Health Policy News Roundup
Marijuana, Menthol Cigarettes, and Long COVID Research
It’s been a busy few months (errr, years) when it comes to health and science. Let’s do a brief roundup of a few health policy-related stories splashed across the headlines.
Federal rescheduling of marijuana.
We have a deep dive coming on Unbiased Science on this topic but here’s a summary: The U.S. Department of Health and Human Services (HHS) recommended reclassifying marijuana from a Schedule I to a Schedule III drug, potentially easing research restrictions and reducing federal penalties under the Controlled Substances Act (CSA).
This move aims to recognize the medical use of cannabis federally, even though 41 states have already legalized it for medical purposes. It would also acknowledge that cannabis has less risk for misuse compared to other scheduled drugs like heroin.
Key findings from the DEA report linked above:
Lower Public Health Risks: HHS concluded that the public health risks posed by marijuana are lower compared to other drugs of abuse (e.g., heroin, cocaine, benzodiazepines), based on an evaluation of various epidemiological databases for emergency department visits, hospitalizations, unintentional exposures, and overdose deaths.
Less Harmful Than Alcohol: Marijuana also proved far less harmful than alcohol when measuring adverse health events, overdoses, and the prevalence of driving under the influence.
It is very important to note that the report doesn't directly compare marijuana to heroin specifically, it highlights the lower risk profile of marijuana compared to other substances currently classified as Schedule I, which includes heroin. This provides strong support for the argument that marijuana should be rescheduled to a lower category since it underscores the lower potential for abuse and dependence. It also emphasizes the importance of responsible use initiatives and education to protect the public and further reduce potential risks associated with cannabis use.
Some key points:
Rescheduling to Schedule III would still prohibit recreational use and possession without a prescription, subjecting it to potential criminal penalties. Notably, it would not free those currently incarcerated on cannabis charges or expunge records.
The rescheduling creates some confusion as the federal ban conflicts with state-level legalization for recreational use in 24 states. The legal distinction between marijuana and hemp products also adds complexity to the matter.
Benefits could include increased research potential and allowing cannabis businesses to claim tax deductions. But it may simply open the market for pharmaceutical companies rather than supporting existing state-licensed dispensaries.
Concerns exist about added federal oversight from the DEA and FDA, including production quotas and requiring pharmacists to dispense cannabis like other controlled substances.
The move contradicts President Biden's stated goal of ending jail time for simple cannabis possession. It's unclear if it will lead to more comprehensive reforms or tighter restrictions on hemp-derived products instead.
Dr.
published a fantastic piece in Medpage on this topic. In it, he shares that the path forward remains “hazy”, with many unanswered questions about how rescheduling will play out in practice and if it truly aligns with both scientific evidence and increasing public support for full legalization.P.S. Unbiased Science covered research on THC (and, separately, CBD) if you want to learn more:
Menthol Cigarette Ban Proposal.
Let’s talk about menthol in cigarettes. The FDA is moving forward with a proposal to ban menthol cigarettes and flavored cigars, aiming to reduce youth tobacco use and health disparities. But it’s a pretty complicated issue that goes back well over a decade.
The journey to potentially ban menthol cigarettes started with the Family Smoking Prevention and Tobacco Control Act (TCA) of 2009 (which I studied extensively while in grad school).
Here's a quick timeline and summary of key points:
2009: The TCA gave the FDA authority to regulate tobacco products and banned all characterizing flavors (other than tobacco and menthol) in cigarettes. Menthol was notably exempted from this ban due to intense lobbying from the tobacco industry and concerns about potential unintended consequences like a black market for menthol cigarettes.
2011: The FDA's Tobacco Products Scientific Advisory Committee (TPSAC) issued a report concluding that menthol cigarettes pose a greater public health risk than regular cigarettes and recommended removing them from the market.
2013: The FDA issued an Advance Notice of Proposed Rulemaking (ANPRM) to gather public comment on the potential regulation of menthol in cigarettes.
2022: The FDA proposed rules to ban menthol as a characterizing flavor in cigarettes and all characterizing flavors (other than tobacco) in cigars.
The exclusion of menthol in the 2009 ban has been a major point of contention, as it's argued that this exemption perpetuated racial health disparities due to the targeted marketing of menthol cigarettes towards African Americans. Public health groups have very vocally urged the FDA to remove menthol flavor from cigarettes, cigars, and cigarillos for over a decade. After being sued for inaction on this issue, the FDA reported in April 2021 that it planned to move forward to remove menthol from cigarettes and all flavors, including menthol, from cigars. In October 2023, the proposal was finalized by the FDA and sent to the White House Office of Management and Budget for review. Now, in 2024, we wait to see if the ban will crystalize.
Take a step back, why is menthol such a hot topic? Menthol, a chemical added to cigarettes, makes them easier to smoke and more difficult to quit. This is because menthol creates a cooling sensation that masks the harshness of the smoke and suppresses coughing. The menthol also creates a numbing sensation that allows people to take deeper inhalation of cigarettes, increasing nicotine exposure. These effects can make menthol cigarettes more attractive to young and inexperienced smokers, increasing the likelihood of addiction.
