1

Centre for Addiction and

Mental Health
1001 Queen St. West
Toronto, Ontario
Canada M6J 1H4
Tel: 416.535.8501

www.camh.ca




















































A PAHO / WHO
Collaborating Centre
Fully affiliated with the
University of Toronto
















!"##"$%& '()%!* +,"-./(,0








CcLober 2014




0

12345 67 869:59:;

.<58=:>?5 ;=@@2AB CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC D
/E2: F5 G96F CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC H
Cannabls ls Lhe mosL commonly used lllegal drug ln Canada ..................................................... 2
Cannabls use carrles healLh rlsks ................................................................................................ 3
CannablsrelaLed harm ls concenLraLed among a llmlLed group of hlghrlsk users ................... 3
CrlmlnallzaLlon of cannabls use causes addlLlonal harms, wlLhouL dlssuadlng lL ...................... 6
Legal reform of cannabls conLrol ls needed ............................................................................... 7
/EB 45I24>J5 29K A5I=42:5L CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC M
uecrlmlnallzaLlon: a half measure .............................................................................................. 9
LegallzaLlon: an opporLunlLy for evldencebased regulaLlon ................................................... 11
-6?>9I 7A6@ NA6E>3>:>69 :6 A5I=42:>69 ....................................................................................... DH
rlnclples Lo gulde healLhfocused cannabls conLrol ................................................................ 12
oLenLlal rlsks, and how Lo mlLlgaLe Lhem ............................................................................... 13
!6984=;>69 CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC DO
"36=: !"-P CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC DQ
,575A5985;CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC DM


1

.<58=:>?5 ;=@@2AB

Cannabls ls a favourlLe recreaLlonal drug of Canadlans, along wlLh alcohol and Lobacco. Llke
Lhose drugs, cannabls (popularly known as marl[uana) ls assoclaLed wlLh a varleLy of healLh
harms. unllke Lhose drugs, cannabls ls lllegal, prohlblLed under Lhe same federal and
lnLernaLlonal drug sLaLuLes as heroln and cocalne.

1he landscape of cannabls pollcy ls changlng. 1he neLherlands, orLugal, and more recenLly
uruguay and uS sLaLes Colorado and WashlngLon have reformed Lhelr approach Lo cannabls
conLrol. Pere ln Canada, changes Lo Lhe rules of Lhe federal Medlcal use of Marl[uana program
are expecLed Lo lead Lo an lncrease ln Lhe number of reglsLered users over Lhe nexL few years.
ubllc supporL for reform of Canada's cannabls laws conLlnues Lo grow. Meanwhlle, we
conLlnue Lo lmprove our undersLandlng of Lhe healLh rlsks of cannabls use.

As Canada's leadlng hosplLal for menLal lllness, Lhe CenLre for AddlcLlon and MenLal PealLh
(CAMP) offers evldencebased concluslons abouL cannabls and measures almed aL reduclng
harm. CAMP has revlewed Lhe evldence on cannabls conLrol and drawn Lhe followlng
concluslons:
Cannabls use carrles slgnlflcanL healLh rlsks, especlally for people who use lL frequenLly
and/or begln Lo use lL aL an early age.
CrlmlnallzaLlon helghLens Lhese healLh harms and causes soclal harms.
A publlc healLh approach focused on hlghrlsk users and pracLlces - slmllar Lo Lhe
approach favoured wlLh alcohol and Lobacco - allows for more conLrol over Lhe rlsk
facLors assoclaLed wlLh cannablsrelaLed harm.

lrom Lhese concluslons follows anoLher:
LegallzaLlon, comblned wlLh sLrlcL healLhfocused regulaLlon, provldes an opporLunlLy Lo
reduce Lhe harms assoclaLed wlLh cannabls use.

1hls approach ls noL wlLhouL rlsks. A legal and unregulaLed or underregulaLed approach may
lead Lo an lncrease ln cannabls use. llndlng Lhe rlghL balance of regulaLlons and effecLlvely
lmplemenLlng and enforclng Lhem ls Lhe key Lo ensurlng LhaL a legallzaLlon approach resulLs ln a
neL beneflL Lo publlc healLh and safeLy whlle proLecLlng Lhose who are vulnerable Lo cannabls
relaLed harms.

CAMP nelLher makes a moral sLaLemenL on cannabls nor encourages lLs use. uesplLe Lhe
prohlblLlon of cannabls, more Lhan one Lhlrd of young adulLs are users, and our currenL
approach exacerbaLes Lhe harms. lL's Llme Lo reconslder our approach Lo cannabls conLrol.

2

/E2: F5 G96F

!"##"$%& %& '() *+&' ,+**+#-. /&)0 %--)1"- 02/1 %# !"#"0"

Canada has one of Lhe hlghesL raLes of cannabls use ln Lhe world. More Lhan 40 of Canadlans
have used cannabls ln Lhelr llfeLlme and abouL 10 have used lL ln Lhe pasL year.
1
no oLher
lllegal drug ls used by more Lhan 1 of Canadlans every year.
2


opulaLlon surveys ln CnLarlo
3
lndlcaLe LhaL 14 of adulLs and 23 of hlgh school sLudenLs used
cannabls ln 2013. As shown ln Lhe Lable below, men are nearly 30 more llkely Lo be pasLyear
users Lhan women. Cannabls use ls mosL common among adolescenLs and young adulLs, buL
half of Lhe provlnce's users are age 30 or older. 8eLween 1997 and 2003, cannabls use among
adulLs Lrended upward - parLlcularly among 18 Lo 29 yearolds - buL has levelled off slnce Lhen.
Among hlgh school sLudenLs Lhere has been a sLeady and slgnlflcanL decrease ln pasLyear use
slnce 2003.

!"##"$%& R&. %# (#1",%(S N5A859:2I5 67 :E5 N6N=42:>69 =;>9I 829923>; >9 :E5 N2;: B52A
4

DTTQ HUUD HUUV HUUT HUDW
Ceneral populaLlon (age 18+) 9.1 11.2 14.4 13.3 14.1
8y gender
Men 11.4 13.4 18.8 17.4 17.6
Women 7.0 7.3 10.3 9.3 10.8
8y age
Crades 712 28.0* 28.6 26.3 23.6 23.0
Age 1829 21.4 26.8 38.2 33.8 40.4
Age 3039 9.8 13.8 16.9 12.9 17.3
Age 4049 4.3 7.2 10.8 11.7 8.4
Age 30+ 1.7 3.3 2.6 4.7 3.9
* flgure from 1999



1
PealLh Canada, 2013
2
PealLh Canada, 2013
3
lalomlLeanu eL al., 2012, lalomlLeanu eL al., 2014, 8oak eL al., 2013
4
All daLa lalomlLeanu eL al., 2012, excepL Crades 712 (8oak eL al., 2013) and general populaLlon daLa for 2013 (lalomlLeanu eL al., 2014)
3

60 of pasLyear adulL cannabls users ln CnLarlo use lL aL leasL once a monLh,
3
and abouL 27,
or nearly 4 of Lhe LoLal adulL populaLlon, use lL every day.
6
lrom oLher [urlsdlcLlons we know
LhaL a small proporLlon of cannabls users ls responslble for Lhe bulk of consumpLlon, lL ls
esLlmaLed LhaL 20 of users accounL for 8090 of consumpLlon.
7


MosL people who use cannabls do noL use oLher lllegal drugs, and cannabls use alone does noL
lncrease Lhe llkellhood LhaL a person wlll progress Lo uslng oLher lllegal subsLances.
8


ubllc oplnlon on cannabls conLrol has shlfLed conslderably ln Lhe pasL decade. 1en years ago
abouL half of Canadlans belleved cannabls use should be decrlmlnallzed or legallzed, Loday,
abouL Lwo Lhlrds of Canadlans hold Lhls vlew.
9



!"##"$%& /&) ,"22%)& ()"-'( 2%&3&

Cannabls ls noL a benlgn subsLance. lLs healLh harms lncrease wlLh lnLenslLy of use. arLlcularly
when used frequenLly (dally or neardally), cannabls ls assoclaLed wlLh lncreased rlsk of
problems wlLh cognlLlve and psychomoLor funcLlonlng, resplraLory problems, dependence, and
menLal healLh problems.

roblems wlLh cognlLlve and psychomoLor funcLlonlng
Cannabls use ls known Lo negaLlvely affecL memory, aLLenLlon span, and psychomoLor
performance. lrequenL use may reduce moLlvaLlon and learnlng performance, and work or
sLudy can be negaLlvely affecLed as a resulL.
10
ln adulLs, Lhese changes are noL generally
permanenL, effecLs usually dlsslpaLe several weeks afLer use ls dlsconLlnued.

