Legalization In Canada Research Articles

Cannabis Legalization in Canada and Combatting the Illicit Cannabis Market

Despite the elimination of the illegal cannabis market being a fundamental element to cannabis legalization, as outlined in the Cannabis Act (S.C. 2018, c. 16), the Canadian federal government's efforts have had a mild impact in mitigating its influence. In analyzing possible contributions to the illicit sector's sustainability, these factors are in large part due to the federal government failing to understand consumer behaviours in recreational cannabis usage, as evidenced by lack of accommodation for frequent users, pricing and quality of legal cannabis compared to illegal cannabis, alongside faulty enforcement of cannabis law due to issues of conciseness and discretionary powers between the police and federal government. However, there are some suggestions that could better help the federal government in achieving its goal of combatting the illegal cannabis market. The potential amendments to cannabis policy include lowering tax on legal cannabis to better compete with illegal cannabis at the market level while refocusing on addressing public health concerns through promoting the safety of legal cannabis, controlling accessibility of legal cannabis, and providing public education regarding cannabis consumption. If done correctly, each amendment made would address the flaws within cannabis policy, allowing the Canadian federal government to combat the illegal cannabis market more efficiently.

Cannabis Use and Awareness of Risks and Policies Among Canadian University Students Post-Legalization

ABSTRACT Since the cannabis legalization in Canada in 2018, cannabis consumption among Canadian university students has become widespread. This study aimed to determine the prevalence, attitudes, and awareness of cannabis use among students at a major research university in Western Canada. An anonymous online survey, conducted from February 16, 2022, to March 25, 2022, gathered responses from 935 participants. Results revealed that 28.2% of respondents currently used cannabis, with 50.4% having tried it sometime in their lives. Common reasons for use included social use, stress relief, and curiosity. Interestingly, both current users and non-users held similar perceptions regarding the benefits and misconceptions surrounding cannabis, though users tended to perceive lower risks. Knowledge about cannabis policies varied among participants. These findings shed light on usage and attitudes among students, suggesting the need for proactive prevention to enhance awareness of risks and debunk myths associated with cannabis use.

Off-road vehicle crashes: dangers of alcohol and drug impairment.

Impaired driving is a public health issue, yet little is known concerning the prevalence of substance use in drivers involved in off-road vehicle crashes. The goal of the present study was to describe the demographics and prevalence of alcohol and drug use in drivers of off-road vehicle crashes. In this observational substudy, we collected clinical and toxicological data on all moderately or severely injured off-road vehicle drivers who had blood samples obtained within 6h of the crash. Clinical data were extracted from patients' medical charts and toxicology analyses were performed for blood alcohol, cannabinoids, recreational drugs, and impairing medications. Thirty-three injured drivers met the inclusion criteria. The mean age was 37.6 ± 13.4years and 79% were male. Blood alcohol was detected in 58% of drivers and 42% of these were above the legal limit. Tetrahydrocannabinol was positive in 12% of drivers, and 18% were positive for recreational drugs. Opiates were detected in 21% of drivers. Overall, 85% were positive for at least one substance and 39% tested positive for multiple substances. This study presents the first evidence of alcohol and drug use in off-road vehicle drivers after cannabis legalization in Canada. Our results show that over half of drivers in off-road vehicle crashes test positive for alcohol and 30% tested positive for THC, cocaine, or amphetamines. Opiates are also commonly detected in off-road vehicle drivers. Emergency department (ED) visits resulting from drug driving of off-road vehicles serve as an opportunity for screening, initiating treatment, and connecting patients to interventions for substance use disorders.

