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Published on October 9th, 2014 | from CAMH

CAMH’s Cannabis Policy Framework: Legalization with regulation

Dr. Jürgen Rehm

Dr. Jürgen Rehm

By Dr. Jürgen Rehm, Director of the Social and Epidemiological Research Department at CAMH

Today CAMH released a new Cannabis Policy Framework . This document examines the evidence on the harms associated with cannabis use and, based on that evidence, recommends legalization with strict regulation as the most effective means of reducing the harms associated with its use.

There is growing agreement that our current system of cannabis control has failed. All available evidence indicates that this system is ineffective, costly and, far from preventing harm, actually causes it. There is less agreement on what should actually be done about this situation. Many in the health sector favour decriminalization, and this option is currently being discussed at the federal level. This was also the approach recommended by CAMH in 2002 – the last time we made a public statement on cannabis. So why the shift? How is legalization with regulation preferable to decriminalization?

First, some definitions. Our current system can be described as prohibition: use and possession of cannabis are punishable by criminal law, and they have been punished until now. Decriminalization involves removing possession of small amounts of cannabis from the sphere of criminal law, instead making them civil violations punishable by a fine. Legalization removes all penalties for cannabis possession and use by adults. Once legalized, cannabis can be sold commercially with no restrictions, or it can be regulated. CAMH is recommending legalization with strict regulation.

Decriminalization sounds good in theory. About 3% of all arrests in Canada are for simple possession of cannabis; at least half a million Canadians hold a criminal record for this this offence. Most Canadians agree that cannabis use should not be punishable by prison time or a lifelong criminal record. In many jurisdictions that have decriminalized cannabis, this approach has reduced the social burden of cannabis without causing an increase in consumption. However, it has some glaring problems:

  • Decriminalizing cannabis does nothing to address the health harms. Cannabis remains unregulated and users know nothing about its potency or quality.
  • Decriminalization cannot regulate the market, and cannabis users will get into contact with other forms of illegal drugs via purchasing an illegal substance.
  • Treating cannabis use primarily as a criminal justice issue and not a health issue discourages the use of prevention, risk reduction and treatment services.

Decriminalization can also have serious unintended consequences. In Canada, marginalized and vulnerable populations have a higher chance of being arrested for cannabis use offences. We know from the experiences of jurisdictions where cannabis has been decriminalized that racial profiling remains a problem and that racialized minorities continue to be disproportionately targeted for cannabis-related offences. Thus, the possible benefits of decriminalization are not likely to be equally spread through society. Public policies should be assessed not only according to their effect on population health but also by their impact on health equity, and decriminalization fails this test.

We know from our experience with substances like alcohol and tobacco that the right set of regulations can help reduce risks and harms. We also know that something that is illegal cannot be regulated. In other words, legalization is a necessary first step towards regulation.

The system we envision is in no way similar to the ones recently adopted in Colorado and Washington. In those states, regulations are insufficiently health-focused, with inadequate controls on availability, marketing, and product potency and formulation.

CAMH’s recommendations for public health-focused cannabis control include:

  • a government monopoly on sales
  • a minimum age for purchase and consumption
  • controls on availability
  • a pricing system that curbs demand and discourages use of higher-harm products
  • a ban on marketing, advertising and promotion
  • a requirement that products be sold in standardized plain packaging

These regulations would be accompanied by measures to address and prevent cannabis-impaired driving, ensure access to treatment, and enhance investment in education and prevention. There would be a strong focus on prevention and a range of interventions aimed at groups that are at higher risk of harm, including youth and people with a personal or family history of mental illness.

It may seem counter-intuitive at first to suggest that legalizing cannabis can reduce its harms. But based on a thorough review of the evidence, we believe that legalizing with strict regulation would allow for more control over important risk factors like age of initiation, product potency and formulation, and impaired driving.

We need an approach to cannabis that puts health first. The right set of regulations, carefully implemented and thoroughly evaluated, can help us achieve that.

CAMH's Cannabis Policy Framework - 10 Principles     Cannabis use in Canada


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18 Responses to CAMH’s Cannabis Policy Framework: Legalization with regulation

  1. Pingback: CAMH Recommends Legalization of Marijuana | culture | Torontoist

  2. Marc Emery says:

    Your approach has me concerned.