MosL slgnlflcanL from a publlc healLh perspecLlve ls Lhe lmpacL of cannabls use on Lhe skllls
necessary for safe drlvlng and Lhe subsLanLlal lncrease of rlsk of moLorvehlcle accldenLs.
11
ln
CnLarlo, an esLlmaLed 9 of llcensed drlvers aged 18 Lo 29 and 10 of Lhose ln grades 10 Lo 12
reporL havlng drlven wlLhln an hour of uslng cannabls ln Lhe pasL year.
12
8aLes of cannabls
lmpalred drlvlng exceed raLes of alcohollmpalred drlvlng for boLh age groups. AlLhough Lhe
accldenL rlsk assoclaLed wlLh cannablslmpalred drlvlng ls slgnlflcanLly lower Lhan LhaL of
alcohollmpalred drlvlng, lL ls a serlous concern: moLorvehlcle accldenLs due Lo lmpalred
drlvlng are Lhe maln conLrlbuLlon of cannabls Lo Canada's burden of dlsease and ln[ury.



3
lalomlLeanu eL al., 2014
6
PealLh Canada, 2013
7
8oom eL al., 2010
8
8oom eL al., 2010
9
4"'%+#"- 5+&', 2013, 6''"7" !%'%8)#, 2014
10
8lock eL al., 2002, ope eL al., 1996
11
ParLman and PuesLls, 2013, Pall and uegenhardL, 2009
12
lalomlLeanu eL al., 2012, 8oak eL al., 2013
4

8esplraLory problems
Llke Lobacco, cannabls smoke conLalns Lar and oLher known cancercauslng agenLs. 8egular,
longLerm cannabls smoklng ls llnked Lo bronchlLls and cancer.
13
Cannabls smokers ofLen hold
unfllLered smoke ln Lhelr lungs for maxlmum effecL, whlch adds Lo Lhese rlsks. AbouL half of
pasLyear users also smoke Lobacco and lL ls llkely LhaL Lobacco smoklng conLrlbuLes greaLly Lo -
or ls Lhe prlmary cause of - many of Lhese resplraLory problems.
14


uependence

AbouL 9 of cannabls users develop dependence.
13
eople who develop cannabls dependence
may have dlfflculLy qulLLlng or cuLLlng down and may perslsL ln uslng lL desplLe negaLlve
consequences, Lhose who sLop suddenly may experlence mlld wlLhdrawal sympLoms lncludlng
lrrlLablllLy, anxleLy, upseL sLomach, loss of appeLlLe, dlsLurbed sleep, and depresslon.
16
Long
Lerm frequenL users have a hlgher rlsk of dependence Lhan occaslonal users. 8y way of
comparlson, Lhe esLlmaLed probablllLy of developlng dependence ls 68 for nlcoLlne, 23 for
alcohol, and 21 for cocalne.
17


MenLal healLh problems


lrequenL cannabls use has been found by many sLudles Lo be assoclaLed wlLh menLal lllness.
18
lL
ls LhoughL Lo lncrease Lhe llkellhood of menLal lllness ln people wlLh a preexlsLlng vulnerablllLy
Lo lL and Lo exacerbaLe sympLoms ln people already experlenclng menLal lllness.
19
Lven
occaslonal use can lncrease Lhese rlsks: lL has been esLlmaLed LhaL cannabls users have a 40
hlgher rlsk of psychosls Lhan nonusers.
20
lrequenL users have an even hlgher rlsk - 30 Lo
200 hlgher Lhan nonusers - lndlcaLlng a posslble dose response. PlghpoLency cannabls -
LhaL ls, cannabls wlLh a hlgh concenLraLlon of LeLrahydrocannablnol (1PC), Lhe maln
psychoacLlve componenL of cannabls - places users aL hlgher rlsk of menLal healLh problems
Lhan lowpoLency cannabls.
21
1hls assoclaLlon beLween cannabls use and menLal lllness ls
robusL buL noL yeL well undersLood. CausallLy has noL been deLermlned.
22





13
1eLraulL eL al., 2007
14
llscher eL al., 2011
13
LopezCulnLero eL al., 2011
16
AnLhony, 2006, kalanL, 2004
17
LopezCulnLero eL al., 2011
18
lor a summary see volkow eL al., 2014, and llscher eL al., 2011.
19
McLaren eL al., 2009, Pall eL al., 2004
20
Moore eL al., 2007
21
ul lorLl eL al., 2009
22
McLaren eL al., 2009
3

!"##"$%&2)-"')0 ("2* %& ,+#,)#'2"')0 "*+#1 " -%*%')0 12+/9 +: (%1(2%&3 /&)2&

AL Lhe levels and paLLerns of use reporLed by mosL adulL cannabls users, Lhe healLh rlsks are
modesL - slgnlflcanLly lower Lhan Lobacco or alcohol. 1he Lable below llsLs Lhe esLlmaLed
lnLrlnslc or lnherenL rlsks of slx dlfferenL drugs, raLed along dlfferenL dlmenslons of harm on a
scale of 0 Lo 100 (wlLh 100 represenLlng Lhe hlghesL rlsk):
23



"486E64 1632886 !29923>;
"@NE5
:2@>95;
P5A6>9
!682>95X
!A28G
LeLhallLy*
30 0 0 20 100 22.3
uamage Lo physlcal healLh
80 100 20 30 20 40
lmpalrmenL of menLal funcLlonlng
63 0 30 60 30 80
* Lxpressed as raLlo of leLhal dose and sLandard dose

1he healLh rlsks of cannabls lncrease slgnlflcanLly wlLh lnLenslLy of use, frequency of use ls a
sLrong predlcLor of cannablsrelaLed harms.
24
roblems wlLh cognlLlve, psychomoLor, and
resplraLory funcLlonlng, as well as dependence and menLal healLh problems, are all
concenLraLed among people who use cannabls dally or neardally - an esLlmaLed 2030 of
users.

1here ls also a sLrong and growlng body of evldence LhaL regular cannabls use ln adolescence
can serlously harm Lhe developlng braln. Larly regular cannabls use ls assoclaLed wlLh low levels
of educaLlonal aLLalnmenL, dlmlnlshed llfe saLlsfacLlon, hlgher llkellhood of developlng cannabls
use dlsorder, and lncreased rlsk of developlng menLal healLh problems.
23
Several sLudles have
suggesLed LhaL cannabls use before Lhe age of 18 lncreases Lhe rlsk of developlng
schlzophrenla.
26
And whlle Lhe cognlLlve problems assoclaLed wlLh regular cannabls use
dlmlnlsh afLer abouL a monLh of nonuse for adulLs, Lhese effecLs may noL be reverslble ln
adolescenL users.
27
1hese flndlngs are of concern, glven LhaL abouL 3 of CnLarlo's hlgh school
sLudenLs - an esLlmaLed 26,000 adolescenLs - use cannabls dally.

ln 2011, a Leam led by ur. 8enedlkL llscher and ur. !urgen 8ehm of CAMP developed and
publlshed a seL of lowerrlsk cannabls use guldellnes (L8CuC).
28
noLlng LhaL cannablsrelaLed
harm ls malnly concenLraLed among a llmlLed subgroup of users who use cannabls heavlly
and/or began Lo use lL aL an early age, and LhaL Lhese rlsk facLors are poLenLlally modlflable, Lhe
auLhors recommended Lhese guldellnes as a way of reduclng Lhe harms of cannabls use aL an
lndlvldual and a populaLlon level. Modelled on Lhe example of lowrlsk drlnklng guldellnes LhaL

23
nuLL eL al., 2010
24
llscher eL al., 2011
23
lor a summary see volkow eL al., 2014, and llscher eL al., 2011.
26
lor a summary see Lynch eL al., 2012.
27
oraLhWaller, 2009
28
llscher eL al., 2011
6

have been lnLroduced ln Canada and elsewhere, Lhls proposal for L8CuC can be summarlzed as
follows:

AlLhough absLlnence ls Lhe only way Lo compleLely avold Lhe healLh rlsks of cannabls use,
for Lhose who do use lL, Lhe rlsks are expecLed Lo be reduced lf:
use ls delayed unLll early adulLhood
frequenL (dally or neardally) use ls avolded
users shlfL away from smoklng cannabls Lowards less harmful (smokeless) dellvery
sysLems such as vaporlzers
less poLenL producLs are used, or 1PC dose ls LlLraLed
drlvlng ls avolded for 3 Lo 4 hours afLer use, or longer lf needed
people wlLh hlgher rlsk of cannablsrelaLed problems (e.g. people wlLh a personal or
famlly hlsLory of psychosls, people wlLh cardlovascular problems, and pregnanL
women) absLaln alLogeLher

1hese guldellnes have been endorsed by a number of organlzaLlons lncludlng CAMP and Lhe
Canadlan ubllc PealLh AssoclaLlon (CPA) as an educaLlonal means of reduclng hlghrlsk
cannabls uses and pracLlces.


