Cannabis legalization: adhering to public health best practice
Added on 2023-06-14
6 Pages6409 Words266 Views
AnalysisCMAJ©2015 8872147 Canada Inc. or its licensors CMAJ, November 3, 2015, 187(16) 1211
According to the 2011 United Nations
World Drug Report, the prevalence of
cannabis use in the Netherlands, where
cannabis has been de facto legal for the last 40
years, is lower than in many other European
countries, the United States and Canada.1 Juris-
dictions that have recently legalized cannabis
(Uruguay and four US states) or redefined can-
nabis legalization policies (Catalonia) may be
expecting a similar result. However, if their poli-
cies governing cannabis are different, they may
see different outcomes.
In this article, we analyze cannabis legaliza-
tion policies through a public health lens using a
framework2 created from extensive data on to-
bacco3 and alcohol regulation.4 The aim of this
article, and indeed the framework, is to go be-
yond reduction in use and include minimization
of harms and realization of benefits.5 Cannabis
policy will be a topic of debate in Canada in the
lead-up to the federal election in October. The
governing party favours the status quo, one of
the competing political parties has promised
decriminalization, and another party supports le-
galization.6 Surveys have shown that most Can-
adians are looking for change.7,8 We provide a
resource for Canadian policy-makers looking to
reform cannabis laws and a tool for researchers
evaluating cannabis policies and their outcomes.
A broad picture of cannabis use
and legality
A 2013 UNICEF study found that the prevalence
of cannabis use among youth in the preceding
year was highest in Canada (28%) and lower in
Spain (24%), the US (22%) and the Netherlands
(17%).9 A 2014 survey in Uruguay found that
17% of secondary school children reported using
cannabis in the preceding year.10 According to the
2011 UN World Drug Report, cannabis use in the
general population was higher in Canada, the US
and Spain than in Uruguay and the Netherlands.1
There are an estimated 180.6 million cannabis
users worldwide,11 most living in jurisdictions
where cannabis is illegal.
In the past three years, Uruguay and four US
states have gone beyond the limited legalization
policies in Spain and the Netherlands to fully legal-
ize the possession, production and sale of cannabis.
Many other jurisdictions have removed criminal
penalties for possession or have legalized cannabis
for medical use, or both. Canada legalized the use
of cannabis for medical indications in 2001 and
implemented updated regulations for medical use
and production in 2014.12 Possession of cannabis
for nonmedical use remains a criminal offence, and
about 60 000 Canadians are charged yearly.13
Legalization of cannabis for nonmedical use
remains contrary to the 1961 UN Single Conven-
tion on Narcotic Drugs. Signatory countries can
address this by renegotiating, withdrawing from
or ignoring the treaty. Uruguay has chosen the
third approach, arguing that its legalization
framework follows the more important UN val-
ues of human rights, public health and safety.14
What are the harms from cannabis
use and its prohibition?
Policies that prohibit cannabis cause harm.15 They
funnel money into the illegal market and drive
criminal activity. They harm individuals through
imprisonment, marginalization and the creation of
barriers to treatment. This burden falls dispropor-
tionately on vulnerable groups; even though white
and black Americans use cannabis at about the
Cannabis legalization: adhering to public health best practice
Sheryl Spithoff MD, Brian Emerson MD MHSc, Andrea Spithoff MA
Competing interests: None
declared.
This article has been peer
reviewed.
Correspondence to:
Sheryl Spithoff,
sheryl.spithoff@wchospital.ca
CMAJ 2015. DOI:10.1503
/cmaj.150657
• Prohibition of cannabis has failed to achieve its goal of reducing use
and causes substantial public health and societal harm.
• Two of Canada’s three main political parties promise to reform
cannabis policies if voted into power.
• If Canadian policy-makers move away from prohibitionist policies and
create a legal framework for cannabis, public health promotion and
protection must be the primary goals.
