Reducingcannabisharms:AguideforOntariocampuses

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AboutThisGuideThisguideexploresissuesrelatedtocannabisuseandprovidesreaderswithanoverviewofhealthapproachesthatcanreducetheharmsandrisksassociatedwithit.Anycampusprofessional—whetherfaculty,academicadvisor,counsellor,orstudentservicesprofessional—workingwithstudentswhousecannabiswillbeabletorefertotheguideforinformation.

Thefirstsectionwillgiveyouabetterunderstandingofcannabis,theOntariocontext,thesubstanceusespectrum,aswellassubstanceusedisordersandproblematicsubstanceuse.Section2looksatthereasonswhystudentsuseordon’tusecannabis,theeffectsofcannabisuseonthebraininadolescentsandyoungadults,thelinkbetweencannabisuseandmentalhealth,theeffectsoflanguageandstigma,andstrategiesthatcampusprofessionalscanusetoreduceharmswhendirectlyengagingwithstudents.Thefinalsectionprovidesconcretestepsfordevelopingacampus-widecannabis-useframeworktoreduceharm.

Whilethefocusofthisguideisoncannabisusebystudents,notcampusstafforfaculty,thisisinnowaymeanttominimizetheneedtoaddressthebroaderscopeofmentalhealth,substanceuse,andwell-beingoncampuses,includingamongfacultyandstaff.Eachpost-secondaryinstitutionhasuniquestrengths,circumstances,andneeds.Forthisreason,whilethebroadareasaddressedinthisguidearerelevanttoallinstitutions,itisnotmeanttobeprescriptiveortoserveaslegaladvicepertainingtocannabisuselegislation.Asofitswriting,theinformationinthisguideisaccurateandreflectscurrentresearchandlegislation.However,thisinformationmaybesubjecttochangeandwillbeupdatedaccordingly.ThisguideistheresultofacollaborativeeffortbetweentheCentreforInnovationinCampusMentalHealth(CICMH),theProvincialSystemSupportProgram(PSSP)attheCentreforAddictionandMentalHealth(CAMH)andtheCanadianMentalHealthAssociationOntarioDivision(CMHA).ThewritingteamconsistedofPearlynNg(CICMH),MarijaPadjen(CICMH),SanéDube(CAMH),JewelBailey(CAMH),TamarMeyer(CAMH),JeanHopkins(CMHA),andColinMcCullough(MinistryofAdvancedEducationandSkillsDevelopment).RossanaCoriandoli(CAMH)copyeditedtheguide.

ThecreationofthisguidewasinspiredbyasimilardocumentaboutcannabisuseoncampusfromHealthyMinds,HealthyCampusandtheCanadianInstituteforSubstanceUseResearch.SpecialthankstothewritersofClearingtheAir:Lower-RiskCannabisUseonCampusfortheirwork.

SpecialappreciationisgiventoMavisFung,NelsaRoberto,BrendaWhiteside,DominikaFlood,JeanFrancoisCrépault(CAMH),ChrisMercer(LaurentianUniversity),BenBridgstock(AlgonquinCollege),ColinAtchison(OUSA),andOliviaDagbo(CSA)onourAdvisoryCommitteefortheirsignificantcontributionstothisjointproject.

Asincerethankyoutothe58representativesfrompost-secondaryinstitutionsacrossOntariowhotookpartinouranonymousneedsassessmentsurveytodeterminethescopeandstructureofthisguide.

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Section1:CannabisandSubstanceUseSectiononeprovidesanoverviewofcannabis,itslegalizationandregulationinCanada,cannabisuseamongOntario'syouthandanexplanationofsubstanceuse.Thissectionalsodiscusseswhypublichealthandharmreductionapproachesarenecessarytoreducecannabis-relatedhealthandsocialharms.

1. AboutCannabis

Cannabisisaplantthatisformallycalledcannabissativa.Thisguideusesthescientifictermcannabis,whichreferstoallproductsobtainedfromtheplant(includingtheflowers,leaves,stem,stalks,andresin).Itisgivendifferentnames(suchasweed,pot,andmarijuana)dependingonthecontext.Differentgroupsindifferentsettingsarelikelytouseothernames.

Thecannabisplantcontainschemicalcompoundscalledcannabinoids,whichactonreceptorsinthebrainandhavepsychoactiveormind-alteringeffects.1Themainchemicalcompoundisdelta-9tetrahydrocannabinol,orTHC.2Itisresponsibleforthehighthatfollowscannabisuse.3

CurrentmethodsusedtogrowcannabishaveledtohigherconcentrationsofTHC.4TheaverageconcentrationofTHChasgonefrom3%inthe1980stoabout15%today,andsomeproducts,suchasresinsextractedfromthecannabisflower,havelevelsashighas80%.5ThereisvariationinTHClevelsincannabisediblesandotherproductswhichresultsindifferenteffectsandintensitiesforusers.6The

1CanadianCentreonSubstanceUseandAddiction(2017).Canadiandrugsummary:cannabis.Retrievedfrom:http://www.ccdus.ca/Resource%20Library/CCSA-Canadian-Drug-Summary-Cannabis-2017-en.pdf2WorldHealthOrganization.(2018).Managementofsubstanceabuse:cannabis.Retrievedfrom:http://www.who.int/substance_abuse/facts/cannabis/en/3CentreforAddictionandMentalHealth.(2012).HealthinformationA-Z:cannabis.Retrievedfrom:http://www.camh.ca/en/hospital/health_information/a_z_mental_health_and_addiction_information/cannabis/Pages/default.aspx4TheTaskForceonCannabisLegalizationandRegulation.(2016).AFrameworkforthelegalizationandregulationofcannabisinCanada.Thefinalreportofthetaskforceoncannabislegalizationandregulation.Retrievedfrom:https://www.canada.ca/en/services/health/marijuana-cannabis/task-force-marijuana-legalization-regulation/framework-legalization-regulation-cannabis-in-canada.html5Ibid6Ibid

“Thisguideisalivingdocument,andisup-to-dateasofJune2018.AsthefederallegislativeprocessforBillC-45,TheCannabisActisstillunderway,thelegalrequirementsandprovincialframeworkinOntariodiscussedinthisdocumentmaychange.”

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strongertheconcentrationofTHC,thelowerthedoseneededtoreachthedesiredeffect.7Higherpotencymayalsoresultingreaterharmstothepersonusingit.8

Anotherchemicalcompoundiscannabidiol,orCBD.CBDdoesnotproducepsychoactiveeffectsbutmaymoderatetheeffectsofTHC.9Cannabiscanbeusedinvariousways,suchas:

● Inhalation–Thiscanbedoneinavarietyofways:○ Smokingitrolledinpaper(alsocalleda“joint,”“blunt,”or“spliff”).○ Combinedwithtobaccoandsmokedasacigarette.○ Inhaledthroughavaporizer(alsoknownas“vaping”),suchaswithane-cigarette,waterpipe

(bong),andhookah,wherethecannabisisheatedbelowburningpointandthevaporsareinhaled.

