By Dr. Jürgen Rehm, Director of the Social and Epidemiological Research Department at CAMH
Today CAMH released a new Cannabis Policy Framework . This document examines the evidence on the harms associated with cannabis use and, based on that evidence, recommends legalization with strict regulation as the most effective means of reducing the harms associated with its use.
There is growing agreement that our current system of cannabis control has failed. All available evidence indicates that this system is ineffective, costly and, far from preventing harm, actually causes it. There is less agreement on what should actually be done about this situation. Many in the health sector favour decriminalization, and this option is currently being discussed at the federal level. This was also the approach recommended by CAMH in 2002 – the last time we made a public statement on cannabis. So why the shift? How is legalization with regulation preferable to decriminalization?
First, some definitions. Our current system can be described as prohibition: use and possession of cannabis are punishable by criminal law, and they have been punished until now. Decriminalization involves removing possession of small amounts of cannabis from the sphere of criminal law, instead making them civil violations punishable by a fine. Legalization removes all penalties for cannabis possession and use by adults. Once legalized, cannabis can be sold commercially with no restrictions, or it can be regulated. CAMH is recommending legalization with strict regulation.
Decriminalization sounds good in theory. About 3% of all arrests in Canada are for simple possession of cannabis; at least half a million Canadians hold a criminal record for this this offence. Most Canadians agree that cannabis use should not be punishable by prison time or a lifelong criminal record. In many jurisdictions that have decriminalized cannabis, this approach has reduced the social burden of cannabis without causing an increase in consumption. However, it has some glaring problems:
- Decriminalizing cannabis does nothing to address the health harms. Cannabis remains unregulated and users know nothing about its potency or quality.
- Decriminalization cannot regulate the market, and cannabis users will get into contact with other forms of illegal drugs via purchasing an illegal substance.
- Treating cannabis use primarily as a criminal justice issue and not a health issue discourages the use of prevention, risk reduction and treatment services.
Decriminalization can also have serious unintended consequences. In Canada, marginalized and vulnerable populations have a higher chance of being arrested for cannabis use offences. We know from the experiences of jurisdictions where cannabis has been decriminalized that racial profiling remains a problem and that racialized minorities continue to be disproportionately targeted for cannabis-related offences. Thus, the possible benefits of decriminalization are not likely to be equally spread through society. Public policies should be assessed not only according to their effect on population health but also by their impact on health equity, and decriminalization fails this test.
We know from our experience with substances like alcohol and tobacco that the right set of regulations can help reduce risks and harms. We also know that something that is illegal cannot be regulated. In other words, legalization is a necessary first step towards regulation.
The system we envision is in no way similar to the ones recently adopted in Colorado and Washington. In those states, regulations are insufficiently health-focused, with inadequate controls on availability, marketing, and product potency and formulation.
CAMH’s recommendations for public health-focused cannabis control include:
- a government monopoly on sales
- a minimum age for purchase and consumption
- controls on availability
- a pricing system that curbs demand and discourages use of higher-harm products
- a ban on marketing, advertising and promotion
- a requirement that products be sold in standardized plain packaging
[link to YouTube: Cannabis in Canada: CAMH recommends a public health approach]
These regulations would be accompanied by measures to address and prevent cannabis-impaired driving, ensure access to treatment, and enhance investment in education and prevention. There would be a strong focus on prevention and a range of interventions aimed at groups that are at higher risk of harm, including youth and people with a personal or family history of mental illness.
It may seem counter-intuitive at first to suggest that legalizing cannabis can reduce its harms. But based on a thorough review of the evidence, we believe that legalizing with strict regulation would allow for more control over important risk factors like age of initiation, product potency and formulation, and impaired driving.
We need an approach to cannabis that puts health first. The right set of regulations, carefully implemented and thoroughly evaluated, can help us achieve that.