• Lessons learned from permissive alcohol and tobacco regulation can
guide public health–oriented policy-making; in particular, a ban on
promotion and advertising of cannabis to prevent commercialization
will be important.
• Policy-makers should look to jurisdictions with legalized cannabis that
prioritize public health and use evidence, not ideology, to guide policies.
Key points
CMAJ Podcasts: author interview at https://soundcloud.com/cmajpodcasts/150657-ana
According to the 2011 United Nations
World Drug Report, the prevalence of
cannabis use in the Netherlands, where
cannabis has been de facto legal for the last 40
years, is lower than in many other European
countries, the United States and Canada.1 Juris-
dictions that have recently legalized cannabis
(Uruguay and four US states) or redefined can-
nabis legalization policies (Catalonia) may be
expecting a similar result. However, if their poli-
cies governing cannabis are different, they may
see different outcomes.
In this article, we analyze cannabis legaliza-
tion policies through a public health lens using a
framework2 created from extensive data on to-
bacco3 and alcohol regulation.4 The aim of this
article, and indeed the framework, is to go be-
yond reduction in use and include minimization
of harms and realization of benefits.5 Cannabis
policy will be a topic of debate in Canada in the
lead-up to the federal election in October. The
governing party favours the status quo, one of
the competing political parties has promised
decriminalization, and another party supports le-
galization.6 Surveys have shown that most Can-
adians are looking for change.7,8 We provide a
resource for Canadian policy-makers looking to
reform cannabis laws and a tool for researchers
evaluating cannabis policies and their outcomes.
A broad picture of cannabis use
and legality
A 2013 UNICEF study found that the prevalence
of cannabis use among youth in the preceding
year was highest in Canada (28%) and lower in
Spain (24%), the US (22%) and the Netherlands
(17%).9 A 2014 survey in Uruguay found that
17% of secondary school children reported using
cannabis in the preceding year.10 According to the
2011 UN World Drug Report, cannabis use in the
general population was higher in Canada, the US
and Spain than in Uruguay and the Netherlands.1
There are an estimated 180.6 million cannabis
users worldwide,11 most living in jurisdictions
where cannabis is illegal.
In the past three years, Uruguay and four US
states have gone beyond the limited legalization
policies in Spain and the Netherlands to fully legal-
ize the possession, production and sale of cannabis.
Many other jurisdictions have removed criminal
penalties for possession or have legalized cannabis
for medical use, or both. Canada legalized the use
of cannabis for medical indications in 2001 and
implemented updated regulations for medical use
and production in 2014.12 Possession of cannabis
for nonmedical use remains a criminal offence, and
about 60 000 Canadians are charged yearly.13
Legalization of cannabis for nonmedical use
remains contrary to the 1961 UN Single Conven-
tion on Narcotic Drugs. Signatory countries can
address this by renegotiating, withdrawing from
or ignoring the treaty. Uruguay has chosen the
third approach, arguing that its legalization
framework follows the more important UN val-
ues of human rights, public health and safety.14
What are the harms from cannabis
use and its prohibition?
Policies that prohibit cannabis cause harm.15 They
funnel money into the illegal market and drive
criminal activity. They harm individuals through
imprisonment, marginalization and the creation of
barriers to treatment. This burden falls dispropor-
tionately on vulnerable groups; even though white
and black Americans use cannabis at about the
Cannabis legalization: adhering to public health best practice
Sheryl Spithoff MD, Brian Emerson MD MHSc, Andrea Spithoff MA
Competing interests: None
declared.
This article has been peer
reviewed.
Correspondence to:
Sheryl Spithoff,
sheryl.spithoff@wchospital.ca
CMAJ 2015. DOI:10.1503
/cmaj.150657
• Prohibition of cannabis has failed to achieve its goal of reducing use
and causes substantial public health and societal harm.
• Two of Canada’s three main political parties promise to reform
cannabis policies if voted into power.
• If Canadian policy-makers move away from prohibitionist policies and
create a legal framework for cannabis, public health promotion and
protection must be the primary goals.