!2%*%#"-%8"'%+# +: ,"##"$%& /&) ,"/&)& "00%'%+#"- ("2*&; 7%'(+/' 0%&&/"0%#1 %'

ln Canada crlmlnal law governs Lhe producLlon and possesslon of cannabls vla Lhe ConLrolled
urugs and SubsLances AcL (CuSA). 8ecreaLlonal cannabls users musL elLher buy lL on Lhe black
markeL or grow lL Lhemselves, boLh of whlch consLlLuLe producLlon / Lrafflcklng offenses under
Lhe CuSA. 1hls prohlblLlon lnLroduces lndlvldual and soclal cosLs beyond Lhe healLh rlsks.

Around 60,000 Canadlans are arresLed for slmple possesslon of cannabls every year, accounLlng
for nearly 3 of all arresLs.
29
1he maxlmum senLence for flrsLLlme offenders ls a $1,000 flne
and slx monLhs ln [all. AL leasL 300,000 Canadlans carry a crlmlnal record for Lhls offense, whlch
can slgnlflcanLly llmlL a person's employmenL opporLunlLles and place resLrlcLlons on Lhelr
ablllLy Lo Lravel.
30
1he enforcemenL of cannabls laws ls very cosLly: for 2002, Lhe annual cosL of
enforclng cannabls possesslon laws (lncludlng pollce, courLs, and correcLlons) ln Canada was
esLlmaLed aL $1.2 bllllon.
31




29
SLaLlsLlcs Canada, 2013
30
Lrlckson and llscher, 1993
31
8ehm eL al., 2006
7

1he prohlblLlon of cannabls and crlmlnallzaLlon of lLs users does noL deLer people from
consumlng lL. 1he evldence on Lhls polnL ls clear: Lougher penalLles do noL lead Lo lower raLes of
cannabls use.
32
ln [urlsdlcLlons llke Canada where cannabls use ls prohlblLed, large proporLlons
of Lhe populaLlon use lL noneLheless - ofLen aL hlgher levels Lhan [urlsdlcLlons wlLh more
relaxed cannabls conLrol reglmes - exposlng Lhemselves Lo crlmlnallLy and rlsklng belng caughL
up ln Lhe crlmlnal [usLlce sysLem. eople who are already vulnerable are affecLed
dlsproporLlonaLely, evldence suggesLs LhaL pollce ofLen use Lhe charge of cannabls possesslon
as an easy way of harasslng or maklng llfe dlfflculL for marglnallzed populaLlons."
33



<)1"- 2):+2* +: ,"##"$%& ,+#'2+- %& #))0)0

All avallable evldence lndlcaLes LhaL crlmlnallzaLlon of cannabls use ls lneffecLlve, cosLly, and
consLlLuLes poor publlc pollcy. 1hls vlewpolnL ls far from new, havlng noLably been arLlculaLed
ln Canada by Lhe federal governmenL's Le ualn Commlsslon ln 1972, Lhe SenaLe ln 1974, Lhe
Canadlan 8ar AssoclaLlon ln 1994, Lhe Canadlan CenLre on SubsLance Abuse ln 1998, CAMP ln
2000, Lhe lraser lnsLlLuLe ln 2001, Lhe SenaLe Speclal CommlLLee on lllegal urugs ln 2002, Lhe
Canadlan urug ollcy CoallLlon ln 2013, and Lhe Canadlan ubllc PealLh AssoclaLlon ln 2014. 1he
case for change generally resLs on four evldencebased proposlLlons:
34

1) rohlblLlon has noL succeeded ln deLerrlng cannabls use.
2) 1he rlsks and harms of cannabls are lower Lhan Lhose of Lobacco or alcohol.
3) Cannabls can and should be separaLed from llllclL drug markeLs, ln whlch users are
exposed Lo oLher (more dangerous) lllegal drugs.
4) 1he resources spenL enforclng laws agalnsL personal cannabls use are beLLer allocaLed
elsewhere.

lL ls clear from Lhe evldence LhaL Canada needs legal reform ln order Lo lmplemenL a publlc
healLh approach Lo cannabls LhaL reduces lLs harms Lo lndlvlduals and socleLy.



32
8oom eL al., 2010
33
8oom eL al., 2010: 72
34
8oom eL al., 2010
8

/EB 45I24>J5 29K A5I=42:5L

ln Canada Lhe governmenL's approach Lo subsLance use has been LhaL lL's malnly a crlmlnal
[usLlce lssue. Cannabls and oLher drugs are vlewed Lhrough a law enforcemenL lens. 1here's no
dlspuLlng LhaL cannabls use can, ln some cases and for some people, be harmful. lL does noL
follow LhaL prohlblLlon ls Lhe mosL senslble or healLhy pollcy. As 8oom eL al. polnL ouL, ln
modern socleLles, a flndlng of adverse effecLs does noL seLLle Lhe lssue of Lhe legal sLaLus of a
commodlLy, lf lL dld, alcohol, auLomoblles, and sLalrways, for lnsLance, would all be prohlblLed,
slnce use of each of Lhese resulLs ln subsLanLlal casualLles."
33


A publlc healLh approach Lo subsLance use LreaLs lL as a healLh lssue - noL a crlmlnal one. Such
an approach ls based on evldencelnformed pollcy and pracLlce, addresslng Lhe underlylng
deLermlnanLs of healLh and puLLlng healLh promoLlon and Lhe prevenLlon of deaLh, dlsease,
ln[ury, and dlsablllLy as lLs cenLral mlsslon.
36
lL seeks Lo maxlmlze beneflL for Lhe largesL number
of people Lhrough a mlx of populaLlonlevel pollcles and LargeLed lnLervenLlons. 1hls phllosophy
guldes Canadlan approaches Lo alcohol and Lobacco, and lL should gulde our approach Lo
cannabls as well:
1he [currenL] pollcy approach Lo cannabls ls fundamenLally dlfferenL from currenL
approaches Lo oLher popular drugs llke alcohol, where a publlc healLh approach lnsLead
focuses on hlghrlsk users, rlsky use pracLlces and seLLlngs, and especlally on modlflable
rlsk facLors, Lo reduce harms Lo lndlvlduals and socleLy. Clven LhaL Lhe ma[orlLy of harms
relaLed Lo cannabls use appear Lo occur ln selecLed hlghrlsk users or ln con[uncLlon wlLh
hlghrlsk use pracLlces, a slmllar publlc healLhorlenLed approach Lo cannabls use should
be consldered. Such an approach would rely on LargeLed and healLhorlenLed
lnLervenLlons malnly almed aL Lhose users aL hlgh rlsk for harms, and noL crlmlnallzaLlon
of use - and lLs llmlLed effecLlveness and undeslrable slde effecLs - as Lhe maln
lnLervenLlon paradlgm, Lherefore lncreaslng beneflLs for socleLy."
37


WlLh a wlde range of opLlons for reformlng cannabls conLrol, Lhe quesLlon before us ls Lhls:
WhaL legal and regulaLory approach can besL reduce Lhe rlsks of healLh and soclal harms
assoclaLed wlLh cannabls use? lor a deLalled dlscusslon of Lhe range of posslble reforms boLh
wlLhln and beyond Lhe currenL lnLernaLlonal drug reglme, see 8oom eL al., 2010. 1hls secLlon
wlll dlscuss decrlmlnallzaLlon (l.e. prohlblLlon wlLh clvll raLher Lhan crlmlnal penalLles) and
legallzaLlon wlLh sLrlcL regulaLlon - and why Lhe evldence favours Lhe laLLer.




