Changes in health harms due to cannabis following legalisation of non‐medical cannabis in Canada in context of cannabis commercialisation: A scoping review

Abstract

Issue: On 17 October 2018, Canada legalised non-medical cannabis. Critically, the cannabis market in Canada has changed considerably since legalisation. In this scoping review, we identified available evidence on changes in cannabisrelated health harms following legalisation and contextualised findings based on legal market indicators.Approach: Electronic searches were conducted to identify studies that compared changes in cannabis-related health harms pre-and post-legalisation. We contextualised each study by the mean per capita legal cannabis stores and sales during the study period and compared study means to per capita stores and sales on October 2021-3 years following legalisation.Implications and Conclusions: Some measures of cannabis harms have increased since legalisation but studies to date have captured periods of relatively low market maturity. Longer-term monitoring of health harms as the market continues to expand is indicated.

Access to legal cannabis market in Canada over the four years following non‐medical cannabis legalisation

“…Each province in Canada was allowed to determine their own cannabis retail policies, which has led to enormous variation in retail access. While the implications of this variation are relatively unknown, a large body of literature from alcohol control [5] caution that it may result in differences in use and consequent harms. Increasing research from Canada and the United States has found that greater retail access to cannabis stores is associated with increases in cannabis use and health care visits caused by cannabis across several populations [6,7,[14][15][16].…”

“…Canadian evidence suggests minimal changes in cannabis use and consequent health care visits immediately following legalisation [5]. More recent studies suggest that cannabis use and health care visits may be increasing as the market has expanded including the phased introduction of new higher-potency products such as vapes, edibles and concentrates, which began 1 year post legalisation in October 2019 [6][7][8][9].…”

“…While marketing and promotion of cannabis are restricted under the Cannabis Act , we previously published a study showing large increases in retail store access over the first 2 years following legalisation [4]. Canadian evidence suggests minimal changes in cannabis use and consequent health care visits immediately following legalisation [5]. More recent studies suggest that cannabis use and health care visits may be increasing as the market has expanded including the phased introduction of new higher‐potency products such as vapes, edibles and concentrates, which began 1 year post legalisation in October 2019 [6–9].…”

Response to Smyth & McCarron: Increases in cannabis‐attributable emergency department visits during different phases of the pre‐ and post‐legalization period are multi‐factorial

“…Importantly, while we believe that the Canadian experience regarding legalization will generalize to other countries, we highlight that legalization itself can take multiple forms. Our ongoing research suggests that regulatory decisions such as allowing or restricting cannabis marketing and promotion, retail access, product types and cannabis potency can all influence cannabis use and related health outcomes post-legalization [10][11][12][13]. Consequently, as other countries proceed towards legalization, we caution that policies that allow higher levels of commercial access risk important population-level changes in cannabis use and consequent harms.…”

On offer to Ontario consumers three years after legalization: A profile of cannabis products, cannabinoid content, plant type, and prices

“…In the US, cannabis use is higher in states that have legalized cannabis, with dried cannabis being the most dominant form ( 5 ). It is too early to determine the impact of legalization in Canada as the legal market continues to evolve, but early evidence suggests increased use in adults, mixed effects in adolescent use and on driving under the influence of cannabis, increases in pediatric emergency room visits and hospitalizations, and decreases in arrests and convictions ( 6 – 13 ). Given the acute and long-term health risks associated with cannabis containing high levels of THC ( 14 – 17 ), documenting the potency of the cannabis products available in the legal market is of interest to public health.…”