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Aman: Folks, are you interested in the mystical world of marijuana? Or have you been fascinated by how we should navigate our own media space within healthcare? Well, today's guest is gonna be nothing short of a treat for all of you. On this episode of the I AM GPH podcast, we have Dr. Danielle Ompad, Associate Dean for Education at NYU and associate professor of epidemiology. Dr. Ompad is focused in areas of urban health, HIV, illicit drug use and adult access to vaccines. But today we're gonna do a deep dive into Dr. Ompad herself and her most recent publication on edible packaging in the cannabis space including a whole lot more. Dr. Ompad, welcome back to the I AM GPH podcast. We're glad to have you.
Danielle: Thank you so much, I'm so excited to be here.
Aman: So let's start off because what fascinated me was the fact that you've been in the academic space for a very long time. And I'm curious to how has your journey evolved within academia since you first began?
Danielle: Sure, so I started out, actually at a nonprofit, called the New York Academy of Medicine, and we did research. I was part of the center that did urban epidemiology and I did that for about nine years. And so, I was involved in NIH funded studies. I didn't do very much teaching. Although about six years after I started there, I started being an adjunct at NYU and I actually really enjoyed teaching. I was a little surprised, but I loved being around students. I loved talking to them about epidemiology and especially about drug use and harm reduction. And so, after a few years I decided to come to academia full-time and I accepted a job at NYU, before we were even a school of public health, when we were still a program in the Steinhardt School of Culture, Education, and Human Development. So I've been here for a little while.
Aman: And is there something that stands out to you within the academic space that has changed or do certain academic concepts stand the test of time, since day one to today?
Danielle: I think in terms of epidemiology, the basics don't change, right? So the odds ratio and the two by two table, that's pretty standard, but our methods are always evolving and there's always something exciting on the horizon, whether it's a statistical method or a new study design. And so, that's kind of exciting.
Aman: I love it. Well then, as an epidemiologist, you have been deeply involved within the urban health space for a while. How have all your experiences within this space influenced your journey going forward to perhaps your journey even pre-pandemic times and how it's evolved throughout in all their experiences that you have had?
Danielle: Sure, so what's interesting is, I actually didn't grow up in a city. I mostly grew up on military bases in the U.S. and Europe. And so the first city I ever lived in was a suburb of Honolulu. And I lived right next to the Aloha Stadium. So if you've ever watched the Pro Bowl on TV, the house where I lived was in spitting distance of the Aloha Stadium. And then the next city I lived in was Baltimore and then New York. And so I really became fascinated by cities. And then as an epidemiologist, I started to think about how cities are an exposure. So, in epidemiology we think about exposures and outcomes. So outcomes are things like HIV, hepatitis, drug use, malaria. And I started to think about what are some of the features of cities that may impact health either negatively or positively. And so, what was interesting as we entered COVID is that, New York City became the epicenter, the first epicenter of the COVID pandemic. And it was interesting to see how the city reacted to that and what features of the city changed and how city policy impacted the trajectory of the epidemic. And so, I kind of envy students right now who are getting their public health degree, particularly those who have done so during the past two years, because what an amazing time to be a public health student, where you were seeing how public health decisions are made, how people design studies to be reactive to the current crisis. This is something that students are gonna be able to dine out on for the rest of their career. Back in the day, I got my MPH in the middle of the COVID epidemic. I mean, that's really an amazing place to be. So, I think that students right now are really lucky because they can see directly how public health plays a role. And it's a part of your daily life. You can see how those decisions are made, whether they're good, whether they're bad. So it's been really fascinating and in every aspect of public health, not just about COVID outcomes, but we're seeing impacts of the COVID pandemic on drug use outcomes, on HIV outcomes, on people's access to care for a variety of conditions. And so it's been a far reaching exposure.
Aman: Wow. I'm very curious about this concept of... In your world, there's this thing that students could learn from in my eyes and it's your superstar presence in the media, especially during the lockdown and the pandemic time. So I'm just curious to know how was that experience for you as well, navigating the media and how can we show the importance of... If a lot of students are going to in the future perhaps, have some sort of media experience when they come on TV or they're sharing something in a presentation form, how can you help them navigate the important of that, or even your journey when it comes to a media presence?
