BILL C-45 DEBATE Reality Check
Following the debate during second reading of the Cannabis Act in the House of Commons earlier this month, we were struck by the types of concerns expressed by the opposition parties. Fears around things like legalization of cannabis meaning increased access to youth, increases in driving incidents, Canadians under 25 having access, children being used as ‘drug mules’, and more, show how far we still have to go to help educate Canadians on the facts around cannabis and legalization.
While legalization advocates may be surprised at some of the arguments made during this debate, they do represent about 30% of the population based on recent polling. For the legislation to pass, and for legalization to succeed, these questions and concerns need to be understood and addressed. Many fears about legalization stem from often old, inaccurate or misrepresented information, and to help address this, we decided to address some of the questions raised by the members of parliament during second reading.
While the House of Commons rises for the summer, be sure to talk to your friends, family, even reach out to your local MP, and help start a discussion about legalization based on the facts. For cannabis legalization in Canada to succeed, we have to dismantle nearly a century of misunderstanding and confusion. NICHE approached harm-reduction expert Jenna Valleriani about fact-checking some of these comments.
If there are any other matters pertaining to legalization that you would like us to look into, please contact us.
1. LEGALIZATION WILL LEAD TO INCREASED YOUTH USE
“Mr. Speaker, one of the voices that the government should listen to is the Parliamentary Budget Office, because it did take a look at whether this was going to stay out of the hands of kids between the ages of 15 and 17. I think it would be a surprise to the minister to note that what it said is quite the opposite of what she has already said in the House today, which is that it will increase the use in 15- to 17-year-olds... Is the minister telling me, a mom of a 15-year-old, that she is guaranteeing, despite the PBO's advice, that marijuana use in the age group between 15 and 17 is going to decrease?” - Lisa Raitt, Milton, ON, Conservative
The government has stated over and over again that the bill is aimed to protect children and young people from cannabis. The irony in this statement, however, is that by legalizing cannabis and actually providing legal backup for the production, possession, distribution, and use of cannabis, the bill would actually encourage cannabis to be used more. - Alice Wong, Richmond Centre, BC - Conservative
WHAT WE KNOW
This is a common rebuttal discussed in the legalization context.
All evidence around legalization must be interpreted cautiously, as it’s too early to really map the long term trends of youth use in states that have legalized cannabis, but there is some preliminary evidence on youth use rates so far which are promising. Overall, the claim that youth use will increase under a legal framework is weakly supported by evidence.
The Drug Policy Alliance released a report in 2016 that focused on some preliminary evidence on youth use and legalization in the United States. They conclude that “preliminary data… show that legalization of marijuana has had little to no impact on the overall youth use of marijuana” (DPA, 2016:4) across Colorado, Washington State, Oregon and Alaska. For example, in Washington, the report looks at a sample of students in grades 6, 8, 10, and 12, finding no significant changes in youth use between 2002-2014 (which is two years post-legalization). Lifetime youth rates in Washington for youth also remained stable (Washington State Healthy Youth Survey, 2016). In Colorado, the same trend was observed: youth use has remained stable since legalization was enacted. For example, the 2015 Healthy Kids Colorado Survey (which includes 17,000 students), found a slight decline in reported use from 25% in 2009 to 21.2% in 2015, two years after legalization in Colorado (Healthy Kids Colorado Survey, 2015). Other studies have supported the idea that legalization has not led to increased youth use (see for example Schinke et al. 2017; Choo et al., 2014; Lynne-Landsman, Livingston & Wagenaar 2013).
However, one study that is cited frequently by opponents of legalization did emerge with different results, finding a slight increase in some youth use in Washington, but not in Colorado. Methodologically, however, they use a much smaller sample of youth surveys (contrary to state wide surveys sampled above), including 17 schools in Washington and 30 schools in Colorado. In Colorado, there were no changes in past month adolescent marijuana use following legalization. However in Washington, there was a slight increase identified among eighth and tenth grade students, but no significant change among 12th graders (Cerda, Wall & Feng 2017). These researchers posit this is because Colorado had much more liberal medical cannabis laws, which is supported by the fact that youth perceptions around risk decreased with a slight increase in use in 2009, when Colorado permitted medical cannabis dispensaries and advertising of medical cannabis products.