33
8oom eL al., 2010: 13
36
Canadlan ubllc PealLh AssoclaLlon, 2014
37
llscher eL al., 2011: 324
9

=),2%*%#"-%8"'%+#> " ("-: *)"&/2)

Models of cannabls decrlmlnallzaLlon vary greaLly, buL generally Lhey lnvolve removlng
possesslon of small amounLs of cannabls from Lhe sphere of crlmlnal law. rohlblLlon remalns
Lhe rule, buL sancLlons for possesslon and use of cannabls lnsLead become clvll vlolaLlons
punlshable by a small flne.

Lvldence suggesLs LhaL a decrlmlnallzaLlon approach can reduce some of Lhe adverse soclal
lmpacLs of crlmlnallzaLlon.
38
8emovlng crlmlnal penalLles for cannabls possesslon should resulL
ln a reducLlon ln boLh Lhe number of people caughL up ln Lhe crlmlnal [usLlce sysLem and Lhe
cosL of enforcemenL, Lhus reduclng Lhe burden Lo lndlvlduals and Lo Lhe legal sysLem. 1here ls
llLLle evldence LhaL decrlmlnallzaLlon causes an lncrease ln Lhe consumpLlon of cannabls or Lhe
prevalence of cannabls dependence.
39


ln orLugal, possesslon and use of all drugs have been decrlmlnallzed slnce 2001. 1he
orLuguese model focuses on dlverslon: drug use ls formally prohlblLed buL auLhorlLles refer
users Lo a Lhreeperson panel whose prlmary alm ls Lo dlrecL people wlLh subsLance use
problems Lo LreaLmenL. 1hese panels are also empowered Lo apply clvll penalLles such as flnes.
Slnce Lhe lmplemenLaLlon of Lhls sysLem, orLugal has seen decllnes ln subsLance mlsuse and ln
drugrelaLed harm, a reduced burden on Lhe crlmlnal [usLlce sysLem, and a reducLlon ln Lhe use
of llllclL drugs by adolescenLs.
40
AlLhough lL ls noL posslble Lo concluslvely aLLrlbuLe Lhese Lrends
ln orLugal Lo Lhe shlfL Lo decrlmlnallzaLlon and dlverslon, Lhese flndlngs presenL a sLrong
challenge Lo Lhe noLlon LhaL decrlmlnallzlng drugs - wheLher cannabls or oLhers - musL resulL ln
lncreased mlsuse, dependence, and harm.

1hese advanLages of decrlmlnallzaLlon are slgnlflcanL. 8uL Lhls model falls Lo address several of
Lhe harms assoclaLed wlLh prohlblLlon of cannabls use:
under decrlmlnallzaLlon, cannabls remalns unregulaLed, meanlng LhaL users know llLLle
or noLhlng abouL lLs poLency or quallLy.
As long as cannabls use ls lllegal, lL ls dlfflculL for healLh care or educaLlon professlonals
Lo effecLlvely address and help prevenL problemaLlc use. 1he law enforcemenL focus of
prohlblLlon drlves cannabls users away from prevenLlon, rlsk reducLlon and LreaLmenL
servlces.
uecrlmlnallzaLlon may encourage commerclallzaLlon of cannabls producLlon and
dlsLrlbuLlon - wlLhouL glvlng governmenL addlLlonal regulaLory Lools. 1hose acLlvlLles
remaln under Lhe conLrol of crlmlnal elemenLs, and for Lhe mosL parL users musL sLlll
obLaln cannabls ln Lhe llllclL markeL where Lhey may be exposed Lo oLher drugs and Lo
crlmlnal acLlvlLy.


38
8oom eL al., 2010
39
8oom eL al., 2010
40
Pughes and SLevens, 2010
10

1he experlences of [urlsdlcLlons LhaL have decrlmlnallzed cannabls possesslon also suggesL LhaL
Lhere can be unlnLended consequences. ln many such places Lhe advanLages of
decrlmlnallzaLlon have been undermlned by pollce pracLlces LhaL lncrease Lhe number of users
who are penallzed."
41
1hls phenomenon ls referred Lo as neL wldenlng": more people are
geLLlng caughL up ln Lhe enforcemenL neL, even lf Lhey suffer less serlous consequences on
average."
42
ln addlLlon, flnes are a regresslve penalLy ln Lhe sense LhaL Lhey place a
dlsproporLlonaLe burden on lowlncome lndlvlduals. 1here ls a rlsk of secondary
crlmlnallzaLlon" lf people who are unable Lo pay a flne are Lhen charged crlmlnally.
43
1hus Lhe
maln LheoreLlcal beneflL of decrlmlnallzaLlon - a reducLlon ln adverse soclal lmpacLs - ls unllkely
Lo be equally spread Lhrough socleLy.

lollowlng Lhe publlcaLlon of Lhe resulLs of Lhe Commlsslon on Soclal ueLermlnanLs of PealLh ln
2008, Lhe World PealLh CrganlzaLlon has placed a hlgh emphasls on healLh equlLy and has
made a commlLmenL Lo lmplemenLlng a Soclal ueLermlnanLs of PealLh approach Lo reduclng
healLh lnequlLles.
44
1hls lnvolves Lhe rouLlne examlnaLlon and evaluaLlon of wheLher healLh
pollcy measures are noL only effecLlve ln reduclng a [urlsdlcLlon's healLh burden, buL also ln
reduclng healLh lnequlLles.
43
ln Lhls conLexL, any pollcy change for cannabls should be examlned
on lLs poLenLlal Lo reduce or lncrease healLh lnequlLy. 1he currenL sysLem of cannabls conLrol ln
Canada causes hlgh levels of lnequlLy, wlLh raclallzed mlnorlLles havlng a hlgher chance of belng
arresLed and prosecuLed for cannabls use offences.
46
uecrlmlnallzaLlon, belng prone Lo pollce
dlscreLlon and Lo raclal proflllng, ls unllkely Lo remove or lmprove Lhls lnequlLy.

1he unlnLended consequences of decrlmlnallzaLlon are parLlcularly lmporLanL ln vlew of a
model proposed by Lhe Canadlan AssoclaLlon of Chlefs of ollce (CAC) ln AugusL 2013. ollce
would be glven Lhe opLlon Lo lssue a LlckeL under Lhe ConLrolled urugs and SubsLances AcL for
possesslon of small amounLs of cannabls, buL would also reLaln Lhe ablllLy Lo lay crlmlnal
charges under Lhe AcL. Accordlng Lo Lhe CAC, Lhls proposal would expand Lhe range of
enforcemenL opLlons avallable Lo more effecLlvely and efflclenLly address Lhe llllclL possesslon
of cannabls whlle malnLalnlng Lhe ablllLy Lo lay formal courL process charges."
47
ln vlew of whaL
we know abouL Lhe dlsproporLlonaLe LargeLlng of marglnallzed and vulnerable populaLlons,
glvlng pollce dlscreLlon Lo apply more or less severe enforcemenL opLlons for Lhe same offense
ls unllkely Lo poslLlvely lmpacL healLh equlLy.




41
8oom eL al., 2010: 127
42
8oom eL al., 2010: 147
43
8oom eL al., 2010
44
Commlsslon on Soclal ueLermlnanLs of PealLh, 2008, see also Lhe 8lo ollLlcal ueclaraLlon on Soclal ueLermlnanLs of PealLh.
43
8las and kurup, 2010
46
WorLley and Cwusu8empah, 2012, khenLl, 2014
47
Canadlan AssoclaLlon of Chlefs of ollce, 2013
11

<)1"-%8"'%+#> "# +99+2'/#%'. :+2 )?%0)#,)$"&)0 2)1/-"'%+#

LegallzaLlon removes Lhe soclal harms and cosLs of prohlblLlon. 8emovlng crlmlnal and clvll
penalLles for possesslon of cannabls would ellmlnaLe Lhe more Lhan $1 bllllon Canada spends
annually Lo enforce cannabls possesslon laws, unequal enforcemenL of Lhose laws, lnvolvemenL
of cannabls users ln Lhe llllclL drug markeL, and Lhe burden a cannablsrelaLed crlmlnal record
places on a person's employmenL and Lravel opporLunlLles. ln a [urlsdlcLlon where cannabls
producLlon and dlsLrlbuLlon are legal and properly regulaLed, crlmlnal lnvolvemenL ln Lhose
acLlvlLles should shrlnk slgnlflcanLly and poLenLlally dlsappear.

