Public Health and Cannabis

Canada boasts one of the highest cannabis usage rates in the world in spite of prohibition (Fischer, Kuganesan, & Room, 2015). Cannabis is also the most widely used illegal drug in the country by a wide margin (Hajidazeh, 2016). The complete decriminalization of cannabis in Canada would be unlikely to have any appreciable effect on raising rates of usage except potentially an initial spark of interest subsequent to the lifting of prohibition. Unfortunately, a dearth of literature exists on the actual effects of decriminalization given that the phenomenon has yet to occur, and given the fact that there are few case studies from other countries. The only country in the world to have outright legalized marijuana has been Uruguay; several other countries have relatively relaxed policies toward the drug but Canada's proposal to fully legalize would be revolutionary. This research can potentially contribute to the growing understanding of what consequences might arise with the legalization of cannabis in Canada.

Hypothesis: Fully legalizing cannabis in Canada would lead to public health benefits for all age cohorts, a more humanitarian approach to drug use, reductions in organized crime, and enhanced civil liberties for all Canadians.

Literature Review: Health

The Liberal government under Prime Minister Trudeau has made a statement confirming its commitment to legalizing cannabis, on the grounds that prohibition has not worked, that Canadians use the drug anyway, and that criminalization leads to gross human rights violations and violations of civil liberties (Lopez, 2016). Public acceptance of legalization reflects general acceptance of recreational marijuana use. The Government of Canada conducted a study showing not only that prohibition does not work, but also that most Canadians no longer support the existing criminalization of cannabis and are ready for a change. The report addresses the fact that organized crime is the primary recipient of prohibition, with billions of dollars in profits reaped from selling marijuana alone (Government of Canada, n.d.). The war on drugs model has also led to the unnecessary incarceration of innocent, nonviolent drug offenders. Therefore, legalization is viewed as having a projected net positive effect on Canadian society.

Research on the potential health effects of marijuana legalization is varied, but the area of personal and public health remains the primary area of research interest. Some caution that legalization may lead to increased use, but that potential increase in usage would easily be offset by the fact that a more widely available cannabis may divert users from more dangerous substances like opioids (Lake & Kerr, 2016). Cannabis in the literature is widely considered a relatively safe and soft drug, not linked to any known overdoses, and with only indirect negative effects such as driving under the influence. Research has also shown that cannabis has clear health benefits, which is why many states in the United States have medical marijuana programs and also why Canada has had a medical marijuana program too.

There is a low to moderate link between cannabis use and vehicle collisions, though, showing that the danger is not a significant factor in the decision-making process of whether or not to legalize (Lake & Kerr, 2016). Other potential adverse health effects from cannabis use, including lung cancer due to excessive smoking or impacts on mood disorders, can be mitigated via directly targeted interventions that would be paid for by tax revenues raised via legalization (Hajizadeh, 2016).

Because of prohibition, the overall health effects of legalization are as of yet unknown. However, empirical experimental studies have revealed promising trends. There is now a "great deal of consensus within the scientific community that cannabis is comparatively safer than a host of other commonly abused substances," many of which are legal including alcohol (Lake & Kerr, 2016).

The potentially harmful effects of legalization on children is discussed in some research. Although it is impossible to know in advance what the ramifications might be from legalization, it is already certain that Canada has the highest rate of cannabis use among teens and children, with as many as 28% of Canadians between the ages of 11 and 15 having used the drug within the past year (Hajizadeh, 2016). Perhaps the discourse on legalization needs to reframe the issue; young people are already using. Their use reflects general social trends, and the hugest risk posed to young people is not legalization but criminalization given the fact that young people using pot are buying it on the black market. Their exposure to black market systems of distribution can be more harmful than their potentially procuring government tested and regulated cannabis (Hajizadeh, 2016). The cannabis that would be legally tested and regulated by the government would also foreseeably be safer in the sense that users would know exactly what they were buying. Legalization of cannabis could also lead to the legalization of other drugs, thereby diminishing the stranglehold of the black market on mind-altering substances and making those substances and their distribution methods safer for all Canadians.

Literature Review: Legal and Political Ramifications

Although Canada does not have the prison overcrowding humanitarian crisis evident in the United States, criminalization can be framed as a human rights affront. The Government of Canada (n.d.) admits that thousands of Canadians are saddled with unnecessary criminal records for nonviolent offences each year. The research definitely shows that legalization of cannabis would lead to reductions in drug-related sentencing. The questions that may arise in future research will be how to address the sentences of already incarcerated individuals, or whether it would be a humanitarian move to remit them.

The political ramifications of legalization may be far more complicated than the legal ramifications. The American-driven war on drugs has become a global endeavor requiring a "series of treaties" between nations that enforce the global war on drugs through security measures and anti-trafficking endeavors (Lopez, 2016). The ramifications of Canada legalizing cannabis will be truly global in scope, and may lead to a domino effect whereby other nations partner to the prohibition treaty may also start to opt out of their responsibilities to usher in a new era in which cannabis is treated more sensibly (Lopez, 2016).

