Are we prepared for marijuana to go mainstream?
Recreational use will be legal, but let’s not forget the potential for harm
As a crisis nurse working in a large community hospital, I regularly look after individuals and families whose lives are affected by problematic substance use. The substance I encounter most frequently is alcohol. Yes, legal, regulated and highly profitable alcohol. With the announcement that the federal government will introduce legislation next spring to legalize and regulate cannabis for recreational use, I’m concerned that this drug may give alcohol a run for its money.
Canada is one of many countries seeking better public health approaches and moving away from criminalizing use of cannabis. Although I support the legalization of cannabis as a public health strategy, I am concerned that the commercial and tax revenue potential — estimated to be in the billions of dollars a year — may drive policy toward financial profit and away from health. The government says it wants to keep cannabis out of the hands of kids and profits out of the hands of criminals but isn’t explaining how legalization will lead to reducing the number of users and to mitigating social harms. The government needs to send a clear message that legalization is not an endorsement for use.
The Centre for Addiction and Mental Health’s "Cannabis Policy Framework, which was developed with a public health focus, contains some excellent recommendations for a legalized system, including setting a minimum age for purchase and consumption and banning advertising, marketing and sponsorship (something we have unfortunately failed to do with alcohol). However, I believe a few of the other recommendations could worsen some of the social problems that legalization is proposed to resolve. Establishing a government monopoly on sales, curbing demand through pricing policy, and mandatory product potency testing and labelling are unnecessarily onerous and will deter illegal suppliers from entering the legal market.
Legalization should not be viewed as giving up on the war on drugs; it would just mean that the tools used to fight the war are evolving. A harm reduction approach is an effective tool but so too is action taken on the larger social and mental health problems that may be contributing to cannabis use.
Health-care professionals need to be more open to exploring the potential benefits of cannabis for treating health conditions. I’ve heard many anecdotal reports from patients that it helps to relieve pain and distress for a variety of illnesses and health problems, but much more research needs to be conducted in these areas. Once cannabis is legalized, more people may decide it’s now OK to self-medicate. We will need to be ready to have open, non-judgmental discussions with patients, offering them education on using the drug safely or helping them explore other treatments and coping strategies. To be able to have those conversations and to raise awareness with the public, we need to be well educated ourselves.
The government has vowed to consult with stakeholders and experts while the legislation is being drafted. This will be our best shot, while the details are being worked out, to press the government to make the health and well-being of Canadians its number 1 consideration. How inclusive and successful that process turns out to be could mean the difference between seeing a reduction in health and social harms or an increase in already serious mental health, social and substance use problems.