○ Heatingcannabisconcentrates(aprocesscalled“dabbing”).● Ingestion–Cannabisisaddedtofoodanddrink,suchascandies,bakedgoods,juices,teas,

tinctures,andingestibleoils.● Appliedtotheskin–Cannabisisrubbedontotheskinthroughalotion,cream,oroil.SmokingisthemostcommonlyreportedwaytousecannabisinCanada.TheCanadianCannabisSurveyfoundthat93%ofrespondentssaidtheysmokecannabisand33%saidtheyconsumeitinfood.10

Syntheticcannabinoids,knownas“Spice”or“K2”,aresubstancesthataredevelopedinalaboratoryandcopytheeffectsofTHC.11Syntheticcannabinoidsareoftenpresentedasalegalsubstitutetocannabisandreferredtoas“legalhighs”or“herbalincense.”12Syntheticcannabinoidshavebeenassociatedwithpanicattacks,hallucinations,seizures,andotherhealthissues,andthereislimitedresearchtodeterminetheirimmediateandlong-term,health-relatedharms.13

2.CannabisUseinOntarioCanadahasoneofthehighestratesofyouthcannabisconsumptionintheworld—among15to19yearolds,about23%aredailyusers—butCanadianyouthuselessofothersubstances,suchastobaccoandalcohol,thanyouthinothercountries.1415Accordingtothe2016NationalCollegeHealthAssessment,7Ibid8Ibid9HealthCanada.(2018).Drugsandmedication:cannabis.Retrievedfrom:https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/about.html10HealthCanada(2017).Canadiancannabissurvey.Retrievedfrom:https://www.canada.ca/en/health-canada/services/publications/drugs-health-products/canadian-cannabis-survey-2017-summary.html11TheTaskForceonCannabisLegalizationandRegulation.(2016).AframeworkforthelegalizationandregulationofcannabisinCanada.Thefinalreportofthetaskforceoncannabislegalizationandregulation.Retrievedfrom:https://www.canada.ca/en/services/health/marijuana-cannabis/task-force-marijuana-legalization-regulation/framework-legalization-regulation-cannabis-in-canada.html12Ibid13CanadianCentreonSubstanceUseandAddiction.(2014).CCENDUBulletin.SyntheticcannabinoidsinCanada.Retrievedfrom:http://www.ccsa.ca/Resource%20Library/CCSA-CCENDU-Synthetic-Cannabis-Bulletin-2014-en.pdf14UNICEFOfficeofResearch(2013).‘ChildWell-beinginRichCountries:Acomparativeoverview’,Innocentireportcard11,UNICEFOfficeofResearch,Florence

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19%ofOntario’spost-secondarystudentsusedcannabisintheprevious30days.Moremen(22%)usedthissubstancethanwomen(17%).16

InApril2017,thegovernmentofCanadaintroducedBillC-45,theCannabisAct,whichwouldlegalizeandregulatethenon-medicaluseofcannabis.Provincesareresponsiblefordecidingaspectssuchasminimumageoflegaluse,andwherecannabiscanbepurchasedandused.17BillC-45isexpectedtobecomelawinlate2018.

Cannabislegalizationisasignificantshiftinsubstance-uselegislationinCanada.Previously,itwasclassifiedasascheduleIIdrug,makingitillegaltogrow,possess,distribute,andsellcannabisfornon-medicalpurposes.18InresponsetoBillC-45,OntariopassedBill174,theCannabisAct,tosupportthelegalizationofnon-medicaluseofcannabisandmaderelatedchangestotheSmoke-FreeOntarioActandtheHighwayTrafficAct.

HealthCanadadefinesnon-medicaluseas“useforarangeofnon-medicalreasons,suchasforenjoyment,pleasure,amusement,orforspiritual,lifestyle,andothernon-medicalreasons.”19

Legalizationpresentsanopportunitytodevelopahealth-focusedresponsethataimstoreducethepotentialharmstopeopleandcommunitiesassociatedwiththeuseofcannabis,20includinguniqueharmsandriskswhichemergeincampussettings.ThegovernmentofOntario’sSafeandSensibleFrameworktoManageCannabisLegalizationidentifiedthepreventionofcannabis-relatedharmsandharmreductionapproachesaspartoftheprovince’soverallresponse.21

KeysurveyssuchastheCanadianStudentTobacco,AlcoholandDrugsSurvey(CSTADS)andtheOntarioStudentDruguseandHealthSurvey(OSDUHS)providecampusprofessionalswithusefulinsightstobetterunderstandsubstanceuseinstudentpopulations.AccordingtotheCSTADS,cannabisisthesecondmostcommonpsychoactivesubstanceusedbystudentsingrades7-12,afteralcohol.22Andthe

15StatisticsCanada.(2015).Canadiantobacco,alcoholanddrugssurvey:summaryofresultsfor2013.Ottawa,Ont.Retrievedfrom:healthycanadians.gc.ca/scienceresearch-sciences-recherches/data-donnees/ctads-ectad/summary-sommaire-2013-eng.php16AmericanCollegeHealthAssociation.(2016).AmericanCollegeHealthAssociation-NationalCollegeHealthAssessmentII:OntarioCanadareferencegroup,executivesummaryspring2016.Retrievedfrom:http://oucha.ca/pdf/2016_NCHA-II_WEB_SPRING_2016_ONTARIO_CANADA_REFERENCE_GROUP_EXECUTIVE_SUMMARY.pdf17GovernmentofOntario(2017).Cannabislegalization.Retrievedfrom:https://www.ontario.ca/page/cannabis-legalization18CanadianCentreonSubstanceUseandAddiction(2017).Canadiandrugsummary:cannabis.Retrievedfrom:http://www.ccdus.ca/Resource%20Library/CCSA-Canadian-Drug-Summary-Cannabis-2017-en.pdf19HealthCanada(2017).Canadiancannabissurvey.Retrievedfrom:https://www.canada.ca/en/health-canada/services/publications/drugs-health-products/canadian-cannabis-survey-2017-summary.html20CentreforAddictionandMentalHealth.(2014).CAMHcannabispolicyframework.Retrievedfrom:https://www.camh.ca/en/camh-news-and-stories/camhs-cannabis-policy-framework-legalization-with-regulation21GovernmentofOntario(2017).Ontarioreleasessafeandsensibleframeworktomanagefederallegalizationofcannabis.Retrievedfrom:https://news.ontario.ca/mag/en/2017/09/ontario-releases-safe-and-sensible-framework-to-manage-federal-legalization-of-cannabis.html22CanadianStudentTobacco,AlcoholandDrugsSurvey(2015).Summaryofresults:Canadianstudenttobacco,alcoholanddrugssurvey.Retrievedfrom:https://www.canada.ca/en/health-canada/services/canadian-student-tobacco-alcohol-drugs-survey/2014-2015-summary.html

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2017OSDUHSresultsshowthat37%ofstudentsingrades12usedcannabisinthepreviousyear,while3%usedsyntheticcannabisinthepreviousyear.Cannabisuseamonggrade12studentshasremainedstablesince2011.23

Inadditiontodataonuse,theOSDUHScollectsvitalinformationonperceptionsofcannabisuseamongstudents.The2017resultsshowthat35%ofstudentsthinkcannabisshouldbelegalforadultsandstudentsintheoldergradesweremorelikelytosharethisview.Aswell,4%ofstudentssaidtheywouldusemorecannabisoncelegalizedand11%saidtheywouldusesimilaramountstowhattheyusedbeforelegalization.

