smoking and your co-op - chf canadasmoking and your co-op 1 andrew noble, program manager smoking...

Smoke-free Housing Ontario

CHF Canada Workshop 1

Smoking and Your Co-op

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Andrew Noble, Program Manager Smoking and Health Action Foundation Lauren Blumas, Lawyer ller Campbell

Welcome and Introductions

Smoking and Multi-unit Housing

Why a Smoke-free Policy?

Legal Issues

Implementing a policy

Communications

Agenda

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www.smokefreehousingon.ca www.ilercampbell.com

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Supported by the Ministry of Health and Long-Term Care




How many are considering a smoke-free policy?

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How many have a policy in-place?

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How many are not convinced that this is a good idea?

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• Do you have a smoking problem in your co-op?

• Is it more than tobacco?

• What do you hope will happen with a policy?

• What are your concerns?

• What would you like to learn today?

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Table Discussion

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Expectation of cleaner air much

higher today

• Public places

• Workplaces

• Many homes

Tobacco Overview

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Tobacco Overview

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Tobacco Overview

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0

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20

30

40

50

60

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Smoking rates by province and territory

Tobacco Overview

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Tobacco Overview

• Note: Smoking rates are higher in lower income populations.

• In the lowest income (under $10 000/ Year) grouping it is about 30% in Canada

7/10

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15.8 cigarettes per day is the average for daily smokers

~10.8 cigarettes per day for daily smokers.

Tobacco Overview



Tobacco Overview

That is 3679 cigarettes per year

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A toxic mix of

more than 4,000

chemicals

Tobacco Overview

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Residual tobacco smoke contamination

Volatile organic compounds off-gas for days, weeks, months…

Reacts with other chemicals to form secondary pollutants like potent “tobacco-specific nitrosamines” (TSNAs)

Experts on third-hand smoke recommend 100% smoke-free homes and vehicles.

Tobacco Overview

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Third-hand Smoke

https://youtu.be/eAXpYhGeRFE

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Tobacco Overview

Third hand smoke video



• Severe asthma attacks

• Respiratory infections

• Ear infections

• Sudden Infant Death Syndrome (SIDS)

• Heart disease

• Lung cancer

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No safe level of exposure

Tobacco Overview

Rates of use (last 12 months)

• 14.5% All Canadians

– 19.2% Men

– 10.2% Women

• Highest use in BC (17%)

• Lowest in NS (8%)

• Most users aged 20-24

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Marijuana Overview



Addictive Properties (Marijuana)

• 9% experience dependence

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Marijuana Overview Addictive Properties (other substances)

• 68% tobacco

• 23% Alcohol

Lower dependency rate MAY make it easier to get compliance with the policy

Second-hand Smoke effects

• Common to mix with tobacco

• Many of the same chemicals as tobacco

• Risks greater for those with respiratory illness

• “Contact high” risk low

• More research needed

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Marijuana Overview



• Legalization

• Recreational

• Medicinal

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Marijuana Overview

https://youtu.be/XLnllIkjSFc?list=PLxdDQiAI50j9dvC6FgzlIi7dHbevdQz86

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Mother’s Asthma Story video




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Affected by second hand exposure from outside their unit in Ontario.


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Exposure lengthy in home environments



How does the smoke travel?

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Smoking and Multi-unit Housing How does the smoke travel? Stack Effect

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Smoking in Multi-unit Housing

What about vents and fans?

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What about other repairs?

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What about him?

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“the only means of effectively eliminating health risk associated with indoor exposure is to ban smoking activity.”

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American Society of Heating, Refrigerating and Air-Conditioning Engineers



What is a Smoke-free Policy?

Above and beyond what is required in your provincial, territorial law or municipal smoking legislation

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• Hallways

• Laundry rooms

• Stairwells

• Garages

Most laws

covers indoor

common spaces

such as:

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A co-op bylaw that would prohibit smoking in other areas

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Units


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Balconies


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Why Balconies?


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Entrances


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Grounds


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What is a Smoke-free policy?

• Prohibit smokers from becoming members

• Automatically evict current members who smoke

• Force residents to quit smoking

Policy does not:

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Smoking Not the Smoker



• Current members?

• New members?

• Staff?

• Contractors?

• Pets?

Who does it affect in your co-op?

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Why a smoke-free policy?

Given a choice, with all other things being equal, 80% of current MUH residents would choose a smoke-free building

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Year Smokers Non-Smokers

2013 29.4 % 88.2 %

2011 (Pre-policy) 26.0 % 86.7 %


Support for policy in Waterloo Region Housing

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Co-op Values

Co-operatives are based on the values of self-help, self-responsibility, democracy, equality, equity and solidarity.

In the tradition of their founders, co-operative members believe in the ethical values of honesty, openness, social responsibility and caring for others.

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Why smoke-free policy?

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Why smoke-free policy?

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Why a smoke-free Policy?

• Shelter is a prerequisite for health

• If the shelter is poisonous, it cannot fulfill that role

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Canadian Child and Youth Health and Housing Network

Why a smoke-free Policy?

Co-op members exposed to SHS have fewer housing options.

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Smoke-free policies can lead to reduced tobacco consumption and quitting.

Why Smoke-free Policy?

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Cigarettes, pipes, and cigars ranked as the #1 ignition source for residential fire fatalities.

1 in 4 home fire fatalities are caused by smoking articles.”, (2009-2013)

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Why Smoke-free Policy?



• Smoke residue (tar) on walls, ceilings, appliances

• More cleaning, painting and maintenance required


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Why a Smoke-Free Policy?

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2009 Study by Smoke-free Housing New England

https://youtu.be/BQhl9clvoRo

Waterloo video

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– Tobacco under the Human Rights Code

– Tobacco Under the Residential Tenancies Act

– Under the co-op’s by-laws

– Medical marijuana

– Recreational marijuana

– E-cigarettes

– Case Studies

Legal Issues and Implementation

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HR in context

HR Code

Other legislation – Residential

Tenancies, Co-op Corporations

Act, etc.

By-laws; occupancy agreements; leases

Personal Preferences



HR in context

HR Code

Other legislation – Residential

Tenancies, Co-op Corporations

Act, etc.

By-laws; occupancy agreements; leases

Personal Preferences

Smoking tobacco in a

unit

• race • ancestry • place of origin • colour • ethnic origin • citizenship • creed (i.e religion) • sex • sexual orientation • age • marital status

• family status • disability • gender identity • gender expression • the receipt of public

assistance (housing only) • record of offences

(employment only)

Tobacco and the Human Rights Code Protected grounds



Tobacco and the Human Rights Code Duty to accommodate – Principles

• respect for dignity

• undue hardship

• no set formula – consult

• be responsible and willing - explore solutions

• comply voluntarily

Tobacco and the Human Rights Code

• Smoking affects allergies and sensitivities – disabilities

• Smoking is an addiction and therefore a human right ???

