Unintended Equity Consequences of Canadian Cannabis Policy: Reflections on Implications of Medical Cannabis Taxation
by Emily Jenkins RN, MPH, PHD
One of my proudest moments as a nurse came during the Senate study of the Cannabis Act when both the Canadian Nurses Association (CNA) and the Canadian Medical Association (CMA) provided testimony positioning the voice of their respective professional bodies. During this proceeding, the CNA stood out for endorsing a public health approach to cannabis underpinned by pragmatism and harm reduction. Our professional body resisted getting caught up in the fear-based message frenzy cautioning a highly contested policy change that portrayed cannabis legalization as capable of leading to the demise of adolescent brains as we know them, amongst other sensationalized claims.
As we near the 1-year anniversary of the legalization of cannabis in Canada, it is safe to say that the world as we know it did not "go up in smoke" post-legalization. In fact, Statistics Canada data suggests that while overall rates of cannabis use have increased post-legalization, the rates of problematic use associated with harms (daily or near daily use) have remained stable, with British Columbia being the exception to this trend.
From a public health and social justice perspective, the legalization of cannabis is a policy win. For example, under our former policy, cannabis use was dealt with through criminalization and based not in evidence for harms, but rather, on an outdated punishment-focused paradigm framed around ideology and moral disapproval of drugs. Further, while we lack good data on the full spectrum of costs associated with our former approach, cannabis-related enforcement measures alone were estimated at $1.2B annually. Additionally, the social costs of criminalization were profound and disproportionately affected young people as well as Indigenous, racialized, and otherwise marginalized communities. These harms have included stigmatization and exclusion, limited opportunities for meaningful employment, worsening levels of poverty and poorer health outcomes – all while exhausting limited public resources. The Cannabis Act created a new legal and regulatory framework that is grounded in a public health approach, with potential to target and respond to these inequities and to generate revenue that can be directed toward intervention across the full spectrum of need – from education and prevention efforts, as well as the treatment needs of the small proportion of our population requiring this type of specialized care.
However, while the Cannabis Act was crafted with social justice aims – and certainly positions Canada to reduce cannabis-related inequities resulting from criminalization – one of the (perhaps) unintended consequences of the Act is rising costs (and resulting challenges with accessibility) for people who use cannabis for medical purposes. Specifically, the Cannabis Act removed cannabis from the Controlled Drugs and Substances Act (CDSA), and became the governing Act behind the production and sale of cannabis in Canada, including the Access to Cannabis for Medical Purposes Regulations (ACMPR). Under the Cannabis Act, changes to the medical cannabis access program included the implementation of an excise tax (i.e., "sin tax") applied to cultivators and producers and passed along in many cases to consumers, including those purchasing cannabis for medical purposes. Additionally, medical cannabis is now subject to Provincial Sales Tax in many provinces, including BC (7%) as well as Goods and Services Tax (5%). These cannabis taxes are concerning given that medications are not typically subject to sales tax in Canada, contributing to issues of access and affordability for medical cannabis patients. Further, medical cannabis has yet to be assigned a Drug Identification Number (DIN) like other prescribed medications. As such, cannabis tends not to be covered by provincial or workplace insurance plans, further contributing to inequities for people who use cannabis for the treatment of health conditions.
Beyond concerns regarding the affordability of procuring medical cannabis, challenges with costs also limit medical cannabis patients from mitigating potential harms of smoking cannabis. For example, affordability concerns may limit access to alternatives such as cannabis oils or vaporizers for patients who are at the greatest risk of harms – those with daily or near daily use. As we head into the second year of cannabis legalization in Canada, it is critical that we reflect on the intended and unintended impacts of the Cannabis Act and work collectively to advocate for policy refinements that further support the health equity and social justice aims of this precedent setting legislation.
For further reading:
Slemon, A., Jenkins, E., Haines-Saah, R., Daly, Z., Jiao, S. (2019). "You can't chain a dog to a porch": A multisite qualitative analysis of youth narratives of parental approaches to substance use. Harm Reduction, 16:26.
Haines-Saah, R., Mitchell, S., Slemon, A & Jenkins, E. (2019). 'Parents are the best prevention'? Troubling assumptions in cannabis policy discourses in the context of legalization in Canada. International Journal of Drug Policy, 16, 132-138.
Haines-Saah, R. & Jenkins, E. (2017). Setting the legal age for access to cannabis in Canada: Bridging neuroscience, policy and prevention. Neuropsychopharmacology Reviews. 43, 213-231. PMID: 29192661
Jenkins, E. Slemon, A., & Haines-Saah, R. (2017). Developing Harm Reduction in the context of youth substance use: Insights from a multi-site qualitative analysis of young people's harm minimization strategies. Harm Reduction, 14:53. DOI 10.1186/s12954-017-0180-z
Moffat, B., Jenkins, E., & Johnson, J. (2013). Weeding out the information: An ethnographic approach to exploring how young people make sense of the evidence on cannabis. Harm Reduction, 2013, 10:34.
Kids and drugs: The Vancouver teachers transforming substance use education. (July 14, 2019). Vancouver Sun.
What kids need to learn about drugs. (May 30, 2019). Georgia Straight.
Teens tune out zero tolerance of substance-use talk: UBC study. (April 27, 2019).
About Emily Jenkins RN, MPH, PHD
Dr. Emily Jenkins leads a research program in mental health and substance use, with a focus on youth populations. As a PhD prepared registered nurse and Assistant Professor in the UBC School of Nursing, she brings extensive clinical and research expertise from acute and community mental health settings. Dr. Jenkins' ongoing research in youth mental health and cannabis use leads the way for youth-engaged mental health and substance use scholarship and intervention. These studies have generated outputs (community reports, youth-designed pamphlets, academic articles, web applications) that have been adopted to enhance mental health and substance use outcomes within BC and across Canada, including community-based approaches to mental health promotion and informing resources that are among the first to incorporate inclusive, strengths-based approaches to youth cannabis use. In recognition of her expertise, Dr. Jenkins has been invited to inform policy development locally and nationally, including providing witness testimony during the Senate of Canada's study of Bill C-45 (the Cannabis Act). Dr. Jenkins has strong and well-developed relationships with key mental health decision makers and advocates in BC and nationally as well as with community organizations serving youth who experience health and social inequities.