3.UnderstandingSubstanceUse

Cannabisandotherdrugssuchasalcoholandtobaccoarepsychoactivesubstanceswhich,whentakenintothebody,altermentalprocessessuchascognition.24Psychoactivesubstanceusefallsonaspectrum.Movementalongthespectrumisnotnecessarilylinear;thatis,apersonmayusesubstancesdifferentlyatdifferentpointsintheirlife.Itispossibletointroduceinterventionstominimizerisksandharmswhenproblematicuseoccurs.Problematicusemeansuseofsubstancesinwaysthatareassociatedwithphysical,psychological,economicorsocialproblemsoruseposehealthorsecurityriskstotheperson,andthosearoundthem.25

Itisimportanttorecognizethatuseofsubstancessuchascannabisisnotthesameasbeingdependentoraddicted.Rather,substanceusecanrangefrombeneficialtoproblematic,asshownbelow:

●Abstinence:Nouse.●Beneficial:Useresultinginmorepositivethannegativeeffects.●Non-problematic:Useresultinginfewhealthorsocialeffects.●Problematicuse:Useresultinginpotentiallynegativeeffectsfortheperson,theirfriends,orfamily.●Substanceusedisorder:Usethatiscompulsiveordifficulttostopdespitenegativehealthandsocialeffects.

23Boak,A.,Hamilton,H.A.,Adlaf,E.M.,&Mann,R.E.(2017).DruguseamongOntariostudents,1977-2017:DetailedfindingsfromtheOntariostudentdruguseandhealthsurvey(OSDUHS)(CAMHResearchDocumentSeriesNo.46).Toronto,ON:CentreforAddictionandMentalHealth.

24CanadianPublicHealthAssociation.(2014).CanadianPublicHealthAssociationdiscussionpaper.AnewapproachtomanagingillegalpsychoactivesubstancesinCanada.Retrievedfrom:https://www.cpha.ca/sites/default/files/assets/policy/ips_2014-05-15_e.pdf25CanadianPublicHealthAssociation.(2014).CanadianPublicHealthAssociationdiscussionpaper.AnewapproachtomanagingillegalpsychoactivesubstancesinCanada.Retrievedfrom:https://www.cpha.ca/sites/default/files/assets/policy/ips_2014-05-15_e.pdf

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Figure1:SubstanceUseContinuum(adaptedfromApathforward:Aprovincialapproachtofacilitateregionalandlocalplanningandaction.)26

Somepeopleusecannabisformedicalpurposes.Cannabishasbeenendorsedforabroadrangeofmedicalconditionsbutevidenceofitseffectivenesstotreatalltheseconditionsisincomplete.27Sufficientevidenceexistsontheuseofcannabistotreatend-of-lifepain,chemotherapy-inducednauseaandvomiting,andspasticityduetomultiplesclerosisorspinalcordinjury.28

InCanada,regulationsgoverningaccesstomedicalcannabishavebeeninplacesince2001.Sincethen,theseregulationshavechangednumeroustimes.Intheirmostrecentversion,introducedbythefederalgovernmentin2016,theAccesstoCannabisforMedicalPurposesRegulationsallowmedicaluseofcannabiswhenauthorizedandprescribedbyahealthcareprovider.MedicalcannabiscanbepurchasedfromaproducerthatislicensedbyHealthCanada,orapersoncanproducetheirowncannabisbasedonthedailyamountprescribedbytheirhealthcareprovider.29

Purchasesfromalicensedproducercanbemadeonline,byawrittenorder,orthroughtelephone,andaredeliveredbymail.Untillegalization,onlylicensedproducersareauthorizedtoproduce,sell,andmailcannabistothepublic."Dispensaries"or"compassionclubs"arenotallowedtosellcannabisformedicalornon-medicalpurposes.30Thelegalizationofcannabiswillnotchangetherulesandprocessesforaccessingcannabisformedicalpurposes.31

26FirstNationsHealthAuthority,BritishColumbiaMinistryofHealth&HealthCanada.(2013).Apathforward:Aprovincialapproachtofacilitateregionalandlocalplanningandaction.Retrievedfrom:http://www.fnha.ca/documents/fnha_mwsu.pdf27Perry,D.,Ton.J.,Beahm,N.P.,Crisp,N.,...Lindblad.A.J.(2018).Simplifiedguidelineforprescribingmedicalcannabinoidsinprimarycare.CanadianFamilyPhysician,64.28Perry,D.,Ton.J.,Beahm,N.P.,Crisp,N.,...Lindblad.A.J.(2018).Simplifiedguidelineforprescribingmedicalcannabinoidsinprimarycare.CanadianFamilyPhysician,64.29GovernmentofCanada.(2016).Medicaluseofmarijuana.Retrievedfromhttps://www.canada.ca/en/health-canada/services/drugs-health-products/medical-use-marijuana/medical-use-marijuana.html30GovernmentofCanada.(2018).StatementfromHealthCanadaconcerningaccesstocannabisformedicalpurposes.Retrievedfrom:https://www.canada.ca/en/health-canada/news/2016/08/statement-from-health-canada-concerning-access-to-cannabis-for-medical-purposes.html31GovernmentofOntario.(2018).Cannabislegalization.Retrievedfrom:https://www.ontario.ca/page/cannabis-legalization

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4.UnderstandingSubstanceUseDisordersandProblematicSubstanceUseForsomepeople,theuseofsubstancessuchascannabiscanleadtoproblematicuse.Insomepeople,itcanleadtoasubstanceusedisorder,thetermusedinthemostrecentversionoftheDiagnosticandStatisticalManualofMentalDisorders(DSM),theAmericanPsychiatricAssociation'stextofrecognizedmentalillnesses.32Substanceusedisorderisacomplexconditioninwhichproblematicpatternsofsubstanceusemayinterferewithaperson’slifeandleadtophysicaland/orpsychologicaldependenceandwithdrawalsymptoms.Itiscommonlyknownasaddictionorproblematicuseofsubstances(Figure1),andcanrangefrommildtosevere.