Here are some of the key issues related to menthol use:
Appeal to youth: Menthol cigarettes are more appealing to youth and young adults, making them easier to start and harder to quit compared to non-menthol cigarettes. Menthol use is higher among certain populations, particularly African Americans, leading to health disparities (Black American smokers predominantly use menthol cigarettes. As of 2020, 81% of Black smokers use menthol cigarettes).
Marketing and targeting: The tobacco industry has historically targeted specific communities, particularly African Americans, women, and teens, with menthol cigarette marketing, leading to disproportionate use and health consequences.
Stanford Medicine’s SCOPE mapped out the history of targeted marketing efforts:
Billboards: Menthol cigarette billboards have been placed in predominantly Black inner-city neighborhoods
Free samples: Street vans have distributed millions of free packs of menthol cigarettes
Magazine ads: Ads have appeared in Ebony and Jet magazines and Black community newspapers
Retail promotions: Menthol products have been given more shelf space in neighborhood stores
Community events: The tobacco industry has sponsored community events
Marketing campaigns: Campaigns have featured prominent Black athletes and entertainers, and have been youth-oriented
Left: A Kool cigarettes advertisement targeting Black communities for a sponsored event, the Kool Jazz Festival; Right: A Newport cigarettes ad targeting young Black customers.
Source: Stanford Research into the Impact of Tobacco Advertising
This snippet also stood out from Stanford’s report:
“From the 1920s through the 1950s, the industry aimed menthol cigarettes toward ‘health-conscious smokers’ (GASP!), using claims that the additive could soothe your throat if you had a cold. By the 1950s and '60s, menthol cigarettes were marketed as fashionable to women -- advertisements suggested the taste was better and their breath would smell better.”
Removing menthol cigarettes from the market is likely to have substantial public health benefits by reducing smoking initiation and increasing cessation rates. Time will tell if the policy passes and menthol is removed as a flavor additive in cigarettes.
Long COVID Research and Treatment.
Ok so, no-- there isn't a single, comprehensive proposed policy specifically for Long COVID research and treatment, but there have been significant actions and initiatives at the federal level to address the growing concerns surrounding this condition that I thought you might find interesting. Here's a summary:
RECOVER COVID Initiative:
The National Institutes of Health (NIH) launched the RECOVER COVID Initiative (“Researching COVID to Enhance Recovery”), a $1.15 billion nationwide research program to understand, treat, and prevent Long COVID, which is supported in part through the American Rescue Plan Act of 2021. It seeks to identify how people recuperate from COVID-19 and who is at risk for developing post-acute sequelae of SARS-CoV-2 (PASC) aka Long COVID. This initiative includes clinical trials to test potential treatments, studies to identify the biological mechanisms underlying Long COVID, and efforts to collect data from diverse populations to understand the full spectrum of symptoms and risk factors. This funding supports a wide range of research projects, including clinical trials, basic science research, and epidemiological studies.
So, why is this in the news? Deidentified data from thousands of adults with long COVID are now available to researchers! Secure data from over 14,000 adults participating in the NIH's long COVID observational research are now accessible to authorized researchers via BioData Catalyst (BDC), a cloud-based platform developed by the NHLBI. This dataset includes information from over 92,000 study visits collected between October 2021 and September 2023 at 79 U.S. locations through the NIH RECOVER Initiative. By providing secure access to data, tools, and resources, BDC aims to accelerate scientific innovation, collaboration, and discovery in long COVID research. This initiative will help researchers identify and explore long COVID connections, ultimately leading to better diagnosis and treatment options for this condition. New RECOVER data will be added to BDC regularly. (We data science nerds are very excited about this!)
Other research initiatives and funding for Long COVID research include the following:
Office of Long COVID Research and Practice:
In July 2023, the Department of Health and Human Services (HHS) established the Office of Long COVID Research and Practice to coordinate and enhance efforts across the federal government. This office aims to improve the lives of individuals with Long COVID by accelerating research, expanding clinical care, and providing resources and support for patients.
National Research Action Plan on Long COVID:
HHS released a National Research Action Plan on Long COVID, which outlines a comprehensive and equitable research strategy to inform the national response. This plan prioritizes research on the underlying mechanisms of Long COVID, the development of effective treatments, and the identification of strategies to prevent and mitigate the condition.
Various organizations and experts have issued policy recommendations to address Long COVID, including calls for increased research funding, improved data collection and surveillance, expanded access to care and support services, and the development of a comprehensive national strategy to address the long-term consequences of the pandemic.
While these initiatives and recommendations represent significant progress in addressing Long COVID, there is still much work to be done. The development of a comprehensive national policy for Long COVID research and treatment remains an ongoing effort, with ongoing discussions and debates among policymakers, researchers, and patient advocacy groups.
P.S. Remember that we recently covered Long COVID in a newsletter and post. Check them out for a refresher!
Did you enjoy this rundown? I hope so. Can’t wait to share more public health content with you soon. Thanks for your support!
xo Jess
Great round up on current hot topics!! Thanks!!