Cannabis

The Alberta government is currently considering how to regulate the distribution, sale and use of recreational cannabis in response to federal cannabis legalization. This process must take into consideration the strong association between cannabis and tobacco use and the potential for cannabis legalization to impact tobacco initiation and consumption.

Cannabis and tobacco are two of the most commonly used psychoactive substance in the world.  Approximately 17 percent of Canadians currently smoke tobacco products,1 and 12 percent of Canadians have used cannabis at some point during the previous year.2

Studies suggest that up to 90 percent of cannabis users are also tobacco users and that cannabis use during adolescence and early adulthood is associated with increased risk of initiation of tobacco use and nicotine dependence.3 Joint or mixed use of cannabis and tobacco is associated with an increased risk of adverse health effects4 more challenges when quitting,5 6 and greater risk of relapse.7  Thus, any increase in overall cannabis use resulting from legalization may increase tobacco use, particularly among youth.8 The smoking of cannabis in public settings also has the potential to renormalize public smoking and to threaten decades of progress in creating smoke-free environments.

Cannabis legalization presents a critical opportunity to develop comprehensive legislation that will support controls on recreational use of cannabis and fill gaps in tobacco control regulation.

Tobacco kills significantly more Canadians than Cannabis

Estimates of annual attributable deaths9 10

Taxation: Taxation should be a cornerstone of the province’s strategy to reduce tobacco and cannabis use, as its effectiveness in reducing consumption has been well documented.11 When implementing a cannabis tax framework in Alberta, tobacco taxes should also be increased to match tobacco product affordability levels in neighboring provinces and to reduce the likelihood of mixed/joint use of cannabis and tobacco. A significant portion of any new cannabis and tobacco tax revenue should be earmarked for research, programming and education to prevent and reduce the harms of substance use.

Retail Licensing: Evidence indicates that when strong retail licensing requirements are implemented and actively enforced, they are effective at reducing tobacco product sales to minors and can help reduce consumption among youth.12 Alberta’s regulatory framework for alcohol (managed by the Alberta Gaming and Liquor Commission) is a possible working model that could be used to develop a regulatory framework for cannabis and tobacco.

Protecting Youth: Several additional policy measures have been proven to protect youth from the dangers of tobacco use which can be applied to cannabis regulation. These measure also have the potential to decrease the negative impact of cannabis legalization on tobacco control. These measures include actively implementing and enforcing sales-to-minors restrictions, prohibiting flavoured products, maintaining smoke-free public spaces including a ban on cannabis smoking in public settings, prohibiting the colocation of tobacco, cannabis and alcohol retail sales, discouraging joint use or poly-substance use (the use of tobacco, cannabis and alcohol together is common among youth13), and prohibiting the sale of mixed products.

Full text backgrounders

Footnotes

  1. Statistics Canada. Canadian Community Health Survey, 2015. http://www.statcan.gc.ca/daily-quotidien/170322/dq170322a-cansim-eng.htm
  2. Government of Canada. Canadian Tobacco Alcohol and Drugs (CTADS), 2015 Summary. March 2017. https://www.canada.ca/en/health-canada/services/canadian-tobacco-alcohol-drugs-survey/2015-summary.html
  3. Agrawal, A, & Lynskey, M. T. Tobacco and cannabis co-occurrence: Does route of administration matter? (English). Drug And Alcohol Dependence 2009; 99(1-3), 240-247.
  4. Leos-Toro C, Reid JL, Madill CL, Rynard VL, Manske SR, Hammond D. Cannabis in Canada - Tobacco Use in Canada: Patterns and Trends, 2017 Edition, Special Supplement. Waterloo, ON: Propel Centre for Population Health Impact, University of Waterloo
  5. Agrawal, A, & Lynskey, M. T. Tobacco and cannabis co-occurrence: Does route of administration matter? (English). Drug And Alcohol Dependence 2009; 99(1-3), 240-247.
  6. Peters, E. N, Budney, A. J, Carroll, K. M., et al. Clinical correlates of co-occurring cannabis and tobacco use: a systematic review (English). Addiction (Abingdon. Print) 2012; 107(8), 1404-1417.
  7. Hindocha, C, Shaban, N. D, Freeman, T. P., et al. Associations between cigarette smoking and cannabis dependence: A longitudinal study of young cannabis users in the United Kingdom. Drug And Alcohol Dependence, 2012; 148165-171. doi:10.1016/j.drugalcdep.2015.01.004.
  8. Ibid
  9. Health Canada, Smoking and mortality Accessed June 2017: https://www.canada.ca/en/health-canada/services/health-concerns/tobacco/legislation/tobacco-product-labelling/smoking-mortality.html
  10. Fischer,Benedikt et. al.Crude estimates of cannabis-attributable mortality and morbidity in Canada–implications for public health focused intervention priorities. Journal of Public Health. Vol. 38, No. 1, pp. 183 –188 (2015).
  11. U.S. National Cancer Institute and World Health Organization. The Economics of Tobacco and Tobacco Control. National Cancer Institute Tobacco Control Monograph 21. Chapter 4. The impact of Tax and Price on the Demand for Tobacco Products. NIH Publication No. 16-CA-8029A. Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute; and Geneva, CH: World Health Organization; 2016. https://cancercontrol.cancer.gov/brp/tcrb/monographs/21/index.html
  12. Pacula, R. L, Kilmer, B, Wagenaar, A. C., et al. Developing Public Health Regulations for Marijuana: Lessons From Alcohol and Tobacco. American Journal Of Public Health 2014; 104(6), 1021-1028. doi:10.2105/AJPH.2013.301766.
  13. Haines-Saah, R, Moffat, B, Jenkins, E., et al. The Influences of Health Beliefs and Identity on Adolescent Marijuana and Tobacco Co-Use. Qualitative Health Research, 24(7), 946-956.