In the lead-up to this summer’s legalization of marijuana, many medical organizations have been revisiting their respective positions regarding the change. The Canadian Medical Association (CMA) has been a proponent of a multi-faceted public health strategy with respect to marijuana, and seeks the prioritization of certain goals prior to the legalization date. Its position is laid out in submissions previously made to the House of Commons Standing Committee on Health while Bill C-45 (The Cannabis Act) was still being debated.

The CMA’s Submissions on Medical Marijuana

Since 2002, the CMA has taken a “public health perspective” to marijuana and other illegal drugs. The Association has long-standing concerns about the health risks associated with consuming cannabis, particularly in smoked form and especially by children and youth. The CMA has advocated that legalization must be guided by a comprehensive cannabis public health strategy that includes a strong legal regulatory framework emphasizing harm reduction principles and addressing addiction, prevention, treatment, and enforcement. The Association has noted some key public health initiatives that the federal government has not adequately addressed in their opinion and which should be implemented before legalization. The most important of these is education around the “health, social and economic harms of cannabis use especially in young people”.

Protection of Children and Youth

The CMA notes that youth and young adults are among the highest users of marijuana in Canada. The Association believes that, from a health perspective, the biggest focus of physicians should be protecting the brain of adolescents and young adults during development. Allowing any use of marijuana by youth under the age of 25, and particularly those under the age of 21, is a challenge for physicians since there are documented neurotoxic effects of cannabis use on the brain. This impact is more severe in adolescents and young adults than adults. Studies have shown that use of marijuana by adolescents produces bigger deficits and impairment in executive functioning, verbal IQ, learning, and memory than its use by adults. Based on this, the CMA believes that 21 should be the minimum age for legal use of marijuana and that quantities and potency of cannabis be restricted to those under 25.

Strong, Effective Education Aimed at Dispelling Common Misconceptions

The CMA notes that the federal government has earmarked $9.6. million towards a public awareness campaign aimed at informing Canadians (particularly youth) of the risks of marijuana consumption. This is in comparison to the $38 million budget for campaigns intended at helping reduce smoking tobacco, and similarly high budgets towards alcohol education. The Association believes that any marijuana harm reduction strategies should include a hierarchy of goals with an immediate focus on young people. These strategies should include educational interventions, social marketing interventions, and mass media campaigns. Education should focus not only on the general risks of marijuana but also on its specific harm to young people, particularly as evidence shows that fewer adolescents believe that marijuana use has any serious health risks for them. In the CMA’s view, a strong educational program that is rolled out prior to legalization would reduce the numbers of “uninformed young recreational users”. Other notable CMA proposals include plain packaging and labelling with health information and health warnings.

Supporting a “One-System” Approach

The CMA believes once legalization occurs, there will no longer be a need for two systems (one for medical marijuana use and one for non-medical marijuana use). As such, the medical profession will no longer need to continue to be involved as a “gatekeeper” once marijuana is legal, particularly since cannabis has not undergone the standard Health Canada pharmaceutical regulatory approval process. If there continue to be two systems post-legalization, it is the CMA’s recommendation that the systems be revisited within five years.

Other Goals

The CMA also identified several other goals that they believe need to be reached before legalization. These include:

• Proper data collection;
• Monitoring and surveillance;
• Ensuring a proportionate balance between enforcement harms and the direct and indirect harms caused by cannabis use; and
• Research.

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