Danielle: Sure, so the first thing is that somebody who is trained in public health, somebody who received a National Institutes of Health Loan Repayment Program, which means that the U.S. taxpayers paid for my education, I feel obligated to share my knowledge with the public. The public paid for my education. And it is my duty, I feel, to make sure that I provide good, solid public health information to the public when I am asked to. And being in public health, we have to remember that part of our discipline begins with public. And so you really should be prepared to be in the public sphere. That being said, it's a little challenging to talk to reporters. And so, I do try to prepare of myself. I do a little studying before I go and talk to a reporter. I think about what are the messages I wanna get across. I do a little bit of research to find any statistics that I want to share so that I have them on hand and at my fingertips at the moment that I need to provide them. And I try to use language that is straightforward and not be too jargony. I remember that I'm talking to the public. So, I'm talking to my family and friends who are not in public health. And that really helps. And so I just think it's really important that in the public health space, that we remember that we are here for the public, not just for the science.
Aman: I couldn't agree more, from someone that is not in the public health space as well. And just hearing things that make sense, and it's crystal clear for any person not involved, that it is really a superpower, if you will, to avoid the jargon in our world. Well, with that said, Dr. Ompad, let's hear a little bit about your publication, and then we'll dive deeper into that. What new in your world? What are we excited to talk about here?
Danielle: So, I'm really excited about this publication. What we did was look at marijuana packaging. So we had a study, during COVID actually, where we asked people about their use of cannabis and different types of cannabis products, because as different states have started to legalize adult use and medical marijuana, the number and different types of cannabis products have really exploded. So, back in the day, it was mostly people smoking, bud or flour, smoking the leaves. And maybe they were making their own edibles with the bud. But now, we start to see that there are companies that are manufacturing all sorts of products. So you can buy bud, but you can also buy the vapes to vape THC concentrate. There are edibles, there are tinctures that people put under their tongues. There are capsules, there are topicals, for example, there are creams. Somebody even reported that there is a sex lube that has cannabis in it. And so, we wanted to understand all the different ways in which people use marijuana. And we were also interested in the sexual effects of marijuana. As a part of that study, we asked people to upload pictures of up to two of their marijuana products. And we were really interested in the packaging. And so, they could upload two pictures of up to two products. And so we asked for the front and back, and when we started to look through these photos, as well as... Lots of people in the U.S. use cannabis or marijuana. And so, my friends would talk about it or family members or people I know, and I would see their packaging. And I started to see some really interesting packaging. And I noticed that some of them were, interestingly, very much looking like regular products. And so, we went through our collection of photos and of picked out all the edibles, all the edible packaging. And then we looked at the edible packaging and looked to see which of those packages replicated a non-cannabis mass market product. And we were surprised by what we found. So, a little over 20% of the packages that were uploaded were edible packaging, and about 8% of the edible packaging were lookalikes or copycats. And so, what do I mean by that? What I mean is that somebody provided us with a photo of a bag of what looked like Doritos. It said Doritos on the front, it looked almost exactly like the bag that you would buy in a corner store. And there were two small symbols on the front, one that said, THC, I think it said five or six hundred milligrams. And another one that was the California marijuana/cannabis symbol. And I was so surprised. So, it was almost exactly like a Dorito bag. And if you looked at it very quickly, you might not know it was an edible, if you were only looking at the front. And that was a little problematic, I don't begrudge people having an edible. People like edibles that taste good. I like an edible that tastes good. But what I don't want is an edible that could be mistaken for a non-cannabis product, and that somebody could potentially eat that whole bag of chips, which is way more THC, if it actually contains the 500 milligrams that was advertised than anybody should have in one dose. If you have had 500 milligrams of THC, that is no longer fun or therapeutic, right? It is no longer giving you a high that might be enjoyable or therapeutic, if you're taking it for medical reasons. That is gonna make you feel pretty terrible. It's just too much THC. And so, that's a little problematic. And so our paper, we looked at the variety of copycat products that we saw in our collection of photos to see what was going on there.
