I just want to touch on one of the other areas in which we've done some work, and that is how we define harmful or problematic cannabis use. A national and international group I work with has looked at how we define this issue. I know it's an issue of concern for the committee.
Simply put, there are various tools that are used by clinicians to assess or screen for problematic use. These tools include the WHO's ASSIST, for instance, and others, such as the CUDIT, the cannabis use disorders identification test. These tools are used to identify people at potential risk for cannabis misuse and problems.
When we look at this issue, we find that these items typically set the threshold or the bar too low. These items typically identify any use as being problematic use, so we see them as not very useful tools. What often gets looked at is simply whether somebody uses and the frequency of use.
For instance, with the ASSIST tool, you could use cannabis once a month and be identified as being a problematic or harmful user, and that would over-screen people from a health care perspective. That would be a terrible tool to identify problematic use. What gets excluded are true problems related to use that might be experienced by the individual. I think we have to be careful when we use these kinds of tools to identify problematic use, and we must consider broader issues around real harms that might be affecting the individual.
One of the things we looked at is that it's maybe more important to measure the quantity of consumption, as we do with alcohol. We can draw on the alcohol literature here. Quantity is more important than frequency. Bingeing is more important than regular use of one joint a day. It would be more important to look at somebody who smokes in excess of three or four joints in a single sitting at more irregular intervals or at somebody who uses multiple joints in a particular day. Drawing on the alcohol literature, I think quantity is something that's not considered strongly enough when we're looking for problematic and harmful use.
I have a lot more to say, but I'll leave my points right here and answer questions.