• Lessons learned from permissive alcohol and tobacco regulation can
guide public health–oriented policy-making; in particular, a ban on
promotion and advertising of cannabis to prevent commercialization
will be important.
• Policy-makers should look to jurisdictions with legalized cannabis that
prioritize public health and use evidence, not ideology, to guide policies.
Key points
CMAJ Podcasts: author interview at https://soundcloud.com/cmajpodcasts/150657-ana
LAPTOP_MP194
4/10/2018, 9:36:53 AMLAPTOP_MP194
4/10/2018, 9:36:31 AMLAPTOP_MP194
4/10/2018, 9:35:42 AMAnalysis1212 CMAJ, November 3, 2015, 187(16)
same rate, the latter are 3.73 times more likely to
be arrested for possession.16 Finally, society pays
with high policing, court and prison costs.15,17
Harms from regular cannabis use may be less
than those associated with other psychoactive
substances,18 but they are still substantial at a pop-
ulation level. At higher doses, cannabis is a well-
established risk for motor vehicle crashes.19,20
Combining alcohol with cannabis results in
greater impairment than either substance alone.21
A recent study estimated that 6825–20 475 inju-
ries from cannabis-attributed motor vehicle
crashes occur in Canada annually.19 Each year in
Canada, 76 000–95 000 people undergo cannabis
addiction treatment and 219–547 cannabis-related
deaths occur (from injuries in motor vehicle
crashes and lung disease).19 Youth are particularly
vulnerable to the effects of cannabis: regular users
frequently report loss of control over their canna-
bis use,22 have lower educational attainment23 and
may have, according to one cohort study, a drop
in IQ that persists into adulthood.24
Often the harms from prohibition versus harms
from potential increased use of cannabis are
falsely pitted against each other. Evidence shows,
however, that cannabis prohibition has no effect
on rates of use, at least in developed countries.25–28
Some have advocated for the removal of crimi-
nal penalties for possession instead of legalization.
With Portugal’s experience in decriminalizing can-
nabis, users benefit from reduced marginalization,
imprisonment and barriers to treatment, and soci-
ety benefits from reduced policing, court and
prison costs.17 The illegal supply chain, however,
continues to fund criminal activity. In addition, be-
cause the government does not control the produc-
tion, processing, supply or price of cannabis, it has
a limited ability to achieve public health goals.
What objectives should underpin
legalization?
If policy-makers opt to legalize cannabis, careful
planning and comprehensive governmental con-
trols would provide the greatest likelihood of
minimizing harms and maximizing benefits. A
cannabis legalization framework should explic-
itly state that public health promotion and pro-
tection are its primary goals. It should list spe-
cific objectives,5,29,30 including delayed onset of
use by youth; reduced demand; reduced risky
use (e.g., reduced impaired driving); decreased
rates of problematic use, addiction and concur-
rent risky use of other substances; reduced con-
sumption of products with contaminants and un-
certain potency; increased public safety (e.g.,
reduced drug-related crime); reduced discrimina-
tion, stigmatization and marginalization of users;
and realization of therapeutic benefits.
A frequently cited concern with legalization is
that it will allow the rise of Big Cannabis,31 simi-
lar to Big Tobacco and Big Alcohol. These pow-
erful multinational corporations have revenues
and market expansion as their primary goals, with
little consideration of the impact on public health.
They increase tobacco and alcohol use by lobby-
ing for favourable regulations32 and funding huge
marketing campaigns.33 It is important that the
regulations actively work against the establish-
ment of Big Cannabis.
Evaluating cannabis regulations
through a public health lens
There is scant direct evidence to guide the cre-
ation of public health–oriented cannabis policies.
Fortunately, there is an extensive evidence base
for two other substances with potential for addic-
tion and other harms: tobacco3 and alcohol.4
With these data, researchers have proposed pol-
icy frameworks for cannabis.28–30,34
For our analysis, we built on previous
work,29,35–38 using a framework created by Can-
adian public health researchers2 that was based
on a report by the Health Officers Council of
British Columbia.5 We included jurisdictions
with well-articulated cannabis policies and regu-
lations, which we analyzed from a public health
perspective using a systematic method (Table 1).