• Right to smoke for Indigenous cultural reasons



Tobacco under the Residential Tenancies Act

• Eviction for:

– Substantial interference with reasonable enjoyment

– Damage to the unit

Tobacco under the Co-op’s by-laws

• Old model by-law – section 5.2 Nuisance

• New model by-law – section 7.1, 7.2 Prohibited Conduct; Human Rights

• Smoking by-law



Medical Marijuana

• Access to Medical Cannabis for Medical Purposes Regulations (ACMPR) – Government’s response to successful challenges to

the former medical marijuana regime

– Individuals authorized by health care practitioners using a “Medical Document” (like a perscription)

– Patients may apply to Health Canada to grow their medical cannabis

– Health Canada says 1 gram/day = 2 outdoor or 5 indoor plants

– Meant to be temporary measure

Medical Marijuana

• The “Allard Injunction”

– Allows individuals authorized under the old Medical Marijuana Access Regulations to continue to grow and possess medical cannabis

– Quantities prescribed under this program were generally larger

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Medical Marijuana

Why should you care about the “framework”?

• Potentially 2 sets of documents for legal access (right now)

– “Medical Document” and “Authorization to Possess”

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Medical Marijuana

• Authorization to grow from Health Canada

– Requires registration with Health Canada

– Grow at home or designate third-party to grow

– Application form requires signed consent of “site owner”



Medicinal use of cannabis

• Major differences between medicinal and recreational use of cannabis

– Medicinal = legal

– Medical use attract protections under the Human Rights Code

Medicinal use of cannabis • Implications in housing context

– Medical cannabis patients have the right to use their medicine as prescribed

– General use of medical cannabis to treat and control symptoms of a disability is protected under the Human Rights Code

– Does not mean that medical cannabis patients have the right to smoke anywhere - no “right” to smoke in unit

– Exceptions may need to be made on case-by-case basis as an accommodation under the Human Rights Code to the point of “undue hardship”

– Depending on form, may be no impact on occupancy- ie. ingestion by eating or tinctures

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• Housing Providers can have bylaws or policies that restrict smoking in units [incorporate units as they turnover] - extend to cigarette and cannabis smoke

• Must consider requests for accommodation for medical marijuana as they come


• STEP 1: discerning legal vs. recreational use – Medical Document from health care provider or unexpired

Authorization to Possess from Health Canada (refer back to slide 3)

• STEP 2: smoking medical cannabis in unit as an accommodation – Not the default

– Landlord may ask for medical information setting our limitations and disability-related needs

• Smoking as method of administering is necessary for treatment

• Medically significant symptoms that require use in unit

• STEP 3: provide appropriate accommodation short of undue hardship1

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• EX - tenant has the right to use medical marijuana, but no basis to smoke inside unit. Continued use in contravention of “no smoking” clause in lease


• Potential grounds for eviction under RTA -

– Substantial interference with reasonable enjoyment or lawful right, privilege or interest of Landlord or another Tenant

– Serious impairment of safety

– Illegal act

– Willfully causing undue damage

• Proceed cautiously - may want to consult lawyer to avoid triggering a human rights complaint

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Recreational use of marijuana

• Recreational possession and growing of marijuana continues to be illegal (for the time being) - legalization in 2018 to include allowance for growing up to 4 plants

• Landlords and Housing Providers are not required to make any exceptions for recreational marijuana use within units

• Can be explicitly forbidden in occupancy agreements and bylaws

Recreational use of marijuana

• Repeated use can be pursued at the LTB with varying degrees of success

– Substantial interference with reasonable enjoyment or lawful right, privilege or interest of Landlord or another Tenant (s. 94.2(1)8 RTA)

– Serious impairment of safety (s. 94.2(1)9 of RTA) - difficult to prove

– Illegal act (s. 94.2(1)6 RTA) – probably not in current climate

– Willfully causing undue damage (s. 94.2(1)7 of RTA) – possible, but unlikely

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E-cigarettes and vapour

• Very little caselaw

• May be a significant legal difference between smoke and vapour on account of the medical evidence (or lack thereof)

• E-cigarettes and vaporizing (non-medical purposes) may be included in a smoke-free policy or clause BUT will have difficulty enforcing it at LTB

E-cigarettes and vapour

• Vaporizing medical marijuana - need to be very cautious about any limitations

– Ban might not satisfy the “rational connection” test under the Human Rights Code

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Case Study 1 The Board of ABC Co-op has received complaints over the years about second hand smoke travelling between units through the HVAC system. They have typically resolved the problem by transferring people who complain into other units, keeping all the smokers together in one corner of the Co-op. Mario is a long time smoker just diagnosed with lung cancer. He lives among the smokers. He asked if the Board would consider designating the building non-smoking. He’s trying to quit and would really appreciate having some limits placed on where he can smoke. He also doesn’t want to inhale his neighbours’ second hand smoke.

What should the Board do?

Case Study 2 Gwen and Mike live with their three small children in a townhouse at New Co-op. Gwen has recently been diagnosed with liver cancer and has been given 6 months to live. To ease the end of life symptoms, her doctor has prescribed medical marijuana. New Co-op has a no smoking by-law. Gwen smokes her medical marijuana in her unit when her children are at school, but uses the backyard when she is home. She smokes as she needs to, but at least three times a day. There is a designated smoking area on the Co-op property that medicinal marijuana patients are encouraged to use. Amanda lives next door. She intensely dislikes the smell of pot smoke. She complains to the office that it’s not fair that she cannot use her yard. She insists that she be transferred to another unit and that the move be paid for by the co-op.

What should the Board do?



• Notify Members

• Do it in writing and explain the policy and the reasons

• Explain the decision making process

• Frame it positively

• Note grandfathering, if applicable

Communications

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• For people who want to quit, consider providing some information

• Remind them smokers can still be members of co-op

Communications

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Social Media

Communications

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Website

Communications

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Application

• Mention and describe policy

• Ask for initials

• Be clear about transition issues (Grandfathering)

Communications

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No-smoking Sign

Occupancy and Member Agreement

• Include explanation of the policy

• Again, include transition issues

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Communications



Signage

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Communications

Quitting Support

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Communications



Quit Smoking Drugs

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Communications

Quit Smoking Contests

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Communications



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Getting workshop materials

www.chfcanada.coop/workshopmaterials https://eventmobi.com/2017agm

CHF Canada Website AGM Conference App

https://eventmobi.com/2016agm

http://www.chfcanada.coop/workshopmaterials



Time for Evaluation Evaluations on Conference App

https://eventmobi.com/2017agm/

Paper copies also available in the workshop room!

Thank you.

