“Where does the high road lead?” Potential implications of cannabis legalization for pediatric injuries in Canada
Abstract
The purpose of this commentary is to discuss how legalization of non-medical marijuana (LNMM) in Canada can potentially influence child and adolescent unintentional injuries based on evidence from states (American) and jurisdictions that have already legalized cannabis for recreational purposes. Although the evidence is still not conclusive, LNMM can bring about higher exposure, lower perceived harms, and higher prevalence of cannabis use by minors through role modeling and normalization of behaviour within the household and the community, and higher rates of driving under the influence of cannabis, which can contribute to a higher burden of road traffic injuries. Experience of American states with LNMM shows higher rates of emergency visits for pediatric poisoning due to unintentional ingestion of cannabis-containing foods and severe burns due to explosions during the course of home-based cannabis extraction. While the justification for legalization has created a strict legal framework for improved control of cannabis in Canada, the implications for health and safety of children and adolescents necessitate further study, communication with policy-makers and public health practitioners, and evidence-based education of parents, caregivers, and youth.
Introduction
Commencing October 2018, Canadians will witness a change in the national policy toward cannabis, which will see the legalization of non-medical marijuana (LNMM) with the passing of Bill C-45, The Cannabis Act (Task Force on Cannabis Legalization and Regulation 2016).
The potential impacts of legalization on the safety of children and youth merit serious debate, as the rate of cannabis use by Canadian adolescents is one of the highest among developed countries (UNICEF Office of Research 2013). Some experts believe that legalization in the context of a strictly regulated framework for controlling production, distribution, and sale can decrease harms, such as marginalization, stigmatization, and convictions for personal cannabis use. Current criminal penalties are considered to be disproportionately harsh and hamper future educational and career opportunities of young cannabis users without having an adequate deterrent influence. Moreover, legalization is expected to improve control over cannabis price, quality, potency, and access—especially by minors (Rehm and Fischer 2015).
Others argue, however, that valid comparative evidence does not exist to conclude that the current policy has been ineffective in promoting a safe community, as we are unable to predict the extent of cannabis use, nor the magnitude of consequences that would have occurred without current prohibitions. Moreover, it is argued that the state-controlled cannabis supply may contribute to the growth of a black market that targets young users of limited means to provide them with less expensive and low-quality products. In this latter perspective, major concerns regarding unfavourable public health impacts of legalization include lower perceived harm of use, higher rates of use, driving under the influence of cannabis (DUIC), road traffic injuries (RTIs), and healthcare utilization (Kalant 2015; Hajizadeh 2016).
In the midst of these uncertainties about the potential public health and safety impacts, the experiences of jurisdictions that are in the post-legalization period might serve to shed a light on the status quo. In 2012, Washington State (WA) and Colorado (CO) became the first states in the US to vote for LNMM. Approximately 9 months later, the proportion of drivers testing positive for THC (delta-9-tetrahydrocannabinol) in fatal crashes began to trend upward at an annual rate of 9.7% in WA. By 2014, this proportion was more than twice as high as the averages of the prior four years (Tefft et al. 2016). In CO, the number of cannabis-related fatal crashes also increased sharply and steadily (Colorado Department of Transportation nd), and the ED visits for marijuana exposure in patients aged 9 years and older nearly doubled following LNMM. The same increasing trend was observed in the number of calls to the Colorado Poison Control Center (Kim and Monte 2016). The available rates and trends, although alarming, are mixed and not conclusive (Compton 2017), and causality cannot be inferred. Still, the available evidence indicates grounds for concern as LNMM draws closer in Canada.
Amid the expressed concerns over the potential public health impacts of LNMM, child and adolescent safety issues are underrepresented. Currently, preventable injuries claim more lives than all other causes of death among children in Canada (Parachute 2015). This already significant burden justifies caution toward any policy that might lead to more pediatric injuries and deaths. Drawing on the experience of other jurisdictions that have legalized recreational cannabis use, the purpose of this commentary is to discuss the implications of legalization of recreational cannabis in Canada for unintentional injuries among children and adolescents. These potential implications and underlying mechanisms and pathways are discussed based on the review of published papers and reports.
Leia o artigo completo: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6267639/