2. HOME GROWING PUTS CHILDREN AT MORE RISK
“I would like to quote a real example of a neighbour whose house was what is called a grow-op. In the basement we could see mould and a lot of things, and then finally the police discovered it was a grow-op. Then when the school board looked at the kids living upstairs, above that very basement, all those students showed signs of being stoned, as if they were smoking grass.” - Alice Wong, Richmond Centre, BC - Conservative
“Mr. Speaker, it is positively negligent that the government is shutting down debate on this topic. We have already established that this legislation would put marijuana in the hands of children, not just with the 15 joints that 12-year-olds can have but with the four plants per household, so little Johnny can put some in the toaster oven and smoke it up.” - Marilyn Gladu, Sarnia-Lambton, ON - Conservative
“The other thing the Liberals keep telling us is that they are doing it to protect children. The minister must have heard the same thing people have said to me. Could there be any greater access for children than to have four three foot plants in one's kitchen, have a mini grow-op in one's house, and somehow we are protecting children?” -Rob Nicholson, Niagara Falls, ON - Conservative
WHAT WE KNOW
The idea that home cultivation sparks a series of risks—including risk to children, risk of fire and mould, organized crime and community risks—is not new to cannabis discourse. While a relative dearth of literature exists in this area, there are a handful of studies that discuss this using different measures. Overall, there is weak evidence to suggest that home cultivation increases risk to children.
First, it’s important to note that research has identified that the media perpetuates a drug scare around the issue of growing cannabis, or home cultivation. Some of the work that is Canada-specific looks at 15 years (1985-2009) of news articles to analyze this issue, highlighting that:
...a majority of these articles draw on law enforcement spokespeople, and consistently overlap concerns about children with the supposed dangers of grow-ops related to the presence of dangerous equipment, possibility of fire, mould, theft of hydro, electrocution, presence of weapons, and the possibility of violence because of burglaries and turf wars between organized crime groups (Boyd & Carter, 2011: 4).
Boyd & Carter (2014) analyze how grow-ops have been framed by Canadian media, but also examine some of the biggest reports to come from RCMP-funded projects on the topic. These are particularly important because these reports were often used to justify harsher approaches to home cultivation. Aside from noting that these reports are not peer-reviewed research, they problematize how they have been used by law enforcement and others to exaggerate claims around grow-ops. They also contrast these claims with a 2011 Canadian Justice Department report that refutes many of the claims made by the RCMP reports. For example, while the RCMP claim “most” grow-ops are run by organized crime, the 2011 Canadian Justice Report noted only 5% of offenders in cases around grow-ops were affiliated with organized crime (Boyd & Carter, 2014). They demonstrate through a lack of RCMP data that many of the risks attributed to home growing are exaggerated and lack actual evidence.
This is also confirmed in Boyd’s affidavit in Allard v. the Queen, where she notes that “scholarly Canadian evidence does not substantiate the claim of harm.” Additionally in the affidavit, Boyd critiques some of the RCMP funded reports, such as one published by Diplock, Plecas & Garis (2013), as lacking any information on methodology and containing many unsubstantiated claims, despite being widely cited by enforcement and other key decision makers.
An important study by Moller et al. (2011) conducted research on Canadian children who were removed from ‘drug producing homes’—over 80% for cannabis production. This included 75 children identified by police and the Children’s Aid Society in York region, Ontario who were referred to the Motherisk Program at the Hospital for Sick Children. They concluded that the majority of children that were removed from these homes were healthy and drug-free, thus reiterating that there is there is no evidence to suggest that children found in the homes where grow operations exist are at more risk for poor health outcomes than other children.
Another Canadian study by Douglas & Sullivan (2013) also found similar results, examining 181 children found living in cannabis grow-ops in British Columbia. By collecting characteristics about the homes, health of the children, and prescription drug history (also comparing to groups of children from the same geographical areas), they found no significant difference between the health of children living in grow-ops compared to those who were not.
Further, other jurisdictions that have implemented cannabis home cultivation as part of a comprehensive legalization system include regulation to protect the safety of individuals, particularly youth who may be residing in the home. For example, in Colorado, which has a 6 plant limit per person (in comparison to Canada’s proposed 4 plant limit per household), plants in homes with residents under the legal age of access must have their cannabis cultivation area enclosed and locked in a separate space that minors can’t access (State of Colorado 2017a).
