Implications of the 2018 Canadian Cannabis Act: Should regulation differ for medicinal and non-medicinal cannabis use?⋆

Trema micranthum (L.) Blume as a new source of cannabinoids

Trema micranthum (Cannabaceae) has emerged as a promising new source of cannabinoids, including cannabidiol (CBD). Given the substantial medicinal demand for cannabinoids and the regulatory challenges associated with Cannabis sativa due to the presence of Δ9-tetrahydrocannabinol (THC), this study sought to explore the presence of CBD, THC, and their precursors, Δ9-tetrahydrocannabinolic acid A (THCA A) and cannabidiolic acid (CBDA), in various parts of Trema micranthum using UHPLC-HRMS/MS (Orbitrap). Extracts from fruits, leaves, inflorescences, and stems were obtained using a methanol/hexane (9:1, v/v) solvent mixture. UHPLC coupled with an Orbitrap mass spectrometer was employed for cannabinoid identification and quantification, with standard mixtures prepared in methanol. The extracts yielded significant quantities, such as 6.6%/g from leaves and 3%/g from fruits. Cannabinoids were detected in fruits, leaves, and inflorescences, with acidic forms (CBDA and THCA A) present in higher concentrations than their neutral counterparts. Notably, leaves contained 4.43 × 10-3 µg/g of CBD and 1.05 ×  10-3 µg/g of THC. These findings, facilitated by high-resolution analytical methods, underscore the potential of Trema micranthum as an alternative source for cannabinoids, guiding future research in this area.

Canada's Recreational Cannabis Legalization and Medical Cannabis Patient Activity, 2017-2022

Objectives. To estimate changes in medical cannabis patient activity after Canada's recreational cannabis legalization. Methods. I used linear regressions of interrupted times series models to analyze medical cannabis patient registrations per 10 000 residents, purchases per 100 registrations, and packages per purchase in Canada's 10 provinces between April 2017 and December 2022. I tested relationships between the recreational law's passage in June 2018, recreational sales starting in October 2018, and the arrival of edibles and vapes in December 2019. Results. Medical patient registrations initially increased; they slowed after the law passed and started decreasing after edibles became available. Medical purchasing frequencies initially decreased; they decreased further in proportion to recreational sales but stabilized after edibles became available. Medical purchase sizes were initially stable; they began increasing after edibles became available. Conclusions. Canada saw substantial decreases in medical cannabis patient registrations, but the remaining patients stabilized their purchasing frequencies and increased their purchase sizes. Public Health Implications. Other countries might see significant changes in patient usage of their medical cannabis systems after nationwide recreational cannabis legalization. (Am J Public Health. 2024;114(S8):S673-S680. https://doi.org/10.2105/AJPH.2024.307721).

Cannabis policy in The Netherlands: Rationale and design of an experiment with a controlled legal ('closed') cannabis supply chain

Since the Dutch tolerance policy, allowing the purchase of cannabis in 'coffeeshops', is associated with problems of public order and safety as well as health risks, there has been a long debate about legalisation of cannabis production and supply. It was therefore decided to conduct an experiment with a controlled legal ('closed') cannabis supply chain for recreational use. This is of international relevance in view of the current illegal cannabis exports from the Netherlands, the importance of sharing knowledge about the effectiveness of cannabis policies, and the accumulation of evidence needed to evaluate and update international treaties. Here we describe and discuss the background, general approach and design of the experiment. An independent expert committee elaborated how the closed chain will operate and be evaluated, based on the experience with the medicinal cannabis chain, and round table discussions with stakeholders (mayors, coffeeshop owners, cannabis consumers, growers, regulators, scientists, and addiction experts). Ten trusted cannabis growers are contracted to produce and supply cannabis to the coffeeshops in intervention municipalities, with product quality control, law enforcement against criminal interference, and preventive efforts to reduce health risks being implemented. No changes will be made in the cannabis supply to the coffeeshops in participating control municipalities. A process evaluation will assess whether the chain from production to sale in the intervention municipalities was really closed. In a quasi-experimental study comparing intervention and control municipalities, the chain's effects on public health, cannabis-related crime, safety and public nuisance will be estimated. The fieldwork period is expected to start early 2024 and will take four years, including reporting to the government and parliament. These will then decide whether and what further steps towards legalisation of the production and supply of cannabis will be taken.

