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To the editor:
Your recent editorial entitled “Watching Canada’s experiment with legal cannabis” proposes that any increase in use rates would represent a failure on the part of cannabis legalisation.
This ignores the reality that use rates will almost certainly rise due to artefact, in that previously surveyed use rates were subject to a social acceptability bias that likely lead to underreporting.
It also ignores the fact that from a public health perspective, evaluating the success of the policy should focus on the myriad health outcomes and impacts anticipate on health rather than use rates alone.
To be sure, there are numerous concerns with legalization that must be attended to through a public health approach. However, one must also recall some of the anticipated positive health aspects of legalization, particularly in allowing people who use cannabis to seek assistance for problematic use that would otherwise be stigmatized (1) and addressing the health inequities arising from the disparity that saw ethnic and racialized populations more typically criminalized for possession and use. (2)
Evidence has long suggested that the legal status of a substance does not necessarily deter use or prohibit harms, which means a focus on outcomes is much more useful than examining use rates in isolation. (3) In fact, as a comparator, despite decreasing use rates in recent years, tobacco remains the leading cause of preventable death in the Canada. (4)
To employ use rates as a principal indicator in determining the success of cannabis legalization fails to adequately examine the broader anticipated community health outcomes – both negative and positive - that might be more representative and usefully deployed in future regulatory amendments.
References
1. Barry CL, McGinty EE, Pescosolido BA, Goldman HH. Stigma, discrimination, treatment effectiveness, and policy: public views about drug addiction and mental illness. Psychiatr Serv. 2014 Oct;65(10):1269-72. doi: 10.1176/appi.ps.201400140.
2. Nguyen H, Reuter P. How Risky is Marijuana Posesssion? Considering the Role of Age, Race and Gender. Crime & Deliquency 2012 58:879 DOI:10.177/0011128712461122
3. Nadelmann EA. Drug prohibition in the United States: costs, consequences, and alternatives. Science. 1989 Sep 1;245(4921):939-47.
4. Government of Canada. About Tobacco Control. [website] Available at: https://www.canada.ca/en/health-canada/services/health-concerns/tobacco/... (last accessed December 1, 2018)