3. HOME GROWING IS RISKY AND LEADS TO DIVERSION
“I suspect that the prices are going to be high and between the diversion from the homegrown, because no one is monitoring four plants, there is going to continue to be a significant element of organized crime. To be frank, if this goes ahead, and I hope that I am wrong, I do not think that they have created the right circumstances to remove organized crime out of this particular business. Perhaps, in many ways, they will be getting into the legal component of it.” - Cathy McLeod Kamloops—Thompson—Cariboo, BC - Conservative
“We can have up to four plants. It is just common sense that it will be diverted, or the possibility of diversion will be increased incredibly.” - Colin Carrie Oshawa, ON - Conservative
“If the bill is passed, we will end up buried so deep in drugs that we will have no way of knowing where it comes from anymore. Does it come from organized crime or from the user's own personal crop? It will become very difficult for police to go after drug traffickers.” - Luc Berthold Mégantic—L'Érable, QC - Conservative
The government says it wants to strictly control and regulate the sale, production, and distribution of marijuana. Yet, in the bill is an allowance for up to four marijuana plants, which is going to increase the risk of diversion to the black market...and is going to make it impossible for law enforcement to enforce against diversion and overproduction, which is why the chiefs of police have expressed opposition to the bill. - Michael Cooper St. Albert—Edmonton, AB - Conservative
WHAT WE KNOW
This also isn’t new to the conversation around home cultivation - the risk of diversion has been cited as a potential concern related to home growing in the federal medical cannabis access program (Garis & Clare, 2013), however empirical evidence that legal home grows lead to diversion, particularly in Canada, is lacking. Further, research on diversion and small-scale cultivators (for personal use) are even less available (Decorte, 2010). In the context of Canada’s medical cannabis program, one study notes, “Implicit.. is the suggestion that medical cannabis users—people living with cancer, HIV/AIDS, MS, Hepatitis C and chronic pain—cannot be trusted to produce or use cannabis without succumbing to the lure of black-market diversion” (Lucas 2009: 299).
More broadly on the topic of diversion from cannabis markets, other studies have noted there is no evidence situating medical cannabis diversion that has empirically tested the extent of this diversion and its mechanisms (Sznitman & Zolotov, 2015). The same study notes that, “a commonly held assumption is that CTP [cannabis for therapeutic purposes] legalization increases crime rates... but there is no strong direct empirical evidence to support this” (p. 24; also see Freistühler et al., 2013; Kepple & Freisthler, 2012; Morris et al., 2014).
Further, as mentioned above, a 2011 Canadian Justice Department study (as cited by Boyd & Carter, 2014), revealed that out of a random sample of 500 grow-ops, only 5% had connections to organized crime. Further, “firearms or other hazards” were involved in only 6% of grow-op cases examined (Boyd & Carter 2014).
Also, in his Reasons for Judgement for Allard v. Her Majesty the Queen (2016), the Honourable Judge Phelan made some interesting points in the decision, including:
“Health Canada had no information that the Plaintiffs or a substantial number of licensees ever overproduced their licences, diverted marihuana to the black market, produced unsafely, caused smells, had any fires, produced any mouldy marihuana or suffered any negative health consequences from consuming their medicine” (p.14, point 33).
“[in Sfetkopoulos] the government’s concern about the risk of diversion had to be justified, and it was found not to be” (p.20, point 51).
“The Defendant relied heavily on both the risk of fire and crime (home invasion and diversion) as its justification for the MMPR. On both these topics the Defendant’s experts exhibited a significant degree of bias against marihuana generally. There was a lack of objectivity both in data and analysis” (p.45, point 116).
“In response to the Defendant’s primary defense that health and safety risks of cultivation are reduced by the MMPR, the evidence does not qualify this risk. Many of the risks purported to be significant were not proved to exist, including fire, home invasion/violence/diversion and community impacts” (p.87-88, point 253).
Finally, while there is lack of empirical data supporting this misuse of growing licenses under the federal medical cannabis program in Canada, it’s also important to acknowledge that some absolutely do “over-grow” their medical allowance. However, a majority of cannabis found in the overall illicit marketplace is likely grown outside of the federal medical system, where, for example, British Columbia’s entire illegal cannabis trade has been (conservatively) estimated to be worth hundreds of millions to billions of dollars annually, “suggest[ing]...policy makers should consider regulatory alternatives” (Werb et al., 2012).
*While there are a series of RCMP-funded reports, the “evidence” presented in these papers (such as Plecas et al. 2005; Garis & Clare, 2013; Plecas et al. 2002) were found to lack evidence, inflate numbers and source incorrect data (Boyd & Carter 2014; Allard et al., v the Queen) thus are excluded from this discussion.
