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<div>Provinces and territories are responsible for developing, implementing, maintaining and enforcing systems to oversee the distribution and sale of cannabis. They are also able to add their own safety measures, such as:</div><div></div><div></div><div></div><div></div><div></div><div>The UK will legalise cannabis, say MPs</div><div></div><div>Download File: https://t.co/1i57aUts4J </div><div></div><div></div><div>The Government of Canada has committed close to $46 million over the next five years for cannabis public education and awareness activities. These are to inform Canadians, especially youth, of the health and safety risks of cannabis consumption.</div><div></div><div></div><div>Statistics Canada reports that in 2017, almost 48,000 cannabis-related drug offences were reported to police. The majority of these (80%) were possession offences. A criminal record resulting from a cannabis offence, even a minor possession charge, can have serious and lifelong implications for the person charged. In allowing the production and possession of legal cannabis for adults, the Act helps keep Canadians who consume cannabis out of the criminal justice system, reducing the burden on the courts.</div><div></div><div></div><div>Cannabis offences target those acting outside of the legal framework, such as organized crime. Penalties are set in proportion to the seriousness of the offence. Sanctions range from warnings and tickets for minor offences to criminal prosecution and imprisonment for more serious offences. Some offences specifically target people who make cannabis available to youth.</div><div></div><div></div><div></div><div></div><div></div><div></div><div>Thirty-eight states and Washington, D.C., have legalized medical cannabis, while 23 states and D.C. have legalized recreational use. Cannabis legalization has benefits, such as removing the product from the illegal market so it can be taxed and regulated, but science is still trying to catch up as social norms evolve and different products become available.</div><div></div><div></div><div>In this Q&A, adapted from the August 25 episode of Public Health On Call, Lindsay Smith Rogers talks with Johannes Thrul, PhD, MS, associate professor of Mental Health, about cannabis as medicine, potential risks involved with its use, and what research is showing about its safety and efficacy.</div><div></div><div></div><div>The momentum has been clear for a few years now. California was the first to legalize it for medical reasons [in 1996]. Washington and Colorado were the first states to legalize recreational use back in 2012. You see one state after another changing their laws, and over time, you see a change in social norms. It's clear from the national surveys that people are becoming more and more in favor of cannabis legalization. That started with medical use, and has now continued into recreational use.</div><div></div><div></div><div>And, when we say cannabis, in a way it's a misnomer because cannabis is so many things. We have different cannabinoids and different concentrations of different cannabinoids. The main cannabinoids that are being studied are THC and CBD, but there are dozens of other minor cannabinoids and terpenes in cannabis products, all of varying concentrations. And then you also have a lot of different routes of administration available. You can smoke, vape, take edibles, use tinctures and topicals. When you think about the explosion of all of the different combinations of different products and different routes of administration, it tells you how complicated it gets to study this in a rigorous way. You almost need a randomized trial for every single one of those and then for every single indication.</div><div></div><div></div><div>Cannabis use disorder is a legitimate disorder in the DSM. There are, unfortunately, a lot of people who develop a problematic use of cannabis. We know there are risks for mental health consequences. The evidence is probably the strongest that if you have a family history of psychosis or schizophrenia, using cannabis early in adolescence is not the best idea. We know cannabis can trigger psychotic symptoms and potentially longer lasting problems with psychosis and schizophrenia.</div><div></div><div></div><div>It is hard to study, because you also don't know if people are medicating early negative symptoms of schizophrenia. They wouldn't necessarily have a diagnosis yet, but maybe cannabis helps them to deal with negative symptoms, and then they develop psychosis. There is also some evidence that there could be something going on with the impact of cannabis on the developing brain that could prime you to be at greater risk of using other substances later down the road, or finding the use of other substances more reinforcing.</div><div></div><div></div><div>When we look at the public health landscape and the effect of legislation, in this case legalization, one of the big benefits is taking cannabis out of the underground illegal market. Taking cannabis out of that particular space is a great idea. You're taking it out of the illegal market and giving it to legitimate businesses where there is going to be oversight and testing of products, so you know what you're getting. And these products undergo quality control and are labeled. Those labels so far are a bit variable, but at least we're getting there. If you're picking up cannabis at the street corner, you have no idea what's in it.