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Asking the Right Questions About Cannabis Legalization

August 27, 2018
by Mercer, Caroline

Starting in October, Canada’s marijuana smokers will be able to get high off government-regulated cannabis as the nation makes recreational pot legal.

But Tony George, MD, HS ’96, an addiction specialist at the University of Toronto, believes that the federal government has not prepared for legalization and its consequences. He argues that more research on the effects—positive and negative—of smoking pot is needed, as well as increased access to treatment for those who suffer from cannabis use disorder.

“Canada actually has the chance to be a world leader in this area, to take an evidence-based approach to legalization,” George says. “I am concerned that we are not doing that sufficiently although I recognize that the policy change is a new one.”

George is an addiction psychiatrist, professor of psychiatry at the University of Toronto, and chief of the addictions division at the Centre for Addiction and Mental Health (CAMH). His research group began at Yale University and The Connecticut Mental Health Center in 1996.

In a recent report in the Canadian Journal of Psychiatry, George argued that more research is needed to understand health and social effects of cannabis use, especially in vulnerable groups such as youth and people with mental health issues. Ideally, data collection would have started before legalization, but George says little research exists.

Don Davies, politician and vice-chair of Canada’s parliamentary health committee, sees legalization as an opportunity to change that. “One of the major casualties of the criminalized approach has been research,” he says.

Beyond amplifying research, treatment for cannabis addiction is essential, George says. One of the few cannabis treatment programs in Canada opened late last year—in George’s service.

Julianne Vandervoort, PsyD, is an addiction psychologist at the clinic. She says legalization was a catalyst for the creation of the program. “It’s so important to have this in place so people can seek support and normalize that it is okay to seek treatment,” Vandervoort says.

George also calls for a public health education strategy that helps Canadians understand the benefits and risks of using cannabis. In his report, George cites such benefits as reduced burden on law enforcement, increased tax revenue, and decreased stigma associated with the drug. On the other hand, increased risk of cannabis use disorder and impaired driving are concerns.

Canada actually has the chance to be a world leader in this area, to take an evidence-based approach to legalization.

Tony George

Donald Lyman, MD '68, is a retired physician and former board member at the California Medical Association. Recently, he’s been leading a movement to legalize cannabis in California. Lyman believes that legalizing cannabis doesn’t endanger public health, but promotes it.

“The issue in front of us is not whether cannabis should be legalized or not,” Lyman says. “The issue is control. It is out of control.”

By creating a legal cannabis industry, Lyman says California can regulate a drug that has become very easy to procure illegally. By offering a product superior to that of the black market at a lower price, Lyman thinks the state government can “undercut them and make the black market go away.”

George credits Yale, where he completed his residency, with teaching him to “question everything” and giving him the framework to initiate the right types of inquiries.

He recalls researching tobacco addiction with Stephanie O’Malley, PhD, professor of psychiatry. “She was quite visionary,” George says. O’Malley brought together researchers from disparate fields like economics, public health, neuroscience, and psychology to brainstorm innovative approaches to tobacco addiction.

One study was particularly memorable. The results showed that smokers were more likely to quit if they were given positive health messages, rather than negative ones.

George hopes that policy makers in Canada and the United States will use multidisciplinary approaches to better understand potential harms that may accompany cannabis legalization.

“It's like the iceberg that you see coming. It’s just this little blip on the water, but who knows what lies underneath,” George says.

Submitted by Adrian Bonenberger on August 27, 2018