Uruguay
Uruguay follows the key public health best prac-
tices.40 It has established a central, governmental,
arm’s length commission to purchase cannabis
from producers and sell to distributors. The com-
mission will have control over production, quality
and prices, and the ability to undercut the illegal
market.41 Uruguay has banned cannabis-impaired
driving and has set the cut-off for impaired driv-
ing to a serum tetrahydrocannabinol (THC) level
of 10 ng/mL. Because of its zero-tolerance policy
for alcohol-impaired driving, the country has cre-
ated a lower threshold for the combination of can-
nabis and alcohol. Tax revenues will fund the
commission and a public health campaign. (Can-
nabis will initially be sold tax free to undercut the
illegal market.) Uruguay bans all promotion of
cannabis products. Pharmacies will sell bulk can-
nabis in plain bags, labelled only with the THC
percentage and warnings. (Sales are slated to start
early in 2016.) Individuals are permitted to grow
their own cannabis and to form growing co-
operatives. People who purchase or grow canna-
bis will be registered and fingerprinted to prevent
same rate, the latter are 3.73 times more likely to
be arrested for possession.16 Finally, society pays
with high policing, court and prison costs.15,17
Harms from regular cannabis use may be less
than those associated with other psychoactive
substances,18 but they are still substantial at a pop-
ulation level. At higher doses, cannabis is a well-
established risk for motor vehicle crashes.19,20
Combining alcohol with cannabis results in
greater impairment than either substance alone.21
A recent study estimated that 6825–20 475 inju-
ries from cannabis-attributed motor vehicle
crashes occur in Canada annually.19 Each year in
Canada, 76 000–95 000 people undergo cannabis
addiction treatment and 219–547 cannabis-related
deaths occur (from injuries in motor vehicle
crashes and lung disease).19 Youth are particularly
vulnerable to the effects of cannabis: regular users
frequently report loss of control over their canna-
bis use,22 have lower educational attainment23 and
may have, according to one cohort study, a drop
in IQ that persists into adulthood.24
Often the harms from prohibition versus harms
from potential increased use of cannabis are
falsely pitted against each other. Evidence shows,
however, that cannabis prohibition has no effect
on rates of use, at least in developed countries.25–28
Some have advocated for the removal of crimi-
nal penalties for possession instead of legalization.
With Portugal’s experience in decriminalizing can-
nabis, users benefit from reduced marginalization,
imprisonment and barriers to treatment, and soci-
ety benefits from reduced policing, court and
prison costs.17 The illegal supply chain, however,
continues to fund criminal activity. In addition, be-
cause the government does not control the produc-
tion, processing, supply or price of cannabis, it has
a limited ability to achieve public health goals.
What objectives should underpin
legalization?
If policy-makers opt to legalize cannabis, careful
planning and comprehensive governmental con-
trols would provide the greatest likelihood of
minimizing harms and maximizing benefits. A
cannabis legalization framework should explic-
itly state that public health promotion and pro-
tection are its primary goals. It should list spe-
cific objectives,5,29,30 including delayed onset of
use by youth; reduced demand; reduced risky
use (e.g., reduced impaired driving); decreased
rates of problematic use, addiction and concur-
rent risky use of other substances; reduced con-
sumption of products with contaminants and un-
certain potency; increased public safety (e.g.,
reduced drug-related crime); reduced discrimina-
tion, stigmatization and marginalization of users;
and realization of therapeutic benefits.
A frequently cited concern with legalization is
that it will allow the rise of Big Cannabis,31 simi-
lar to Big Tobacco and Big Alcohol. These pow-
erful multinational corporations have revenues
and market expansion as their primary goals, with
little consideration of the impact on public health.