Research consistently shows that legalization will harm organized crime (Hajizadeh, 2016). Therefore, the legalization of cannabis could mean that law enforcement can redirect attention to the organized crime syndicates rather than focusing on low level users and distributors. Furthermore, legalization would liberate resources that are devoted to the war on drugs, instead channeling those funds into counterterrorism and other worthwhile goals.

Harm Reduction

Legalization would promote general harm reduction vis-a-vis drug use. Research that focuses on harm reduction shows that "any increases in cannabis use and harm could be minimised if governments introduced public health policies that limited the promotional activities of a legal cannabis industry, restricted cannabis availability to adults, and maintained cannabis prices at a substantial fraction of the black market price." (Hall & Lynskey, 2016, p. 900). This multi-pronged approach is common in the literature, indicating a well-devised strategy for harm reduction. Legalization would allow for greater consumer empowerment and transparency, but only so long as effective policies are put into place.

Proposed Research Overview

The proposed research attempts to add to the existing, but far from extensive, body of literature related to the ramifications of marijuana legalization. Because only one country has legalized pot, and because that country (Uruguay) shares little in common with Canada in terms of size and demographics, it would be unfair to use the preliminary data emerging from Uruguay to make any policy decisions in Canada. Similarly, only a few states in the United States have legalized cannabis for recreational use and those that have (Alaska, Colorado, Oregon, and Washington) did so only recently. No longitudinal data, especially no quantitative studies that could inform evidence-based health practices, yet exists. The current research attempts to establish a precedent for gathering longitudinal data on the effects of cannabis legalization, while also offering a framework for public policy.

The proposed research builds on the hypothesis that legalization of cannabis in Canada will have a net positive effect on all measures, including public health, civil liberties and humanitarian issues, and on global security. This research will begin with a qualitative and quantitative approach that will survey professionals in the areas of health care and public health, and also in law. Interviews with qualified professionals will also help address gaps in the literature, to allow policy makers to make more informed decisions.

This research differs from all prior research because there have yet to be any extensive studies on the impressions of healthcare workers, public health policy analysis and public health administrators, and attorneys toward marijuana legalization. The use of survey instruments allows for the quantification of the data, and the qualitative method of interviewing provide additional information that can be used to bolster the argument that legalization will have a net overall benefit for Canadian society.

Methods

From their respective political organizations including the Canadian Psychological Association, the Canadian Public Health Association, and the Canadian Bar Association, a list of potential survey participants will be gleaned. From this list, 500 individuals will be randomly selected from each professional organization. Only individuals who are active and in good standing within their professional organizations will be selected. An introductory letter outlining the purpose of the survey and/or interview will be mailed to each of these professionals, and it is hoped that response rates will be high to gain the largest possible population sample. Once they provide their informed consent, participants in this sample will be mailed a questionnaire. There will be three different questionnaires, one for each profession. The survey questions will vary depending on their areas of expertise. Questions will be phrased so that answers can be given on a Likert-type scale so that results can be quantified.

From the sample, a small number (n = 10) from each profession (Psychology, Public Health, and Law) will be randomly selected for an interview, which they had consented to earlier in the introductory letter. Those who assent to the interview will be asked questions about their personal opinions on how legalization of cannabis will impact their client cohort as well as their colleagues.

Questions for the legal professionals will relate to the Charter of Rights and Freedoms, the relationship between drug use and civil liberties, views on the legalization of all drugs versus only cannabis, and attitudes towards using the criminal justice system as a mental health proxy. All members of the Canadian Bar Association will be asked whether they have any experience handling drug-related offenses in the legal system, or whether they are aware of the legal issues surrounding legalization, to control for knowledge variables. Also asked will be their views on whether to commute the sentences of existing non-violent drug offenders, and whether amnesty might not be justified in this situation. Given the familiarity with the legal ramifications of cannabis legalization, some attorneys will be able to offer policy makers a sound way forward as Canada is poised to legalize cannabis. Similarly, attorneys will be asked to comment on their opinions on Canada's opting out of the global treaties that bind the country to the failing war on drugs, and will be asked their opinion on the war on drugs in general.

Questions for public health administrators will cover the gamut of topics related to the legalization of cannabis. Referring to prior studies on how cannabis use in general impacts public health, questions will focus on their anticipated role in mitigating harm, their role in public relations and public health awareness campaigns, their role in working with schools to prevent harm, and their role in working with communities to develop effective public health institutions. All members of the Canadian Public Health Association will be asked about their prior experience with cannabis-related public health programs or the issues surrounding harm reduction and substance abuse in their work. The attitudes of public health administrators may already be based on information and data gleaned from empirical studies, and therefore the survey results from this cohort may be extremely useful for future policy analysts.