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TheVoiceofPublicHealth

OCTOBER 2017 | A PUBLIC HEALTH APPROACH TO CANNABIS: COMMUNITY CONSULTATION

A PUBLIC HEALTH APPROACH TO CANNABIS

NORMALIZING CONVERSATION, NOT CONSUMPTION


OCTOBER 2017 | A PUBLIC HEALTH APPROACH TO CANNABIS: COMMUNITY CONSULTATION 2

WELCOME

WewouldliketobeginbyacknowledgingthatthelandonwhichwegatheristheuncededterritoryoftheCoastSalishpeoples,includingtheterritoriesofthexʷməθkwəy̓əm(Musqueam),Skwxwú7mesh(Squamish),Stó:lōandSəl Mí

lwətaʔ/Selilwitulh(Tsleil-Waututh)Nations



OPENING AND INTRODUCTIONS


AN INFORMED APPROACH TO CANNABIS PROGRAMS & SERVICES

A COMMUNITY RESPONSE TO CANNABIS

CLOSING AND NEXT STEPS

TODAY

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PARTICIPANT ROUNDTABLECONSULTATION OBJECTIVES

CONSULTATION GROUND RULES


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Whatisyournameandroleinyourorganization?

Whatconnectsyoutothetopicofcannabisuse?

PARTICIPANT ROUNDTABLE




Today’sconsultationisdesignedtomeetthefollowingobjectives:1) Reflectonpersonalthoughtsrelatedtocannabislegalizationand

cannabisuse2) Discusscurrentevidencebaserelatedtocannabisandadesired

publichealthapproach3) Discusscurrentanddesiredapproachtocannabismonitoring

andsurveillanceinthecommunity4) Considerhowhealthandsocialserviceproviderscanrespondto

cannabisusetodayandhowlegalizationmayimpacthowserviceproviderscanrespondtocannabisuseinthecommunityinthefuture

CONSULTATION OBJECTIVES




Today’ssessionisdesignedtoenabledialoguebetweenhealthandsocialserviceproviderswithdiverseprofessionsandbackgrounds:1) Ifyouwouldfeelmorecomfortableatanothertable,

pleasefeelfreetorelocatewithdiscretion2) Ifthereisaconflictatthetablethatyouwouldlikehelp

resolving,orisaffectingyourabilitytoparticipatefully,pleasefeelfreetospeakprivatelywithanyoftheCPHAorconsultationteam

CONSULTATION GROUND RULES



CPHA PROJECT CANNABIS PRIMER

CANNABIS USE DEMOGRAPHICSRESEARCH EVIDENCE

HEALTH PROMOTION & HARM REDUCTION


2



CPHA PROJECT


10OCTOBER 2017|APUBLICHEALTHAPPROACHTOCANNABIS:COMMUNITYCONSULTATION




TheGovernmentofCanadahasannouncedthatitwillintroducelegislationtolegalizeandregulatecannabis

Thegrowingacceptance,accessibility,anduseofcannabisraiseimportantpublichealthconcerns

TheCanadianPublicHealthAssociationismobilizingapublichealthapproachtocannabislegalization

CPHA PROJECT




ShouldtheproposedCannabisActactcomeintolawinJuly2018,eachprovinceandterritorywillbelefttomaketheirownchoicesonseveralkeyitems,forexample:Age: minimumageof18yrs (discretiontoincrease)

Personal cultivation: numberofpersonalplants(4)(furtherrestrictionscanbeapplied)

Consumption: whereandhowcannabismaybeconsumed(restrictionsandrequirementstobesetlocally)

CPHA PROJECT




CurrentBills(FirstReadings,April13,2017):BILL C-45: AnActrespectingcannabisandtoamendtheControlledDrugsandSubstancesAct,theCriminalCodeandotherActs

BILL C-46 - Impaired driving as it relates to substances including cannabis: AnActtoamendtheCriminalCode(offencesrelatingtoconveyances)andtomakeconsequentialamendmentstootherActs

CPHA PROJECT




Thegoalforthisprojectistoimprovethecapacityofthehealthandsocialservicesectortorespondtocannabisuse(andothersubstances)incommunitiesacrossCanadausingapublichealthapproach

