Canada is in the process of introducing increasingly stringent measures to discourage use of tobacco, while simultaneously moving forward with a plan that, regardless of its intentions, tacitly legitimizes the recreational use of marijuana through its legalization. These two very different approaches to smokable leaf products fail to give due attention to a crucial similarity between smoking tobacco and smoking marijuana: the smoke.

Making good on its campaign promise to legalize marijuana, on June 30 of this year the government launched a Task Force on Marijuana Legalization and Regulation, whose recommendations on a new regulatory framework for the sale and distribution of marijuana are to be guided by a public health approach. To this end, the accompanying government discussion paper talks about minimizing harms associated with legalization.

Strangely, however, while it does address a range of issues, such as ensuring legalization does not encourage use by minors and addressing the risks of toking and driving, the discussion around the risks associated with different marijuana use methods focuses on consuming baked goods and overlooks the deleterious effects of smoke inhalation. As well, the key goal of promoting methods of use less harmful than smoking is mentioned only in passing, or not at all, in submissions to the task force from many prominent health organizations (such as the Canadian Medical Association, the Canadian Pharmacists Association, and the Canadian Public Health Association). Given that tobacco smoke remains the number one preventable cause of death in Canada, it seems quite bizarre that its marijuana counterpart is such a low priority in the development of a legalization framework.

Smoking involves combustion. Combustion results in unwanted and harmful chemicals being inhaled into the lungs. Although the way people smoke tobacco and marijuana differs in ways such as the amount they smoke and how deeply they inhale, the fact remains that inhaling smoke is a particularly harmful practice. In addition, for both products, smoke and its harms are secondary to what the smoker actually wants: nicotine, in the case of tobacco, and THC and other cannabinoid compounds in the case of marijuana. Consequently, if Canadians are looking for nicotine and THC, we should be directing more attention to how they can find them in less harmful forms. Currently, the most effective alternatives available are noncombustion products such as marijuana vaporizers and e-cigarettes, which mimic the rewards of smoking more effectively than products like gums and patches (cigarettes) or brownies and oils (marijuana), while also minimizing the harms associated with smoke.

Ensuring that the legalization of marijuana coincides with the promotion of or at least dissemination of accurate information about such less harmful methods of ingestion, is a profoundly sensible idea. Through the task force, Canada has a chance to tackle this issue by directly incorporating a shift toward an improved THC delivery method into the resulting plan. (This is not to be confused with far less compelling ideas around delivery, such as the suggestion Canada Post take charge of marijuana distribution.)

The underemphasis of harm reduction in the current marijuana legalization process shines a light on the faults in the abstinence-only approach to tobacco control, which has rejected noncombustion alternatives for those who use tobacco. Given that the task force is overtly adopting a public health approach, it makes no sense to fail to encourage consumers who use a now-legal product to do so in as safe a way as possible. And, given Health Canada has acknowledged in the past that, as way to consume medical marijuana, vaporization appears to pose lower risks than smoking, it would be nonsensical not to promote a similar approach to marijuana’s recreational use, where the harms of smoke are not offset by any medical benefit

Once we acknowledge that it is clearly advantageous to promote a less harmful method of use for those consuming now-legal marijuana, the dogmatic irrationality of treating noncombustion alternatives as equivalent to tobacco cigarettes becomes all too apparent, necessitating a parallel shift to a more sensible regulatory framework that properly balances risks and benefits. In September 2016, as part of an expansion of its Federal Tobacco Control Strategy, Health Canada finally indicated it will introduce a framework to govern legal access to vaping products “as a potentially less harmful alternative to tobacco.” This is not a very enthusiastic attitude, particularly when contrasted with a recent report from Royal College of Physicians in the United Kingdom, which concluded that the long-term health risks of e-cigarettes were “unlikely to exceed 5% of the harm from smoking tobacco,” but it is progress. While less extensively studied, the harm-reducing properties of marijuana vaporizers seem consistent with the science on e-cigarettes. Furthermore, in contrast to the regulatory limbo of e-cigarettes, Health Canada has already approved cannabinoid vaporizer devices for medical marijuana patients.

Canada has a chance to get it right from the beginning with marijuana, gaining the benefits of legalization while minimizing potential harms. At the same time, it has the opportunity to recognize that tobacco users are ill-served by an approach that overlooks the benefits of harm reduction. It should not allow this opportunity to protect Canadians with a harm-reduction strategy that rationally addresses both products to go up in smoke.

Photo: I WALL/


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Adam R. Houston
Adam R. Houston is the medical policy and advocacy officer for Doctors Without Borders/Médecins Sans Frontières Canada. Twitter @HealthLawAdamH
David Sweanor
David Sweanor is a public health advocate and adjunct professor in the Centre for Health Law, Policy and Ethics at the University of Ottawa.

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