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Abstract
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KEY POINTS
In October 2018, recreational use of cannabis was legalized in Canada with the primary objectives of improving cannabis-related public health and safety, reducing youth access to cannabis, and reducing cannabis-related crime and illegal markets.
Five years after policy implementation, available evidence suggests that outcomes related to health -- such as the prevalence of cannabis use, cannabis-related emergency department visits and admissions to hospital and cannabis impaired driving -- have mostly increased or remained steady.
Data on some important health indicators are unavailable.
Substantial reductions in criminal arrests and charges related to cannabis use -- and related stigma and other personal burdens -- among both adults and youth should be noted as related positive social justice and possibly indirect public health outcomes.
Continued measurement of key health and social outcomes, as well as robust ways to integrate diverse data when evaluating policy outcomes, are needed to inform evidence-based adjustments to regulatory parameters that will more effectively serve the declared public health objectives of cannabis legalization in Canada.
In October 2018, Canada was the first G-20 nation to implement the legalization of nonmedical cannabis use and supply for adults.1 Cannabis legalization in Canada had the primary objectives of improving cannabis-related public health and safety; reducing youth access to cannabis; and reducing cannabis-related crime and illegal markets, mainly by allowing adult cannabis use and related behaviours as a legal, regulated activity. We discuss whether, 5 years on, these objectives have been met, drawing on systematic reviews and recent primary studies for our observations.1-3
The Canadian legalization framework comprises a federal law (Cannabis Act) and related regulations, some of which are subject to provincial refinements. Some of the main parameters of legal cannabis use and access are a personal possession limit of 30 g of dried cannabis (or equivalents) in public by adults (with a minimum age of 18-21 yr, depending on the province); restricting use to nonpublic settings (in most provinces); incremental retail sale of flower, extracts or liquids, and ingestible cannabis products; cannabis sales by commercial or public retail systems (or both, in some provinces) and via the Internet; limited home cultivation (in most provinces); and national per se law-and threshold-based restrictions of cannabis-impaired driving.
National survey data monitoring cannabis usage before and after cannabis legalization showed an increase in the prevalence of cannabis use (from 22% in 2017 to 27% in 2022), although rates of near-daily to daily use remained relatively stable (24%-25%).4 In contrast, significant increases in the prevalence of cannabis use (adjusted odds ratio [OR] 1.62, 95% confidence interval [CI] 1.40-1.86), daily cannabis use (adjusted OR 1.59, 95% CI 1.21-2.07) and cannabis use-related problems (adjusted OR 1.53, 95% CI 1.20-1.95) from 2001 to 2019 were shown in a study of the Ontario adult population.5 The prevalence of cannabis use among youth (30%-50%, depending on the survey) and perceived access to cannabis by minors have remained mostly stable at the high levels observed before legalization...
Language: en |