    “CAMH’s recommendations for public health-focused cannabis control include:”

    “a government monopoly on sales”

    * So the cannabis culture is supposed to buy cannabis from the very institution that has oppressed us for 50 years?

    “a minimum age for purchase and consumption”

    * That age has to be reasonable, the Senate Committee recommended 16 as a qualifying age.

    “controls on availability” and “a pricing system that curbs demand and discourages use of higher-harm products” * sounds much like prohibition. Legal cannabis should reflect market principles of production and distribution, pricing should be way less expensive that prohibition pricing.

    “a ban on marketing, advertising and promotion” – * cannabis needs to be aggressively advertised in order to draw people away from using more harmful substances like alcohol, tobacco, prescription drugs.

    “a requirement that products be sold in standardized plain packaging” – * This is consistent with the “government monopoly providers” paradigm. But it is not consistent with the needs of the market. The cannabis consumer does not want to buy from government monopolies. They will rebel.They want to know who the grower is. Who the brand is. The government is completely untrustworthy to the cannabis culture.

  3. Make sure that regulated prices are not too high, nor potency too low; otherwise you will leave a black market open to those who won’t make those mistakes.

    • SAM Canada says:

      With lower prices will come more use and that will mean more youth will also take up the use of marijuana. If we don’t tax enough how will be pay for the regulating of marijuana to keep it out of the hands of kids, pay for the medical costs, the traffic accidents, the cost of higher drop out rates, the cost of cognitive difficulties to young kids exposed to marijuana, work place accidents, and all the other related health care costs that come with greater use? We won’t be able to and the taxpayer will pay the bills just like we do with alcohol and tobacco. Study the Rand Corporations Testimony 2010 presented to the California voters – it was one of the reasons Californians rejected legalization in 2010 – they did the math.

  4. Canadian Taxpayer says:

    This issue is likely to be of some concern to all Canadian voters, with the upcoming federal elections, and should definitely be of concern to all Canadian taxpayers. As Canadian taxpayers, we all need to know the total economic costs of illegal drug use and how any proposed policies will decrease said costs. The policy framework CAMH has just released is lacking in providing estimates of the economic cost-reductions associated with their proposed approaches vs. those they have rejected (prohibition, decriminalization, legalization without strict regulation). The CAMH policy framework needs to clearly present the case for, not only the estimated reductions in health/social harms and the increases in health equity, but also estimates of total economic cost-reduction and how any policy will be assessed in this regard post-implementation to determine its success. With that type of analysis presented in their policy framework, and after giving it time to be critically reviewed, I would be happy to support (with my vote and tax dollars) such a recommendation.

    • SAM Canada says:

      You can look to the examples of the alcohol and tobacco industry that cost the public ten fold what they incur from revenues. The ability to tax this industry will be curtailed and the public will
      pay the balance of costs. The market for marijuana is primarily a youth market and it will remain an illegal market serviced by the criminal element with a legalization model. The risk of legalization is an increase in the use by youth as the product will be further normalized, and given greater access and acceptance. Legalization is not the answer to how we reduce the use by youth. History tells us that the way to reduce the use is through public education not legalization. Sweden, the UK, Holland and other countries understand this and Canada needs to follow along. In California there is a very big push back from the 1996 acceptance of medical marijuana with over 80% of towns and counties now rejected medical marijuana in their area. They are fighting against the legalization of recreational marijuana as well having seen as is Colorado and where 67% of towns have now banned recreational marijuana. Legalization is the wrong way to go – only 8.4% of Canadian adults use marijuana and we do not need to allow a third legal drug to take hold in this country – we need to say no now.

