Schizophrenia Society of Ontario Discussion Paper on the Cannabis Act

Transcription

1 Schizphrenia Sciety f Ontari Discussin Paper n the Cannabis Act Overview The Gvernment f Canada intends t bring the Cannabis Act int frce by July 1, At that pint, adult Canadians will be able t legally pssess, grw and purchase limited amunts f cannabis fr recreatinal use. Given the ptential health effects f cannabis use n peple with schizphrenia and ther vulnerable grups, the Schizphrenia Sciety f Ontari (SSO) has develped a discussin paper, infrmed in part by surveying ur membership as well as individuals living with mental illness, their families and caregivers, healthcare prviders and ther cmmunity frntline wrkers. SSO is a charitable health rganizatin that supprts individuals, families, caregivers and cmmunities affected by schizphrenia and psychsis. Fr ver 30 years, we have made psitive changes in the lives f peple affected by schizphrenia thrugh cunselling supprt prgrams, educatinal initiatives, cmmunity utreach, advcating fr system change and researching the psychscial factrs that directly impact mental illness. SSO supprts a health plicy framewrk fr laws and regulatins which emphasizes the Canadian Drugs and Substances Strategy pillars including preventin, treatment, enfrcement f regulatins and harm reductin (Health Canada, 2016a). Summary f Recmmendatins Yuth are mst susceptible t the mental health risks assciated with cannabis use; at the same time Canadians under 25 have a relatively high rate f cannabis use. Preventin and Awareness Health Canada shuld prvide immediate funding t the prvinces and territries t supprt cmprehensive, crss-ministerial public health campaigns in each jurisdictin t build awareness and knwledge f cannabis, including the risks related t yuth and mental health (particularly psychsis), the harms f using and driving and the risks assciated with secnd-hand smke. The Ministry f Health and Lng-Term Care shuld cllabrate with ther ministries, including the ministries f Children and Yuth Services, Cmmunity and Scial Services, Cmmunity Safety and Crrectinal Services and Attrney General t immediately invest in a cmprehensive preventin strategy wrking with schls, campuses, prfessinal rganizatins and cmmunity rganizatins that wrk with yuth, yung adults and parents/caregivers. Page 1 f 15

2 The federal and prvincial gvernments shuld cnsistently mnitr and gather data n the impacts f regulatins, including intended impacts (e.g., savings t the criminal justice system; reductin f the illicit cannabis market) and unintended impacts (e.g., increases in the use f hspital and cmmunity health care services due t cannabis use; access t cannabis by yung peple under the legal age f use) in rder t make adjustments t regulatins and t target educatin campaigns and preventin strategies accrdingly. Persns under the age f 25 are als mst likely t be charged with a cannabis-related ffence and mst f these charges are related t pssessin. At the same time, peple with mental illness wh lack access t services and supprts may be at increased risk f cming int cntact with the criminal justice system. Preventin and Awareness The Ministry f Cmmunity Safety and Crrectinal Services shuld wrk with plice services acrss Ontari t incrprate educatin abut cannabis use and stigma related t substance use as part f their brader mental health training. The federal and prvincial gvernments shuld cnsistently mnitr illicit surces f cannabis t minimize access fr peple under the minimum age. Laws and Regulatins Pssessin shuld be decriminalized and criminal sanctins like custdy r prbatin fr yuth shuld be replaced with mandatry educatin r preventin prgrams, cmmunity service, and fines fr peple wh can realistically affrd these. In Ontari, the need fr increased investment in cmmunity mental health and addictins services, a traditinally neglected area f health, is clear. What is unclear, hwever, is if the system is prepared t respnd t pssible increases in mental health issues, including Cannabis Use Disrder (CUD) and cncurrent disrders as a result f a ptential influx in cannabis use and if the federal and prvincial gvernments are prepared t make crucial investments. Preventin and Awareness The Prvince f Ontari shuld immediately invest in a cmprehensive public awareness campaign n mental illness and addictins, including less prevalent mental health cnditins like psychtic disrders, t reduce stigma and increase knwledge f these health issues. Enhanced mental health and addictins treatments and supprts The federal and prvincial gvernments shuld invest all prceeds frm revenue frm cannabis sales in the mental health and addictins system and reinvest related cst savings by: Earmarking a prtin f revenue frm cannabis sales fr investment in cmmunity mental health and addictins prgrams, services and supprts; this shuld include: Page 2 f 15

