Cannabis legalization in Canada: how might ‘strict’ regulation impact youth?
Tara Marie Watson & Patricia G. Erickson
DRUGS: EDUCATION, PREVENTION AND POLICY, 2018
Cannabis legalization in Canada: how might ‘strict’ regulation impact youth? Canada is on course to become, in October 2018, the second country in the world, after Uruguay, to federally legalize cannabis for recreational use. Prime Minister Justin Trudeau’s Liberal government has set out to achieve several objectives with this major drug policy reform, including ‘[to] Protect young Canadians by keeping marijuana out of the hands of children and youth’ (Government of Canada, 2016). While protecting the health and safety of youth is a socially desirable and important public health goal, the government’s vague phrasing of this objective leaves open multiple possibilities for policy strategies and implications. Indeed, in the past 2 years, Canadians have had much exposure through the media, especially news stories featuring the government’s legalization spokespersons, to arguments that cannabis regulation will ‘protect’ youth by reducing their access to the drug, early-onset use, and/or contact with illicit markets and the criminal justice system (e.g. D’Amore & Goodfield, 2017). Based on research evidence about cannabis use among youth in Canada, key questions to consider include: what do young people need protection from, and will the federal government’s plan increase or decrease these potential harms? As well, what are the likely benefits legalization will have for youth?
The illicit status of cannabis in Canada began in 1923 under federal criminal law (Hathaway & Erickson, 2003). Despite this long history of prohibition, in 2015 past-year cannabis use was reported by 21% of people aged 15–19 years (Statistics Canada, 2017). Out of about 40 countries surveyed, Canadian youth have ranked second highest for past-month cannabis use (World Health Organization, 2016). Average age of cannabis use initiation is a useful marker of early-life usage, but findings vary. While the 2015 Canadian Tobacco, Alcohol and Drugs Survey (Statistics Canada, 2017), which samples Canadians aged 15 years and over, reports a median initiation age of 17 years, the 2014–15 Canadian Student Tobacco, Alcohol and Drugs Survey (Health Canada, 2016), which samples students in grades 6–12, reports a mean initiation age of 14.2 years. Canadian students in grades 7–12 perceive cannabis to be a readily available drug (Boak, Hamilton, Adlaf, & Mann, 2017). By the time youth reach university, cannabis is purportedly ‘very easy’ or ‘easy’ to obtain through social networks of supply (Hathaway, Mostaghim, Erickson, Kolar, & Osborne, 2018). In short, even before legalization, a sizable segment of youth has at least tried cannabis and considers the drug readily available, typically starting in adolescence; this calls into question how much ‘protection’ children need from cannabis exposure and the effectiveness of efforts promoting this aim.
Since the outset of the legalization process, the federal government has promised to adopt a ‘strict’ public healthfocused model of production and sale that emphasizes minimizing harms, such as the risks of contamination or unknown potency associated with drugs sold in illicit markets. Besides providing a ‘safe and responsible’ cannabis production and supply system, other core objectives of the government’s plan include removing profits from organized crime groups and reducing burdens on the criminal justice system (Government of Canada, 2016). Bill C-45 (2017), also known as the Cannabis Act, details the new federal regulatory system and gives high priority to the objective ‘to prevent young persons from accessing cannabis’. In accordance with input from cross-Canada consultations with a broad range of stakeholders, including roundtable sessions with youth and ‘youth-serving organizations’ (Task Force on Cannabis Legalization and Regulation, 2016), and expert group recommendations (Crepault, Fischer, & Rehm, 2016), the Cannabis Act sets a minimum age for possession, purchase, and sale. While that federally designated minimum age is 18 years, the provinces and territories have the authority to set higher (but not lower) minimums, along with various other features of cannabis distribution and access, as these jurisdictions already do with alcohol. Most provinces, for instance, will set the minimum age at 19 years to match the regional legal drinking age. (See Table 1 for an overview of the evolving provincial and territorial plans for minimum age and key distribution system details.) As noted, recent pre-legalization surveys show that adolescents under age 18 or 19 are accessing and using cannabis. Whatever the ultimate provincial and territorial decisions, the minimum legal age requirement—a hotly debated issue, with some groups having advocated for 21 or even 25 years (Cain, 2017; Canadian Medical Association, 2017)—would appear to hold little promise for eliminating or curtailing underage cannabis use.
