Thank you, honourable members. It's great to be here and to share some thoughts with you.
My name is Benedikt Fischer. I'm a senior scientist at the Institute for Mental Health Policy Research at CAMH, and chair in addiction psychiatry of the Department of Psychiatry at the University of Toronto.
I will share my opening remarks with my colleague, Dr. Le Foll. I will speak to you primarily from the public health perspective, and he will speak primarily from the clinical perspective on treatment.
I have worked on cannabis epidemiology, interventions, and policy for almost 20 years. Let us generally say that we very much welcome the federal government's initiative towards legalization of cannabis use and supply with strict regulations, because we believe—and we have stated this clearly in our 2014 CAMH policy framework—that this is the best way to improve public health and the safety outcomes related to cannabis use. We have said that before it was politically popular on the federal level.
On cannabis use, I'll make a few substantive comments. Cannabis use is not benign in terms of health risks. Cannabis use is associated with a number of different acute and chronic health risks. I will not repeat those; they're very well documented in the scientific literature.
This is a panel on prevention and treatment interventions. I'll elaborate a bit on the prevention side. In the intervention field, we typically distinguish between primary and secondary prevention, primary prevention being general prevention, and secondary or targeted prevention being aimed at users to reduce concrete use-related risks for adverse outcomes.
Let me emphasize that primary prevention for cannabis, especially under legalization, is an important facet of policy and interventions. Let me emphasize that abstinence from cannabis use is still the safest and most reliable way to avoid and reduce the risks of use.
However, we have a large number of Canadians—about 15% of the adult population, but up to 40% to 45% of youth and young adults—who've made the decision, for whatever reasons, to be users. So we have to combine our efforts on the prevention side both to keep the true abstinence rate as low as reasonably possible and to do everything we can to reduce the risks and harms among those large populations of people who've made the decision to actually use. That really, in essence, is the main practical challenge under legalization.
Given that the majority of use is concentrated in the 15-to-29 age group—in other words, youth and young adults—we have to ensure that this sizable population of young Canadians makes it through that cannabis use period into mid- and late adulthood with as little and the most limited health and social harms as possible for legalization to succeed as a public health intervention. That's essentially the quintessential challenge under legalization policy for the benefit of public health.
To elaborate a bit on the secondary or targeted prevention side with some examples, secondary prevention is of course a very broad realm or range of efforts that relate to a lot of different details of how legalization is designed and implemented. In other words, these are things such as what do we sell, where do we sell, who do we sell to, and how do we control distribution, but they're also things like avoiding the promotion and advertising of cannabis, and also pricing policy. All those kinds of aspects of the organization of legalization as it is enacted, as we know very well from data from alcohol and tobacco policy, are extremely powerful levers in terms of the risks and harms that we want to avoid. A lot of these details—or the devil that is in those details—are very relevant to the kinds of outcomes that legalization policy will produce and entail.
I'll just give a couple of examples. What will be extremely relevant for those kinds of risks and harms is what products are sold. We should avoid selling high-risk and high-potency products. At the same time, things such as edibles should be allowed, because they bear the potential to reduce, for example, smoking-related harms.
We should categorically not allow any kind of commercialization through advertising or promotion that leads to higher use and higher harms. As we know from alcohol and tobacco, we should keep distribution in public monopoly hands.
Pricing and taxation is enormously important, but not in a static way. It needs to be flexible so that we can adjust to organize demand and supply.
I'm personally concerned about restricting cannabis use—and potentially production through home growing—to private homes. It's not in the good interest of public health.
Finally, there's also the potential to reduce risks and harms among cannabis users through behavioural choices they make. That's exactly the conceptual basis of the lower-risk cannabis use guidelines that we launched in June from an international committee of scientists, published in the American Journal of Public Health and endorsed by the federal Minister of Health and five leading national health organizations. This is one ready tool for targeted prevention among users, as part of a comprehensive prevention strategy that we're happy to help with.
I'll hand it over to my colleague, Dr. Le Foll, to speak on issues of cannabis disorder and treatment.