3 Targeted investment in treatments fr cncurrent disrders, CUD and yuthspecific services. Investment in supprtive husing, emplyment supprts, incme and fd security and recreatinal pprtunities fr peple with mental illness and addictins. Investing in building capacity fr acute care and inpatient units t deal with the ptential influx f cannabis-related cases. Re-directing resurces that are saved frm prcessing cannabis-related pssessin charges t mental health and addictins diversin prgrams. Earmarking a prtin f revenue frm cannabis sales fr research t imprve scientific understanding f the relatinship between substance use and psychtic disrders and ther mental illnesses, and t imprve treatments fr bth. Laws and Regulatins The Prvince f Ontari shuld establish an versight bdy t versee all aspects f cannabis regulatin including regulatin f strengths and quality, licensing, sales and distributin, marketing and labeling: Limit cannabis ptency t safe levels based n best available evidence. Clearly label prducts with infrmatin including strengths (i.e., tetrahydrcannabinl [THC] and cannabidil [CBD] cntent) and warnings f risks and harms assciated with cannabis use including secnd-hand smke, driving under the influence and harms t children and yuth. Strictly prhibit marketing which targets yuth r encurages peple t use. Backgrund On April 13, 2017, Bill C-45, An Act respecting cannabis and t amend the Cntrlled Drugs and Substances Act, the Criminal Cde and ther Acts (the Cannabis Act) was intrduced in the Huse f Cmmns t legalize and regulate the use f cannabis (marijuana) fr nn-medicinal purpses in Canada. The prpsed legislatin aims t meet public health and safety bjectives including (Health Canada, 2017): Prtecting the health f yung persns by restricting their access t cannabis. Reducing crime related t an illegal cannabis market. Prtecting yung peple and thers frm incentives t use cannabis. Reducing the burden n the criminal justice system in relatin t cannabis ffences. Enhancing public awareness f the health risks assciated with cannabis use. The Gvernment f Canada intends t bring the Cannabis Act int frce by July 1, At that pint, adult Canadians will be able t legally pssess, grw and purchase limited amunts f cannabis meaning that pssessin f specified amunts f cannabis wuld n lnger be cnsidered a crime. Page 3 f 15

4 Many imprtant details related t the regulatins and their implementatin, are yet t be determined. Althugh the federal gvernment has established a legal framewrk, jurisdictinal minimum ages fr buying cannabis and the systems fr distributing it will fall under the purview f each prvince and territry. The Schizphrenia Sciety f Ontari s (SSO) Psitin SSO is a charitable health rganizatin that supprts individuals, families, caregivers and cmmunities affected by schizphrenia and psychsis. Fr ver 30 years, we have made psitive changes in the lives f peple affected by schizphrenia thrugh cunselling supprt prgrams, educatinal initiatives, cmmunity utreach, advcating fr system change and researching the psychscial factrs that directly impact mental illness. Schizphrenia is a serius but treatable mental illness that has a prfund impact n all areas f a persn s life. It affects 1 in 100 peple; that is almst 140,000 Ontarians. Althugh symptms and experiences vary, schizphrenia is characterized by prfund disruptins in thinking, affecting language, perceptin and sense f self and symptms f psychsis such as delusins and hallucinatins. Peple with schizphrenia are at a significantly increased risk f substance use, hmelessness, victimizatin and suicide cmpared t the general ppulatin. Despite the presence f symptms r diagnses hwever, recvery frm schizphrenia and ther mental illness 1 is pssible, and is supprted by a range f treatments and supprts. Given the ptential health effects f cannabis use n peple with schizphrenia and ther vulnerable grups, SSO has develped a discussin paper t highlight key cncerns abut and recmmendatins fr its legalizatin and regulatin. T infrm this paper and t better understand the implicatins assciated with the prpsed legislatin, we surveyed ur membership, as well as individuals living with mental illness, their families and caregivers, healthcare prviders and ther cmmunity frntline wrkers. Many respndents welcmed legalizatin as a mve away frm a punitive apprach t drug plicy and twards a mre health-fcused ne which emphasizes preventin, treatment and harm reductin. Several respndents expressed cncern that the criminalizatin f substance use leads t stigma and discriminatin that can have lasting effects n peple s lives and that certain grups, like racialized cmmunities, have been disprprtinately affected by criminal sanctins related t the pssessin f cannabis. While hpeful that the legalizatin f cannabis wuld ultimately result in a reductin f harm 1 The term mental illness refers t symptms and cnditins which may take the frm f changes in thinking, md r behaviur, r sme cmbinatin f all three, that impact a persn s ability t functin effectively ver a perid f time. It shuld be nted that nt all individuals living with a mental health issue wuld identify with this label. Page 4 f 15

