#49 Canada Legalizes Cannabis

Dr. Pat Erickson, Professor Emerita, Dept. of Sociology, University of Toronto


October 17, 2018

The day has arrived. After being prohibited in Canada for over 90 years, cannabis has been legalized for recreational use across the country. Just about everybody has an opinion on cannabis legalization. Throughout this episode, you'll hear from people around downtown Toronto, sharing their views on legalization and some interesting personal experiences. There are also many misconceptions out there. We sat down with some researchers who study cannabis at the University of Toronto to learn about the science behind cannabis. The conversation starts with Lauren DeFreitas, a graduate student at CAMH whose research focuses on the THC and CBD content of different products and how these active chemical compounds in cannabis impact health outcomes. Dr. Ruth Ross is a professor in the Department of Pharmacology and Toxicology at the University of Toronto. She talks about how THC interacts with the endocannabinoid system at the molecular level, and the potential to target this complex system for therapeutic purposes. Karolina Kozak is a PhD candidate from Dr. Tony George's lab at CAMH. Her work focuses on cannabis use disorder in schizophrenia and she tells us about what exactly happens with the brain in addiction. We also delve into some of the societal impacts of cannabis legalization in this episode. We talked to Dr. Pat Erickson, a professor emerita at the Department of Sociology at the University of Toronto. Her work looked at some of the personal and societal impacts of criminalization. We'll hear from her about the normalization of cannabis use over time, and the importance of having engaging and accurate educational material, especially for youth, now that it has been legalized. Sudha Sabanadesan is a policy development officer at Toronto Public Health. She tells us about some of the concerns they have going forward, including cannabis use by adolescents and driving while impaired, and the public health perspective on harm reduction. There's a lot to learn about cannabis legalization and this episode is a great place to start! If you haven't already, let us know what you think of the show! It's an important way for us to create the content you want to hear. Please complete this survey (https://rawtalkpodcast.typeform.com/to/PH50b2?name=RawTalk&source=Shownotes) - it'll only take you 5 minutes!

Written by: Thamiya Vasanthakumar

Mashup Clip 1 [0:00] Hey man, you got a joint?... Uhhh, no not on me man....It'd be a lot cooler if you did.-Fall under the influence of marijuana and your blood pressure increases, the central nervous system changes. -And I wouldn't be the least bit surprised to learn that all four of them habitually smoked marijuana cigarettes.-This is drugs. This is your brain on drugs. -Just got a shipment of Pineapple Express, dopest is dope I've ever smoked. -We need grownups in charge in Washington. Good people don't smoke marijuana. -I experimented with marijuana in Tennessee, and I didn't like it, and didn't inhale. -When I was a kid, I inhaled frequently. That was that was the point.-Legalize it. -I mean, it's legal right. -The new recreational cannabis regime will officially come into force on October 17 of this year.

Grace Jacobs [1:01] Despite being illegal in Canada for decades, recreational cannabis use has slowly become a more widely accepted and normalized part of society. Attitudes towards cannabis have shifted dramatically going from being an almost completely unknown drug when it was first banned in 1923, to having a surge in popularity in the 60s and 70s. This was accompanied by an increase in the number of cannabis related arrests and panic over the perceived harmful effects it was having on society. As more research has been conducted on both the beneficial and harmful effects of cannabis, and some of the negative societal impacts of criminalization have become more apparent, the general consensus has shifted over time. Today on October 17, cannabis has been legalized for recreational use across Canada. This opens up a whole host of questions and concerns to be addressed, and there will likely be some unanticipated consequences. But legalization also opens up the opportunity for more research and studies to be conducted to improve our understanding of the impacts of cannabis use. Welcome to Episode 49 of raw talk.

Grace Jacobs [2:13] There are many misconceptions about cannabis out there. In this episode we took to the streets and asked a variety of Torontonians about what they knew about cannabis, their opinions on legalization, and their personal stories. We'll also hear from several researchers studying cannabis at the University of Toronto who will help clear up some of these myths, as well as a health policy specialist from Toronto Public Health to hear more about their priorities moving forward. Before we talk about the implications of legalization of cannabis here in Canada, we wanted to find out exactly how cannabis interacts with our brain. Why does cannabis have an effect on us and cause us to experience what we do? We talked to Lauren DeFreitas as a graduate student in the Institute of Medical Science at the University of Toronto. She's studying cannabis and its different components and shed some light on the physiological system in our body called the endocannabinoid system.

Lauren DeFreitas [2:58] We all have this inherent endocannabinoid system within us. So it's really made up of receptors ligands, and the enzymes that degrade them. So we have two cannabinoid receptors called CB1 and CB2. CB1 is essentially associated more so with the brain and the central nervous system, whereas CB2 is more associated with the immune system. CB1 essentially is responsible for maintaining homeostasis in the body, so energy balance, our sleep wake cycle, inflammation, memory, which is essentially everything that its responsible for controlling. Our endocannabinoids are essentially the ligands that bind to these receptors that we naturally produce within our body also, and then there's obviously enzymes that degrade them and synthesize them, which is how our endocannabinoid system helps to maintain homeostasis in the body. So cannabinoids are essentially a class of chemical compounds that are found within the plant cannabis sativa. They essentially are very similar to the endocannabinoids that we produce naturally in our body, which is how they have such a huge impact and role on our system itself and how we see acute impairments in memory and cognition, anxiety, which ties back to our natural inherent processes that they affect. So because there's so many different receptors within different parts of the brain, so mainly the cerebellum, hippocampus, basal ganglia, and then the prefrontal cortex, because there's so many different areas, the endocannabinoids really just maintain homeostasis within the brain. So if one specific area is out of balance endocannabinoids will be targeted towards that area. But for example, when you ingest cannabis, cannabis just acts on the brain overall. So it really interrupts the synchronicity of firing more so than actually targeting specific areas.

Grace Jacobs [4:55] We also spoke to Dr. Ruth Ross, a molecular pharmacologist in the Department of Pharmacology and Toxicology at the University of Toronto. She's been working on the pharmacology of the endocannabinoid system for around 25 years and has done a lot of work studying the CB1 Endocannabinoid receptor, which belongs to a family of receptors known as the G protein coupled receptors, or GPCRs. They play an important role in how our brain functions.

Dr. Ruth Ross [5:18] So the CB1 receptor is the most widespread, highly expressed G protein coupled receptor in the brain. So it's found in many, many brain regions, and endocannabinoids are released on demand part of a neurotransmitter systems in all these different brain regions. So endocannabinoids are crucial kind of modulators, and regulators have lots of physiologies like appetite, memory, mood, and the system can be working well or potentially become imbalanced in different disease states. So that's what we're working on trying to understand what's the role of the endocannabinoid system? Is it overactive or underactive in different physiological situations or pathophysiology? Then, how can we find ways of intervening to rebalance the system, or activate or inactivate the system in ways that are therapeutically relevant?