LegallzaLlon alone does noL reduce Lhe healLh rlsks and harms of cannabls. lL presenLs
governmenLs wlLh Lhe opporLunlLy Lo 2)1/-"') cannabls Lo mlLlgaLe Lhose rlsks - someLhlng LhaL
cannoL effecLlvely be done under prohlblLlon or decrlmlnallzaLlon. We know from decades of
research on Lobacco and alcohol conLrol LhaL chooslng Lhe rlghL mlx of regulaLlons ls cruclal:
WheLher legallzaLlon ls a neL poslLlve or negaLlve for publlc healLh and safeLy largely depends
on regulaLory declslons and how Lhey are lmplemenLed."
48
1he graph below lllusLraLes Lhls
polnL. 8oLh LoLal prohlblLlon and, aL Lhe oLher exLreme, unregulaLed legallzaLlon can resulL ln
slmllarly heavy soclal and healLh harms.



48
Apfel, 2014: 1
12

-6?>9I 7A6@ NA6E>3>:>69 :6 A5I=42:>69

1wo legal lssues pose challenges Lo endlng prohlblLlon ln Canada. llrsL, slnce cannabls ls sub[ecL
Lo federal legal conLrols ln Canada, any provlnclal lnlLlaLlve Lo reform cannabls pollcy would flrsL
have Lo be sancLloned by Lhe federal governmenL. Second, Canada ls a parLy Lo lnLernaLlonal
drug conLrol LreaLles LhaL prohlblL Lhe producLlon and use of cannabls for nonsclenLlflc and
nonmedlcal purposes. Much llke Lhe lncluslon of cannabls ln Canada's federal drug conLrol
laws, Lhe genesls of Lhls lnLernaLlonal prohlblLlon ls besL descrlbed as a hlsLorlcal accldenL," lL
was noL based on any evldence LhaL Lhe harms of cannabls were sufflclenL Lo warranL lL or could
be effecLlvely managed by lL.
49
Whlle Lhese lnLernaLlonal LreaLles are legally blndlng, counLrles
can opL Lo denounce elemenLs of LreaLles Lhey dlsagree wlLh or push for meanlngful LreaLy
reform.
30
lor deLalled dlscusslons of Lhese legal quesLlons, as well as posslble paLhs forward,
see 8oom eL al. 2010, 8oom 2013, and Apfel 2014.


52%#,%9-)& '+ 1/%0) ()"-'(:+,/&)0 ,"##"$%& ,+#'2+-

8egulaLlng legal cannabls markeLs wlLh lmproved publlc healLh as Lhe maln ob[ecLlve would be
a complex underLaklng spannlng producLlon, dlsLrlbuLlon (supply), and consumpLlon
(possesslon and use). lrom alcohol conLrol we know LhaL sLraLegles Lo reduce harm musL be
coordlnaLed and mulLlsecLoral, wlLh effecLlve conLrols on avallablllLy (e.g. reLall locaLlon
denslLy, hours of sale) and accesslblllLy (e.g. mlnlmum age requlremenLs, prlce levels) as well as
LargeLed educaLlon and healLh promoLlon LhaL senslLlze Lhe publlc - parLlcularly vulnerable
groups - Lo harms and rlsks.
31


CAMP offers Len baslc prlnclples Lo gulde regulaLlon of legal cannabls use. 1hese should be
consldered a sLarLlng polnL - mlnlmum requlremenLs for a publlc healLhfocused regulaLory
framework.
1) .;:234>;E 2 I6?5A9@59: @696N64B 69 ;245;C ConLrol board enLlLles wlLh a soclal
responslblllLy mandaLe provlde an effecLlve means of conLrolllng consumpLlon and
reduclng harm.
2) &5: 2 @>9>@=@ 2I5 76A 829923>; N=A8E2;5 29K 869;=@N:>69C Sales or supply of
cannabls producLs Lo underage lndlvlduals should be penallzed.
3) )>@>: 2?2>423>4>:BC lace caps on reLall denslLy and llmlLs on hours of sale.

49
8oom eL al., 2010, SchwarLz, 2014
30
8oom, 2012
31
See 8abor eL al., 2010, and Canadlan ubllc PealLh AssoclaLlon, 2011.
13

4) !=A3 K5@29K :EA6=IE NA>8>9IC rlclng pollcy should curb demand for cannabls whlle
mlnlmlzlng Lhe opporLunlLy for conLlnuaLlon of lucraLlve black markeLs. lL should also
encourage use of lowerharm producLs over hlgherharm producLs.
3) !=A:2>4 E>IE5AA>;G NA6K=8:; 29K 76A@=42:>69;. 1hls would lnclude hlgherpoLency
formulaLlons and producLs deslgned Lo appeal Lo youLh.
6) 'A6E>3>: @2AG5:>9IY 2K?5A:>;>9IY 29K ;N69;6A;E>NC roducLs should be sold ln plaln
packaglng wlLh warnlngs abouL rlsks of use.
7) !452A4B K>;N42B NA6K=8: >976A@2:>69C ln parLlcular, producLs should be LesLed and
labelled for 1PC and C8u (cannabldlol)
32
conLenL.
8) Z5?546N 2 86@NA5E59;>?5 7A2@5F6AG :6 2KKA5;; 29K NA5?59: 829923>;>@N2>A5K
KA>?>9IC Such a framework should lnclude prevenLlon, educaLlon, and enforcemenL.
9) .9E2985 2885;; :6 :A52:@59: 29K 5<N29K :A52:@59: 6N:>69;C lnclude a specLrum of
opLlons from brlef lnLervenLlons for aLrlsk users Lo more lnLenslve lnLervenLlons.
10) %9?5;: >9 5K=82:>69 29K NA5?59:>69C 8oLh general (e.g. Lo promoLe lowerrlsk cannabls
use guldellnes) and LargeLed (e.g. Lo ralse awareness of Lhe rlsks Lo speclflc groups, such
as adolescenLs or people wlLh a personal or famlly hlsLory of menLal lllness) lnlLlaLlves
are needed.

A successful publlc healLh approach would embed Lhese pollcles and lnLervenLlons ln a
comprehenslve sLraLegy LhaL lncludes research, knowledge exchange, and evaluaLlon. A porLlon
of governmenL revenues from cannabls should be formally dedlcaLed Lo Lhese acLlvlLles.


5+')#'%"- 2%&3&; "#0 (+7 '+ *%'%1"') '()*

As dlscussed above, early lnlLlaLlon and frequenL use are Lhe Lwo maln facLors assoclaLed wlLh
longLerm harm from cannabls. We know LhaL youLh are parLlcularly suscepLlble Lo cannabls
relaLed harms. A publlc healLhlnformed cannabls conLrol sLraLegy would lnclude educaLlon and
prevenLlon measures almed aL curblng poLenLlal lncreases ln use as well as rlsky pracLlces such
as lmpalred drlvlng. SLlll, Lhe posslblllLy LhaL legallzaLlon could lead Lo hlgher levels of cannabls
use among adolescenLs and/or an earller age of onseL musL be consldered. WhaL does Lhe
evldence say abouL Lhe lmpacLs of legallzaLlon boLh among youLh and Lhe general populaLlon?

unLll recenLly, dlscusslons of legallzaLlon were sLrlcLly hypoLheLlcal, buL ln 2012 uruguay and
Lwo uS sLaLes, Colorado and WashlngLon, announced plans Lo legallze recreaLlonal cannabls
use. uruguay has passed leglslaLlon lnLended Lo make lL Lhe flrsL counLry Lo legallze and
regulaLe Lhe possesslon and producLlon of cannabls for personal use. Cannabls has been legally