**See the full Reasons for Judgement at http://cas-cdc-www02.cas-satj.gc.ca/rss/T-2030-13%20reasons%2024-02-2016%20(ENG).pdf
4. YOUTH CANNABIS USE AND COGNITIVE BRAIN OUTCOMES/MENTAL HEALTH/IQ
“Mr. Speaker, this is not a situation of trust. This is a situation of science and the neurological development of the brain. Members only have to have been in an emergency department where a 20-year-old who has smoked somewhat excessively has come in with their first psychotic break, knowing that it could have been prevented and knowing that they are now into a lifelong psychiatric illness, to know that it is not about trust. This is about people and how young adult brains can respond to the use of cannabis, especially between those ages of 18 and 21. Obviously, 25 is the recommended age in terms of when it is not going to impact to that degree. This is not about trust. It is about lifelong impacts, psychiatric illness, schizophrenia, and all those other sorts of issues.” - Cathy McLeod Kamloops—Thompson—Cariboo, BC - Conservative
“Madam Speaker, the literature is very clear on this. Lancet has stated that of young individuals who utilize marijuana, 60% have a lower chance of graduating from high school or graduating from university. The Journal of Neuroscience is also very clear. If people between the ages of 18 and 25 use cannabis regularly, they will experience structural changes to the brain.” - Kellie Leitch, Simcoe-Grey, ON - Conservative
“I will not tell my children's stories, but I have seen first-hand what happens after marijuana use. Whether they see grades drop by 30% or attendance go from perfect to nothing, parents are having to deal with these challenges each and every day. When we talk about it, I want to make sure the government is listening. We have talked about what happens to children who have smoked marijuana. The Canadian Mental Health Association has talked about the formation of the brain, and I am really concerned. As the member for Kamloops—Thompson—Cariboo mentioned, children's brains are not developed until age 25, and what is said is fair, but we had a task force saying it should be 21 years old and now we have legislation to make the legal age 18.” - Karen Vecchio Elgin—Middlesex—London, ON - Conservative
*Note: The Task Force recommended an age of access of 18 years old
WHAT WE KNOW
Understanding the risks and harms to young people—and not just on health—is part of a larger discussion about what it means to protect youth in the context of legalization. While cannabis is not harmless to young people and prevention is a key piece of a comprehensive educational approach, often the research around these outcomes and their links to cannabis are poorly understood or over-exaggerated. The evidence for these claims is inconclusive and heavily debated for a variety of reasons—some of which I’ll mention briefly below.
The current debate around youth and cannabis often conflates the difference between ‘association’ and ‘causation’. Causality is “the science of inferring the presence and magnitude of a direct cause–effect relationships from data” (Daniel & De Stova, 2012), while an association (or link) is only able to identify some type of relationship between two (or more) variables. In the latter case, unless they are properly controlled for, there could be an unknown (third, fourth, fifth...) variable affecting or causing the relationship—variables that researchers may be unable to account for without rigorous longitudinal studies that also include pre-use data. A link is simply just a relationship between two variables, but there is no evidence that one caused the other, and often even the direction of the relationship is unknown. It is often discussed as “an association,” “likely to,” “related,” “suggests” or “links,” and in the case of cannabis and youth outcomes, it remains unclear if cannabis is the causal agent in these outcomes or if it is part of a variety of vulnerability factors.
This is not to say that cannabis is harmless, but rather, more research is needed. We know, for example, that the earlier the onset of cannabis use, the stronger the links are to various negative outcomes (Fischer et al. 2010). Research also suggests that these risks are more likely to be experienced among regular, long-term users (Swift, Copeland, & Lenton, 2000) and much of the current research investigates harms to chronic or daily cannabis users. Heavy patterns of use as linked to harm are confirmed by other (Canadian) studies (Fischer et al. 2010; DeWitt et al. 2000).
While we want to keep an eye on this work, most of the studies that link youth cannabis use to various outcomes suffer from some methodological concerns, where:
Research “...has yet to conclusively establish cannabis as the sole cause of structural changes to the brain associated with diminished cognitive outcomes for youth...a similar lack of evidence exists at the population level to suggest cannabis is a primary cause in the development of schizophrenia—rather, cannabis may be one of several risk factors, or these outcomes could be a reflection of pre-existing differences that led some young people to more substance use and risk taking behaviours” (Valleriani & Haines-Saah 2017).
Recent results from two prospective longitudinal twin studies did not support a causal relationship between marijuana use and IQ loss and suggested that observed IQ declines, at least across youth, may be caused by shared familial factors (e.g., genetics, family environment), not by cannabis use itself (Jackson et al. 2016)—meaning these familial factors underlie both marijuana initiation and low intellectual attainment, and more broadly, that various social determinants of health must be considered in this research.
Concerning, for example, the long-term impact on the developing brain, past studies are often limited by the fact that participants use multiple substances, and there is often limited data about the participant's’ health or mental well-being before the study* (NIH 2017).
Many of these limitations are well documented. A study by Weiland et al. (2015) found that many of these studies do not control for alcohol use, gender, age, and other variables that may be important to assessing these outcomes. Since alcohol, for example, has also been linked to cognitive brain changes in both youth and adults (Sullivan, 2007; Harper, 2009), alcohol or other drug use is an important factor. Weiland et al. (2015) also note the mixed evidence, explaining, “...marijuana use has been associated with both increased (Cousijn et al., 2012) and decreased (Yucel et al., 2008; Demirakca et al., 2011; Solowij et al., 2011) volumes of subcortical structures, or both (Battistella et al., 2014). Importantly, these studies were not designed to determine causality...which would require a longitudinal design to establish temporal precedence” (1506).