</div><div></div><div></div><div>We know there are certain, most-often-mentioned conditions that people are already using medical cannabis for: pain, insomnia, anxiety, and PTSD. We really need to improve the evidence base for those. I think clinical trials for different cannabis products for those conditions are warranted.</div><div></div><div></div><div>Large national studies are done every year or every other year to collect data, so we already have a pretty good sense of the prevalence of cannabis use disorder. Obviously, we'll keep tracking that to see if those numbers increase, for example, in states that are legalizing. But, you wouldn't necessarily expect to see an uptick in cannabis use disorder a month after legalization. The evidence from states that have legalized it has not demonstrated that we might all of a sudden see an increase in psychosis or in cannabis use disorder. This happens slowly over time with a change in social norms and availability, and potentially also with a change in marketing. And, with increasing use of an addictive substance, you will see over time a potential increase in problematic use and then also an increase in use disorder.</div><div></div><div></div><div>I think your mileage may vary there with how much your doctor is comfortable and knows about it. It's still relatively fringe. That will very much depend on who you talk to. But I think as providers and professionals, everybody needs to learn more about this, because patients are going to ask no matter what.</div><div></div><div></div><div>Legalizing recreational cannabis at the state level does not increase substance use disorders or use of other illicit drugs among adults and, in fact, may reduce alcohol-related problems, according to new CU Boulder research.</div><div></div><div></div><div>In addition, by specifically comparing twin to twin in 240 pairs in which one lives in a state that has legalized and the other in a state that has not, researchers sought to determine what changes, if any, cannabis legalization causes.</div><div></div><div></div><div>Twins in states where cannabis is legal did show fewer symptoms of alcohol use disorder: Specifically, they were less likely to engage in risky behavior after drinking, such as driving while intoxicated.</div><div></div><div></div><div>Legalization of cannabis is the process of removing all legal prohibitions against it. Cannabis would then be available to the adult general population for purchase and use at will, similar to tobacco and alcohol. Decriminalization is the act of removing criminal sanctions against an act, article, or behavior. Decriminalization of cannabis means it would remain illegal, but the legal system would not prosecute a person for possession under a specified amount. Instead, the penalties would range from no penalties at all, civil fines, drug education, or drug treatment.</div><div></div><div></div><div>No state has legalized cannabis thus far. It remains a US federally-controlled substance, which makes possession and distribution illegal. However, at the time of this writing, 26 states in the US have passed either medical cannabis laws, cannabis decriminalization laws, or both. See Table 1. A major concern of this commentary is that both the medicinal use of smoked cannabis plant and legalization/decriminalization of cannabis are being advocated in a way that circumvents the normal testing and regulatory processes by the FDA that is otherwise required for all drugs marketed for human use in the US. By circumventing this process, advocacy groups put state legislatures and/or voters in the position to decide on proposals with a certain impact on public health and medical treatment without necessarily being qualified to understand the pertinent scientific evidence.</div><div></div><div></div><div>The Drug Enforcement Agency (DEA), which administers the Controlled Substances Act, continues to support the Schedule I assignment (and FDA concurred) noting that cannabis meets the three criteria for such placement under 21 U.S.C. 812(b):</div><div></div><div></div><div>More recently, two types of cannabinoid receptors have been identified: CB1 found mostly in the central nervous system and responsible for psychoactive properties of cannabis, and CB2 found mostly in the spleen, immune tissues, and peripheral blood, and responsible for immunological and anti-inflammatory effects of cannabis.9,10 A group of endo-cannabinoids has been also identified, e.g., arachidonoylethanolamine or anandamide, as endogenous chemical modulators which mimic the actions of phytocannabinoids and activate cannabinoid receptors.10 These discoveries have led to the development of numerous CB receptor agonists and antagonists and numerous studies have tested therapeutic indications for these compounds. Medications containing natural or synthetic cannabinoids currently approved or being considered for approval for medicinal use are listed below:</div><div></div><div></div><div>The movement toward relaxing punishment on marijuana use took a new turn in October 2022, when President Joe Biden said he would issue pardons to everyone convicted of the federal crime of simple marijuana possession, while calling for governors to make similar moves for convictions under state laws. The proclamation will apply to about 6,500 Americans, but a senior White House official clarified to reporters that no one is currently behind bars for simple possession of marijuana.</div><div></div><div> dd2b598166</div>
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