Grace Jacobs [6:13] We also asked her about the effect of cannabis on the endocannabinoid system and specifically what kind of effect it has on the CB1 receptor at the molecular level.

Dr. Ruth Ross [6:21] The pharmacology of cannabis is really complex. We do know that the endocannabinoid system is involved in multiple scenarios. I'm a pharmacologist, so one of the key things that people often don't realize about THC is that it's what we call a partial agonist. So people usually know about agonists which are activators, and antagonists, which are blockers, but THC is a partial agonist. The interesting thing about partial agonist is they can... THC can activate the CB1 receptor, but also at high doses or under certain circumstances where there's lots of endocannabinoids being released, it can actually act as an antagonist. So the pharmacology of THC is very complex, and the endocannabinoid system is very complex and that we've got potentially an overproduction in some scenarios where you've got too many endocannabinoids being produced and they're actually making the disease worse. Then you've got some situations where the endocannabinoid system might be under active and you want to potentially tune that system up so that you can bring it back into basal balanced levels. The problem with THC is that it's a very unknown quantity because you've got something as a partial agonist, it can act as an activator, it can act as an antagonist. It depends on the dose, it depends on the individuals, whether they have a particular disease state, or also potentially their genetics.

Grace Jacobs [7:52] Clearly the effects of THC on the brain and CB1 receptors are quite complex. We wanted to know how much people knew about this though. So we asked some students on campus and others around downtown Toronto, what they know about the main active compounds in cannabis and the effects they have on the body.

Speaker 1 [8:11] THC is the chemical that like makes you high and I know CBD is the one that's good for you. I think?

Speaker 2 [8:18] It produces different sensations, like a bodily feeling versus a mental feeling.

Speaker 3 [8:25] CBD that's the one that is pain helping but doesn't get you high. And then THC is the one that gives you the buzz

Speaker 4 [8:36] THC is psychoactive one and CBD is the healthy one, helps anti inflammatories and stuff.

Speaker 5 [8:41] I actually know this... something T something C, right?

Grace Jacobs [8:47] Lauren clarified this a bit more for us.

Lauren DeFreitas [8:49] THC and CBD are just two of over 100 cannabinoids found within the plant. THC we all know as the typical cannabinoid that's associated with the effects of marijuana. So the high that people associate with cannabis, the paranoid effects, the anxiety, impairments in memory concentration, that sort of thing. Whereas CBD, or cannabidiol, is essentially the opposite of THC, where it doesn't produce any of these psychoactive effects, but it actually has promising findings in terms of being an anti-psychotic, being an anti-anxiety and having really important neuro cognitive properties to it. But this is just on its own as a pure isolated compound.

Grace Jacobs [9:30] Lauren also told us a bit more about other components of cannabis, terpenes, which we don't hear about too often. There's some preliminary evidence that types of these can have beneficial effects, but it's clear that more research is needed before we draw any conclusions.

Lauren DeFreitas [9:43] What's really been popular guess in the literature lately is this idea of terpenes and the pharmacological effects that terpenes have on cannabis and their synergistic effect with cannabinoids. So terpenes are essential oil compounds found within cannabis that give it the flavor aroma, but as I just mentioned, they also have pharmacological properties. So what we've been seeing is terpenes, such as limonene, which is naturally found in lemons, if we can combine that with CBD and THC that actually helps to reduce anxiety and depression. For example, alpha pinene, if you combine that with THC that's really good for anti-inflammatory or pain populations, but because a lot of this work is preclinical, we can't say definitively whether or not that is true. So going forward, I really do hope to see a lot of randomized control trials using terpenes. Also in their different treatment arms, instead of just using differing ratios of cannabinoids, I think that is something that is really unexplored and potentially really interesting.

Grace Jacobs [10:47] Part of Lauren's Master's project was to assess the THC and CBD levels and cannabis being sold through licensed producers and make recommendations to inform policy. She took us through her surprising findings.

Lauren DeFreitas [10:57] Really, what my research is looking at is if we combine CBD with THC in the same strain, will that reduce THC induced harms that we see with isolated THC or high THC concentrations? My colleague at CAMH when I first started my Master's in 2016, he asked me if I would like to help him out with this little side project that he was working on, which was essentially to look at all of Health Canada's licensed producers that were licensed to sell and cultivate cannabis for medical populations. So essentially, what I did was, I went on every licensed producers website, and took down the THC and CBD concentrations of every single strain that they had, and then analyze all the strains overall, just to kind of see what the landscape of cannabis that we were offering to Canadians. What was interesting that we found was that over 76% of all strains that were being sold across Canada had THC dominant products or THC dominant concentration. So that means everything 17% and higher. So we really weren't seeing any low THC concentrations whatsoever, which also I find interesting considering in the 60s and 70s THC potency was 3%, and now we're seeing it upwards of 25. So given that there were 76% THC dominant products I also wanted to see okay, even if there are THC dominant products, we know that CBD may potentially be able to mitigate some of these THC induced harms when they're combined together in the same strain. But when I looked into that over 91% of those THC dominant strains had less than 0.01 of CBD concentration in that. So that essentially gave me a great idea of what I wanted to look into for my research was, if CBD actually does have this effect on THC, then why aren't we informing policy to be able to put these regulations in place to licensed producers saying, "hey, we know that these high THC dominant strains are not good for a mental health outcomes, schizophrenia and psychosis outcomes." So we really should be regulating this in Canada. That's hopefully what my research will help inform by the end.

Grace Jacobs [13:15] That's definitely really interesting that there was kind of this movement towards more THC. Is there a different feel or effect of the marijuana when it's more CBD or THC? Is that perhaps why people just like the high of THC more and that's why that market has grown?

Lauren DeFreitas [13:29] Absolutely. So interestingly, the outcomes that I'm looking at in my research is psychological. So anxiety, paranoia, cognitive such as memory performance, concentration, attention, and then abuse liability, so addiction related outcomes. What studies have shown and noticed is that when you add CBD in a one to one ratio to THC, or higher, so two to one of CBD to THC, consumers are actually able to still get the high or feel the effects that they want to feel. But what CBD is able to do, it's able to modulate the wanting and the liking when those same consumers are sober, so that they're not actually craving to use cannabis again. But when they do use it, they still get the same nice euphoric effects that they want. So that I think that is a huge finding, especially going forward and forming legislation.

Grace Jacobs [14:24] As a pharmacologist Dr. Ruth Ross has a great understanding of the nuanced ways in which a molecule can interact with the receptor to cause a physiological effect. In the case of THC, she makes it clear that there are actually still a lot of unknowns, we still don't fully understand the ways in which number of different variables can influence the outcomes of cannabis use.