Overall, the evidence is mixed and lacking the methodological rigor that would allow researchers to conclude cannabis is the sole cause of these negative outcomes. While the absence of evidence doesn’t mean this couldn’t be the case, a majority of young people do not experience these negative outcomes. Further, rather than focusing on the potential negative outcomes, an important piece that is almost absent from this discussion is the development of non-judgemental, fact based education and prevention efforts for youth.
*National Institutes of Health is funding a longitudinal study called the Adolescent Brain Cognitive Development (ABCD) study, that will track a large sample of young Americans from late childhood (before the first use of drugs) to early adulthood. It will use a variety of tools such as neuroimaging to attempt to clarify these links.
5. CANNABIS USE CAN LEAD TO DEATH
“I believe in our youth, and I do not want to let our young people die. Why is marijuana not already legal in other G7 countries? That is a good question… The Liberal government wants to use our young people as guinea pigs. He wants to sacrifice a generation by improvising the legalization of marijuana in order to fulfill an election promise.” - Joël Godin, Portneuf—Jacques-Cartier, QC - Conservative
WHAT WE KNOW
Ok, Ok, I know this was in reference to the lyrics Mr. Portneuf read moments before (My head's going to explode/I'm about to crash/Lie down on the road/And breathe my last), but it deserves to be said: there are no instances of deaths caused directly by cannabis. While some drugs can kill through toxic or lethal doses, “...no acute lethal overdoses of cannabis are known, in contrast to several of its illegal (for example, cocaine) and legal (for example, alcohol, aspirin) counterparts... Although the use of cannabis is not harmless, the current knowledge base does not support the assertion that it has any notable adverse public health impact in relation to mortality” (Sidney, 2003: 635-636; ICT, 2010). More broadly, other longitudinal studies confirm that the data doesn’t support the characterisation of cannabis as a risk factor for mortality (Andreasson & Allebeck, 1990; Sidney et al., 1997). Cannabis is considered relatively “low risk,” and studies have noted its harms “have been overestimated in the past” (Lachenmeier & Rehm, 2015).
However, also important to this discussion are cases where cannabis may be related to cause of death (such as driving under the influence*) rather than being the direct cause. There was an interesting study released by Fischer et al. (2016) that attempted to predict cannabis related morbidity and mortality for motor vehicle accidents, use disorders, mental health (psychosis) and lung cancer, noting:
“...while cannabis use is not associated with direct acute mortality (e.g. from overdose/poisoning), it may lead to fatalities from MVAs and cancer. While these problems are rather different phenomena in terms of risk-behavioral characteristics—for example, cannabis use can be separated from the risk of impaired driving, while this is more difficult for cancer risks...these should be key areas of attention for interventions given the (potentially extensive) mortality involved” (p.185-186).
However, they note the limitations of ‘crude and simple estimates’.
*However, I note that it is difficult to assess cannabis as a contributor to driving fatalities as we currently lack the data to measure cannabis impairment while driving. Data on this topic is limited by measures that indicate presence of THC (which can stay in one’s system for weeks) versus actual intoxication at the time of accident).
6. DRIVING UNDER THE INFLUENCE OF CANNABIS WILL INCREASE WITH LEGALIZATION
“We know from Colorado that there is a 32% increase in drug-impaired driving and that has not been addressed. Issues have been raised about treaties and about inadequate resources in the provinces and municipalities.” - Mariyln Gladu, Sarnia-Lambton, ON - Conservative
“This law will expose new consumers to greater harm. Not only will law-abiding citizens start using, there will also be an increase in the number of road accidents caused by marijuana use. I am not the one saying this. This data comes from the various states, regions and municipalities that have legalized marijuana.” - Joël Godin Portneuf—Jacques-Cartier, QC - Conservative
“We have former peace officers here, and one has taken charge of this file. There are a number of road deaths of innocent people because of the legalization of a drug that has a mind-altering effect and affects the reaction time of people when they are driving. Apparently there is not yet a roadside test, but it may be close. We have one for alcohol. We may have one for drugs, but I am not sure how testing for a combination of the two is going to happen.” - Bev Shipley, Lambton-Kent-Middlesex, ON - Conservative
WHAT WE KNOW
Driving under the influence of cannabis is certainly one of the most frequently cited concerns around legalization. However, data coming from states that have legalized cannabis is promising—signaling this assumption is unsupported.
The claim that there has been a 32% increase in “drug-impaired” driving is inaccurate. This claim by Mrs. Gladu is based on the State of Colorado’s statistics on the number of ‘cannabis involved’ fatalities in Colorado (i.e positive tests for presence of THC, not impairment). This number did rise from18% in 2013 to 44% in 2015 (State of Colorado, 2017a). However, what she leaves out is that traffic fatalities since 2002, overall, are at an all-time low (State of Colorado, 2017b).
