Jenna Valleriani is a strategic adviser for Canadian Students for Sensible Drug Policy and a PhD candidate at the University of Toronto. Rebecca Haines-Saah is an assistant professor in the Department of Community Health Sciences at the University of Calgary.
On May 29, the Canadian Medical Association Journal released an editorial criticizing the government's approach to the protection of youth in the proposed Cannabis Act. The legislation, which was introduced in April, will create a legal regulated market for adult access to non-medical cannabis in Canada. The editorial took issue with the Act's mandated minimum age of at least 18. It argued that the minimum age should be raised to 21 and use restricted until age 25, concluding with: "If Parliament truly cares about the public health and safety of Canadians, especially our youth, this bill will not pass."
This is part of an ongoing narrative which misrepresents what it means to take a "public health approach" to drug regulation. While not neglecting individual and population-level health protection measures, fundamental to a public health approach is an emphasis on the costs of having a criminal record for cannabis possession for young Canadians, especially when criminal charges are unequally distributed amongst black and Indigenous youth, and youth who have socioeconomic disadvantages.
As outlined by the Federal Task Force, the rationale for legalization is not solely about individual-level health outcomes as potential "harms," but also the social and legal harms associated with criminalization and prohibition. Rather than point the hypothetical finger to the "tragedies" of "lives derailed" and continuing to anchor the idea of risk solely within the individual, the author neglects the social complexities – and multiple risk factors – of how problematic use of any substance develops for youth. As we currently find ourselves in the middle of an overdose epidemic in Canada where young people are dying in unprecedented numbers, we need to critically assess our approach, face uncomfortable truths, and ask who we are actually protecting with the prohibition of drugs.
We shouldn't ignore that Canadian young people currently have the highest prevalence of use compared to other countries under our current model of drug control which, in theory, is meant to completely restrict youth access. In reality, it creates a robust and unregulated market with easy access for all ages. While it's easy to declare that young people simply shouldn't use cannabis, it is well documented that this isn't a realistic or successful approach to drug prevention. The logic is flawed when our answers point only to restrictions and abstinence, and leaves out evidence-based drug education that includes equipping adolescents with strategies to avoid harmful use, beyond a focus on abstinence-only.
A critical misrepresentation in such medicalized arguments to prevent potential "harms to the developing brain" is that the evidence has yet to conclusively establish cannabis as the sole cause of structural changes to the brain associated with diminished cognitive outcomes for youth. In most studies, the effects of cannabis use are almost always comorbid with alcohol and other drug use, and often related to differences in socioeconomic status – which have potential impacts on brain development in and of themselves. Firm conclusions that cannabis by itself is explicitly damaging to the developing brain are difficult to assess. A similar lack of evidence exists to suggest cannabis is a primary cause in the development of schizophrenia. Rather, cannabis may be one of several risk factors, or these outcomes could be a reflection of pre-existing differences which lead some young people to more substance use and risk-taking behaviours. What is continually overlooked is that the majority of young people who use cannabis do not experience these severe, negative effects.
It is frustrating to observe that in discussions about youth and cannabis use, the professional bodies that speak for the medical community in Canada have continually neglected an issue that is at the very crux of the need for drug policy reform: setting regulations which give equal weight to the "real life" harms and lifelong societal costs of criminalization. It should not be forgotten that the actual targets of this discussion are young adults (i.e. not children), who fall between the ages of 18-25 – adults by every marker of society. Setting high age limits on access and telling young people to "just say no" will not accomplish either goal of deterring youth use or reducing harms as this is simply doing more of the same that created our current situation. By now it should be abundantly clear that we do not share the pessimism – or the fears – expressed by the CMAJ editorial. Rather, we believe that legal regulation of cannabis provides a context for having new and different conversations with the young people we care about, using approaches that respect the agency of young adults to make informed decisions.