Melissa Valentik, Health Promotion Specialist
Eric Nadalin, Manager, Chronic Disease and Injury Prevention
October 5, 2018
Non-Medical Cannabis Legalization
Cannabis is currently the most commonly used illegal substance in Canada (CCSA, 2017). Approximately 15.7% of Ontario residents self-reported cannabis use within 12 months (CAMH, 2016). In Windsor and Essex County, approximately 28, 900 residents used cannabis in the last year. Among those who consume cannabis, rates are highest among youth and young adults (WECHU, 2016). With legalization of cannabis, effective October 17, it is anticipated that the number of residents that report using cannabis will rise given the social acceptability of cannabis use.
Although cannabis smoke contains similar toxins to those found in tobacco smoke including those that are associated with cancer, as well as heart and respiratory disease, the harms of cannabis consumption extend beyond those directly associated with long-term chronic disease. Increased rates of injury or harms associated with impaired driving, falls or general impairment, damage to cognitive functioning (i.e., memory, focus, ability to think and learn), depression, anxiety, psychosis, and addiction are all associated with cannabis use. These harms increase when cannabis use begins prior to the age of 25, as well as with frequent or heavy use (CCSA, 2016, Parachute Vision Zero Network, 2018). Lastly, maternal cannabis use is linked to low birth weight, pregnancy complications, and may affect children’s cognitive functioning, behaviour, mental health and future substance use (Best Start, 2017).
The process leading toward legalization began In December 2015, when the Government of Canada announced its commitment to legalize, regulate, and restrict access to non-medical cannabis in Canada, with the intent to keep cannabis out of the hands of children and the profits out of the hands of criminals. In response, the Windsor-Essex County Health Unit Board of Health passed a resolution on January 14, 2016 supporting a public health approach to cannabis legalization, including strong health-centered and age-restricted regulations to reduce the health and social harms associated with cannabis use. In addition, the resolution mandated the Windsor-Essex County Health Unit support the development of healthy public policies and enforcement of future regulations to ensure minimal negative effects on public health and safety. The federal government introduced Bill C-45, the Cannabis Act, in April of 2017. This legislation would legalize access to non-medical (i.e., recreational) cannabis in Canada and provide a foundation of regulations on which provincial/territorial governments could develop more specific controls for how cannabis is grown, distributed, and sold in their provinces and territories. The federal Cannabis Act contains the following baseline regulations:
- restricts youth access to cannabis by prohibiting sale or supply to anyone under the age of 18;
- applies a personal possession limit of no more than 30g;
- limits personal cultivation to a maximum of four plants per household;
- prohibits packaging or labelling which makes cannabis products appealing to youth;
- requires standardized serving sizes and potency, and
- allows for only certain cannabis products to be offered for sale (i.e., dried cannabis, oils, and seeds), with others to be permitted at a later date (i.e., edibles).
In anticipation of further provincial regulation, the Windsor-Essex Board of Health passed a second resolution which aimed to better position municipalities to prepare in the context of federal and provincial regulation. This resolution, passed in October 2017, provided Windsor-Essex County Health Unit (WECHU) the mandate to prepare and protect our community from potential harms of cannabis legalization by:
- Encouraging Windsor-Essex municipalities to develop strict licensing, planning, and zoning regulations,
- Working with enforcement agencies and municipalities to support smoking prohibitions, and
- Promoting Canada’s Lower-Risk Cannabis Use Guidelines to reduce harms of cannabis use.
Building on the foundation of regulations provided by the federal government, the Province of Ontario passed the provincial Cannabis Act on December 12, 2017 to further refine the legal sale and use of cannabis in Ontario by applying the following broad set of controls:
- restricts sale, purchase, possession, and sharing of cannabis to age 19 or older (consistent with the minimum age for obtaining alcohol); and
- allows for the purchase and possession of up to 30 grams (about one ounce) of dried cannabis at one time;
- permits the smoking and vaping of cannabis anywhere the smoking of tobacco is permitted; and
- allows for the growth of up to four plants per household for personal use.
