The Regional Municipality of Halton

Report To:

Chair and Members of the Health and Social Services Committee

From:

Hamidah Meghani, Commissioner and Medical Officer of Health

Date:

November 1, 2016

Report No.

MO-34-16 - Proposed Legalization, Regulation and Restriction of Access to Marijuana

RECOMMENDATION 1. THAT Report No. MO-34-16 re: “Proposed Legalization, Regulation and Restriction of Access to Marijuana” be received for information. 2. THAT the Regional Chair write to the Prime Minister advocating that the Government of Canada take a public health approach, which seeks to prevent and reduce health and social harms associated with marijuana use, to the legalization of marijuana in Canada. 3. THAT the Regional Clerk forward a copy of Report No. MO-34-16 to the local Members of Parliament for their information.

REPORT Executive Summary •

Marijuana is the most used illicit psychoactive substance in the world. In Canada, it is the second most used recreational drug, after alcohol.

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The Government of Canada is committed to legalizing, regulating and restricting access to marijuana. Legislation is expected to be tabled in the spring of 2017.

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There is a need to take a public health approach to legalization based on the principles of social justice, evidence informed policy and the determinants of health.

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A public health approach is recommended for the restriction of the production, distribution, sale and promotion of non-medical marijuana, thereby preventing and reducing health and social harms associated with marijuana use.

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Background The cannabis plant is found throughout the world. It has been used for millennia for its psychoactive effects – euphoria (“the high”), relaxation, a sense of well-being, and intensification of ordinary sensory experiences (i.e.; sight, sound, taste, smell). Historically it has been used for medical and social purposes. A variety of products can be produced or derived from the flower of the cannabis plant including: • • • • •

Dried herbal material (i.e.; “marijuana”); Oil (e.g.; “Hash oil”); Hash (i.e.; compressed resin); Concentrates (e.g.; “shatter”); or Foods and beverages containing extracts of cannabis.

Cannabis is most often smoked (as a dried herbal product, either alone or as a concentrate mixed with tobacco), but it can also be vaporized, or eaten. For the purpose of this report the popular, commonly-used term marijuana will be used throughout. Marijuana is the world’s most used illicit psychoactive substance. A World Health Organization study conducted in 2009 ranked Canada highest among all nations in terms of rates of marijuana use among youth. It is the second most used recreational drug in Canada after alcohol, especially among youth. In Halton, between 2009 and 2012, 33% of youth age 15 to 24 reported using marijuana in the last year. Those percentages decrease with age and overall are not statistically different from rates of use across Ontario (Health Indicator Report). As well, according to the 2012-2013 Halton Youth Survey (Our Kids Network), 18% of Grade 10 students in Halton report using marijuana at least once in the past 12 months. However, an important long-term trend has been noted in the Centre for Addiction and Mental Health (CAMH) Monitor eReport on Substance Use, Mental Health and Wellbeing Among Ontario Adults, 1977-2013. The findings show the continuing aging of marijuana users. The proportion of past year marijuana users aged 30 to 49 years more than doubled from 15% in 1977 to 32% in 2013, and the proportion of past year marijuana users aged 50 and older increased six fold, from 3% to 19% during the same period. CAMH does not provide a regional breakdown of their findings. Health Risks Health risks associated with marijuana use can be acute (i.e., immediate and short-lived) or chronic (i.e., delayed and longer-lasting).

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Short-term health risks can include: • • • • • • •

altered perception of time, distance and space impaired judgement loss of coordination disorientation sleepiness increased heart rate panic attacks or feeling paranoid

Effects due to long-term use can include: • • • • •

difficulty concentrating reduced memory and attention span psychological dependence and possible physical dependence increased risk of lung cancer worsening mental health issues such as depression and anxiety

Marijuana-related harm is concentrated among a limited sub-group of users who use marijuana frequently and/or began use at an early age. There is evidence that regular use of marijuana in adolescence can seriously harm the developing brain. This can lead to low educational attainment and increase the risk of developing mental health problems among other issues. Health risks may also increase depending on a number of other factors, including: • • • • •

longer duration of use larger amount used and stronger potency of the product delivery system (smoking can be more harmful than smokeless) high risk behaviours while intoxicated, such as driving or consuming other substances or medications health conditions such as chronic disease or a family history of psychosis

At all levels and pattern of use reported by most adult marijuana users, with the exception of the sub-group of users noted above, the health risks are relatively modest and significantly lower than tobacco or alcohol. Marijuana in Canada The production, sale and possession of marijuana is illegal in Canada, although the Marijuana for Medical Purposes Regulations (MMPR) provides a regime allowing for legal access to marijuana for medical purposes. However, the Government of Canada has committed to the legalization, regulation and restriction of access to marijuana for recreational purposes. The government recognizes that the current approach to marijuana prohibition is not working and that:

