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Lower Risk Cannabis Use Guidelines for Canada (LRCUG): A Narrative Review of Evidence and Recommendations

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Abstract

Objectives: More than one in ten adults–and about one in three young adults–report past year cannabis use in Canada. While cannabis use is associated with a variety of health risks, current policy prohibits all use, rather than adopting a public health approach focusing on interventions to address specific risks and harms as do policies for alcohol. The objective of this paper was to develop ‘Lower Risk Cannabis Use Guidelines’ (LRCUG) based on research evidence on the adverse health effects of cannabis and factors that appear to modify the risk of these harms.

Methods: Relevant English-language peer-reviewed publications on health harms of cannabis use were reviewed and LRCUG were drafted by the authors on the basis of a consensus process.

Synthesis: The review suggested that health harms related to cannabis use increase with intensity of use although the risk curve is not well characterized. These harms are associated with a number of potentially modifiable factors related to: frequency of use; early onset of use; driving after using cannabis; methods and practices of use and substance potency; and characteristics of specific populations. LRCUG recommending ways to reduce risks related to cannabis use on an individual and population level–analogous to ‘Low Risk Drinking Guidelines’ for alcohol–are presented.

Conclusions: Given the prevalence and age distribution of cannabis use in Canada, a public health approach to cannabis use is overdue. LRCUG constitute a potentially valuable tool in facilitating a reduction of health harms from cannabis use on a population level.

Résumé

Objectifs: Plus d’un adulte sur dix–et environ un jeune adulte sur trois–déclare avoir consommé du cannabis au cours de la dernière année au Canada. La consommation de cannabis est associée à divers risques pour la santé, mais contrairement aux politiques sur l’alcool, la politique actuelle sur le cannabis interdit toute consommation plutôt que d’adopter une approche de santé publique avec des interventions faites pour aborder les risques et les méfaits particuliers de cette drogue. Nous avons voulu élaborer des « directives de consommation à moindre risque pour le cannabis » (DCMRC) à la lumière des données de recherche sur les effets défavorables du cannabis pour la santé et sur les facteurs qui semblent atténuer le risque de ces méfaits.

Méthode: Nous avons examiné des publications à comité de lecture, de langue anglaise, portant sur les méfaits pour la santé de la consommation du cannabis, et rédigé des DCMRC selon un processus consensuel.

Synthèse: Notre examen a montré que les méfaits du cannabis pour la santé augmentent avec l’intensité de la consommation, mais que la courbe du risque n’est pas bien définie. Les méfaits du cannabis sont associés à des facteurs potentiellement modifiables liés à: la fréquence de consommation; le début précoce de la consommation; la conduite automobile après la consommation; les méthodes et les pratiques de consommation et la teneur de la substance; et les caractéristiques de certaines populations. Nous présentons nos DCMRC, qui recommandent des moyens de réduire les risques de la consommation de cannabis à l’échelle individuelle et populationnelle–un peu comme les « directives de consommation à faible risque » pour l’alcool.

Conclusion: Étant donné la prévalence et la structure par âge de la consommation de cannabis au Canada, une politique publique sur le cannabis conçue sous l’angle de la santé publique se fait attendre depuis longtemps. Nos DCMRC pourraient être un précieux outil pour faciliter la réduction des méfaits pour la santé de la consommation de cannabis à l’échelle de la population.

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Author information

Authors and Affiliations

  1. Centre for Applied Research in Mental Health and Addiction (CARMHA), Faculty of Health Sciences, Simon Fraser University, 2400-515 West Hastings Street, Vancouver, BC, V6B 5K3, Canada

    Benedikt Fischer PhD, Victoria Jeffries MA & Elliot Goldner MD

  2. Centre for Addiction and Mental Health, Toronto, ON, Canada

    Benedikt Fischer PhD & Jürgen Rehm PhD

  3. University of Queensland Centre for Clinical Research, Queensland, Australia

    Wayne Hall PhD

  4. School of Population Health, University of Melbourne, Melbourne, Australia

    Robin Room PhD

  5. Dalla Lana School of Public Health and Department of Psychiatry, University of Toronto, Toronto, ON, Canada

    Jürgen Rehm PhD

  6. AER Centre for Alcohol Policy Research, Turning Point Alcohol and Drug Centre, Victoria, Australia

    Robin Room PhD

Authors
  1. Benedikt Fischer PhD
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  2. Victoria Jeffries MA
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  3. Wayne Hall PhD
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  4. Robin Room PhD
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  5. Elliot Goldner MD
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  6. Jürgen Rehm PhD
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Correspondence to Benedikt Fischer PhD.

Additional information

Acknowledgements: The authors acknowledge research funding support from the Canadian Institute of Health Research (CIHR), the Michael Smith Foundation for Health Research (MSFHR), and the Ontario Ministry of Health and Long-Term Care for salary support for CAMH-affiliated authors. Wayne Hall is funded by an NHMRC Australia Fellowship.

Conflict of Interest: None to declare.

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Fischer, B., Jeffries, V., Hall, W. et al. Lower Risk Cannabis Use Guidelines for Canada (LRCUG): A Narrative Review of Evidence and Recommendations. Can J Public Health 102, 324–327 (2011). https://doi.org/10.1007/BF03404169

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