Theaimisto‘normalizeconversation,notconsumption’

CPHA PROJECT




Toassesstheneedsofhealthandsocialserviceprovidersandinformthedesignofcapacitybuildingresources,theprojectismobilizingthefollowing:1) Ongoingenvironmentalscanning2) Keyinformantinterviews3) Communityconsultations4) An‘ExpertReferenceGroup’

CPHA PROJECT




CPHA project team: keyinformantinterviewsandongoingenvironmentalscanningtoinformandcreatecapacitybuildingresourcesGestalt Collective (GC): contentcreation,design,facilitationandreportingforcommunityconsultationsandExpertReferenceGroupengagementsSocial Research and Demonstration Corporation (SRDC): projectevaluationthoughdatacollectionacrossallofthecommunitiesconsultedandtheExpertReferenceGroup

CPHA PROJECT



This is a pivotal time in the world of cannabis policy and research. Shifting public sentiment, conflicting and impeded

scientific research, and legislative battles have fueled the debate about what, if any, harms or benefits can be attributed to the

use of cannabis or its derivatives.

NationalAcademiesofSciences,Engineering,andMedicine.2017.TheHealthEffectsofCannabisandCannabinoids:TheCurrentStateofEvidenceandRecommendationsforResearch.Washington,DC:TheNationalAcademiesPress.




Theprojectendeavourstomobilizethehealthandsocialserviceprovidercommunitytotakeapublichealthapproachtocannabis,that:• emphasizesevidence-informed,pragmaticinitiatives• takesintoconsiderationsocialjustice,equity,respectfor

humanrights,efficiency,andsustainability• recognizesthatproblematicsubstanceuseisoften

symptomaticofunderlyingpsychological,social,orhealthissuesandinequities

CPHA PROJECT




CPHA PROJECT

CANNABIS USE/ CONSUMPTION

AUTHORIZED FOR MEDICINAL

PURPOSESRETAIL

PERSONAL GROWINGILLEGAL



CANNABIS PRIMER




Cannabisisaplantthathasmanyderivativesincludingmarijuana,hash,hemp,andmanymore

Thetwomainactiveingredientsincannabisare:

• THC (delta-9 tetrahydro-cannabinol or d-9-TCH): thepartoftheplantthatgivesthe"high”

• CBD (cannabidiol): analgesic,anti-inflammatory,andanti-anxietypropertieswithoutthepsychoactiveeffects(the“high”)thatTHCprovides

Themostcommonformsofcannabisareconcentrates,ediblesandflower

CANNABIS PRIMER




Flower:Onceafemalecannabisplanthasmatured,growerstrimtheflowerstoproducewhatarereferredtoasbudsThebudsarecoatedwithacrystal-likeresincalledtrichomes andarerichwithTHCandCBDTherearetwostrainsofflower– sativaandindica – andhybrids,whichareacombinationofthetwostrains

CANNABIS PRIMER




Concentrates:Procuredduringanextractionprocesswherethecannabisplants’cannabinoidsandterpenesareseparatedfromtheplantmatterresultinginaconcentratethatispackedfullofcannabinoids(morepotentthanflower)Cannabisconcentratesarecategorizedaseithersolventornon-solventbased(referstotheextractionprocess)• Solvent concentrates areextracted(mostcommonly)usingbutane,CO2,alcoholorethanoltoproduceshatter,wax,hashoil,tincturesandmore

• Non-solvent concentrates areextractednaturallytoproduce(mostcommonly)icewater,hashandkief

CANNABIS PRIMER




Edibles:

Anyfoodorbeveragethatcontainscannabis,whetherornotthecannabinoidsarebioavailable

Mostoften,ediblesareinfusedusingingredientshighinfatlikebutteroroliveoilthatenableextractionoftheplant’sproperties

CANNABIS PRIMER




Therearethreebasiccannabisdeliverymethods,eachwithavarietyoftechniquesusingdifferentformsofcannabisandhardwareortoolstofacilitateconsumption:1) Inhalation2) OralorIngestion3) Topical