Dr. Ruth Ross [14:41] Obviously, in pharmacology, we're always talking about doses, pharmacodynamics, pharmacokinetics. So there's doses, there's route of administration, how you take it, and frequency, and then there's the combination with CBD which is the other principal component of cannabis. So from the perspective of THC, potentially there are higher risks associated with high dose THC, and more frequent use. The earlier you start, the more frequently used, the higher dose you take, the more the potential negative effects could be. But on the other hand, if you have some kind of susceptibility to THC and you're particularly sensitive, then even lower doses might trigger some kind of acute psychosis, or you're a new user, you may be susceptible. From a pharmacology perspective, any drugs that activate G protein coupled receptors, there's a certain amount of tolerance though down regulation of the receptor or the effect. So people who smoke heavy or exposed to heavy high doses of THC will have a certain amount of tolerance, whereas people who are new users might be highly sensitive. So there's a lot of unknowns. The other issue with doses is that... another thing we talked about in pharmacology and lots of fields of science is epidemiology. So we're looking at maybe we've got 30, 40, 50 years of data on people using cannabis and the implications of that. Lots of people will talk about say, "well, we've got 40 years of data of people using cannabis, and then there's been no increase in whatever, schizophrenia, so therefore, it must be safe and it's not an issue." But the reality is we've got 30 or 40 years of data of maybe 4% or 5% THC combined with an equal ratio of CBD. From a pharmacology perspective, to then go on and say that 20-25% is going to give you the same outcome, is really not scientific at all.

Grace Jacobs [16:45] It's clear that more detailed research needs to be carried out to fully understand the pharmacological effects of cannabis.

Lauren DeFreitas [16:50] In the 90s, that's really when the medicinal use of marijuana is being investigated also. We began to see that it actually had really amazing therapeutic effects for pain populations, and especially end of life care, so cancer chemotherapy, multiple sclerosis, musculoskeletal pain. So because we were seeing that different researchers kind of went a different route and went more the therapeutic route instead of investigating the harms of cannabis. So then we started seeing things like nabilone and dronabinol being created, which are synthetic versions of THC. THC is a great anti inflammatory, I think it has 20 times the anti inflammatory power of aspirin and two times out of hydrocortisone. So it really is a great analgesic muscle relaxant. But having said that, it also does have the psychological and cognitive effects associated with it. Then more as we got into the 2000s, people started investigating CBD a little bit more also, and then we realized the amazing potential that CBD has. So by using CBD, we're really hoping to harness those great therapeutic properties that THC has, while reducing the cognitive and psychological harms that we're seeing with high THC. So, I mean, we've really only seen this in preclinical studies so far and in a lot of observational studies. So I'm really excited to see this kind of transition more to the clinical research world. There is actually a drug that was just recently approved by the FDA in 2015 called Sativex, which is a one to one ratio of CBD to THC, that was really meant to help with muscle spasticity and multiple sclerosis, as well as help with pain in certain populations. But more over what was recently just approved this year as another cannabinoid medication was palodex, which is just a pure CBD formulation that's been able to reduce seizures in children. So really lots of exciting therapeutic potentials with cannabis and I really do see that's where the future with cannabis is. Now that we're coming to an age where we're very scientifically advanced, and we're able to manipulate the different chemical compounds within the plant to be able to really act on the different areas of the brain that we need it to for these medicinal populations that are lacking endocannabinoids in different areas.

Max Strauss [19:25] One intriguing area of research into medical cannabis is the use of cannabidiol or CBD to treat epilepsy and seizures in children. Dr. Blathnaid McCoy is an Assistant Professor of Pediatrics at the University of Toronto and a clinician investigator in the Division of Neurology at SickKids. Her research has been investigating the use of cannabis oil to treat a form of epilepsy known as Dravet syndrome. Dravet syndrome is responsible for about 30% of all cases of epilepsy children with Dravet experienced lifelong seizures, sometimes upwards of 100 seizures a day. These seizures lead to developmental delays and significant learning disabilities and have profoundly detrimental effects on quality of life. Dravet syndrome is difficult to treat, it does not respond well to anticonvulsant medications and it has no cure. In October 2015, Dr. McCoy spoke at the marijuana and seizure management conference where she described how she planned to construct a clinical trial to investigate how CBD may be safely used to control seizures in children with droplets.

Dr. Blathnaid McCoy [20:22] So at sickkids, we're hoping to have a safety trial first, and basically it's a small study with Health Canada approval we're hoping, and where we can just figure out what should we be giving? How much should should we be giving, and what happened when we gave it to these kids in terms of their other drugs that they were on, do their levels go up or down? What happened with their seizures? And basically around safety. It'll take 20 weeks, have to give it for a reasonable amount of time, but actually, we plan on following them for a year because it's just so much on them. We just don't have enough information. After that, all things being well, we would hope to move on to a bigger study. We need that extra step in kids though, because we have to be extra careful around the safety parameters in terms of dosing. So what I'm saying is the specific components is what's important. It's not well known. Yes, it is certainly plausible that cannabinoids have an effect on epilepsy. But we need to know that information, that extra piece. I will say to you watch this space because I know that a lot of us are working very hard in terms of trying to make this something that we know and we understand better.

Max Strauss [21:29] Since this speech, Dr. McCoy's team has been studying the use of CBD oil that contains a small amount of THC in the hopes of finding a safe pediatric dose that can enhance the anticonvulsant properties of CBD. Their recent study has found in 20 children with Dravet, CBD oil containing a small amount of THC saw immediate reduction in seizures of about 70%. While not all children responded positively others saw dramatic reduction in seizures when compared with CBD alone. McCoy and her team are planning on conducting a follow up study of at least 200 children with non Dravet epilepsy in order to further explore the therapeutic potential of combined CBD THC oil on seizures. However, McCoy has stressed that their study only provides an idea of dosing and safety for the use of combined oil therapy and pediatric patients, and that more statistical power is needed before anything concrete can be said about the effectiveness of this treatment.

Grace Jacobs [22:20] Another interesting way to target the endocannabinoid system for medical purposes is with other small molecule drugs that interact with the CB1 receptor in a more subtle, indirect way. In 2005, Dr. Ruth Ross made an interesting discovery about the CB1 receptor that has opened up a potential new way to target and fine tune the CB1 receptor activity, possibly with fewer adverse effects.

Dr. Ruth Ross [22:41] We've known for a long, long time that the endocannabinoid system is key in lots of different pathophysiology. There have been various attempts to harness this therapeutically, and we made a discovery we back in 2005. So I've been working on this for a long time, that there was what we called allosteric binding pocket in the CB1 receptor. Allostery is very kind of interesting topic in gpcr research where our allosteric pocket, so it's a way of targeting the receptor, so that you can tune up or down the effects of the endocannabinoids. So rather than it being a direct effect, or THC has a direct effect, it is kind of like a volume control on a radio. So you've got these endocannabinoids being released, they're being released on demand, depending on the scenario. So maybe during pain and inflammation, you've got an increased level of endocannabinoids being released, they may be causing an analgesic effect. If you can tune that up, you basically get more of an analgesic effect or more pain relief. You're harnessing this endogenous system and making it more efficient. There are other situations we think where the endocannabinoid system may be tuned up, and it's actually making the condition worse. Now, psychosis might be one of those, we were still looking at that, its very early days. But if the endocannabinoid system is tuned up, and it's making something worse, then we have another family of molecules that tune the system down, turn the volume down, as it were. So these are sets of small molecule drug like compounds that actually can be used in a suite of different illnesses depending on whether the system needs balanced up or balanced down.