Recently, the provincial government released its plan for retail sale of cannabis in Ontario. The provincially controlled Ontario Cannabis Retail Corporation (OCRC) will be the exclusive online retailer of cannabis in Ontario as well as the exclusive wholesaler of cannabis products to private retailers across the province. Online sale will be the only legal means through which consumers will be able to access cannabis in Ontario as of October 17th, with retail storefronts to be permitted beginning in April 2019. The licensing and enforcement of regulations for private retail businesses will be the responsibility of the Alcohol and Gaming Commission of Ontario (AGCO) and currently, there is no plan to set a cap on the number of licenses that will be issued in a particular area or municipality. Municipalities have the opportunity to “OPT OUT” of permitting cannabis retail outlets in their communities with a deadline of January 22nd, 2019 to submit this decision. Store authorizations will be permitted in areas that do not opt out, but each application will be subject to a 15-day consultation period for public to input to be considered by the AGCO in granting an authorization for a given location. In addition, the proposed legislation currently leaves no room for municipal control in the form of licensing or zoning for retail storefronts which would allow municipalities to determine appropriate areas for locations based on the unique needs of their municipalities.
Under the proposed provincial retail model, private retailers would be licensed to operate by the Alcohol and Gaming Commission of Ontario (AGCO), which will issue a Retail Operator License, a Retail Store Authorization, and Cannabis Retail Manager Licence to authorized individuals. The AGCO will conduct compliance and audit processes, including store inspection prior to opening. The proposed provincial legislation would also establish due diligence requirements and specific eligibility criteria for the issuance of licenses and involve a public consultation process for each retail establishment. Store operating parameters are set to be established by regulations prior to the AGCO receiving applications for licenses beginning at the end of 2018. The proposed legislation also proposes distance buffers between retail storefronts and schools, which would also be set through regulation.
There are clear areas for intervention from a public health perspective, which would decrease harms associated with this new framework for cannabis sale in Ontario communities. With respect to Windsor and Essex County, the OPT OUT approach would certainly provide the greatest level of protections to residents by prohibiting the operation of retail outlets across the region. Such a model would prevent municipalities from competing with one another for revenue, while ensuring that vulnerable populations would not be exposed to cannabis retail in Windsor-Essex. Should opting out on a permanent basis not be the appetite of incoming municipal councils, the possibility of opting out on a temporary basis should be strongly encouraged. Such an opportunity would provide municipalities the opportunity to learn from others across the province who did not choose to opt out, learn more about their options upon the passing of the final provincial regulations, and consider (to the extent which is permitted by the provincial legislation) the possibility of establishing regulations at the local level to establish appropriate areas for retail storefronts in their communities. Additional advocacy activities should be implemented at the municipal level to provide for the opportunity for such regulations at the local level, rather than the black and white Opt in or Opt out model proposed at the provincial level. See the attached Board of Health Resolution for additional recommendations for provincial and municipal oversight.
In-kind resources have been allocated from the Windsor-Essex County Health Unit’s cost-shared budget to begin educating the public about the health implications of cannabis use, safer consumption practices, how to speak with children, impaired driving, and other key message areas ahead of legalization. Additionally, the Smoke-free Ontario Act 2017 is set to come into effect as well on October 17th. Recent amendments to this Act permit the consumption of medical and non-medical cannabis anywhere where the smoking of tobacco is permitted. This will add to the enforcement role and broaden the scope of responsibility for Windsor-Essex County Health Unit Tobacco Enforcement Officers. These two activities alone will burden the WECHU with additional costs tied to legalization, in addition to those which may be required to be added in the form of human resources to respond to cannabis legalization and address the potential harms to health and safety.
WECHU Activities to Date
Internal Health Promotion Collaboration – WECHU Cannabis Legalization Working Group
The Windsor-Essex County Health Unit’s Cannabis Legalization Working Group (CLWG) is a collaborative of staff from various departments that aims to mitigate the potential harms of cannabis legalization across broad target populations. The group convened in 2017 and is Chaired by the Chronic Disease and Injury Prevention department, with representation from Policy and Strategic Initiatives, Epidemiology and Evaluation, Communications, Healthy Schools, and Healthy Families departments. Guided by the findings of a situational assessment, the CLWG has established key messages and target populations for cannabis health promotion efforts.
