Guidelines for public health and safety metrics to evaluate the potential harms and benefits of cannabis regulation in Canada

Lake, Stephanie; Werb, Dan; Haines‐Saah, Rebecca; Fischer, Benedikt; Thomas, Gerald; Walsh, Zach; Ware, Mark A.; Wood, Evan; Milloy, M‐J

doi:10.1111/dar.12971

Cited by 23 publications

(38 citation statements)

References 86 publications

(243 reference statements)

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“…Harm-to-others such as violence constitutes an essential outcome to monitor in a public health perspective (7,11). There are two main positions that have prevailed as to the consequence cannabis use policies might have on violence outcomes that depends chiefly on the impact these policies have on cannabis use as well as the mechanism by which cannabis and violence are associated (e.g.…”

Section: Overview Of Potential Mechanisms Explaining Violent Behaviormentioning

confidence: 99%

“…psychophysiological effects versus social context described below). Hence, although literature remains inconclusive, it has been hypothesized that there may be an increase in the number of cannabis users following the legalization of medical and recreational cannabis more particularly for adult samples (4)(5)(6)(7)39). Accordingly, for illustrative purposes, considering an expected increase of cannabis use:…”

Section: Overview Of Potential Mechanisms Explaining Violent Behaviormentioning

confidence: 99%

“…lessening the penalties for cannabis offenses) or legalizing its use for medical or recreational purposes (3,4). Following these policy changes, although literature remains inconclusive and very preliminary with some studies having found no effect, there is some evidence that has also suggested a certain increase of cannabis use in some age groups such as young adults and older adult populations (4)(5)(6)(7). Some data likewise suggested changes in frequency of use following recreational cannabis legalization in the U.S. with findings showing a small increase in adolescent CUD and increases in past-month cannabis use, past-month frequent cannabis use, and past-year CUD among adults over 26 years (8).…”

Section: Introductionmentioning

confidence: 99%

“…Of note, studies, furthermore, suggest that cannabis has grown more potent as measured by the proportion of D 9 -tetrahydrocannabinol (THC) content in relation to cannabidiol (CBD) content (THC to CBD ratio) (9,10). Accordingly, with policy changes, there has been increased attention into cannabis-related harms such as motor vehicle accidents, emergency medical attendances and hospitalizations, severe mental disorders (SMD) as well as suicides (1,7). Harm-to-others including injuries from violence have nevertheless been unfortunately largely overlooked (11).…”

Section: Introductionmentioning

confidence: 99%

“…(13)(14)(15)(16)(17)(18)(19)(20)], there is meta-analytical evidence pointing towards an association. Particularly with liberalization policies aiming for public health and safety while using cannabis, harm-to-others should constitute an essential element for outcome monitoring (7,11). The aims of this focused review are two-fold: (I) review evidence from meta-analyses on the association between cannabis and violence; and (II) provide an overview of possible mechanisms relating cannabis use to violence.…”

Section: Introductionmentioning

confidence: 99%

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Violence and Cannabis Use: A Focused Review of a Forgotten Aspect in the Era of Liberalizing Cannabis

et al. 2020

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There has been a shift surrounding societal and legal perspectives on cannabis reflecting changing public attitudes towards the perceived safety and social acceptability of cannabis use. With cannabis liberalization internationally, the focus of most cannabisrelated harms has been on effects with users themselves. Harm-to-others including injuries from violence have nevertheless been unfortunately largely overlooked. While studies remain heterogeneous, there is meta-analytical evidence pointing towards an association. The aims of this focused review are twofold: (I) review the evidence from meta-analyses on the association between cannabis and violence; and (II) provide an overview of possible mechanisms relating cannabis use to violence. First, evidence from meta-analytical studies in youths, intimate partners, and individuals with severe mental disorders have shown that there is a global moderate association between cannabis use and violence, which is stronger in the latter more at-risk population. Preliminary data has even highlighted a potential dose-response relationship with larger effects in more frequent users. Although of importance, this subject has remained essentially forgotten as a public health concern. While literature remains inconclusive, data has suggested potential increases in cannabis use following liberalization policies. This may increase violent outcomes if the effect is directly related to the use of cannabis by means of its psychophysiological modifications. However, for the moment, the mechanisms associating cannabis use and violence remain to be clearly resolved. Considering the recency of policy changes on cannabis, further methodologically sound research using longitudinal designs should examine the effects that cannabis use may have on different forms of violence and the trends that emerge, while evaluating the effects of possible confounding factors (e.g. other substance use). In addition, as evidence-based research from meta-analyses have shown that cannabis use is associated with violence, measures must be taken to mitigate the risks.