The health-focused rationale for recommending prevention or delayed initiation of cannabis use among youth is founded on a large and growing body of evidence that suggests the earlier the onset of use, the greater the risk of harm to the developing brain and other adverse outcomes in later years (Fischer et al., 2017; George & Vaccarino, 2015). Family and pediatric physicians have vocalized concerns about the health-related impacts of anticipated greater youth access to cannabis, albeit having expressed mixed views on legalization (cf. Ammerman, Ryan, Adelman, & The Committee on Substance Abuse, The Committee on Adolescence, 2015; Frappier et al., 2003; Grant & Belanger, 2017; Kelsall, 2017; Spithoff & Kahan, 2014). Despite mounting evidence that early-onset cannabis use can be harmful to cognitive development and mental health, particularly for individuals who are susceptible due to genetic or family history, it is unhelpful to slide into a prohibitionist mentality that equates any consumption by youth as harmful. The evidence base suggests that it is intense and frequent cannabis use that poses the most cause for health-related concerns (see again Fischer et al., 2017; George & Vaccarino, 2015). The available evidence also indicates that cannabis potency (often expressed as a percentage of tetrahydrocannabinol, the main psychoactive element of the drug) and mode of administration deserve attention as elements that can increase health-related risks. Newer cannabis products and concentrates (edibles, oils, ‘shatter’) might therefore pose reasonable concerns for their potential effects on young consumers, though how much these products appeal to youth is unclear at this point. The Cannabis Act does not currently set potency limits or restrictions on sale of highpotency products to young adults (Vomiero, 2017) and the future of edibles is to be determined once the legislation is in force. There is a pressing need for more evidence in relation to youth consumption practices and patterns.
Moreover, while Canadian youth report having used cannabis, a small minority admit recent frequent use and many indicate that they do not intend to start using (e.g. only 1.4% of a large sample of Ontario students in grades 7–12 reported past-month daily use, while 62% indicated that they would not use the drug even after legalization; Boak et al., 2017). Thus, the implicit assumption found in the new legislation’s embedded preference for abstention for people under age 18 seems questionable, as a majority of this population do not appear to need ‘protection’ from the harms that may result from intensive cannabis use. Nonetheless, the removal of prohibition in Canada will potentially open many
more opportunities for the development of practical, harm reduction-informed and evidence-based education that contains messaging about cannabis use rather than simply against cannabis use (see Erickson, 1997; Fischer, Rehm, & Crepault, 2016).
While the health outcomes of legalization—namely, increasing the prevalence and incidence of use, and possibly related harms and benefits—are currently uncertain, the Canadian government’s plan will provide significant benefits in terms of removing the threat of cannabis-related arrests, charges, criminal records, and the associated stigma for youth (Erickson, 1980). Until recently, these threats have continued to be a reality, with over 44,000 cannabis possession arrests in Canada in 2016 (Boyd, 2018). Indeed, the consequences of criminalization are major social and individual harms that should be finally mitigated by legalization. That said, the minimum age limit and other features of the Cannabis Act raise worthwhile questions about whether the new system will increase or decrease certain harms and inequities for young people. The data we cite earlier on cannabis use prevalence and initiation illustrate that prohibition has not prevented youth access to the drug. If under the new system people under age 18 continue to access cannabis, how will they do so? Concerns have been voiced by young persons across Canada about whether legal cannabis access, still constrained by age limits, will mean that youth will continue to resort to illicit supply networks (McKiernan & Fleming, 2017). Notably, under the Cannabis Act persons who provide the drug to anyone under legal age to purchase could be subject to up to 14 years imprisonment, though it is anticipated that judicial discretion will limit application of this maximum penalty and provide alternatives (Curry, 2017). Additionally, while the new legislation does not permit legal purchase for people under age 18, it stipulates that younger persons can possess up to no more than what would be equivalent to 5 g of dried cannabis. This provision is ostensibly in place to ensure that youth are not arrested for possessing small amounts of the drug (Bueckert, 2017), but it leaves open the question of how underage youth who may be carrying, say, more than a couple joints (likely to share or provide to others in some cases; see Coomber, Moyle, & South, 2016; Hathaway et al., 2018) will be treated by the police. As recommended by the Task Force on Cannabis Legalization and Regulation (2016), ‘the discretion and flexibility available in the criminal justice system, in particular under the Youth Criminal Justice Act, should be used constructively to minimize’ (p. 39) any potential harms from criminalization. This recommendation from the group that informed the federal government in its crafting of the Cannabis Act sets some guidance to protect youth under 18 from criminalization, but many questions remain about how new laws will be enforced in practice. Disproportionate policing and continued criminalization of Indigenous and racialized youth is also of important concern given the historical and contemporary contexts of over-policing of these populations, especially in connection with drugs (e.g. see Hayle, Wortley, & Tanner, 2016; Marshall, 2015; Rankin, Contenta, & Bailey, 2017).
