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Canada needs 'risk management' approach to pot: study


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Jun 21, 2007
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Canada's existing public health approach to cannabis use is unrealistic and should be adjusted to reflect the way the system approaches alcohol, a new article suggested Thursday.

The piece, published in the Canadian Journal of Public Health, concluded the high prevalence of marijuana use throughout the country requires public health practitioners to adjust their thinking around the substance.

Current attitudes towards cannabis use are too rigid to be effective in the current environment, co-author Benedikt Fischer said, adding more than 10 per cent of the adult population and about a third of young adults admit to using the drug in the past year.

Current practices advocating for total abstinence are unrealistic given the drug's widespread popularity, and less tolerant than public health positions towards alcohol, tobacco and even injection drugs, he said.

Fischer said the system should instead adopt a more conciliatory position, urging people to modify their behaviours and reduce their personal health risks.

The "lower risk cannabis use guidelines" tabled in the article are modelled on the public health approach used to keep alcohol consumption in check over the years, said Fischer, research chair in applied public health at Simon Fraser University.

"I think alcohol is a really good model, and in fact the model I look to a lot," Fischer said in a telephone interview from Vancouver.

"We're accepting the fact that this is a drug that's out there, that people embrace, that people actually enjoy. At the same time, absolutely not a benign drug, comes with a lot of acute and long-term problems that can be very hazardous and harmful to both individuals and society.

"However we have very targeted interventions, rather than the blunt hammer, black and white approach. We target these specific risks with the best interventions we have and try and reduce the very specific behaviours and outcomes rather than trying to reintroduce alcohol prohibition."

Although abstinence from cannabis is still the safest approach, Fischer said users can take many steps to mitigate the drug's harmful effects.

People who begin using marijuana later in life are less likely to encounter health problems, he said, adding early onset use can hamper brain development and expose youth to higher-risk situations involving more dangerous substances. Early use of cannabis has also been a predictor of mental health conditions such as depression, the article said.

Starting later in life, as well as limiting the frequency and intensity of cannabis use, can have significant long-term health benefits, Fischer said.

Users should also disregard a common myth that marijuana users are fit to drive while under the influence, he said, saying the substance impairs memory and motor functions.

The article said five per cent of adults admit to driving while under the influence of cannabis.

Fischer recommends waiting at least three to four hours after using cannabis to get behind the wheel of a vehicle, adding more time may be necessary depending on how much has been consumed.

Users wishing to limit cannabis-related harm may also want to change the way they ingest the drug, Fischer said, adding the common practice of smoking the substance has potential links to cancer risk and other respiratory ailments.

Eating or drinking cannabis products might negate some of those effects, the article said, adding vaporizers that heat the cannabis and release its active ingredients into the air may also prove to be a safer method of ingestion.

The lower risk guidelines have been enthusiastically received, earning official endorsement from the Canadian Public Health Association.

In an editorial accompanying the article, Patricia Erickson of the Centre for Addiction and Mental Health described the approach as both "welcome" and "reasonable," but said its ultimate effectiveness may be impeded by Canada's legal system.

The fact that all cannabis-related activity -- except specific medical use cases -- is illegal in Canada will make it very difficult for the guidelines to be put into practice, she said.

"Public health tolerates limited degrees of personal choice, far removed from the forbidden status of cannabis and the lack of discrimination among various mild and serious consequences," Erickson wrote.

"While the recognition that many young people consume alcohol before they reach the legal age may seem to warrant comparison with cannabis, and justify low-risk guidelines as a preventive measure for youth as well as adults, no threshold of acceptability in law is possible for cannabis."

Alan Young, professor of law at York University, said the current political climate presents another barrier to changes in public health policy.

No public health questions can be addressed at the provincial level, where they usually reside, until the federal government decides to release control of the substance and either decriminalize it or regulate it, Young said. The Conservative government's hardline crime policies make this unlikely to happen in the foreseeable future, he said.

The current climate stifles many potential benefits to public health, he said, adding medical marijuana use has the potential to ease the burden on the country's health care system.

"It may be that cannabis is a valuable therapeutic product. Right now the criminalization of cannabis is preventing it from being fully explored," he said. "If you do acquire a public health perspective, that should open the door to a much more informed approach to medical cannabis."

Fischer said the most pressing demand for a modified public health approach to the drug comes from its rising popularity in society.

Cannabis' less addictive properties have allowed it to escape the scrutiny lavished on alcohol and other harder drugs, which are in general more dangerous than marijuana, Fischer said.

Cannabis, however, is not benign, and the fact that it has gained traction as the nation's most popular drug calls for a re-examination of the way it's treated in the health system.

"This is what really necessitates and amplifies the need to embrace a public health approach," Fischer said. "There's a lot of harm to be prevented when you have somewhere in the neighbourhood of up to three million users in the country who are actively using this drug."


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