But despite some positive signs, some health experts are concerned that the rapid growth of the industry combined with a lack of recent data about potential public health impacts means we could be missing some warning signs.

“Legalization is not an on-off switch that occurred,” said Dr. Daniel Myran, a public health doctor in Ottawa. “The retail market has matured over time, but at the same time, a lot of the data that we have about what happens after legalization comes from a very early period.”

Cannabis use is up

On Oct. 17, 2018, cannabis became legal in all provinces and territories for adults 18 and over, making Canada just the second country to legalize recreational use of the drug.

The Cannabis Act, introduced by Prime Minister Justin Trudeau’s government, had a number of goals. Among them were to keep the drug out of the hands of youth, take profits away from criminals and to protect public health.

Since then, more Canadians seem to be using cannabis.

According to the government’s most recent survey, 27 per cent of participants reported having used marijuana in the past year — an increase from 22 per cent in the first cannabis survey conducted in 2017.

Statistics Canada data suggests retail sales in 2020 were just over $2.6 billion, which represented a 120 per cent increase compared to 2019.  

While there are indications marijuana consumption has gone up, criminal convictions for cannabis-related crimes among youth have dropped dramatically.

Akwasi Owusu-Bempah, an assistant professor of sociology at the University of Toronto, says the effects of cannabis legalization in this area are significant.

“From the perspective of a criminologist, legalization has been successful with respect to reducing the criminalization of people for cannabis offences,” said Owusu-Bempah, who is also an adviser to the Canadian Civil Liberties Association and director of research for Cannabis Amnesty.

However, there are still areas of concern, he said.

The economic benefits of legalized cannabis are not being shared equitably, as the industry is disproportionately white and male. Eighty-four per cent of directors and executives in the industry are white, he reported in research conducted in 2020, and women make up just 14 per cent.

And many of those left with criminal records from offences committed prior to legalization are people of colour, he said, and he wants to see more records cleared.

Public health impact

Russell Callaghan, a professor in the University of Northern British Columbia’s northern medical program, is researching the impacts of legalization on a range of public health indicators. He says research in that area is still in its early stages. 

What has stuck out to him so far, however, is that many of the concerns around legalized cannabis — including potential increased cases of cannabis-induced psychosis and schizophrenia, and driving under the influence of drugs — have not materialized.

Callaghan says his research on traffic injuries in Ontario and Alberta does not suggest legalization has had a significant effect, at least not yet.

A recent report from Mothers Against Drunk Driving Canada (MADD) says the number of drug-impaired driving charges is “extremely low” — accounting for just 11 per cent of the 5,506 impaired driving charges across Canada in 2019.

Some provinces, such as Ontario and Quebec, saw a significant increase in drug-impaired driving charges that year, but the report attributes that mainly to new laws and enforcement powers.

Challenges ahead

Some experts caution it may be too early to call legalized marijuana an all-round success.

“The research is still quite new, so there’s a caveat there,” Callaghan said of his work.

Another goal of the Cannabis Act is to protect public health, and on that measure, rising consumption may bring new challenges.

“When we see increases in rates of use, that starts to raise a bit of a warning sign in terms of public health, because we don’t want to see more people consuming,” said Rebecca Jesseman, the director of policy at the Canadian Centre on Substance Use and Addiction (CCSA), an Ottawa-based non-governmental organization.

Callaghan says his ongoing research suggests youth visits to emergency departments because of poisoning or overuse of marijuana may be trending upward “significantly.” That mirrors American trends in states that have legalized marijuana, he said.

But what we know may not be as concerning as what we don’t, Jesseman said.

“To be honest, it’s just too soon,” she said of assessing legal marijuana’s effects on public health.

“The retail sales system is still stabilizing and really rapidly expanding, if you look at provinces like Ontario, where we’ve seen over 1,000 new stores in less than a year introduced. So I think that we really need to keep watching for the health and safety impacts and adjusting as we go.”

It’s a concern shared by Myran, who is a fellow in the department of family medicine at the University of Ottawa. 

That’s because almost all of the available research on legal marijuana comes from the first six months after legalization, he said. The industry in many provinces and territories looks very different now than it did then — both in terms of the commercial availability of cannabis and the range of cannabis products available.

Data is still limited, and the COVID-19 pandemic has overlapped with much of the time marijuana has been legal.

Myran led a study published in June that found the number of retail cannabis stores in Canada had increased from 158 in November 2018 to 1,792 in April 2021.

“The problem it creates is that we have lots of data about the early phases after legalization, at the exact time that there was essentially no legal market,” he said.

“The concern is that, will we now, as the market matures and you see a large increase in cannabis sales, see related increases in cannabis use and harms?”

Edibles are not accounted for in much of the available data. That’s notable, Myran says, because edibles present some difficult public health challenges compared to other cannabis products such as flowers and oils.

“One of the chief harms is it’s much easier for people to take too much cannabis,” he said.

Myran adds that some provinces and territories have allowed edible products that closely resemble candy or baked goods when removed from their packaging, which can look appealing to children.

Industry seeks changes

Now that the third anniversary of legalization has come, the statutory review of the Cannabis Act is set to begin.

The Cannabis Council of Canada (C3), which represents more than 700 licensed producers and processors of cannabis in Canada, has some policy changes it wants the government to make.

In a report card on legalization released this week, C3 gives governments a B grade on keeping cannabis out of the hands of youth and protecting public health — but that’s as high as the grades go.

C3 gives governments a failing grade in four areas — combating the illicit market, taxation policy, consumer education and awareness, and financial viability.

“We can’t get too excited in a circumstance where the illicit market remains with at least 50 per cent of the business,” said George Smitherman, the president and CEO of C3

“If the illicit market is still selling billions of dollars of cannabis, that’s a lot of tax revenue that governments aren’t getting.”

Despite the many poor grades, Smitherman doesn’t call the overall execution of cannabis legalization a failure.

“I think maybe better put as a failed opportunity,” said the former Ontario health minister.

To that end, C3 is hoping to work with policy-makers on a number of changes to the industry, including reducing regulations and taxes. Smitherman says the excise tax is putting significant financial pressure on producers.

“There are regulations which weigh us down, which some people have characterized as nanny state regulations,” Smitherman said. “Including, just as an example, that you’re limited in the amount of cannabis as an individual that you can have to 30 grams.”

But it’s those types of proposed changes that most concern Myran, the public health doctor.

He predicts the government is going to come under heavy pressure from the industry to roll back public health regulations, including things like child-resistant packaging and restrictions on advertising. Those are public health measures that have proven effective in limiting harms from tobacco and alcohol, he said.

“That’s kind of my big worry, that as we move forward, we will take this lack of evidence on harms in the first three years as evidence that legalization and commercialization do not cause increases in use and harms, roll back some of the policies that are currently in place, and a couple of years from now see large increases in use … and harms and have to deal with them.”