Cannabis advertising impacts on youth cannabis use intentions following recreational legalization in Canada: An Ecological Momentary Assessment (EMA) study

ObjectiveIn 2018, Canada’s Cannabis Act legalized adult recreational cannabis use and limited cannabis product advertising to adults. Cannabis product advertising to youth remains illegal. The extent to which adult-targeted, or illicit youth-targeted cannabis advertisements is reaching and impacting Canadian youth is unknown. We used Ecological Momentary Assessment (EMA) to describe how often and how much exposures to cannabis advertising influence Canadian youths’ real-world, real-time intentions to use cannabis. Methods120 Ontario, Canada youths ages 14–18, took photos of cannabis advertising that they encountered in their natural environments over a period of nine consecutive days. Following each exposure and twice daily device-issued random prompts, they also rated their intentions to use cannabis. ResultsMany participating youth (n = 85; 70.83 %) reported at least one cannabis advertising exposure during the study (range 1–30, M = 4.02). Exposures occurred through a range of advertising channels (e.g., internet ads, billboards). Multilevel modeling showed that youth advertising exposure increased cannabis use intentions in vivo (β = 0.06,SE = 0.03;t = 1.98;p =.04;n = 1,348). ConclusionData from this study shows that cannabis advertisements are regularly reaching Canadian youth and increasing their intentions to use cannabis. This suggests that current Canadian prohibitions on cannabis advertising to youth are ineffective and/or ineffectively enforced, and that the Canadian government needs additional or enhanced prohibitions on cannabis promotion to protect youth from harms associated with increased advertisement exposure, such as increased cannabis use.

The Effects of Stigma: Older Persons and Medicinal Cannabis.

Cannabis has long been stigmatized as an illicit drug. Since legalization in Canada for both medical and recreational purposes, older adults' cannabis consumption has increased more than any other age group. Yet, it is unclear how the normalization of cannabis has impacted perceptions of stigma for older adults consuming cannabis medicinally. Qualitative description was used to elucidate the experiences of older Canadians aged 60+ related to stigma and their consumption of cannabis for medicinal purposes. Data collection involved semi-structured interviews. Data analysis examined how participants managed stigma related to cannabis use. Perceived stigma was evident in many participants' descriptions of their perceptions of cannabis in the past and present, and influenced how they accessed and consumed cannabis and their comfort in discussing its use with their healthcare providers. Participants employed several distinct strategies for managing stigma-concealing, re-framing, re-focusing, and proselytizing. Findings suggest that while medical cannabis consumption is becoming increasingly normalized among older adults, stigma related to cannabis persists and continues to shape older adults' experiences. A culture shift needs to occur among healthcare providers so that they are educated about cannabis and willing to discuss the possibilities of medicinal cannabis consumption with older adults. Otherwise, older adults may seek advice from recreational or other non-medical sources. Healthcare providers require education about the use of medical cannabis, so they can better advise older adults regarding its consumption for medicinal purposes.

Impact of non-medical cannabis legalization with market restrictions on health service use and incident cases of psychotic disorder in Ontario, Canada

BackgroundCannabis is a risk factor in the onset and persistence of psychotic disorders. There is concern that non-medical cannabis legalization in Canada may have population-level impacts on psychotic disorders. We sought to examine changes in health service use and incident cases of psychotic disorder following cannabis legalization, during a period of tight restrictions on retail stores and product types. MethodsWe conducted a cross-sectional interrupted time-series analysis using linked population-based health administrative data from Ontario (Canada) from January 2014 to March 2020. We identified psychosis-related outpatient visits, emergency department visits, hospitalizations, and inpatient length of stay, as well as incident cases of psychotic disorders, among people aged 14 to 60 years. ResultsWe did not find evidence of increases in health service use or incident cases of psychotic disorders over the short-term (17 month) period following cannabis legalization. However, we found clear increasing trends in health service use and incident cases of substance-induced psychotic disorders over the entire observation window (2014–2020). ConclusionOur findings suggest that the initial period of tight market restriction following legalization of non-medical cannabis was not associated with an increase in health service use or frequency of psychotic disorders. A longer post-legalization observation period, which includes expansion of the commercial cannabis market, is needed to fully understand the population-level impacts of non-medical cannabis legalization; thus, it would be premature to conclude that the legalization of non-medical cannabis did not lead to increases in health service use and incident cases of psychotic disorder.

