Issue #28  October 2023

[This issue includes a modified and updated excerpt from “Buzz Kill: The Corporatization of Cannabis”.  NOW AVAILABLE at or at your local independent bookstore. They could really use the support.

In the previous issue I talked about how frequency of drug use, particularly daily and near daily drug use, potentially increases the risk for experiencing some harm with the drug. In this issue I will examine risk more broadly with a focus on alcohol and cannabis.

Higher risk drug use could involve using a large amount of a drug at one time, using a drug too often, or using it in dangerous circumstances, or any combination of the above. An important caveat is that engaging in high-risk scenarios does not guarantee that an individual will experience harm – it just increases the likelihood. For example, drinking and driving is a well-known high-risk behaviour. Yet, there are people who become intoxicated and drive, and have the good fortune to navigate their way to their destination without incident.

We would expect to see more types of high-risk use in a person who uses on a daily or almost daily basis. However, higher risk use can also occur in a pattern of occasional use only – such as drinking to a point of intoxication on a single occasion that led to an injury. This could also happen during a person’s first time using a drug. Operating a chainsaw during one’s first use of magic mushrooms would be considered higher risk circumstances.

Drug use generally occurs along a spectrum, ranging from negligible risk to substantial risk for experiencing drug problems. An individual’s location on the spectrum is not necessarily fixed but can change over time. One major factor is simple maturation. Some older adolescents and young adults will spend time at the higher risk end of the spectrum. As they reach various maturational milestones in their lives – such as graduation, moving into the workforce, building a career, getting married, buying a home, having children – most people will move a few steps towards the lower risk end. So, older adults generally spend more time closer to the lower risk end of the continuum. A change in peers or dramatic life changes can also lead to changes in drug use – in either direction.

Movement along the continuum is not always unidirectional. For a given individual, there may be back and forward movement over the course of their lives. A reunion may provide an opportunity to reconnect with former acquaintances and former high-risk behaviours, and some people will move back towards higher drug risk use, but not permanently. Once the triggering antecedents are no longer in play, and with some favourable fortune, the revelers will re-emerge at the lower risk end. Other people, who have experienced serious disruption or trauma in their lives, may engage in increased or less judicious drug use to cope, but in time by themselves, and/or with help, may be able to return to less risk-laden drug use.

The Canadian Centre for Substance Use and Addiction (CCSA) has been the lead organization in the development of Canada’s Low-risk Alcohol Drinking Guidelines. The guidelines were developed by a team of alcohol researchers in 2011 to provide evidence-based guidance to Canadians on maintaining low risk alcohol consumption. The research team reviewed the available evidence and identified circumstances for zero consumption (pregnancy, driving). It also set limits for low-risk consumption. The Guidelines specified daily limits of two standard drinks for women and three standard drinks for men. The weekly limits were 10 standard drinks for women and 15 standard drinks for men. A standard drink is defined by an equivalent amount of alcohol by volume: 1.5 oz. of 40% distilled spirits, or 5 oz. of 12% wine, or 12 oz. of 5% beer or cider. Each of these standard drinks has exactly 0.6 oz of absolute or pure alcohol.

The 2023 release of The Canadian Alcohol and Drugs Survey (CADS) used the 2011 guidelines described above to determine that, in 2019, 18% of Canadians exceeded the (chronic) low-risk consumption guidelines. That means that 5.4 million Canadians over the age of fifteen were, at least occasionally, drinking in a manner that placed them at risk for experiencing harm.

Given that the 2011 guidelines were based on research that was more than a decade old, CCSA assembled a team of experts to review more recent research. I was not completely familiar with the more recent research on alcohol consumption and related harms, but I had read enough that I expected the limits to be lowered. But I did not expect them to be lowered by as much as they were. I was not the only one to be surprised. The new guidelines were released in January 2023 and attracted a great deal of attention in the world of public health and the popular media. I imagine the alcohol industry was also paying attention. Highlights of the new guidelines are as follows:

  • abstinence is associated with better health and better sleep and is particularly recommended during pregnancy and breastfeeding
  • at 2 standard drinks or less per week, you are likely to avoid alcohol-related consequences for yourself and others and are likely to avoid several types of cancer such as breast and colon cancer
  • at 7 standard drinks or more per week, the risk of heart disease or stroke increases significantly
  • consuming more than 2 standard drinks per occasion is associated with an increased risk of harms to self and others, including injuries and violence.

 Maybe alcohol is the new tobacco.

 Neither CCSA or CADS have yet to release data on how many Canadians exceed the new guidelines, but it will certainly be many more than the 18%, or 5.4 million, based upon the previous guidelines.

 Implications for Cannabis Legalization: Over the last three decades, we have seen major reductions in cigarette use and drinking and driving. These have been hard-earned, major public health achievements. Will cannabis legalization increase cannabis use, the inhalation of smoke, and the associated health hazards? Will cannabis legalization increase impaired driving by cannabis alone and combined with other drugs?

 With such important questions arising, the Public Health Agency of Canada developed and released Canada’s Lower-risk Cannabis Use Guidelines in 2019. The highlights are:

  • The most effective way to avoid the risks of cannabis use is to abstain from use.
  • Delaying cannabis use, at least until after adolescence, will reduce the likelihood or severity of adverse health outcomes.
  • Use products with low THC content and high CBD:THC ratios.
  • Synthetic cannabis products, such as K2 and Spice, should be avoided.
  • Avoid smoking burnt cannabis and choose safer inhalation methods including vaporizers, e-cigarette devices and edibles.
  • If cannabis is smoked, avoid harmful practices such as inhaling deeply or breath-holding.
  • Avoid frequent or intensive use, and limit consumption to occasional use, such as only one day a week or on weekends, or less.
  • Do not drive or operate other machinery for at least 6 hours after using cannabis. Combining alcohol and cannabis increases impairment and should be avoided.
  • People with a personal or family history of psychosis or substance use disorders, as well as pregnant women, should not use cannabis at all.
  • Avoid combining any of the risk factors related to cannabis use. Multiple high-risk behaviours will amplify the likelihood or severity of adverse outcomes.

 It is noteworthy that the guidelines for both alcohol and cannabis include abstinence as a viable option. I find it interesting that some people find that to be non-viable, even offensive. It is my intention to make this fascinating dynamic the subject of a future issue of this newsletter.

 Finally, a couple Hallowe’en bonuses:

 Should the Cannabis Act get a gold star for reducing cannabis arrests? See my published response to a recent commentary in the Canadian Medical Association Journal.

See below for what can happen when a jack ‘o’ lantern exceeds the low-risk drinking guidelines. You can email me your ideas for what might happen when they exceed the lower-risk cannabis use guidelines. Happy Hallowe’en.

Mike DeVillaer
Hamilton Ontario Canada
October 26 2023