Internal Staff Training and Knowledge Assessment
A survey was distributed to staff of the Windsor-Essex County Health Unit to assess their knowledge and confidence in speaking to clients or community partners related to key cannabis health messages. Findings were used to identify areas of training that would best prepare staff for engaging with their clients. Following this, training for all direct-client service departments provided an overview of the resources available, and WECHU’s key messages. Based on the unique populations served by staff in each department, additional information was provided (e.g., information regarding risks to pregnant and breastfeeding women for Healthy Families, youth-focused information for Healthy Schools).
Community Environmental Scan
In August, 2018, an environmental scan was disseminated to health and social service providers, school boards, law enforcement and emergency services to assess the work currently being done in Windsor-Essex County to address cannabis use disorders or prevention efforts, and gaps in efforts to reduce cannabis harms in Windsor and Essex County.
Cannabis Mass Media Campaign
A mass media campaign has been created to begin educating the public utilizing a variety of media to target priority populations. This campaign will largely make use of content housed on the WECHU website. The goal of WECHU’s Cannabis- Your Questions, Answered campaign is to direct residents to credible, evidence-informed information in a format that encourages sharing through online and social networks. The website contains information related to key messages, a directory of treatment options for cannabis use and other addictions, and resources for workplaces, healthcare providers, and educators. In addition, radio ads have been created to disseminate our key messages and expand the campaign reach, and billboards have been developed to promote safe driving.
Community Outreach and Presentations
As a supplement to the mass media campaign, WECHU staff have already begun delivering community presentations and distributing resources. For example, in June of 2018, two presentations were provided at the Erie St. Clair Regional Cancer Program Frontline Connect events. In addition, a presentation was given to attendees of the Working Toward Wellness Luncheon in June 2018, along with the hosting of an information and resource booth.
Current and Future Initiatives
Windsor-Essex Cannabis Community of Practice
The Windsor-Essex Cannabis Community of Practice will be led by WECHU and meet biannually, starting in 2019, for the purposes of information sharing, collaboration, and capacity building. Group members have been identified through the Environmental Scan with representatives from health, social and community services, and education and municipal services. Meetings of the Community of Practice will include provincial/federal updates related to cannabis legalization, information sharing among members on current community activities, identifying gaps in community services related to legalization, combining resources and identifying opportunities to collaborate, and building capacity to address cannabis use.
Through connecting with representatives from the administration of each municipality, WECHU has provided recommendations on how they can address cannabis in their communities. Primarily, it is the goal of these engagements to encourage municipalities to opt out of retail establishments; however, in the event that this is not of interest, WECHU is committed to supporting municipalities through the development of local regulations which will place restrictions on the areas in which cannabis-related businesses are permitted to operate. Such regulations may involve licensing or zoning parameters, which restrict cannabis-related businesses to operate in areas near schools, addictions facilities, parks, playgrounds, and other areas that serve or are frequented by vulnerable populations.
Teachers, Schools, and School Boards
Ongoing discussion and meetings between WECHU and school board liaisons have led to the population of an online drop box with presentations, toolkits, curriculum supports, posters, resources, and background information on the dangers of cannabis consumption for young people. A letter of support was provided for School Board advocacy of zoning for the location of cannabis retailers and production facilities to have municipalities set minimum distance between such establishments and school property. Support has also been offered onsite at school events and during teacher professional development opportunities, with additional school-aged presentations planned for the 2018-2019 school year that focus on cannabis-impaired driving. Cannabis activities in the school setting have also been integrated with the Windsor-Essex Community Opioid and Substance Strategy through the development of a Youth Engagement Strategy as part of their work in general substance use prevention and education.
Employers and Workplaces
The WECHU has supported workplaces in preparing for legalization by attending community events and developing template resources for employers to utilize in setting up health-promoting education and environments for their employees. By communicating with employers through existing communication channels and continuing to attend community events, WECHU will provide resources for employers to utilize in making decisions related to cannabis and impairment in the workplace.