Social Norms for Cannabis Use After Nonmedical Legalization in Canada

Social norms play an important role in cannabis use; however, there is little evidence on how social norms change in jurisdictions that legalize cannabis. This study examined trends in social norms before and after legalization of nonmedical cannabis in Canada in 2018. Data are from the International Cannabis Policy Study, a series of cross-sectional surveys conducted annually with Canadian respondents aged 16-65 years. Analyses were conducted in 2023 and included data from 58,045 respondents across 4 waves: the year immediately before legalization (2018) and 3 post-legalization waves (2019-2021). Regression models examined trends in injunctive norms (perceived approval of cannabis) and comfort in using cannabis in six different social contexts, adjusting for cannabis use frequency, medical authorization, and sociodemographic covariates. Perceived social approval of cannabis use and comfort using cannabis in different social contexts was highest among males, frequent cannabis consumers, and those who reported medical authorization (p<0.05 in all cases). No changes in perceived approval were observed across years, except a temporary decrease in 2020 versus 2018 (OR=0.87, 95% CI=0.80, 0.95). Modest increases in comfort of using cannabis in 6 different social contexts were observed in 2019 (ß=0.10, p=0.001), 2020 (ß=0.10, p=0.001), and 2021 (ß=0.12, p<0.001) versus in 2018. Social norms have remained relatively stable after nonmedical legalization in Canada, with only modest increases in comfort of using cannabis in different social settings. The findings may reflect widespread cannabis use in Canada prior to nonmedical legalization in 2018 as well as comprehensive restrictions on promotion and advertising.

Changes in Cannabis-Attributable Hospitalizations Following Nonmedical Cannabis Legalization in Canada

The impact of adult-use cannabis legalization and subsequent commercialization (ie, increasing store and product access) on hospitalizations in Canada is unclear. To examine changes in overall and subtypes of hospitalizations due to cannabis and associated factors following legalization in Canada and to compare changes between provinces. This repeated cross-sectional analysis included all acute hospitalizations for individuals aged 15 to 105 years in Canada's 4 most populous provinces (Ontario, Quebec, Alberta and British Columbia, population 26.9 million individuals in 2018). Data were obtained from routinely collected health administrative databases. Immediate and gradual changes in the age- and sex-standardized rates of hospitalizations due to cannabis were compared using an interrupted time series design over 3 time periods: prelegalization (January 2015 to September 2018), legalization with product and store restrictions (October 2018 to February 2020), and commercialization, which overlapped with the COVID-19 pandemic (March 2020 to March 2021). Rates of hospitalizations due to cannabis per 100 000 individuals and per 1000 all-cause hospital admissions. There were 105 203 hospitalizations due to cannabis over the 7-year study period, 69 192 of which (65.8%) were among male individuals, and 34 678 (33%) of which were among individuals aged 15 to 24 years. Overall, the age- and sex-standardized rate of hospitalizations increased 1.62 times between January 2015 (3.99 per 100 000 individuals) and March 2021 (6.46 per 100 000 individuals). The largest relative increase in hospitalizations was for cannabis-induced psychosis (rate ratio, 1.40; 95% CI, 1.34 to 1.47 during the commercialization period relative to the prelegalization period). Nationally, legalization with restrictions was associated with a gradual monthly decrease of -0.06 (95% CI -0.08 to -0.03) in hospitalizations due to cannabis per 100 000 individuals. Commercialization and the COVID-19 pandemic were associated with an immediate increase of 0.83 (95% CI, 0.30 to 1.30) hospitalizations due to cannabis per 100 000 individuals. There was provincial variation in changes, with provinces with less mature legal markets experiencing the greatest declines immediately following legalization. This cross-sectional study found that legalization with restrictions was not associated with an increase in hospitalizations due to cannabis but commercialization was. The findings suggest that commercialization of cannabis may be associated with increases in cannabis-related health harms, including cannabis-induced psychosis.