32
lor an overvlew of C8u and a dlscusslon of lLs poLenLlal LherapeuLlc uses, see lzzo eL al., 2009.
14

boughL and sold ln Colorado and WashlngLon slnce !anuary and !uly 2014 respecLlvely buL lL ls
Loo early Lo draw any flrm concluslons abouL Lhe lmpacL of legallzaLlon from Lhelr experlences.
nelLher sLaLe has adopLed a healLhfocused regulaLory model llke Lhe one descrlbed above -
one wlLh sLrlcL conLrols on avallablllLy, markeLlng, and producL poLency and formulaLlon.
33


1he experlence of Lhe neLherlands ls lnsLrucLlve. Cannabls use remalns lllegal ln Lhe
neLherlands buL has been LoleraLed for decades Lhrough a sysLem of coffee shops" LhaL sell
small amounLs of cannabls. 1he lnLroducLlon of 0) :",'+ legallzaLlon lnlLlally led Lo an lncrease
ln Lhe percenLage of youLh havlng used cannabls, buL once Lhe governmenL lncreased lLs
overslghL of coffee shops Lo ensure LhaL Lhere was no adverLlslng and no sales Lo Lhose under
18 years old, Lhere was a decllne ln use among youLh aged 13 Lo 24. Cn balance, Lhe
neLherlands' approach has noL been assoclaLed wlLh lncreased use of cannabls aL Lhe
populaLlon level among adulLs or youLh.
34
1here ls also evldence LhaL Lhls model has separaLed
cannabls and lLs users from Lhe harder" drug markeLs. llnally, a sLudy comparlng cannabls use
ln AmsLerdam and San lranclsco (where cannabls ls prohlblLed) dld noL flnd a dlfference
beLween Lhe Lwo clLles wlLh respecL Lo age aL onseL of use, age aL Lhe sLarL of regular use and
age aL Lhe sLarL of maxlmum use.
33


Cn Lhe oLher hand, we know LhaL lncreases ln alcohol avallablllLy are assoclaLed wlLh lncreases
ln alcoholrelaLed problems. AlLhough cannabls ls already easlly accesslble ln Canada, lL ls
posslble LhaL a LranslLlon Lo a LlghLly regulaLed legal cannabls markeL could lead Lo an lnlLlal
lncrease ln use among Lhe general populaLlon and/or parLlcular aLrlsk groups. 1hls makes
rlgorous evaluaLlon of any legal reform all Lhe more essenLlal. A governmenL legallzlng cannabls
use would need Lo clearly deflne lLs prlorlLles and ob[ecLlves, esLabllsh measurable lndlcaLors
for Lhose ob[ecLlves, and bulld ln Lhe capaclLy and flexlblllLy Lo ad[usL as needed based on Lhe
measured lmpacL of reforms. lL should waLch for negaLlve unlnLended consequences and be
prepared Lo alLer lLs course lf and when necessary.

Some observers fear LhaL legallzaLlon would send Lhe wrong message" abouL Lhe rlsks of
cannabls. 8uL raLes of cannabls use ln Canada suggesL LhaL youLh are noL geLLlng Lhe rlghL"
message. uesplLe prohlblLlon, 23 of CnLarlo's hlgh school sLudenLs and 40 of young adulLs
use cannabls. A 2013 unlCLl sLudy of 29 wealLhy naLlons found LhaL Canadlan youLh rank flrsL
ln cannabls use buL Lhlrd from lasL ln Lobacco use - even Lhough cannabls ls lllegal whlle
Lobacco ls legal.
36
ln Lhe process Lhey are exposed Lo llllclL drug culLure and markeLs and have
llLLle or no rellable lnformaLlon abouL Lhe poLency or quallLy of Lhe cannabls Lhey consume.

Sendlng Lhe rlghL" message abouL Lhe rlsks of cannabls use ls lmporLanL, and any reform of
Canada's sysLem of cannabls conLrol should lnclude a sLrong prevenLlon focus as well as
lnLervenLlons almed aL groups known Lo be aL hlgher rlsk of harm, such as youLh and people

33
8oom, 2013
34
8oom eL al., 2010
33
8oom eL al., 2010
36
unlCLl, 2013
13

wlLh a personal or famlly hlsLory of menLal lllness. 8uL some people wlll use cannabls regardless
of lLs legal sLaLus, and a slgnlflcanL advanLage of legallzaLlon ls LhaL lL provldes Lhe opporLunlLy
Lo conLrol some lmporLanL facLors relaLed Lo Lhe rlsk of harm. LlmlLlng cannabls poLency and
curLalllng hlgherrlsk producLs and formulaLlons are Lwo concreLe examples of regulaLlon LhaL
has Lhe poLenLlal Lo reduce Lhe harms assoclaLed wlLh cannabls use for youLh and people wlLh a
personal or famlly hlsLory of menLal lllness.

1he lessons of one [urlsdlcLlon cannoL be dlrecLly lmporLed Lo anoLher, buL Lhe experlence of
Lhe neLherlands and Lhe hlsLory of alcohol conLrol suggesL LhaL legallzaLlon wlLh sLrlcL
regulaLlon - cauLlously lmplemenLed, conLlnuously evaluaLed and ad[usLed as requlred - need
noL necessarlly lead Lo lncreased use. uevelopmenLs ln Lhe unlLed SLaLes, uruguay and
elsewhere should be closely monlLored, wlLh Lhe hope LhaL Lhelr experlences - poslLlve and
negaLlve - wlll shed furLher llghL on pollcy opLlons for effecLlvely reduclng cannablsrelaLed
healLh rlsks ln a legal, regulaLed seLLlng.

llnally, as we know from Lobacco and alcohol, prlvaLesecLor acLors ln a legal cannabls markeL -
llke any proflLmoLlvaLed enLlLy - would seek Lo push Lhe boundarles of healLhfocused
regulaLlon. 8uL unllke Lobacco and alcohol, ln Canada we may have Lhe opporLunlLy Lo preempL
Lhls confllcL LhaL exlsLs beLween publlc healLh goals and Lhe proflL moLlve: lor mosL
[urlsdlcLlons cannabls offers a blank canvas, an opporLunlLy Lo learn from pasL errors, and
replace crlmlnal markeLs wlLh regulaLory models LhaL are bullL on prlnclples of publlc healLh and
wellbelng from Lhe ouLseL, wlLhouL a largescale legal commerclal lndusLry reslsLlng reform."
37


1hls may noL be Lhe case for long. Already, Lhe federal governmenL's recenL overhaul of medlcal
cannabls regulaLlons have creaLed a green rush" of lnvesLmenL ln legal cannabls producLlon,
and many of Lhe enLrepreneurs lnvolved have Lhelr eyes seL on evenLual legallzaLlon and Lhe
exLraordlnary buslness opporLunlLles lL would brlng.
38
1he creaLlon of a cannabls lndusLry wlLh
an lncenLlve Lo flnd new cusLomers, reLaln exlsLlng ones, and encourage hlgh levels of
consumpLlon should be of concern - as should Lhe posslblllLy of a governmenL growlng
accusLomed Lo revenues from cannabls sales or Laxes. lL ls crlLlcal LhaL legal reform of cannabls
conLrol be conducLed wlLh publlc healLh as lLs prlmary ob[ecLlve and LhaL Lhe resulLlng
regulaLory framework be carefully proLecLed from commerclal and flscal lnLeresLs.



37
Apfel, 2014: 17
38
!@! 4)7&, 2014, 4)7 A+23 B%*)&, 2014, 8armak and McCullough, 2013. See also llscher eL al., 2014.
16

!6984=;>69

A flndlng LhaL a producL or pracLlce has adverse effecLs does noL necessarlly lmply LhaL
prohlblLlon ls Lhe mosL senslble or healLhy sysLem of conLrol. ubllc pollcy musL be grounded ln
a more hollsLlc undersLandlng of Lhe relaLlve rlsks Lo lndlvlduals and socleLy.

Cannabls use ls rlsky - and some lndlvlduals are parLlcularly vulnerable - buL prohlblLlon has
noL succeeded ln prevenLlng cannabls use or mlLlgaLlng lLs harms. Cn Lhe conLrary, lL has
exacerbaLed Lhe healLh harms of cannabls and creaLed cosLly soclal ones as well. Legallzlng and
sLrlcLly regulaLlng cannabls allows for more conLrol over Lhe rlsk facLors assoclaLed wlLh
cannablsrelaLed harm.

