Academic journal article Canadian Journal of Public Health

Cannabis Use in Canada: The Need for a 'Public Health' Approach

Academic journal article Canadian Journal of Public Health

Cannabis Use in Canada: The Need for a 'Public Health' Approach

Article excerpt


Cannabis is the most commonly used illicit drug in Canada, used by 1 in 7 adults and 1 in 4 students. Other forms of drug use (e.g., alcohol or injection drug use) are increasingly approached within a public health policy framework that focuses on reducing harms rather than use per se. Cannabis, by contrast, remains formally controlled by a criminal justice approach that focuses on enforcing abstinence. Its use is associated with a variety of possible acute or chronic health problems that include cognitive and respiratory impairment, psychotic episodes, dependence and injury risk. The incidence of these outcomes, however, is predicted by early onset and a high frequency and length of use that only apply to a minority of users. In a public health framework, cannabis use - especially in young populations - should be systematically monitored and high-risk patterns of use screened for in appropriate settings, e.g., schools and GP offices. Evidence-based primary and secondary prevention, treatment and enforcement need to be targeted at these high-risk patterns of use. Given the large cannabis user population, especially among young people, and the failure of the criminalization approach to discourage use, a public health framework for cannabis use is urgently needed in Canada.

Key words: Cannabis use; public health; morbidity; policy; interventions; Canada

La traduction du résumé se trouve à la fin de l'article. Can J Public Health 2009;100(2):101-3.

Mots clés : consommation de cannabis; santé publique; morbidité; politique; interventions; Canada

Cannabis is one of the three psychoactive substances most commonly used in Canada (the other two being alcohol and tobacco). In 2004, after substantial increases in use rates for about a decade, one in seven adults reported recreational use of cannabis in the past year.1 Among Ontario secondary school students, one in four reported past-year cannabis use - double the proportion of tobacco users.2 Compared to other industrialized nations, Canada features some of the highest cannabis use rates among adults and adolescents. The specific reasons for these increasing use rates are not clear but they suggest the limited effectiveness of the current deterrence-based policies.

Key areas of popular psychoactive substance use have become embraced by a public health framework in recent years. This approach is primarily concerned with reducing substance use related harms by acting on determinants and risks, rather than focusing on use per se, and by implementing targeted interventions to reduce the public health burden of use.3 A leading example of such a policy framework is alcohol use, where problems like binge-drinking, alcohol dependence and drunk driving have been recognized as key harms that are targeted by prevention, treatment and enforcement. 4 Even the field of injection drug use has been influenced by public health-oriented policy with the adoption of interventions like needle exchange programs, supervised consumption sites and opioid prescription for maintenance to reduce the overall health burden of this form of drug use.5

Cannabis use, however, has been conspicuously exempted from a public health approach in Canada. The enforcement of abstinence is its primary policy objective.6,7 The predominant approach of criminalization proscribes any use of the drug as illegal and subject to punishment (implying that all use is harmful). The large number of cannabis users, and especially the larger proportion of young users, in Canada indicate the need to rethink our approach to cannabis use by better aligning it with principles and objectives of public health.

A public health framework for cannabis use requires a solid footing in evidence on the health risks and harmful consequences of its use and the identification of patterns of use that predict such problems. When considering the disease burden of cannabis use, the acute toxicity of cannabis use is low with few if any deaths attributable directly to its use, most of which are related to traffic accidents and possibly cancers. …

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