Cannabis Use Frequency and Cannabis-Related Consequences in High-Risk Young Adults Across Cannabis Legalization

A key concern about recreational cannabis legalization is increases in use and adverse consequences, particularly among young adults (aged 18-29 years) who have the highest prevalence of cannabis use, and especially in higher-risk, more vulnerable young adults. However, few longitudinal studies have examined patterns of cannabis consumption in high-risk young adults over the course of legalization. To examine changes in cannabis use frequency and cannabis-related consequences over recreational cannabis legalization in Canada in a longitudinal sample of high-risk young adults. Longitudinal observational cohort study following young adults in Ontario, Canada, aged 19.5 to 23.0 years who reported regular heavy episodic drinking (65% past-month cannabis use) at enrollment. Participants were surveyed every 4 months for 3 years between February 2017 and February 2020 (3 prelegalization waves, 4 postlegalization waves). Data were analyzed from March to May 2023. Recreational cannabis legalization in Canada and 4 potential moderators of change: sex, income, education, and prelegalization cannabis use frequency. Cannabis use frequency and cannabis-related adverse consequences. In a cohort of 619 high-risk young adults (baseline mean [SD] age, 21.0 [1.2] years; 346 female participants [55.9%]), omnibus model testing revealed significant overall decreases in both cannabis use frequency (F = 2.276, 3000.96; P = .03) and cannabis-related consequences (F = 10.436, 3002.21; P < .001) over time, but these changes were substantially moderated by prelegalization frequency (frequency: F = 7.5224, 3021.88; P < .001; consequences: F = 7.2424, 2986.98; P < .001). Follow-up tests showed individuals who used cannabis more frequently prelegalization significantly decreased their use and cannabis-related consequences postlegalization. In contrast, individuals who did not use cannabis prelegalization exhibited a small magnitude increase in frequency over time but nonsignificant changes in cannabis-related consequences. Sex, income, and education did not moderate changes over time. In this cohort study of high-risk young adults, individuals using cannabis frequently prelegalization showed significant reductions in use and consequences over time, reflecting an aging out pattern. Small increases in use among participants with no prelegalization use were observed over time, but without parallel changes in cannabis-related consequences. The results did not reveal substantive adverse near-term outcomes across the legalization period, although a within-participants design cannot rule out the possibility of alternative trajectories in the absence of legalization.

O-053 Link between cannabis use and fertility: effects on gamete competence and early embryonic development

Worldwide human fertility has been facing a significant decline over recent years. Therefore, attention has been focused on identifying environmental and lifestyle risk factors that may be contributing to impact human reproductive function. The use of alcohol, tobacco and certain medications have undergone substantial assessment into their effects on fertility. As physicians aim to offer the most appropriate recommendations to their patients, it is of utmost importance to understand the side effects of readily available substances and their mechanisms of action. Cannabis falls into this group of substances used regularly by women and men of reproductive age, with its consumption steadily rising with the onset of legalization in Canada in 2018 also amongst pregnant women. At present, the Society of Obstetricians and Gynecologists of Canada recommends that women of reproductive age, especially if considering pregnancy, discontinue cannabis use. There is, however, inconclusive evidence that links cannabis and fertility. This presentation will outline the most recent data from our laboratory on the effects of Delta-9 tetrahydrocannabinol (THC), the main psychoactive component of cannabis, on oocytes competency and sperm fertilization capability. In fact chronic exposure to cannabis also adversely affects the male reproductive system, inducing oligospermia, morphologically abnormal sperm, and impaired sperm motility in rodents. Using a bovine model as translational model for humans, we identified effects of THC on oocyte developmental parameters, gene expression as well on sperm parameters, such as motility, morphology, capacitation and mitochondrial potential. The general hypothesis at the basis of this research program aims to elucidate the effects of THC at clinically relevant doses on gene and epigenetic modifications in sperm, oocytes and embryos, ultimately affecting fertility and pregnancy outcome. We showed a significantly reduced ability of THC-treated oocytes to undergo nuclear maturation, ultimately leading to decreased oocyte fertilization capability and poor embryonic development. We showed that THC acts as a partial agonist at the Cannabinoid receptors 1 and 2 (CB1 and CB2), as THC effects were reverted by the addition of antagonists. The significant decrease in maturation and cleavage rate of oocytes exposed to the higher doses of THC, representative of high recreational use of Cannabis, allows us to speculate that THC might act as a selection factor for only the highest quality oocytes, that overcome the THC effects. The more immature oocytes may be negatively affected by THC by being pushed towards meiotic resumption, leading to early maturation, prior to gaining developmental competence. Levels of connexin gap-junction proteins were used as indicator of oocyte competency, as they highly correlate to oocyte fertilization potential and embryo quality. Our results demonstrated a significant decrease in connexin 37 (CX37) and connexin 43 (CX43) mRNA levels measured by digital droplet PCR (ddPCR), in oocytes only in the low dose THC group, representative of the therapeutic use of Cannabis. More recently we have also shown how THC affects methylation in granulosa cells, via disrupting methylation and de-methylation enzymes, ultimately determining oocyte competency and, therefore, fertility. THC exerts parallel effects on the male gametes as well, increasing capacitation of in vitro treated sperm, affecting their mitochondrial potential and disrupting the expression of key microRNAs in sperm that are linked to early embryonic development, therefore affecting pre-implantation development and, ultimately, pregnancy outcome. Our results suggest an overall detrimental effect of THC on the competency and fertilization potential of both female and male gametes, negatively influencing fertility and the likelihood of a viable pregnancy, especially of importance when undergoing artificial reproductive technologies procedures. Trial registration number XXXX

