Stephanie Lake1,2, Thomas Kerr1,3, Dan Werb4,5, Rebecca Haines-Saah6, Benedikt Fischer7,8,9,10,11, Gerald Thomas12, Zach Walsh13, Mark A Ware14, Evan Wood1,3, M-J Milloy1,3. 1. British Columbia Centre on Substance Use, Vancouver, Canada. 2. School of Population and Public Health, University of British Columbia, Vancouver, Canada. 3. Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, Canada. 4. Department of Medicine, University of California San Diego, La Jolla, USA. 5. International Centre for Science in Drug Policy, St. Michael's Hospital, Toronto, Canada. 6. Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada. 7. Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada. 8. Department of Psychiatry, University of Toronto, Toronto, Canada. 9. Institute of Medical Science (IMS), University of Toronto, Toronto, Canada. 10. Centre for Criminology and Sociolegal Studies, University of Toronto, Toronto, Canada. 11. Centre for Applied Research in Mental Health and Addiction (CARMHA), Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada. 12. Alcohol, Tobacco, Cannabis and Gambling Policy and Prevention, British Columbia Ministry of Health, Victoria, Canada. 13. Department of Psychology, University of British Columbia, Kelowna, Canada. 14. Departments of Family Medicine and Anesthesia, McGill University, Montréal, Canada.
Abstract
ISSUES: Canada recently introduced a public health-based regulatory framework for non-medical cannabis. This review sought to identify a comprehensive set of indicators to evaluate the public health and safety impact of cannabis regulation in Canada, and to explore the ways in which these indicators may be expected to change in the era of legal non-medical cannabis. APPROACH: Five scientific databases were searched to compile a list of cannabis-related issues of interest to public health and safety. A set of indicators was developed based on topics and themes that emerged. Preliminary evidence from other jurisdictions in the USA and Canada that have legalised medical and/or non-medical cannabis (e.g. Colorado, Washington) was summarised for each indicator, wherever possible. KEY FINDINGS: In total, 28 indicators were identified under five broad themes: public safety; cannabis use trends; other substance use trends; cardiovascular and respiratory health; and mental health and cognition. Preliminary trends from other legalised jurisdictions reveal little consensus regarding the effect of cannabis legalisation on public health and safety harms and an emerging body of evidence to support potential benefits (e.g. reductions in opioid use and overdose). IMPLICATIONS: In addition to indicators of commonly discussed challenges (e.g. cannabis-related hospitalisations, cannabis-impaired driving), this review led to the recommendation of several indicators to monitor for possible public health and safety improvements. CONCLUSION: In preparing a comprehensive public health and safety monitoring and evaluation system for cannabis regulation, this review underscores the importance of not only measuring the possible risks but also the potential benefits.
ISSUES: Canada recently introduced a public health-based regulatory framework for non-medical cannabis. This review sought to identify a comprehensive set of indicators to evaluate the public health and safety impact of cannabis regulation in Canada, and to explore the ways in which these indicators may be expected to change in the era of legal non-medical cannabis. APPROACH: Five scientific databases were searched to compile a list of cannabis-related issues of interest to public health and safety. A set of indicators was developed based on topics and themes that emerged. Preliminary evidence from other jurisdictions in the USA and Canada that have legalised medical and/or non-medical cannabis (e.g. Colorado, Washington) was summarised for each indicator, wherever possible. KEY FINDINGS: In total, 28 indicators were identified under five broad themes: public safety; cannabis use trends; other substance use trends; cardiovascular and respiratory health; and mental health and cognition. Preliminary trends from other legalised jurisdictions reveal little consensus regarding the effect of cannabis legalisation on public health and safety harms and an emerging body of evidence to support potential benefits (e.g. reductions in opioid use and overdose). IMPLICATIONS: In addition to indicators of commonly discussed challenges (e.g. cannabis-related hospitalisations, cannabis-impaired driving), this review led to the recommendation of several indicators to monitor for possible public health and safety improvements. CONCLUSION: In preparing a comprehensive public health and safety monitoring and evaluation system for cannabis regulation, this review underscores the importance of not only measuring the possible risks but also the potential benefits.