Lauren Blumas

[email protected]

Andrew Noble

[email protected]

98

mailto:[email protected]

https://eventmobi.com/2017agm/

mailto:[email protected]

Case Study 1The Board of ABC Co‐op has received complaints over the years about second hand smoke travelling between units through the HVAC system. They have typically resolved the problem by transferring people who complain into other units, keeping all the smokers together in one corner of the Co‐op. Mario is a long time smoker just diagnosed with lung cancer. He lives among the smokers. He asked if the Board would consider designating the building non‐smoking. He’s trying to quit and would really appreciate having some limits placed on where he can smoke. He also doesn’t want to inhale his neighbours’ second hand smoke. What should the Board do?

Case Study 2

Gwen and Mike live with their three small children in a townhouse at New Co‐op. Gwen has recently been diagnosed with liver cancer and has been given 6 months to live. To ease the end of life symptoms, her doctor has prescribed medical marijuana. New Co‐op has a no smoking by‐law. Gwen smokes her medical marijuana in her unit when her children are at school, but uses the backyard when she is home. She smokes as she needs to, but at least three times a day. There is a designated smoking area on the Co‐op property that medicinal marijuana patients are encouraged to use. Amanda lives next door. She intensely dislikes the smell of pot smoke. She complains to the office that it’s not fair that she cannot use her yard. She insists that she be transferred to another unit and that the move be paid for by the co‐op. What should the Board do?

Ottawa non-profit housing group first to go smoke free in Canada CBC News Posted: Jan 23, 2013 6:41 PM ET Last Updated: Jan 23, 2013 9:37 PM ET

Conservation Co-operative's second hand smoke committee chair Wayne

Sawtell stands at the apartment's new smoking digs, after the co-op banned

smoking inside any of its buildings.

The Conservation Co-operative Homes at 140 Mann Avenue in Ottawa is now smoke free — on

Weedless Wednesday no less — making it the first non-profit housing group in Canada to ban

smoking everywhere inside its facility.

Three designated smoking sections will be set up outside the building, about 30 metres away and

they will remain there for a year, after which time the co-op board will consider banning smoking

outside, as well.

"The smoke moves around the building, through the ventilation system or cracks in the walls, what

have you," said Wayne Sawtell, chair of the co-op's second-hand smoke committee. "And some

people have been suffering quite badly in their own apartments as a result."

So Sawtell surveyed the co-op's members and realized that implementing restrictions had some

traction.

"We found, overwhelmingly that people were in favour of a ban on smoking of some kind," he said.

Last year, co-op members voted to ban smoking in the residences — 48 in favour, 18 against — and

the Non Smokers Rights Association says there is momentum for more non-profit housing groups in

Ontario to consider this.

Already, 70 such housing co-operatives in the province have restricted smoking on the premises to

some degree.

http://www.cbc.ca/news/cbc-news-online-news-staff-list-1.1294364

"It's really rewarding to see the social norm change happening. People are so happy to be able to

find a home where they're protected from smoke," said Pippa Beck, spokesperson for the

association. "It's a really stressful experience when you're at your home and you're being exposed."

As for enforcing the new rules at the Conservation Co-operative's apartments, anyone caught

smoking in the building could be subject to membership reviews with the board. But the co-op is

urging members who still smoke to consider quitting.

Sawtell hopes this is part of a bigger trend in favour of healthy living.

"We're realistic. We know that people do smoke. But the idea is not to persecute them, or victimize

smokers, it's just to try and educate them to change their behaviour," he said.

And Conservation co-op members hope it catches on. They've already been contacted by other co-

ops across the country about implementing similar smoke-free bylaws.

Smoking and Health Action Foundation (2017) www.smokefreehousingon.ca Page | 1

The Impact of Smoke-free Housing on Quitting Smoking

The implementation of smoke-free policies in multi-unit housing is a growing trend. Non-smokers should not have to breathe the toxic second-hand smoke that infiltrates from neighbouring units, as it is a proven health risk. There is another powerful reason for the creation of smoke-free multi-unit housing – the positive health impact it has on smokers. Research demonstrates that in addition to clearing the air of second-hand smoke, smoke-free policies also lead to smokers choosing to quit. 1 A review of 37 studies found that smoke-free policies decreased the number of people who smoked and the number of cigarettes smoked per day.2 Studies about smoking bans in individual homes (i.e. a ‘house rule’) have also shown a similar effect. 3 A smoke-free home seems to increase the desire to quit by creating barriers to smoking, such as having to go outside. These barriers disrupt smokers’ established habits, which increases their ability to quit and avoid relapse. 4 Even when this disruption does not result in successfully quitting, it can contribute to reduced consumption of cigarettes. 5

In general, home smoking bans are associated with

• increased number of quit attempts • a longer duration of quit attempts • greater use of smoking cessation medications • reduced cigarette consumption • increased quit rates 6

Many smokers make quit attempts when they live in smoke-free housing. According to a large study conducted across the US, as many as half of smokers living in smoke-free housing attempted to quit in the last year. 7

1 Callinan JE, Clarke A, Doherty K, Kelleher C. Legislative smoking bans for reducing secondhand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database Syst Rev. 2010;(4):CD005992. doi(4):CD005992. 2 Hopkins DP, Razi S, Leeks KD, Priya Kalra G, Chattopadhyay SK, Soler RE, et al. Smokefree policies to reduce tobacco use. A systematic review. Am J Prev Med. 2010;38(2 Suppl):S275-89 3 Mills AL, Messer K, Gilpin EA, Pierce JP. The effect of smoke-free homes on adult smoking behavior: a review. Nicotine Tob Res. 2009;11(10):1131-41. 4 IBID 5 IBID 6 Kernoghan, A., Lambraki, I., Pieters, K., & Garcia, J.M. (2014). Smoke-Free Housing: A Review of the Evidence. Toronto, Ontario: Program Training and Consultation Centre and the Propel Centre for Population Health Impact, University of Waterloo. 7 Smoking and smoking-related health issues high in public housing. Retrieved March 31, 2017, from https://www.elsevier.com/connect/smoking-and-smoking-related-health-outcomes-high-in-public-housing


A study in Oregon observed a self-reported annualized quit rate of 14.7% over the study compared with a historical quit rate of 2.6%. Also, almost half of ongoing smokers reduced their cigarette consumption. 8 Dr. Pam Kaufman, a scientist at the Ontario Tobacco Research Unit, explains that: “Smoke-free housing policies protect residents from harmful tobacco smoke exposure and also support smokers who want to reduce or quit smoking.” 9 Other experts agree. Dr. Patricia Czapp describes the process of apartments going smoke-free by stating, “The Smoke-free Policy has helped the overall wellness of this community. When we make it easier for people to quit … it normalizes the quitting behavior.” 10 Although a smoke-free policy does not mean smokers cannot live in multi-unit housing, quitting definitely makes life more convenient for smokers because it avoids having to go outside to smoke. For property managers and landlords who have put a smoke-free policy in place, it also is preferable because it supports the idea of creating healthier living spaces. For those reasons, it is important to consider the best way to encourage smoking cessation.

