The Devil Is in the Details! On Regulating Cannabis Use in Canada Based on Public Health Criteria; Comment on “Legalizing and Regulating Marijuana in Canada: Review of Potential Economic, Social, and Health Impacts”

Document Type : Commentary

Authors

1 Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada

2 Addiction Policy, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

3 Institute of Medical Science, University of Toronto, Faculty of Medicine, Toronto, ON, Canada

4 Department of Psychiatry, University of Toronto, Toronto, ON, Canada

5 Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany

6 Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Dresden, Germany

7 Campbell Family Mental Health Research Institute, CAMH, Toronto, ON, Canada

8 Communications and Partnerships, CAMH, Toronto, ON, Canada

9 Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada

Abstract

This commentary to the editorial of Hajizadeh argues that the economic, social and health consequences of legalizing cannabis in Canada will depend in large part on the exact stipulations (mainly from the federal government) and on the implementation, regulation and practice of the legalization act (on provincial and municipal levels). A strict regulatory framework is necessary to minimize the health burden attributable to cannabis use. This includes prominently control of production and sale of the legal cannabis including control of price and content with ban of marketing and advertisement. Regulation of medical marijuana should be part of such a framework as well

Keywords

Main Subjects

References

  1. Government of Canada. Plenary statement for the Honourable Jane Philpott Minister of Health – UNGASS on the world drug problem. http://news.gc.ca/web/article-en.do?nid=1054489 Accessed 06/06/2016. Published 2016.
  2. Hajizadeh M. Legalizing and regulating marijuana in Canada: review of potential economic, social, and health impacts. Int J Health Policy Manag. 2016;5:1-4. doi:10.15171/ijhpm.2016.63
  3. Caulkins JP, Kilmer B, Kleinman MA, et al. Options and isses regarding marijuana legalization: Rand Corporation; 2015: http://www.rand.org/pubs/perspectives/PE149.html. Accessed August 12, 2016.
  4. Caulkins JP, Kilmer B, Kleinman MA, et al. Considering marijuana legalization: Insights for Vermont and other jurisdictions. Santa Monica, CA: Rand Corporation; 2015.
  5. LeBlanc D. Legalizing marijuana will come with strict controls, MP Bill Blair says. The Globe and Mail. January 12, 2016. http://www.theglobeandmail.com/news/politics/legalizing-marijuana-will-come-with-strict-controls-mp-bill-blair-says/article28137320/.
  6. Crépault JF, Rehm J, Fischer B. Cannabis policy framework by the centre for addiction and mental health: a proposal for a public health approach to cannabis policy in Canada. Int J Drug Policy. 2016; forthcoming. doi:10.1016/j.drugpo.2016.04.013
  7. Centre for Addiction and Mental Health. Cannabis Policy Framework. Toronto, Canada: Centre for Addiction and Mental Health; 2014.
  8. Rehm J, Anderson P, Fischer B, Gual A, Room R. Policy implications of marked reversals of population life expectancy caused by substance use. BMC Med. 2016; 14:42. doi:10.1186/s12916-016-0590-x
  9. Forouzanfar MH, Alexander L, Anderson HR, et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;386(10010):2287-2323. doi:10.1016/S0140-6736(15)00128-2
  10. Deaton A. The Great Escape – health, wealth and the origins of inequality. Princeton, NJ: Princeton University Press; 2013.
  11. Riley JC. Rising Life Expectancy: A Global History. Cambridge, UK: Cambridge University Press; 2001.
  12. Leon DA, Chenet L, Shkolnikov V, et al. Huge variation in Russian mortality rates 1984-1994: artefact, alcohol, or what? Lancet. 1997; 350(9075):383-388.
  13. Bhattacharya J, Gathmann C, Miller G. The Gorbachev Anti-Alcohol Campaign and Russia’s Mortality Crisis. Am Econ J Appl Econ. 2013;5(2):232-260.
  14. Aburto JM, Beltrán-Sánchez H, García-Guerrero VM, Canudas-Romo V. Homicides in Mexico reversed life expectancy gains for men and slowed them for women, 2000-10. Health Aff. 2016;35(1):88-95. doi:10.1377/hlthaff.2015.0068
