3.1 Minimizing harms of use

Considerations

One of the central issues to consider in the design of a legal and regulatory framework for legal access to marijuana is to identify those system features that will best reduce the risks of health and social harms associated with use.

When considering how best to minimize harms associated with marijuana use, it is helpful to consider the two different approaches taken in controlling tobacco and alcohol use.

In the case of tobacco, the overall objective is to reduce or even eliminate use for all Canadians.

In contrast, the overall objective with respect to alcohol is to promote responsible use amongst adults, and to prohibit use amongst youth. These objectives are achieved largely through actions such as setting a minimum age for purchase, educational tools aimed at promoting responsible use, and taxation measures.

Given that the majority of harms related to marijuana use appear to occur in select high-risk users (e.g., youth) or in conjunction with high-risk use practices (e.g., frequent use; highly potent products; impaired driving), an approach that draws lessons from both tobacco and alcohol control should be examined. Both approaches rely on a comprehensive suite of actions aimed at those users at highest risk for harms through active prevention, education and treatment, as well as policy and legislative interventions.

Few other countries have been as successful as Canada in lowering smoking rates and shifting public attitudes about tobacco. Canadian smoking rates are among the lowest in the world, dropping from 22% in 2001 to 15% in 2013. Since 2001, actions taken under the Government of Canada's Federal Tobacco Control Strategy have helped lay the foundation for continued success in tobacco control. Such actions include:

restrictions on tobacco advertising;

mandatory health warning messages on tobacco packaging;

minimum age for legal purchase of tobacco;

public health education campaigns against smoking; and,

excise tax changes to make tobacco less affordable and accessible.

In addition, all provinces and territories have tobacco legislationof their own. Many municipalities have also taken action in their sphere. This collective action has helped drive the rate of tobacco use among Canadian youth aged 15--17 to its current low of 7%. Another key measure underpinning the success of Canada's tobacco control efforts has been the way smoking has become socially unacceptable, or "denormalized", particularly among youth.

In contrast, alcohol consumption is highly normalized in Canadian society, with nearly 75% of adult Canadians reporting that they have used alcohol in the previous year. In part this may be explained by the different regulatory and other control measures that have been implemented. For example, alcohol remains heavily marketed and promoted to adults.

When examining the current frameworks for tobacco and alcohol control, it is also worth noting the different approaches to regulating taken at the federal level. In the case of tobacco, the Tobacco Act protects the health of Canadians by imposing certain minimum standards, such as quantities to be sold in packages, prohibitions on flavours that appeal to youth, and restricting the age of purchase. In contrast, with alcohol, there are no comparable national minimum standards set and federal regulatory oversight is mainly focused on labelling requirements.

These two examples highlight different regulatory approaches and point to the potential for regulation of the same product by different orders of government.

The early experiences of Colorado and Washington State suggest very strongly that the Government should take steps to avoid the commercialization of legalized marijuana, including the active promoting and marketing of marijuana, leading to widespread use. Preventing widespread use—or "normalization"—is especially important when considering the need to decrease rates of use amongst Canadian youth. Marijuana is not a benign substance and the scientific evidence clearly demonstrates that young people are at a higher level of risk for experiencing negative impacts. Protecting youth and children from the negative consequences of marijuana use is central to the Government's interest in legalizing, regulating and restricting access.

As with the experience in tobacco and alcohol control, the need for a comprehensive approach to prevention, education, and treatment is clear, including public education strategies aimed at better informing youth and families of the risks and harms, in tandem with a range of other safeguards that are described below.

Possible Options

It is proposed that establishing a national minimum standard for protecting Canadians is critical, and as such it is proposed that federal legislation and regulation be developed to create an overall framework for legal access to marijuana. This framework would address the following issues:

Minimum age for legal purchase: Health protection—particularly for children and youth—demands that marijuana purchase and possession be subject to age restrictions. The science indicates that risks from marijuana usage are elevated until the brain fully matures (i.e., when someone reaches about age 25). For context, age limits for alcohol and tobacco purchases in Canada vary across provinces and territories—either 18 or 19 years of age. In Colorado and Washington, the state governments have chosen to align the minimum age for purchasing marijuana with the minimum age for purchasing alcohol, 21 years. Advertising and marketing restrictions to minimize the profile and attractiveness of products: Since marketing, advertising and promotion of marijuana would only serve to "normalize" it in society and encourage and increase usage, it has been proposed that these should be strictly limited so as to dampen widespread use and reduce associated harms. This is particularly the case for promotional materials that would otherwise be targeted to impressionable youth. As in the case of tobacco, there may be limitations to possible restrictions on marketing, advertising and promotion of marijuana; however within those limits these restrictions should be as tight as possible. Moreover, other limitations could include products being sold in plain packaging with appropriate health warning messages. Taxation and pricing: When used appropriately, effective taxation and price controls can discourage the use of marijuana and provide the government with revenues to offset related costs (such as substance abuse services, law enforcement, and regulatory oversight). As such, the design of any regulatory framework should allow accommodation for an appropriate taxation regime in which there is sufficient flexibility in controlling the final price to the consumer. However, the use of taxation and pricing measures to discourage consumption must be properly balanced against the need to minimize the attractiveness of the black market and dissuade illegal production and trafficking. Limits of allowable THC potency in marijuana: THC is the main psychoactive component of marijuana. Current research shows average THC levels of between 12-15%. In contrast, marijuana from the 1980s had average THC levels of 3%. In addition, various higher potency marijuana products such as "shatter" are available with THC concentrations reaching levels as high as 80-90%. As outlined in section 1, higher concentration products have added risks and unknown long term impacts, and those risks are exacerbated for young people, including children. Given the significant health risks, maximum THC limits could be set and high-potency products strictly prohibited. Restrictions on marijuana products: Marijuana can be consumed in many ways, including a wide range of products like foods, candies, salves or creams. Some people may choose these methods of consumption, rather than choosing to smoke dried marijuana. However, certain products present increased risks, notably when considering the increased potency of some of these derivative products and the increased harms associated with their use. They also represent an increased risk of accidental or unintentional ingestion, particularly by children. This view is supported by the experience in Colorado, where the availability of edible products led to a rise in the number of accidental or unintentional overdoses (non-fatal). As a result, the state government amended their regulatory framework to enact limits on dosing and potency. It is understood that individuals may choose to create marijuana products, such as baked goods, for personal consumption. However, consideration should be given to how edibles are treated in the new regime in light of the significant health risks, particularly to children and to youth, including whether and how to limit the potency of marijuana and types of products sold. Limitations on quantities for personal possession: Most jurisdictions have set limits on the quantities of marijuana that an individual may possess, which has the obvious advantages of helping to dampen demand and to minimize opportunities for resale of legally purchased marijuana on the illicit market (particularly to children and youth). Limitation on where marijuana can be sold: The availability of marijuana via retail distribution is also an important issue when considering means to minimize harms of use. This issue is further explored in Section 3.

Questions