Public Health Approach to Cannabis Regulation Dr. Robert Strang, CMOH Nova Scotia Department of Health and Wellness

Cannabis use, lifetime and past year, by province, 2013 Cannabis use is prevalent in Canada. 33.7 of Canadians report ever using cannabis in their lifetime. Nova Scotia has the highest rate of lifetime use at 42.8%. Past year use among Canadians in 2013 was 10.6%, with the highest rate in BC at 13.3%. BC was followed by Nova Scotia at 12.5%. Health Canada (2014)

Last 12 month use of cannabis, by province, grades 7-12, 2012-2013 Cannabis use among youth in Canada has now exceeded tobacco use. Past year use of cannabis use among students grades 7-12 was 19.3% in 2013. By comparison, tobacco use among those ages 15-19 years was down to 11%. Past year use among youth was highest in New Brunswick at 27.1% following by Nova Scotia at 24%. * * Manitoba declined participation in the 2012-2013 Youth Smoking Survey Health Canada (2014)

Health Impacts Mental health Increased risk for psychosis High comorbidity with schizophrenia, bipolar disorder Cannabis use disorder 9% of cannabis users Adults who use cannabis less than 10x/month account for less than 5% of cannabis consumption

Health Impacts Child poisoning Edibles & flavours Youth health Brain development Negative effects are not reversible as with adult users Lung health (?) Injury risk Impaired driving

Social Impacts Criminalization Justice system involvement Impact on racialized populations Educational attainment Employment The criminalization of cannabis has resulted in a range of harmful social impacts to individuals and communities. The criminalization of cannabis disproportionately negatively impacts those who are more vulnerable by exacerbating existing social inequities. This includes racialized and other marginalized populations who are more likely to be penalized for cannabis possession despite having usage rates that are no different from non-racialized or non-marginalized populations. Outside of the issue of criminalization, cannabis has been associated with other social harms including educational attainment and negative impacts on employment. Researchers acknowledge that there may be other variables at play such as early childhood adversity, behavioural challenges, and social disadvantage.

Public Health Approach Cannabis Policies & Harm: A Conceptual Model Adapted from Apfel, 2014 Unregulated criminal market Unregulated legal market Health & social harms Cannabis legalization provides an opportunity to reduce the health risks and social harms of cannabis that currently exist in Canada. Of critical importance in reducing harms is delaying the onset of usage until adulthood. However, this will only be achieved if cannabis is regulated from a public health and safety perspective. As demonstrated in the figure on this slide, health and social harms are highest in a society when the model is an unregulated criminal market or an unregulated legal market. Legalization of cannabis combined with strict regulation will result in the least health and social harms to society. Total prohibition Legalization with strict regulation Decriminalization Legalization with light regulation Legalization without regulation

A PH Framework for Legalization Product Potency Edibles Flavours/candy Access Age of majority Government-owned, single product stores Outlet density & hours and days of sale The criminalization of cannabis has resulted in a range of harmful social impacts to individuals and communities. The criminalization of cannabis disproportionately negatively impacts those who are more vulnerable by exacerbating existing social inequities. This includes racialized and other marginalized populations who are more likely to be penalized for cannabis possession despite having usage rates that are no different from non-racialized or non-marginalized populations. Outside of the issue of criminalization, cannabis has been associated with other social harms including educational attainment and negative impacts on employment. Researchers acknowledge that there may be other variables at play such as early childhood adversity, behavioural challenges, and social disadvantage.

A PH Framework for Legalization Pricing Potency Taxation Sales/discounts Marketing Advertising Sponsorship Production The criminalization of cannabis has resulted in a range of harmful social impacts to individuals and communities. The criminalization of cannabis disproportionately negatively impacts those who are more vulnerable by exacerbating existing social inequities. This includes racialized and other marginalized populations who are more likely to be penalized for cannabis possession despite having usage rates that are no different from non-racialized or non-marginalized populations. Outside of the issue of criminalization, cannabis has been associated with other social harms including educational attainment and negative impacts on employment. Researchers acknowledge that there may be other variables at play such as early childhood adversity, behavioural challenges, and social disadvantage.

A PH Framework for Legalization Public Safety Counter-marketing Impaired driving law Smoke/vape-free places The criminalization of cannabis has resulted in a range of harmful social impacts to individuals and communities. The criminalization of cannabis disproportionately negatively impacts those who are more vulnerable by exacerbating existing social inequities. This includes racialized and other marginalized populations who are more likely to be penalized for cannabis possession despite having usage rates that are no different from non-racialized or non-marginalized populations. Outside of the issue of criminalization, cannabis has been associated with other social harms including educational attainment and negative impacts on employment. Researchers acknowledge that there may be other variables at play such as early childhood adversity, behavioural challenges, and social disadvantage.

Conclusion Unregulated commercialization of a legalized cannabis market could negatively impact road safety in Canada by increasing rates of impaired driving A public health approach to cannabis legalization can improve health and safety outcomes