Social Service and Healthcare Providers
To support reproductive healthcare providers and reach clients through WECHU and community programs, WECHU has utilized resources developed by the Public Health Agency of Canada to their clients through various programs offered through WECHU’s Healthy Families Department (i.e., hospital liaison program, Physician Outreach Program, Healthy Babies Healthy Children, lactation support, Well Baby Clinics and Building Blocks for Better Babies). Additional resources developed by WECHU and gathered from external partners will be provided through other WECHU networks such as the Windsor-Essex Cannabis Community of Practice, and the Windsor-Essex Tobacco Cessation Community of Practice.
Ongoing Surveillance and Monitoring
Currently, WECHU staff contribute to the Ontario Public Health Collaboration on Cannabis Indicators Working Group which seeks to identify existing indicators for cannabis use and related health outcomes and support development of cannabis surveillance at regional and provincial levels. Locally, ongoing work is being done to assess existing local data for cannabis-related health outcomes that can be used to monitor cannabis health outcomes pre and post-legalization, and identify gaps and opportunities for new data collection methods.
The Windsor-Essex County Health Unit is a co-applicant for the Public Health Ontario Substance Use Locally Driven Collaborative Project. The focus of this project is to identify regional strategies employed by public health agencies and applicable partners in addressing cannabis use among 18-25 year olds. This age often represents the highest rate of cannabis use, is not protected by age restrictions under the federal Cannabis Act, and is still at risk for cognitive damage tied to consumption due to continued brain development at this age. In addition, WECHU attends bi-monthly meetings as part of the Ontario Public Health Collaboration on Cannabis and through this network of public health professionals working in cannabis health promotion, is able to share and gather information on existing strategies and key message areas with public health units across the province.
Theresa Marentette, CEO
- Best Start. (2017). Risks of cannabis on fertility, pregnancy, breastfeeding and parenting. Retrieved from https://www.beststart.org/resources/alc_reduction/RisksOfCannabis_A30-E.pdf
- Canadian Centre on Substance Use and Addiction [CCSA]. (2017). Cannabis: Canadian drug summary. Retrieved from https://www.cpha.ca/sites/default/files/uploads/resources/cannabis/ccsa-...
- Canadian Centre on Substance Abuse [CCSA]. (2016). Clearing the smoke on cannabis: Highlights.
- Federation of Canadian Municipalities [FCM]. (2017). Cannabis legalization primer: How municipalities can get ready. Retrieved from https://fcm.ca/Documents/issues/Cannabis_Legislation_Primer_EN.pdf
- Government of Canada. (2018). Cannabis legalization and regulation. Retrieved from http://www.justice.gc.ca/eng/cj-jp/cannabis/
- Government of Ontario. (2018). Cannabis legalization. Retrieved from www.ontario.ca/cannabis
- National Academies of Sciences, Engineering, and Medicine. (2017). The health effects of cannabis and cannabinoids: The current state of evidence and recommendations for research. Retrieved from https://www.nap.edu/read/24625/chapter/1
- Parachute Vision Zero Network (2018). Cannabis and drug impaired driving: What’s happening in Canada right now? Retrieved from https://parachute.ca/wp-content/uploads/2019/06/Vision-Zero-Case-Study-4.pdf
- Smoke-Free Ontario Scientific Advisory Committee, Ontario Agency for Health Protection and Promotion (Public Health Ontario). Evidence to guide action: Comprehensive tobacco control in Ontario (2016). Toronto, ON: Queen's Printer for Ontario; 2017.
- Wettlaufer, A., Florica, R. O., Asbridge, M., Beirness, D., Brubacher, J., Callaghan, R., Fischer, B., Gmel, G. & Imtiaz, S. (2017). Estimating the harms and costs of cannabis-attributable collisions in the Canadian provinces. Drug and Alcohol Dependence, 173, 185-190.
- Windsor-Essex County Health Unit (2016). Community needs assessment report. Windsor, Ontario.