Five years of legal cannabis in Canada: mixed success

Five years after cannabis legalization in Canada, it appears to be a mixed success, with social justice benefits outweighing health benefits, write authors in a commentary published in CMAJ (Canadian Medical Association Journal) https://www.cmaj.ca/lookup/doi/10.1503/cmaj.230808.

Cannabis use was legalized in Canada in October 2018, with the goal to improve cannabis-related public health and safety, and reduce youth access and illegal activities related to cannabis. There was concern among some health professionals that legalization could lead to adverse health effects in Canadians.

"Limited evidence exists to support benefits as they relate to the original stated policy objectives of improving cannabis users' and public health," writes Dr. Benedikt Fischer, Simon Fraser University, Vancouver, BC, with coauthors. "At this stage, cannabis legalization in Canada appears not to have been the public health disaster anticipated by some of its opponents, but it cannot be described as a comprehensive or unequivocal success for public health either."

Evidence indicates that cannabis use, cannabis-related emergency department visits and admissions, and cannabis-related impaired driving have stayed the same or increased. On the other hand, most cannabis consumers now obtain their cannabis from legal, rather than illegal, sources, and cannabis-related arrests, along with personal burdens from stigma and possible criminal records among adults and youth have decreased substantially. The authors assert these are important social justice benefits that may have indirect positive health effects.

"These major societal benefits of legalization must be included in any systematic assessments of the policy reform's impacts," write the authors.

Ongoing monitoring of cannabis use in adults, youth and high-risk people, and major health harms such as cannabis use disorder, cannabis-related injuries, hospital admissions or emergency department visits, and related crime and other socioeconomic indicators is needed to better understand the impact of legalization.