Themajorityofstudentswillnotdevelopasubstanceusedisorderwhencannabisislegalized,buttherearerisksofharmassociatedwithuse.Signsandsymptomsofproblematicuseamongstudentsincludenotshowinguptoclassesorotheractivities,difficultywithmemoryorconcentration,andputtingsubstanceuseaheadofschoolworkorotherobligations.33

The4Csapproach34isasimplewaytodescribeproblematicsubstanceusethatmayhaveanegativeimpactonaperson:

• Craving:Strongneedtousethesubstance.• Control:Difficultcontrollinghowmuchorhowoftenthesubstanceisused.• Compulsion:Feelingurgestousethesubstance.• Consequences:Continuingtousethesubstancedespitenegativeoutcomes

About9%ofpeoplewhousecannabiswilldevelopcannabisusedisorder,andthatnumbermayincreaseto16%amongthosewhostartusingitasteenagers.35Bycomparison,theestimatedriskofdevelopingasubstanceusedisorderwithothersubstancesis68%fornicotine,23%foralcohol,and21%

32AmericanPsychiatricAssociation.(2018).DiagnosticandStatisticalManualofMentalDisorders(DSM–5).Availableat:https://www.psychiatry.org/psychiatrists/practice/dsm33GovernmentofCanada.(2017).Helpafriendwhoisusingorabusingdrugs.Retrievedfrom:https://www.canada.ca/en/health-canada/services/substance-abuse/get-help/help-friend.html#a134CentreforAddictionandMentalHealth.(2007).Addiction:Aninformationguide.Retrievedfrom:https://www.camh.ca/en/hospital/health_information/a_z_mental_health_and_addiction_information/drug-use-addiction/Documents/addiction_guide_en.pdf35Anthony,J.C.(2006).Theepidemiologyofcannabisdependence.InR.A.Roffman&R.S.Stephens(Eds.),Cannabisdependence:Itsnature,consequencesandtreatment(pp.58–105).Cambridge,UK:CambridgeUniversityPress

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forcocaine.36Morethanonein20Canadiansbetweentheagesof15and24metthecriteriaforcannabisusedisorderin2012andthepeakageforthedisorderisbetween16and18yearsold.37

Screeningandassessmentstools*whicharegroundedinresearchandproventobereliableandvalid,canhelpserviceprovidersunderstandwhereastudentmightbeonthesubstanceusecontinuum.Someofthesecanalsoidentifyifthesubstanceuseisaffectingtheperson’slife,iftheymeetthecriteriaforcannabisusedisorder,andappropriateinterventionstohelpthemreducetheiruse.BelowarecommonlyusedassessmenttoolsinOntario:

Tool Information

Alcohol,SmokingandSubstanceInvolvementScreeningTest(ASSIST)

ASSISTisdesignedprimarilyforusebyprimaryhealthcareprovidersbuthasalsobeenfoundusefulforthoseinotherfieldswhoworkwithpeoplewhousesubstances.Itincludescannabis-relatedquestions.

GlobalAppraisalofIndividualNeeds(GAIN)-SS

GAINinstrumentscanbeusedtoidentifythosewhohaveasubstanceusedisorderinavarietyofclinicalsettings.

CRAFFT

CRAFFTisusedwithadolescentsandyoungadults(12-21years)andcanbecompletedasaself-administeredquestionnaireinclinicalsettings.Briefadvice/interventionsarerecommendedbasedontheperson’srisklevel.

*Costsmaybeattachedtousingsomeofthesetools.

5.PublicHealthandHarmReductionApproachestoCannabisUseApublichealthapproachpromotesthehealthandwell-beingofthewholepopulationandworkstohelpallgroupsofpeoplehaveanequalchanceofhavinggoodhealth.38Takingapublichealthapproachto

36Lopez-QuinteroC,PérezdelosCobosJ,HasinDS,OkudaM,WangS,etal.(2011).Probabilityandpredictorsoftransitionfromfirstusetodependenceonnicotine,alcohol,cannabis,andcocaine:ResultsoftheNationalEpidemiologicSurveyonAlcoholandRelatedConditions(NESARC).DrugandAlcoholDependence115:120-13037Pearson,C.,Janz,T.,&Ali,J.(2013).Healthataglance:MentalandsubstanceusedisordersinCanada.(StatisticsCanadaCatalogueno.82-624-X).38CanadianPublicHealthAssociation.(2014).CanadianPublicHealthAssociationdiscussionpaper.AnewapproachtomanagingillegalpsychoactivesubstancesinCanada.Retrievedfrom:https://www.cpha.ca/sites/default/files/assets/policy/ips_2014-05-15_e.pdf

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cannabisusemeansworkingtoreduceharmswhilealsousingtargetedmeasuresforthosewhoareathigherriskofharmduetotheircannabisuse.39

Thestrategiesusedinapublichealthapproacharehealthpromotionandprotection,prevention,harmreduction,andevidence-basedservicestosupportthosewhohavedevelopedorareatriskofdevelopingasubstanceuseproblem.40Addressingtheriskandprotectivefactorsthatdeterminethehealthofpopulationsisalsopartofapublichealthapproach(seesection2,subsection3,forexamplesofriskandprotectivefactorsamongpost-secondarystudents).41

Thelegalizationandregulationofcannabisprovidestheopportunityforcannabisusetobetreatedasahealthissueratherthanasacriminalone.

Aspreviouslynoted,harmreductionispartofapublichealthapproachtoaddresscannabisuse.Harmreductionreferstoanyeffortstominimizetheharmsassociatedwithsubstanceuse.42Itoperatesonthepremisethatsomepeoplewillusesubstances,andthatthosewhousethemmaynotbeableorwanttostopusingthem.43Harmreductionisgroundedinthebeliefthatpeoplehavetherighttochoosehowtheylivetheirlivesandthattheydeserverespect.44Thefocusisonpromotingsaferuseofsubstancestopreventharm.45FormoreinformationonharmreductionapproacheswhenworkingwithstudentsseeSection2.

39TheTaskForceonCannabisLegalizationandRegulation.(2016).AframeworkforthelegalizationandregulationofcannabisinCanada.Thefinalreportofthetaskforceoncannabislegalizationandregulation.Retrievedfrom:https://www.canada.ca/en/services/health/marijuana-cannabis/task-force-marijuana-legalization-regulation/framework-legalization-regulation-cannabis-in-canada.html40CanadianPublicHealthAssociation.(2014).CanadianPublicHealthAssociationdiscussionpaper.AnewApproachtomanagingillegalpsychoactivesubstancesinCanada.Retrievedfrom:https://www.cpha.ca/sites/default/files/assets/policy/ips_2014-05-15_e.pdf41CanadianPublicHealthAssociation.(2014).CanadianPublicHealthAssociationdiscussionpaper.AnewapproachtomanagingillegalpsychoactivesubstancesinCanada.Retrievedfrom:https://www.cpha.ca/sites/default/files/assets/policy/ips_2014-05-15_e.pdf42InternationalHarmReductionAssociation.(2010).Whatisharmreduction?ApositionstatementfromtheInternationalHarmReductionAssociation.Retrievedfrom:https://www.hri.global/contents/126943Ibid44CanadianNursesAssociation&CanadianAssociationofNursesinAIDSCare.(2012).Jointpositionstatement.Harmreduction.Retrievedfrom:https://cna-aiic.ca/~/media/cna/page-content/pdf-en/jps_harm_reduction_2012_e.pdf45CanadianNursesAssociation&CanadianAssociationofNursesinAIDSCare.(2012).Jointpositionstatement.Harmreduction.Retrievedfrom:https://cna-aiic.ca/~/media/cna/page-content/pdf-en/jps_harm_reduction_2012_e.pdf

