Legalization of Cannabis in Canada Perspectives from a Local Public Health Department November 14, 2018 Bessie Ng, MPH Research & Policy Analyst Region of Peel-Public Health
Presenter Disclosure Bessie Ng • The following personal financial relationships with commercial interests relevant to this presentation during the past 12 months: No relationships to disclose 2
Presentation Co-Authors • Inga Pedra, MPP • Dr. Kate Bingham, MD, MSc, CCFP, FRCPC • Paul Sharma, MSc • Dr. Jessica Hopkins, MD, MHSc, CCFP, FRCPC • Dr. Lawrence Loh, MD, MPH, CCFP, FRCPC 3
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Presentation Objectives 1. Describe the policy development process and legislative framework for legal cannabis 2. Discuss broad population health considerations with implementing the legislative framework 3. Outline Region of Peel- Public Health’s (ROP -PH) approach to addressing legal cannabis 5
Public Health System in Ontario • 35 local public health units (PHUs) – Each governed by a local board of health – Programs and services cost- shared between Province and municipalities – Work focuses on improving Ontario population health • ROP-PH is one of 35 PHUs Peel Region 6
About Peel Region • Comprised of 3 area municipalities • Home to over 1.4 Toronto Pearson million residents and International Airport 163,000 businesses • Has a mix of rural and suburban areas 7
Policy Development & Legalization Framework 8
Key Developments Federal Jun – Dec 2016 • Federal Task Force created • Consultations held • Recommendations submitted Apr 2017 Jun 2018 Federal cannabis Federal legislation introduced legislation passed Liberal Party of Oct 2018 Canada’s Cannabis campaign legalized promise in 2015 election Dec 2017 Nov 2017 Jun 2018 Oct 2018 Ontario Sept 2018 Ontario Jul – Aug 2017 Ontario cannabis New New legislation New legislation Consultations legislation government legislation passed introduced held 9 introduced elected passed
Jurisdictional Responsibilities 1-3 Federal Provincial Municipal ✓ Advertisement and Packaging ✓ ✓ * Age Limit ✓ ✓ Land Use and/or Zoning ✓ ✓ * Personal Cultivation Influence ✓ ✓ Places of Use Influence ✓ ✓ * Possession Limit ✓ Production ✓ ✓ ✓ Public Health and Education ✓ ✓ ✓ Regulatory Compliance/Enforcement ✓ ✓ Retail and Distribution Influence ✓ ✓ ✓ Road Safety * Provinces and territories can strengthen federal legislation 10
Ontario’s Cannabis Legislative Framework 4 Online; private storefronts Minimum age of 19 years to start in April 2019 Smoking/vaping prohibited in Possession limit of 30g enclosed public places and other specified places Can grow up to 4 plants Zero tolerance for young, per residence novice, and commercial drivers 11
ROP- PH’s Involvement in Cannabis Policy Development Advocacy to decision-makers through: • Responses to federal and provincial consultations • Participation in stakeholder groups – Ontario Public Health Unit Collaboration on Cannabis (OPHCOC) – Association of Municipalities of Ontario (AMO) Task Force on Cannabis 12
Considerations for Population Health 13
A Public Health Approach to Legalization 5 (Centre for Addiction and Mental Health, 2014) 14
Potential Impacts Related to Cannabis Use and Legalization Health 6,7 Environmental 8-11 Economic Respiratory effects CO 2 and CO emissions Tax revenues Injury and death Prenatal, perinatal, neonatal outcomes Mould & other airborne Economic development particles Psychosocial outcomes Mental health outcomes Electrical hazards Implementation costs Problem cannabis use Chemical exposure Health care utilization Use of other substances 15
Protecting Public Health and Safety & Mitigating Risk Delaying Age of Initiation Ensuring Safeguards for Personal Cultivation • Impacts on youth brain development • Health and safety hazards • Potential diversion of cannabis Establishing Retail System Controls Restricting Places of Use • Physical availability of cannabis products and • Second-hand smoke and vapour exposure locations relative to sensitive land uses • Normalization of smoking Preventing Potential Injuries Restricting Marketing and Regulating • Cannabis-impaired driving rates; challenges Packaging with detection and assessment • Product appeal (particularly among youth) • Accidental THC poisoning with cannabis edibles 16