Grace Jacobs [24:31] With this theory, the idea is to use small molecule drugs, the targeted interact with the CB1 receptor in a way that modulates its activity in a more subtle way than something like THC would. Such molecules can be positive modulators, or negative modulators and could be useful scientific tools to interrogate the endocannabinoid system. They may also have the potential to be useful as drugs.

Dr. Ruth Ross [24:51] The cannabinoid system is one of those things that's involved in multiple kind of feedback loops. So one of the important things we need to do with these molecules, first of all, is use them to work out if you tune the system down what happens? Because of the situation of multiple connections and multiple pathways and feedback loop both positive and negative feedback loops, it's very hard to predict exactly what will happen. Which is why it's very nice that we've got both positive modulators and negative modulators. We can look at both so for example, in pain and inflammation, we can look at both, we can look at these in metabolic syndrome. So the endocannabinoid system has been implicated in non alcoholic fatty liver disease. We're looking at them and now we're looking at them in again, in brain related scenarios, we can look at both the positives and the negatives. One of the reasons why there's potentially such confusion and controversy over THC and psychosis may be that the endocannabinoid system may be evolving and changing as the disease progresses. So we started a certain imbalance being something that's trying to make the thing better, but then it turns into a pathophysiology. So then you've got layer onto that THC, which can, as I said, at the beginning, behave as both an agonist or an antagonist. It could start off as an agonist and then you've got overproduction of the endocannabinoids in an illness and it becomes a blocker. So I have no really clear answers yet. It's complicated, and the bottom line is we need to do lots more research to really get a clearer picture.

Grace Jacobs [26:33] We're still in the early stages of understanding the medicinal uses of cannabis in particular diseases. However, there are many anecdotal examples out there of people who have successfully used cannabis to deal with some conditions like pain. Here's a story we heard from a graduate student at the University of Toronto.

Speaker 3 [26:49] I have a friend who actually takes the CBD oil for pain management, and he's even more straight laced than me, if that's possible. So he was like, don't judge me, don't judge me. But like, he replaced, I think, three or four narcotics that he was taking for this neck injury that he had. He replaced it with the couple drops of this thing three times a day. His mom who has been an emergency room nurse, like forever, when she looked at his prescriptions for pain, she just looked at him and said, you need to get off those now. Like those are damaging to your long term health and you're going to be addicted and messed up. So he looked at alternative medicine and he took the CBD oil. He's like, you can't believe how amazing that it fixes the pain. His mom gave him the thumbs up and said, you know what, like a little bit of that oil versus those, go ahead. Like it's cool.

Grace Jacobs [27:46] One of the reasons why people might be hesitant to use cannabis, either for medical or recreational purposes, over the concern that it's possible to become dependent on it. We asked some U of T students and people around downtown Toronto if they think cannabis is addictive.

Speaker 6 [28:01] You may be able to develop a sort of dependency, but I don't know if it's necessarily addictive in the same way that like cocaine is addictive, or heroin is addictive, or nicotine.

Speaker 7 [28:14] Yeah, I think like any drug can be addictive by for certain people in certain contexts. But like Mitchell said, I don't think it's as addictive as a lot of other drugs that are in use today.

Speaker 8 [28:27] Yes and no. Like for people that do it and limit, no. Cause I know people that have taken it before but don't feel the urge to do it all the time.

Speaker 9 [28:41] Well, it depends. Anything is addictive, you just use it excessively.

Speaker 4 [28:46] I stopped smoking marijuana once to like join the army, and it was easy. I stopped smoking cigarettes once and it was it was hard. You know, it was hard to quit cigarettes.

Speaker 10 [28:58] Cannabis is definitely addictive, because when you ingest it, or you take it, then it sends really good messages to your brain, and everything is enhanced, everything looks a lot better, your thinking is... it's just everything is enhanced. So based off of experience from my friends and I, we all just have a lot of fun, and the feeling of being happy and feeling relaxed is such a good feeling. Everybody wants to feel that. So if people are stressed or they're anxious or they're mad, or whatever. If they use that then most likely they'll become even more relaxed, and everyone wants to feel that and so you just become addicted to that feeling.

Speaker 11 [29:45] No, it's not addictive at all, no. No.

Grace Jacobs [29:47] Karolina is a PhD student and Dr. Tony George's lab at the Center for Addiction and Mental Health. She focuses on research about cannabis use in schizophrenia, and is quite familiar with addiction to cannabis or cannabis use disorder.

Karolina Kozak [29:59] Compared to the general population, I'm going to refer to cannabis use disorder, essentially, it's cannabis addiction. DSM (Diagnostic and Statistic Manual of Mental Disorders) defines that as cannabis use disorder. So the prevalence of that disorder in the general population is around 3%. But certain disorders, the prevalence of cannabis use disorder is much higher. So particularly schizophrenia, which is what I study, the rates are at 25%. So that comorbidity is much higher than the general population. So individuals that I, for example, assess for study, I have to confirm their diagnosis of a cannabis use disorder, and there's different levels of it. There's mild, moderate, and severe, and that's based on the amount of symptoms they present. These range from their level of tolerance, withdrawal, doing hazardous activity while high, it ranges on a spectrum. In that sense, there's there certain areas of it. But ultimately, you want to see whether or not that individual is using it often enough that it presents some kind of problem, or there is a physical dependence of it. There's also a psychological dependence of it. It ranges in really that field. Actually, a lot of the participants who do our study say that "oh, well, cannabis isn't addicting, I can stop if I want to." That's a common kind of response you get. I like to kind of have individuals realize that it is, is whether or not you are able to not use it for X amount of days? During that time of not using it, are you experiencing any kind of withdrawal symptoms? A lot of people don't know, but there are withdrawal symptoms from cannabis use, and those range from irritability, sleeping difficulties, your appetites affected, your mood is affected. That is withdrawal from cannabis use. So if you're not using it for some amount of time, and and there's changes like that, that's what you can most likely attribute it to. By definition, I would assume, or I would say that that that kind of shows that it is an addictive substance.

Grace Jacobs [32:04] Recent data suggests that 30% of people who use cannabis may have some degree of cannabis use disorder. Additionally, people who start using cannabis during adolescence have a higher likelihood of developing a cannabis use disorder. But how exactly do people become addicted to a substance such as cannabis? Karolina explains how your brain and a neurotransmitter called dopamine respond to drugs and the changes that occur as a person becomes addicted.