There is good reason to think that some smoking tenants will be interested in information about quitting. In Canada, about 63% or 1.7 million daily smokers are considering quitting in the next 6 months.11 In addition, 50% of daily cigarette smokers aged 15 years and older, have made at least one quit attempt lasting 24 hours in the past year and 33% tried to quit on two or more separate occasions. 12 Studies in the US also have observed the high desire of smokers to quit. 13

Quitting may feel impossible or difficult for smokers but there are also many former smokers who have successfully quit. Among Ontario adults who have ever been smokers, over half (53.1%) have now quit.14 That said, it is important to recognize that some groups have a more challenging but not impossible time quitting. For example, lower income smokers15 and those with mental health challenges sometimes find it more difficult to quit.16 Smokers from these groups may need extra support and encouragement but are able to successfully stop smoking.17

How to support quit attempts in multi-unit housing? Focus on providing information and resources in a non-judgemental manner. In your messaging, avoid nagging, preaching, teasing, etc. This may make smokers feel worse about themselves. Remember, this is a powerful addiction and most smokers would love to quit.

8 Pizacani, B. A., Maher, J. E., Rohde, K., Drach, L., & Stark, M. J. (2012). Implementation of a Smoke-free Policy in Subsidized Multiunit Housing: Effects on Smoking Cessation and Secondhand Smoke Exposure. Nicotine & Tobacco Research,14(9), 1027-1034. doi:10.1093/ntr/ntr334 9 (2017, January 30). Home. Retrieved March 17, 2017, from http://www.smokefreehousingon.ca/ 10 Implementing and Enforcing Smoke-Free Housing Policies. (2015, September 18). Retrieved March 31, 2017, from https://youtu.be/jZ6Uyw3xOL4 11 Canada, (2017, March 13). Canadian Tobacco Alcohol and Drugs (CTADS): 2015 summary. Retrieved April 04, 2017, from https://www.canada.ca/en/health-canada/services/canadian-tobacco-alcohol-drugs-survey/2015-summary.html 12 IBID 13 Babb S, Malarcher A, Schauer G, Asman K, Jamal A. Quitting Smoking Among Adults — United States, 2000–2015. MMWR Morb Mortal Wkly Rep 2017;65:1457–1464. DOI: http://dx.doi.org/10.15585/mmwr.mm6552a1. 14 Cancer Care Ontario. Cancer Risk Factors in Ontario: Tobacco. Toronto, Canada, 2014. 15 IBID 16 Banham L, Gilbody S. Smoking cessation in severe mental illness: What works? Addiction. 2010;105(7):1176-89 17 Centre for Addiction and Mental Health. (2012). Mental Illness and Smoking [Brochure]. Author. https://www.nicotinedependenceclinic.com/English/teach/SiteAssets/Pages/Smoking-Fact-Sheets2/Mental%20Illness%20and%20Smoking%20Fact%20Sheet%20for%20Healthcare%20Providers.pdf

http://dx.doi.org/10.15585/mmwr.mm6552a1


Partnerships with public health units can help residents quit smoking. Quit attempts made without support are successful only about 3-5% of the time whereas with counselling and medication, success rises to about 20%. 18 Ensure that residents and staff know where they can access products like the “patch”, gum, and other aids. In some cases they may be able to get them for little or no cost from your local public health unit. Also, some aids (e.g. varenicline or bupropion) are covered by some drug plans such as the Ontario Drug Benefit Plan. When the Region of Waterloo implemented their smoke-free policy in 2010, they offered a range of support services before and after the policy came into effect. Programs and services were promoted using flyers, their website and through conversations with staff and tenants. According to follow-up research, “Ensuring specific services were in place for those who may find it difficult to comply with the policy was important as it showed the Region was considering the needs of all tenants. “19 Sharing information about available services, even when direct support from public health units is not manageable, can be a big help. Letting people know about helplines such as www.smokershelpline.ca or 1-877-513-5333 can assist residents if they would like to quit. Sometimes contests that offer the chance to win cash for quitting such as the First Week Challenge offered by the Canadian Cancer Society can appeal to residents. Keep in mind that several studies have shown that financial incentives can increase the likelihood of a smoker quitting. 20 Combining information about quitting smoking with other aspects of healthy living can benefit everyone. By promoting healthy living in general, residents who smoke will not feel as ‘picked on’ and therefore may be more responsive. Consider that people use different languages and read at various levels. Try to ensure the information you are posting is clear for all residents. Timing makes a difference when it comes to providing support for quitting. Consider offering information about services before residents move in. For example, if you have a waitlist, include information about quitting when you do a mailing.

18 Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update.Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008. 19 McCammon‐Tripp, L.1 , Stich, C., & Region of Waterloo Public Health and Waterloo Region Housing Smoke Free Multi‐Unit Dwelling Committee. (2010). The development of a smoke‐free housing policy in the Region of Waterloo: Key success factors and lessons learned from practice. Toronto, Canada: Program Training and Consultation Centre, LEARN Project. 20 Giles EL, Robalino S, McColl E, Sniehotta FF, Adams J. The effectiveness of financial incentives for health behaviour change: systematic review and meta-analysis. PloS one. 2014;9(3):e90347.

March 27, 2017

SAMPLE NO-SMOKING POLICY BY-LAW

Due to the known health risks of exposure to second-hand smoke, increased risk of fire and increased maintenance costs: A. No member, resident, guest, business invitee, or visitor shall smoke cigarettes, cigars or any

similar product whose use generates smoke within the building, except those used for spiritual traditions e.g., smudge ceremonies. This prohibition includes all residential units within the building, all balconies and patios, enclosed common areas, as well as outside within nine metres of doorways, operable windows and air intakes.

B. “Smoking” shall include inhaling, exhaling, burning or carrying of lighted tobacco or marijuana,

and similar product whose use generates smoke. C. “Business invitee” shall include but is not limited to any contractor, agent, household worker,

or other person hired by the housing providers, member or resident to provide a service or product to the housing providers, member or resident.

Exceptions may be made on a case by case basis for members requiring the use of medical marijuana.

For more information visit www.smokefreehousingon.ca or contact your local public health unit

Smoke-free Housing Co-operatives

Many families wait years to get access to co-operative housing only to find that they are involuntarily exposed to second-hand smoke (SHS) on a regular basis. Co-ops have the opportunity to change this and protect members from SHS. Smoke free housing policies are increasingly becoming a social norm. Over 80% of Ontarians are non-smokers and 75% of homes are now voluntarily smoke-free. Because there is no safe level of exposure to SHS - it contains over 60 carcinogens and has both short and long-term negative health consequences, going smoke-free makes a lot of sense. It exacerbates conditions such as angina and asthma, and over the long term substantially increases the risk for heart disease and several cancers. It would not be acceptable to allow any other substance this dangerous inside members' homes. Co-op housing should be an affordable, safe community.