  15. Anderson P, Braddick F, Conrod P, et al. The New Governance of Addictive Substances and Behaviours. Oxford, UK: Oxford University Press; 2016.
  16. Kilmer B, Caulkins JP, Pacula RL, MacCoun RJ, Reuter PH. Altered state? Assessing How Marijuana Legalization in California Could Influence Marijuana Consumption and Public Budgets. Santa Monica, CA: RAND Corporation; 2010.
  17. MacQueen K. Why it's time to legalize marijuana. http://www.macleans.ca/news/canada/why-its-time-to-legalize-marijuana/. Accessed August 12, 2016. Published 2013.
  18. Shanahan M, Ritter A. Cost benefit analysis of two policy options for cannabis: status quo and legalisation. PLoS One. 2014;9(4):e95569. Doi:10.1371/journal.pone.0095569
  19. World Health Organization (WHO). The health and social effects of nonmedical cannabis use. Geneva, Switzerland: WHO; 2016.
  20. Fischer B, Imtiaz S, Rudzinski K, Rehm J. Crude estimates of cannabis-attributable mortality and morbidity in Canada–implications for public health focused intervention priorities. J Public Health. 2016;38(1):183-188. doi:10.1093/pubmed/fdv005
  21. Imtiaz S, Shield KD, Roerecke M, et al. The burden of disease attributable to cannabis use in Canada in 2012. Addiction.  2016;111:653-662.
  22. Fischer B, Jeffries V, Hall W, Room R, Goldner E, Rehm J. Lower risk cannabis use guidelines for Canada (LRCUG): a narrative review of evidence and recommendations. Can J Public Health. 2011;102(5):324-327.
  23. Rehm J, Marmet S, Anderson P, et al. Defining substance use disorders: do we really need more than heavy use? Alcohol Alcohol. 2013;48(6):633-640. doi:10.1093/alcalc/agt127
  24. Asbridge M, Hayden JA, Cartwright JL. Acute cannabis consumption and motor vehicle collision risk: systematic review of observational studies and meta-analysis. Br Med J 2012344:e536. Doi:10.1136/bmj.e536
  25. Rogeberg O, Elvik R. The effects of cannabis intoxication on motor vehicle collision revisited and revised. Addiction.  2016;111(8):1348-1359. doi:10.1111/add.13347
  26. Volkow ND, Baler RD, Compton WM, Weiss SR. Adverse health effects of marijuana use. N Engl J Med. 2014;370(23):2219-2227. doi:10.1056/NEJMra1402309
  27. George T, Vaccarino F. Substance abuse in Canada: the effects of cannabis use during adolescence. Ottawa, ON: Canadian Centre on Substance Abuse; 2015.
  28. Chaloupka FJ, Yurekli A, Fong GT. Tobacco taxes as a tobacco control strategy. Tob Control. 2012;21:172-180. doi:10.1136/tobaccocontrol-2011-050417
  29. Boyd C, Veliz P, McCabe S. Adolescents' use of medical marijuana: a secondary analysis of monitoring the future data. Journal of Adolescent Health. 2015;57:241-244.
  30. Pigou AC. The Economics of Welfare. London: Macmillan; 1920.
  31. Chisholm D, Doran C, Shibuya K, Rehm J. Comparative cost-effectiveness of policy instruments for reducing the global burden of alcohol, tobacco and illicit drug use. Drug Alcohol Rev. 2006; 25(6):553-565.
  32. U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta, GA: Department of Health and Human Services. Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion. Office on Smoking and Health; 2014.
  33. Freedman KS, Nelson NM, Feldman LL. Smoking initiation among young adults in the United States and Canada, 1998-2010: a systematic review. Prev Chronic Dis. 2012;9:E05.
  34. Sornpaisarn B, Shield KD, Cohen JE, Schwartz R, Rehm J. Can pricing deter adolescents and young adults from starting to drink: an analysis of the effect of alcohol taxation on drinking initiation among Thai adolescents and young adults. J Epidemiol Glob Health. 2015;5(Suppl 4):S45-S57.
  35. National Highway Traffic Safety Administration. NHTSA releases two new studies on impaired driving on U.S. roads. 2015. http://www.nhtsa.gov/About+NHTSA/Press+Releases/2015/nhtsa-releases-2-impaired-driving-studies-02-2015. Accessed June 1, 2016.
  36. Volkow ND, Swanson JM, Evins AE, et al. Effects of cannabis use on human behavior, including cognition, motivation, and psychosis: a review JAMA Psychiatry. 2016; 73(3):292-297. doi:10.1093/schbul/sbv010
  37. World Health Organization (WHO). Global status report on road safety 2015. Geneva, Switzerland: WHO; 2015.
