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Considerations for a ‘Public Health’ approach to Cannabis Use Control in Canada

PRELIMINARY DRAFT of Presentation to Senate Special Committee on Illicit Drugs, 17/09/01

[Based, in parts, on: Fischer B., Single E., Room R., Poulin C., Sawka E., Thompson H., and Topp J. (1998). Cannabis Use in Canada: Policy Options for Control. Policy Options, October 1998.]

Benedikt Fischer, PhD

University of Toronto and Centre for Addiction and Mental Health

CIHR New Investigator

Cannabis Use

Approx. 7% of Canadians (15yrs +) used in last year

Student use: 23% - 44% in last year

BUT: <1% of adults, <2% of students use daily; 80% of adults use less than once weekly

Approx. 25% of adult Canadians have tried cannabis some time in life


Negative health effects of cannabis

Physical coordination

Respiratory damages

Pregnancy and post-natal development

Memory and cognition

Psychiatric effects

Hormone production and immune system

Dependence/withdrawal symptoms disputed; possibly in heavy chronic users (see sources below)


Therapeutic effects/benefits of cannabis


Appetite stimulant/AIDS wasting





No violence

No deaths (see sources below)


Harms and Risks of Cannabis: Key reviews

Hall, Solowij and Lemon, 1994: Reduce major risks of cannabis use by avoiding driving, chronic/daily use and deep inhalation (1994:20)

WHO/ARF Report: Health Effects of Cannabis, 1999: "On current patterns of use, cannabis appears to pose a much less serious public health problem than is currently posed by alcohol and tobacco in Western societies" (p.495).

Zimmer L. and Morgan J. (1997)

Kendall, Fischer, Rehm, Room, 1997

Institute of Medicine, National Academy of Sciences, 1999 (see excerpts below)

Roques Report, 1998 (see Table)


Relative Harm Potential of Cannabis: Inst. of Medicine

Q: Is marijuana addictive?

A: "In summary, although few marijuana users develop dependence, some do. But they appear to be less likely to do so than users of other drugs (including alcohol and nicotine), and marijuana dependence appears to be less severe than dependence on other drugs." [p. 98]

Q: Does marijuana lead to harder drugs?

A: "It does not appear to be a gateway drug to the extent that it is the cause or even that it is the most significant predictor of serious drug abuse; that is, care must be taken not to attribute cause to association." [p. 101]

"There is no evidence that marijuana serves as a stepping stone on the basis of its particular physiological effect." [p. 99]

Q: Is marijuana more dangerous than tobacco?

A: "Given a cigarette of comparable weight, as much as four times the amount of tar can be deposited in the lungs of marijuana smokers as in the lungs of tobacco smokers. ... However, a marijuana cigarette smoked recreationally typically is not packed as tightly as a tobacco cigarette, and the smokable substance is about half that in a tobacco cigarette. In addition, tobacco smokers generally smoke considerably more cigarettes per day than do marijuana smokers." [Pp. 111, 112]

Q: Does marijuana cause other life-threatening health problems?

A: "Epidemiological data indicate that in the general population marijuana use is not associated with increased mortality." [p. 109]


Comparative Harms of Cannabis: Overview Table, Roques Report ’98 (p. 182)












Dopamine overactivation









Creation of a hypersensitivity to dopamine ++ +++ ? +++ ± ? ± ?
Activation of the opioid system +++ ++ ? + ++ + ± ±

Physical dependency

very strong




very weak




very strong average




Emotional dependency very strong strong but intermittent ? average very strong strong weak very strong


low high  very high (?) high high  0 0 0

General toxicity

high* high possibly very high high high very low very low very high (cancer)

Risk to society

very high very high low (?) low (possible exceptions) high low ** faible Low
Existing substitution or other treat-ments





no no



non recherché


non recherché




* no toxicity when methadone and morphine used therapeutically
** except when driving a vehicle or attempting subjugation or autosubjugation, in which cases the risk becomes very high


Relative Social Costs of Cannabis Use

Of the social costs to the Ontario health care system attributable to drugs in 1992 (Single et al. 1996)

69.0% were for tobacco

28.4% were for alcohol

2.0% for other illicit drugs

0.5% for cannabis


History of Cannabis Prohibition in Canada

Historical mystery: Cannabis added to schedule in 1923 without parliamentary debate

No visibility of widespread use or problems, but based on US prohibition mythology

E. Murphy: Users "completely insane …lose all sense of moral responsibility ,,, become raving maniacs … and kill or indulge in any form of violence … using the most savage methods of cruelty" (1922)

Demon rhetoric and cannabis enforcement picked up by Canadian drug enforcement apparatus in 1940s/50s/60s

Cannabis becomes main focus of Canadian drug prohibition in early 1960s (see Giffen et al. 1991)


Controlled Drugs and Substances Act (CDSA)

Simple Possession of Cannabis for First-Time Offenders: $1000 Fine and/or Six Months Imprisonment (Summary Off.)

Simple Possession of Cannabis for Repeat Offenders: $2000 Fine and/or Twelve Months Imprisonment (Summary Off.)