  5. SAM Canada says:

    SAM Canada is a national organization that opposes the legalization of marijuana which is in keeping with the signing of the United Nations Treaty – The Rights of the Child in 1991. Last week the Drug Chief at the United Nations made a public announcement confirming the UN’s position on legalization. The United Nations top drug official rejected the findings of an international panel urging countries to reassess prohibition by experimenting with decriminalization and regulation of illicit substances. The top drug chief Yury Fedotov ” It’s very hard to reconcile these recommendations with the major provisions of drug-control conventions.” –
    “Such experiments certainly will make drugs more available and cheaper”.
    The report from the CAMH fails to define failure of prohibition. Current statistics show that
    8.4% of Canadian adults use marijuana. Is this a sign of failed drug policy or a success to build on. There is a problem with the rate of use by youth in Canada – a very significant one but moving to a more permissive drug policy may well not prove to be the answer. The evidence of the Rand Corporation testimony on price drops with legalization, and the example of the failed regulatory models of alcohol and tobacco are arguments against the position taken by the CAMH.
    The quoting of legal ramifications for the use of marijuana fall outside the mandate of the CAMH and should be challenged. Youth in this country – Canada are protected from criminal records – and the word adult should be incorporated into the comments above and on other locations within the website of the CAMH otherwise it is misleading. The statistics of the number of people charged with simple possession as their only charge should also be fact checked as should be the number of people imprisoned in Canada.
    Research for 2011 of marijuana possession only cased charges cleared by a charge the numbers are as follows: BC data
    249 cases 169 proceeded to court 42 convicted 7 resulted in a custody charge or which
    1 spent a 14 day jail term, 2 a seven day jail term, 4 a one day jail term.
    The CAMH should not be discussing legal issues and stick to the science, evidence and
    facts surrounding research on addiction and the use of marijuana.

    The CAMH should rethink their position and review the evidence before them.

    • CAMH says:

      Thanks for your comments.

      The harms of substance use cannot be tackled without reference to the legal framework in which they are embedded. The legal context of a substance impacts its users; this is as true for cannabis as it is for any other drug. Criminalization of substance use is demonstrably harmful to health.

      It’s difficult to imagine a more permissive environment for cannabis use than the one we have in Canada today. The model CAMH is recommending would allow for regulations that curtail cannabis availability and potency – within a public health strategy focused on health promotion and prevention. Evidence from decades of alcohol control shows quite clearly that a public health approach and a strong regulatory framework can and do reduce harm.

      • SAM Canada says:

        Alcohol and tobacco are good examples of failed regulatory models when you review the rate of use by youth of both of these drugs. Virtually all people who become regular smokers become addicted before their 18th. brithday and we have had little success in “brown bagging alcohol or brown packaging tobacco” or curtailing these industries reach into the youth market. Monitoring the Future shows that although drug policies are working to bring down all illicit drugs except for marijuana use which is on an increase. Why would this be happening ? Because of the very real decline in the perception of risk of use by youth. Criminalization of substance use is demonstrably harmful to health is an incredulous statement for the CAHM to be making. – we have law to protect the innocent from the actions of individuals who drink and drive – who drive impaired from drugs, it comes down to whose health you are talking about the user or the nonuser. The child exposed to drug use, second hand smoke ? The fetus exposed prenatal drug exposure ? Deterrents are the cornerstone of our legal system – and has been a major factor in keeping rates of usedrug use relatively low. How is breaking the law harmful to health – it is drug use that is harmful to health and we should be doing everything possible to reduce the use of drugs – to reduce the risk of harm to users and non-user.
        The CAHM is not in a position to debate the way the place of law and order in civilized society and to suggest that criminalization is in and of itself a threat to health is way beyond their mandate.

  6. Dr. Freedman says:

    Wow! I was surprised to hear about CAMH supporting legalization of cannabis and was eager to read the report. I was hoping that it was based in some science and not in the naive belief that we’ll do it better and kids won’t use. Alas I was disappointed.

    We have one of the lowest “perceptions of risk” in the civilized world and expanding access and condoning its use ( say what you want but I’ve already been to a pro – cannabis lectures that proudly flash the CAMH logo and show your totally fictional graph (where legalization is at the nadir)).

    It seems to me decriminalization is a partial measure but that’s what cautious doctors do. We change things in small increments and measure the response. We don’t blithely double doses and hope for the best.

    Lastly I question the timing of this report. If we wait just a few more months we will have some significant data from Colorado and Washington. If the rates of high school drop out go down and there is a significant rise in grades and a decrease in admissions to rehab facilities we can follow suit with a bit of confidence. If it is a disaster we can go back to the cautious approach. Not sure what the rush is and why you want to swing the pendulum so far to the left with precious little evidence to back you up and lots of concerns about increasing addiction rates and mental health problems.