Over 80% of Ontarians are non-smokers and 75% of homes are now

voluntarily smoke-free.

Benefits of adopting a smoke-free policy in co-op housing include: Provides a safer and healthier environment for members

and staff Saves money: keeps co-op homes in a state of good repair Reduces board and staff time spent dealing with second-hand

smoke complaints Less fire risk Offers potential savings with insurance premiums

www.smokefreehousingon.ca

Questions and Answers How does the smoke from one unit travel to the next? Air transfer is a complex process. There are multiple factors including differences in air pressure. It can travel through: Ducts, pipes, electrical outlets Cable or phone jacks Dropped ceilings Sinks, countertops Windows, doors, walls, floors Exhaust fans, recessed lighting Is ventilation a solution? Second-hand smoke is extremely toxic and ventilation is not a solution. According to the American Society of Heating, Refrigerating & Air-Conditioning Engineers (ASHRAE): “… the only means of effectively eliminating the health risk associated with indoor exposure is to ban smoking activity.” What about members who are smokers? A no smoking policy: Does not prohibit smokers from becoming co-op members

and signing occupancy agreements Does not evict current residents who smoke Does not force residents to quit smoking Members just need to smoke outside—as in workplaces and restaurants. The vast majority have implemented policies by grandfathering. This means that only new members are affected by the policy. Over time, the co-op will become smoke-free as old members move out and new ones move in. Have other co-ops gone smoke-free? Yes. Conservation Co-op was one of the first non-profits in Canada to implement a no-smoking policy.

“… the only means of effectively eliminating the health risk associated with indoor exposure is to ban smoking activity.” ASHRAE

www.smokefreehousingon.ca

S m o k i n g a n d H e a l t h A c t i o n F o u n d a t i o n

October 2014

Smoke-Free Policies Make Good Dollars and Sense:

The Business Case for Smoke-Free Multi-Unit Housing

1. Secondhand smoke damages property and costs

landlords money

Smoking in the home decreases property value by up to 29% and real estate agents and brokers overwhelmingly agree that it is more difficult to sell a home that has been smoked in.i Residual secondhand smoke pollution, also known as thirdhand smoke (THS), persists in indoor environments with its characteristic lingering odour and yellowish-brown residue. Cigarettes can burn laminate, linoleum, hardwood, and can even stain bathtubs and sinks.

Landlords report that it typically costs two to three times as much money to turn over a unit where heavy smoking has occurred as it does for a non-smoking unit. Waterloo Region Housing (WRH), with a portfolio of 2,723 units, reported $31,300 in smoking-related maintenance costs for the period from April 2010 – December 2013, or approximately $8,000/year.ii

Image courtesy of Pfizer Canada Inc.

The Business Case for Smoke-Free Housing


Page 2

Prior to Bruce County Housing Corporation passing its no-smoking policy in 2011, staff had noted increasing costs associated with tenant smoking—on average $300 to $450 more per unit for cleaning, priming and painting. In some extreme instances, appliances even had to be replaced because of smoke damage.iii As the Haliburton Community Housing Corporation (HCHC) knows from experience, sometimes smoking-related costs can skyrocket. After a long-term tenant died, HCHC was shocked to discover that it would cost more than $25,000 to repair damages in the unit from over 10 years of chain smoking. Because of excessive odour and staining from THS, this involved removing and replacing the drywall and insulation from the walls and ceiling. The housing provider also lost three months of rent while the work was underway. In contrast, HCHC expenditures to turn over a unit typically cost between $1,250 and $1,500.iv

2. Smoking increases the risk of fire

Smoking remains the number one cause of fatal residential fires in Ontario.v The Housing Services Corporation (HSC) reports that in 2013, 21% of the fires at properties insured through its group insurance program were caused by smoking, with damages at $2 million. A smoke-free building reduces the risk of fire, fire and water damage, and injuries and deaths by eliminating lit cigarettes and cigars from the interior of buildings. Housing Services Corporation’s insurance application asks if housing providers have a no-smoking policy in place, and non-smoking is now a factor in its premium allocations.vi As well, some Ontario tenants enjoy a 5% discount on their content and liability coverage if their housing provider has a no-smoking policy for the property.vii

3. There is increasing demand for smoke-free housing

The vast majority of Ontarians don’t smoke and prefer smoke-free environments, especially their own homes. An increasing number of Canadian households, including those where smokers live, do not permit smoking indoors. When asked which they would choose, 80% of Ontarians reported that all other things being equal, they would select a building where smoking was prohibited.viii Market rate landlords and social housing providers alike are realizing that smoke-free is an important amenity to offer tenants, and at last count over 100 had adopted no-smoking policies.ix

Thirdhand smoke damage to the ceiling of a unit following a decade of chain

smoking. Photo courtesy of Haliburton Community Housing Corporation.



Page 3

4. Smoke-free does not mean increased vacancies or higher turn-over rates Concerns regarding increased vacancies or higher turn-over rates are largely unfounded and for the most part do not reflect actual outcomes. For example, one American study (n=118) that surveyed landlords’ attitudes and behaviour found that 96.3% of respondents with smoke-free policies reported no increased turn-over rates compared with 50% of landlords without policies who expected increased rates.x A 2011 study on the effects of smoking and THS pollution on rental properties found that units previously occupied by smokers were vacant for a median of 62 days compared to 34 days for non-smoking units.xi Perhaps most telling of all is that over 100 social housing providers and market rate landlords in Ontario have adopted no-smoking policies, and to date none of these policies has been revoked. 5. No-smoking policies are enforceable

Social norms are changing, with more tenants than ever before specifically seeking smoke-free housing. Tenants who breach a no-smoking policy are the exception, not the norm. In Ontario, a no-smoking policy is not considered a “material” term of a lease. However, landlords who go before the Landlord and Tenant Board (LTB) to enforce a no-smoking policy can cite breach of reasonable enjoyment of another tenant, substantial interference with the right, privilege or interest of the landlord, damage or safety. Enforcement of no-smoking policies is largely complaint driven. Data from Waterloo Region Housing indicate that the vast majority of smoking-related complaints are handled internally and very few end up before the LTB. Smoking related case law from the LTB demonstrates that landlords can successfully enforce their no-smoking policies even when they do not directly witness tenants or their guests smoking in non-smoking units.xii

6. Prohibiting smoking is neither illegal nor discriminatory It is legal for a landlord to include a no-smoking policy in the lease; this has been confirmed through decisions made at the LTB. Smoking is not a disability, nor is it a protected ground under the Human Rights Code. It is not considered discriminatory for a landlord to dictate where smoking can or cannot take place. The Ontario Human Rights Commission has stated that a landlord may have little or no obligation to accommodate a tenant’s need to smoke when to do so would amount to undue hardship, such as negatively affecting the health and safety of other tenants.xiii