Relationships between sales of legal medical cannabis and alcohol in Canada. Health Policy 2023;128:28-33. [PMID: 36443110 DOI: 10.1016/j.healthpol.2022.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

The extent to which legalizing cannabis use might lead to increased or decreased alcohol use has important implications for public health, economic growth, and government policy. This study analyzed Canada's monthly per capita sales of alcohol and legal medical cannabis using fixed effect panel data linear regressions. The data covered seven Canadian regions from January 2011 to September 2018, and controlled for changing levels of retail activity, alcohol prices, tertiary education, unemployment, and impaired driving penalties. The analysis estimated that each dollar of legal medical cannabis sold was associated with an average alcohol sales decrease of roughly $0.74 to $0.84. This suggests that medical cannabis was an economic substitute for alcohol in Canada, and that the country's 2017-2018 alcohol sales were roughly 1.8% lower than they would have been without legal medical cannabis. The results therefore indirectly imply that reduced alcohol consumption might have partly offset cannabis legalization's health and economic impacts.

Clinician views on and ethics priorities for authorizing medical cannabis in the care of children and youth in Canada: a qualitative study

BACKGROUND

The use of cannabis for medical purposes by pediatric patients is expanding across Canada; however, supporting evidence, federal regulations and treatment guidelines are lacking. To understand factors affecting treatment decisions in this landscape, we sought to delineate clinician perspectives, ethics priorities and values for cannabis authorization.

METHODS

We sampled participants purposefully through Canadian Childhood Cannabinoid Clinical Trials listservs, which include the majority of pediatric oncologists and palliative care physicians practising in Canada, among many other pediatric physicians and clinicians. Inclusion criteria were being a practising clinician in Canada, involvement in the care of children and willingness to be interviewed regardless of stance on medical cannabis. In November and December 2020, we conducted semistructured interviews focusing on principles, values and priorities, including medical, professional, regulatory, evidentiary and social considerations, for authorizing medical cannabis to children. Interviews were recorded, transcribed and analyzed by means of deductive and inductive thematic methods.

RESULTS

We conducted 18 interviews with a diverse group of clinicians representing a range of specialties within pediatric care, including neurology, palliative care, oncology, family medicine and pharmacology. The interviews yielded 4 themes and 12 subthemes related to a priori (medical, professional, regulatory, evidentiary and social themes) and emergent themes. The 4 themes of access, relationships and relational autonomy (autonomy within relationships), medically appropriate use and research priorities were grounded in principles of harm reduction. Participants described problematic authorization procedures that negatively affect patient use. Principles associated with relational autonomy were highlighted as a feature of open clinical communication. Benefits of appropriate medical uses weighed positively over risks, even in the context of potential effects on neurodevelopment. Participants expressed that more research is essential to align medical cannabis with biomedical standards.

INTERPRETATION

Clinicians reported pursuing ethical use of medical cannabis for pediatric patients and prioritizing their safety under principles of harm reduction. There is a need for evidence about neurodevelopmental risks, support for research, treatment guidelines and greater knowledge about stakeholder perspectives to alleviate burdens related to use of medical cannabis for pediatric patients in Canada.

Coverage of medical cannabis by Canadian news media: Ethics, access, and policy

BACKGROUND

The use of recreational cannabis by adults was legalized in Canada in 2018 (The Cannabis Act, 17 October 2018). This change in drug policy indirectly opened the doors to broader uses, including those for health-related conditions. As a first step towards understanding ethical, legal, and social shifts on this landscape, we examined messaging surrounding medical cannabis and health in Canadian news media before and after legalization.

METHODS

We retrieved news articles about medical cannabis and health from Canadian sources (2010-2020). Deductive and inductive content analytic approaches were applied to code eligible articles for both a priori ethical, legal, social, and issues, and emergent themes. Wilcoxon-Mann-Whitney U tests were used to test for thematic changes pre- and post-legalization.

RESULTS

Two hundred and sixteen (216) articles met inclusion criteria. Analysis yielded three themes and eight subthemes, comprising 4931 coded references. The a priori theme of Ethical, Legal and Social Issues (access, benefits/risks of medical cannabis, public engagement, and conflicts of interest) dominated news media coverage across the decade (coded in 99% of articles). The emergent theme of Medical Applications (therapeutic use of cannabis, consumption considerations, comparisons to other drug and treatment options) was coded in 86% of articles; Resource Issues (research and education) in 50%. We found little discourse on ethics issues specific to exceptional populations. Coverage on aspects of access declined significantly post-legalization.

CONCLUSION

Capturing the push of Canadian news coverage of medical cannabis is a powerful means of understanding how public opinions on the subject are shaped and then, by extension, inform public policy for well-being and healthcare. Continued examination of these issues, public consultation, engagement with diverse populations such as people with disabilities and neurologic and mental health conditions, and integration of diverse cultural views into the policy discourse are critical steps for future research and action.