5 related t criminalizatin, respndents were clear that effective regulatins and their strict enfrcement are critical t alleviating ptential shrt- and lng-term health and scial harms. In light f current evidence and cncerns abut the ptentially harmful effects f cannabis use n mental health, particularly in adlescents and yung adults, sme peple have cncerns that cannabis is being legalized at all. We heard frm peple whse families have experienced the adverse effects f cannabis use n mental health and are distressed that a substance that is clearly nt benign will likely becme mre accessible thrugh legalizatin. There is als cncern amng sme respndents that legalizatin will nrmalize cannabis use and undermine its ptential harms, particularly fr yuth. It is clear that an apprach which balances bth health and safety with reducing the harms related t criminalizatin is warranted. As such, we supprt a health plicy framewrk fr laws and regulatins which emphasizes the Canadian Drugs and Substances Strategy pillars including preventin, treatment, enfrcement f regulatins and harm reductin (Health Canada, 2016a). SSO s values fr a preventative framewrk fr legalizatin and regulatin are that it: 1. Prmtes educatin and preventin, including targeted strategies arund mental health in general, and schizphrenia and psychsis in particular. 2. Takes an evidence-based health plicy apprach which aims t reduce health, scial and criminal justice-related harms. 3. Supprts increased investment in mental health and addictins services and supprts and in further research n the effects f cannabis use n mental health. Discussin Implicatins fr psychsis, schizphrenia and ther mental health cnditins Ntably, research has fund that traditinal public health effrts t reduce substance use have been unsuccessful in individuals with severe psychtic disrders (Hartz et al., 2014), ne f the grups mst vulnerable t substance use and its ptential harms. Substance use can cmplicate and exacerbate symptms f psychtic disrders like schizphrenia and can adversely affect the curse f treatment and rates f relapse (Canadian Centre n Substance Use and Addictin [CCSA], 2009; Archie and Gyömörey, 2009). Research als finds that individuals with schizphrenia and ther psychtic disrders experience higher rates f substance use cmpared t the general ppulatin (Duva et al., 2011; Hartz et al., 2014), with ne review finding that ne in fur peple with a diagnsis f schizphrenia had a cncurrent diagnsis f CUD (Kskinen et al., 2009). As with substance use in general, the reasns sme peple with schizphrenia use drugs and alchl vary, including t feel better r different, t achieve intxicatin, t relax and have fun and t be part f a grup (Schizphrenia Sciety f Canada, N.D., Asher and Gask, 2010). Fr thers, use may be assciated with managing the symptms f their illness, including psitive (e.g., hallucinatins) and negative (e.g., feelings f hpelessness) symptms, r t manage medicatin side effects (Schizphrenia Sciety f Canada, N.D.; Asher and Gask, 2010). Page 5 f 15

