Category Archives: Public Health

Cannabis Public Forum with Dr. David Swann

This week I was part of a panel discussion hosted by MLA for Calgary Mountainview Dr. David Swann, who brought together experts with diverse perspectives from Indigenous health and wellness, public health, law, policing and the City of Calgary, to discuss the risks and benefits of legalization. What I found resonated most with attendees was drawing from the public health evidence to talk about what we know about the prevalence of use and the risks of harm. Surprisingly to me, some people thought that prevalence of lifetime reported use* was already at 80-90%. In fact, what we know is that this is about 43% nationally and 48% for Alberta based on the most recent data from our major general population survey of substance use, Health Canada’s CTADS. In more recent past-year prevalence data from the CCS, which was designed to over-sample cannabis users** we see that reported use in the past 12 months was at 22% for those age 16+. So yes, cannabis is the most frequently used (currently) illicit drug, but based on these representative surveys of Canadians, we can still say that there are more people who are not using it than those who are. In short, nothing to panic about here!

You can watch the Facebook live recordings of the event here (I am the last speaker on the panel):

Part 1 (the forum) here: https://bit.ly/2r2n8l7
Part 2 (questions) here: https://bit.ly/2HZkHYD

*this includes anyone who has used at least once in their lifetimes.
**this survey is not meant to provide general population prevalence estimates for cannabis use as the CTADS does.

Understanding the public health rationale for legalization in Canada

On February 6th the University of Calgary’s Campus Mental Health Strategy hosted a cannabis townhall event, where a panel of speakers addressed the university community on the evidence and policy issues surrounding cannabis legalization. The event was moderated by Kathy Le from CTV Calgary, and coincidentally Cathy did a very good series in 2015, reporting on Calgary mother Sarah Wilkinson’s struggles to access medical cannabis for her daughter Mia, who has severe epilepsy. Sarah was one of the patient advocates who spoke at our O’Brien Forum on Cannabis and Public Health in May 2017.

Photo Credit: Justin Schellenberg (UC Gauntlet)

It was great to see such a strong turn out for this event and the high level of engagement from the campus community and members of the general public. I only wish we had more time to field audience questions, which is always the case! I was also struck by the fact that every time I do a public event like this I meet people from many different walks of life who want to tell me about their experiences – mainly positive, but also negative – with using cannabis. I am really curious to see how this conversation will broaden and shift among Canadians post-legalization. As I mentioned in my talk, I think we are going to see many more people admitting to using and also speaking out about the social stigma of having charges for cannabis possession.

Although no one really enjoys listening to themselves give a talk (especially when you have the voice of a 12-year-old, as I do), I was happy with the way this one turned out. You can hear the audio from my presentation, “Understanding the public health rationale for legalization in Canada,” as well as all of the other panelists, over on SoundCloud (thanks to Trevor Howell for capturing these recordings). You will also want to check out talks from my UCalgary colleagues Fiona Clement and Matt Hill.

For more on this event see:

How can legalizing cannabis promote public health?

There is a great deal of current debate about whether or not legalizing cannabis will ‘protect’ public health. In this segment from CBC Radio Calgary’s the Homestretch, I spoke to Rob Brown about the public health approach that is informing Canada’s approach to legalization, what it is, where it differs from ‘medical’ perspectives and why it is the best option for reducing the potential for problematic use or the harms associated with cannabis use.

Listen: Marijuana and public health

Want to read more? Check out these reports and links:
Cannabis use in Canada: the need for a ‘public health’ approach (Fischer & Rehm, 2009)
Cannabis Policy Framework (CAMH, 2014)
A vision for cannabis regulation: a public health approach based on lessons learned from the regulation of alcohol and tobacco (Haden & Emerson, 2014)
A Public Health Approach to the Legalization, Regulation and Restriction of Access to Cannabis (CPHA, 2017)

Marijuana age limit should be low – not high

This article was originally published on The Conversation. Read the original article.

Rebecca Haines-Saah, University of Calgary

Lowering the legal age for marijuana use will help to improve prevention, safety and education for young people.

As the public debate on legalization of cannabis in Canada gains momentum, one of Bill C-45’s most contentious recommendations is to set the age of 18 as the floor for access. Because provinces have jurisdiction, we may see variations in the law when it is implemented across Canada.

I am one of a few vocal advocates for a harmonized policy with the age of access set at 18 years. I am a youth substance-use researcher with a PhD in behavioural health sciences and addiction studies. I have studied adolescent cannabis and tobacco use for more than a decade, and currently co-lead the TRACE program to understand teen cannabis culture. Based on this, I believe a lower age is better for two key reasons: It will help to divert youth from illicit markets, and it will prompt an earlier start for cannabis prevention and education.

Since legalization was announced, associations that represent medical professionals in Canada have argued for the age of access to be set at 21. The groups include the Canadian Psychiatric Society and the Canadian Medical Association.

Their stances stem from a 2015 report by the Canadian Centre on Substance Use and Addiction, which has been used to recommend an age floor of 24 or 25. This is based on emerging research of cannabis-use effects on brain structure and function in the developmental period that extends into the mid-twenties. The Canadian Pediatric Society declined to specify an age, but focused on harmonizing the legal access age with those for tobacco and alcohol.

