Dr. Jason Kilmer shared his lessons learned from state cannabis legalization for campus policy and enforcement:

1. Be aware of terminology and language.

• Students don’t always know what cannabis means. You want to cast a wide net when talking about cannabis.  Rather than solely referencing “smoking,” it is much more inclusive of the range of products to reference “using cannabis” or “cannabis use” to account for gummies, edibles, dabbing, hash oil, budder, shatter, vaping, etc.  Even in surveys, consider defining cannabis or at least initially referencing “cannabis/marijuana” since the latter is term most familiar to college students.

2.  Look at your campus data. Realize that most students don’t use cannabis.

• Those who use weed heavily don’t believe the norms.
  https://doi.org/10.1037/0893-164X.14.3.295
• Most people aren’t using.  Even among college students and past 30 day rates of use, 75% don’t use.

3.  Get people on board with the understanding that this is not “just weed”, including law enforcement.

• It stopped being “just weed” years ago. The high potency of THC is not natural. Researchers consider anything over 10% THC to be “high potency” cannabis.  THC concentration/potency has changed from 1%-1.5% in the 1970s to 2-3% in the 1980s to 4% by the mid-1990s to where it is today.  In Washington, smokeable bud or flower typically ranges from 20-30% THC, and concentrates (e.g., dabs, wax, hash oils) range from 60-90% THC.
  • 95% of Colorado recreational cannabis market is “high potency” cannabis.
    https://doi.org/10.1371/journal.pone.0230167
  • In the state of Washington, the legal cannabis market is currently dominated by high THC cannabis flower, and features growing expenditures on extracts.
    https://onlinelibrary.wiley.com/doi/abs/10.1111/add.13886
• Potency matters because the risk of developing cannabis use disorder or addiction, particularly among adolescents, increases dramatically with use of high potency cannabis products. https://adai.uw.edu/cerp/high-potency-cannabis
• The more often people use high potency cannabis over 10% THC, the greater the likelihood of developing a psychotic disorder,  cannabis use disorder, or generalized anxiety disorder. JAMA Psychiatry, 77, 1044-1051. doi: 10.1001/jamapsychiatry.2020.1035.

4.      Look at lessons learned from alcohol.

• Consider a mix of individual and environmental strategies. Looking at CollegeAIM Matrix
  • Increased enforcement (e.g. compliance checks) is effective in reducing sales to minors by at least 50%. Enforcement needs are there for cannabis. [JRK1]
• Implement, enforce laws, and increase publicity of enforcement of laws.
• Restrict alcohol retail outlet density near campus.
• Support for policies and enforcement is there! Saltz found a universal tendency to underestimate support for prevention policies, particularly those with some “teeth” to them. (2007) https://doi.org/10.1080/14659890701262320
  • This suggests efforts to correct students’ perception of peer alcohol consumption may want to correct perceptions of  peer support for policies as well.
• An effective mix includes policies, enforcement, treatment, education, prevention, and intervention and recovery.

5. Nothing should change on campus. – Enforce policies and be mindful of mixed messages.
    https://safesupportivelearning.ed.gov/sites/default/files/hec/product/dfscr.pdf

• Each school must certify it has adopted and implemented a program “to prevent the unlawful possession, use, or distribution of illicit drugs and alcohol by students and employees as a condition of receiving any federal funding.
• Schools need to prepare a biennial report on the effective of its AOD programs and the consistency of enforcement.

6. Communicate policies as early as possible to students, staff, and faculty.

• Message: nothing changes on our campus.

7. Make sure those policies are clear wherever relevant on campus, and make sure those policies are enforced.

• Make sure people responsible for enforcement know about it.
• R.A.s have an impact. When they enforce policies consistently, it impacts student behavior[JRK2] .

8. Consider event-specific prevention and/or enforcement, particularly if it’s an event where there will be driving.

• On 4/20, risk of fatal crash goes up.
  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5876802/
• 7/10 is considered to be a secondary “holiday” for consuming cannabis concentrates. Don’t introduce it the idea of this to those who haven’t thought of it, but be aware of potential activities on July 10th.
• Five years after Washington State legalized recreational cannabis, the proportion of fatal-crash-involved drivers who are THC positive was double the level before legalization.  https://aaafoundation.org/cannabis-use-among-drivers-in-fatal-crashes-in-washington-state-before-and-after-legalization/

9. Consider screening in health and counseling centers, and go a step further with SBIRT, especially since motivational enhancement-based brief interventions show promise.

• In-person personalized intervention using MI works.
  https://pubmed.ncbi.nlm.nih.gov/23750464/
• Consider screening with CUDIT-R for screening.
  http://www.warecoveryhelpline.org/wp-content/uploads/2018/04/CUDIT.pdf

10.   If considering harm reduction approaches, recommend “lower risk” rather than “low risk” use.
        https://www.sciencedirect.com/science/article/pii/S0955395921002863

• There is no safe level of use.
• While there is no one safe route of administration, smoking is the most risky and an alternative method of use should be considered if people make the choice to use.
• Use lower potency products.
• Keep use occasional (no more than one or two times a week, weekends only).
• Use legal and quality-controlled cannabis products.
• If a person notices it impacts their attention or memory, they should stop use.
• Avoid driving.
• Some groups should avoid cannabis completely, such as people with a mood disorder.

11.  Correct misperceived norms.

• Correct norms include:
  • Most people are not using.
  • Most people are not driving under the influence.
    The more people use, the more they think others are using. Use:
    • Personalized normative feedback
    • Personalized feedback interventions
    • Social norms campaigns

12.  Consider what you’re offering to people 21 and older.

• 21-25 year-olds were using cannabis more frequently across all indicators (past year, at least monthly, at least weekly, and at least daily) and had increased symptoms of cannabis use disorder in six years after Washington State legalized recreational cannabis.  https://pubmed.ncbi.nlm.nih.gov/35319936/

13.  Realize the amazing influence parents and caregivers can have.
        https://www.collegeparentsmatter.org/cannabis.html

14.  You can do everything right and there can still be speed bumps along the way.

Discussion

• If you can get administrators on board, that’s huge.
• Beware of mixed or confusing messages, especially ones that are not in line with the campus mission of student success (e.g., books about “pot games” or edibles cookbooks displayed prominently in the bookstore).
• Student Advisory voices are important. Too often administrators only hear from students who complain about cannabis policies and enforcement.
• Messaging about federal law is important: “Nothing is changing.” If we’re committed to student success, this matters.
• Engaging student leaders to support policies is effective.
• Employees who use cannabis off campus and test positive for THC on campus can be found in violation of federal law by their college/university.