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youth continue to use marijuana at rates among the highest in the world thousands of Canadians end up with criminal records for non-violent drug offences each year organized crime reaps billions of dollars in profits from its sale most Canadians no longer believe that simple marijuana possession should be subject to harsh criminal sanctions, and support the government’s commitment to legalize, tax and regulate marijuana

Legislation is scheduled to be tabled in the spring of 2017. The objectives of this legislation, listed in the 2016 Toward the Legalization, Regulation and Restriction of Access to Marijuana Discussion Paper, are to: • • • • •

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protect young Canadians by keeping marijuana out of the hands of children and youth keep profits out of the hands of criminals, particularly organized crime reduce the burdens on police and the justice system associated with simple possession of marijuana offences prevent Canadians from entering the criminal justice system and receiving criminal records for simple marijuana possession offences protect public health and safety by strengthening, where appropriate, laws and enforcement measures that deter and punish more serious marijuana offences, particularly selling and distributing to children and youth, selling outside of the regulatory framework, and operating a motor vehicle while under the influence of marijuana ensure Canadians are well-informed through sustained and appropriate public health campaigns, and for youth in particular, ensure that risks are understood establish and enforce a strict system of production, distribution and sales. This would include regulation of quality and safety (e.g.; child-proof packaging, warning labels), restriction of access, and application of taxes ensure support for addiction treatment, mental health support and education programs continue to provide access to quality-controlled marijuana for medical purposes consistent with federal policy and Court decisions conduct on-going data collection, including gathering baseline data, to monitor the impact of the new framework

This proposed legislation is anticipated to follow similar changes made in four (4) U.S. states (Alaska, Colorado, Oregon and Washington) as well as the District of Columbia. Internationally, Uruguay is the only country to fully legalize marijuana to-date. Lessons learned from those jurisdictions identify the need for a comprehensive regulatory system that controls production, regulates advertising and prevents use by youth. As well, it was noted that there is a need for ongoing monitoring and adjustments to public policy and the need for public health education.

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The Need for a Public Health Approach A public health approach, as defined by the Canadian Public Health Association, is based on the principles of social justice, attention to human rights and equity, evidence informed policy and practice and addressing the underlying determinants for health (CPHA, 2014). This approach can be applied to many population health concerns, including the legalization of marijuana. Research on tobacco and alcohol, as well as information from other jurisdictions where marijuana is legal, suggests that taking a public health approach to establishing regulations for the legalization of marijuana in Canada is crucial for reducing health and social harms. Specific areas of concern for public health include marijuana-impaired driving, the effect on youth brain development and mental health, respiratory effects, use during pregnancy and risk of dependence. In 2014, the Centre for Addiction and Mental Health (CAMH) released the “Cannabis Policy Framework” report, that concluded that Canada needs a strong policy framework for marijuana and recommended legalization with strict regulations. The CAMH report recommends: • • • • • • • • • •

establishing a government monopoly on sales setting a minimum age for purchase and consumption limiting availability curbing demand through pricing curtailing higher-risk products and formulations prohibiting marketing, advertising and sponsorship clearly displaying product information developing a comprehensive framework to address and prevent marijuanaimpaired driving enhancing access to treatment and expand treatment options investing in education and prevention

The CAMH policy framework is consistent with the views of other agencies such as the Canadian Public Health Association (CPHA) and the Canadian Centre on Substance Abuse (CCSA). Halton Region Health Department (HRHD) supports this need for a strong policy framework and for strict regulation of marijuana. Such regulation will in turn support the work of public health going forward in preventing and reducing the health and social harms associated with marijuana use.

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Discussion Public health is an important stakeholder on the issue of the legalization of marijuana and supports the recommendations outlined in the CAMH policy framework that includes a standard minimum age for legal use across all provinces and territories, controls on marketing, advertising and packaging of the product, similar to those found with tobacco and alcohol, and quality control and limits on the potency of the product. The Federal Task Force on Marijuana Legalization and Regulation is preparing a final report, which will provide advice on the design of a new legislative and regulatory framework to the Federal Ministers of Justice, Public Safety and Emergency Preparedness, and Health and the Attorney General of Canada in November 2016. It is not known when the final report will be made public. The actual role of the HRHD will be established once the legislation has been passed and various jurisdictions determined. Staff may be required to provide oversight and education not unlike what is currently being done through the Smoke-Free Ontario strategy. At this time, there is no additional information available on the pending legalization of marijuana or the potential implications for public health. Staff will report back to Council when more is known.

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FINANCIAL/PROGRAM IMPLICATIONS There are no financial or program implications associated with this information report.

Respectfully submitted,

Dorothy Barr Director, Healthy Families

Hamidah Meghani, MD Commissioner and Medical Health

Officer

Approved by

Jane MacCaskill Chief Administrative Officer If you have any questions on the content of this report, please contact:

Attachments:

None

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Dorothy Barr Roslyn Ralph

Tel. # 7890 Tel. # 7346

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