Cannabis legalization in the provinces and territories: missing opportunities to effectively educate youth?

Abstract

Cannabis is now legal in Canada, yet important questions remain regarding how the provinces and territories are approaching cannabis education and messaging aimed at youth. Although widespread education and awareness campaigns are long considered cornerstones of substance use and related harm prevention, there is limited evidence to support the effectiveness of such campaigns. We continue to see examples of cannabis-related messaging that focus on risk and harm and often adopt a narrow view of the ways in which young people may use cannabis. This traditional risk-based messaging does not resonate with how many youth experience cannabis use. We have further observed that most provinces and territories have yet to fully reveal concrete details regarding what they are and have been planning in terms of youth engagement in the development and delivery of educational initiatives. As Canadian youth desire reliable, evidence-based educational material on cannabis, and can be credible key partners in the development of such materials, we hope that all levels of government will see the value of promoting balanced cannabis discussions and co-designing resources with youth.

After much consultation and debate, cannabis legalization arrived in Canada in October 2018. In the previous 3 years leading up to this major drug policy shift that reverses nearly a century of prohibition on recreational cannabis, the federal Liberal government maintained a commitment to prioritize public health and safety in the new legislation (An Act Respecting Cannabis and to Amend the Controlled Drugs and Substances Act 2017). Youth have been and continue to be a strong focus of these priorities, exemplified in the frequently repeated statements from government and other stakeholders that centralize “protecting” young people as a core objective of cannabis legalization (Watson and Erickson 2019).

While the Cannabis Act (An Act Respecting Cannabis and to Amend the Controlled Drugs and Substances Act 2017) sets 18 years as the federal minimum age for cannabis purchase and sale, the provinces and territories can, and have, modified this and other policy and regulatory mechanisms aimed at constraining youth access. Although changes are still possible, especially in light of recent shifts in government (e.g., Québec’s new premier promises to raise the province’s minimum age for cannabis from 18 to 21 years) (Picard 2018), the provinces and territories have consistently aligned the new minimum age with the existing regional legal drinking age, except in Manitoba (The Cannabis Act in the Senate 2018).

Where we expect to see greater cross-jurisdictional diversity is in provincial/territorial approaches to education and messaging about cannabis, a critical component of stated plans to protect young people. Federally, Health Canada has committed over $100 million to “cannabis public education, awareness and surveillance” over 6 years, including support for community organizations and Indigenous communities to undertake cannabis education efforts (Dickson 2018). However, many questions remain at the level of the provinces and territories, which are also responsible for developing and delivering public health prevention and education programs to their populations. How are these jurisdictions approaching cannabis education and messaging for youth in this new era of legalization? In this commentary, we contemplate this question in relation to evidence-based recommended practices in developing drug education and prevention campaigns for youth which emphasize a need to move away from traditional risk-focused messaging that often does not resonate with the experiences of young people (Hyshka 2013; Ripley 2005; Valleriani et al. 2018). While school-based and other types of interventions will surely be developed in the coming years to educate Canadian youth about cannabis and could potentially yield some positive outcomes (Champion et al. 2013; Lemstra et al. 2010; Porath-Waller et al. 2010), here we focus on more widespread education and awareness campaigns which are long considered cornerstones of prevention efforts aimed at substance use and associated harms.

Legalization and outcomes in youth

Many have expressed concerns that legalization will prompt increases in cannabis consumption by youth through mechanisms such as increased availability, social acceptance and normalization, and decreased perceived harms of use. Youth are perceived as a vulnerable population due to scientific evidence on the increased risk of negative health outcomes associated with early-onset, daily and/or higher intensity cannabis use (Fischer et al. 2017). It is far too soon to know how increased access to cannabis for non-medical use will impact Canadian youth, and data from jurisdictions in the United States that have legalized cannabis remain unclear. Although perceived ease of access to cannabis increased among American (US) youth between 2002 and 2015 (Salas-Wright et al. 2017), studies examining trends in states with established legal-market access to cannabis, such as Colorado and Washington, report inconsistent or little change in cannabis use and perceived harms of use among young people (Cerdá et al. 2017; Harpin et al. 2018).

At present, decreases in perceived risk of cannabis use have not been associated with increases in use among youth (Sarvet et al. 2018), though we should be cautious about generalizing findings from the US to the Canadian context. In 2016–2017, 17% of Canadian students in grades 7 to 12 reported past-year cannabis use, and respondents also reported using diverse routes of administration (e.g., smoking, edibles, vaping) (Health Canada 2018). Meanwhile, a significant proportion of students have reported no intention to try cannabis and it appears that only a small minority report daily use (Boak et al. 2017). Nonetheless, uncertainty regarding the potential impacts of legalization on youth in Canada and their increased vulnerability to harm necessitate a proactive approach to educating young people about cannabis and developing their drug literacy.

Risk-based campaigns and messaging

Despite the longstanding appeal of mass-media campaigns and public service announcements with various community and political stakeholders, there is limited evidence to support the effectiveness of such approaches—particularly, it appears, when they deliver anti-drug or abstinence-focused, risk-based messaging (Hyshka 2013)—when it comes to prevention outcomes related to drug use or intention to use drugs (Allara et al. 2015; Werb et al. 2011). In some instances, such efforts have produced adverse effects, including increased intent to use drugs and perceptions of the prevalence of use among peers (Allara et al. 2015; Werb et al. 2011).

