Pubdate: Fri, 23 Jun 2017
Source: Globe and Mail (Canada)
Copyright: 2017 The Globe and Mail Company
Author: Andre Picard
Page: A8


Group advises users to avoid holding breath, suggests alternatives to

How do you minimize the health impacts of marijuana in a country where
it is legal to smoke - or otherwise consume - the drug?

As Canada approaches full legalization on July 1, 2018, a blue-ribbon
panel of experts has provided an evidence-based answer to that thorny
question and, on Friday, they will release a set of "lower-risk
cannabis-use guidelines."

The research, published in the American Journal of Public Health, is
essentially a list of practical tips for current and potential
marijuana smokers.

The guidelines begin with the statement that the health risks of
cannabis - including impairment, pulmonary damage and neurological
impacts - are most easily avoided by abstaining.

"It's a bit of a mandatory, prophylactic statement, but it's true,"
said Dr. Benedikt Fischer, senior scientist at the Institute for
Mental Health Policy Research at the Centre for Addiction and Mental
Health in Toronto.

"Cannabis is not benign and people should not assume that it's
perfectly safe because it's being legalized," he said.

"But, ultimately, legalization should make it easier for cannabis
users to make smart choices," Dr. Fischer added.

About 15 per cent of Canadians - including roughly 30 per cent of
adolescents and young adults - report using cannabis in the past year,
according to surveys.

The guidelines are aimed principally at helping them reduce potential
health risks.

The recommended measures include:

- - Delay using cannabis until adulthood: The researchers say that there
is strong evidence that cannabis can affect the developing brain, so
it is best delay use until after the age of 18, or even 21. The
earlier someone starts smoking marijuana, the greater the potential
harms, according to the research.

- - Avoid smoking cannabis products: Much of the harm comes from
combustion, so users should favour safer methods such as vaping,
bongs, edibles and drinkables. They should also avoid mixing cannabis
with tobacco.

- - If you smoke cannabis, avoid harmful practices such as deep
inhalation and breath-holding, which intensify the absorption of both
psychoactive components and hazardous by-products.

- - Choose lower-risk cannabis: The researchers say high-potency
products (meaning high THC content) such as "skunk" and "wax dabs" are
best avoided.

- - Limit and reduce use: The greater the intensity and frequency of
cannabis consumption, the higher the health risks. If you're going to
smoke cannabis, the guidelines recommend doing it occasionally, such
as on weekends.

- - Don't use synthetic cannabinoids: Products such as K2 and Spice are
much more powerful and the effects are more severe than organic
cannabis, so they should be avoided.

- - Don't drive or operate heavy machinery: The guidelines recommended
that users not drive for at least six hours after smoking or otherwise
consuming cannabis and be especially cautious if they combine
marijuana and alcohol.

- - Avoid cannabis altogether if you have a family history of mental
illness (particularly psychosis) or if pregnant.

Dr. Fischer, who is also lead author of the guidelines, said it's up
to individuals to decide if and how they use cannabis, but it's up to
government and public-health officials to facilitate making smart choices.

For example, he said that good labelling is essential so users can
know the THC content of products.

The guidelines stress that education is also required if people are
going to be expected to make reasoned choices.

The dangers of driving while stoned should be heavily publicized, as
was done with drunk driving.

While many other drugs, both legal and illicit - from alcohol to
opioids - pose more health risks than cannabis, the guidelines stress
that is not a reason for the risks to be ignored, and that harm
reduction measures need to be embraced.

"Cannabis use carries with it real health risks and mitigating those
risks for Canadians - particularly young Canadians - must be the first
priority," said Laurent Marcoux, president-elect of the Canadian
Medical Association.

The guidelines are endorsed by a number of health groups, including
the Canadian Medical Association, the Canadian Public Health
Association and the Canadian Centre on Substance Use.
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