With the introduction of the Cannabis Act in 2018, Canada was the second jurisdiction (after Uruguay) to legalize cannabis at a national level for adult recreational use. Given this substance was illegal for over 90 years, and ending this prohibition was unprecedented for Canadian society, Parliament mandated a review of the Act within three years of its passage.
The objective of the review is to understand the impact of the Act on public health with a specific focus on: youth consumption habits; indigenous persons and communities; and on allowing the cultivation of the plant in a dwelling house.
However, due to intense efforts by the industry and several other active stakeholders, the Minister of Health agreed to broaden the scope of the review so that there is also an analysis on the economic, social, and environmental impacts of the Act.
To undertake this work, the Government of Canada created an independent Expert Advisory Group (Group). Note, this Group was established a year after the review was supposed to begin. No official explanation was given by the Government as to why the review was delayed. However, officials in Ottawa will claim that a review after three years was not sufficient to properly understand the impact of the Act on Canadian society. The Expert Advisory Group, seems to agree with this assessment. 1
The Group is Chaired by of a former Deputy Minister of Health Canada (a career civil servant); three public health care professionals in Mental Health, Psychiatry and Psychology; and a Criminal Lawyer who is nehiyaw iskwew and member of the Fisher River Cree Nation in Manitoba, Treaty Five Territory. In late 2022 the Group was briefed by Health Canada officials and held consultations with stakeholders (virtual and in person across the country) until June 2023. They met with: “…almost 500 individuals from over 200 organizations in nearly 90 meetings.” 2
In late October of 2023, the Group released their “What We Heard Report”. This document reports on the Group’s work: “…engaging with stakeholders and experts to consider evidence and collect opinions and perspectives.” 3
What Was Heard
The report in its entirety (all 112 pages) can be found here. The report comes with a 9-page Executive Summary. Cleary, Canadians have several opinions and views (complimentary and divergent) on the current state of the Act. The report compiled its findings into 8 sections.
Public Health
There is widespread agreement that the Act has met its public health objectives but that its protections must be enhanced and continued into the future while additional research should be undertaken (with funding made available).
Youth
The Group heard that cannabis use remains high and that this has led to increased hospitalizations and that more engagement and education with youth need to be undertaken. It was noted that: “…dramatic reduction in the number of youth charged with cannabis-related offences.” 4
First Nations, Inuit and Métis
One of the key issues raised was the limited engagement undertaken by the Government of Canada with representatives from First Nations, Inuit and Métis as the Act and Regulations were being crafted, implemented and enforced. The lack of support for education, public health and harm reduction programs specific to these populations also remains a concern.
Home Cultivation
Interestingly, given the history of legal cannabis programs in Canada (home cultivation being only 1 of 2 legal sources to access the product for several years), home cultivation was not a regular topic of discussion or concern.
Economic, Social, and Environment Impacts
The main issues raised were the financial viability of the industry, an excessive regulatory burden, high taxes and an archaic Provincial Government controlled distribution system (e.g. high mark-up fees). These concerns were juxtaposed by public health representatives stating that a precautionary approach still needs to be applied and such concerns need to be placed within that context.
Adult Access
While access to retail locations is not an issue, the types of products, price and packaging size available remains problematic when compared to the lower price, convenience and availability of unregulated illegal products. In addition, it was pointed out that further educational material on the risks and benefits of cannabis use are essential.
The Illicit Market
Some progress has been made in the reduction of the illegal market. However, there are mixed views on how successful (size and scope) legalization has been in displacing this market.
Cannabis for Medical Purposes
There is support for the continuation of a distinct medical program. However, a system that can codify cannabis-based health products needs to be implemented while additional health care providers should be included in the regime (e.g., pharmacists and pharmacy distribution).
Conclusion/Next Steps
Among the many things the Government of Canada does well, is establishing various independent committees/groups/boards/commissions etc. to study important policy issues. Dedicated professionals (who donate their time) make up the Group while it is supported by a Secretariat comprised of equally dedicated civil servants from Health Canada. Unfortunately, the Government of Canada did not include any individual(s) from the industry (cultivator, retailer, product producer), practicing family physician, pharmacist or a cannabis medical researcher.
This is an oversight and one that cannot be addressed by simply consulting with the aforementioned groups. Such an (internal) perspective should have been included as the Group considers its recommendations to the Government of Canada.
The Group has started another round of stakeholder consultations (Fall 2023) virtually and via various roundtables across Canada – such extensive engagement is to be applauded. The author was able to attend two of these meetings and found the group to be engaged and interested in all views and opinions brought forth in the sessions attended.
However, it appears (in the opinion of this author), the Group is solely concerned about public health at the expense of all other issues. There is no question that public health considerations are an important mandate of the review and that there is a duty to understand the health impacts on Canadians, but it needs to be placed in the context of credible research done to-date and available evidence.
That is, legalization can be viewed as a positive policy: it is slowly eliminating the illegal market (more work needs to be done); therapeutic research has and is being conducted; a complete supply chain has been built in Canada for a new industry; and people are not being convicted (and all that entails) for simple use and possession.
Every public policy is multifaceted and should therefore be considered within its entire ecosystem. The concern is that while the Group is making every effort to listen and engage with Canadians, old biases need to be checked so that there can be a robust analysis on the risks and benefits of cannabis legalization.
The Group will present its findings and recommendations to the Government of Canada by March 2024. What the Government then does with the final report remains to be determined.
