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If pot use increases, government should amend legislation, says CMAJ

An editorial in the Canadian Medical Association Journal says Canada should actively monitor the use of cannabis following legalization. Dr.Brian Goldman (@NightshiftMD) explains why.
A marijuana plant with others behind it out of focus.
An editorial in the Canadian Medical Association Journal calls on the federal government to take responsibility for the consequences of legislation it describes as 'controversial.' (Jeff McIntosh/The Canadian Press)
  As access to recreational marijuana becomes legal this week, an  editorial published Monday in the Canadian Medical Association Journal has some tough words for the federal government. 

The editorial calls on the federal government to take responsibility for the consequences of legislation it describes as "controversial."

It says the government must provide adequate funding for robust monitoring of cannabis use across all segments of society, especially youth and other high-risk populations. It says that the anticipated tax revenue windfall from sales of licit marijuana should be used to pay for research on the harms related to the use of cannabis. 

In the event that the use of cannabis increases, the article states that the federal government should be prepared to amend the act.

There are several reasons why the journal has called the government to account. It argues that the federal government's stated commitment to push the legislation through has triggered substantial investment in cannabis firms.

Their goal, argues CMAJ, is to generate profits through increased sales of marijuana. They'll do that, the article predicts, by first capturing consumers of black-market cannabis and later by getting users to increase their consumption and by attracting young people.

Problem use

The editorial says the government must provide adequate funding for robust monitoring of cannabis use across all segments of society. (Thomas Samson/AFP/Getty Images)
Data from Health Canada shows problem use in nearly one in three adult users of cannabis, and addiction in close to one in 10. The risk among youth is higher. Given that, the CMAJ said it's highly likely that use and problem use will go up both in adults as well as young people.

Precautions have been put in place to prevent or discourage youth from obtaining marijuana.

The new law prohibits providing or selling cannabis to youth. It also prohibits the selling, packaging, and labelling of cannabis products that are considered appealing to youth, and puts in place the same advertising restrictions that exist for tobacco products. 

  The journal argues that even with those restrictions in place, there is plenty of leeway for cannabis use among youth.

It notes that Canada is seeing the rise of brands of cannabis. Some are using music festivals and other venues to promote their products.  Beyond that, the legalization of cannabis sends a clear message to Canadians that its use is acceptable.

Last year, the government announced $46 million in funding over the next five years to be invested in public education, awareness and surveillance activities to inform Canadians, including youth and other priority populations of the health and safety risks of cannabis use and drug-impaired driving.

Driving while impaired

  There's reason to be concerned about young people driving while under the influence of marijuana. A  recent survey in Ontario by the Canadian Automobile Association documented rising rates of drivers impaired by cannabis use.

A study of 180 participants ages 18 to 24 looked at driving skills after a 100 mg dose of cannabis. Researchers found that test subjects could perform simple tasks, but were significantly impaired on complex driving tasks. They were also more likely to be judged as having a high risk of being involved in an automobile collision. The effects lasted five hours after using cannabis.

As an emergency physician, I'll be watching for patients who come to the ER with symptoms of marijuana intoxication. These include rapid heart rate, hallucinations, mental confusion, panic attacks and, in some cases, extreme paranoia.

I expect we'll be seeing more patients who present with symptoms of psychosis. We'll also see more patients who complain of vomiting caused by more frequent use of cannabis. I wonder if we'll see an increase in impaired driving and motor vehicle collisions.

As a parent, I'm interested in seeing how effective the law is in preventing younger teens from using.

I also wonder just how big the market for legal cannabis will become.


Dr. Brian Goldman is a veteran ER physician and an award-winning medical reporter. As host of CBC Radio’s White Coat, Black Art, he uses his proven knack for making sense of medical bafflegab to show listeners what really goes on at hospitals and clinics. He is the author of The Night Shift and The Power of Kindness: Why Empathy is Essential in Everyday Life.