Earlier this year CSSDP – the Canadian chapter of the NGO Students for Sensible Drug Policy – released a prevention and education toolkit on cannabis use. Their toolkit will be discussed during the International Cannabis Policy Conference (in particular Saturday plenary debate on harm reduction to cannabis use, and Sunday workshop on youth approach to cannabis).
Find all their work here:
- Sensible Cannabis Toolkit. An introduction.
- Sensible Cannabis Education: a toolkit to educate youth [PDF]
Given that cannabis remains the most popular illegal drug consumed by young people in Canada, as well as Canada’s pending legalization and regulation of cannabis, the development of new cannabis education for youth is of critical importance, and a key aspect of developing young people’s health literacy. The legalization of cannabis in Canada provides an opportunity to revise our approach to cannabis education for youth and consider pragmatic youth education which is inclusive of both prevention and harm reduction to maximize effectiveness and protect all youth.
Generally, the central purposes of drug education are to provide accurate information and awareness of resources, develop decision-making skills and health literacy, reduce risks of consumption, and support increasing an individual’s risk competency. However, this toolkit goes beyond these mandates.
Key points around sensible cannabis education_
Legal regulation of cannabis offers an opportunity for more pragmatic “cannabis conversations”– the same old approach repackaged will likely miss the mark.
In light of relatively high use rates among youth, we need education within a legalized context which serves youth who don’t use cannabis – but also youth who are already using cannabis. Drug education and cannabis conversations should be inclusive of both prevention and harm reduction in order to maximize effectiveness and protect all youth. “Just say no” might work for some youth, some of the time, but does a disservice to youth who may already be using cannabis.
It’s critical to involve youth in program design and implementation to ensure key messaging resonates with their experiences – these approaches and programs must be prioritized.
While there is no silver bullet approach to talking to youth, access to evidence-based drug education is critical for young people, their health literacy and well-being – globally, pragmatic drug education is critical for young people to achieve the highest attainable standard of health.
It is also important to note some youth will choose to use cannabis no matter what resource or information is provided – cannabis will remain an illegal substance for youth under the age of 18 or 19, but what can change is our approach to educating youth on what is now a legal and regulated substance in Canada.
Key points around harms_
It’s important to acknowledge harms and risks around cannabis and youth is still developing, but most young people who use cannabis do so infrequently and do not experience significant harms.
We need to consider how we can establish norms around “appropriate adult use” of cannabis much like we have with alcohol consumption.
More long-term controlled studies are needed to truly assess the impact of cannabis on youth and to make claims around causality, and much of the available literature pertains to samples of youth who are frequent or chronic cannabis use, which is not representative of the majority of youth who use cannabis.
Research suggests a relationship exists between early, heavy cannabis use and impairments in cognition, as well as mental health outcomes, but any strong conclusions around causality (i.e. that cannabis was the direct cause of outcome), direction (i.e. which came first? are some youth more inclined to seek out risk behaviours?), and magnitude (i.e. strength of relationship) are not available, mostly due to lack or research.
Critical to this conversation is thinking about the role of confounders which are not often accounted for in this discussion. For example, we know social demographics, such as socio-economic status, as well as the use of other substance use (such as alcohol), are critical to this conversation and outcomes (i.e. growing up in a poor neighbourhood or using alcohol also has impacts on brain development in and of themselves which are often not accounted for in this work).
Preliminary evidence suggests heavy cannabis use during youth may be linked to lower IQ, but there is also additional work to suggest this is reversed after a period of abstinence. Again, the research is unclear around if cannabis is the cause, and there is also evidence that suggests when confounders (such as socio-economic status) are considered, cannabis use is not associated with a decline in IQ or educational attainment.
Research has found an association between cannabis use and schizophrenia, but causality, direction, or strength of that relationship is still unclear. It may be the case that early initiation of cannabis use leads to an increased risk of early onset of schizophrenia, especially for those with a preexisting vulnerability and those who use cannabis daily. Third variables (i.e., sociodemographic factors, poly-substance use) make it more difficult to depict a clear picture. It may also be the case that some youth are using cannabis to alleviate symptoms of mental illness or to self-medicate.
The gateway theory
The majority of people who use cannabis do not transition to “harder” illegal drugs. While people who use cannabis (particularly early onset and/or regular users) are more likely to report having used other drugs compared to non-users, there is no evidence to suggest that the use of cannabis causes an increase in the risk of using other drugs. Some have suggested a variety of alternative explanations, such as thrill-seeking behaviors more generally.
The evidence of a causal relationship between cannabis and lung cancer remains inconclusive. The evidence is also limited because many relevant studies do not account for simultaneous tobacco use, which has a proven causal relationship to lung cancer. Studies have suggested tobacco and cannabis smoke are not equally carcinogenic.
Finally, there is evidence to support that early onset of use and the frequency of use are key risk factors, and associated with the most adverse outcomes, including substance misuse. We believe a preventative approach is appropriate for youth, however, a preventative approach should not be mutually exclusive from offering youth additional tools such as harm reduction education and resources and critical to the protection of all youth.
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