They increase tobacco and alcohol use by lobby-
ing for favourable regulations32 and funding huge
marketing campaigns.33 It is important that the
regulations actively work against the establish-
ment of Big Cannabis.
Evaluating cannabis regulations
through a public health lens
There is scant direct evidence to guide the cre-
ation of public health–oriented cannabis policies.
Fortunately, there is an extensive evidence base
for two other substances with potential for addic-
tion and other harms: tobacco3 and alcohol.4
With these data, researchers have proposed pol-
icy frameworks for cannabis.28–30,34
For our analysis, we built on previous
work,29,35–38 using a framework created by Can-
adian public health researchers2 that was based
on a report by the Health Officers Council of
British Columbia.5 We included jurisdictions
with well-articulated cannabis policies and regu-
lations, which we analyzed from a public health
perspective using a systematic method (Table 1).
Uruguay
Uruguay follows the key public health best prac-
tices.40 It has established a central, governmental,
arm’s length commission to purchase cannabis
from producers and sell to distributors. The com-
mission will have control over production, quality
and prices, and the ability to undercut the illegal
market.41 Uruguay has banned cannabis-impaired
driving and has set the cut-off for impaired driv-
ing to a serum tetrahydrocannabinol (THC) level
of 10 ng/mL. Because of its zero-tolerance policy
for alcohol-impaired driving, the country has cre-
ated a lower threshold for the combination of can-
nabis and alcohol. Tax revenues will fund the
commission and a public health campaign. (Can-
nabis will initially be sold tax free to undercut the
illegal market.) Uruguay bans all promotion of
cannabis products. Pharmacies will sell bulk can-
nabis in plain bags, labelled only with the THC
percentage and warnings. (Sales are slated to start
early in 2016.) Individuals are permitted to grow
their own cannabis and to form growing co-
operatives. People who purchase or grow canna-
bis will be registered and fingerprinted to prevent
AnalysisCMAJ, November 3, 2015, 187(16) 1213
Table 1: Policy strategies for the legalization of cannabis, and level of adherence by jurisdiction, based on an analysis of public
health best evidence from the regulation of tobacco and alcohol2,3
Portion of core policies adhered to by jurisdiction
Strategy
The
Netherlands
Oregon
State
Washington
State
Colorado
State Uruguay Catalonia
Availability and accessibility
Control structure: The government should form a central commission
with a monopoly over sales and control over production, packaging,
distribution, retailing, promotion and revenue allocation. The primary
goal should be public health promotion and protection (to reduce
demand, minimize harms and maximize benefits). The commission should
be at arm’s length from the government to resist interference with this
goal, such as industry influence and the government’s desire to increase
revenues from promoting sales, fees and taxation.
Few or
none
Few or
none
Few or
none
Few or
none
Most NA
Provision to consumers: Cannabis should be sold only at licensed or
commission-operated retail outlets. Public health objectives should determine
the locations and the appearance of the outlets. Health promotion messages
should be displayed. Hours of operation should be limited.
Few or
none
Some Some Some Most NA
Price: The price should be set high enough to reduce demand, and low
enough to undercut the illegal market.
Few or
none
Few or
none
Some Few or
none
Most NA
Purchase, consumption and use
Purchase: There should be a minimum age for purchase. Purchases should
involve completing a form. A limit should be placed on the amount of
daily purchases.
Most Most Most Most Some Most
Locations for use: The public should not be exposed to cannabis smoke. Use
should be restricted to licensed locations (or private homes). Cannabis lounges
should be neutral, not promote cannabis use and include health promotion
material. Alcohol and tobacco use should not be permitted. Locations, hours
and amounts of a sale to an individual should be restricted.
Some ND NA NA NA Most
Cannabis and driving:† Cannabis-impaired driving should be an offence
with a range of available legal sanctions. There should be active and visible
enforcement along with prevention campaigns. Testing should be effect
based (i.e., road-side impairment testing) confirmed with blood testing.