CANNABIS PRIMER



WATER PIPE

HAND PIPE

HOOKAH

ROLLING PAPERS

VAPORIZER

G-PEN




InhalationDeliveryMethods• Mostcommonwaypeopleusecannabiswithmanystrains

andproductstochoosefrom(e.g.cannabisflowers,concentratesandoils)

• THCandothercannabiscompoundsareabsorbedintothesystemthroughinhalingvaporizedorcombustedcannabisintothelungs

• Onsetofeffectsisrapidwithmostpeoplefeeling“high”within5-10minutesofinhalation

• Straingeneticsandpersonalbodychemistrymakethisuniqueforeveryone

CANNABIS PRIMER



CHOCOLATE

CANDIES

HARD CANDY

SODA

TINCTURE

OIL




Oral/IngestionDeliveryMethods• Ingestibleproductsincludecannabis-infusedediblesand

beverages• Duringconsumptionofcannabisproducts,cannabinoidsare

absorbedthroughthedigestivetractandmetabolizedbytheliver• Duetocannabinoidsandothercompoundsneedingtobebroken

downinthedigestivesystem,onsetofeffectscantakeupto2hours(muchlongerthaninhalation)

• Therearemanyfactorsthatcanaffecttheexperiencewithediblesincludingwhethersomeonehaseatenrecently,howmuch,comfortlevelwithcannabisandthepotencyoftheproductingested

CANNABIS PRIMER




OralDeliveryMethods• Thefastestandmosteffectivemethodofmedicatingis

oral-mucosal,administeredunderthetongueandintotheliningofthemouth

• Absorbedintothebodyversusswallowedanddigested• Cannabistincturesarethemostcommonproductstouse

oral-mucosaldelivery• Duetotherapidonsetofeffects,thisisthepreferred

deliverymethodformanyseriousmedicalconditionslikeepilepsyandnervoussystemdisorders

CANNABIS PRIMER




• Oral/IngestionDeliveryMethods• C-45doesnotallowforfood-basedordrink-basededibles

tobemarketedandsold• Tinctures(takenorallyorsublingually)willbeallowedand

arecurrentlybeingsold

CANNABIS PRIMER



SALVE

BODY CREAM

HARD CANDY

BATH SOAK PLEASURE OIL

CREAM SHAMPOO




TopicalDeliveryMethods• Commontopicalproductsincludebalms,oils,rubs,salves

andcreams• Topicalcannabisproductsareappliedandabsorbed

throughtheskin• Theeffectsofthecannabinoidsandothercompoundsare

localizedandcannotenterthebloodstreamsothereisno“high”fromtheseproducts

• Topicalproductscanofferrelieffrompain,inflammationandskinconditionslikeeczema

CANNABIS PRIMER



CANNABIS USE DEMOGRAPHICS





43%PercentageofCanadians(15+)thatreportusingcannabisinlifetime

12.2%PercentageofCanadians(15+)thatreportusingcannabisinpastyear

1.8%PercentageofCanadians(15+)thatreportusingcannabisdaily

3.2%PercentageofCanadians(15+)thatreportusingcannabisatleastweekly





8.3%

16.1%PercentageofmaleCanadians(15+)thatreportusingcannabisinpastyear

PercentageoffemaleCanadians(15+)thatreportusingcannabisinpastyear

Inallagegroupsexcept15to17,malesweremorelikelythanfemalestoreportpast-yearuse.

2.4%PercentageofmaleCanadians(15+)thatreportusingcannabisdaily

1.2%PercentageoffemaleCanadians(15+)thatreportusingcannabisdaily



14.2%



PercentageofBCadults(15+)thatreportusingcannabisinlifetime

10.5%

18.0%

PercentageofBCadults(15+)thatreportusingcannabisinpastyear

PercentageofmaleBCadults(15+)thatreportusingcannabisinpastyear

PercentageoffemaleBCadults(15+)thatreportusingcannabisinpastyear

46.2%




• BCYouths(15– 24):• 28% of BC youths have used cannabis in the past year• 30.8% of males and 25% females used in the past year• 11% reported cannabis abuse or dependence at any

point in their lives





• VancouverYouths(Grades9-12,2013):• 17% of youth had tried cannabis (2013), down from 24%

in 2003• 49% were 15 or older the first time they used cannabis

(up from 34% in 2003)• 54% of those who had tried cannabis had used it in the

past month (2013)• 9% had driven after using cannabis





Cannabisdependenceischaracterizedbyarecurrentpatternofusewhereatleastthreeofthefollowingoccurina12monthperiod:


• Increasedtolerance• Withdrawal• Increasedconsumption• Unsuccessfulattemptstoquit• Alotoftimelostrecoveringor

using• Reducedactivities• Continuedusedespite

persistentphysicalorpsychologicalproblemscauseorintensifiedbycannabisuse




Cannabisabuse*ischaracterizedbyarecurrentpatternofusewhereatleastoneofthefollowingoccurs:


• Failuretofulfillmajorrolesatwork,school,orhome• Useinphysicallyhazardoussituations• Recurrentcannabisrelatedproblems,orcontinuedusedespite

socialorinterpersonalproblemscausedorintensifiedbycannabisuse

*Bydefinition,thosewhomeetthecriteriaforcannabisdependenceareexcludedfrommeetingthecriteriaforcannabisuse




• InCanada,relativetootherdevelopedcountries,thereisahigherproportionofcannabisusersamongyouthaged15-25

• Youthwhoconsumeonaregularandheavybasisbeforeage15areatagreaterriskofnegativephysicalandmentalhealthoutcomes

• Therisk(negativephysicalandmentalhealthoutcomes)remainselevateduntilbrainmaturationatage25

• Delayingtheonsetofcannabisusehasbeenshowntoreducetheriskoffuturesubstancedependenceandotherassociatedchallenges



46OCTOBER 2017|APUBLICHEALTHAPPROACHTOCANNABIS:COMMUNITYCONSULTATION 46

RESEARCH EVIDENCE




• Whilethereissomeevidencefortheassociationbetweencannabisuseandhealthrisksorharms,theevidenceisnotconclusiveandrangesfrommoderatetosubstantial

• Wedonotknowtheamountofcannabisneededtocausethesehealthortherapeuticeffects• For example, is it only for daily/heavy users?• If you stop using, do health or therapeutic effects

disappear?

RESEARCH EVIDENCE




Someoftheareaswherewehavemoderateevidencetosupportanassociationbetweencannabisuseandhealthrisksandharms:• Impairmentinthecognitivedomainsoflearning,memory,

andattention(acutecannabisuse)

• Asmallincreasedriskforthedevelopmentofdepressivedisorders

• Increasedincidenceofsocialanxietydisorder(regularcannabisuse)

RESEARCH EVIDENCE

TheHealthEffectsofCannabisandCannabinoids:Committee’sConclusions.January,2017.TheNationalAcademiesofSciences,Engineering,Medicine.Washington,DC




Someoftheareaswherewehavemoderateevidencetosupportanassociationbetweencannabisuseandhealthrisksandharms:• Increasedincidenceofsuicidalideationandsuicide

attemptswithahigherincidenceamongheavierusers

• Worseningofnegativesymptomsofschizophrenia(e.g.bluntedaffect)amongindividualswithpsychosis

• Increasedsymptomsofmaniaforthosewithbipolardisorder

RESEARCH EVIDENCE





Someoftheareaswherewehavemoderateevidencetosupportanassociationbetweencannabisuseandhealthrisksandharms:• Increasedriskofoverdoseinjuries,includingrespiratory

distress,amongpediatricpopulationsinU.S.stateswherecannabisislegal

• Bettercognitiveperformanceforpeoplewithpsychoticdisordersandhistoryofuse

RESEARCH EVIDENCE





Someoftheareaswherewehavesubstantialevidencetosupportanassociationbetweencannabisuseandhealthrisksandharms:• Worserespiratorysymptomsandmorefrequentchronic

bronchitisepisodes(long-termcannabissmoking)• Thedevelopmentofschizophreniaorotherpsychoses,with

thehighestriskamongthemostfrequentusers• Increasedriskofmotorvehiclecrashes• Lowerbirthweightofoffspring*

