Study Shows Cannabis Use During Pregnancy Doesn’t Affect Neurodevelopment of Children

A new study has shown that cannabis use during pregnancy is not associated with differences in the neurodevelopment of children exposed to cannabis in the womb. The study, which was published last month in the peer-reviewed journal Paediatric and Perinatal Epidemiology last month, found that prenatal cannabis exposure was not associated with lower scores on neuropsychological tests in children or with autism among young adults.

“Prenatal marijuana exposure was not associated with secondary outcomes or risks of clinical deficit in any neuropsychological assessments,” the authors of the study wrote.

To conduct the study, researchers affiliated with Columbia University and the University of Western Australia, Perth used data on 2,868 children from the Raine Study, one of the world’s largest prospective cohorts of pregnancy, childhood, adolescence and adulthood, to analyze the progression of prenatal cannabis exposure from pregnancy through age 20. The children in the study underwent neuropsychological testing at age 10, and again as young adults aged 19 or 20.

The researchers designed the study to control for a wide range of clinical and sociodemographic factors that might affect the outcome of the results. The study was also conducted over a long time span, much longer than other studies that have attempted to investigate the potential outcomes of prenatal cannabis exposure. Because of the study’s characteristics and its robust sample size, the research helps provide a better idea of what prenatal cannabis exposure can do to unborn children.

With the study’s controls in place to account for confounding factors, the researchers found no association between exposure to cannabis in the womb and neurodevelopmental outcomes. Specifically, the authors of the study determined that prenatal exposure to marijuana “was not associated with worse neuropsychological test scores at age 10 or autistic traits at 19-20,” according to their conclusions.

The researchers noted limitations of their study, including changes in the average potency of cannabis products and evolving methods of ingesting the drug over the last few decades. The researchers studied children born between 1989 and 1992, meaning they were likely exposed to less potent cannabis than what is available today. The researchers noted that “further research is warranted in a more contemporary birth cohort with a range of neuropsychological outcomes to further elucidate the effect of prenatal marijuana exposure on neurodevelopment.”

Other Research Inconclusive

The results of previous studies investigating the effects of prenatal cannabis exposure have been inconsistent. Some studies have shown an increase in neurodevelopmental differences such as autism, ADHD and anxiety in children who were exposed to cannabis in the womb, while others have not revealed such associations.

A systematic review of available research published in 2020 found that cannabis use during pregnancy may be associated with ADHD and related symptoms such as anxiety in children exposed to cannabis in utero. A separate study published the same year found that children whose mothers used cannabis while pregnant were 50% more likely to be diagnosed with autism. However, some experts note these studies may not be reliable because of limitations including problems with the methodology of the original research the studies are based on and small sample sizes.

Like the study published last month, other research has not found associations between prenatal cannabis exposure and neurodevelopmental problems in children.

A 2021 study found no association between cannabis exposure in the womb and autism when confounding factors such as the education of the mother and the use of alcohol and tobacco were controlled for. Another study published this year found that when maternal stress, a factor associated with both autism and cannabis use, was controlled for, no association between prenatal cannabis exposure and autism was found.

Expert Recommends Caution

Cannabis use during pregnancy is controversial, with many healthcare professionals warning that it should be avoided at all costs. Some cannabis advocates argue the dangers are overstated and that using cannabis during pregnancy can help relieve symptoms of morning sickness and alleviate stress, allowing pregnant women to get the nutrition and rest they need for a healthy pregnancy, among other benefits.

Dr. Peter Grinspoon, a primary care physician at Harvard Medical School and Massachusetts General Hospital and the author of “Seeing Through The Smoke: A Cannabis Specialist Untangles the Truth About Marijuana,” believes that there is still too much that is not known about how the drug can affect an unborn baby and cautions against cannabis use during pregnancy.

“It has not been conclusively demonstrated that cannabis is (or isn’t) safe during pregnancy or breastfeeding. As such, the prudent thing to do is to presume that cannabis use, especially regular, heavy cannabis use, is unsafe during pregnancy and breastfeeding until we uncover reasonable evidence that it is safe,” Grinspoon writes in the book. “Given what’s at stake, the burden of proof is on cannabis in this case. That means cannabis ought to be avoided or minimized by anyone who is pregnant or breastfeeding. Women who might become pregnant need to be carefully educated about the risks.”

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Budtenders Are Holding Back Cannabis—but It’s Not Their Fault

Some pregnant and breastfeeding women aren’t listening. Despite health professionals’ warnings, the number of pregnant women using cannabis at least once a month doubled over the last decade to seven percent of women surveyed, according to one recent study. Though this upwards trend is partially a result of healthcare professionals’ reluctance to talk about weed with their patients, researchers from Washington State University’s College of Nursing identified another culprit: budtenders.

In interviews with ten healthcare professionals, the researchers noted universal opposition to using cannabis while pregnant or breastfeeding—the same advice given about drinking alcohol or smoking tobacco, though the issue isn’t as black-and-white as one would think. But when the researchers asked ten people who worked the sales counter at the local dispensary, they discovered “much more positive” attitudes around cannabis. In fact, a cannabis study revealed states where marijuana is legal had a higher birth rate when compared to other states.