Health Equity Considerations • Protecting priority populations • Addressing the social determinants of health • Monitoring unintended consequences of policy and program decisions 17
ROP-PH Response Following Legalization 18
ROP- PH’s Approach Comprehensive Stakeholder Lens Engagement Policy Surveillance & Development Monitoring & Advocacy Evidence- Enforcement & Informed Health Decision Protection Making 19
Summary • Public health and safety must maintain a priority in the legalized system • Stakeholder engagement an essential component of policy and program development • Comprehensive monitoring and evaluation is needed to assess policy objectives 20
Contact Information Bessie Ng Email: bessie.ng@peelregion.ca 21
References (1) Government of Canada. Backgrounder: Roles and responsibilities [Internet]. Ottawa, ON: Her Majesty the Queen in Right of Canada; 2017 [cited 2018 Sept 16]. Available from: https://www.canada.ca/en/health-canada/news/2017/04/backgrounder_rolesandresponsibilities.html (2) Region of Peel. Implications of the legalization of cannabis for recreational use (Report to Regional Council). Brampton, ON: Region of Peel; 2018. (3) Government of Alberta. Cannabis legalization in Canada [Internet]. Edmonton, AB: Alberta Queen’s Printer; n.d. [cited 201 8 Sept 16]. Available from: https://www.alberta.ca/cannabis-legalization-in-canada.aspx. (4) Government of Ontario. Cannabis Legalization [Internet]. Toronto, ON: Queen’s Printer for Ontario; 2018 [cited 2018 Sept 28]. Available from: https://www.ontario.ca/page/cannabis-legalization. (5) Centre for Addiction and Mental Health. Cannabis policy framework. Toronto, ON: Centre for Addiction and Mental Health; 2014. (6) National Academies of Sciences, Engineering, and Medicine. The health effects of cannabis and cannabinoids: The current state of evidence and recommendations for research. Washington, DC: The National Academies Press; 2017. (7) Fischer B, Russell C, Sabioni P, van den Brink W, Le Foll B, Hall W, et al. Lower-risk cannabis use guidelines: A comprehensive update of evidence and recommendations. AJPH. 2017;107(8):e1-e12. 22
References (8) Plecas D, Diplock J, Garis L. Revisiting the issues around commercially viable indoor marihuana growing operations in British Columbia. Abbotsford, BC: University of the Fraser Valley; 2012. Available from: https://www.surrey.ca/files/RevisitingtheIssuesAroundCommerciallyViableIndoorMarihuanaGrowingOperationsinBritishColumbia.pdf. (9) National Collaborating Centre for Environmental Health. Recommendations for safe re-occupancy of marijuana grow operations. Vancouver, BC: National Collaborating Centre for Environmental Health; 2009. Available from: http://www.ncceh.ca/sites/default/files/Marijuana_Grow_Operations_Mar_2009.pdf. (10) Garis L, Clare J. Cleaning up former drug operations in our residential neighbourhoods. Abbotsford, BC: University of the Fraser Valley; 2013. Available from: https://www.ufv.ca/media/assets/criminal-justice-research/Research-Note-Cleaning-Up-Former-Drug-Operations-in-our-ResidentIal- Neighbourhoods.pdf. (11) Wearmouth V, Sabapathy D, Fehr M. Marihuana grow operations abatement program. Edmonton, AB: Alberta Queen’s Printer; 2011. Available from: http://www.ncceh.ca/sites/default/files/MGO%20Program%20Report%20(v20).pdf. 23
Image Sources Slide 1 • https://cannabis-seeds-usa.org/wp-content/uploads/2017/12/big-bud-marijuana-seeds-1_large.jpg Slide 5 • https://www.google.com/maps/place/Peel+Regional+Municipality,+ON/@43.4975798,- 79.7872738,10z/data=!4m5!3m4!1s0x882b3c30c9eb87ab:0x3bec33bf3e68e6a3!8m2!3d43.6766398!4d-79.7848422 Slide 6: • https://commons.wikimedia.org/wiki/File:Greater_toronto_area_map.svg Slide 8 (left to right): • https://pm.gc.ca/sites/pm/files/media/pm_trudeau_600x683.jpg • https://www.canada.ca/content/dam/hc-sc/healthy-canadians/migration/task-force-marijuana-groupe-etude/framework- cadre/alt/framework-cadre-fig2.jpg • https://en.wikipedia.org/wiki/Centre_Block#/media/File:Centre_Block_-_Parliament_Hill.jpg • https://biobanking.org/img/resources/Biobankconsulting.png • http://queensparktoday.ca/wp-content/uploads/2016/06/download.jpeg • https://www.iconsdb.com/red-icons/check-mark-2-icon.html • https://files.ontario.ca/df_hero-image_1200x675_bio_1010x710.jpg • http://queensparktoday.ca/wp-content/uploads/2016/06/download.jpeg • https://www.iconsdb.com/red-icons/check-mark-2-icon.html 24
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