Karolina Kozak [32:27] In terms of what's going on in the brain. It's related to the dopamine function, at least that's what I heavily center my work around, and the effects that has on that neurotransmitter. So the reward processing that occurs, which is a brain pathway that's associated with any kind of addictive disorder or behavior, even like gambling, and it's related to dopamine release. So in terms of, for example, stimulants, when you're using some sort of stimulant, you're having a upshot of dopamine being released to certain components of your brain. What can happen is the dopamine will be released, but I won't be re upped, like uptaken back. So then you have this like influx of dopamine going on, and that's what a lot of individuals end up feeling that pleasure feeling. It becomes kind of a cue reactive response even to how one might see a cigarette, or a lighter, and they kind of get an urge to smoke. So your brain gets to a point where the response of certain cues has the same kind of effect as even using the drug.

Grace Jacobs [33:37] We asked Dr. Ruth Ross to clear up some misconceptions surrounding cannabis and its potential as an addictive substance.

Dr. Ruth Ross [33:43] There's been a lot said on the addiction and also on toxicity that's confusing or not sufficiently expanded to communicate the well. So it's important for people to know that there is a potential for dependence. That can translate into not being able to stop cannabis when you want to even although it's adversely affecting your life. So that is very different from an opioid addiction. But it is still something that is a concern and that people certainly need to be aware of, that it's a real thing cannabis use disorder. In terms of toxicity, that's another really interesting one because clearly cannabis isn't like an opioid, it's not going to cause you to stop breathing and to have an acute, toxic effect. Similarly, alcohol can have acute toxic effects on your physiology. I think it's really important for people to know that there have been instances and it is the case that if people take high dose cannabis, for example, an edible or a high dose, smoking cannabis in a naive user or whatever, they may develop an acute psychosis, paranoia, fear, anxiety. In that scenario, they may be in danger. So they may be in danger because they're feeling highly fearful and anxious, and psychosis can be very terrifying. So it would happen in a small percentage of people, high dose, potentially first time user or with an edible. But when people say cannabis is you know, it's not a total toxic, that it's entirely safe even at you know, you could take huge amounts and you wouldn't die. While that statement has to be qualified in terms of it's not physiologically toxic, as in, it's not going to stop your heart, but it can cause effects that could be quite dangerous. There's also scenario called hyper cannabis induced hyperemesis, which is people can't stop vomiting, more and more emergency rooms are seeing people coming with hyperemesis and they just constant vomiting and can't stop.

Grace Jacobs [35:56] So we know that there are some harmful outcomes of cannabis use related to dependence and toxicity. But we also know that people have been using it recreationally even prior to it becoming legal. What are the general perceptions of appropriate versus inappropriate cannabis use?

Speaker 2 [36:12] I guess if you got to a point where you kind of relied on cannabis, or you were smoking it to the point where it was a consistent thing, or you felt like you had to do it for social aspect, or to have fun or relax, I think that would definitely be a point where it's too far.

Speaker 1 [36:28] When I first started out, I, I didn't have more than two days sober, like each time. So I would like it was like almost every other day. So it was definitely a unhealthy relationship with cannabis. Because it was also during a time where I had a lot of things going on. It definitely, it definitely did become a way for me to calm down when I was like stressed or angry, but I've learned how to not depend on it. It depends. It depends on the setting of when people are using it, if they're using it. Like right now before class. That's terrible.

Speaker 4 [37:05] I think some people can take anything to an extreme right, I think anyone can get addicted to just about anything. I've seen guys who can't even like have fun without smoking weed, again, still reliant on it, that I think that's kind of a dime a dozen. You know what I mean? It's not very often. Inappropriate recreational activity of any kind is activity that gets in the way of you doing what you need to do.

Speaker 12 [37:27] Drinking and driving bad. Smoking, it's not cool to smoke weed and drive. It's not cool to smoke weed in... we got rules, don't smoke them in school zones. Be respectful. That's it.

Grace Jacobs [37:43] Although not everyone we spoke to use cannabis themselves. They all had similar ideas about when and where it was appropriate to use. The trend towards tolerance of appropriate cannabis use is something that social scientists have been tracking for decades. We sat down with an expert Pat Erickson, a Professor of Sociology and Criminology at the University of Toronto, and a scientist emerita at CAMH. She discussed the changing attitudes towards cannabis.

Dr. Pat Erickson [38:07] So I started at the former addiction Research Foundation in 1973, which was on the heels of the Le Dain commission. I was hired specifically as a Criminologist to assess the social impact of using criminal sanctions against marijuana possession.

Amber Mullin [38:26] But hold up what was the Le Dain commission? Well, in the 1960s cannabis use and the number of cannabis related arrests rose rapidly. Many felt that there was a drug crisis, and it was clear that the increase in both the number and harshness of cannabis related punishments were not serving to deter cannabis use. This prompted Pierre Trudeau's Liberal government to form the Commission of Inquiry into the non medical use of drugs, also known as the Le Dain commission. The purpose of the commission was to rigorously investigate the recreational use of drugs including cannabis. The final findings of the Le Dain commission were published in a 1000 plus page report in 1973. The report raised some concern about the use of cannabis by adolescence and its impact on their development, as well as the link between cannabis use and mental health disorders like schizophrenia. But the commission also identified several misconceptions. For example, that cannabis is a gateway drug or that cannabis use incites crime. In the end, they actually concluded that the harms produced by criminalizing cannabis outweighed the harms that came from cannabis use. The final recommendation from the Le Dain commission was to decriminalize cannabis across Canada. The report was widely praised for its thoroughness, and to some including Pat, it felt like Canada was on the verge of decriminalization. Even though cannabis was never officially decriminalized, attitudes towards cannabis and cannabis use shifted dramatically through a process that social scientists like Pat referred to as normalization.

Dr. Pat Erickson [40:00] So I did the research there. I thought, well, I suppose it will be decriminalized or even legalized in the next three or four years in the 70s, and I'll move on to something else. Ofcourse, that didn't happen. I've continued now for over 40 years to be monitoring cannabis use and cannabis policy impacts over that time. My focus has been as a social researcher on the individual and social impacts of criminalization.

Amber Mullin [40:35] Alright, would you mind speaking a little bit on the trend towards tolerance of marijuana? I know you've done some work on what it means for marijuana to become normalized in society?