6 Evidence als suggests that even ccasinal use can put peple at risk f certain mental health cnditins, with cannabis users having an estimated 40 per cent higher risk f experiencing psychsis than nn-users (CAMH, 2014). Cannabis use may increase the risk f depressin (Canadian Psychiatric Assciatin [CPA], 2017) and may wrsen depressive disrders, biplar disrders and anxiety disrders (CCSA, 2016) althugh mre research is needed t determine the precise relatinship between cannabis use and mental illness. Yuth and cannabis use Cannabis use has been assciated with increased risk fr pr mental health, particularly amng yuth. This is particularly prblematic because Canada has the highest rates f cannabis use amng yuth (ages 11-15) cmpared t ther develped cuntries (Halah et al., 2017; Gerge & Vaccarin, 2015). This increased vulnerability is said t be related t the fact that the human brain cntinues t underg imprtant develpmental prcesses until abut the mid-20s, making it mre susceptible t the ptential negative impacts f cannabis than the mature brain (Vlkw et al., 2014). Research has cnsistently fund an assciatin between cannabis use and increased risk fr develping psychsis and in sme cases, a primary psychtic disrder such as schizphrenia in thse wh are vulnerable (i.e., peple wh may have a pre-existing genetic risk) (Gage et al., 2016; Vlkw et al., 2016; CCSA, 2016). The risk f relapse f psychsis is als increased if a yung persn cntinues t use while in treatment (Archie & Gyömörey, 2009). Available evidence strngly suggests that the assciatin between cannabis and develping psychtic symptms r a lasting psychtic disrder is increased the earlier ne begins t use (e.g., befre 18), the mre frequently they use and the higher the THC level in the cannabis (Vlkw et al., 2016; Gage et al., 2016; CAMH, 2014). The risk fr develping CUD is significant, particularly fr individuals wh start using earlier and wh use frequently (Vlkw et al., 2014). Research frm the United States, which has shwn a marked increase in CUD in the ppulatin since 2001 (Hasin et al., 2015), presents implicatins fr an expected increase in these cnditins with legalizatin in Canada. This is particularly cncerning fr thse with cnditins such as schizphrenia which have been assciated with significantly higher rates f CUD cmpared t the general ppulatin especially because the presence f CUD is linked t pr utcmes, increased rates f hspitalizatin and lwer quality f life (Halah et al., 2016). Chrnic cannabis use has als been assciated with deficits in memry, attentin, psychmtr speed and ther cgnitive functins (CCSA, 2016; CPA, 2017) that in sme cases may be enduring (CCSA, 2016; CPA, 2017). There are als serius implicatins fr the safety f yuth in terms f driving under the influence f cannabis. Mtr vehicle crashes are a leading cause f death amng 16 t 25 year lds and alchl and/r drugs are a factr in the majrity f these cases (MADD Canada, 2006). Accrding t evidence cited by CCSA, it has been estimated that cannabis use can increase the risk f serius r fatal injury in a mtr vehicle crash by tw t three times (CCSA, 2017). Significantly, studies als find that bth yuth and parents f adlescents d nt cnsider driving under the influence f cannabis t be as bad as Page 6 f 15