Social cost is high

As I have previously argued, setting the age of access higher based on the evidence for potential brain harm neglects social costs of a criminal record for cannabis possession. For example, an arrest record limits one’s ability to travel outside Canada, be bonded for employment or volunteer in the community.

Without a “clean” criminal record, a person would be unable to participate in mundane but important activities: coaching a children’s soccer team or volunteering to chaperone their school field trips. Such a person certainly could not be a foster parent or adopt a child.

In the long, historical policy debate on cannabis legalization in Canada, we’ve been taught that cannabis use is illegal and bad. That poses a challenge now that we say continuing to criminalize cannabis use doesn’t make good policy sense.

The Canadian Drug Policy Coalition offers a “public health approach” for legalizing drugs, which “recognizes that people use substances for anticipated beneficial effects and is attentive to the potential harms of the substances and the unintended effects of control policies… It seeks to ensure that harms associated with control interventions are not out of proportion to the benefit-to-harm ratios of the substances.”

Similarly, the Federal Task Force on Cannabis Legalization and Regulation report explains why greater restrictions on youth access aren’t necessarily protective policy choices: “Excessive restrictions could lead to the re-entrenchment of the illicit market.”

Youth behaviour varies

In short: Set the age too high and youth will continue to seek cannabis through existing, unregulated suppliers. The product will be of unknown quality and safety due to THC content (the main psychoactive ingredient in cannabis), additives such as pesticides, or mould contamination.

Illicit cannabis is easily accessible to youth at any time. Our research with B.C. teens who use cannabis supports Prime Minister Justin Trudeau’s oft-quoted line about youth having easy access to cannabis, more than tobacco or alcohol.

In the TRACE project that began in British Columbia in 2006, we spoke to teens who were frequent cannabis users. It was the first study in Canada that aimed to explore the culture and context of teen use from their own perspective.

Contrary to a “stoner” stereotype, some used cannabis as a “gateway to nature” to enhance outdoor activities such as biking or skiing. Cannabis use was influenced by gender and used in different ways by boys and girls. Teens were also aware of the harms of co-use (smoking tobacco and cannabis together) and some engaged in what we called “relief-oriented” use to deal with or manage health problems.

Perhaps most importantly, our research highlighted the value of eliciting teen perspectives on the evidence about cannabis use, and applying findings to shape prevention efforts that might better resonate with youth.

Degrassi TV series a model for education

Much of my approach as a teen substance use researcher comes from my experience as an actress: I was one of the original cast of the popular Degrassi teen television series from about age 13 to 19.

This is where we often go wrong in programming for young people: We don’t consult, include or listen to them in a meaningful way when developing programming for them, and wonder why our “adults know best” approach fails.Key to the franchise’s success and 30-year longevity has been its edgy and honest way of addressing teen coming-of-age issues. No topic is off-limits, including suicide, abortion and drug use. The strategy is the antithesis of the 1980s “after-school special” network television narrative, in which adults save the day when a kid gets into serious trouble. Degrassi storylines take an honest and non-judgmental approach to teen experiences and dilemmas, in which youth first turn to peers to solve their own problems.

A youth-centered approach explicitly informed the CYCLES film that was developed from the TRACE research program.

CYCLES aimed to be a tool for teachers to have open and honest dialogue with students about cannabis use. It was a type of non-judgmental and “reality based” prevention tool teachers lacked.

The film does not harp on the potential for health or legal consequences of cannabis use. Instead, it focuses on how teens make decisions about cannabis in the context of peer and romantic relationships. We did this because our research showed scare tactics turned teenagers off and were unlikely to prevent or reduce use in their view.

Ultimately, the main character in CYCLES decides to move away from cannabis use when he sees the impact it has on his girlfriend, how his use may be influencing his younger sibling and could compromise a part-time job that he loves — not because an adult told him unequivocally to “just say no.”

Drug use a social ritual

Experimentation with psychoactive substances has been a coming of age ritual for North American adolescents for generations. Like sexuality, youth initiate these experiences because they mark “grown-up” status and entail pleasure, social connections and peer bonding. They also hold potential for physical and emotional harm.

Yet drug education is unlike current approaches to sex education in which we see the value of teaching youth active consent and decision-making to prevent harm from “risky,” coerced or unprotected sex.

In cannabis and other drug prevention, we cannot get beyond an abstinence-based mandate. We fear that teaching children and youth about reducing drug harm is the same as enabling drug use.

We won’t be able to legislate or educate away these behaviours, if history is any guide. Prevention and education for youth, how we talk to them and — most importantly — whether or not we listen to them matters more than what the law says about when they’re old enough to buy it.

The ConversationWhen cannabis is no longer an illicit substance we will have the latitude to do more and better prevention. Legalization with a low age of access will create the context and impetus to prevent potential harms of cannabis use through a truly youth-centered approach.

Rebecca Haines-Saah, Assistant professor of community health sciences, University of Calgary