Co-use of cannabis and alcohol before and after Canada legalized nonmedical cannabis: A repeat cross-sectional study.

This study examined changes in population-level co-use of cannabis and alcohol before and 12 months after nonmedical cannabis legalization in Canada, relative to the United States that had previously legalized and not legalized (US legal and illegal states, respectively). Data are from waves 1 and 2 of the International Cannabis Policy Study, collected in 2018 (before) and 2019 (12 months after legalization in Canada). Respondents aged 16-65 years from Canada (n = 25,313) and US legal (n = 25,189) and US illegal (n = 19,626) states completed an online survey. Changes in co-use between 2018 and 2019 in US legal and illegal states compared to those in Canada were assessed using multinomial logistic regression. Descriptive analyses show increases in cannabis use and monthly or more frequent (MMF) co-use between 2018 and 2019 in all jurisdictions. Compared to no MMF use of cannabis or alcohol, there was no evidence suggesting differences in changes in MMF co-use in US legal or illegal states relative to Canada. However, respondents in US legal states had 33% higher odds of MMF alcohol-only use (OR = 1.33, 99% CI: 1.12, 1.57) compared to no MMF use relative to Canada. Increases in co-use were observed between 2018 and 2019 in all jurisdictions regardless of the legal status of cannabis. These shifts were largely due to increases in cannabis use across the population, including those that use alcohol, and may indicate changing societal norms toward cannabis generally. As the cannabis legalization transition in Canada matures, evaluation over the longer term will improve understanding of the influence of cannabis liberalization on co-use.

Rollin’ papers: Newspaper coverage of cannabis legalization in Canada

With Canada becoming the first G20 country to legalize the recreational use of cannabis, there has been increasing interest in the emergence of this new marketplace. Newspaper framing helps to shape public opinion on legalization and news sources play a role in determining how the public perceives the use of cannabis. This research analyzes how mainstream newspapers reported on the legalization of recreational cannabis in Canada in the years before and after legalization (between 2016 and 2019). Using a content analysis of 1,390 cannabis-related articles, 11 dominant reporting themes are identified. Over time, there was a shift from negative and sensationalist cannabis news coverage toward more balanced and progressive framing. The findings identify the influence of editorial political stance on thematic coverage.