7 drinking and driving (MADD Canada, n.d.) suggesting the need fr better public educatin arund this issue. At the same time, the Task Frce n Cannabis Legalizatin and Regulatin, cnvened by the federal gvernment t infrm the legislatin, pints ut that current research des nt indicate a specific age fr safe cannabis use (Health Canada, 2016b); hwever age restrictins fr legalizatin ranging frm 18 t 25 have been suggested by healthcare prviders and public health prfessinals (Health Canada, 2016b). The respndents t ur survey strngly supprted the need fr a strictly enfrced age restrictin and their suggestins fr this age als ranged frm 18 t 25. Althugh suggested ages varied, the general themes that emerged were that the age restrictin impsed needs t take int accunt the currently knwn risks f cannabis n the develping brain; the fact that adlescents and yung adults in Canada are mre likely t use cannabis than the adult ppulatin; and that the higher the age restrictin, the greater the number f peple at risk f turning t illicit surces, which can have higher ptency levels and/r culd be mixed with ther substances and may carry criminal justice-related cnsequences. The federal gvernment has set the age f use at 18, hwever prvincial and territrial gvernments can decide t raise the age restrictin. Ontari annunced that it will prhibit individuals under the age f 19 frm pssessing r cnsuming recreatinal cannabis (which will allw plice t cnfiscate small amunts f cannabis frm yung peple) and that the prvince s apprach t prtecting yuth will fcus n preventin, diversin and harm reductin (Ministry f the Attrney General, 2017). We supprt the gvernment s apprach t restrict use t thse 19 and lder t align with alchl and tbacc age restrictins, but emphasize the imprtance f ensuring that preventin and diversin strategies are cmprehensive, well-funded and based n best practice. Althugh mst peple wh use cannabis d nt experience psychsis r develp schizphrenia, the evidence is strng enugh verall t supprt a public health message that cannabis use can increase the risk f psychtic disrders, particularly fr individuals with a genetic predispsitin (Gage et al., 2016; Vlkw et al., 2016; CPA, 2017), and t cnsider cannabis use t be a key envirnmental risk factr fr psychsis that is preventable (The Schizphrenia Cmmissin, 2012) in vulnerable peple. Further studies are required t determine the extent f the effect f cannabis n mental health, the effect f different strains, and t further identify high-risk grups particularly susceptible t these effects (Gage et al., 2016). Recmmendatins Preventin and Awareness Health Canada shuld prvide immediate funding t the prvinces and territries t supprt cmprehensive, crss-ministerial public health campaigns in each jurisdictin t build awareness Page 7 f 15

8 and knwledge abut cannabis, including the risks related t yuth and mental health (particularly psychsis), the harms f using and driving and the risks assciated with secndhand smke. Start with materials that already exist, like Canada s Lwer-Risk Cannabis Use Guidelines (Fischer et al., 2017) fr the public and fr prfessinals. Include plain-language public educatin resurces abut the legislatin and regulatins themselves t help the public understand changes t legislatin and the ratinale fr these changes. Identify and develp public educatin campaigns and preventin prgrams that are geared t higher-risk grups, like yuth and peple with mental illness and based n evidence, best practice and c-designed with these grups. Fr instance, research by CCSA fund that the yung peple they interviewed recmmended the fllwing fr cannabis preventin effrts (Prath-Waller et al., 2013): There shuld be increased fcus n cannabis cntent in preventin prgrams and materials. Preventin effrts shuld be delivered earlier. Thse delivering the preventin message shuld as much as pssible have firsthand experience with the drug as well as an ability t cnnect with yuth. Appraches aimed at reducing the harms assciated with cannabis use wuld be valuable. The Ministry f Health and Lng-Term Care shuld cllabrate with ther ministries, including the ministries f Children and Yuth Services, Cmmunity and Scial Services, Cmmunity Safety and Crrectinal Services and Attrney General t immediately invest in a cmprehensive preventin strategy wrking with schls, campuses, prfessinal rganizatins and cmmunity rganizatins that wrk with yuth, yung adults and parents/caregivers; this shuld include: Educatin in schls targeting grups such as children (the earlier the better), adlescents, yung adults and parents/caregivers; Educatin t prfessinal bdies including educatrs, elementary schl, cllege and university administratrs, and ther public agencies that wrk with children, yuth and families (e.g., Children s Aid Sciety; yuth shelters) and prfessinal clleges and assciatins (e.g., nurses, scial wrkers, ccupatinal therapists, etc.). The federal and prvincial gvernments shuld cnsistently mnitr and gather data n the impacts f regulatins, including intended impacts (e.g., savings t the criminal justice system; reductin f the illicit cannabis market) and unintended impacts (e.g., increases in the use f hspital and cmmunity health care services due t cannabis use; access t cannabis by yung peple under the legal age f use) in rder t make adjustments t regulatins and t target educatin campaigns and preventin strategies accrdingly. Implicatins fr Criminalizatin In additin t being mre likely t cnsume cannabis, persns under the age f 25 are als mst likely t be charged with a cannabis-related crime (Ctter & Karam, 2015). Mst charges are related t Page 8 f 15