However, the number cited above, referring to ‘cannabis involved’ fatalities, only tells us that the driver used cannabis at some point, not that cannabis impairment was the cause of the fatality. The difficult piece of this conversation is the lack of technology to detect impairment, rather than just the presence of THC. We also know that traces of THC can remain in someone’s body for days to weeks after it is consumed, which means an individual can test positive but not be impaired (Woods, Brooks-Russell & Drum, 2015). There are scientifically accurate links between blood alcohol concentration and impairment, but not for THC (DPA, 2016). This means in a state where cannabis is legal, like Colorado, it is likely that more people overall would test positive for THC—how does this help us evaluate road safety? A positive test is not the same as measuring impairment, or accidents caused due to cannabis related impairment specifically, and importantly, traffic fatalities overall remain low.
The data from Colorado and Washington also suggests that the total number of arrests for driving under the influence of both alcohol and drugs has declined since legalization. For example, in Colorado, the number of DUI’s declined by 18% (from 5,546 in 2014 to 4,546 in 2015) (Colorado Department of Public Safety, 2016). In Washington, DUI citations declined by 8% from 2013 to 2014 (Washington State Patrol, 2015). Also important is that overall, only 8% of DUIs in Colorado and 4% of DUIs in Washington involved cannabis as the only drug (DPA, 2016). It’s too soon to really know what the cause of this decline is (some have, for example, suggested a substitution effect with substances like alcohol), but as I’ve mentioned above, there has not been an increase in traffic fatalities in either state after legalization (Dills, Goffard & Miron, 2016).
While Canada is certainly a different climate, a robust public education campaign and increased penalties for driving under the influence will likely not lead to more dangerous road conditions, particularly if we couple this with the promising data coming from the above US states. Further, a recent synthesis by Capler et al. (2017) identifies that according to roadside testing, only 4-6% of drivers drove within two hours of cannabis use in the past year*, and using studies that control for alcohol use, cannabis increases the MVA risk by 18%. They conclude, “The rate of cannabis-related driving offences in Canada remains low in comparison to the rate of driving offences associated with alcohol” (3).
Driving under the influence of cannabis is a concern under the context of legalization, however, these concerns must be contextualized with emerging evidence from legal jurisdictions, as well as a discussion of the comprehensive educational approach Canada will need to take to minimize negative public health outcomes.
*Self-reported studies indicate about 20% of cannabis users report driving within 2 hours of using cannabis.
7. ALCOHOL USE HAS NO DETRIMENTAL EFFECTS
“We cannot compare alcohol to drugs, because they do not compare. Alcohol is one element called “alcohol”. Drugs are a huge range of products that are toxic and harmful to people's health...To my knowledge, there are no studies that talk about permanent damage with regard to alcohol, whereas for drugs, and for people under 25, there are a number of studies that show there may be some.” - Joël Godin Portneuf, Jacques-Cartier, QC - Conservative
WHAT WE KNOW
Aside from Johnny and his toaster, this may be the most uninformed and incorrect statement from the second reading. This statement is a reflection of the permissive cultural norms and acceptance of alcohol as Canada's “drug of choice,” despite concrete evidence that alcohol is “one of the major risk factors for burden of disease and social harm in both developing and developed countries” (Rehm & Montiero, 2005: 241; see also Ezzati et al., 2002; WHO, 2002; Rehm et al., 2004; Murray & Lopez, 1997). This risk is particularly elevated in North America, even over and above smoking tobacco, as the most important risk factor for burden of disease (Rehm & Montiero, 2005).
Further, many studies have called attention to the extensive negative health impact and economic burden and benefits associated with alcohol consumption, coupled with the sheer number of individuals who use alcohol globally (van Amsterdam & van den Brink 2013), where alcohol “is more harmful for public health and society than illicit drug use” (248). Further, alcohol kills 35 people per every 100,000, nine times more than illicit drug use (Degenhardt and Hall, 2012). Alcohol, then, should really be the number one public health priority. As van Amsterdam & van den Brink (2013) conclude:
...the estimated worldwide number of problematic users of alcohol is considerably higher than the number of problematic users of opioids, cocaine and amphetamines (1.2% vs. 0.3–0.9%). Based on the estimate of UNODC of 27 million problematic users of illicit drugs (including cannabis) (UNODC, 2012), the number of subjects with an alcohol use disorder (76 million) (WHO, 2010b, 2011b) is some three times higher. In addition, the estimated number of attributable deaths and DALYs is much higher for alcohol use disorders than for problem illicit drug use (3.8% vs. 0.4% and 4.5% vs. 0.9%, respectively). Together, these data suggest that excessive alcohol consumption is more harmful for public health and for society than the use of illicit drugs.
