It’s now official: as of October 17, 2018, Canada will become the first G7 nation to legalize both medical and adult-use recreational cannabis. It’s a historic, disruptive and uncertain moment.
The Guardian newspaper recently pointed out that “all eyes” are now on Canada. Those eyes are watching to see how this public policy will be deployed and what the ripple effects will be on crime, health, consumer spending, public safety, job creation and more.
How legalization will roll out in Canada in the next 18 months will also have a significant impact on the rate and number of other countries following suit. The shift will have a series of implications, including decreasing prescription opioid use and helping end the disproportionate impact that criminalizing cannabis has on low-income communities and communities of colour. Furthermore, Canada’s bold cannabis policy has become linked to our global credibility, particularly as it relates to successfully undertaking significant policy shifts.
To increase the likelihood that legalizing cannabis will be successful, policy-makers, the cannabis industry and all those invested in the outcome of this legislation must come together to drive forward four urgent public conversations and changes. Support for legalization is fragile, and if public opinion turns sour, the political response is likely to be swift and damagingly prohibitive.
Here’s what we need to do to prevent a negative outcome.
Manage industry and public expectations
At the recent World Cannabis Congress, Anne McLellan, chair of Canada’s Task Force on Cannabis Legalization and Regulation, did an excellent job of managing expectations around the initial months after legalization. “This is transformative public policy. This is not going to be perfect in the first year or the first few years,” she told her audience. She stressed that lawmakers need to be adaptable and flexible regarding these new laws — traits that are uncommon in government and therefore require deliberate and proactive preparations.
She highlighted that, despite due diligence and widespread consultation within Canada and in other jurisdictions where cannabis is already legalized (including Colorado and Uruguay), the expectation should be that in whatever form the laws are finalized, they will need to evolve. “For the first decade that legalization is in place, we are all going to be learning and adapting…There will be surprises. We have to be flexible and nimble to adapt to the surprise,” she said.
This message needs to be shared widely, both with the cannabis industry — which, as one sector leader pointed out, is not a group generally predisposed to sympathy for policy-makers — and, more urgently, with the public at large.
It’s essential to create the necessary social licence to be able to pivot and amend specifics of the legislation while maintaining public confidence, and this will happen only if policy-makers establish the understanding that initial bumps in the road are inevitable in a shift of this magnitude and that they can be successfully addressed and resolved.
Better engage the medical community
One misstep on the path to cannabis legalization has been the failure to engage positively with Canadian doctors, who will soon be on the front lines as more patients seek advice on and prescriptions for medical cannabis.
Most physicians are not adequately informed on cannabis treatment options or on how cannabis can be used alongside other prescriptions. Currently, eight out of nine physicians in Canada say they do not feel comfortable discussing or providing access to medical cannabis.
Lack of information is one of the reasons why the powerful Canadian Medical Association (CMA) has been so vocal about its opposition to the medical cannabis system, but the CMA’s is a circular argument. Little support among the medical community means that little research is being undertaken, which means that little validation is available, which means that little support is forthcoming, and so it goes. A CMA spokesperson has explained that medical cannabis is a choice that many doctors are reluctant to prescribe because of the shortage of peer-reviewed research. This lack of sufficient research is the result of cannabis being illegal in most jurisdictions.
A successful transition to a medical cannabis regime alongside legal recreational use by adults requires better engagement with the medical community, from long-practising doctors to those currently in medical school. Future doctors are already advocating for deeper, more thoughtful cannabis education. The Canadian Federation of Medical Students recently published a white paper seeking this training, which hints that a more open approach to medical cannabis is popular among younger doctors.
Industry leaders, policy-makers and champions in the medical and research community must come together to create a variety of opportunities and means of providing this education, as well as regular forums for research updates and new study results — which are now expected to come in massive waves.
Stop the tax on medical cannabis
Successful public policy starts with consistent public policy, but this is not the state of the existing cannabis regulatory regime. Specifically, one of the most severe cannabis policy gaps is that, despite the plant being treated as a medicine under the medical cannabis regime, the government confirmed in the February 2018 budget that it would be applying a 10 percent excise tax to all cannabis, whether for medical or recreational use. This means that a medical cannabis patient will be subject to both provincial and federal sales tax — a poor policy position on a number of fronts.
The first problem is the inherent inconsistency of treating medical cannabis, which can be obtained only via prescription from licensed health care practitioners, differently from other prescription medications, which are tax-exempt. Second and most important, this policy position hurts a group that the federal government should be looking to support: people who are financially or otherwise vulnerable and using cannabis for legitimate medical purposes. In 2015, research funded by the University of British Columbia Institute for Healthy Living and Chronic Disease Prevention found that more than half of respondents who use cannabis for medical purposes reported that they can never or only sometimes afford to buy enough to relieve their symptoms. A third of respondents stated that they often or always have to choose between medical cannabis and necessities such as food, rent and other medicines.
According to Jonathan Zaid, former executive director of the nonprofit Canadians for Fair Access to Medical Marijuana, which has been campaigning against the idea of taxing the ill since the Minister of Finance first raised this proposal, this policy position is both unjust and unpopular. “A recent Environics poll found that a majority of Canadians (62 percent) are opposed to taxing medical cannabis,” said Zaid in March. “And to date, over 16,000 Canadians and a group of 12 non-profits have advocated for the elimination of it. Despite this fierce opposition, the federal government decided to forge ahead, implementing the new tax in its federal budget.”
Given the enormous amount of revenue that the government will collect on recreational-use cannabis, and the lack of public support for taxing medical use, eliminating the tax on medical cannabis should be a priority.
Have robust public safety conversations
This is probably the most important and urgent point of all.
Research commissioned by Business of Cannabis in partnership with Nanos Research earlier this year showed that Canadians are looking for the industry to do far more than it currently is to educate the public on safe cannabis use. Only 17 percent of Canadians agree, and another 25 percent somewhat agree, that the industry is taking sufficient steps to ensure safe and responsible use. This situation has to change, and there is much work to be done.
From explaining Canada’s world-class safety and tracking system that ensures quality control, to addressing concerns about the effects of cannabis on the developing brain, to dealing with worries about driving and cannabis use, a series of multistrand, multistakeholder conversations should be undertaken.
An article on McLellan’s speech to the World Cannabis Congress reports that she pointed out that most Canadians “don’t use cannabis either recreationally or medicinally, and generally haven’t been paying close attention like those with a stake in legalization. So if the general public doesn’t understand what’s going with the laws, and something horrible happens in their community that they attribute to cannabis — such as a driver who is high and hits someone — the climate of acceptance could switch fast. ‘You are asking people to change their mindset. Don’t be dismissive, because you need those people to understand why this is happening, what to expect, and that we are all responsible actors. If not, they are the ones who have the political power.’”
It’s time for all actors invested in the success of this bold economic, social, health and cultural evolution to help drive forward these conversations and education campaigns, and to engage with as many Canadians as possible, as soon as possible.
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