A86 CANNABIS USE IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE IS HIGHER FOLLOWING LEGALIZATION OF CANNABIS IN CANADA AND IS ASSOCIATED WITH LOWER QUALITY OF LIFE

Abstract Background Patients with inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), often experience fluctuating and unpredictable symptoms. Most individuals require chronic therapy with immunomodulators or novel biologics to maintain disease remission. In addition to conventional medical therapy, many patients also seek out alternative therapies such as cannabis. Reports in the USA suggest that cannabis is used by ~12% of UC and ~16% of CD patients, despite it being legally prohibited. Purpose The aim of our study is to evaluate the use of cannabis in a cohort of patients with IBD following its legalization in Canada, and to assess its effects on IBD disease severity. Method We conducted a prospective cohort study of adult IBD patients seen in clinic at a tertiary care center in London, ON. Patients completed an online 40-question survey that collected data on demographics, IBD disease history, cannabis use, and included the Short Inflammatory Bowel Disease Questionnaire (SIBDQ). The survey was distributed and collected by the REDCap platform maintained by Western University. The study was approved by the Western University Ethics Committee. Result(s) Completed surveys were obtained from 254 individuals (148 individuals with CD, 90 with UC and 16 with indeterminate colitis). Over half of participants were between 35-64 years of age and female. Fifty-three percent of participants reported life-time cannabis use and 51% of users started using cannabis only in the preceding 3 years. Individuals with CD had higher rates of recent use, defined as use within the past 6 months, when compared with UC (41% vs 31%). Cannabis was taken multiple times per week by 57% of users. Cannabis was used to treat GI symptoms by 30% of users, as well as to help with sleep (26%) and for recreation (27%). Despite side effects such as dry mouth, anxiety and concentration issues, 79% of users felt the benefits of cannabis outweighed its harms. Interestingly, only 46% of cannabis users discussed their use with their family physician or gastroenterologist. Recent cannabis users did not differ in the use of IBD medication or self-reported rates of GI symptoms. Furthermore, recent users did not differ in the rates of surgical procedures for IBD (recent 35% vs non-recent 32%). Recent cannabis users did have a significantly lower quality of life as indicated by SIBDQ scores when compared to non-recent users (recent use 37 vs non-recent use 40). Conclusion(s) Cannabis use among patients with IBD after its legalization is more than double the rate previously reported in the literature. Importantly, physicians are likely to be unaware of its prevalence in their practice. Cannabis was used by patients to treat GI and non-GI symptoms, and it was associated with lower SIBDQ scores. Our results suggest that physicians should inquire about Cannabis use amongst their patients with IBD, and that further studies are required to determine its effects on disease severity. Please acknowledge all funding agencies by checking the applicable boxes below CIHR Disclosure of Interest None Declared

Legal sourcing of ten cannabis products in the Canadian cannabis market, 2019–2021: a repeat cross-sectional study

BackgroundOne of the objectives of cannabis legalization in Canada is to transition consumers from the illegal to the legal market. Little is known about how legal sourcing varies across different cannabis product types, provinces, and frequency of cannabis use.MethodsData were analyzed from Canadian respondents in the International Cannabis Policy Study, a repeat cross-sectional survey conducted annually from 2019 to 2021. Respondents were 15,311 past 12-month cannabis consumers of legal age to purchase cannabis. Weighted logistic regression models estimated the association between legal sourcing (“all”/ “some”/ “none”) of ten cannabis product types, province, and frequency of cannabis use over time.ResultsThe percentage of consumers who sourced “all” their cannabis products from legal sources in the past 12 months varied by product type, ranging from 49% of solid concentrate consumers to 82% of cannabis drink consumers in 2021. The percentage of consumers sourcing “all” their respective products legally was greater in 2021 than 2020 across all products. Legal sourcing varied by frequency of use: weekly or more frequent consumers were more likely to source “some” (versus “none”) of their products legally versus less frequent consumers. Legal sourcing also varied by province, with a lower likelihood of legal sourcing in Québec of products whose legal sale was restricted (e.g., edibles).ConclusionLegal sourcing increased over time, demonstrating progress in the transition to the legal market for all products in the first three years of legalization in Canada. Legal sourcing was highest for drinks and oils and lowest for solid concentrates and hash.

Changes in Medical Cannabis Use After Recreational Cannabis Legalization in Canada.