For more information on adopting, implementing and enforcing no-smoking

policies, visit www.smokefreehousingon.ca

http://www.smokefreehousingon.ca/



Page 4

i Pfizer Canada Inc. Up in smoke: Smoking in the home can lower resale value by tens of thousands. 16 April 2013.

http://www.newswire.ca/en/story/1146741/up-in-smoke-smoking-in-the-home-can-lower-resale-value-by-tens-of-

thousands.

ii Regional Municipality of Waterloo. Waterloo Region Community Housing Advisory Committee Agenda. February 20, 2014.

http://www.regionofwaterloo.ca/en/regionalGovernment/resources/HA2014-0220.pdf.

iii Smoke-Free Housing Ontario. Success Stories: Bruce County Housing Corporation. February 2014.

http://www.smokefreehousingon.ca/hsfo/file/files/Bruce_County_case_study-FINAL.pdf.

iv Smoke-Free Housing Ontario. Success Stories: Haliburton Community Housing Corporation.

http://www.smokefreehousingon.ca/cms/file/files/Haliburton_Community_Housing_Corp_final.pdf.

v Ministry of Community Safety and Correctional Services - Office of the Fire Marshal and Emergency Management. Fire Loss in

Ontario 2008 – 2012: Causes, Trends and Issues. December 2013.

http://www.mcscs.jus.gov.on.ca/english/FireMarshal/MediaRelationsandResources/FireStatistics/OntarioFires/FireLossesC

ausesTrendsIssues/stats_causes.html.

vi Housing Services Corporation. Managing Risky Business: Q1/2014. http://www.hscorp.ca/our-programs-and-

services/insurance/managing-risky-business/managing-risky-business-q12014/#benchmarking.

vii Personal communication with Breda Quinlivan, Administrator, Collier Place. 3 October 2014.

viii Smoke-Free Housing Ontario. Multi-unit dwelling second-hand smoke survey. Ipsos Reid 2010.

http://www.smokefreehousingon.ca/hsfo/file/files/Ipsos_Reid_final_report.pdf.

ix Smoke-Free Housing Ontario. Smoke-Free Housing Directory. 2014.

http://www.smokefreehousingon.ca/sfho/directory.html.

x Cramer ME, Roberts S & Stevens E. Landlord attitudes and behaviours regarding smoke-free policies: Implications for

voluntary policy change. Public Health Nursing 2011; Jan-Feb;28(1):3-12. doi: 10.1111/j.1525-1446.2010.00904.x.

xi Matt GE, Quintana PJE, Zakarian JM et al. “When smokers move out and non-smokers move in: Residential thirdhand smoke

pollution and exposure.” Tobacco Control 2011; 20:e1.doc10.1136/tc.2010.037382.

xii Smoke-Free Housing Ontario. Landlord applications: Policy. http://www.smokefreehousingon.ca/sfho/landlords-case-law-

policies.html.

xiii Ontario Human Rights Commission. Policy on Human Rights and Rental Housing, 2009.

http://www.ohrc.on.ca/sites/default/files/attachments/Policy_on_human_rights_and_rental_housing.pdf.

http://www.mcscs.jus.gov.on.ca/english/FireMarshal/MediaRelationsandResources/FireStatistics/OntarioFires/FireLossesCausesTrendsIssues/stats_causes.html

http://www.newswire.ca/en/story/1146741/up-in-smoke-smoking-in-the-home-can-lower-resale-value-by-tens-of-thousands

http://www.smokefreehousingon.ca/sfho/landlords-case-law-policies.html

http://www.smokefreehousingon.ca/cms/file/files/Haliburton_Community_Housing_Corp_final.pdf

http://www.mcscs.jus.gov.on.ca/english/FireMarshal/MediaRelationsandResources/FireStatistics/OntarioFires/FireLossesCausesTrendsIssues/stats_causes.html

http://www.smokefreehousingon.ca/sfho/directory.html

http://www.smokefreehousingon.ca/hsfo/file/files/Bruce_County_case_study-FINAL.pdf

http://www.smokefreehousingon.ca/sfho/landlords-case-law-policies.html

http://www.ohrc.on.ca/sites/default/files/attachments/Policy_on_human_rights_and_rental_housing.pdf

http://www.hscorp.ca/our-programs-and-services/insurance/managing-risky-business/managing-risky-business-q12014/#benchmarking

http://www.newswire.ca/en/story/1146741/up-in-smoke-smoking-in-the-home-can-lower-resale-value-by-tens-of-thousands

http://www.smokefreehousingon.ca/hsfo/file/files/Ipsos_Reid_final_report.pdf

http://www.regionofwaterloo.ca/en/regionalGovernment/resources/HA2014-0220.pdf

http://www.hscorp.ca/our-programs-and-services/insurance/managing-risky-business/managing-risky-business-q12014/#benchmarking

Smoking and Health Action Foundation September 2016

Secondhand Marijuana Smoke: Health effects of exposure

Introduction

Concern about exposure to secondhand marijuana

smoke is an emerging issue—the Smoking and

Health Action Foundation (SHAF) has noted a

steady increase in enquiries and complaints over

the past number of years, especially from multi-

unit housing residents. This comes as no surprise:

10.6% of Canadians 15+ report past year use.1

However, marijuana use is generally infrequent.

Among Canadians who reported past year use,

approximately 2% indicated they use it daily.2 It

should also be noted that marijuana is not as

addictive as nicotine, with an estimated probability

of developing dependence at 9% versus 68% for nicotine.3 Cannabis, which includes marijuana as well as hash, hash oil

and a variety of other derivatives, comes from the plants Cannabis sativa and Cannabis indica. Recreationally, it is

consumed primarily for the active ingredient tetrahydrocannabinol (THC) which gives users a “high,” although there are

many other cannabinoids and chemicals present in marijuana. Although cannabis can be consumed in a variety of ways,

smoking it is the most popular method in Canada.4

The federal government has promised to legalize marijuana; however, for the moment, the only legal consumption is for

medical purposes by individuals who have been granted authorization. Since January 2016, the number of registrations

for medical marijuana has jumped 55% to over 67,000, reflecting a growing interest among Canadians and a growing

acceptance among medical practitioners who can provide access to it. Canadian cannabis producers say they are

increasing their operations in response to the demand, anticipating that it will only intensify when the drug is legalized.

Indeed, one industry insider anticipates the market could exceed $10 billion, capturing both the illegal market and a

portion of the distilled spirits market.5 SHAF anticipates that exposure to secondhand marijuana smoke could increase

as more Canadians continue to register for medical marijuana, and as people enter the market once it is legalized. This

fact sheet provides information on the health effects of exposure to secondhand marijuana smoke, strategies to reduce

exposure, and clarification on human rights and the use of medical marijuana.