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6.Prohibition/LegalizationParadoxExistinglawsandmeasurestoregulatemanypsychoactivesubstancesweredevelopedinthe20thcentury;theselawsweredevelopedbasedonfear,racism,politicalandmoralperspectives,andexistingknowledgeatthetime.46Butevidenceshowsthatthecriminalizationofcannabishasnotstoppedpeoplefromusingit.47InCanada—whereproduction,distribution,sale,andpossessionofcannabiswasagainstthelawupuntil2018—morepeopleusethissubstancethanincountriesthatembracealessstringentapproach.48Ineffect,theselawshaveactuallyincreasedassociatedsocialharms.Forexample:

● ThousandsofCanadiansarearrestedeachyear,impactingtheirabilitytogetandkeepjobs;

● Certaingroupsaredisproportionatelytargetedwithchargesofcannabispossession;and● Prohibitionhasfueledtheillicitdrugmarket,andassociatedcrimeandviolence.49

Figure2presentsamodelforcannabispoliciesandtheireffectsonphysicalandsocialwell-being.Inthismodel,legalizationofcannabiswithoutregulationresultsinincreasedcommercialmarkets,whichcontributetoincreasedhealthandsocialharms.InColoradoandWashington,wherecannabisislegalized,therewasgrowthinthecannabisediblesmarket.InColorado,theediblesmarketexpandedbecauseoflackofregulationforedibles,andediblesappealedtothosewhodidnotwanttosmoke.Thisresultedinunintentionaloverconsumptionandoverdose.50Ontheotherendofthecurve,totalprohibitionresultsinanunregulatedcriminalmarket,whichalsoresultsinincreasedhealthandsocialharms.Inthemiddleofthecurveislegalizationwithstrictregulation,whichisassociatedwithfewersocialandhealthharms.Withinthistypeofregulatoryframework,apublichealthapproachcanbeusedtoreducecannabis-relatedrisksandharmstothewholepopulation,includingtargetedinterventionsforhigh-riskgroups.

46CanadianPublicHealthAssociation.(2014).CanadianPublicHealthAssociationdiscussionpaper.AnewapproachtomanagingillegalpsychoactivesubstancesinCanada.Retrievedfrom:https://www.cpha.ca/sites/default/files/assets/policy/ips_2014-05-15_e.pdf47CentreforAddictionandMentalHealth.(2014).CAMHcannabispolicyframework.Retrievedfrom:https://www.camh.ca/en/camh-news-and-stories/camhs-cannabis-policy-framework-legalization-with-regulation48CentreforAddictionandMentalHealth.(2014).CAMHcannabispolicyframework.Retrievedfrom:https://www.camh.ca/en/camh-news-and-stories/camhs-cannabis-policy-framework-legalization-with-regulation49CentreforAddictionandMentalHealth.(2014).CAMHcannabispolicyframework.Retrievedfrom:https://www.camh.ca/en/camh-news-and-stories/camhs-cannabis-policy-framework-legalization-with-regulation50TheTaskForceonCannabisLegalizationandRegulation.(2016).AframeworkforthelegalizationandregulationofcannabisinCanada.Thefinalreportofthetaskforceoncannabislegalizationandregulation.Retrievedfrom:https://www.canada.ca/en/services/health/marijuana-cannabis/task-force-marijuana-legalization-regulation/framework-legalization-regulation-cannabis-in-canada.html

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Figure2:Cannabispoliciesandsocial/healthharm:Aconceptualmodel.AdaptedwithpermissionfromApfel.51

SECTION2:CannabisUseonCampusThereareconflictingmessagessurroundingcannabis,includingregardingitspotentialharmsandbenefits,whichcanmakeitdifficulttoprovideappropriatemessagesandsupportforpost-secondarystudents.52Thissectionwillhelpcampusprofessionalsprovideinformationtostudentsabouttherisksofcannabisuseandinterventionstrategiestoreduceharms.

51Apfel.F.(2014).Cannabis:fromprohibitiontoregulation.Whenthemusicchangessodoesthedance.ARPolicyBrief5.Barcelona:ALICERAP(AddictionsandLifestylesinContemporaryEurope–ReframingAddictionsPolicy).Retrievedfrom:http://www.aie.nl/wp-content/uploads/2014/05/AR-Policy-Paper-5.pdf52HealthyMinds,HealthyCampuses(2016).ClearingtheAir:Lower-RiskCannabisUseonCampus.Accessedfrom:https://healthycampuses.ca/wp-content/uploads/2015/01/Cannabis-Guide-2016.pdf

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1) ReasonsforCannabisUseandNon-useThereasonsforusingcannabisnon-medically,aswellasthechoicenottousecannabis,arecomplexandcanbedifferentforeachperson.53AccordingtotheCanadianCentreonSubstanceUseandAddiction,someofthemostcommonreasonsforcannabisuse,specificallyamongyouth,include:

● Itiseasytoaccess● Toovercomeroutineorboredom● Tofitinwiththeirpeers● Tofeelgood(improvetheirmood,appetite,andsleep)● Tobemoresociable● Tofeelexcitementorpleasure● Tocopewithsadness,anger,andanxiety● Itisavailableandacceptable● Ithelpsthemgainanalternativeperspectiveoftheirexperiences

Youthreportnotusingcannabisforthefollowingreasons:5455

● Fearoflegalandparentalconsequences● Negativeeffectsonthebodyandmind● Toavoidsocialconsequencesandstigma● Toavoidstereotypesofcannabisusers

2) CannabisUseAmongAdolescents,Youth,andFrequentUsers

Whiletheimpactsofcannabisonpublichealtharesignificantlylowerthanthoseoftobaccoandalcohol,cannabisconsumptionisnotwithoutrisks,especiallyifusedfrequentlyorifusebeginsearlierinlife.56Frequentuseofcannabis(typicallydefinedasdailyornear-dailyuse)isassociatedwithhealthcomplications,includingmildimpairmentstomemory,attention,andothercognitivefunctions,especiallytheyoungerapersonbeginstoconsumeit.Andthosewhostartusingcannabisearlyanduseitfrequentlyareatriskofhavingnegativeimpactslaterinlife.57

53McKiernan,A.,&Fleming,K.(2017).CanadianYouthPerceptionsonCannabis,Ottawa,Ont.:CanadianCentreonSubstanceAbuse.54George,T.,&Vaccarino,F.(Eds.).(2015).SubstanceabuseinCanada:TheEffectsofCannabisUseduringAdolescence.Ottawa,ON:CanadianCentreonSubstanceAbuse.55McKiernan,A.,&Fleming,K.(2017).CanadianYouthPerceptionsonCannabis,Ottawa,Ont.:CanadianCentreonSubstanceAbuse.56CentreforAddictionandMentalHealth.(2014).CannabisPolicyFramework.RetreivedFrom:https://www.camh.ca/en/camh-news-and-stories/to-2016/camhs-cannabis-policy-framework-legalization-with-regulation57George,T.,&Vaccarino,F.(Eds.).(2015).SubstanceabuseinCanada:TheEffectsofCannabisUseduringAdolescence.Ottawa,ON:CanadianCentreonSubstanceAbuse.

