Public health must be top priority if cannabis is legalized in Canada

"If Canadian policy-makers decide to create a legal, regulatory framework for cannabis, it is critical that public health objectives be the foundation of changes," writes Dr. Sheryl Spithoff, Department of Family Medicine, Women's College Hospital, Toronto, Ontario, with coauthors. "Otherwise, Canada may experience the same health and social harms that resulted from the commercialization of alcohol and tobacco."

In the lead up to Canada's federal election in October, cannabis policy may be an issue. Two of the three major national parties support decriminalization or legalization, whereas the governing party favours the status quo.

In 2001, Canada legalized marijuana for medical use and in 2014, implemented detailed rules for medical-related commercial production and use. However, possession of cannabis for nonmedical use is still illegal in this country.

The authors outline the harms of prohibiting cannabis use, such as fuelling of the illegal drug trade and the high costs and harms associated with policing and prosecuting people. They compare the experiences with cannabis policies in the Netherlands, Spain, Uruguay and three US states, where cannabis is legal.

"Often the harms from prohibition versus harms from potential increased use of cannabis are falsely pitted against each other," write the authors. "Evidence shows, however, that cannabis prohibition has no effect on rates of use, at least in developed countries."

They suggest that policy-makers draw upon the extensive research on tobacco, alcohol and cannabis policy frameworks developed by public health researchers to create a Canadian approach that maximizes benefits and minimizes harm of a potentially addictive substance.