1 Health Canada. Canadian Tobacco, Alcohol and Drugs Survey (CTADS) 2013. http://healthycanadians.gc.ca/science-research-

sciences-recherches/data-donnees/ctads-ectad/tables-tableaux-2013-eng.php#t8 2 Rotermann M & Langlois K. (2015). Prevalence and correlates of marijuana use in Canada, 2012. Health reports, 26(4), 10.

http://www.statcan.gc.ca/pub/82-003-x/2015004/article/14158-eng.pdf 3 Centre for Addiction and Mental Health. Cannabis Policy Framework. October 2014.

https://www.camh.ca/en/hospital/about_camh/influencing_public_policy/Documents/CAMHCannabisPolicyFramework.pdf 4 Fischer B et al. Lower Risk Cannabis Use Guidelines for Canada (LRCUG): a narrative review of evidence and recommendations.

Canadian Journal of Public Health (2011): 324-327. https://www.tni.org/files/publication-downloads/2758-7245-1-pb_1.pdf 5 Posadzki A. Producers expand operations to meet growing demand for marijuana. The Globe and Mail. September 10, 2016.

https://www.camh.ca/en/hospital/about_camh/influencing_public_policy/Documents/CAMHCannabisPolicyFramework.pdf

https://www.tni.org/files/publication-downloads/2758-7245-1-pb_1.pdf

http://healthycanadians.gc.ca/science-research-sciences-recherches/data-donnees/ctads-ectad/tables-tableaux-2013-eng.php#t8

http://www.statcan.gc.ca/pub/82-003-x/2015004/article/14158-eng.pdf

http://healthycanadians.gc.ca/science-research-sciences-recherches/data-donnees/ctads-ectad/tables-tableaux-2013-eng.php#t8

Smoking and Health Action Foundation

2

Health effects of exposure to marijuana smoke

Burning marijuana produces smoke that is a complex, dynamic mixture of thousands of chemicals. Scientific studies

demonstrate that marijuana smoke is similar to tobacco smoke, containing many of the same fine particles, cancer-

causing compounds, volatile organic chemicals (VOCs), carbon monoxide (CO) and heavy metals.6 Thirty-three known

cancer-causing chemicals found in both tobacco and marijuana smoke are on California’s list of chemicals known to

cause cancer or birth defects, and marijuana smoke itself was officially added to this list in 2009.7 An investigation by the

Globe and Mail found that one third of dried marijuana samples purchased from Toronto dispensaries and sent for

laboratory analysis contained potentially dangerous compounds such as bacteria, yeast and mould which add to smoke

toxicity.8 However, some research has found that tobacco and cannabis smoke are not necessarily equally carcinogenic:

whereas nicotine can promote tumour growth, cannabinoids in cannabis smoke have been observed to actually kill

cancer cells.9

Scientists are still trying to identify the specific health

effects caused by exposure to secondhand marijuana

smoke. Marijuana’s illegal status in most parts of the

world makes it challenging to study: people may not

want to admit that they consume cannabis, or may

under-report consumption. Further, it is common for

people to smoke a mixture of tobacco and marijuana

together, which makes it difficult to identify the

health effects of exposure to secondhand marijuana

smoke alone. There are a few human studies that

look at THC in secondhand marijuana smoke and how

it affects bystanders. It appears that under normal

ventilation conditions, the chances of getting high are

low.10

Health Canada acknowledges that many of the chemicals found in tobacco smoke are also found in marijuana smoke

and advises against smoking marijuana.11 This is sound advice. There is no safe level of exposure to secondhand tobacco

smoke. Although clear links between smoking cannabis and cancer have not been found, avoiding smoke of any kind is a

6 Sparacino, CM, Hyldburg PA & Hughes TJ. Chemical and biological analysis of marijuana smoke condensate. NIDA Res Monogr 99

(1990): 121-40. http://archives.drugabuse.gov/pdf/monographs/99.pdf#page=128 7 Tomar RS, Beaumont J & Hsieh JCY. Evidence on the Carcinogenicity of Marijuana Smoke. Aug. 2009. California Environmental

Protection Agency, Reproductive and Cancer Hazard Assessment Branch, Office of Environmental Health Hazard Assessment. http://oehha.ca.gov/media/downloads/crnr/finalmjsmokehid.pdf 8 Robertson G & McArthur G. What’s in your weed? The Globe and Mail. August 12, 2016.

http://www.theglobeandmail.com/news/investigations/globe-investigation-whats-in-your-weed-we-tested-dispensary-marijuana-to-findout/article31144496/ 9 Melamede R. Cannabis and tobacco smoke are not equally carcinogenic. Harm Reduction Journal 2.1 (2005): 1.

https://harmreductionjournal.biomedcentral.com/articles/10.1186/1477-7517-2-21 10

Cone EJ et al. Nonsmoker Exposure to Secondhand Cannabis Smoke. III. Oral Fluid and Blood Drug Concentrations and Corresponding Subjective Effects. Journal of analytical toxicology (2015): bkv070. http://jat.oxfordjournals.org/content/early/2015/07/01/jat.bkv070.full.pdf+html 11

Health Canada. Consumer Information - Cannabis (Marihuana, marijuana). http://www.hc-sc.gc.ca/dhp-mps/marihuana/info/cons-eng.php

Marijuana and tobacco are often smoked together.

A marijuana cigar, also known as a blunt, is marijuana

wrapped in tobacco leaf (often a hollowed out cigar).

http://www.theglobeandmail.com/news/investigations/globe-investigation-whats-in-your-weed-we-tested-dispensary-marijuana-to-findout/article31144496/

http://jat.oxfordjournals.org/content/early/2015/07/01/jat.bkv070.full.pdf+html

http://www.hc-sc.gc.ca/dhp-mps/marihuana/info/cons-eng.php

http://www.hc-sc.gc.ca/dhp-mps/marihuana/info/cons-eng.php

http://oehha.ca.gov/media/downloads/crnr/finalmjsmokehid.pdf

https://harmreductionjournal.biomedcentral.com/articles/10.1186/1477-7517-2-21

http://www.theglobeandmail.com/news/investigations/globe-investigation-whats-in-your-weed-we-tested-dispensary-marijuana-to-findout/article31144496/

http://archives.drugabuse.gov/pdf/monographs/99.pdf#page=128


3

good idea. A recent study that exposed rats to secondhand marijuana smoke demonstrated that the harm to their hearts

and blood vessels was comparable to the harm from secondhand tobacco smoke.12 Fine particles, CO and other by-

products of combustion that are known to cause heart disease and respiratory illnesses such as emphysema and COPD

are present in cannabis smoke and pose a health risk with exposure.13 More and better research is needed, including

studies done with humans. SHAF advises that all Canadians, and especially special risk groups including children,

pregnant women, older adults and those with pre-existing conditions such as asthma, COPD and heart conditions, avoid

exposure.