Dr. Pat Erickson [40:43] Yes, these were more recent projects on normalization. Normalization, I think it's very important to understand how we use it in the scientific field, which is that it refers to the occasional use in certain circumstances, in a controlled way. So when we talk about normalizing cannabis use, we're referring to actually a lot of social norms and informal rules that govern access. So normalization means that cannabis, which was illegal, and still is, for another month, has moved along a continuum from being stigmatized and hidden kind of subcultural activity to being a fairly public one with a large number of people accessing it quite readily in society. So normalization doesn't happen overnight. It doesn't happen on October 17. In fact, it's been going on really since the 60s in a gradual way. I think it's important to think about perhaps alcohol as well and realize that when we say alcohol is normalized in society, we don't mean that any use anytime anywhere is acceptable. We mean that there are certain boundaries around what is acceptable use, who uses it, when where, and this is the same process that's been underway for marijuana use. So that when we did our studies of fairly long term adult users, ages 20 to 50, we found that they were very aware of appropriate situations to use, they weren't approving of excessive use, and they were cautious, perhaps in public use in certain areas. But the idea that normalization means it's kind of opening the floodgates to anybody using it all over any time being promoted, that isn't what normalization is about. In fact, normalization is important mechanism of social control, because the users themselves will sense monitor friends and associates about what, where, it's important to use, or not use. So when we ask people, where do you think it's appropriate to use? And they said well, with people who are okay with you using, and they don't mind, or that you go outside or you go somewhere, you don't offend them, Where shouldn't you use? You know, baby showers, church funerals, around anyone who isn't comfortable with it. So kind of what we concluded, because we were also studying in this project, people who use tobacco, and people who use both tobacco and marijuana, three groups, and marijuana only. There was really a convergent in norms around tobacco, and marijuana in the sense that even though they're they have operated different polls of legality, the tobacco users or the considerate cigarette smokers, are also quite aware of where it's appropriate or inappropriate to use. I think one of the important implications of that study is that most of the marijuana users along with tobacco users accepted that there should be certain restrictions on who sold to, and where it's used, and with who. I think that means that in the future of legal regulation of marijuana, I think people will continue to be sensitive to appropriate norms of use, and are not going to, for the most part, want to offend non users or use in front of children. So they will accept there are going to be public health restrictions on marijuana that it isn't going to be simply, you know, every place is like one of the marijuana fairs that are happening in the States. Society will restrict use in certain ways. I think that's a very important part of our Canadian approach.

Amber Mullin [44:37] Yeah, definitely. I would agree. What would you say is acceptable versus non acceptable use of marijuana? You can compare that to tobacco use, or maybe alcohol would be a better comparison for that.

Dr. Pat Erickson [44:47] Well, again, it's going to vary by your age group, maybe by male, female, for instance, campus, we found high tolerance of marijuana. Even among non users, you go to a equivalent of an abstaining community for alcohol, you will have, perhaps religious groups, particular groups from different backgrounds, different countries that will be not happy about marijuana use and will not want to see people using. On the other hand, I had interview subjects who said, yeah, we go out and use with my parents or, you know, so it's variable. I think the important thing is to realize that these norms are already being established, given the widespread use given that almost half of university students have used it, at least we're getting to higher levels in the population overall have tried it. We have to realize that doesn't mean that everybody has to use it just because it's legal, or that everybody is going to use it in an uncontrolled or irresponsible way. I think the norms are already there, and it's important that that education, public policy, municipal guidelines, and so on, all reinforce a responsible and more cautious use of marijuana than perhaps people sometimes imagine will happen. The legal barrier, I think, as a Criminologist I have to say people inflate that far too much as both a deterrent and something that once it's removed, people will somehow go wild. That just isn't the case with other types of less acceptable behaviors and for marijuana as well.

Grace Jacobs [46:30] So what do people think? Overall, is legalization a good step for Canada?

Speaker 1 [46:37] I think that the legalization is definitely not the best route. Because with it being illegal, a lot of people are still doing it. So now that it's going to become illegal, it's going to become even easier to access and those types of things is just adding onto the list of things that you can use to not be sober. It's like giving more access to things to become addicted to, and just a lot of problems can arise.

Speaker 12 [47:07] I guess with the legalization, I can see why it's a negative like some people view it negatively. But I guess you also have to think about how like, now people won't be getting it from dangerous sources, I guess maybe now it'll be a little bit safer to do it.

Speaker 6 [47:21] I would say yes. Because especially like for white people, it's pretty it's like largely been decriminalized for a long time. It's like you're very unlikely to be charged for like possessing or like even selling cannabis. But drug laws have primarily targeted like marginalized communities for a long time. It seems like radically unfair to me that, like they would be punished. Whereas like the majority of white people would not.

Speaker 13 [47:57] Yeah, I think it's like a huge waste of government resources to prosecute people for using cannabis. I think there's like, more important things that could be doing.

Speaker 14 [48:08] Yeah, no issues against it becoming legal might as well, it's gonna probably give more clarity to like the older people using it too, because I think right now, it's kind of got a stigma for a lot of younger use. So it'll definitely kind of promote that, and hopefully, like help a racist stigma and kind of erase the use of other narcotics.

Speaker 4 [48:24] If anything, a lot of people see legalization as more access. What I see is kind of a obstructionist to most people who don't have the money for paying taxes and all that stuff. So because we've been able to get it off any corner you want forever, it actually really hasn't opened access at all, just made it more legitimate and more highly priced, you know.

Speaker 15 [48:46] Legalization, I thought it was a great idea. Recently, though, I started smelling the marijuana smoke in all the parks and things like this, and I have a kid as well and doesn't feel that great.

Speaker 3 [48:56] Prohibition doesn't work. I mean, we've tried it with alcohol, we've tried, you know, now with drugs. I think, you know, we need to have it monitored and safe. Because as long as drugs are not legal, it means there's no pathways they have to go through to make sure any sort of quality control and without quality control, then you know, we're having all kinds of accidents and things.

Speaker 16 [49:17] I think the legalization would take away the stigma and promote a lot of education around marijuana. I think right now because it's illegal, there is a lot of negative misconceptions of marijuana and, and leading to a lot of over exaggeration of the use and the effects of it. But I think as it becomes more mainstream and people understand how the drug works and understand the dosages and the different strains of THC and the different strains of cannabis, then I think it'll ease up.

Dr. Ruth Ross [49:46] My view on legalization is that it has been a very, very rushed process. I think decriminalization could have been a very important first step. There are a number of other models for legalization that Canada could have looked at. So I think I would have liked to have seen legalization rolled out much more slowly. I'm not necessarily against legalization per se, but I am very concerned about the rush. I'm very concerned about some of the unknowns that we've talked about.

Karolina Kozak [50:27] It's a very political question. I feel I'm usually very like apolitical too. I don't know, I think if there was more research done before it was going to be legalized in terms of short term effects of use and long term effects of use, and if you end up abstaining from it, quitting it, can any of those effects be reversed. I think I'd be more comfortable with that happening. Unfortunately, many individuals aren't educated about potentially the negative effects of cannabis use. I'm not denying that there has been also positive effects found. But I think that also lies in you know, that CBD and THC content difference. So what people were, you know, smoking 20-30 years ago, and THC content doesn't even compare to what you can find now in and on the local dispensary. So that level of ease that some people might think about using back in the day versus now it's totally different game, you could say. But I think in terms of overall usage, I think there will be a spike of more individuals using it. I think what could be problematic is the usage of marijuana in vulnerable populations, and by vulnerable populations, I'm referring to those who may be have mental health issues, other kinds of mental health issues, or are more susceptible to developing some sort of mental health issues. Because it's been shown that cannabis use leads to a lot of rehospitalization, quicker kind of Induced Psychotic symptoms, you know, developing eventually schizophrenia. So I think that's where the worry might be found, and I think any kind of research is valuable to kind of help the public become educated and in terms of the usage of substances in general. Presenting it to the general public, I think, is also kind of key because a lot of these studies we as researchers are aware of, because we know how to use PubMed. But presenting it to the public, whether it's the news broadcasts it or social media wise, I think that's also needs to be considered when the results of some of these studies are going to start coming out, for it to be kind of translated to anyone from any kind of background to understand and be informed.

