"Legalization, combined with strict health-focused regulation, provides an opportunity to reduce the harms associated with cannabis use."
That simple, no-nonsense, evidence-based conclusion on how to deal with the thorny issue of marijuana comes courtesy of the Centre for Addiction and Mental Health, which has just published a new "Cannabis Policy Framework."
It's a welcome counterpoint to the federal government's Reefer Madness world view, which holds that pot smokers are all criminals and deviants who are frying their brains.
As Dr. Jurgen Rehm, director of the social and epidemiological research department points out, that approach is "failing to prevent or reduce the harms associated with cannabis use."
At the same time, he notes that cannabis is not benign; it's associated with a number of health problems including impaired functioning, respiratory issues, dependence and mental illness. But most of the harm is concentrated in a small minority of heavy users.
And, yes, as many people will point out (and so does the report) the harms caused by cannabis are lesser than those caused by alcohol.
But it's not a contest to see whose drug of choice screws up fewer people. The goal should be to minimize the misuse, abuse and damage done by cannabis, alcohol, and other harmful substances.
The CAMH approach is one that is the mainstay of good public health policies: Harm reduction.
It recognizes that, despite the potential harms, a lot of people smoke pot. (Or vaporize it, or eat it in brownies, or whatever.)
Two in five young adults, aged 18-29, used cannabis in the past year; so did one in four teens in Grades 7 to 12.
Prohibition and criminalization have not succeeded in deterring cannabis use. But they have consumed a lot of resources and caused a lot of collateral damage.
Enforcement of cannabis laws – police, courts, corrections – costs about $1.2-billion a year in Canada. More than half a million Canadians now have a criminal record for possession of cannabis and that number is growing by more than 60,000 annually.
A criminal record does a lot more harm than smoking a couple of joints.
So, given the drug's popularity, how do you minimize the harms – social, legal and physical?
The best way, according to the CAMH experts (and the evidence) is to regulate pot much like alcohol.
The report says there are 10 elements that should be addressed when in moving prohibition to decriminalization and regulation of cannabis:
- Establish a government monopoly on sales;
- Set a minimum age for cannabis purchase and consumption;
- Limit availability;
- Curb demand through pricing;
- Curtail higher-risk products and formulations;
- Prohibit marketing advertising and sponsorship;
- Clearly display product information, including labelling THC (tetrahydrocannabinol) and CBD (cannabidiol) content;
- Address the risk of cannabis-impaired driving, including prevention, education and enforcement;
- Enhance access to treatment;
- Invest in education and prevention.
Most of these strategies have been used successfully in tackling tobacco smoking and alcohol use, especially in youth.
Implicit in the approach is a recognition that the real harms come from early initiation and excessive use, and that you have to pay particular attention to high-risk users, those with a genetic pre-disposition (or familial history) to addiction or mental illness.
The call for strict regulation will disappoint the proponents of legalization without restrictions and the budding legions of "potrepreneurs."
The CAMH report says abolishing current laws would definitely be an improvement, but there can be greater health risks and other unintended consequences from decriminalization.
"To reduce harm, legalization of cannabis is a necessary – but not a sufficient – condition," the report concludes.
Just as criminalization has discouraged cannabis users from prevention, risk reduction and treatment services, decriminalization without ballasts risks doing the same.
What the new report does is take a pragmatic middle ground. It recognizes that having a lot of people smoking pot – like having a lot of people drinking alcohol or smoking cigarettes – is not ideal.
But given that it's happening, let's prevent and mitigate the damage to the health of individuals and the population more broadly.
It's the kind of statement and policy direction that should be coming from Health Canada.
But all we get from the $3.6-billion a year department is tired 1970s War On Drugs rhetoric rather than practical solutions.
André Picard is The Globe's public health columnist.