RESEARCH EVIDENCE





Someoftheareaswherewehavesubstantialevidencetosupportanassociationbetweencannabisuseandhealthrisksandharms:• Lowerbirthweightofoffspring*• Thisconclusionreliedonprimarystudiesandoneoftwo

systematicreviewspublishedin2016• Asecondsystematicreviewandmeta-analysisonthistopic

controlledfortobaccouseanddidnotfindastatisticallysignificanteffectofcannabisonbirthweight

RESEARCH EVIDENCE

ConnerSN,Bedell V,Lipsey K,Macones GA,CahillAG,Tuuli MG.Maternalmarijuanauseandadverseneonataloutcomes:asystematicreviewandmeta-analysis.Obstet Gynecol.2016;128(4):713-23.GunnJK,RosalesCB,CenterKE,NunezA,GibsonSJ,ChristC,etal.Prenatalexposuretocannabisandmaternalandchildhealthoutcomes:asystematicreviewandmeta-analysis.BMJOpen.2016;6(4):e00986.




Possibletherapeuticeffectsofcannabisusecurrentlybeingstudiedinclude:• Treatmentforchronicpain• Treatmentofnausea• Improvingshort-termoutcomesforthosewithsleep

disturbances• Treatmentofmultiplesclerosis-relatedsymptoms

RESEARCH EVIDENCE




ACTIVITY 1: (10 MIN)REFLECTION ON CURRENT RESPONSE

TO CANNABIS

• Readthequestionsandcaptureyourthoughtsinthespaceprovided

• Bepreparedtosubmityournotestothefacilitators



BREAK



HEALTH PROMOTION AND HARM REDUCTION




Expertsidentifytheneedforanapproachtocannabisrelatedhealthpromotionmessagingthat(CPHA,2017;Rottach etal.,2009):• Includesharms,butdoesnotexaggerateorfixateonthem• Focusesontheplaceofcannabisinaperson’slifeandtheir

goalswithuse





• Harmreductionreferstothepoliciesandpracticesfocusedonreducingtheproblematiceffectsofalcoholandotherdruguse(Ericksonetal.,2002)

• Harmreductionistheonlyglobaldrugpolicyresponsethathasproventosavelivesandmoneyatthesametimeasincreasingqualityoflife(Stone&Sander,2016)

• Examplesoffamiliarharmreductioninterventions:seatbelts,airbags,helmets,SmartServe,needleexchangeprograms,smoke-freepublicspaces





• Afocusontheharmsnotonthesubstance

• Acceptancethattherearebenefitsandconsequencesofsubstanceuse

• Afocusondecreasingmoreimmediateharmsversusstrivingforadrugfreesociety

• Theneedtogivepeoplechoiceandaccesstoabroadrangeofoptionsforsafetyandhealth

• Afocusonwhatthepersonseesastheirmostimmediate need

• Acceptancethatsmallgainsaddupovertime

• Recognitionthatpeopleknowwhatisbestforthem

• Recognitionthatpeoplearedoingthebesttheycan withwhattheyhave





Examplesofcannabisharmreductionstrategies(CentreforAddictionsResearchofBC,2012):• “Beforeyoustart beclearaboutwhyyouwanttouse;be

sureyoutrustyoursource;tryasmallamounttotestthestrength”

• “Whenusingcannabis bediscreet;avoidcannabissmokeifpossible;preventburnsonyourlipsorfingers;takeshallowpuffs,notdeepinhalations;leavetobaccooutofthemix”

• “Ifeatingordrinkingcannabis takeyourtime”• “Cannabisanddriving don’tmix,stayawayfromthe

steeringwheel”





Canada’sLower-RiskCannabisUseGuidelines(LRCUG):• PublishedJune23rd 2017in

AmericanJournalofPublicHealth• Brochureforthepubliccurrently

availableonCentreforAddictionandMentalHealthwebsite





RecommendationsfromCanada’sLowerRiskCannabisUseGuidelines(LRCUG):1. Cannabisusehashealthrisksbestavoidedbyabstaining2. Delaytakingupcannabisuseuntillaterinlife3. Identifyandchooselower-riskcannabisproducts4. Don’tusesyntheticcannabinoids5. Avoidsmokingburntcannabis—choosesaferwaysofusing