1o reduce harm, legallzaLlon of cannabls ls a necessary - buL noL a sufflclenL - condlLlon. lL musL
lnclude effecLlve conLrols on avallablllLy and regulaLlons LhaL sLeer users Lowards less harmful
producLs and pracLlces. lL musL be embedded ln a comprehenslve sLraLegy wlLh a sLrong
prevenLlon focus and a range of lnLervenLlons almed aL groups aL hlgher rlsk of harm, such as
youLh and people wlLh a personal or famlly hlsLory of menLal lllness. llndlng Lhe rlghL mode and
balance of regulaLlon, and effecLlvely lmplemenLlng and enforclng Lhem, wlll be key Lo ensurlng
LhaL Lhls approach resulLs ln a neL beneflL Lo publlc healLh and safeLy. Such a model appears Lo
be Lhe healLhlesL and mosL senslble way forward. CAMP welcomes furLher dlscusslon of Lhls
Loplc.
17

"36=: !"-P
1he !59:A5 76A "KK>8:>69 29K -59:24 P524:E (CAMP) ls Canada's largesL menLal healLh and
addlcLlon Leachlng hosplLal, as well as one of Lhe world's leadlng research cenLres ln Lhe area of
addlcLlon and menLal healLh. CAMP comblnes cllnlcal care, research, educaLlon, pollcy
developmenL and healLh promoLlon Lo help Lransform Lhe llves of people affecLed by menLal
healLh and addlcLlon lssues.

CAMP's SLraLeglc lan, C%&%+# DEDE> '+*+22+7F'+0"., reafflrms our commlLmenL Lo advocaLlng
for publlc pollcles LhaL are responslve Lo Lhe needs of people wlLh menLal lllness and addlcLlons.
As one of Lhe slx plllars of Lhls plan, CAMP ls commlLLed Lo urlvlng Soclal Change" by playlng a
leadlng role ln Lransformlng socleLy's undersLandlng of menLal lllness and addlcLlon and
bulldlng a beLLer menLal healLh care sysLem. CAMP alms Lo be a champlon for healLh equlLy,
soclal [usLlce and lncluslon for Lhose wlLh menLal lllness and addlcLlon. 1o help achleve Lhese
goals, CAMP communlcaLes evldencebased pollcy advlce Lo sLakeholders and pollcymakers.


"=:E6A
!eanlranols CrepaulL, MA


"8G96F45KI5@59:;
1he followlng people conLrlbuLed Lhelr experLlse Lo Lhe developmenL of Lhls documenL:
8enedlkL llscher, hu
1ony Ceorge, Mu, l8CC
8ernard Le loll, Mu, hu, CCl
!osee Lynch, Mu
8omlna Mlzrahl, Mu, hu
8ruce ollock, Mu, hu, l8CC, lC
!urgen 8ehm, hu
8uLh 8oss, hu
eLer Selby, M88S, CCl, lCl, dlp A8AM


+6A @6A5 >976A@2:>69
!l CrepaulL
Senlor ollcy AnalysL, CenLre for AddlcLlon and MenLal PealLh
!eanlrancols.CrepaulL[camh.ca
416 3338301 exL. 32127
18

,575A5985;

AnLhony ! (2006). 1he epldemlology of cannabls dependence. ln 8offman & SLephens (eds.), !"##"$%&
=)9)#0)#,)> G'& 4"'/2); !+#&)H/)#,)& "#0 B2)"'*)#'. Cambrldge: Cambrldge unlverslLy ress.
Apfel l (2014). Cannabls: lrom prohlblLlon Lo regulaLlon. A8 ollcy 8rlef 3. 8arcelona: ALlCL 8A (AddlcLlons
and LlfesLyles ln ConLemporary Lurope - 8eframlng AddlcLlons ollcy).
8abor 1, CaeLano 8, Casswell S, Ldwards C, ClesbrechL n, eL al. (2010). I-,+(+-> 4+ 620%#"2. !+**+0%'. J
K)&)"2,( "#0 5/$-%, 5+-%,.F K)?%&)0 L0%'%+#F Cxford: Cxford unlverslLy ress.
8armak S, McCullough M (2013). Pow blg buslness wlll make bllllons on legallzaLlon of poL. Avallable aL
hLLp://www.canadlanbuslness.com/companlesandlndusLrles/marl[uanalnc/. Accessed May 30, 2014.
8las L, kurup AS (eds.) (2010). LH/%'.; &+,%"- 0)')2*%#"#'& "#0 9/$-%, ()"-'( 92+12"**)&. Ceneva: WPC.
8lock 8l, C'Leary uS, Plchwa 8u, AugusLlnack !C, 8oles onLo LL, eL al. (2002). LffecLs of frequenL marl[uana
use on memory relaLed reglonal cerebral blood flow. 5("2*",+-+1.; @%+,()*%&'2. M @)("?%+2 72: 237230.
8oak A, PamllLon P, Adlaf LM, Mann 8L (2013). urug use among CnLarlo sLudenLs, 19772013: ueLalled
CSuuPS flndlngs. CAMP 8esearch uocumenL Serles no. 36. 1oronLo: CAMP.
Canadlan AssoclaLlon of Chlefs of ollce (2013). Medla 8elease: CAC propose 'LlckeLlng opLlon' for slmple
possesslon of cannabls." Avallable aL hLLp://www.cacp.ca/medla/news/download/1434/llnal_
_CAC_Medla_8elease__Cannlbus_osseslon.pdf. Accessed !anuary 7, 2014.
Canadlan ubllc PealLh AssoclaLlon (2014). I #)7 "992+",( '+ *"#"1%#1 %--)1"- 9&.,(+",'%?) &/$&'"#,)& %#
!"#"0"F CPA oslLlon aper. CLLawa: CPA.
Canadlan ubllc PealLh AssoclaLlon (2011). B++ (%1( " ,+&'> I 9/$-%, ()"-'( "992+",( '+ "-,+(+- 9+-%,. %#
!"#"0". CPA oslLlon aper. CLLawa: CPA.
!@! 4)7& (2014). vancouver marl[uana conference seeks Lo caplLallze on 'green rush'. Avallable aL
hLLp://www.cbc.ca/news/canada/brlLlshcolumbla/vancouvermarl[uanaconferenceseeksLocaplLallzeon
greenrush1.2633064. Accessed May 8, 2014.
Commlsslon on Soclal ueLermlnanLs of PealLh (2008). !-+&%#1 '() 1"9 %# " 1)#)2"'%+#> N)"-'( )H/%'. '(2+/1(
",'%+# +# '() &+,%"- 0)')2*%#"#'& +: ()"-'(F llnal 8eporL of Lhe CSuP. Ceneva: WPC.
ul lorLl M, Morgan C, uazzan , arlanLe C, Mondelll v, eL al. (2009). PlghpoLency cannabls and Lhe rlsk of
psychosls. @2%'%&( O+/2#"- +: 5&.,(%"'2. 193: 48891.
Lrlckson C, llscher 8 (1993). Canadlan cannabls pollcy: 1he lmpacL of crlmlnallzaLlon, Lhe currenL reallLy and
fuLure pollcy opLlons. Avallable aL hLLp://www.parl.gc.ca/ConLenL/SLn/CommlLLee/371/llle/
presenLaLlon/erlckson1e.hLm. Accessed March 20, 2014.
llscher 8, kuganesan S, 8oom 8 (2014). Medlcal Marl[uana programs: lmpllcaLlons for cannabls conLrol pollcy
- CbservaLlons from Canada. G#')2#"'%+#"- O+/2#"- +: =2/1 5+-%,. ln press.
llscher 8, !effrles v, Pall W, 8oom 8, Coldner L, 8ehm ! (2011). Lower rlsk cannabls use guldellnes: A
narraLlve revlew of evldence and recommendaLlons. !"#"0%"# O+/2#"- +: 5/$-%, N)"-'( 102: 324327.
19