Aman: Oh boy. All right, so there's there a lot in there and I'm thinking if we could just take a step back and how... I'm someone that's foreign to the complete world of cannabis, and I'm sure there's a lot of listeners that are as well. How should we view this world of cannabis? How can we simplify it, for our people that may not know, as you did mention that, there are circumstances that the edible packaging is identical pretty much to any product that's out there and it can be mistaken. What are some things that we should know about the world of cannabis from a completely new perspective for someone that doesn't know. Any things to think about from that end?
Danielle: Sure, so the first thing I would say is that cannabis is a plant that is grown. It is dried often, and people... There are many ways to use it, but people often crush the leaves and the bud... Crush the bud and they roll it up and smoke it or they put it in a pipe and smoke it. It can give a variety of effects, sometimes a little euphoric, sometimes calming, people call it getting high, and it can often be a very pleasant experience for a lot of people. It also seems to have some medical benefits. So there are people who may have certain medical conditions, where they take it to increase their appetite, reduce pain, reduce anxiety. So, it has some therapeutic effects. And so it's one of the most common drugs that are used in the United States. Almost half of the U.S. population has tried marijuana at least once. And it's very common. I would also remind people that marijuana is legal in some states, meaning that some states have medical marijuana policies that make marijuana available to people with certain conditions. And then a growing number of states actually have adult use policies, which basically means that any adult can purchase and use marijuana.
Aman: Okay.
Danielle: Now, edible products are typically made with cannabis concentrates. So people concentrate the active ingredients in cannabis, which is THC or Tetrahydrocannabinol. And they infuse edible products with these concentrates. So, edibles range and form from tortilla chips to gummy candies, to chocolates. I've seen drinks, I've seen brownies, I've seen cookies, I've seen tiramisu, so it can be infused into a variety of food, snack and beverage products.
Aman: Folks, there you go. That's a crash course for everything you need to know in this space. And that really helps me also clarify things and understand how there are positive impacts to this and there could be detrimental impacts of misunderstanding and just using a brand that exists to have easy access, to cause a misunderstanding for someone that might not be able to access that might not be able to understand that concept. So I'm curious, Dr. Ompad, how did you end up finding this niche? Was it something that came out of, you saw this and it caught your eye because there're so many unique publications you have had? Wwhat made you niche down on this specific one for this time around?
Danielle: Sure, that's a great question. So, your listeners should know that I've been studying drug use since the late 90s. I've mostly studied heroin, crack and cocaine use. Although I will say, my master's thesis that I wrote back in 1997/1998, actually looked at whether or not marijuana was associated with increased dietary intake, which is basically a very scientific way of asking the question, does marijuana give you the munchies? And by the way, my master's thesis suggested that it does. So, marijuana is not new to me, but what interests me in this was the increase in states that were legalizing adult use cannabis and the proliferation of different types of cannabis products. And then I saw a lot of packages that were really interesting looking packages and I'm somewhat of a collector in my regular life. So for example, I grew up collecting spoons, like the collector spoons that you get at airports and things like that. And I have like over 300 spoons. And so, when I started to see that there was all this interesting cannabis packaging, I started collecting photos of cannabis packages, 'cause that's just what I do. I collect things. Luckily, collecting photos doesn't take up as much room as collecting spoons or everything else that I collect. So, that's how that came about. And the other thing that we noticed because for this work, I was actually working with two other faculty members, Dr. Emily Goldmann and Dr. Melody Goodman. What we noticed when we looked at the photos is that, sometimes there was a disconnect between the math on the products. So, a package might say that there were a hundred milligrams of THC in the package. And then it would say that there is 10 milligrams of THC per serving, and then it would say that there were 20 servings in the package. So, 20 servings times 10 milligrams would be 200 milligrams, but the front of the package would say that it included 100 milligrams. So we thought that there was some interesting things going on in the cannabis market, where they weren't really paying attention to what they were putting on packages. It also made me doubt that what a package says is actually what it contains. And so we just wanted to unpack that a little bit.
Aman: Unpack all those packages.
Danielle: Exactly.
