Dr. Cynthia Morrow

Dr. Cynthia Morrow, who was hired as director of the Roanoke City and Alleghany Health Districts last fall, in the middle of the global COVID-19 pandemic, has taken on a role in another high-profile health issue: She will help shape how Virginia designs its cannabis marketplace.

How Virginia will regulate cannabis

In July, soon after personal possession and home cultivation became legal in Virginia, Gov. Ralph Northam announced appointments to three boards that will manage the road to full legalization, which is expected to take effect Jan. 1, 2024.

The five-member board of the Cannabis Control Authority will create the framework for the state’s cannabis marketplace, from cultivation to sales to distribution. That board includes Bette Brand of Roanoke; we have this Q&A with her.

The authority board will work closely with the Cannabis Public Health Advisory Council, which will focus on public health issues related to marijuana legalization and must approve any health-related regulations.
The 20-member Cannabis Equity Reinvestment Board will decide how to distribute the tax revenue that will be set aside to help communities that have been disproportionately affected by drug enforcement and economic disinvestment. The law earmarks 30% of tax revenue from marijuana sales for the Cannabis Equity Reinvestment Fund.

Gov. Ralph Northam this summer named Morrow to a post on the Cannabis Public Health Advisory Council, which will work alongside the Cannabis Control Authority board as that body develops a regulatory structure for legalization.

The council will advise the board on matters involving public health, including health warnings, product safety and public health programming. The council also must approve any health-related regulations before they can be finalized.

The General Assembly will appoint 10 more members to the council, but for now, Morrow is the only member from Southwest or Southside; the other three Northam appointees are from Richmond, Petersburg and Leesburg.

Morrow said she was encouraged by the Virginia Department of Health’s central office to apply for the council, which by law must have a representative from a local health district. What made her a good fit? She thinks it’s her time as a public health practitioner – more than 20 years, between Virginia and New York – combined with a stint teaching public health administration and policy at Syracuse University, where she said she was “surrounded by policy experts.”

She knows that some Virginians are wondering why the legalization process is expected to take so long. (While state law allowed some personal marijuana use and cultivation to start in July, full legalization won’t occur until Jan. 1, 2024.)

“The personal part has been addressed, right? That individual has been addressed,” she said. “But the policy implications of commercialization … that is where we really need to have a lot of intentionality.

“I applaud the process of making sure that we look at both the intended and the unintended consequences of a complex policy,” she said. “Virginia is taking time to do it right, and that’s important.”

Morrow spoke last week with Cardinal News about how her background will help shape her work on the council and about the issues that the group will have to consider, including how to keep kids safe and how to make sure that the process works for all parts of Virginia. The interview has been edited for length and clarity.

What in your background makes you a good fit for this post?

I’ve been in public health for over 20 years. I served as the commissioner of health for Onondaga County – that’s in Syracuse, New York – for about 10 years but was with that health department for a total of about 15 years. But also after I left the health department in Onondaga, I taught at Syracuse University. I taught public health administration and health policy. I had the advantage of really living with academicians at Syracuse University, at Maxwell School of Public Administration, and I was surrounded by policy experts.

I hadn’t had the academic exposure to the background of policy, and being at the Maxwell school for three years really helped me understand not only the practical aspects of policy and policymaking, but also the really important academic aspect of policy making and policy implementation. I think that that combination was probably something that was helpful.

What are the key issues that the council will be asked to consider?

Our primary job is to really make sure that we’re looking at what the practical implications are to the public, and how do we assure the safety of everybody as we go into this new area.

How much of a focus will you have on children and youth?

That’s going to be a huge focus, I’m assuming; I have to be very careful because we haven’t met yet and we have to have all of that preliminary information. 

One of the things that is really important for everyone to know is that just because something is legal doesn’t make it safe. That’s true for alcohol, that’s true for tobacco, that’s true for so many things. It’s our job collectively to ensure that we’re looking at how do we optimize the safe implementation of this new policy. 

We know that cannabis use in youth can lead to a range of health implications. This cannabis law is not meant to apply to children by any stretch of the imagination. It will be our job to make sure that it’s implemented in a way that protects children and youth. 