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Anadditionalhealthriskisassociatedwiththeconsumptionofburnedcannabis.Smokingisthemosthazardousmethodofcannabisuse,andcancauserespiratoryhealthproblems,suchascough,wheeze,worseningofasthmasymptoms,sorethroat,chesttightness,andshortnessofbreath.58Alternatives(suchasvaporizersoredibles)arenotrisk-free,buttheycanreducetherisksassociatedwithsmokingcannabis.Formoreinformationaboutlower-riskpracticesseesub-section5.59

Inadolescenceandearlyadulthood,thebraingoesthroughamaturationprocessthatincludesrefinementsandreorganizationofthebrain’scircuitry.Cannabisusecannegativelyaffectthisprocess.60Thosewhostartusingcannabisearly(suchasinadolescence)areathigherriskofharm.61Althoughthereisnotenoughevidenceofacause-and-effectrelationship,earlyandfrequentuseofcannabisisariskfactorfordevelopingmentalillness,includingpsychosis.62FormoreinformationabouttheselinksseeSection2.

Drivingundertheinfluenceofsubstances,includingcannabis,contributestofatalroadcrashesand,inCanada,youngpeoplearethelargestgroupofdriversinfatalcarcrasheswhotestpositivefordrugs.63YoungCanadians(ages15–24)weremorethantwiceaslikelyasolderCanadianstoreportdrivingafterusingcannabis.64In2017,aHealthCanadasurveyshowedthatmanypeopleareunawareofthepotentialrisksofcannabis-impaireddriving.65WhilesignificantstepshavebeenmadetoinformyoungadultsinCanadaabouttheharmsofdrinkinganddriving,studentsinOntarioweremorelikelytoreportdrivingafterusingcannabisthandrivingafterdrinking.66Campusmessagingandharmreductioninitiativesshouldprovideaccurateinformationandeducationregardingtherisksofdrivingafterusingcannabis.

58McInnis,O.,&Plecas,D.(2017).ClearingtheSmokeonCannabis.RespiratoryeffectsofCannabisSmoking.CanadianCentreforSubstanceAbuse.Retrievedfrom:http://www.ccdus.ca/Resource%20Library/CCSA-Cannabis-Use-Respiratory-Effects-Report-2016-en.pdf59Fischer,B.,Russell,C.,Sabioni,P.,vandenBrink,W.,LeFoll,B.,Hall,W.etal.(2017).Lower-riskcannabisuseguidelines(LRCUG):Anevidence-basedupdate.AmericanJournalofPublicHealth,107(8).60CanadianPsychiatricAssociation.(2017).ImplicationsofCannabisLegalizationonYouthandYoungAdults.Retreivedfrom:https://www.cpa-apc.org/wp-content/uploads/Cannabis-Academy-Position-Statement-ENG-FINAL-no-footers-web.pdf61George,T.,&Vaccarino,F.(Eds.).(2015).SubstanceabuseinCanada:TheEffectsofCannabisUseduringAdolescence.Ottawa,ON:CanadianCentreonSubstanceAbuse.62BenAmarM,PotvinS.(2007).CannabisandPsychosis:WhatistheLink?JournalofPsychoactiveDrugs;39(2),131-4263HealthCanada.(2018).DrugImpairedDriving.Retrievedfrom:https://www.canada.ca/en/services/policing/police/community-safety-policing/impaired-driving/drug-impaired-driving.html64CanadianCentreforSubstanceUseandAddiction.(2018).ImpairedDrivinginCanada.Retrievedfrom:http://www.ccdus.ca/Resource%20Library/CCSA-Impaired-Driving-Canada-Summary-2018-en.pdf65HealthCanada(2017).CanadianCannabisSurvey—2017summary.Retrievedfrom:www.canada.ca/en/healthcanada/services/publications/drugs-health-products/canadian-cannabis-survey-2017-summary.html.66Boak,A.,Hamilton,H.A.,Adlaf,E.M.,&Mann,R.E.,(2017).DruguseamongOntariostudents,1977-2015:DetailedOSDUHSfindings(CAMHResearchDocumentSeriesNo.46).Toronto,Ont.:CentreforAddictionandMentalHealth.

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Giventhehighratesofcannabisuseamongyouthandtheconcernsrelatedtotheeffectsofcannabisonbraindevelopmentanddrivingability,youthareaprioritypopulationthatneedstargetedhealthpromotioninterventionsandmessaging.

3) CannabisandMentalHealth

Asdiscussedintheprevioussection,thereisconsistentevidencethatlinksfrequent,earlyonsetcannabisusewithnegativeeffects,includingmentalhealthproblems.Andwhilethereisnoevidenceatthistimethatcannabiscausesmentalillness,researchshowsthatitisariskfactorforthedevelopmentofpsychosis,67especiallyifthereisapersonalorfamilyhistoryofpsychosis,orcannabisisusedfrequently.68Onestudyfoundthatthosewhousecannabisregularlyasadolescentshavetwicetheriskofpsychoticsymptomsorofaschizophreniadiagnosisinadulthoodcomparedtothosewhodonotuseit.69Foryoungadultswhohavepsychosis,ongoingcannabisusecanworsensymptomsoverthelongterm.70RecentresearchalsofoundthathighTHCcontentincannabisproductsislinkedtoahigherriskofdevelopingpsychoticsymptoms.71Somestudieshavesuggestedthatcannabismayalsoincreasetheriskofanxietyanddepression.72

Moreresearchisneededtobetterunderstandtherelationshipbetweenmentalillnessandcannabisuse.Inthemeantime,thereareessentialcomponentsofacampusstrategytoaddresscannabisuseamongpost-secondarystudents.Thesecomponentsincludeeducation,healthpromotion,andharmreductionstrategiesthatencouragereducingcannabisuseandthatincreaseaccesstocommunity-basedmentalhealthandaddictionssupports.

Riskandprotectivefactors

Therearefactorsthatcanpotentiallyincreasetherisksofproblematicsubstanceuse,suchaslowself-esteem,stressfullifeevents,andlackofconnectiontoacommunity.Theseriskfactorscanresultinnegativehealtheffects,includinganincreasedriskofdevelopingsubstanceuseproblems.

67McInnis,O.&Porath-Waller,A.(2016).ClearingtheSmokeOnCannabis:ChronicUseandCognitiveFunctioningandMentalHealth.TheCanadianCentreonSubstanceUse.Retrievedfrom:http://www.ccdus.ca/Resource%20Library/CCSA-Chronic-Cannabis-Use-Effects-Report-2016-en.pdf68Degenhardt,L.,&Hall,W.(2007).Therelationshipbetweencannabisuseandpsychosis:epidemiologicalevidenceandbiologicalplausibility.AdvancesinSchizophreniaandClinicalPsychiatry,3,2–7.69Hall,W.(2015).Whathasresearchoverthepasttwodecadesrevealedabouttheadversehealtheffectsofrecreationalcannabisuse?Addiction,110(1),19–35.70CanadianPsychiatricAssociation.(2017).ImplicationsofCannabisLegalizationonYouthandYoungAdults.Retreivedfrom:https://www.cpa-apc.org/wp-content/uploads/Cannabis-Academy-Position-Statement-ENG-FINAL-no-footers-web.pdf71DiForti,M.,Marconi,A.,Carra,E.,Fraietta,S.,Trotta,A.,Bonomo,M.,&Stilo,S.A.(2015).ProportionofpatientsinsouthLondonwithfirst-episodepsychosisattributabletouseofhighpotencycannabis:acase-controlstudy.TheLancetPsychiatry,2(3),233–238.72Lev-Ran,S.,Roerecke,M.,LeFoll,B.,George,T.P.,McKenzie,K.,&Rehm,J.(2014).Theassociationbetweencannabisuseanddepression:asystematicreviewandmeta-analysisoflongitudinalstudies.PsychologicalMedicine,44(04),797–810.