Since we love hysteria around cannabis use and youth, I’ll also add that while a growing body of research is identifying these serious risks (Butt et al. 2011), young people in Canada use alcohol more than any other drug. In Ontario, for example, 46% of students in grades 7-12 report past year alcohol use, as high as 72% for grade 12 students* (OSDUHS 2015). Further, one in 5 of those students report drinking “harmfully” or “hazardously,” and a majority report getting alcohol from a family member (OSDUHS 2015). Where’s the outrage?
There is ample evidence of the increasing consumption of alcohol in Canada over the last decade, as well as increasing levels of alcohol-related harm (Butt et al., 2011; Kendall, 2008; Thomas et al, 2009), so to claim otherwise is not only factually incorrect, but a strategic attempt to appeal to how we construct and negotiate various norms around particular drugs in Canada that are often not rooted in the state of the scientific evidence.
*These numbers only include students, thus the proportion of at-risk or youth outside the school system may be much higher.
8. PROPOSED LEGISLATION MAKES IT “LEGAL” FOR YOUTH TO CARRY AND SHARE 5 GRAMS OF CANNABIS
“What that says, in a kind of sneaky way, is that it is prohibited above five grams, but it is completely okay to distribute five grams or less. We have heard other members of my party tonight say that five grams can be as many as 15 joints of marijuana. I have a vision of kids selling marijuana to other kids. The government members are saying that they are trying to protect our kids, when the bill says the opposite. They say that they are absolutely not going to do anything about kids selling marijuana to other kids. To me, the health of our kids is not being considered in what they are saying here. If they really cared about our kids, they would toughen up the regulations and laws they are putting forward on kids' possession and distribution of marijuana. This is not just about having one joint, even though that is still going to be harmful, potentially. We are talking about 15 joints they are going to be allowed to distribute among themselves, legally, with no threat of any kind of prosecution, ticket, offence, or anything.” - Bob Zimmer, Prince George—Peace River—Northern Rockies, BC - Conservative
“However, what the government's law says is that children between 12 and 17 years old can possess up to five grams of marijuana, and they can distribute it among themselves. They cannot sell it, but they can distribute it. It makes it a severe penalty for someone who is 18 to give marijuana to someone who is 17, yet someone who is 17 can give marijuana to someone who is 12 with absolutely no penalties. Therefore, there is a real demonstrable incoherence to the government's approach.”- Garrett Genuis, Sherwood Park—Fort Saskatchewan, AB - Conservative
Note: most research cites the “average” joint as 0.5 grams (Zeisser et al., 2015).
WHAT WE KNOW
Again, this claim is a stretch. The proposed Cannabis Act does not make it “legal” for youth to carry and share 5 grams of cannabis—as if this is similar to the possession limits of 30 g for adults—but rather it means that it will not be a criminal offense for a young person (defined in this section of the Cannabis Act as 12-17 years old).
To contextualize the importance of this, young people are disproportionately the targets of drug related arrests, a majority for cannabis possession alone (80%+) (Statistics Canada 2013). Canadian Students for Sensible Drug Policy, for example, advocated during the Task Force Consultations that all youth offenses outside the legal cannabis system be decriminalized because of this disproportionate impact on young people, particularly minority and at-risk youth. This carve-out of up to 5 grams is a start, but is absolutely meant to ensure that youth—under a new system that will continue to prohibit legal access to anyone under the age of 18—will not continue to be disproportionately harmed by criminal records under legalization. A criminal record can have lifelong negative effects on young people who otherwise have had no criminal justice contact. Also, claims that this would lead to youth cannabis dealers distributing in 5 gram increments defies all entrepreneurial common sense and lucrative logic, and classifying these youth as potential ‘drug mules’ is completely out of touch with youth culture and experiences around access.
Further, this offers provinces and territories an opportunity to provide non-criminal sanctions for small amounts. In theory, provinces could, for example, establish a ticketing system, similar to underage drinking, but I’d also flag concerns about the disproportionate burden of this on some youth over others (arguably those who are more at-risk or come from socio-economically disadvantaged families). Considering the detrimental effects of entering the criminal justice system at a young age, it seems like a no-brainer. Its unclear to me why a party would advocate for the continued disproportionate criminalization of our future generations, as if restrictions in and of themselves stop young people from accessing and using cannabis.
This is particularly senseless when we know strict prohibition does little to deter youth use, as evidenced by our current system, which boasts some of the highest use in the world for cannabis. As Erickson (1993) writes concerning the general deterrent effect of the laws around cannabis, "deterrent effects of the law in preventing cannabis use were demonstrated repeatedly to be minimal.” This isn’t new—since the late 1980s research has noted that “the impact of the law resulted in no effect on marijuana use” among youth (Single, 1989: 460). It’s time for a new approach to youth and cannabis that embodies more than just restrictions and law.