  38. Wong K, Brady JE, Li G. Establishing legal limits for driving under the influence of marijuana. Inj Epidemiol. 2014;1:26. Doi:10.1186/s40621-014-0026-z
  39. Babor T, Caetano R, Casswell S, et al. Alcohol: No ordinary commodity. Research and public policy. 2nd ed. Oxford: Oxford University Press; 2010.
  40. Squeglia LM, Jacobus J, Tapert SF. The influence of substance use on adolescent brain development. Clin EEG Neurosci. 2009;40(1):31-38.
  41. Mehmedic Z, Chandra S, Slade D, et al. Potency trends of Delta9-THC and other cannabinoids in confiscated cannabis preparations from 1993 to 2008. J Forensic Sci. 2010;55(5):1209-1217. doi:10.1111/j.1556-4029.2010.01441.x
  42. Davis JM, Mendelson B, Berkes JJ, Suleta K, Corsi KF, Booth RE. Public health effects of medical marijuana legalization in Colorado. Am J Prev Med. 2016;50(3):373-379. doi:10.1016/j.amepre.2015.06.034
  43. Wang GS, Le Lait MC, Deakyne SJ, Bronstein AC, Bajal L, Roosevelt G. Unintentional pediatric exposures to marijuana in Colorado, 2009-2015. JAMA Pediatr. 2016;e160971. doi:10.1001/jamapediatrics.2016.0971.
  44. Leung L. Cannabis and its derivatives: review of medical use. The Journal of the American Board of Family Medicine. 2011;24(4):452-462.
  45. ProCon. 25 Legal marjuana states and DC - Laws, fees, and possession limits. 2016. http://medicalmarijuana.procon.org/view.resource.php?resourceID=000881#summary. Accessed June 27, 2016.
  46. Walsh Z, Callaway R, Belle-Isle L, et al. Cannabis for therapeutic purposes: Patient characteristics, access, and reasons for use. Int J Drug Policy. 2013;24:511-516.
  47. Feingold D, Weiser M, Rehm J, Lev-Ran S. The association between cannabis use and mood disorders: A longitudinal study. Journal of Affective Disorder. 2015; 1(172):211-218. doi:10.1016/j.jad.2014.10.006
  48. Lev-Ran S, Roerecke M, Le Foll B, George TP, McKenzie K, Rehm J. The association between cannabis use and depression: a systematic review and meta-analysis of longitudinal studies. Psychol Med. 2014;44(4):797-810. doi:10.1017/s0033291713001438
  49. Moore TH, Zammit S, Lingford-Hughes A, et al. Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. Lancet. 2007;370(9584):319-328. doi:10.1016/s0140-6736(07)61162-3
  50. Health Canada. How drugs are reviewed in Canada. http://www.hc-sc.gc.ca/dhp-mps/prodpharma/activit/fs-fi/reviewfs_examenfd-eng.php. Accessed  June 1, 2016. Published 2015.
  51. Stith SS, Vigil JM. Federal barriers to Cannabis research. Science. 2016; 352(6290):1182. doi:10.1126/science.aaf7450
  52. CBC News. Second round of pot shop raids as police descend on city dispensaries. 2016. http://www.cbc.ca/news/canada/toronto/second-round-of-pot-shop-raids-as-police-descend-on-city-dispensaries-1.3649510. Accessed June 27, 2016.
  53. Rehm J, Kailasapillai S, Larsen E, et al. A systematic review of the epidemiology of unrecorded alcohol consumption and the chemical composition of unrecorded alcohol. Addiction. 2014;109(5):880-893. doi:10.1111/add.12498
  54. Lachenmeier DW, Rehm J. Von Schwarzbrennern und Vieldrinkern. Die Auswirkungen des deutschen Branntweinmonopols auf den gesundheitlichen Verbraucherschutz. [Bootleggers and heavy drinkers. The impact of the German alcohol monopoly on public health and consumer safety]. Sucht. 2010;56(2):91-93.
  55. Pacula RL, Kilmer B, Wagenaar AC, Chaloupka FJ, Caulkins JP. Developing public health regulations for marijuana: Lessons from alcohol and tobacco. Am J Public Health. 2014;104(6):1021-1028.
  56. Campbell DT. Reforms as experiments. American Psychologist. 1969;24:409-429.
  57. Campbell DT. The social scientist as methodological servant of the experimenting society. Policy Stud J. 1973;2:72-75.
  58. Fischer B, Rehm J, Crépault JF. Realistically furthering the goals of public health by cannabis legalization with strict regulation: Response to Kalant. Int J Alcohol Drug Res. 2016. pii: S0955-3959(16)30196-7. doi:10.1016/j.drugpo.2016.06.014

Files

History

  • Receive Date: 01 July 2016
  • Revise Date: 13 August 2016
  • Accept Date: 13 August 2016
  • First Publish Date: 01 March 2017

Share

How to cite

Statistics