PHOTO Lightfield Studios

Though the budtenders tended to recommend products lower in THC and identified (correctly) that tobacco and alcohol were much more harmful than weed, this was still problematic. According to one budtender, most advice given at the dispensary counter amounted to anecdotal and unverified “stoner science” or quickly Googled tidbits. One takeaway, as the researchers wrote in a recent study published in The American Journal of Drug and Alcohol Abuse, is that America needs better budtenders.

Workers at the counter ought to trained “on cannabis products” and “how to best serve perinatal customers” before dispensing medical advice, they said.

For an understanding of why they aren’t—and why, under current circumstances, this is a reasonable expectation—you could take a quick trip to Denver, where Andrew Mieure broke into the cannabis industry as a budtender during Colorado’s medical-cannabis era.

Better off flipping burgers than selling buds

Driving around the city during a visit in early 2020, Mieure noticed a sign outside a fast-food shop looking for workers: Now Hiring, $15 an hour, the sign said. He then compared that to job listings for budtender positions. The average pay for an entry-level counter worker at a cannabis dispensary was $13 to $14 an hour, he recalled.

“You can literally flip burgers for better pay than selling an intoxicating drug that’s still federally illegal,” said Mieure, who became co-founder of Top Shelf Budtending, an organization that curates sommelier-level cannabis experiences, but is still incredulous at the memory.

For Mieure, complaints about budtending boil down to the simple cruelty of cold economic logic. “I believe that when you’re not paid properly, you’re only going to do the work you’re paid for,” he said. And neither increased demand for cannabis during the COVID-19 pandemic nor budtenders’ classification as “essential workers” has done anything to change this disparity.

Though advanced certification and worker training courses do exist, there’s little economic incentive, since the skills learned during a weeklong, $3,000 intensive training course don’t translate into higher hourly wages. At some high-volume dispensaries with strict sales quotas, answering questions from a curious patron may actually be discouraged in favor of quickly ringing up a sale and moving onto the next customer. 

Low pay coupled with a lack of health and retirement benefits—one former dispensary worker recalls being offered “medical weed” when she inquired about her employers’ healthcare plan—ensures worker turnover is high. Thus, experienced workers—and knowledgeable budtenders—are a rarity. And so, after a cordial greeting and a recitation of whatever’s on sale or on special, comes the same warmed-over “stoner science” passing for medical advice, followed by critiques from researchers complaining that budtenders are contributing to the delinquency of pregnant women.

PHOTO Gracie Malley for Cannabis Now

How to break this troubling cycle? A good start would be better-paid budtenders and a re-evaluation of the role of the counter help at dispensaries, which today is understood as little more sophisticated than a mere retail clerk. But demanding medical advice from an underpaid retail clerk may require an evolution in the dispensary model itself. Instead of convenience stores, liquor stores or even Apple stores, dispensaries should act more like lounges or clinics. And that will require a reevaluation of the entire dispensary retail model, starting with government regulations.

Budtender, reimagined

Budtender jobs pay poorly in part because—like driving for Uber or Lyft or waiting tables at the local Applebee’s—it’s a job almost anyone can get. Still viewed as a “cool” job, dispensaries report being flooded with applications for every opening. In this market—and in a tough environment where every dispensary owner is trying to find efficiencies wherever possible—dispensaries can afford to skimp on the labor (or so they believe).

Few states require much in the way of qualifications (aside from, counterintuitively, a criminal record free of certain drug-related crimes). Just 56 percent of budtenders surveyed during a 2016 review received training of any kind before taking the job. What training there is doesn’t have to meet any “vetted or certified” standards,” said Mieure, who observed that other job sectors are held to much higher standards that the supposedly tightly regulated cannabis industry.

“I always like to say that the people who do your nails or your hair go through more training,” he said, when budtenders are far “beyond retail. We’re part pharmacist, part psychologist, in some cases.”

A state-certified minimum training course might help. So would worker rights won by labor unions, which have notched wins against employers who have tried to walk back certain basic rights. But so would a re-imagining of the dispensary experience. Instead of a five-minute “in-and-out,” what if a dispensary was a social gathering space—what if, instead of like a corner liquor store, it operated more like a bar?

Some cannabis aficionados bristle at comparisons to the alcohol industry. After all, Colorado legalized cannabis in 2012 on the strength of an advertising campaign that juxtaposed cannabis as a safer alternative. But with its tasting notes hinging on the finer points of climate and terroir, high-end cannabis begs comparisons to nothing more so much as fine wine.

That said, it’s wishful thinking to expect a sommelier to appear at your corner liquor store to help you choose between a jug of Gallo or a box of Franzia. However, the time and space for a discriminating selection and an in-depth conversation is a perfect fit for dispensaries that are social-consumption lounges—a concept seen during the medical-cannabis era that hasn’t quite transitioned to adult-use. “I think we’re going to see the specialty budtender come into play with consumption lounges,” Mieure predicted. Fair pay for a position like that could command as much as  $55,000 a year, with management scraping the six-figure mark. And in an industry supposedly worth tens of billions, why not? The cost of not doing so, as the Washington State researchers found, is bad advice that carries an even steeper bill.

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