Zero tolerance is not recommended because THC detection may occur long
after effects have resolved. There should be lower thresholds for the
combination of cannabis and alcohol because the effects are additive.
Some Some Some Some Most Some
Supply
Production: The commission should be the only organization permitted to
purchase cannabis from producers and sell to retailers. It should support
small producers to prevent the growth of large, multinational corporations
with lobby power to achieve their profit-driven goals. Individuals should be
permitted to grow cannabis for personal use but not be allowed to sell
privately.
Few or
none
Few or
none
Some Few or
none
Most Most
Product: The cannabis product should be regulated (constituents and
emissions). The THC percentage should be clearly labelled, with pricing policies
to favour products with low THC concentrations. Only bulk products should be
sold (i.e., no pre-made cigarette-type products), with the exception of
processed products for oral consumption to avoid the harms of inhalation.
Few or
none
Some Some Some Most Few or
none
Demand drivers/mitigators
Promotion and packaging: All branding and promotion (e.g., advertising,
sponsorship and product placement§) should be banned. Partial bans
have little effect. Labels should include information on health risks.
Most ND Few or
none
Few or
none
Most Most
School and public education campaigns:‡ The government should
support evidence-based school and public education campaigns to temper
demand. Large, mass-media campaigns should be avoided because they
can stimulate interest and increase use.
NE NE NE NE NE NE
Dedicated revenue
Dedicated revenue: The revenue should be used for health and social
initiatives.
Few or
none
Most Most Most Most NA
Note: ND = not yet defined, NA = not applicable, NE = not evaluated, THC = tetrahydrocannabinol.
*Items in italics have moderate to strong evidence from the tobacco, alcohol and cannabis literature to support them. Other items have weaker evidence to support
them or are the authors’ recommendations2 based on the cannabis literature and public health goals.
†Because cannabis-impaired driving was not addressed in the framework article,2 we relied on other similar sources to create this section.19,20,28–30,34,39 This area is
rapidly evolving, with a currently unclear association between cannabis levels in bodily fluids and effects on driving. Policies should change as the evidence changes.
Evidence currently supports a blood THC level of 3.5–5 ng/mL (serum level 7–10 ng/mL) as a reasonable threshold for impaired driving. Per se laws (automatic
ticketing above a threshold concentration in blood even without demonstrated impairment) are gaining popular support. These laws concern some experts because
they may lead to charges for individuals who are not impaired.
‡Evidence-based school and public education campaigns can be effective measures in reducing demand and harm. However, we excluded them from our analysis
because of the complexity and difficulty of ascertaining what is happening in each jurisdiction.
§See examples in Appendix 1 (available at www.cmaj.ca/lookup/suppl/doi:10.1503/cmaj.150657/-/DC1).
Table 1: Policy strategies for the legalization of cannabis, and level of adherence by jurisdiction, based on an analysis of public
health best evidence from the regulation of tobacco and alcohol2,3
Portion of core policies adhered to by jurisdiction
Strategy
The
Netherlands
Oregon
State
Washington
State
Colorado
State Uruguay Catalonia
Availability and accessibility
Control structure: The government should form a central commission
with a monopoly over sales and control over production, packaging,
distribution, retailing, promotion and revenue allocation. The primary
goal should be public health promotion and protection (to reduce
demand, minimize harms and maximize benefits). The commission should
be at arm’s length from the government to resist interference with this
goal, such as industry influence and the government’s desire to increase
revenues from promoting sales, fees and taxation.
Few or
none
Few or
none
Few or
none
Few or
none
Most NA
Provision to consumers: Cannabis should be sold only at licensed or
commission-operated retail outlets. Public health objectives should determine
the locations and the appearance of the outlets. Health promotion messages
should be displayed. Hours of operation should be limited.
Few or
none
Some Some Some Most NA
Price: The price should be set high enough to reduce demand, and low
enough to undercut the illegal market.
Few or
none
Few or
none
Some Few or
none
Most NA
Purchase, consumption and use
Purchase: There should be a minimum age for purchase. Purchases should
involve completing a form. A limit should be placed on the amount of
daily purchases.