Grace Jacobs [52:53] To get a perspective through the lens of public health, Max spoke with Sudha Sabanadesan a Public Health Policy and Research Specialist at Toronto Public Health to see what worries the government has about cannabis legalization.

Sudha Sabanadesan [53:04] I work as a Policy Development Officer at the Toronto Drug Strategy Secretariat at Toronto Public Health. My role has been lately very much involved in looking at the cannabis legislation, working collaboratively with other partners and responding to the issues that have come up on cannabis. The harms of prohibition, so when a substance such as cannabis, which is so widely used is prohibited and criminalized, people end up with criminal records for simple possession. Many of them are young people, disproportionately it impacts people, racialized people and Aboriginal people. So the social harms from it, were just not balanced in terms of what might be the harms of actual consumption of cannabis. So when something is prohibited, it's quite harmful, obviously, for different reasons you don't have as a product, people are criminalized. But then once that ban is removed, and if you don't strictly regulate the substance, then you go into commercialization and is just as bad. So the balance is to to find that spot where harms are minimal. So the approach public health takes is a harm reduction approach, which means to minimize the harms, without necessarily, if people want to continue consuming cannabis without having to ask them to reduce or stop the use. Because you know what happens with the whole say no to drugs, that hasn't worked. So that's the idea, but the issue with that is you need to continually monitor and fine tune the regulations and the policies to make sure that you've got the right balance. So the two things that we are most concerned about from a public health point of view is early initiation and frequent use of cannabis. The other thing that is the biggest concern for public health is impaired driving, people don't think it's a concern, which especially a lot of young people are not aware that cannabis use can impair your driving ability. So, you know, our advice is that if you consumed cannabis, wait for about six hours. Unlike alcohol where we have quite a bit of research to look at about blood alcohol concentrations, and what would that means for impairment, we don't have that type of dosage information for cannabis. That may be different for each individual, but just as a general rule of thumb, six hours don't drive after consuming cannabis.

Grace Jacobs [56:05] We were also curious to know if Toronto Public Health thinks that there will be an overnight change with legalization.

Sudha Sabanadesan [56:12] Now that it's legal, is it going to be everybody's going to be on board? There is a lot of stigma there, there has to be that culture shift on considering this as a substance that, it's psychoactive substance. It's not benign. It's got harms associated with it. But it's something that is consumed, and therefore it should be treated the same way as any other product that we consume. Honestly, the big impact would be to be able to talk about and educate people on cannabis, we have to talk about both the health harms associated with cannabis, it's important to keep that in mind, as well as the issues on how to perhaps improve the health of the whole population. When you look at the different factors such as social harms, and health harms, and find ways to keep refining their regulations, and investing in treatment if people do need treatment. Also prevention activities, especially with youth, and have a more holistic approach because in reality, we cannot look at cannabis in isolation. Cannabis is consumed, along with other substances, and our messaging has to do with harm reduction, or any substance use, and cannabis being one, treated for what it is and find less potent products and just keep learning more about it.

Dr. Pat Erickson [57:51] Well, I think it'll be very important to adapt some of the health curriculum to recognize that cannabis is out there, and that users are going to have to make choices and they should be armed with some information. It's not that simple though, because they already have a certain amount of information. Now, we're not starting with a blank page as we could have 40 years ago. So there hasn't been a lot of material developed on harm reduction education. So you know, there's the school based harm reduction, which can be more structured. Then there can be ads, there can be the universality approach, which in the Harper era, of course, was all scare tactics and was even worse before that in the States. Some of the young people have stepped in, I mean, young academics, new scholars, the Canadian students for Sensible Drug Policy, have put out a whole set of cannabis work plans for youth that could be adapted in some ways, it's very balanced really emphasizes health issues and caution when you're young. I mean in a perfect world, no one would touch it until 25, but we know that isn't what's been happening. No matter what, some of the more worried medical people feel that this couldn't happen, and you can't, by legislating an age of 25, you are not going to get around the fact that the age of initiation is mid teens. So I really would like to see, and I think the government has said they will put resources into education and harm reduction. I know that there are people working on it. So I think the key is to put it in perspective, and before now it was always out there as this is terrible, then you are stigmatized if you were a user. I mean the effort was to maximize stigma and to make people feel like they were taking a huge risk. Then if they did take a risk, they did it in secret, which is always the worst way to use drugs by yourself. I mean, that's partly what's happened with the overdose crisis, which is a much bigger issue. Right now, to worry about it, I think whether we'll have a little blip in cannabis trying but It's sort of just to bring it out in the open, you know, and have people discussing it. That would mean, at least some generations of parents are going to have to also become more informed because they're scared. You know, and I understand that, you know, fear has been the driver of a lot of the prohibitionist movements.

Grace Jacobs [1:00:18] Dr. Ruth Ross echoes the importance of education, especially unbiased educational messaging, without any conflicts of interest.

Dr. Ruth Ross [1:00:26] So I think a key thing, which isn't the realm in which I work, but I think it's really important that we get some strong educational messaging. I think it's really important that's being done at arm's length, and that being done by the government, the education needs to be done free of any conflicts of interest. That's really important. We have learned from a whole lot of different scenarios that people will be very well aware of that there can be conflicts of interest when people produce materials around promotion, marketing, and potentially under the heading of education. So it's very important that we have educational materials, the latest research getting into the hands of the public as soon as possible as quickly as possible. As I see, it needs to be clear of any conflict of interest that may affect the way in which that educational material is disseminated, and people are made aware of it. There are lots of different experts working on different things and seeing this from different perspectives. It's important, we all listen to one another. So experts aren't necessarily all in alignment with their views. But certainly, there are some topics where most people actually do agree about potential harms, and most people do agree on things that we don't know. Those are the things that we can communicate quite clearly. Currently, there are other things we need to actually just communicate well, we don't know how you're going to respond to cannabis, and you need to know that if you take it then to a certain extent, it's an unknown. So we can actually communicate that rather than communicating something that sounds like we have lots of research, we know everything, and this is very clear, because there's lots of nuance, there's lots of unknowns.

Grace Jacobs [1:02:24] Lauren shared how she's personally involved in cannabis education.