9 pssessin in 2016, fr example, f the 23,329 peple charged with cannabis-related ffences, 17,733 (76%) were charged with pssessin (Keighley, 2017). Under the prpsed act, individuals under the age f 18 wuld nt face criminal prsecutin fr pssessing r sharing small amunts f cannabis (i.e., up t 5 grams f dried cannabis). Any vilatins f this prvisin wuld be subject t punishment under the Yuth Criminal Justice Act. The prpsed legislatin als strictly prhibits peple 18 and ver frm prviding r selling cannabis t anyne under the age f 18. These prvisins seek t discurage use amng yuth and t minimize an illicit market while reducing criminal justice-related cnsequences fr simple pssessin. In Ontari, accrding t the Ministry f the Attrney General s annuncement, peple under 19 years f age wuld nt be allwed t pssess r cnsume recreatinal cannabis and the prvince will fcus n diversin and harm reductin withut unnecessarily bringing them int cntact with the justice system (Ministry f the Attrney General, 2017). What this apprach will lk like has yet t be cmmunicated. We strngly supprt a diversin and harm reductin apprach that minimizes the ptential fr criminal justice-related harms. Evidence shws that criminal sanctins are nt an effective way t deal with substance use, particularly fr yung peple (Ammerman et al., 2015) and especially if they have a mental illness r a substance use disrder. Yet, accrding t a Statistics Canada 2015 reprt, sentences fr yuth fund guilty f a cannabis-pssessin charged between 2008/2009 t 2011/2012 included prbatin, fines and custdy (Ctter et al., 2015) penalties that culd have a lasting impact n a persn s life. At the same time, peple with mental illness wh lack access t services and supprts may be at increased risk f cming int cntact with the criminal justice system fr several reasns. One reasn may be simply being mre visible in the cmmunity because f the symptms f their illness. This ppulatin als experiences unique and significant challenges when incarcerated, including barriers t accessing mental health treatments and supprts, disprprtinate placement in segregatin and increased vulnerability in an envirnment that is punitive, distressing, crwded and ften unpredictable. Fr these reasns, we supprt decriminalizatin and diversin, rather than criminal sanctins fr simple pssessin f cannabis, particularly fr thse wh are under 18. Alternatives t criminal penalties fr pssessin culd include mandatry educatin r preventin prgrams, cmmunity service and fines fr peple wh can realistically affrd these. Recmmendatins Preventin and Awareness The Ministry f Cmmunity Safety and Crrectinal Services shuld wrk with plice services acrss Ontari t incrprate educatin abut cannabis use and stigma related t substance use as part f their brader mental health training. The federal and prvincial gvernments shuld cnsistently mnitr illicit surces f cannabis t minimize access fr peple under the minimum age. Page 9 f 15

