EditorialThe Cannabis Policy Framework by the Centre for Addiction and Mental Health: A proposal for a public health approach to cannabis policy in Canada
Introduction
In October 2014 the Centre for Addiction and Mental Health (CAMH), Canada's largest academic health science centre devoted to mental illness and substance use (Rehm et al., 2011), released a Cannabis Policy Framework (CAMH, 2014). An interdisciplinary expert group from across CAMH's clinical and research (both brain science and social/epidemiological research) programs studied the evidence around cannabis-related harm, existing models of cannabis control, and public health approaches to substance use. Following nearly a year of debate, the group came to a consensus on the position outlined in the Cannabis Policy Framework: that legalisation, in conjunction with strict health-focused regulation, appears to be the most effective means of reducing the harms associated with cannabis use (CAMH, 2014).
CAMH's engagement in public policy development is rooted in the work of the Addiction Research Foundation (ARF), one of its four predecessor organizations (Rehm et al., 2011). In 1997 the ARF released a paper calling for a public health approach to cannabis (Addiction Research Foundation, 1997). In 2000, the newly formed Centre for Addiction and Mental Health recommended decriminalising simple possession of cannabis (CAMH, 2000); this position was reiterated between 2002 and 2008 in a series of position papers and policy submissions. In 2012, as part of its strategic planning process, CAMH began conducting a systematic review of its public policy positions, including cannabis.
By coincidence, the period in which CAMH conducted this review was one in which cannabis reforms were occurring in other jurisdictions, notably Uruguay, Colorado and Washington, and cannabis policy was becoming a politically charged topic in Canada. In July 2013, Liberal Party leader (and now Prime Minister) Justin Trudeau announced that, if elected, his party would legalise and regulate cannabis; the following month, he admitted having smoked cannabis since becoming a Member of Parliament (National Post, 2013). The ruling Conservative Party reiterated its commitment to the status quo, emphasizing its opposition to legal reform of cannabis control and widely stating that the Liberal approach to legalisation would “make buying marijuana a normal, everyday activity for young Canadians” (National Post, 2014). In mid-2014 three physicians’ groups declined to join a Health Canada anti-cannabis campaign, stating that it had become “a political football on Canada's marijuana policy” (CBC News, 2014). It was into this shifting policy environment that CAMH released the Cannabis Policy Framework in October 2014.
Section snippets
Cannabis and harm
In Ontario, 14% of adults and 23% of high-school students report past-year cannabis use (Boak et al., 2013, Ialomiteanu et al., 2014). Among young adults aged 18 to 29, self-reported prevalence is 40% (Ialomiteanu, Adlaf, Hamilton, & Mann, 2012). Approximately 4% of the adult population and 3% of high-school students use cannabis every day (Boak et al., 2013, Health Canada, 2013), and 20% of users account for 80–90% of consumption (Room, Fischer, Hall, Lenton, & Reuter, 2010). These patterns,
Policy options
Uruguay and several US states have legalized recreational cannabis use or taken steps towards doing so. In Canada, calls for legal reform to cannabis control have been made since at least 1972, when the Le Dain Commission recommended repealing the prohibition of cannabis use. In the intervening decades it has only become clearer that prohibition is ineffective, costly, and constitutes poor public policy.
CAMH's previous position called for cannabis possession to be converted from a criminal
CAMH recommendations
It is important to note the parameters of our review. Legalisation in Canada would be a complex undertaking requiring changes to the federal criminal code and possibly to international drug control treaties, as well as provincial rules of implementation – but we did not make recommendations on those areas. Similarly, cannabis production was beyond the scope of the review. Rather, our focus was on policies to reduce the health and social harms of cannabis use.
There are of course few examples of
Conclusion
CAMH's review of the evidence led to the conclusion that legalisation is a necessary – but not a sufficient – condition for reducing health and social harms associated with cannabis use. Some people will use cannabis regardless of its legal status, and a significant advantage of legalisation is that it creates the opportunity for more control over the risk factors associated with cannabis-related harm through a public health approach to regulation.
Conflict of interest
The authors declare to have no conflict of interest.
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