Benedikt Fischer’s research while affiliated with Simon Fraser University and other places

Purpose Cannabis policies are increasingly being liberalized, including the de jure legalization of non-medical cannabis use and supply in Canada (2018) implemented toward improved public health and safety outcomes. While health outcomes have shown mixed results, less attention has been given to crime- and public safety-related outcomes. The purpose of this paper is to provide a targeted literature/data summary on select main crime- and public safety-related outcomes associated with cannabis legalization policy in Canada as implemented in 2018. Design/methodology/approach The authors conducted a targeted literature/data review focusing on key, publicly available outcome indicators associated with cannabis legalization in Canada in three main domains, obtained from both academic (e.g. journal) and “grey” (e.g. survey/government reports) literature/data sources: cannabis crime and enforcement; cannabis-impaired driving and related motor-vehicle-crash involvement; and cannabis markets and sourcing. The data draw on targeted searches in related areas, are narratively summarized by topic and briefly discussed for implications and knowledge gaps. Findings The results of this study suggest that cannabis – and specifically possession – crimes have substantially decreased; less is known about enforcement patterns for the remaining cannabis offenses or impacts on other potentially cannabis-related crimes. The prevalence of cannabis-impaired driving appears to be declining, while levels of cannabis involvement in motor vehicle crashes appear to have increased. Legal cannabis markets and the legal sourcing of cannabis among consumers have steadily increased to involve approximately three-quarters of acquisition activities, implying major reductions of illegal cannabis retail markets. Conversely, data on the evolution of illegal cannabis production and supply markets in legalization policy contexts is highly limited and may include displacement effects. Practical implications *Cannabis legalization has been implemented toward public health and safety improvement objectives, including in Canada (2018). For key outcomes, legalization has been associated with substantive reductions in enforced cannabis offenses among adults and youth. The prevalence of cannabis-impaired driving may be declining, but levels of cannabis-related motor-vehicle-crashes have been increasing. Cannabis sourcing has gradually but steadily shifted from illegal to legal sources among the majority of consumers; legalization’s effects on cannabis production and supply markets are largely unclear. Data on crime-related outcomes of legalization need to be systematically expanded, as they form an essential aspect of comprehensive policy impact assessments. Originality/value While available data suggest improvements in some (e.g. health-related) areas, there is a need for comprehensively expanded research on legalization’s impacts on key crime- and safety-related indicators, required for consideration in overall, integrated policy assessments.

Background: North America has been experiencing an unprecedented public health-crisis from illicit/synthetic fentanyl/fentanyl-analogue (F/FA)-related overdose-deaths (DODs), with speculative warnings for a similar crisis to unfold in Europe. Aim: We summarize key Canada-based experiences relevant for reducing the adverse impacts of a (hypothetical) F/FA-crisis in Europe. Results: F/FA-availability in North America has risen in contexts of major oscillations in pharmaceutical opioid control and supply. Illicit F/FA-products are potent opioids for which correlates of (injection/non-injection) use-modes, adulteration (with other drugs) and use-contexts produce distinct risk environments for DOD. Standard treatment (e. g., OAT) and ‘harm-reduction’ (e. g., supervised-consumption, naloxone, drug-checking) interventions have been widely expanded; however, their overall scope and reach has been limited in curbing the F/FA-related DOD-toll. In response, ‘safer-opioid-supply’ (SOS) programs have been implemented to reduce exposure to illicit F/FA-drugs with promising initial signals for DOD-related outcomes, while requiring more evaluation and ramp-up for possible benefits. Conclusions: The likelihood of a possible F/FA-crisis in Europe is difficult to forecast; if unfolding, Canadian experiences suggest that standard interventions are essential, but likely would be insufficient for effectively containing the consequential DOD-toll; additional, evidence-based intervention strategies should pre-emptively be considered and developed.

