Stigma down but health consequences up on Canada's five-year anniversary of cannabis legalization

Happy anniversary, Canada! It’s been five years to the day that cannabis was legalized.

In the time since, negative health consequences related to cannabis use have either increased or stayed steady. But there have been substantial reductions in criminal arrests and general stigma, which can be considered wins for social justice and indirect public health outcomes. That’s according to an analysis published in the Canadian Medical Association Journal this month, which calls for continued measurement of key health and social outcomes.

Canada was the first G-20 country to legalize cannabis (only Uruguay legalized it at a federal level before us), and ever since Canadians have been able to buy dried flower at dispensaries around the country or online. Edibles were allowed one year later in 2018.

Cannabis prevalence and hospital visits increase

There’s been a slight increase in the prevalence of cannabis use since legalization — up to 27% in 2022 from 22% in 2017. But rates of near-daily use have remained stable.

There’s also been a marked increase in emergency department visits for cannabis-related disorders and poisonings. One study found a 20% post-legalization increase in Ontario and Alberta. Another Ontario-based study pegged the increase between legalization and May 2021 at between 12% and 22%.

“At this stage, cannabis legalization in Canada appears not to have been the public health disaster anticipated by some of its opponents, but it cannot be described as a comprehensive or unequivocal success for public health either,” the authors say.

The analysis also notes that the COVID-19 pandemic, which hit in early 2020, may have influenced patterns of substance use more broadly — and could be a confounding variable when it comes to looking at these trends.

At the same time, the reduction in cannabis-related arrests and charges can also be seen as positive health outcomes since the stress associated with those has negative impacts on people’s lives, and in many cases were the result of arbitrary or discriminatory enforcement practices.

Having a criminal record restricts work, travel, and other opportunities, and eliminating that risk brings societal benefits, which the authors argue cannot be ignored when looking at health outcomes.