Lauren DeFreitas [1:02:27] So Believe is a licensed producer of cannabis under Health Canada, which means that we're licensed to grow and cultivate and sell our own cannabis. So we have been operating since we got our sales license May of this year. So we've been selling to medical marijuana patients ever since then. But really w hat I love about Believe, and what really drew me to them as a company that I wanted to align myself with, is their care and concern for their customers. They're such as socially responsible company, and even just kind of going in and chatting with them, they're fully aware of all the harms that are associated with cannabis. And they're not trying to I guess, fluff it up, or brush it under the rug or undermine everything that there is out there. But they're really trying to focus on education, and informing critical populations. So adolescence, parents, how to talk with your kids about difficult conversations. I think that's really where all of this is needed and where the critical area is right now. So my role there is in charge of education and social responsibility. So right now I'm crafting a strategy that can really target youth, as well as address all of these misconceptions. So misconceptions both in undermining the effects, but also in the over exaggeration of effects of cannabis. So my goal is to be able to provide really clear, accurate information to the public just addressing any kind of misconceptions out there.

Grace Jacobs [1:04:04] There definitely seems to be one thing that most people we talked to agreed on, cannabis use in children and adolescents is a bad idea. Here's one parent's perspective on cannabis use with respect to her children, now that it's legal for recreational use for ages 19 and up.

Speaker 3 [1:04:21] I have children and I've still sort of requested that if they're going to experiment that they wait until their brains are fully formed, sort of after the age of 25. Just do that favor for me. Then, you know, do your thing. But you know, it's... you can only have so many conversations and just hope they listen. Because I think the jury's still out on what these things do to your brain, especially developing brains.

Dr. Pat Erickson [1:04:45] I was very skeptical initially, and I've read enough of the research, talked to enough colleagues. I think it's real, but you have to realize that it's for a very small subset of the adolescent population. So the federal government now in their new bill is a lot more complicated than the old bills. They want to really limit promotion, advertising, which is fine, but also selling to youth or to have youth involved in sales, they want to be tough. They want to show that they can be tough in trying to keep cannabis away from youth. But I think it's not that important to keep it away from all youth, it's might be better to acknowledge that there will be experimentation, and that the social supply network that now operates for teens, it's been well documented everywhere. That's what kids do. They're not getting it from some adult, you know, lurking at the schoolyard. Social supply its sharing, they don't consider it dealing, we found that in our studies, too. It wouldn't make sense to criminalize, to me, a 17 year old for giving a joint to a 16 year old. I'm worried a little bit about how that's gonna unfold, because there is still in the legislation, I think the sense that somehow we have to stop youth from using and that isn't realistic, right? Now we can do our best to delay initiation and to, for the most part, not overstate risks, but we don't want to continue this kind of thinking that any use is bad. It's a hard act, I'm very sympathetic in the sense that government is trying to balance very difficult objectives. When they say keep it out of the hands of children, well, it's never been in the hands of children. I know what they meant. Children are not using cannabis if you're talking about preteens, and most teens aren't either. But we also know, from research that's done by people I've worked with, the teens who get into trouble with overuse of cannabis are ones that generally are disadvantaged in other ways, in terms of learning disability, or poor background, or difficulties at home. It's associated with that, it isn't just associated with being young. So there's a lot to work out. The educators have a real challenge there, and I really hope resources will go into that.

Lauren DeFreitas [1:07:11] I think Health Canada has been treading lightly, in terms of the regulations that it's putting in place around cannabis. First and foremost, it's looking out for youth for sure. It's really trying to make sure that cannabis doesn't get into the hands of youth and the regulations are really trying to curb the black market as well, so that you don't turn there. The regulations that are in place right now, federally, the minimum age is 18, and you're allowed to possess up to 30 grams of cannabis on you at a time. However, each province is allowed to have their own regulations put in place that can be more strict or more stringent on those, for example, Ontario has raised the 18 to 19. So only Ontarians 19, and older will be able to purchase cannabis. Right now as of October 17, that's only going to be through the Ontario cannabis store, which is an online platform. They really want to make sure that they're getting it right, and that they're not just, putting this out there in stores without putting all the necessary precautions in place. So I definitely understand that and respect that in terms of CBD and THC and regulations around that they're being very cautious around that also, because the literature is still a little bit ambiguous. There really are no systematic reviews, looking at specifically what I'm looking into. So that's why I think my research is very important in informing hopefully this policy and regulations around this.

Dr. Pat Erickson [1:08:42] Right now, we're really under surveillance internationally for this plan for cannabis, and we'll be judged on it. I think that a lot of countries that cannabis and heroin still are equally bad. So, you know, there's quite a ways to go. But I think we're on that trajectory to take a more health based approach. I think the public discourse that I've seen over 40 years has changed to be more appreciative of, drug users aren't just bad people and they deserve care and attention and support. I think important thing is that the world won't be that different on October 18, that a lot of the social regulation and informal control on cannabis use will still be there. My hope is that for those who would be users, or current users, I hope they'll give the legal regulation system a chance. I know it's going to be a big test of whether the illegal market can be undercut. With all of provincial variation, and the confusion, and online ordering, and retail or hybrid or monopoly... If people are already have their established channels and access, they may not be that keen to switch, they might be getting good incentives for the illegal market to continue. But I think part of it being normalized, and for users to be kind of responsible, in a broader sense is to really try to give the legal market a chance to develop and and use it. Because if we don't demonstrate that we can seriously undercut the illegal market, not overnight, but in time, then it will be difficult to count that part of the policy of success. So I'm really hoping that people will shift and that of course, then that means that a lot of the smaller producers, growers, etc, they also, this is another big issue that's still not resolved, they need a niche into the market, as well. Otherwise, it's their livelihood. So, you know, there's a lot to balance but it's really going to be important that people don't overreact to legalization, start seeing druggies everywhere and worrying and overreacting, particularly about youth normalization has been going on and it's been around us cannabis is very much part of our modern society. I think your younger generation will will evolve with it and help to form a a better policy.

Grace Jacobs [1:11:28] Hey, listeners, we hope you learned as much about cannabis as we did putting together the show. A special thanks to Thamiya, Amber, and Max, for working with myself on this episode's content. As well as Akshayan and Richie for helping out with the audio editing. Before you go, we've got a big favor to ask for you. We'd love if you would take our survey. A lot has changed since our first season. And we're curious to know what you think of the program, what you like and don't like, what you want to hear more of and how you found us. Just click the link in the episode description. It'll only take a few minutes and your feedback is invaluable. Thanks so much, and until next time, keep it raw.

Amber Mullin [1:12:03] Raw Talk Podcast is a student presentation of the Institute of Medical Science in the Faculty of Medicine at the University of Toronto. The opinions expressed on the show are not necessarily those of the IMS, the faculty of medicine, or the university. To learn more about the show, visit our website rawtalkpodcast.com and stay up to date by following us on Twitter, Instagram and Facebook at Raw Talkd Podcast. Support the show by using the affiliate link on our website when you shop on Amazon. Also, don't forget to subscribe on iTunes, Spotify, or wherever else you listen to podcasts and rate us five stars. Until next time, keep it raw.

Speaker 17 [1:12:37] Be respectful. That's it.