Our Relationship with Recreational Cannabis

Law Reform

It’s complicated…

AMHO 3rd Annual Conference

May 26 2015

Introduction

Mike DeVillaer

CAMH & McMaster University

Suzanne Witt-Foley

MakingConnections4Health

Disclosure

We have never accepted funding from any of the following drug industries:

• Tobacco• Alcohol• Pharma• Illegal drug cartels

This Session

• about questions as much as answers • not just a presentation • facilitated discussion • active participation is essential

Objectives

• increase awareness of complexity• understand various reasons for change• explore key logistical issues• explore some potential models for reform

Getting Oriented to Recreational Cannabis Law Reform

<< Youare here.

Current Statusof Cannabis Law Reform

• criminal justice approach not working • what to do?• reform experiences elsewhere• no assured results• lessons from current legal drug industries

Ontario Quick Stats

• 14.1% of adults used in past yr • 7.5% of adults report some harm• 23.0% of youth used in past yr• 3.0% gr. 7-12 report daily use • 3.0% gr. 9-12 criteria for dependence• 30,000+ admissions to addiction treatment

annually stating a problem with cannabis

Given that some people in particular circumstances

experience harm, why are various groups interested in liberalizing

cannabis laws?

Why liberalize?

• access to medicine• use without legal or financial risk• address social justice issues• economic opportunity for business sector• cost savings for govn’t from reduced

enforcement costs• tax revenue for government• increased revenue for drug education,

treatment & research

Competing Pressures

• address injustice • protect public health• provide new revenue for industry,

government & services• satisfy public preference

Impact of liberalization on prevalence of use, problems

• decriminalization does not lead to increases in use or problems

• Amsterdam (hybrid of decriminalization & legalization): initial increase in use; then flattened

• Grow Your Own (GYO) provisions in Alaska did not increase use

• most sites with legalization are too recent to have adequate data

Holy Trinity of Drug Epidemiology

• increased access of a population to a drug will increase use in that population

• increased use will lead to increased problems in that population

Logistical Issues

Types of Issues

• Power & Control • Legal• Industry Models• Manufacturing• Retail• Product Promotion• Taxation• Health Care

Power & Control

Who Calls the Shots?

• who develops the regulations?• flexibility of the regulations (ease of

changing)• centralized/decentralized • opt-out?

Legal Issues

Minimum Age

• Colorado & Washington: 21

• Ontario for alcohol: 19

• rationale for a higher or lower minimum age?

Driving & THC Levels

• can’t be zero-tolerance• detectable several

weeks after use• Colorado: 5 nanograms

per milliliter of blood

Other Legal Issues

• adult buys for under-age user• use in public• amount possessed • possession of contraband • host liability for conduct of impaired guests• impairment at work • grow your own

Industry Models

Possible Industry Models

• monopoly vs competitive• all phases ‘from seed to vape’ operated by

a monopoly• cannabis only vs combined with other

(tobacco, alcohol or pharma)

Manufacturing

Issues

Packaging

Loose-leaf product

vs. cigarettes, joints branding vs plain

packaging marketing research:

branded packaging important

warning labels

Product Innovation• potency, concentrated product (oil)• edibles a safety risk for children • flavourings popular among young

for tobacco & alcohol• Nova Scotia recently banned all

tobacco flavourings • Ontario too?

Retail Issues

Specialized/Diversified Retail Outlets

• sell cannabis only• same store as alcohol, tobacco, pharma• popular with consumers for convenience• convenience increases consumption

Pot

Drugs

Us

Us

On-premises Use (Bars & Restaurants)

• not in Colorado• coffee shops in Amsterdam

Other Retail

• days & hours of operation• limit amount purchased • minimum age for servers• liable for customers who become impaired• smart serve training required

Other Retail (cont’d)

• outlet density – per population or geographic area

• proximity to schools, playgrounds, recreation, drug treatment facilities

Other Retail (cont’d)

• vending machines; home delivery services • pricing controls: minimum pricing; bulk

discounts• sales to non-Canada residents (cannabis

tourism)

Product Promotion

Advertising, Marketing, Sponsorships

• should promotion be allowed at all ?• restrict content: no cartoon characters,

animals, or celebrities or other images attractive to children

• restrictions on location: eg. not near schools, playgrounds, drug treatment

• fund counter-promotion campaigns• promotion already widespread on internet;

cannot be contained

Taxation

As certain as death, the taxman cometh…

• major draw for government• taxes collected at federal or provincial

level • by price or by weight• black market implications

Impact on Health Care System

General Impact

• decriminalization has no impact on use of social and health services

• legalization is uncertain

Impact of legal recreational cannabis on medical marijuana policy

• does medical marijuana become irrelevant?• unless covered by health plan• how likely is that ?