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Section: Overview Of Potential Mechanisms Explaining Violent Behaviormentioning

confidence: 99%

Section: Overview Of Potential Mechanisms Explaining Violent Behaviormentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Violence and Cannabis Use: A Focused Review of a Forgotten Aspect in the Era of Liberalizing Cannabis

et al. 2020

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Evaluation of State Cannabis Laws and Rates of Self-harm and Assault

et al. 2021

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Key Points Question Are state cannabis legalization laws with varying degrees of commercialization associated with rates of self-harm or assault injuries? Findings In this cohort study based on health insurance claims data from 75 395 344 beneficiaries between 2003 and 2017, rates of self-harm injuries among males younger than 40 years increased more in states legalizing recreational cannabis dispensaries compared with states without cannabis legalization laws. For other age and sex groups and for more restrictive legalization approaches, no association with self-harm and assault was found. Meaning States with recreational cannabis may benefit from monitoring levels of self-harm as a potential consequence of legalization.

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Health, safety, and socioeconomic impacts of cannabis liberalization laws: An evidence and gap map

Sevigny,

Greathouse,

Medhin

2023

Campbell Systematic Reviews

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BackgroundGlobally, cannabis laws and regulations are rapidly changing. Countries are increasingly permitting access to cannabis under various decriminalization, medicalization, and legalization laws. With strong economic, public health, and social justice incentives driving these domestic cannabis policy reforms, liberalization trends are bound to continue. However, despite a large and growing body of interdisciplinary research addressing the policy‐relevant health, safety, and socioeconomic consequences of cannabis liberalization, there is a lack of robust primary and systematic research that comprehensively investigates the consequences of these reforms.ObjectivesThis evidence and gap map (EGM) summarizes the empirical evidence on cannabis liberalization policies. Primary objectives were to develop a conceptual framework linking cannabis liberalization policies to relevant outcomes, descriptively summarize the empirical evidence, and identify areas of evidence concentration and gaps.Search MethodsWe comprehensively searched for eligible English‐language empirical studies published across 23 academic databases and 11 gray literature sources through August 2020. Additions to the pool of potentially eligible studies from supplemental sources were made through November 2020.Selection CriteriaThe conceptual framework for this EGM draws upon a legal epidemiological perspective highlighting the causal effects of law and policy on population‐level outcomes. Eligible interventions include policies that create or expand access to a legal or decriminalized supply of cannabis: comprehensive medical cannabis laws (MCLs), limited medical cannabidiol laws (CBDLs), recreational cannabis laws (RCLs), industrial hemp laws (IHLs), and decriminalization of cultivations laws (DCLs). Eligible outcomes include intermediate responses (i.e., attitudes/behaviors and markets/environments) and longer‐term consequences (health, safety, and socioeconomic outcomes) of these laws.Data Collection and AnalysisBoth dual screening and dual data extraction were performed with third person deconfliction. Primary studies were appraised using the Maryland Scientific Methods Scale and systematic reviews were assessed using AMSTAR 2.Main ResultsThe EGM includes 447 studies, comprising 438 primary studies and nine systematic reviews. Most research derives from the United States, with little research from other countries. By far, most cannabis liberalization research focuses on the effects of MCLs and RCLs. Studies targeting other laws—including CBDLs, IHLs, and DCLs—are relatively rare. Of the 113 distinct outcomes we documented, cannabis use was the single most frequently investigated. More than half these outcomes were addressed by three or fewer studies, highlighting substantial evidence gaps in the literature. The systematic evidence base is relatively small, comprising just seven completed reviews on cannabis use (3), opioid‐related harms (3), and alcohol‐related outcomes (1). Moreover, we have limited confidence in the reviews, as five were appraised as minimal quality and two as low quality.Authors’ ConclusionsMore primary and systematic research is needed to better understand the effects of cannabis liberalization laws on longer‐term—and arguably more salient—health, safety, and socioeconomic outcomes. Since most research concerns MCLs and RCLs, there is a critical need for research on the societal impacts of industrial hemp production, medical CBD products, and decriminalized cannabis cultivation. Future research should also prioritize understanding the heterogeneous effects of these laws given differences in specific provisions and implementation across jurisdictions.

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Guidelines for public health and safety metrics to evaluate the potential harms and benefits of cannabis regulation in Canada

Cited by 23 publications

References 86 publications

Violence and Cannabis Use: A Focused Review of a Forgotten Aspect in the Era of Liberalizing Cannabis

Violence and Cannabis Use: A Focused Review of a Forgotten Aspect in the Era of Liberalizing Cannabis

Evaluation of State Cannabis Laws and Rates of Self-harm and Assault

Health, safety, and socioeconomic impacts of cannabis liberalization laws: An evidence and gap map

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