Strategies to reduce exposure

Smoking marijuana is a dirty delivery system that increases harm to users and to others around them. Canadians’

exposure to secondhand marijuana smoke can be reduced by:

Including marijuana in smoke-free bylaws and legislation. Exposure to any kind of smoke is harmful to health and

smoke-free public places and workplaces must be protected in the interests of public health.

Including marijuana in no-smoking policies for multi-unit housing. Like tobacco smoke, marijuana smoke can infiltrate

private units from elsewhere in a building through cracks and gaps and ventilation systems. Landlords, condominium

corporations and housing co-ops can expand the definition of smoking to include marijuana in no-smoking policies, with

an exemption for medical marijuana users.

Educating Canadians about alternative delivery systems. In the interest of public health, it is critical that people

understand the relative risks of smoking marijuana compared to other delivery options. Mass media public education

campaigns are needed, as is more relative risk research to underpin them. Smoke-free delivery methods include:

Vaporizers heat marijuana at a lower temperature than combustion, which produces an inhalable vapour that still

contains the active ingredients but without all the harmful by-products in secondhand smoke. One small study found

that vaporizing delivered THC as effectively as smoking, significantly reduced exposure to carbon monoxide

compared to smoking and was preferred by the majority of participants.14 However, more research is needed to

determine the chemical composition of secondhand vapour and its possible health effects. Nonetheless, based on

current evidence, Lower Risk Cannabis Use Guidelines for Canada (LRCUG) recommend the use of vaporizers over

smoking joints, blunts and waterpipes.15 The LRCUG have been endorsed by the Centre for Addiction and Mental

Health as well as the Canadian Public Health Association.

Edibles, which represent the fastest growing segment in the American legal marijuana market, include cookies and

other baked goods, chocolates, candies, drinks and more. Eating or drinking cannabis infused products is a slower

drug delivery method than vaping or smoking. However, dosing can be challenging, and edibles carry a higher risk of

12

Wang X et al. One minute of marijuana secondhand smoke exposure substantially impairs vascular endothelial function. Journal of the American Heart Association 5.8 (2016): e003858. http://jaha.ahajournals.org/content/5/8/e003858.full.pdf+html 13

Moir D et al. A comparison of mainstream and sidestream marijuana and tobacco cigarette smoke produced under two machine smoking conditions. Chemical research in toxicology 21.2 (2007): 494-502. 14

Abrams DI, Vizoso HP, Shade SB et al. Vaporization as a smokeless cannabis delivery system: a pilot study. Clin Pharmacol Ther. 2007 Nov;82(5):572-8. Epub 2007 Apr 11. 15

Fischer B et al. Lower Risk Cannabis Use Guidelines for Canada (LRCUG): a narrative review of evidence and recommendations. Canadian Journal of Public Health (2011): 324-327. https://www.tni.org/files/publication-downloads/2758-7245-1-pb_1.pdf

https://www.tni.org/files/publication-downloads/2758-7245-1-pb_1.pdf

http://jaha.ahajournals.org/content/5/8/e003858.full.pdf+html


4

overconsumption because people may take multiple “doses” before the

effects of the first one are felt.16 Concerns have also been voiced about

accidental poisonings in children who can’t tell the difference between

regular goodies and those that are drug-laced.

Tinctures are solutions of liquid cannabis extracts dissolved in alcohol or

other fat-soluble liquids such as vinegar or glycerol. Administered as drops

under the tongue, tinctures are absorbed quickly into the arterial system and

offer better dosing control than edibles.

Topical preparations including lotions, balms and oils allow active ingredients to be absorbed through the skin

without the psychoactive effects. These are reportedly best used for localized pain relief.

Medical marijuana and human rights

Among other things, Canada’s new Access to Cannabis for Medical Purposes Regulations (ACMPR) enable eligible

Canadians to possess marijuana for medical purposes. This does not mean that such individuals have an absolute right to

smoke medical marijuana wherever they choose. Complaints of discrimination based on disability adjudicated at the

Human Rights Tribunal of Ontario confirm this.17 Health Canada advises that people who smoke it publicly should do so

discreetly unless it has been prohibited by smoke-free policy, municipal bylaw or provincial/territorial legislation.18

In June 2015 a Supreme Court of Canada ruling expanded Health Canada’s definition of medical marijuana beyond the

dried form, which is typically smoked, to include fresh marijuana and cannabis oil.19 This means that medical marijuana

can now be legally consumed in the variety of ways described above that do not pollute the air and cause harm. Further,

there are vaporizers that are approved as medical devices in Canada.20

Conclusion

Smoke is smoke and all smoke is harmful to health. Secondhand marijuana smoke contains many of the same toxic

chemicals as those found in tobacco smoke and which are known to cause cancer and heart and respiratory diseases.

SHAF anticipates that exposure could increase due to both mounting medical marijuana registrations and a legalized

market. Mass media public education campaigns are needed to provide relative risk information on alternative delivery

options that mitigate harm and don’t pollute the air. Regardless of whether marijuana is consumed medically or

recreationally, Canadians must be protected through a combination of public education and smoke-free policy.

16

Hancock-Allen, JB et al. Notes from the Field: Death Following Ingestion of an Edible Marijuana Product-Colorado, March 2014. MMWR Morb Mortal Wkly Rep 64.28 (2015): 771-2. http://www.cdc.gov/MMWr/preview/mmwrhtml/mm6428a6.htm 17

For example, Francisco v. Ontario (Community Safety and Correctional Services), 2015 HRTO 1028. https://www.canlii.org/en/on/onhrt/doc/2015/2015hrto1028/2015hrto1028.pdf & Gibson v. Ridgeview Restaurant Limited, 2013 HRTO 1163. https://www.canlii.org/en/on/onhrt/doc/2013/2013hrto1163/2013hrto1163.pdf 18

Health Canada. Cannabis for Medical Purposes. Personal communication. 27 September 2016. 19

R. v. Smith, 2015 Supreme Court of Canada 34; File No.: 36059. 2015: March 20; 2015: June 11. https://www.canlii.org/en/ca/scc/doc/2015/2015scc34/2015scc34.pdf 20

Government of Canada. Medical Devices Active Licence Listing. https://health-products.canada.ca/mdall-limh/information.do?companyId_idCompanie=131505&lang=eng

https://www.canlii.org/en/ca/scc/doc/2015/2015scc34/2015scc34.pdf

http://www.cdc.gov/MMWr/preview/mmwrhtml/mm6428a6.htm

https://www.canlii.org/en/on/onhrt/doc/2013/2013hrto1163/2013hrto1163.pdf

https://www.canlii.org/en/on/onhrt/doc/2015/2015hrto1028/2015hrto1028.pdf

https://health-products.canada.ca/mdall-limh/information.do?companyId_idCompanie=131505&lang=eng

https://health-products.canada.ca/mdall-limh/information.do?companyId_idCompanie=131505&lang=eng