Impact on A&MH Treatment Programs

• if legalization increases # users, then more people with problems

• increased demand for service• increase in cases & complexity of cases

Models for Reform

PublicHealth

SocialJustice

Some Context

“Legalization, combined with strict health-focused regulation, provides an opportunity to reduce the harms” [from prohibition].

- CAMH Cannabis Policy Framework (2014)

“…there is a lot of policy space between traditional prohibition and such commercial legalization.”

- Rand Corporation: Considering Marijuana Legalization (2015)

Models

Punitive Decriminalization (CAMH & Rand)

Non-punitive Decriminalization (Rand)

For-profit Legalization (CAMH & Rand)

Not-for-profit Legalization (Rand)

Punitive Decriminalization Model

• retain all prohibitions• reduce or stop enforcement• decrease penalties for minor offences• eliminate criminal records• charge a fine

Punitive Decriminalization

Advantages & Disadvantages

• ends most social injustice• might still enable some discrimination &

harassment• might deter people from accessing

treatment, harm reduction & education • fines have no public health or social justice

purpose

Non-punitive Decriminalization Model

• similar to punitive, but … • no fines or other penalties for minor

cannabis-related offences• eg. possession of small amounts

Non-punitive Decriminalization Advantages & Disadvantages

• ends harassment & discrimination of users• removes deterrence to use treatment, harm

reduction & education programs• reduces resource draw on enforcement;

maybe on justice bureaucracy• response to public use could be an

opportunity for education, harm reduction & encouraging voluntary counseling

Legal For-profit Model

• private industry provides agriculture, manufacturing, distribution, retail (seed to ‘vape’)

• government regulates: develops legislation, provides licenses, monitors compliance, punishes violators

• legal drugs (tobacco, alcohol, pharma) are regulated now in Ontario & Canada

Legal Private For-profit Context of Current Legal Drug Industries

• tobacco & alcohol biggest drug problems• pharma is becoming increasingly serious• 3 legal drug industries: tobacco, alcohol,

pharma (TAP)• legacy of indiscriminate pursuit of profit• disregard for public health & the law

Legal Private For-profit Advantages & Disadvantages

• familiar model• regulation protects public health, but…• regulations not always evidence-based • lobbying: The National Cannabis Industry

Association (NCIA)• government reluctant to compromise

industry revenue or tax revenue

Legal Private For-profit Advantages & Disadvantages (cont’d)

• regulators not transparent• regulations not meaningfully enforced • small fines, small out-of-court settlements• little accountability

A 4th legal for-profit drug industry?

Legal Not-for-profit Model

• operated by a government-appointed authority holding a monopoly

• all components of the supply chain• agriculture, manufacturing, distribution, retail• seed-to-vape

Legal Not-for-profit Advantages & Disadvantages

• alcohol monopolies protect public health better than less-regulated models

• Board consists primarily of people with expertise in public health

• mandate: meet existing demand within public health framework

• priority: providing education & harm reduction

Legal Not-for-profit Advantages & Disadvantages (cont’d)

• surpluses fund new innovative ideas in education, treatment, research

• not to govn’t general accounts• reversibility – easier to go from monopoly

to commercial competitive than the reverse

Some Final Thoughts

• TAP industries value revenue over rule of law & public health

• regulation inadequate; public health compromised

• TAP too powerful to convert to public health model

• cannabis provides opportunity to try a different kind of model

• will entrepreneurs & government forgo the revenue opportunity?

More final thoughts…

The models that we find acceptable will depend upon our values–policy based upon public health & social

justice –balanced with revenue for industry &

govn’t– Is latter a level playing field?

And another one…

• major advantage of legalization over decriminalization is revenue

• more transparency on societal merits of private interests trumping social welfare

• private wealth vs public health

Rand Report

“What kinds of organizations do we want selling these intoxicants? Those concerned only with profit, or those with a greater goal of producing social benefit or minimizing social harm?”

CAMH Framework

“It is critical that legal reform of cannabis control be conducted with public health as its primary objective and that the resulting regulatory framework be carefully protected from commercial and fiscal interests.”

What Next?

Contact Us

Mike:porticonetwork.ca/web/drug-ppp

Suzanne:suzannewittfoley.com