Background: As part of its recreational cannabis legalization in October 2018, Canada imposed an excise tax of 10% (or $1 a gram, whichever is higher) on both recreational and medical cannabis. There is little evidence to inform the ongoing debate on whether the legalization had adverse impacts on medical cannabis use. Methods: We used an interrupted time series design and data on medical cannabis shipments (i.e., mail-order deliveries of cannabis from a licensed producer to a patient authorized to obtain medical cannabis) in Canada between quarter 1 of 2014 and quarter 1 of 2020. We examined changes in medical cannabis shipments after Canada's recreational cannabis legalization both across Canada and for each province. As this study used publicly available, province-level aggregate data, ethics approval was not required. Results: Recreational cannabis legalization was associated with significant reductions in medical cannabis use in 7 out of 10 Canadian provinces. Compared with the counterfactual estimated from prelegalization trends, the reduction in quarter 1 of 2020 varied from 500 shipments per 100,000 population (95% CI=312-688 shipments per 100,000 population) or 32% (95% CI=22-43%) in Newfoundland and Labrador to 3,778 shipments per 100,000 population (95% CI=2,972-4,585 shipments per 100,000 population) or 74% (95% CI=68-79%) in Alberta. At the national level, the number of medical cannabis shipments decreased by 823 per 100,000 population (95% CI=725-921 shipments per 100,000 population) or 48% (95% CI=45-52%). Conclusions: Recreational cannabis legalization was associated with reductions in medical cannabis use. Our findings call for policy attention to address possible adverse impacts of recreational cannabis legalization on medical cannabis users.

Cannabis legalization and cannabis use, daily cannabis use and cannabis-related problems among adults in Ontario, Canada (2001–2019)

BackgroundIn the context of cannabis legalization in Canada, we examined the effects on cannabis patterns of consumption, including cannabis use, daily cannabis use and cannabis-related problems. In addition, we examined differential effects of cannabis legalization by age and sex. MethodsA pre-post design was operationalized by combining 19 iterations of the Centre for Addiction and Mental Health (CAMH) Monitor Surveys (N = 52,260; 2001–2019): repeated, population-based, cross-sectional surveys of adults in Ontario. Participants provided self-reports of cannabis use (past 12 months), daily cannabis use (past 12 months) and cannabis-related problems though telephone interviews. The effects of cannabis legalization on cannabis patterns of consumption were examined using logistic regression analyses, with testing of two-way interactions to determine differential effects by age and sex. ResultsCannabis use prevalence increased from 11 % to 26 % (p < 0.0001), daily cannabis use prevalence increased from 1 % to 6 % (p < 0.0001) and cannabis-related problems prevalence increased from 6 % to 14 % (p < 0.0001) between 2001 and 2019. Cannabis legalization was associated with an increased likelihood of cannabis use (OR, 95 % CI: 1.62, 1.40–1.86), daily cannabis use (1.59, 1.21–2.07) and cannabis-related problems (1.53, 1.20–1.95). For cannabis-related problems, a significant two-way interaction was observed between cannabis legalization and age (p = 0.0001), suggesting differential effects among adults ≥55 years. ConclusionsCannabis legalization was associated with an increased likelihood of cannabis use, daily cannabis use and cannabis-related problems. Given increases in these cannabis patterns of consumption, broader dissemination and uptake of targeted prevention tools is indicated.

Overpoliced and Underrepresented: Perspectives on Cannabis Legalization From Members of Racialized Communities in Canada.