9. DECRIMINALIZATION IS A BETTER APPROACH
“One government member argued that pot arrests are tying up the courts. I have to ask, why not just decriminalize it? The Canadian Association of Chiefs of Police says so. My colleagues in the NDP do not disagree with it. What is so magical that on June 30 marijuana is going to be illegal but on the very next day, July 1, it is going to be magically okay? I do not often agree with my friends and my colleagues in the NDP, but they do have a point.” - Kelly McCauley, Edmonton West, AB - Conservative
“If the Liberals want to meet that objective, all they have to do is decriminalize marijuana.” - Joël Godin, Portneuf—Jacques-Cartier, QC - Conservative
“I will be honest and put all my cards on the table, because I think that is what Canadians are expecting from us. I believe in decriminalizing cannabis. That is something we should look at. I think that is because I have those sit-down family discussions with my kids, with my nieces and nephews, with my parents, because I think the biggest thing we need to recognize is that it is out there, and what can we do that is better to serve?
“In fact, it is the position of the Conservative Party that we should not move toward legalization but decriminalization, with a ticketing regime for small amounts of marijuana.”- Michael Cooper, St. Albert—Edmonton, AB - Conservative
WHAT WE KNOW
Decriminalization is the idea that rather than criminal sanctions, certain cannabis offenses would be met with civil sanctions, such as a fine (Single, 1989). Decriminalization has been referred to as a “half-measure” (Crepault et al., 2014), which can remove some of the harms of criminalization more broadly, without increasing the use of cannabis or cannabis dependence. However, under a decriminalized system, there are no measures to regulate the actual supply and production of cannabis, which can be problematic, or at least less superior to full regulation, as consumers are accessing unregulated and untested cannabis, and supply is being left in the hands of an illicit market. Arguably, one of the strengths of legalization is knowledge around potency and quality of the cannabis that is being consumed, as well as standards around production and distribution. Also, according to Crepault et al. (2014), decriminalization perpetuates the difficulty in ‘detecting and preventing’ problematic cannabis use.
Under decriminalization, cannabis production and distribution would remain largely underground, and other jurisdictions have seen other unintended consequences. This can include widening the reach of the criminal justice system through ticketing or citations (Room et al., 2010; Crepault et al. 2014). Also, Crepault et al. (2014) point out that ticketing could disproportionately impact those who can’t pay tickets, resulting in “secondary criminalization if people are unable to pay a fine and are then charged criminally” (10).
If our goal is to a) protect young people and b) eliminate the illicit market, decriminalization would achieve neither of those objectives, except to relieve some of the burden of criminalization under prohibition.
10. THE RECENT CMAJ EDITORIAL (WHICH CALLS FOR THE LIBERAL GOVERNMENT TO “KILL THE BILL” IF THEY TRULY CARE ABOUT THE SAFETY OF CANADIANS) REPRESENTS THE VOICE OF ALL DOCTORS
“I will also speak about the other two fronts, public health and public safety. Perhaps the best quote is the editorial by the Canadian Medical Association, which condemns the bill. Its editorial, which was released a few weeks ago, said: “The purported purpose of the act is to protect public health and safety, yet some of the act’s provisions appear starkly at odds with this objective, particularly for Canada’s youth. Simply put, cannabis should not be used by young people. It is toxic to their cortical neuronal networks, with both functional and structural changes seen in the brains of youth who use cannabis regularly.” That is an evidence-based opinion of cannabis doctors. How dare we disagree?” - Erin O'Toole Durham, ON - Conservative
“I am not the only one who is a little confused about what we are trying to achieve with this legislation. Dr. Diane L. Kelsall of the Canadian Medical Association said there were a number of things wrong with the legislation, but if it were truly an intent to produce a public health approach and protect our youth, this legislation would not do it. The medical world does not believe we are trying to keep it out of the hands of youth by legalizing it. It is an oxymoron position. If we want to keep it out of the hands of youth, legalizing it is not achieving that end.” - Arnold Viersen, Peace River-Westlock, AB - Conservative
WHAT WE KNOW
While the CMA is the national association of physicians in Canada, to suggest doctors across Canada have a uniform opinion regarding cannabis is inaccurate. Please see many rebuttals in the most recent CMAJ issue: http://www.cmaj.ca/content/189/21/E737#responses—namely, the response by Dr. Fischer & Dr. Rehm (two of the most well-published and respected scientists from the Centre for Addiction and Mental Health), which states “we categorically disagree—as consistently advocated elsewhere—with the conclusion that legalization will work against the protection of the public's, and especially youth's, health.”
The CMAJ editorial wasn’t very surprising, as the CMA was hoping to see a minimum age of 21, but it was the CMAJ that also wrote in 2001, “the real harm [of cannabis] is the legal and social fallout” (CMAJ, 2001). This is exactly what the editorial misses: the cost of prohibition—namely, the criminalization of Canadians and, most importantly, youth.
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