It is worth noting that in addition to criminal offences for underage possession, as well as distributing and selling to persons under age 18, there are varied youth-specific restrictions under the Cannabis Act regarding how cannabis can be promoted, packaged and labelled, and displayed. For example, it will be prohibited to promote cannabis, accessories (pipes, vaporizers), and cannabis-related services in a manner that ‘could be appealing to young persons’; and promotion by authorized producers and distributors must adhere to taking place ‘where young persons are not permitted by law’ and involve ‘reasonable steps to ensure that the promotion cannot be accessed by a young person’. It remains to be seen how these restrictions will be enforced and how will it be decided that promotional activities and advertising might ‘appeal’ to youth. Will youth be meaningfully consulted about what appeals to them? Further, in the government’s plan to dedicate considerable resources to public education on cannabis, to what extent will youth be consulted for their input on new education and programming, including harm reduction efforts, tailored to their age group? Engaging with and incorporating youth perspectives is critical when youth are the targets of policy and policy change. Youth have often been left out of conversations and decision-making around drug policy, but there are indications that greater efforts are underway in Canada to include their voices on cannabis policy and education (Task Force on Cannabis Legalization and Regulation, 2016; Valleriani et al., 2018). There are numerous outstanding questions related to the potential health and social impacts that cannabis legalization will have on youth, not to mention the general population as well, and outcomes may not be empirically clear for years to come (see Hall & Lynskey, 2016). Although concerns about legalization increasing harms to youth have also been commonly heard in the U.S. (e.g. McGinty et al., 2016), their approach appears to be much more market-driven and commercialized (e.g. Pardo, 2014) than Canada’s plan for a ‘strict public health-oriented’ approach (see Fischer & Rehm, 2017). Currently available evidence from states that have liberalized their cannabis laws is mixed regarding how such laws might be affecting or altering rates of cannabis use, types of use (e.g. smoking, vaping, edibles), driving under the influence of cannabis, and perceived harms among young persons (Borodovsky et al., 2017; Cerda et al. 2017; Johnson, Hodgkin, & Harris, 2017; Masten & Guenzburger, 2014; Pollini, Romano, Johnson, & Lacey, 2015; Schinke, Schwinn, Hopkins, Gorroochurn, & Wahlstrom, 2017). From a public health perspective, while it may be instructive to derive lessons of what not to do from our neighboring nation, there is still much to learn as the process unfolds.
Countries worldwide are paying attention to Canada as it adopts and implements its own unique version of legalization. The overarching point of this editorial is to invite readers to consider how Canada’s planned scheme, though it might look appropriately informed by public health, may not in the near or distant future achieve the important yet multifaceted objective of ‘keeping [cannabis] out of the hands of’ youth. However, the new system has the potential to achieve much more positive outcomes than the long era of prohibition could ever demonstrate, and more doors ought to open to innovate new prevention and harm reduction initiatives. This was the hopeful message of the ground-breaking Le Dain Commission (1972), that withdrawing from criminal sanctions would require other, less harmful modes of drug regulation to be put in place. Canada is finally at that threshold.Cannabis_legalization_in_Canada_How_migh