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Youngpeopletransitioningfromsecondaryschooltouniversityorcollegefaceuniquechallengesthatcanaffecttheirmentalhealth,suchasmovingawayfromtheirsocialsupportstructures,developingnewroutinesandsocialnetworks,andadaptingtoindependentlife.73Asaresult,thesetransitional-ageyouth,whoaretypicallybetween16-and25-years-old,oftenneedhelptocopewiththechallengestheyfaceduringthisperiod.

Ontheotherhand,protectivefactors(suchaseducationandsupportiverelationships)canhavepositiveimpactsonaperson’shealthandmitigatetheirriskofmentalhealthproblems.Whilethechartbelowisnotacomprehensivelistofriskandsupportfactors,itprovidesanoverviewofthecampussupportsthatcanenhancetheseprotectivefactors.

Figure3:RiskFactorsandProtectiveFactorsthatImpactStudentMentalHealth74

RiskFactors Domain Protectivefactors

Lowself-esteemCognitivedevelopmentPoorphysicalhealthPoorlanguageskillsNegativeattitudetowardseducation

Student PositivesocialandemotionalskillsCognitiveskillsPositivementalandphysicalhealthPositiveattitudetowardseducation

FamilyconflictChildhoodabuse,trauma,orneglectAdverseexperiencesinyouthCaregiverwithmentalhealthorproblematicsubstanceuse

Family PositiveandstablehomeenvironmentFinancialsupportfromfamilySupportiveofpost-secondaryeducation

BullyingEarlyinitiationofproblembehaviourorsubstanceuseInteractionswithpeerswithnegativeattitudetowardseducation

Peers PositiveandsupportivesocialnetworkOpportunitiesforhealthysocialinteractions

73CentreforAddictionandMentalHealth.(2016).Transition-AgeYouthEvidenceBrief.MentalHealthPromotion,Prevention,andEarlyInterventionthroughCampusInterventionsandIntegratedServiceCentres.Retrievedfrom:http://eenet.ca/sites/default/files/TAYEnglish_EENetEvidenceBrief_Final.pdf74AdaptedFrom:PublicSafetyCanada.(2018).School-BasedDrugAbusePrevention:PromisingandSuccessfulPrograms.Retrievedfrom:https://www.publicsafety.gc.ca/cnt/rsrcs/pblctns/sclbsd-drgbs/index-en.aspx#ch01a

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Knowledgeof,andaccessto,campussupportsDisconnectionfromcampuscommunity

Campusenvironment

PresenceofcampusapproachesandstrategiesaimedatreducingsubstanceuseAccesstocampussupportsPositiverelationshipswitheducatorsandstaffHealthycampusenvironmentOpportunitiesforinvolvementincampusactivities

Historyoftrauma(e.g.,abuse,deathofalovedone)DifficultschooltransitionSocioeconomicchallenges

Lifeevents SupportiveandstablerelationshipsDevelopedcopingskillsSupportavailableduringcriticallifeevents

DiscriminationLackofaccesstothesocialdeterminantsofhealthLackofaccesstosupportservices

Societal InclusionandcommunityAccesstosupportservicesEconomicsecurity

4) LanguageandStigmaStigmaisoneofthelargestbarrierstoaccessingtreatmentforproblematicsubstanceuse.75ThecreationofanewlegalcannabisframeworkinCanadaoffersauniqueopportunitytoencouragede-stigmatizingconversationsaboutsubstanceuseoncampussostudentscanspeakopenlyandmakeinformeddecisionsaboutconsumingpsychoactivesubstances.

Thelanguageusedisanimportantcomponentinreducingstigmaandbreakingdownthenegativestereotypesassociatedwithsubstanceuse.Forexample,thewordsusedbyhealthcareprofessionalsandothersupportscancontributetosuboptimalcare.76Bychoosingtousenon-stigmatizinglanguage,studentswhoareexperiencingchallengesmayfacelessstigmaandfewerbarrierstoaccessinghelp.

Itisagoodideatouseneutralandpreciselanguagewhentalkingaboutsubstanceuseaswellas“peoplefirst”languagethatfocusesontheindividual.Forexample:

75JohnF.Kelly,RichardSaitz&SarahWakeman(2016)Language,SubstanceUseDisorders,andPolicy:TheNeedtoReachConsensusonan“Addiction-ary”,AlcoholismTreatmentQuarterly.34(1),p116-123.76VanBoekel,etal.(2013).Stigmaamonghealthprofessionalstowardspatientswithsubstanceusedisordersanditsconsequencesforhealthcaredelivery:systematicreview.DrugandAlcoholDependence.1311-2,23-35.

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Insteadof: Say:

Druguser Personwhousesdrugs

Stoner/pothead Personwhousescannabis

Drugabuser/addict Personwithadruguseproblem/personwithasubstanceusedisorder

Drughabit Regularsubstanceuse

AddictedtoX Hasanxusedisorder

Former/ex-addict Personinrecovery

Sufferingfromanaddiction Personlivingwithanaddiction

Stayedsober/clean Maintainedrecovery

Drugoffender Personarrestedforadrugviolation

Non-compliant Choosesnottoatthispoint77

5) Education,HarmReduction,andSkillsforEngagingwithStudents

Whilecannabisusemaybeharmful,manypeoplealsoreportpositivebenefits,whetheritiswithmedicalorrecreationaluse.Itisimportanttofosteranenvironmentwherestudentscantalkaboutboththerisksandbenefitsofcannabisuse.Theaimistohelpstudentsmakeinformeddecisions,offereasyaccesstoscreeningandassessmentforpotentialsubstanceuseproblems,andprovidereferralsiftheyneedtreatment.

