Abstract
Cannabis is the most commonly used illicit drug in Canada, used by 1 in 7 adults and 1 in 4 students. Other forms of drug use (e.g., alcohol or injection drug use) are increasingly approached within a public health policy framework that focuses on reducing harms rather than use per se. Cannabis, by contrast, remains formally controlled by a criminal justice approach that focuses on enforcing abstinence. Its use is associated with a variety of possible acute or chronic health problems that include cognitive and respiratory impairment, psychotic episodes, dependence and injury risk. The incidence of these outcomes, however, is predicted by early onset and a high frequency and length of use that only apply to a minority of users. In a public health framework, cannabis use - especially in young populations - should be systematically monitored and high-risk patterns of use screened for in appropriate settings, e.g., schools and GP offices. Evidence-based primary and secondary prevention, treatment and enforcement need to be targeted at these high-risk patterns of use. Given the large cannabis user population, especially among young people, and the failure of the criminalization approach to discourage use, a public health framework for cannabis use is urgently needed in Canada.
Key words: Cannabis use, public health, morbidity, policy, interventions, Canada
Résumé
Le cannabis est la drogue illicite la plus consommée au Canada; il est utilisé par 1 adulte sur 7, et par 1 étudiant sur 4. Les autres formes de consommation de drogues (p. ex. l’alcool ou l’usage de drogues injectables) ont été examinées dans un cadre stratégique sur la santé publique qui vise à réduire les préjudices plutôt que l’utilisation en soi. Le cannabis, au contraire, demeure officiellement contrôlé par une approche de la justice pénale qui vise à contraindre l’abstinence. Son utilisation est associée à une variété de problèmes de santé graves et chroniques, notamment une insuffisance respiratoire et cognitive, des épisodes psychotiques, la dépendance et les risques de blessures. Toutefois, l’incidence de ces résultats est prédit par une consommation précoce et une fréquence et une longueur d’utilisation qui ne s’appliquent qu’à une minorité d’utilisateurs. Dans un cadre de santé publique, l’utilisation du cannabis, en particulier chez les populations de jeunes, devrait systématiquement être surveillée, et les modèles d’utilisation à haut risque devraient être examinés dans les milieux appropriés, p. ex. les écoles et les bureaux GP. La prévention primaire et secondaire fondée sur les preuves, le traitement et l’exécution de la loi doivent cibler ces modèles à haut risque d’utilisation. Étant donné la grande population de consommateurs de cannabis, en particulier chez les jeunes, et la défaillance de l’approche de criminalisation visant à décourager l’utilisation, la nécessité d’un cadre de santé publique pour la consommation de cannabis est urgente au Canada.
Mots clés: consommation de cannabis, santé, publique, morbidité, politique, interventions, Canada
Footnotes
Acknowledgements: The authors acknowledge research support from the Canadian Institutes of Health Research (CIHR). Dr. Fischer also acknowledges salary support from the CIHR and the Michael Smith Foundation of Health Research (MSFHR).
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