. We're kind of blindly going forward, with legislators who are motivated by a wide range of concerns but less so about understanding what we're doing here.

David Hill: How do you feel New York State is doing on the social justice front?

Lorraine Collins: You know, New York has done quite well in certain areas. I mean, one important area was to expunge criminal records of people who had been arrested on charges that we now consider not as serious as when those arrests were being made, at the height of the war on drugs, especially in New York City. And part of the problem there is, as a state, we were sending people to jail for minor infractions, disrupting communities, and really pulling mostly men out of their families and out of their communities. So those are all problems that the social justice components are seeking to address, and we have begun with expunging records.

Also in the licensing process. There is a license that is available to people from communities that have suffered social disruption related to these drug arrests. And so I think that's all good. One of the things to know, by the way, is that there have been federal cases brought where the notion of giving certain communities a head start in getting licenses has been legally questioned. And so the result of some of that is that the implementation of the cannabis program has been very slow, very frustrating.

David Hill: Now, we've talked quite a bit about New York State’s cannabis regulation. The rules and the laws in New York State are the same as in, let’s say, Nevada or California, right?

Lorraine Collins: No, they're not. I mean, that's part of the challenge of cannabis in the U.S. is that each state is implementing its own regulations. And you mentioned Nevada, which is, you know, I call it the Wild West. Many of us call it the Wild West, because their regulations are just, almost, non-regulation. So, for example, I mentioned dose as being an important concern. When I refer to dose, it's the percentage of THC in the product. In Nevada, you can buy a product that's 90% THC, you know, which is overkill. So we’re not doing that.

But as I mentioned with medical, every state has different disorders that you can get medical cannabis for. Somebody compiled the list, and across the 50 United States, there are 300 disorders for which cannabis can be prescribed. That so does not make sense. Cannabis does have active ingredients that can help, but it's not a panacea for 300 disorders. So I'm a huge advocate for a federal law that would kind of create an equal minimum level of regulation that would help everyone, just to get the lay of the land.

David Hill: Now, you mentioned the federal regulations around cannabis. The federal government still classifies it as a Schedule I drug. What does that mean, and why is that classification a problem for researchers like you?

Lorraine Collins: This happened in the ’30s, and part of the Schedule I designation is that the drug has no medicinal benefits. Well, it turns out that there are components of cannabis that have significant medicinal benefits. People have probably heard about the fact that CBD, which is a component of cannabis, is very effective for certain childhood epilepsies. And the FDA approved a drug called Epidiolex that you can now use to treat those childhood epilepsies. So we do know that there are medicinal benefits. We do know that chronic pain responds well to a ratio of THC and CBD that can be well tolerated.

What people have to understand is how complicated a plant it is. There are over a hundred cannabinoids. I've mentioned two: THC and CBD. Those are the two that we study the most, but we don't know what's going on with the other, you know, 90 or so. So it's really important to get research going.

In order to do research, especially federally funded research, you have to get approval at three levels of the federal government, or three organizations within the federal government. One is the DEA. The other is the FDA. And then in the U.S., for a researcher, the cannabis that you use needs to come from the National Institute on Drug Abuse.

And although NIDA has expanded cultivators of their cannabis and so forth, we're still really constrained by the dose that they provide. It's way lower than the dose that's available at retail. And we're also constrained by the nature of the product. So I've heard complaints: It's been harvested; it gets frozen somewhere; when we get it, it's moldy or participants don't like it, don't respond to it well, because it's not really similar to what they get, whether it's legal or illegal. And so we're really constrained by just the nature of the product that we study.

When you have DEA involvement, you have to have locked facilities. You have to monitor every use. You have to monitor the amount. The infrastructure becomes way more complicated than it would be, let's say, if I needed to do an alcohol study, I could go to the liquor store and buy vodka. I cannot do that. If I buy retail cannabis, even from a New York State licensed retailer, I cannot study that cannabis in my research lab.

The other thing that I will say is, between cannabis and alcohol, I would put alcohol as Schedule I, because we're not aware of, at least I'm not aware of, medicinal properties. Other than when people say, oh, I feel relaxed after a drink.

And there are some effects that are more deleterious than you might find with cannabis. Without going into a long story, the designation of cannabis really came about historically in part because of racism. For example, the word marijuana is a Spanish word for the plant, and it was adopted as a way of maligning the product. It was, you know, at the time in the ’30s linked to jazz musicians and people of color and Mexicans and kind of a whole array of stigmatized or marginalized groups. And so that really drove the way that the federal government designated cannabis. It's definitely not at the same level as heroin, but it's in the same schedule.

David Hill: So are there any movements within the government to reclassify the drug?

Lorraine Collins: I am very pleased to say that we are making progress. The Department of Health and Human Services, HHS, actually sent a letter to the DEA, to ask that cannabis be moved from Schedule I to Schedule III, and that's going to really open things up. However, it's just a request. It doesn't tell us anything about what the DEA might do. And as people have been cautioning everyone, it could take years. But the fact that one federal agency reached out to another federal agency to make this request is a step forward.

David Hill: Well, thanks so much for your time, Dr. Collins. This has been incredibly illuminating.

Lorraine Collins: Well, thank you for having me. One of the things that I try to do as a researcher is to try to relay accurate information about cannabis. There's so much myth, there's so much misinformation, that, you know, you touch the cannabis button, and I'm off and running. So this has been fun. Thank you.