RecommendationsfromCanada’sLowerRiskCannabisUseGuidelines(LRCUG):6. Ifyousmokecannabis,avoidharmfulsmokingpractices7. Limitandreducehowoftenyouusecannabis8. Don’tuseanddrive,oroperateothermachinery9. Avoidcannabisusealtogetherifyouareatriskformental

healthproblemsorarepregnant10. Avoidcombiningtherisksidentifiedabove





Considerationsforapublichealthapproachtoregulation:• Production,distributionandconsumptionofcannabisare

interrelated• Regulation“shouldavoidtrivialization”andnotproduce

setbacksinotherareasofpublichealth(e.g.renormalizingsmoking)

• Goalsofcommercializationconflictwithgoalsofpublichealth(i.e.profitandmarketsharevs.harmreductionandusereduction)





GoodToKnowColorado:MarijuanainColorado,ColoradoDepartmentofPublicHealthandEnvironment,UnitedStates• State-widepublicawarenesscampaigninformingresidents

andtouristsofColoradospecificcannabislaws,harmreductionandhealthpromotionmessages,healtheffectsandyouthprevention

• Incollaborationwith:• Localmediavendor• Focusgroupresearchwithtargetaudiences• Youthadvisorycommittee





GoodToKnowColorado:MarijuanainColorado,ColoradoDepartmentofPublicHealthandEnvironment,UnitedStates• Aprospectivecohortstudyfoundaccurateknowledgeof

cannabislawsincreasedsignificantlyfollowingthiscampaign(Brooks-Russelletal.,2017)

• Contentofthemediacampaignwasmostsalientamongcannabisusers




ACTIVITY 2: (25 MIN)DISCUSSION OF CANNABIS PROGRAMS

& SERVICES IN THE COMMUNITY

• Identifyarecorderandreporter• Discussthequestionsasagroup• Capturethekeypointsmadebythegroupontheworksheet

provided(recorder)• Bepreparedtosharewiththelargegroup(reporter)• Submitonecompletedsetofworksheetstothefacilitator



LUNCH



CANNABIS USE MONITORING AND SURVEILLANCE


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• Mostsurveysavailablecaptureprevalencedata(firstuse,pastyearuse,ever-use)

• Somesurveysexploreadditionalusedata(threemonthusepatterns,dailyuse)andmethodsofuse(ediblesandvaping)

• Somesurveysaskquestionsaroundattitudesandperceptionstowardscannabis

• Overallthesurveysarelimitedintheirabilitytocapturedatarelevantforlocalprogramusesorequirelocaladaptations





• CanadianCommunityHealthSurvey(CCHS)• COMPASS• CanadianTobaccoAlcoholandDrugsSurvey(CTADS)• CAMHMonitor• CanadianStudentTobaccoAlcoholandDrugsSurvey

(CSTADS)• OntarioStudentDrugUseandHealthSurvey(OSDUHS)• BCAdolescentHealthSurvey• HealthBehaviourforSchoolAgedChildren(HBSC)• NationalCollegeHealthAssessmentSurvey(post-secondary

institutions)





CanadianCommunityHealthSurvey(CCHS)• Beganin2000withitsmaingoalsbeingtheprovisionof

population-levelinformationonhealthdeterminants,healthstatusandhealthsystemutilization

• ThisseriesofsurveysisajointeffortofHealthCanada,thePublicHealthAgencyofCanada,StatisticsCanada,andtheCanadianInstituteforHealthInformation(CIHI)

• TheCCHScomprisestwotypesofsurveys:• An annual component on general health• A focused survey on specific health topics





COMPASS• Isanine-yearstudystartedin2012-13aboutyouthhealth

behavioursfundedbytheCanadianInstitutesforHealthResearch(CIHR)andHealthCanada

• StartedinOntariobuthasexpandedtoBC,Quebec,andtheterritoriescovers70schools





CanadianTobaccoAlcoholandDrugsSurvey(CTADS)• TheCanadianTobacco,AlcoholandDrugsSurvey(CTADS)is

abiennialgeneralpopulationsurveyoftobacco,alcoholanddruguseamongCanadiansaged15yearsandolder