    You are entitled to your opinion but unfortunately you are/were a highly respected source when it comes to addiction and likely despite the absence of evidence people will give your voice more weight.

  7. CAMH says:

    Thanks everyone for your comments. It’s great to see that there’s such interest in cannabis policy. We all agree that cannabis use can be harmful, that it should be carefully controlled, and that evidence should drive policy. We look forward to ongoing discussion of this topic.

  8. Ed Gogek says:

    Dr Rehm, the CAMH Framework says Canada spends over $1 billion per year enforcing marijuana possession laws, but there’s no footnote. Can you tell us how you came up with that amount? It seems awfully high.

    • CAMH says:

      This figure was derived from a report called The Costs of Substance Abuse in Canada 2002. This study found that the costs of law enforcement for illegal drugs in Canada was $2.335 billion in 2002. Law enforcement costs specific to cannabis were estimated by assigning half of total enforcement costs – $1.167 billion – to cannabis. This is a conservative estimate since a) more than half of drug-related offences reported by police involve cannabis and b) the numbers are from 2002 and have not been inflation-adjusted.

      • Edward Gogek says:

        I thought that $2.3 billion included all substance-involved crime—drug possession, trafficking, and also crimes committed to get money for drugs as well as crimes committed because people were under the influence.

  9. Joseph says:

    Where is the talk on CBD oil? CBD oil is illegal in Canada, but it has anti-psychotic properties. Other countries such as Israel and the United States are making advances on this front, but Canada seems to be lagging behind. CBD oil contains no THC, and is even used on children in Colorado to treat Dravet’s syndrome. I would definitely like to see CAMH tackle legalization from this direction.


    J. O’Donnell
    University of Ottawa

  10. its all about the money. Legalize cannabis and cam will get billions over the nex few years of cannabis legalization. Cannabis is an amzing plant. The person from Isreal was the first person to discovered CBD, the healing property of cannabis. The meta studies done on the health benefits of cannabis is overwhalming. camh has no choice but to speak about the Harm, danger, and addictive aspects of cannabis, whether-or-not it’s scientifically proven, because their in the drug treatment, prevention. education, and research business. When the Government impliments camh cannabis policy framwork, it will cost taxpayers billions of dollars in funding every project camh comes up, and they will cheery pick their reseach findings with funding provided by taxpayers money, continuing to spead their properganda of mis-information. The health benefits of cannabis far out weigh the risks of harm. Any of the risks spoken of in Cannabis Policy Framework, are very low, NOT even worth mentioning – ~ A fear tactic used by camh to push their hidden agenda. A very important area, where a small mention of Medical Cannabis spoken of, but not anything said about the multible health benefits for maojr chronic and mild health conditions, this is the key to understanding WHY camh avoids the area of Medical Benefits in their public annoucement and PDF Document, Cannabis Policy Framework, WHAT CAMH DOESN’T WANT US TO KNOW — NOW, YOU KNOW!

  11. meduser says:

    Dr. Rehm is a leader in generating and analyzing the scientific data needed to inform policy makers of strategies to reduce alcohol- and tobacco-related harm. He and his team evaluate the economic costs of substance use and abuse. Dr. Rehm was the Principal Investigator on the report “The Costs of Substance Abuse in Canada 2002” released in 2006 that estimated the effects of tobacco, alcohol and illegal drugs in terms of death, illness and economic costs. His current research is focused on estimating avoidable burden and costs of alcohol in Canada, and on conducting Comparative Risk Assessments on the burden of different risk factors in different countries.

    I don’t mean to insult Dr. Rehm but could this be why your numbers are all out of date, whether in current dollars or not it’s not 2002 and Dr. Zahn is a Neurologist who’s specialty was epilepsy in pregnant women and no comments on CBD’s anti-seizure properties. I am personally against legalization despite having been a Health Canada Licensed User since july 2009, it’s safer than many pharmaceuticals but it’s not benign, I have been on well over 150 pharmaceuticals and still take several as I’m also Schizophrenic but this isn’t about me but what’s best for society

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