10 Laws and Regulatins Pssessin shuld be decriminalized and criminal sanctins like custdy r prbatin fr yuth shuld be replaced with mandatry educatin r preventin prgrams, cmmunity service, and fines fr peple wh can realistically affrd these. Implicatins fr the mental health and addictins system It is well knwn that the current mental health and addictins system in Ontari is ill-equipped t supprt the needs f peple and families, particularly thse with cmplex health issues, including cncurrent disrders. Peple with chrnic and cmplex mental illness and addictins cntinue t experience disprprtinate rates f pverty, hmelessness and/r precarius husing, cntact with the criminal justice system and difficulties accessing cmmunity care and scial supprts, placing peple at higher risk fr pr health utcmes. Thrugh ur wrk we have seen the devastating impact that persistent barriers t accessing timely mental health care can have: (re)hspitalizatins, cntacts with plice, scial islatin, pverty and mst tragically, deaths by suicide. In fact, the lifetime risk f suicide amng persns with schizphrenia is between fur and 10 per cent (Hr and Taylr, 2010). In additin, althugh research n the prevalence f mental illness in Canada s prisns varies, it is estimated that mental health issues are tw t three times mre cmmn in prisn than in the general cmmunity (Office f the Crrectinal Investigatr, 2015). Mrever studies in varius Canadian cities indicate that anywhere between 23 and 67 per cent f peple wh are hmeless reprt having a mental illness (CAMH, n.d.). The need fr increased investment in cmmunity mental health and addictins, a traditinally neglected area f health, is clear. What is unclear, hwever, is if the system is prepared t respnd t pssible increases in mental health issues, including CUD and cncurrent disrders as a result f a ptential influx in cannabis use and if the federal and prvincial gvernments are prepared t make crucial investments. Cannabis shuld nt be easier t access than mental health r addictins care, yet in many ways it is and will likely becme mre s with legalizatin. In light f current barriers t accessing mental health and addictins care in the cmmunity, it is critically imprtant that laws and regulatins prevent the cmmercializatin f recreatinal cannabis at the expense f individual and public health. Early learnings frm Clrad and Washingtn state, the first tw states t legalize nn-medical cannabis, suggest that aviding cmmercializatin (i.e., active prmtin and marketing f the substance) by, fr example, ensuring a tightly cntrlled gvernment distributin mdel, is the mst imprtant factr in preventing significant public health impacts (CCSA, 2015). T prevent the cmmercializatin f cannabis, CAMH has recmmended establishing a gvernment mnply n sales thrugh cntrl bard entities with a strict scial respnsibility mandate t cntrl cnsumptin and reduce harm (CAMH, 2014). In line with this, Ontari has stated that the legal retail f cannabis in the prvince will be verseen by the LCBO thrugh standalne cannabis stres and an nline rder service. This will ensure a cntrlled prcess fr legal sales and distributin f cannabis. In additin, it is critical that prfits frm cannabis sales are invested int public educatin and awareness Page 10 f 15

11 effrts, substance use preventin prgrams, mental health and addictins curts, diversin prgrams and mental health and addictins services. Recmmendatins Preventin and Awareness The Prvince f Ontari shuld immediately invest in a cmprehensive public awareness campaign n mental illness and addictins, including less prevalent mental health cnditins like psychtic disrders, t reduce stigma and increase knwledge f these health issues. Enhanced mental health and addictins treatments and supprts The federal and prvincial gvernments shuld invest all prceeds frm cannabis sales in the mental health and addictins system and reinvest related cst savings by: Earmarking a prtin f revenue frm cannabis sales fr investment in cmmunity mental health and addictins prgrams, services and supprts; this shuld include: Targeted investment in treatments fr cncurrent disrders, CUD and yuthspecific services. Investment in supprtive husing, emplyment supprts, incme and fd security and recreatinal pprtunities fr peple with mental illness and addictins. Investing in building capacity fr acute care and inpatient units t deal with the ptential influx f cannabis-related cases. Re-directing resurces that are saved frm prcessing cannabis-related pssessin charges t mental health and addictins diversin prgrams. Earmarking a prtin f revenue frm cannabis sales fr research t imprve scientific understanding f the relatinship between substance use and psychtic disrders and ther mental illnesses, and t imprve treatments fr bth. Laws and Regulatins The Prvince f Ontari shuld establish an versight bdy t versee all aspects f cannabis regulatin including regulatin f strengths and quality, licensing, sales and distributin, marketing and labeling: Limit cannabis ptency t safe levels based n best available evidence. Clearly label prducts with infrmatin including strengths (i.e., THC and CBD cntent) and warnings f risks and harms assciated with cannabis use including secnd-hand smke, driving under the influence and harms t children and yuth. Strictly prhibit marketing which targets yuth r encurages peple t use. Page 11 f 15

12 Summary SSO strngly believes that legalizatin must be supprted by effective targeted public awareness campaigns and preventin strategies and investment int timely, quality mental health and addictins care. Regulatins alne cannt address the ptential harms assciated with cannabis use. Page 12 f 15

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