Examples abound of cannabis-related campaigns that have employed abstinence-focused rhetoric and/or focus solely on individual-level risk and harm, despite observations that this type of messaging is inconsistent with how many young people personally experience cannabis use and/or observe cannabis use by peers and others around them (i.e., most youth do not engage in intensive or higher-risk use) (Hyshka 2013). As noted above, many students report no intention to use cannabis (Boak et al. 2017), and nationally representative Canadian data demonstrate that higher-risk cannabis use accounts for 2.5% of users aged 15 to 19 years, and 2.2% of those aged 20 to 29 years (Leos-Toros et al. 2017). A notable US campaign example was the “Don’t Be a Lab Rat” prevention campaign launched in post-legalization Colorado; it aimed to educate youth about cannabis-related harms, yet was met with much criticism for how it presented its messaging (a strategy that included life-size rat cage installations placed in several locations) (Roberts 2014). Indeed, community reactions to this campaign informed the design of a significantly modified strategy to deliver cannabis use prevention messaging, efforts that tried to include greater participation from youth (Kilroy 2018).

Finding balanced messaging for Canadian youth

Peer-reviewed studies of new, legalization-era provincial/territorial cannabis education and prevention programs have yet to be published as we are still in the very early stages of legalization in Canada. Thus, questions remain about the messaging content, delivery, and effectiveness of any incoming educational initiatives. We are systematically monitoring unfolding educational efforts that target youth in different provinces and territories by searching grey literature (e.g., web content, policy documents from governments, and community-based organizations). Preliminary analysis of this literature to date shows that it is still dominated by a focus on risk and harm, and often adopts a rather narrow view of the ways in which youth may use cannabis. For instance, submissions from varied medical authorities and community-based organizations to provincial governments during broad public consultations on cannabis legalization—which largely took place in the summer and autumn of 2017—reveal many references to familiar risk-based, abstinence-promoting language.

Recent and relevant campaign examples include Manitoba unveiling its “Know the Risks” campaign which warns young people “that cannabis can be addictive” and “will affect brain development”, among other possible risks (see http://www.gov.mb.ca/cannabis/index.html), and Québec’s recent cannabis risk awareness campaign which features some unusual imagery and has been described as “bizarre and confusing” (Spears 2019). Such approaches may overstate the evidence on certain cannabis-related harms, and appear to omit the experiences of young people who have experimented with or are currently using cannabis and have not encountered any harms. Further, new initiatives tend to lack key information on the potential repercussions of obtaining and using cannabis outside the legal system, including the possibility of severe criminal justice sentences for young adults who share cannabis with underage youth (An Act Respecting Cannabis and to Amend the Controlled Drugs and Substances Act 2017). In other words, new resources that deliver credible information on how to reduce harms, including criminalization, should youth choose to use cannabis are critically needed.

That said, we have seen some encouraging examples of resources that utilize a more balanced tone and approach for engaging youth in cannabis conversations, albeit some of these resources are geared towards adults. The Government of Québec’s legalization webpage, for instance, offers advice to parents on how to talk to their adolescent children about cannabis in a way that encourages open dialogue rather than taking an authoritative stance on the issues (see http://encadrementcannabis.gouv.qc.ca/en/le-cannabis/conseils-aux-parents-d-adolescents/). For a more youth-tailored example, the Government of Ontario partnered with Kids Help Phone to create a factual resource sheet for youth that provides information about cannabis and its effects, impaired driving, and supports (see http://kidshelpphone.ca/get-info/cannabis-important-things-know/), the latter section offering some harm reduction strategies (e.g., trying “low and slow”) for young people who may be using or experimenting with cannabis.

We have also observed that most jurisdictions have yet to fully reveal concrete details on what they are and have been planning in terms of youth engagement in the development and delivery of public education and harm reduction initiatives. Knowing that Canadian youth desire reliable, evidence-based educational material on cannabis, and can be credible partners in the development of such materials (Valleriani et al. 2018), our hope is that all levels of government will see the value of balanced discussions and co-designing resources with youth that not only share information on risks and harm but also acknowledge potential benefits that may be derived from cannabis use. Additionally, according to evidence-based guiding principles, it is valuable for resources to highlight the strengths and resiliency of youth, and begin to frame access to this type of education as a key support to youth health literacy (Valleriani et al. 2018).

Despite a few promising counterexamples, the grey literature we have scanned so far suggests that currently available public messaging about youth and cannabis from the provincial/territorial jurisdictions (and organizations within) is inadequate. Considering the lag in implementation and ostensibly continued resistance to adopting a wider scope of educational materials that includes harm reduction messaging, the provinces and territories will miss important opportunities to develop material that resonates with young people if there is a continuation of promoting messaging that is predominantly infused with traditional risk-based rhetoric about cannabis. Evidence also indicates that more attention must be focused on youth engagement and the development of reality-based programs that recognize both harms and benefits of substance use (Moffat et al. 2017), emphasizing harm reduction for those contemplating or currently engaging in cannabis use.

In conclusion, with cannabis now legalized in Canada, we are faced with a natural drug policy experiment of tremendous magnitude on both the domestic and world stages. Moving forward, assessing the impacts of legalization on youth will need to consider interprovincial/territorial differences and similarities, and highlight innovative approaches in youth-inclusive cannabis education and prevention efforts that will reach diverse groups of young people. Legalization affords a tremendous opportunity to invest in new programming and partnerships that will promote young people’s health literacy around cannabis consumption and thereby enhance their resiliency.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.