Pall W, uegenhardL L (2009). Adverse healLh effecLs of nonmedlcal cannabls use. <"#,)' 374: 138391.
Pall W, uegenhardL L, 1eesson M (2004). Cannabls use and psychoLlc dlsorders: an updaLe. =2/1 "#0 I-,+(+-
K)?%)7 23: 433443.
ParLman 8L, PuesLls MA (2013). Cannabls effecLs on drlvlng skllls. !-%#%,"- !()*%&'2. 39: 478492.
PealLh Canada, ConLrolled SubsLances and 1obacco ulrecLoraLe (2013). Canadlan Alcohol and urug use
MonlLorlng Survey (CAuuMS) - deLalled Lables for 2012. CLLawa, CnLarlo: PealLh Canada.
Pughes CL, SLevens A (2010). WhaL can we learn from Lhe orLuguese decrlmlnallzaLlon of llllclL drugs? @2%'%&(
O+/2#"- +: !2%*%#+-+1. 30: 9991022.
lalomlLeanu A8, PamllLon P, Adlaf,LM, Mann 8L (2014). CAMP MonlLor e8eporL 2013: SubsLance use, menLal
healLh and wellbelng among CnLarlo adulLs, 19772013. CAMP 8esearch uocumenL Serles no. 40. 1oronLo:
CAMP.
lalomlLeanu A8, Adlaf LM, PamllLon P, Mann 8L (2012). AddlcLlon and menLal healLh lndlcaLors among
CnLarlo adulLs, 19772011. CAMP 8esearch uocumenL Serles no. 33. 1oronLo: CAMP.
lzzo AA, 8orrelll l, Capasso 8, ul Marzo v, Mechoulam 8 (2009). nonpsychoLroplc planL cannablnolds: new
LherapeuLlc opporLunlLles from an anclenL herb. B2)#0& %# 5("2*",+-+1%,"- P,%)#,) 30: 31327.
kalanL P (2004). Adverse effecLs of cannabls on healLh: An updaLe of Lhe llLeraLure slnce 1996. 52+12)&& %#
4)/2+5&.,(+9("2*",+-+1. "#0 @%+-+1%,"- 5&.,(%"'2. 28: 84963.
khenLl A (2014). 1he Canadlan war on drugs: SLrucLural vlolence and unequal LreaLmenL of 8lack Canadlans.
G#')2#"'%+#"- O+/2#"- +: =2/1 5+-%,. 23: 190193.
LopezCulnLero C, erez de los Cobos !, Pasln uS, Ckuda M, Wang S, eL al. (2011). robablllLy and predlcLors
of LranslLlon from flrsL use Lo dependence on nlcoLlne, alcohol, cannabls, and cocalne: 8esulLs of Lhe naLlonal
Lpldemlologlc Survey on Alcohol and 8elaLed CondlLlons (nLSA8C). =2/1 "#0 I-,+(+- =)9)#0)#,) 113: 120
130.
Lynch M!, 8abln 8A, Ceorge 1 (2012). 1he cannablspsychosls llnk. 5&.,(%"'2%, B%*)&F Avallable aL
hLLp://www.psychlaLrlcLlmes.com/schlzophrenla/cannablspsychoslsllnkmlndyourmlnd. Accessed !anuary
13, 2014.
McLaren !, Slllns L, PuLchlnson u, MaLLlck 8, Pall W (2009). Assesslng evldence for a causal llnk beLween
cannabls and psychosls: a revlew of cohorL sLudles. G#')2#"'%+#"- O+/2#"- +: =2/1 5+-%,. 21: 1019.
Moore 1PM, ZammlL S, LlngfordPughes A, 8arnes 18L, !ones 8, eL al. (2007). Cannabls use and rlsk of
psychoLlc or affecLlve menLal healLh ouLcomes: A sysLemaLlc revlew. <"#,)' 370: 319328.
4"'%+#"- 5+&' (2013). Canada a poL naLlon. Avallable aL hLLp://news.naLlonalposL.com/2013/08/30/graphlc
canadaapoLnaLlon/. Accessed SepLember 3, 2013.
4)7 A+23 B%*)& (2014). When cannabls goes corporaLe. Avallable aL hLLp://www.nyLlmes.com/
2014/03/23/buslness/lnLernaLlonal/whencannablsgoescorporaLe.hLml?_r=3. Accessed May 26, 2014.
20

nuLL u!, klng LA, hllllps Lu (2010). urug harms ln Lhe uk: a mulLlcrlLerla declslon analysls. <"#,)' 376: 1338
1363. 1able provlded by !urgen 8ehm.
6''"7" !%'%8)# (2014). CovernmenL's poll shows Canadlans wanL marl[uana laws changed. Avallable aL
hLLp://oLLawaclLlzen.com/news/pollLlcs/conservaLlvegovernmenLspollshowscanadlanswanLmarl[uana
lawschanged. Accessed !uly 30, 2014.
ope PC, ?urgelun1odd u (1996). 1he resldual cognlLlve effecLs of heavy marl[uana use ln college sLudenLs.
O+/2#"- +: '() I*)2%,"# Q)0%,"- I&&+,%"'%+# 273: 321327.
oraLhWaller A! (2009). !-)"2%#1 '() P*+3) +# !"##"$%&> !(2+#%, R&) "#0 !+1#%'%?) S/#,'%+#%#1 "#0 Q)#'"-
N)"-'(. CLLawa: Canadlan CenLre on SubsLance Abuse.
8amaekers !C, 8ergaus C, van Laar M, urummer CP (2004). uoserelaLed rlsk of moLor vehlcle crashes afLer
cannabls use. =2/1 "#0 I-,+(+- =)9)#0)#,. 73: 109119.
8ehm !, 8allunas u, 8rochu S, llscher 8, Cnam W, eL al. (2006). B() ,+&'& +: &/$&'"#,) "$/&) %# !"#"0" %#
DEEDF CLLawa: Canadlan CenLre on SubsLance Abuse.
8oom 8 (2013). Legallzlng a markeL for cannabls for pleasure: Colorado, WashlngLon, uruguay and beyond.
I00%,'%+# 109: 343331
8oom 8 (2012). 8eform by subLracLlon: 1he paLh of denunclaLlon of lnLernaLlonal drug LreaLles and
reaccesslon wlLh reservaLlons. G#')2#"'%+#"- O+/2#"- +: =2/1 5+-%,. 23: 401406.
8oom 8, llscher 8, Pall W, LenLon S, 8euLer (2010). !"##"$%& 5+-%,.> Q+?%#1 @).+#0 P'"-)*"'). Cxford:
Cxford unlverslLy ress.
SchwarLz u (2014). Marl[uana was crlmlnallzed ln 1923, buL why? !@! 4)7&. Avallable aL
hLLp://www.cbc.ca/news/healLh/marl[uanawascrlmlnallzedln1923buLwhy1.2630436. Accessed May 3,
2014.
SLaLlsLlcs Canada (2013). ollcereporLed crlme for selecLed offences, Canada, 2011 and 2012. Avallable aL
hLLp://www.sLaLcan.gc.ca/pub/83002x/2013001/arLlcle/11834/Lbl/Lbl06eng.hLm. Accessed Aprll 3, 2014.
1eLraulL !M, CroLhers k, Moore 8A, MehLa 8, ConcaLo !, llellln uA (2007). LffecLs of marl[uana smoklng on
pulmonary funcLlon and resplraLory compllcaLlons: A sysLemaLlc revlew. I2,(%?)& +: G#')2#"- Q)0%,%#) 167:
221228.
unlCLl Cfflce of 8esearch (2013). Chlld wellbelng ln rlch counLrles: A comparaLlve overvlew. G##+,)#'%
K)9+2' !"20 TT. llorence: unlCLl Cfflce of 8esearch.
volkow nu, 8aler 8u, CompLon WM, Welss S88 (2014). Adverse healLh effecLs of marl[uana use. 4)7
L#1-"#0 O+/2#"- +: Q)0%,%#) 370: 22192227.
WorLley S, Cwusu8empah A (2012). 8ace, eLhnlclLy, crlme and crlmlnal [usLlce ln Canada. ln kalunLa
CrumpLon (ed.), K",); L'(#%,%'.; !2%*) "#0 !2%*%#"- O/&'%,) %# '() I*)2%,"&. new ?ork: algrave Macmlllan.