Two drug-containing products of increasing public acceptance remain illegal — but perhaps not for long. If and when these products are legalized, proper policies and regulations should be implemented to minimize harm and promote health.
The first is marijuana, a flashpoint in the recent federal election and a source of the psycho-active drug THC. Currently, legal access is only through Health Canada’s highly controlled medical marijuana program. Changes by the previous Conservative government also disallowed new program participants from “growing their own.”
This seemingly coincided with a national increase in non-sanctioned storefront marijuana retailers, with some purveyors promoting marijuana for “health indications” far beyond evidence indicating a medical benefit.
Enforcement issues fall to policing agencies. However, faced with more than 100 marijuana retailers, the City of Vancouver is attempting control through comprehensive business licences. The requirements focus exclusively on the businesses’ operations and the character of the operators, as this is all that is legally allowed. Regulation of the actual product remains a federal responsibility.
A second currently illegal drug-containing product has garnered much less attention — electronic cigarettes containing nicotine, the primary psychoactive ingredient in tobacco. Health Canada does not authorize the importation or sale of e-cigarettes containing nicotine, as their safety, quality and efficacy remain unknown. As well, Health Canada has not approved any e-cigarette-manufacturer’s marketing of their product using health claims such as being a smoking cessation aid.
Despite this, e-cigarettes containing nicotine are readily available in a wide range of venues. The number of Canadian purveyors of e-cigarettes containing nicotine easily exceeds the number of marijuana retailers. (A leading U.S. financial analyst predicts sales of nicotine-containing e-cigarettes will surpass conventional cigarette purchases within a decade.) Enforcement falls to a small number of Health Canada inspectors whose availability is limited.
The Conservative government’s investment in achieving compliance with nicotine-containing e-cigarettes and marijuana regulations was, at best, uneven. A 2002 Canadian Senate report estimates that $200 million to $500 million was expended annually in administering Canadian marijuana laws.
Enforcement efforts aside, purveyors of both products are growing exponentially in economic clout and associated influence.
Currently, retail sales of these products are not subject to a “sin tax” as levied on conventional cigarettes. Consequently, the future tax-generation potential of these products also might serve as a motivation for legalization. There could also be considerable savings in curtailing current expenditures on policing and prosecutions.
We recommend future policies be forged only after considering the far-reaching impact of these drug-containing products on human health. Neither nicotine nor marijuana should be used by pregnant women, as their use could harm an unborn child’s brain development.
The area of the brain controlling judgment and decision-making is not fully developed until the mid-20s. The younger an adolescent begins using nicotine or marijuana, the more likely it is that drug dependence or addiction will develop in adulthood.
Both using e-cigarettes and smoking marijuana generate large amounts of fine particles, causing potential breathing problems in users and bystanders. Also, cancer-causing compounds have been found in the smoke/vapour.
As a smoking-cessation aid and harm-reduction tool for current adult smokers, e-cigarettes are unproven. Concerns about the uses of marijuana have been raised within mainstream medicine. For both products, there is a need for more research and medical education.
The enticingly flavoured liquid used in e-cigarettes and edible marijuana baked products and candies are particularly attractive to children and youth. Serious childhood nicotine poisonings from e-liquids and discarded cartridges are increasing. Edible marijuana product poisonings are up in American states that have legalized marijuana.
Neither e-liquids nor marijuana products are meeting Canadian standards for production or labelling. Manufacturers are not routinely documenting the widely varying concentrations of nicotine and THC.
If one or both products are made legal, we advocate for the early application of a public-health approach to policies and regulations, based on minimizing harm and promoting health.
If those products are legalized, Ontario’s Centre for Addiction and Mental Health provides a blueprint for legislation that should result in a net benefit to public health and safety while protecting those who are most vulnerable to harms from drug-containing products.
Regardless of regulatory outcome, evidence-based public education is a priority, especially for children and youth who are most susceptible to the harms from these products. If informed adults choose to use drug-containing products, risks might be reduced by delaying use until early adulthood, avoiding daily or near-daily use, and using less-potent products.
Dr. Richard Stanwick is the chief medical health officer for Island Health and the primary author of the Canadian Pediatric Society’s statement on e-cigarettes. Dr. Patricia Daly is the chief medical health officer for Vancouver Coastal Health and the primary public health consultant on regulation of medical-marijuana retail outlets for the City of Vancouver.