Historically, overpolicing of some racialized and Indigenous groups in Canada has resulted in unequal application of drug laws contributing to disproportionate rates of charges and convictions in these populations. Criminal records severely and negatively impact an individual's life and can perpetuate cycles of poverty and socioeconomic disadvantage. On October 17, 2018, Canada legalized cannabis production, distribution, sale, and possession for non-medical purposes. Advocates of criminal justice reform have raised concerns that Indigenous and racialized people may not equitably benefit from legalization due to unequal police surveillance and drug enforcement. These groups are among priority populations for research on cannabis and mental health, but their views on cannabis regulation have been largely absent from research and policy-making. To address this gap, we asked self-identified members of these communities about their lived experiences and perspectives on cannabis legalization in Canada. Between September 2018 and July 2019, we conducted semistructured interviews and focus groups with 37 individuals in Québec, Ontario, Alberta and British Columbia. During this phase of early cannabis legalization, participants responded to questions about anticipated public health risks and benefits of legalization, how their jurisdiction is responding to legalization, and what community resources would be needed to address legalization impacts. We conducted a thematic analysis and identified five major themes in the data related to race and early cannabis legalization: overpolicing of racialized communities, severity of penalties in new cannabis legislation, increased police powers, and underrepresentation of racialized groups in the legal cannabis market and in cannabis research. Participants discussed opportunities to support cannabis justice, including establishing priority licenses, issuing pardons or expunging criminal records, and reinvesting cannabis revenue into impacted communities. This work begins to address the paucity of Indigenous and racialized voices in cannabis research and identifies potential solutions to injustices of cannabis prohibition.

Shifting school health priorities pre-post cannabis legalization in Canada: Ontario secondary school rankings of student substance use as a health-related issue.

This study examined how schools prioritize ten key health concerns among their student populations over time and whether schools' prioritization of alcohol and other drug use (AODU) corresponds to students' substance use behaviours and cannabis legalization as a major policy change. Data were collected from a sample of secondary schools in Ontario, Canada across four years (2015/16-2018/19 [N2015/16 = 65, N2016/17 = 68, N2017/18 = 61 and N2018/19 = 60]) as a part of the COMPASS study. School-level prevalence of cannabis and alcohol use between schools that did and did not prioritize student AODU as a health concern was examined. Ordinal mixed models examined whether student cannabis and alcohol use were associated with school prioritization of AODU. Chi-square tests examined changing health priorities among schools pre-post cannabis legalization. School priority ranking for AODU was mostly stable over time. While AODU was identified as an important health concern, most schools identified mental health as their first priority across the four years of the study. No significant changes to school AODU priorities were observed pre-post cannabis legalization nor was school prioritization of AODU associated with student cannabis and alcohol use behaviours. This study suggests that schools may benefit from guidance in identifying and addressing priority health concerns among their student population.

Correction to: Cannabis use patterns among patients with upper extremity conditions at the time of legalization in Canada.

C JS has been made aware of an error that occurred in an article published on May 17, 2022.[1][1] The author Braden Gammon’s name was spelled incorrectly in the article byline, and in the affiliations and contributors paragraphs. This has been corrected at canjsurg.ca. 1. [↵][2]1. Sims L

The impact of cannabis legalization for recreational purposes on youth: A narrative review of the Canadian experience.

Cannabis legalization for non-medical purposes (subsequently referred to as “cannabis legalization” or “legalization”) took place in Canada in October 2018. One of the federal government's stated goals with cannabis legalization was to protect Canadian youth from cannabis-related harms. The main objective of this narrative review is to describe the impact of cannabis legalization on Canadian youth. To that end, we discuss the regulation of the Canadian cannabis market, outline changes in the epidemiology and parameters of cannabis use (modes of use, potency of cannabis) among youth, and discuss prevention and education initiatives related to cannabis. The Canadian model differs from other jurisdictions that legalized recreational cannabis use, especially with regard to a higher degree of government regulation of the cannabis market. Another difference is the development and endorsement of lower-risk cannabis use guidelines to educate the public and health professionals. The results available for this review cover only 3 years post-legalization. Cannabis legalization in Canada brought an apparent increase in use among Canadian older than 25. However, results for youth are mixed, with the majority of studies showing no pronounced increase. Notably, the trend of a decrease in adolescents' cannabis use seen pre-legalization may have reversed. Emerging evidence also suggests that cannabis-related hospitalizations and emergency department visits among Canadian youth may have increased due to cannabis legalization. Data about changes in the age of initiation, the influence of legalization on sex and gender, and race/ethnicity are limited, with evidence suggesting that the age of initiation slightly increased. So far, there is limited data about the impact of cannabis legalization on Canadian youth. Further long-term monitoring and research to assess the effects of cannabis legalization on Canadian youth.