Personal Possession above designated amounts: Max. 7 years imprisonment (indictable)


Cannabis Enforcement Practices in Canada

Approx. 59,000 Cannabis offenses under CDSA (approx. 75% of total) in 1999

Approx. 39,000 Cannabis Possession (Use) offenses (approx. 50% of total) in 1999 (see CCJS, 2000)

Great enforcement discrepancies between provinces/regions as well as urban/rural

Use of enormous police discretion


Cannabis Sentencing Practices in Canada

No clear picture for Canada

Majority of first-time offenders receive discharge, conditional sentence or small fine

Custodial sentences for cannabis possession in conjunction with criminal history, other offenses, default of fine or other sentence

Convictions, conditional discharges, carry criminal record

Questions about the use and appropriateness of criminal sentencing alternatives, I.e. conditional sentencing, treatment orders


Social Costs of Criminal Cannabis Control

Over 3 million arrests in last 3 decades

Approx. 600,000 Canadians with criminal record for cannabis possession offense

Impacts on: profession, citizenship, travel, personal and social stigma

Estimated costs of cannabis enforcement as proportion of CJS costs: $400 million p.a.

No evidence of general or specific deterrence of law/enforcement

(see Fischer et al. 1998)


Calls for Cannabis control reform in Canada

Le Dain Commission Report, 1972/73

Bill S-19

Major parties in platforms or leadership pledges over past 30 years

Major social, legal, health and policy institutions and experts in last 10 years, including:

Canadian Bar Association
Canadian Criminal Lawyers’ Association
Canadian Association of Chiefs of Police
Canadian Police Association
Canadian Centre on Substance Abuse
Centre for Addiction and Mental Health
Canadian Medical Association,
Editorials of all major papers


Public opinion re: Cannabis Use Control

Approximately 7 out of ten Canadians oppose the possibility of jail sentences for cannabis possession/use

Majority of public oppose criminal control/support regulation through a regulatory fine

Consistent public opinion support for de-penalization of personal cannabis use over past 25 years

80%-90% of public support penalty-free medicinal use

(see Fischer et al. 1998, Giffen et al. 1991)


International Treaties re: Cannabis Use Control

Single Convention 1961/1972 Protocol:

"Subject to constitutional limitations, … cultivation, production, manufacture …of drugs ... shall be punishable offenses" Art. 36(1)

Limit of possession, use… to "medical and scientific purposes" Art. 4(c)

Long standing debate on focus of Single Convention: Parties "may take the view that …not required to establish [possession or use] activities as criminal offenses … since the obligations only apply to cultivation, purchase or possession for trafficking" (INCB 1992:6)


International Treaties: 1988 Vienna Convention

"Subject to its constitutional principles …each party shall establish as a criminal offense … the possession of narcotic drugs … for personal consumption" Art. 3(2)

"The Parties may provide, either as an alternative … or in addition to conviction or punishment … measures for treatment, education, aftercare, rehabilitation or social integration of the offender" Art. 3(4)d

INCB: "None of the conventions requires a party to convist or punish drug abusers who commit … even when they have been established as punishable offenses. [They] may deal with drug abusers through alternative non-penal measures involving treatment, education, aftercare, rehabilitation or social integration" (1992:4)


Cannabis Control Reform in other countries

‘De jure’ and ‘de facto’ control/reform (Fischer &Ali-Leppilampi, in progress)

Switzerland: Currently prohibited, yet personal use mostly tolerated or leniently fined (regional variation); Fall 2000 initiative of Fed. Office of Health to legalize personal use and cultivation, due to public acceptance and loss of law’s credibility

Germany: Legal prohibition, de facto non-enforcement/prosecution of personal use, but regional variance; recognition of constitutional issues, wide social acceptance of cannabis use

Netherlands: Legal prohibition, de-facto open tolerance of personal use, licensed distribution system; wide social acceptance


Cannabis Control Reform in other countries

UK: Cannabis use/possession under MDA will typically result in a caution or warning, or a fine at most for repeat offenders.

Spain: Personal use/possession of cannabis controlled under administrative/non-criminal law – quasi-legal in practice.

Australia: Non-criminal control of use by ‘Cannabis Expiation Notices’ (ticketing system with small fine) in some states, no criminal procedures

No system which has non-criminal control has seen evidence for a negative change in cannabis use patterns or harms attributable to reform


Role of enforcement opposition to cannabis control reform

Police as the historical disseminators and proponents of cannabis myths of ‘gateway drug’, ‘cannabis crime’, ‘cannabis addiction’ (see Giffen et al. 1991)

Police as an institutional stakeholder through substantive mandate and resources for drug enforcement, I.e. RCMP

Nils Christie: "Crime as property"

Provisions of cannabis law as a valued and convenient access-tool for person investigations

But: Increasing realization of strain on resources on police resources


Cannabis Control Options for Canada

Take cannabis possession out of criminal drug control law (CDSA)

Include full automatic discharge for cannabis possession into CDSA

Eliminate jail option for cannabis possession

Create a ‘civil’/non-criminal (‘ticketing’) offense under Contraventions Act (limited fine)

Diversion of offenders to education or treatment (Conditional Sentence or other provisions)

Emphasize education, prevention, treatment (where necessary)

Maintain punitive approach to cannabis use where harmful to others (I.e., driving)

(see Fischer et al. 1998)


Cannabis Control: What do we need – what’s at stake?

Sensible, effective and efficient law and government

Constitutional principles of equality and human rights

Rational, evidence-based law and policy

Law and policy reflecting public opinion as basis for respect and credibility

Needed now: Leadership rather than new knowledge

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