Importance There is growing societal interest in and use of psilocybin. While psilocybin in Canada is illegal outside of clinical trials, there have been anecdotal reports of increasing access via unregulated online purchases and retail dispensaries. Objective To describe access to and the characteristics of psilocybin dispensaries across Canada and the health claims and warnings made on dispensary websites. Design, Setting, and Participants This cross-sectional study used systematic web searches and media reports to identify psilocybin dispensaries operating in Canada in May 2024. Data analysis was performed from June 17 to August 29, 2024. Main Outcomes and Measures Descriptive and geospatial analyses were used to identify the psilocybin dispensary characteristics, product types, and store distribution. Content analysis assessed the nature and frequency of health claims and warnings on websites. Results As of May 2024, 57 psilocybin dispensaries were identified in Canada (0.18 dispensaries per 100 000 individuals aged ≥15 years) in 15 of Canada’s 42 major urban cities (35.7%). Approximately 815 628 (2.6%) of Canadians lived within 1 km of a dispensary. Only 4 of 13 provinces and territories had a dispensary, with most in Ontario and British Columbia. Of the 57 stores, 35 (61.4%) were part of a chain (≥2 stores owned by a single company) and 52 (91.2%) had an online presence. Stores sold a wide variety of products, including dried mushrooms (100.0%), microdosing capsules (97.8%), psilocybin-infused chocolate (91.3%) and gummies (93.4%), and most stores (65.2%) sold products mimicking popular food brands. Among stores with websites, 86.4% claimed mental health benefits of psilocybin (eg, alleviating anxiety). While 86.4% of websites provided health warnings, relevant warnings, such as those about use while driving (9.1%), during pregnancy (13.6%), or in individuals with a history of psychosis, schizophrenia, or bipolar disorder (31.8%) were rare. Conclusions and Relevance In this study, psilocybin retailers, who were present in over a third of major Canadian cities, made a variety of unverified health claims and lacked warnings of potential harms, suggesting the need for greater regulatory measures to protect the public.

Importance Cannabis use disorders (CUD) are associated with adverse health effects, including mental disorders and motor vehicle collision-related injuries. However, little is known about whether CUDs are associated with increased mortality risk. Objective To examine whether individuals receiving incident hospital-based care (an emergency department visit or hospitalization) for a CUD is associated with increased risk of death. Design, Setting, and Participants This population-based retrospective cohort study included all individuals aged 15 to 105 years living in Ontario, Canada, between 2006 and 2021 (n = 11 622 571 individuals). Overall and cause-specific mortality were compared between individuals with incident hospital-based CUD care and age- and sex-matched members of the general population or individuals with hospital-based care for other substance use disorders using cause-specific hazard models adjusted for comorbid mental health, substance use, and chronic health conditions. Statistical analysis was performed from September to December 2024. Exposure Incident hospital-based CUD care. Main Outcomes and Measures Overall and cause-specific mortality identified using vital statistics. Results The matched analysis included 527 972 individuals (mean [SD] age, 29.9 [13.6] years; 330 034 [62.5%] female) with a median (IQR) follow-up of 5 (3-9) years; 106 994 had incident CUD. Within 5 years of incident hospital-based CUD care, 3770 individuals (3.5%) died compared with 3770 (0.6%) of matched general population members. After adjusting for comorbid conditions, individuals with incident hospital-based CUD care were at increased risk of death relative to the general population (adjusted hazard ratio [aHR], 2.79 [95% CI, 2.62-2.97]). Individuals with hospital-based CUD care were at increased risk of all investigated types of death and particularly elevated risk of death by suicide (aHR, 9.70 [95% CI, 6.04-15.57]), trauma (aHR, 4.55 [95% CI, 3.55-5.82]), opioid poisoning (aHR, 5.03 [95% CI, 2.86-8.84]), other drug poisonings (aHR, 4.56 [95% CI, 3.11-6.68]), and lung cancer (aHR, 3.81 [95% CI, 2.39-6.07]) relative to the general population. Compared with an individual with hospital-based care for CUD, individuals with hospital-based care for alcohol (aHR, 1.30 [95% CI, 1.26-1.34]), stimulants (aHR, 1.69 [95% CI, 1.62-1.75]), and opioids (aHR, 2.19 [95% CI, 2.10-2.27]) were at relatively increased risk of death within 5 years. Conclusions and Relevance In this cohort study of all residents of Ontario, Canada, individuals with incident hospital-based CUD care were at markedly increased risk of death compared with the general population. These findings suggest important clinical and policy implications, given global trends toward cannabis legalization and market commercialization accompanied by increasing cannabis use and CUDs.

Several jurisdictions have implemented legalization policies for non-medical cannabis, mainly towards improving public health and reducing illegal cannabis markets and crime. As some legalization initiatives are approaching maturity, conducting policy impact assessments has become timely. Emerging data, however, suggest rather mixed pictures for key outcomes and indicators. While many key health-related indicators show increases in adverse outcomes, improvements are shown for main crime-related outcomes associated with legalization. However, legalization policies are evaluated predominantly by utilizing separate approaches for the health outcomes and crime-related indicators, while comprehensive policy assessments require meaningful integration of all related indicators. We provide suggestions for an integrated approach to assessing cannabis legalization policies concerning health and crime-related outcomes. This approach is also valuable for policymakers and other stakeholders to create an empirical basis for relative valuations and choices regarding cannabis legalization’s main policy outcomes.