Most Most Most Most Some Most
Locations for use: The public should not be exposed to cannabis smoke. Use
should be restricted to licensed locations (or private homes). Cannabis lounges
should be neutral, not promote cannabis use and include health promotion
material. Alcohol and tobacco use should not be permitted. Locations, hours
and amounts of a sale to an individual should be restricted.
Some ND NA NA NA Most
Cannabis and driving:† Cannabis-impaired driving should be an offence
with a range of available legal sanctions. There should be active and visible
enforcement along with prevention campaigns. Testing should be effect
based (i.e., road-side impairment testing) confirmed with blood testing.
Zero tolerance is not recommended because THC detection may occur long
after effects have resolved. There should be lower thresholds for the
combination of cannabis and alcohol because the effects are additive.
Some Some Some Some Most Some
Supply
Production: The commission should be the only organization permitted to
purchase cannabis from producers and sell to retailers. It should support
small producers to prevent the growth of large, multinational corporations
with lobby power to achieve their profit-driven goals. Individuals should be
permitted to grow cannabis for personal use but not be allowed to sell
privately.
Few or
none
Few or
none
Some Few or
none
Most Most
Product: The cannabis product should be regulated (constituents and
emissions). The THC percentage should be clearly labelled, with pricing policies
to favour products with low THC concentrations. Only bulk products should be
sold (i.e., no pre-made cigarette-type products), with the exception of
processed products for oral consumption to avoid the harms of inhalation.
Few or
none
Some Some Some Most Few or
none
Demand drivers/mitigators
Promotion and packaging: All branding and promotion (e.g., advertising,
sponsorship and product placement§) should be banned. Partial bans
have little effect. Labels should include information on health risks.
Most ND Few or
none
Few or
none
Most Most
School and public education campaigns:‡ The government should
support evidence-based school and public education campaigns to temper
demand. Large, mass-media campaigns should be avoided because they
can stimulate interest and increase use.
NE NE NE NE NE NE
Dedicated revenue
Dedicated revenue: The revenue should be used for health and social
initiatives.
Few or
none
Most Most Most Most NA
Note: ND = not yet defined, NA = not applicable, NE = not evaluated, THC = tetrahydrocannabinol.
*Items in italics have moderate to strong evidence from the tobacco, alcohol and cannabis literature to support them. Other items have weaker evidence to support
them or are the authors’ recommendations2 based on the cannabis literature and public health goals.
†Because cannabis-impaired driving was not addressed in the framework article,2 we relied on other similar sources to create this section.19,20,28–30,34,39 This area is
rapidly evolving, with a currently unclear association between cannabis levels in bodily fluids and effects on driving. Policies should change as the evidence changes.
Evidence currently supports a blood THC level of 3.5–5 ng/mL (serum level 7–10 ng/mL) as a reasonable threshold for impaired driving. Per se laws (automatic
ticketing above a threshold concentration in blood even without demonstrated impairment) are gaining popular support. These laws concern some experts because
they may lead to charges for individuals who are not impaired.
‡Evidence-based school and public education campaigns can be effective measures in reducing demand and harm. However, we excluded them from our analysis
because of the complexity and difficulty of ascertaining what is happening in each jurisdiction.
§See examples in Appendix 1 (available at www.cmaj.ca/lookup/suppl/doi:10.1503/cmaj.150657/-/DC1).
End of preview
Want to access all the pages? Upload your documents or become a member.
Related Documents
CAMH Cannabis Policy Framework: Health Risks, Legalization, and Regulationlg...
|22
|8721
|488
The Cannabis Policy Framework by the Centre for Addiction and Mental Health: A proposal for a public health approach to cannabis policy in Canadalg...
|4
|4543
|394
Critique of Cannabis Legalization Proposals in Canadalg...
|6
|8397
|500
Substance Abuselg...
|6
|1513
|326