Just as an example: What is the public health messaging about the risks of cannabis use for adolescents? What are we going to do to make sure that there are safety nets available? Do we have programs in place for referral to treatment if someone has substance-use disorder? Not saying that there is an association or that there’s not an association, but we really need to make sure that we take a comprehensive look.

As a public health practitioner, when I think about health, I think about social, physical and mental well-being, not merely the absence of disease or infirmity – that’s the classic WHO, World Health Organization, definition. We need to ensure the health of everybody moving forward, and that includes physical, social and mental well-being. We’re going to have to look at all of the evidence, and of course evidence continues to emerge as other states have cannabis laws. And so it’s going to be our job to make sure that we’re doing everything we can to ensure that we’re optimizing the safety.

I hope that my job on the advisory council is to really take this expansive view of policy, how policy influences behavior, and look at how do we optimize the health of all individuals with a particular attention to youth. It is our collective responsibility to ensure that the unintended consequences of a cannabis law don’t harm children.

Will there be any overlap between the advisory council’s work and the regulation of medical cannabis, which currently is overseen by the Board of Pharmacy?

I don’t know yet what lies ahead of us, and I hate to predict it, but I think that the most important thing is that it’s going to be our job to take a comprehensive look at all aspects as it impacts public health. I’m hopeful that with my experience as a local health director and as an academician, I’ll be able to bring a very broad perspective that looks at all aspects.

Is medical cannabis specifically going to be something that we address? I don’t believe so. But we would not be doing our due diligence if we did not take into account all aspects, including the medical cannabis aspect.

My hope is that there will be communication so that we’re all well informed of what’s happening – and I’m sure that will happen – so that we can make good policy. Because good policy means that you look at the intended and the unintended consequences, and you look at all of the stakeholders and all of the alternatives. If we go through the eight-fold path to policymaking and policy evaluation – that’s the academician in me speaking – we look at what are the alternatives. Medical cannabis laws are an alternative and a complementary policy, and so we wouldn’t be doing our due diligence in going through all of those steps if we didn’t take that into account.

Will legalization affect different parts of the state in different ways?

I think so. We know that every region, every community has its own culture. I’m going to be a little bit of an academic here: I look at the social-ecological model. It’s basically spheres of influence. We have the individual in the center. Then we have the family and friend unit, the interpersonal sphere. Then we have a community sphere, and the community sphere includes resources. So what resources do we have with respect to substance-use disorder treatment, with respect to health care delivery systems, with respect to community-based organizations that serve families? What does our education system look like? That’s in the community sphere. And then the big sphere is the policy-culture sphere. If we’re thinking about federal policy, the Affordable Care Act, that’s something that influences health care decisions at all levels.

The bottom line is that we can’t look at any policy and how it affects an individual without taking into account all of those other spheres that intersect. Culture and policy are that macro sphere. We know that Southwest Virginia has a different culture than Northern Virginia. We have to be really careful about how our policies and our cultures influence each other – the acceptability of a policy in Northern Virginia may be very different from the acceptability of a policy in Southwest Virginia.

Certainly COVID-19 has shown us the interface between policy and culture and feasibility and acceptability, right?

Looking at all of those influences is going to be really critical. I hope that I can bring in not just theory but the reality that any good policy and any good implementation of that policy needs to take into account all of those spheres.

At the end of the day, we’re talking about how does it influence an individual?

The idea behind cannabis laws across the country is to improve health in all three of those ways. I have to be careful — I don’t want to say that cannabis improves health. … But another group [the Cannabis Equity Reinvestment Board] is going to be talking about how does this disproportionately impact health equity and disparate incarceration rates. That, to me, has a public health component to it. 

Virginia wasn’t the first state to go down this road. There’s likely to be a lot to learn from how other states have handled legalization.

That’s part of our responsibility once we start meeting. I’ve been told that we’re going to have lots of work to do. One of the things is all of the pre-work that we need to do. I have very carefully looked at the policies of many other states, done a lot of research into what has worked, what hasn’t worked, what are the health outcomes. Again, both the intended and the unintended. That’s going to take time, and I applaud Virginia for trying to do this in a careful, intentional way.

Megan Schnabel is a reporter for Cardinal News. Reach her at megan@cardinalnews.org.

Megan Schnabel

Megan Schnabel is a reporter for Cardinal News. Reach her at megan@cardinalnews.org.