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Abstract
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With the implementation of non‐medical cannabis legalization in jurisdictions across North and South America over recent years, a major policy experiment in alternative control of this widely used, and previously illicit, substance has been unfolding.
Hall and Lynskey1 review the state of knowledge to date regarding cannabis legalization's impact on public health outcomes. As they correctly observe, the current (mostly North America‐based) evidence base regarding the impacts of legalization is limited, and mixed, including heterogeneous effects on cannabis use and related harms. For example, while cannabis use rates among young people seem to have remained stable in the wake of legal availability, use among others and some severe harm outcomes (e.g., hospitalizations) appear to have increased. Thus, it is yet impossible to conclude if legalization has been an overall success or failure for public health.
This likely relates to several reasons beyond those mentioned by the authors. First, effects observed to date may be driven by “strawfire” (or “novelty”) dynamics. Second, the full public health impact of cannabis legalization will likely hinge on a combination of outcomes, including use prevalence and initiation among youth; high‐risk use patterns (such as frequent and/or high‐tetrahydrocannabinol use); cannabis‐impaired driving and consequent motor vehicle crashes and related injuries; use disorders and related treatment needs; hospitalizations for cannabis‐related problems; use substitution or interactions with alcohol, tobacco or other psychotropics2.
The robust assessment of such primary outcomes as related to legalization faces a number of challenges. The first one is integrating individual outcome measurements into a combined (e.g., index‐type) measure, such as burden of disease, to enable overall public health impact assessment and monitoring2. Of note, such measurements commonly omit, but should ideally include, impacts on marginalized or non‐general (e.g., indigenous) populations. A second challenge is that pre‐legalization trends must be taken into account, as several of the aforementioned outcomes had featured marked pre‐legalization increases. Hence, even just a trend‐change could constitute a relevant impact associated with the policy change.
The “big picture” evidence on cannabis legalization public health impacts may, even in the long run, remain mixed, inconclusive or even contradictory. In that scenario, particular importance may need to be assigned to possible developments in social – including social justice – benefits or harms. While currently no empirical “social burden” (akin to “disease burden”) outcome measure exists, such assessment would need to capture legalization's impacts on reducing the criminalization and stigmatization of large numbers of – predominantly young and often socio‐economically marginalized/racialized – cannabis users, and the severe, long‐term consequences of these punitive processes on young lives3, 4. Such a reduction in social harms, indeed, may need to be considered a (or the) quintessential collective benefit of legalization5. In some – such as Latin American – countries, social harms have translated into widespread violence, including numerous deaths, related to illegal cannabis markets, which legalization may at least somewhat temper.
Legalization has not eliminated all pitfalls of punitive control and consequences. For example, in select provinces in Canada, the possession of any amounts of cannabis by under‐age persons (mostly <19 years) may result in a civil fine. Repeat occurrences or possession amounts ...
Keywords: Cannabis impaired driving
Language: en |