National Research Agenda on the Health Impacts of Non-Medical Cannabis Use
The Issue
As Canada moves towards regulating cannabis for non-medical use, there is a pressing need for evidence on the health-related effects of non-medical cannabis use to inform policy decisions. Legislative changes and the impact of these changes must be informed by current, high-quality research and must be monitored to avoid negative impacts on the health of Canadians. Because cannabis use, regulations and impacts cross jurisdictional and sectoral boundaries, generating this research requires a collaborative approach.
Expert and Stakeholder Meeting
Since 2008, CCSA has worked with federal, provincial and municipal partners at the bureaucratic and political levels to provide evidence-informed advice and analysis on the health impacts of cannabis through a variety of research and knowledge mobilization initiatives (see Additional Resources).
The Canadian Centre on Substance Abuse (CCSA) was created by an Act of Parliament to provide national leadership to address substance use in Canada. A trusted counsel, CCSA provides national guidance to decision makers by harnessing the power of research, curating knowledge and bringing together diverse perspectives.
On October 18–19, 2016, CCSA hosted a meeting to start developing a national research agenda on the health impacts of non-medical use of cannabis. The meeting was organized in collaboration with CCSA’s Expert Advisory Group on Cannabis, Health Canada, the Canadian Institutes of Health Research, the Canadian Academy of Health Sciences, Public Safety Canada and the U.S. National Institute on Drug Abuse — International Program. (A list of participants is at the end of this summary.)
The meeting brought together close to 50 experts and stakeholders representing a wide range of perspectives, including public health, law enforcement, prevention, academia and non-governmental organizations, and federal and provincial representatives:
- To identify current knowledge and research gaps related to the health effects of non-medical cannabis use;
- To identify existing data sources that can augment available data and knowledge in this area;
- To prioritize the short-, medium- and long-term opportunities for research on the health effects of non-medical cannabis use; and
- To discuss opportunities for collaboration among researchers and tangible next steps for moving forward with the research agenda.
Meeting discussions were structured into six thematic areas:
- The Endocannabinoid System
- Neuroscience and the Effects on the Brain and Behaviour
- Mental Health, Dependence, Treatment and Polysubstance Use
- Psychomotor Performance, Impaired Driving, Detection and Polysubstance Use
- Effective Approaches for Health Promotion and Harm Prevention
- Social Determinants of Health, Psychosocial Impacts and Epidemiology
Participants heard presentations from Canadian and international experts on the major gaps in knowledge in each thematic area and discussed each area in focused, small-group discussions. Participants then worked together to establish priorities within and across each thematic area, identifying the key next steps to be taken to begin to address the research questions.
Research Agenda
The group’s work is summarized in the following pages by thematic area organized into research questions and issues, and next steps for the field. As the group worked through the thematic areas, certain questions and considerations arose consistently. These cross-cutting questions and issues are summarized below and should be considered when undertaking research, and monitoring and surveillance efforts in each thematic area.
Cross-Cutting Issues
While much has been learned from the research undertaken to date, the group highlighted the limitations of the existing research due to inconsistencies across studies in the methodologies, measured outcomes and contexts. This heterogeneity makes it difficult to draw conclusions across studies as to the health impacts of non-medical cannabis use over time. Moreover, the group noted that there has been a dramatic rise in the potency of cannabis in recent years, corresponding to a shift in the composition of cannabinoids in the strains of cannabis being consumed. These changes might make older studies less relevant to understanding the current health impacts of cannabis use.
Attendees noted the length of time it will take to determine the long-term impacts of chronic cannabis use, particularly with respect to clarifying causality and the permanence of observed effects. The group agreed that understanding long-term impacts will require developing and implementing a robust, sustained funding strategy and longitudinal research on non-medical cannabis use. This requirement is especially valid given a policy and regulatory context that will continue to change and evolve over time. The group also agreed that it will be important for researchers to study and identify unintended consequences over time of policy decisions (e.g., age limits, enforcement decisions) about the regulation of cannabis.
When considering how best to move forward, meeting participants noted the importance of national coordination to effectively harness existing knowledge and expertise across disciplines, and to make efficient use of limited resources. The group identified the need for three different kinds of coordination:
- Coordination of working groups to advance progress in each of the thematic areas;
- Coordination of national surveillance and monitoring of cannabis use trends; and
- Coordination and operation of the governance structure needed to mobilize around and implement the national research agenda.
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