Daniel Myran is a family physician based in Ottawa who is currently completing a Master’s of Public Health at Harvard University, where his research focus is on alcohol-control policy in Ontario. Ryan Forrest is an international tobacco control policy officer at an Ottawa-based NGO who holds an MSc in Global Health and Public Policy from the University of Edinburgh, where her research focused on alcohol marketing to youth in Ontario.
Canada’s plans for marijuana legalization are gradually coming into sharper focus. Bill C-45, or the Cannabis Act, is now at its second reading in the Senate, and federal legislation legalizing marijuana use and sale is anticipated to be finalized this summer. Many of the details of what “legalization” will entail have been left to the provinces, including licensing and overseeing of the sale and distribution of marijuana, and those are now being released.
What we won’t know, however, is the long-term public health impacts of marijuana legalization, at least for many years—though we can make a pretty good guess at how to best minimize potential harms based on Canada’s decades of experience regulating alcohol and tobacco. But as we learn more details of Canada’s approach to marijuana legalization, we worry that these lessons have been ignored—and that the current approach risks creating a highly commercialized and predatory marijuana industry.
Canada’s approach to regulating both tobacco and alcohol has been starkly different. Tobacco regulation has focused on reducing use with eventual elimination. All forms of marketing are banned, and tobacco packages themselves include graphic health warnings; soon, all tobacco products may be sold in uniform plain packages. Smoking is banned in all indoor public places, and years of raising public awareness has changed social perceptions of tobacco use from glamorous to distasteful.
Alcohol regulation, meanwhile, has promoted “socially responsible use.” Alcohol is widely promoted and advertised, faces less strict regulation, and is seen in a more positive light than tobacco. Although marketing of alcohol to youth is technically illegal, adherence to national regulations is self-regulated by industry; independent investigations have found that alcohol-industry advertising consistently violates self-imposed codes. Further, Canada hasn’t updated its alcohol marketing standards since 1996, meaning that there is no regulation of alcohol marketing in media beyond TV and radio (i.e. the internet). In recent years, alcohol companies have massively expanded alcohol promotion through social media, and research suggests that this marketing is normalizing binge and underage drinking.
The impacts of these differing regulatory approaches speak for themselves. Canada is a global leader in tobacco control. The percentage of the Canadian population that smokes daily has declined from 33 per cent in 1980 to 15 per cent in 2013. Current conversations regarding tobacco regulation envision a tobacco “end game” in which just five per cent of the Canadian population smokes by 2035. Tobacco regulation, in short, has been one of our great public health achievements.
In contrast, Canada has the fourth-highest rate of binge drinking in the developed world, and is one of the few high-income countries where the amount of alcohol consumed per person is increasing. Eighty per cent of Canadians drink alcohol regularly, and one quarter of youth aged 12-17 drank in the past year. The societal impacts of alcohol use in Canada are enormous. A recent report found that in 2016, alcohol led to more hospitalizations in Canada than heart attacks.
At first glance, the marketing regulations in the federal Cannabis Act sound reasonable. They prohibit the “promotion, packaging and labelling of cannabis that could be appealing to young persons.” This is, however, nearly identical to language included in existing alcohol regulation, for which the alcohol industry has found plenty of loopholes. The act also does not specify how marketing standards will be enforced. Ontario has offered little additional guidance on how the province plans to regulate marijuana marketing, and may be leaving it to the federal government. Troublingly, the cannabis industry has proposed a system of voluntary marketing guidelines, similar to those currently used for alcohol marketing. It would be naive to expect industry compliance with voluntary advertising standards for marijuana, given the alcohol industry’s poor track record.
Prior experience from big tobacco and commercial alcohol suggests that these industries aggressively target youth to create lifelong customers. This pattern is particularly concerning since the health impacts of marijuana disproportionately affect users under the age of 25. Multiple studies have found an association between marijuana use and mental health, including one where individuals who reported smoking marijuana even once had over twice the risk of developing schizophrenia compared to those who had not. Another study found a 60-per-cent reduction in high-school graduation rates among regular users of marijuana. Though there is still some uncertainty, there are real concerns that marijuana use can irreparably damage the developing brains of teenage users.
The strongest argument raised in favour of legalization is that Canadian youth have one of the highest rates of cannabis use in the world and that the status quo is failing—and we agree. But our approach to alcohol regulation, which is the model that Canada’s legal-marijuana plan is copying, is similarly failing to prevent use in underage users, the exact population we are most concerned that marijuana will harm.
Though we embrace the legalization of marijuana, primarily to reduce harms associated with criminalization, Canada must apply the lessons learned from tobacco and alcohol control to marijuana to prevent the commercialization of the industry and the aggressive promotion of marijuana products that will follow. Provincial governments still have the opportunity to protect the health of the population by closing regulatory gaps in the federal bill. At a minimum, the provinces must ensure that marketing standards are mandatory with heavy penalties for violations. Preventing all marketing of marijuana, and requiring plain packaging as recommended by the federal task force on cannabis legalization and regulation, would be best. With so much remaining up in the air on marijuana regulation, we would be well-served to look at the established history of regulating similar substances—and see where we went right or wrong.
Correction: A previous version of this post said multiple studies found an association between marijuana use and schizophrenia; this was meant to read “marijuana use and mental health.”
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