• TheCTADSisconductedbyStatisticsCanadaonbehalfofHealthCanada





CAMHMonitor• TheCAMHMonitor,firstconductedin1977,isthelongest

ongoingaddictionandmentalhealthsurveyofadultsinCanada

• ThesurveyisdesignedtoserveastheprimaryvehicleformonitoringsubstanceuseandmentalhealthproblemsamongOntarioadults

• TheCAMHMonitorprovidesepidemiologicaltrendsinalcohol,tobacco,andotherdruguse,problemuse,publicopinionregardingdrugissuesandpolicies,andmentalhealthamongOntarians





CanadianStudentTobaccoAlcoholandDrugsSurvey(CSTADS)• FormerlytheYouthSmokingSurvey(YSS),isabiennial

surveyadministeredtostudentsingrades7-12acrossCanada

• CSTADSisimplementedwiththecooperation,supportandfundingofHealthCanada.CSTADScollectsdataontopicssuchas:

• Tobacco use• Alcohol use• Drug use• Bullying• School connectedness• Mental health





OntarioStudentDrugUseandHealthSurvey(OSDUHS)• TheOntarioStudentDrugUseandHealthSurvey(OSDUHS)isa

populationsurveyofOntariostudentsingrades7through12• TheOSDUHSbeganin1977andisthelongestongoingschool

surveyinCanada,andoneofthelongestintheworld• Thisself-administered,anonymoussurveyisconductedacrossthe

provinceeverytwoyearswiththepurposeofidentifyingepidemiologicaltrendsinstudentdruguse,mentalhealth,physicalhealth,gambling,bullying,andotherriskbehaviours,aswellasidentifyingriskandprotectivefactors





BCAdolescentHealthSurvey• TheBCAdolescentHealthSurvey(BCAHS)isa

questionnaireusedtogatherinformationaboutyoungpeople’sphysicalandemotionalhealth,andaboutfactorsthatcaninfluencehealthduringadolescenceorinlaterlife

• TheBCAHSisconductedbytheMcCrearyCentreSocietyincollaborationwiththeprovincialgovernmentandpublichealthsystem,andwiththecooperationofBC’sschooldistricts





HealthBehaviourforSchoolAgedChildren(HBSC)• TheHSBCresearchnetworkisaninternationalallianceof

researchersthatcollaborateonthecross-nationalsurveyofschoolstudents

• TheHSBCcollectsdataeveryfouryearson11-,13- and15-yearoldyouthshealthandwell-being,socialenvironments,andhealthbehaviours





NationalCollegeHealthAssessmentSurvey(post-secondaryinstitutions)• TheACHA-NationalCollegeHealthAssessment(NCHA)isa

researchsurveyavailableforpurchasethatcancollectdataaboutstudents’healthhabits,behaviors,andperceptionsonawiderangeofhealthissuesincludingbutnotlimitedto:

• Alcohol, tobacco, and other drug use• Sexual health• Weight, nutrition, and exercise• Mental health• Personal safety and violence





Screeningtoolsthatmeasuremisusepatterns:• CannabisUseDisorderIdentificationTest- Revised(CUDIT-R):

abriefscreening/assessmenttoolthatcanbeusedwithadolescentandadultclientsinyourpractice

• Alcohol,SmokingandSubstanceInvolvementScreeningTest(ASSIST):ascreening/assessmenttoolforallsubstancesthatcanbeusedinprimaryandgeneralmedicalcaresettings





Thereisaneedforlocaldatatobecapturedatanearlystageondifferentpopulations(regions,socio-economicstatus,cultures,agegroups),socialcontextforuse(peers),personalcontextforuse,emergingmethodsofuse)





Ideally,whatwouldyouliketoknowaboutcannabisuseinyourcommunity?





