Tag: Fischer

Reading of the Week: Legal Cannabis at 5 – Considering Nonmedical Legalization with a CMAJ Commentary, Dr. Buckley’s Reflections and Major Papers

From the Editor

On Oct. 17, 2018, the government of Canada will launch a national, uncontrolled experiment in which the profits of cannabis producers and tax revenues are squarely pitched against the health of Canadians. When Bill C-45 comes into force in mid-October, access to recreational marijuana will be legal, making Canada one of a handful of countries to legalize recreational use of the drug. Given the known and unknown health hazards of cannabis, any increase in use of recreational cannabis after legalization, whether by adults or youth, should be viewed as a failure of this legislation.

 – Dr. Diane Kelsall, Editor-in-Chief, CMAJ, October 2018

On Tuesday, Canada’s experiment with the legalization of cannabis for nonmedical purposes turned five. Did use go up? What about health care utilization? Have there been benefits from justice and social justice perspectives? Is it the failure that Dr. Kelsall feared?

Now is a good time to pause and review the impact of this change. In this Reading, we try to do just that. 

We start with a CMAJ commentary just published. Benedikt Fischer (of Simon Fraser University) and co-authors look at the evidence, including studies on use and ED presentations, as well as statistics on purchases. “A consideration of the evidence 5 years after implementation suggests that success in meeting policy objectives has been mixed, with social justice benefits appearing to be more tangibly substantive than health benefits.”

Dr. Leslie Buckley (of the University of Toronto) mulls this moment with some comments about the CMAJ paper, and the larger discussion. “[T]he legal changes were enacted and resulted in positive outcomes while the preventive changes which would require more financial investment and tight regulation received less attention.”

Finally, we look at three important papers on cannabis that have been featured in this series over the past five years, and another one that we haven’t looked at before.


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Reading of the Week: Does Opioid Agonist Treatment Save Lives? Also, the Problem with Decriminalization of Illicit Drugs (CJP)

From the Editor

Methadone was invented in the 1930s. The first legal injection site opened its doors nearly two decades ago. Yet our challenges with opioids seem to have only worsened with time. Consider, for example, that in a new, two-year study, the authors found that opioid-related deaths rose almost 600% between 2015 and 2017 in Canada.

What can we do? This week, we consider two selections.

In the first, Thomas Santo Jr (of the University of New South Wales) and his co-authors do a systematic review and meta-analysis for opioid agonist treatment for those with opioid dependence. They write in JAMA Psychiatry: “Our findings suggest a potential public health benefit of OAT, which was associated with a greater than 50% lower risk of all-cause mortality, drug-related deaths, and suicide and was associated with significantly lower rates of mortality for other causes.” We consider the big paper and its implications.


And in the other selection, Benedikt Fischer (of the University of Toronto) and his co-authors weigh the recent interest in decriminalizing illicit drug use. In a new Canadian Journal of Psychiatry commentary, they note their hesitation, writing: “while ‘decriminalization’ proposals for illicit drug use are popular and largely well-intended, their overall merits require cautious analysis and scrutiny.”


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