Aman: The marijuana industry seems to be more accessible from what you mentioned, the legalization in states and there's people that are very well aware and there's people that are completely foreign to it, so how do we manage... It feels like a rapid change in the industry and how do we view that or acknowledge that change, if you will?
Danielle: Yeah, so there has been a rapid change in the industry. I will say that generally marijuana and cannabis products are not easily available in regular settings. So, in states that have adult use cannabis or medical cannabis, they're typically sold in dispensaries. So you're not gonna find them at 7-Eleven. You're not gonna find them at the grocery store. So, you're not gonna find a bag of regular Doritos next to a bag of cannabis infused Doritos. That's typically not gonna happen. But what it does mean is that if there is some person who is using cannabis products and they happen to purchase one of these copycat or lookalike products, they should probably be very thoughtful about where they're storing it and who they're storing it around and make sure that somebody cannot unsuspectingly pick up a package of an edible that looks like a candy that they're used to, like Nerd Ropes or Starbursts or Skittles, pick that up and eat the whole package without realizing it's cannabis. So, you definitely wanna store those in a way that keeps it away from people eating them without intending to.
Aman: So, this podcast is there to educate people on the copycat packaging aspect of things. What more can we do to acknowledge this and share it with the world for the people that are listening? What could they do right now to make others more aware on the copycat packaging aspects?
Danielle: So, I think one of the first things we should understand is that states with medical and adult use cannabis policies, those policies typically contain language around what is acceptable packaging and what is not. And some of these copycat and lookalike packages may be perceived as marketing to children, which you're not allowed to do. And so, we could probably not only strengthen the regulations, but strengthen the enforcement of the regulations. The other thing to keep in mind is that these copycat packages are often in copyright violation or trademark violation of the products that they're copying. So, I do not think that Frito-Lay or Mondelez or Wrigleys, which are some of the companies that are having their products copied and turned into cannabis infused products, have authorized cannabis infused products, right? These are not authorized packages. So, some of these marijuana companies that are producing these lookalike packages are actually being sued. So, I think it's really important for people to understand that, that one, this is a very small proportion of the packages that we saw. Although it's unclear whether this is a small proportion of the different types of cannabis products that are available, because it's really hard to get a representative sample of cannabis packaging, because some of the markets that it is sold in are not legal markets, right? So getting something that's representative is difficult, but what it does suggest is that those people who are using cannabis should be very thoughtful about, where they're storing their lookalike or copycat products, and maybe think twice about whether you should be buying those types of products. And maybe you should be buying products that do not look like non-cannabis snacks and candies. Maybe stick to things that are clearly labeled as cannabis so that you can make sure that folks do not accidentally dose themselves when they didn't really want to.
Aman: Dr. Ompad, this has been a very unique research, and I'm curious to know what's next for you in the coming year or two, where are you pivoting to next in your research endeavors?
Danielle: Sure, so for the cannabis study, we're actually still analyzing these data. We actually have photos of over 700 different cannabis products. So we're gonna continue to analyze that data set. We also have a survey and we are analyzing that data set as well. We're looking at the subjective sexual effects of marijuana or cannabis. We're also looking at the types of cannabis products people use and whether or not they're using more than one type of product on a regular basis. So that's happening. I also have some work that I'm doing with some colleagues over at the College of Arts and Sciences with Dr. Jane Carlton, who runs the Center for the Study of Complex Malaria in India. And so I work with her on a study in rural India, looking at a malaria intervention. And I'll continue to do my research related to substance use. So, this is an area that I have been working in for a long time, longer than I care to admit, I think, but it's a area that is a pretty strong passion of mine. I am very dedicated to working with people who use drugs and making sure that we don't stigmatize people who have drug use experience — that we support them, that we come at people from a harm reduction perspective, and that we understand that not everybody who used drugs has a drug use problem.
Aman: Dr. Ompad, thank you so much. I hope all of you enjoyed this podcast as much as I did, full of golden nuggets, insights in the public health world and what's new, what's next. Everything you would like to be curious about would be in the description, check out the publication, we'll have it up there. And thank you so much for taking the time out, Dr. Ompad. It was awesome chatting with you.
Danielle: Thank you, Aman. You are a great interviewer and I really enjoyed this, and I hope to speak with you soon.