CannabisRegulatoryApproaches.CanadianCentreonSubstanceAbuse,2015




Thefollowingplaceshavelegalizedcannabis:• Colorado• WashingtonState• Oregon• Alaska• Washington,DC• Uruguay






• Regulationscontinuetoevolve• Thereportsuggestsforpeopletoconsultwiththe

respectivejurisdictionalregulatoryauthoritiesforadditionaldetailsandtoensurecurrencyofinformation






PreliminaryevidencefromColorado hasdemonstratedthatlegalizationhashadmixedimpactsforpublichealth,forexample:• Aslightdecreaseinuseamongyouth• Higherratesofpoison-controlcallsandERvisitsfromoutof

statevisitors





TworecentreportshavebeenpublishedinWashingtonState• WashingtonStateMarijuanaImpactReport(Aug2017):

Theaimistodepictwherethestatestandsaftertwoyearsofcommercialization(2014– 2016)

• WashingtonStateInstituteforPublicPolicy(Sept2017):ReportfocusesoninitialresultsofoutcomeanalysesexaminingtheeffectsofInitiative-502implementation





WashingtonStateInstituteforPublicPolicy(WSIPP)(Sept2017,secondrequiredreport):• FollowingthepassingofInitiative502(I-502)legalizing

limitedpossessionandprivateuseofmarijuanabyadultsinNov.2012,WSIPPwasdirectedtoconductbenefit-costevaluationsoftheimplementationofI-502byexaminingoutcomesrelatedto:• Public health, public safety, substance use, the criminal

justice system, economic impacts, and administrative costs and revenues





WashingtonStateInstituteforPublicPolicy(WSIPP)(Sept2017,secondrequiredreport):• Reportresultsfocusesoninitialresultsof

outcomeanalysesexaminingtheeffectsofI-502implementationon:• Youth and adult substance use• Treatment admissions for cannabis abuse• Drug-related criminal convictions





WashingtonStateInstituteforPublicPolicy(WSIPP)(Sept2017,secondrequiredreport):• Theamountoflegalcannabissalesistheprimary

predictorexaminedintheoutcomeanalysesofthisreport

• Findingsreportedrepresentanintermediatesteptowardsthebroader,morecomprehensivebenefit-costanalysis





WashingtonStateInstituteforPublicPolicy(WSIPP)(Sept2017,secondrequiredreport):• Twomainanalysisstrategies:

• BetweenState:examinedtheeffectofI-502oncannabisabusetreatmentadmissions,comparingWashingtonStatetosimilarnon-legalizingstatesbeforeandafterI-502enactment

• WithinState:examinedhowlocaldifferencesintheamountoflegalcannabissalesaffectedcannabisabusetreatmentadmissions,youthandadultsubstanceuse,anddrug-relatedcriminalconvictions





Primaryfindings:• Itwasfoundthatcannabisabusetreatment

admissionswerenotaffectedbyI-502enactment• Theamountoflegalcannabissalesgenerallyhad

noeffectonoutcomes• Oneexceptionwasthatadults21andolderin

countieswithmoreretailcannabissalesweremorelikelytoreportusingcannabisinthepast30daysandtoreportusingitheavily




ACTIVITY 3: (20 MIN)DISCUSSION OF CANNABIS

MONITORING AND SURVEILLANCE IN THE COMMUNITY

• Identifyarecorderandreporter• Discussthequestionsasagroup• Capturethekeypointsmadebythegroupontheworksheet

provided(recorder)• Bepreparedtosharewiththelargegroup(reporter)• Submitonecompletedsetofworksheetstothefacilitator



BREAK



DISCUSSION


4




Whatwouldyouneedtosupportyourworkinthecontextoflegalcannabis?

DISCUSSION




Howmightyoucontinuethisconversationtogether?

DISCUSSION



CPHA PROJECTCONSULTATION EVALUATION

NEXT STEPS AND CLOSING

5




• Reportswillbeproducedfollowingeachcommunityconsultation

• Datafromcommunityconsultationswillinformresourcedevelopment

CPHA PROJECT



Public, provincial consultations in BC are underway and will go until November 1:• http://engage.gov.bc.ca/BCcannabisregul

ation




TakethreePost-ItNotesfromthenotepadprovidedandpleasecompletethefollowingsentences(oneperpaper):• Post-It#1:TodayIlearned…(pink)• Post-It#2:AftertodayIwill…(green)• Post-It#3:InthefutureIwouldlike…(blue)

EVALUATION




Post-consultationsurvey

EVALUATION


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OCTOBER 2017|APUBLICHEALTHAPPROACHTOCANNABIS:COMMUNITYCONSULTATION


GregPenney:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]

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