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RE: The authors respond to Mitchell and Walsh

  • Lawrence C. Loh, MD MPH FCFP FRCPC FACPM, Adjunct Professor, Dalla Lana School of Public Health, University of Toronto
  • Other Contributors:
    • Jasleen K Grewal MD, Resident Physician, University of Toronto
28 January 2020

We thank Drs. Mitchell and Walsh for their response to our article. From a public health perspective, we agree that approaching drug policy from a public health as opposed to legal perspective has the most support in evidence for positive community health outcomes. This has been borne out by Portugal’s experiences and is in line with the declarations of several public health departments such as those issued by Toronto Public Health. (1) With that lens in mind, it is important to note that the commentary does not make any statement that the overall legalization of cannabis as a policy measure is undesirable, nor does it call for any reversal or delay. (2)

Equally important to note, however, that while legalization resolves a whole host of structural determinants that impact health, there are downstream impacts that must be considered in the overall picture. Much like alcohol and tobacco, legal does not mean entirely safe, and the use of cannabis in any form (inhaled, ingested, or otherwise) can present health risks. That our commentary seemingly focuses on the harms of edibles reflects the state of extant literature available to date. The risks of accidental ingestion by at risk groups and overconsumption with cannabis edibles is certainly real and borne out through health services data in other jurisdictions. That the respondents choose to debate aspects of potential contamination of illegally produced edibles does not negate these other risks at all.

Specific to contamination, it is worth noting that poor food handling practices in the home have indeed been identified as a leading cause of foodborne illness in industrialized countries, suggesting that Canadians, in fact, are very much “unsafe in their own pantries.” (3) Finally, while we agree that existing data does not support it, the comments from former Minister Philpott speaks to an absence of “documented evidence” does not dispel the theoretical possibility that cross-contamination, intended or incidental, may occur in settings where multiple illicit drugs are being handled.

The aim of the commentary was to use the legalization of mass market edibles in Canada as an opportunity to review the current state of literature on their specific health impacts. That evidence discourages the consumption of illicit edibles while highlighting very real risks to health presented by consuming legal edibles. Those risks must be carefully considered and mitigated for Canadians to fully enjoy the positive health impacts anticipated to arise from structural and societal changes from legalization of cannabis.

1. Toronto Public Health. A Public Health Approach to Drug Policy, available from: https://www.toronto.ca/legdocs/mmis/2018/hl/bgrd/backgroundfile-118060.pdf
2. Grewal JK, Loh LC. Health considerations of the legalization of cannabis edibles. CMAJ. 2020 Jan 6;192(1):E1-E2. doi: 10.1503/cmaj.191217.
3. Redmond EC, Griffith CJ. Consumer food handling in the home: a review of food safety studies. J Food Prot. 2003 Jan;66(1):130-61.

Competing Interests: None declared.
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Copyright 2021, Joule Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

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