Addressingissuesrelatedtocannabisuseoncampusshouldbeviewedwithinapublichealthframeworkthatsupportscannabisliteracy.Itisimportanttonotethattakingan“abstinenceonly”approachtosubstanceuseeducationhasproventobeineffectiveinreducingcannabisuse.78Inaddition,strictorpunitivepoliciesrelatedtosubstanceusehavealsoproventobeineffective.79

Harmreductionisapragmatic,evidence-basedapproachthatcanprovidestudentswithinformationandskillstominimizerisksandmakeinformedchoicesaboutcannabisconsumption.80Harmreductionhasbeeneffectivewithmanypopulations,includingstudents.Forexample,onestudyshowedthatharmreductioninterventionscanreducethefrequencyofriskybehavioursamongstudentsaged18-28

77AdaptedfromCCSA(2017)andHealthCanada(2018)78CanadianStudentsForSensibleDrugPolicy.(2018).SensibleCannabisEducation:AToolkitforEducatingYouth.Retrievedfrom:https://cssdp.org/youthtoolkit/79Simons-MortonB,etal.(2010).Cross-nationalcomparisonofadolescentdrinkingandcannabisuseintheUnitedStates,Canada,andtheNetherlands.InternationalJournalofDrugPolicy.21(1):64-980CanadianStudentsForSensibleDrugPolicy.(2018).SensibleCannabisEducation:AToolkitforEducatingYouth.Retrievedfrom:https://cssdp.org/youthtoolkit/

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whoidentifyasheavycannabisusers.81Othereffectiveinterventionsrelatedtosubstanceusecombinesupport,resources,andeducationalopportunities.82

Forstudentswhochoosetousecannabis,thereareevidence-basedtoolsthatcanhelpthemmakeinformeddecisionstoreducepotentialharms..SeebelowforthetenrecommendationsintheLower-RiskCannabisUseGuidelinesdevelopedbytheCanadianResearchInitiativeinSubstanceMisuse.”83Theyare:

Abstinence

Recommendation1:Aswithanyriskybehaviour,thesafestwaytoreducerisksistoavoidthebehaviouraltogether.Themosteffectivewaytoavoidanyrisksofcannabisuseistoabstainfromuse.

AgeofInitialuse

Recommendation2:Studiesshowthatinitiatingcannabisatayoungage—primarilybeforeage16—increasestherisksforavarietyofadversehealthoutcomes.Theyoungerapersoniswhenstartingcannabisuse,thegreaterthelikelihoodofdevelopinghealthproblemsthatarealsomoresevere.Therefore,deferringcannabisuseatleastuntilafteradolescenceisadvised.

Choiceofcannabisproducts

Recommendation3:HigherTHCpotencyisstronglyrelatedtoincreasedacuteandlong-termproblems,suchasmentalhealthproblems,dependenceorinjuries.ItisadvisabletousecannabiscontaininghighCBD:THCratios.

Recommendation4:Recentreviewsonsyntheticcannabinoidsindicatemarkedlymoreacuteandsevereadversehealtheffectsfromtheuseoftheseproducts(includinginstancesofdeath).Theuseoftheseproductsshouldbeavoided.

CannabisuseMethodsandPractices

Recommendation5:Regularinhalationofcombustedcannabisadverselyaffectsrespiratoryhealthoutcomes.Whilealternativedeliverymethods(suchasvaporizersoredibles)alsocarryrisks,itisgenerallypreferabletoavoidroutesofadministrationthatinvolvesmoking

Recommendation6:Peoplewhosmokecannabisshouldavoidpracticessuchas“deep-inhalation”asitcanincreasetheintakeoftoxicmaterialintothepulmonarysystem.

81Fischer,B.Jones,W,Shuper,P,Rehm,J.(2012).12-monthfollow-upofanexploratory‘briefintervention’forhighfrequencycannabisusersamongCanadianuniversitystudents.SubstanceAbuseTreatmentPreventionPolicy.(7)182TheCanadianCentreforSubstanceUse.(2014).SubstanceUsePreventionandHealthPromotion.Retrievedfrom:http://www.ccsa.ca/Resource%20Library/CCSA-Substance-Use-Prevention-Health-Promotion-Toolkit-2014-en.pdf83Fischer,B.,Russell,C.,Sabioni,P.,vandenBrink,W.,LeFoll,B.,Hall,W.etal.(2017).Lower-riskcannabisuseguidelines(LRCUG):Anevidence-basedupdate.AmericanJournalofPublicHealth,107(8).

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FrequencyandIntensityofuse

Recommendation7:Frequentcannabisuseisstronglyassociatedwithhigherrisksofexperiencingadversehealthandsocialoutcomesrelatedtocannabisuse.Usersshouldbeawareandvigilanttokeeptheirowncannabisuseoccasional(e.g.,useonlyononeday/week,weekenduseonly,etc.)atmost.

CannabisUseandDriving

Recommendation8:Drivingwhileimpairedfromcannabisisassociatedwithanincreasedriskofinvolvementinmotor-vehicleaccidents.Itisrecommendedthatuserscategoricallyrefrainfromdriving(oroperatingothermachineryormobilitydevices)foratleast6hoursafterusingcannabis.

Special-RiskPopulations

Recommendation9:Therearesomepopulationsatprobablehigherriskforcannabis-relatedadverseeffectswhoshouldrefrainfromusingcannabis.Theseinclude:individualswithpredispositionfor,orafirst-degreefamilyhistoryof,psychosisandsubstanceusedisorders,aswellaspregnantwomen.

CombiningRisksorRiskBehaviours

Recommendation10:Whiledataaresparse,itislikelythatthecombinationofsomeoftheriskbehaviourslistedabovewillmagnifytheriskofadverseoutcomesfromcannabisuse.Preventingthesecombinedhigh-riskpatternsofuseshouldbeavoidedbytheuserandapolicyfocus.

AdditionalHarmReductionStrategies

Additionalharmreductionstrategiescanbesummarizedby“nottoomuch,nottoooften,andonlyinsafesituations.”84Thesestrategiesare:

Nottoomuch

● Takeitslow,asit’sdifficulttoknowtheTHClevelsinacannabisproduct.● Knowyourproductandyoursupplier.Purchasefromgovernment-licensedstores,when

possible.Nottoooften

● Usecannabisoccasionallyratherthanfrequently.Especiallyavoiddailyuse.Onlyinsafesituations

● Avoidconsumingcannabiswithtobaccoproducts.● Avoidcombiningcannabiswithothersubstances(suchasalcoholorotherdrugs).● Knowthecannabislawsbeforeyoupossessorconsumeit.

84AdaptedfromHealthyMinds,HealthyCampuses.(2015).ClearingtheAir:Lower-RiskCannabisUseonCampus.Retrievedfrom:https://healthycampuses.ca/resource/clearing-the-air-lower-risk-cannabis-use-on-campus/

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Whenengagingwithstudentsinanopenconversationaboutcannabiskeepthefollowinginmind:

● Stayopen,objectiveandnon-judgementalwhenastudentspeaksaboutsubstanceuse.● Listencarefullyandseriouslywhenastudentdiscussesusingeithermedicalornon-medical

cannabisforcopingwithspecificsymptomsorconditions.● Becalm,relaxed,andpositive.Avoidusingshaming,scaretactics,orguilt.Instead,becurious,

respectful,andunderstanding.● Shareaccurateinformationandavoidlecturing.Becompassionateandcuriousaboutthe

student’sperceptionandexperiencewithcannabisuse.● Educateyourselfandusefactswhereyoucan.● Matchthelanguagethatthestudentisusing.Forexample,ifastudentusestheword”weed,“

dosoaswell.● Don’tassumethatyouknowastudent’sexperiences,feelings,orinterestincannabis.

SECTION3:Developing,implementing,andevaluatingacannabis-useframeworkforyourcampusThissectiondiscusseshowacampusmayapproachthedevelopment,implementation,andevaluation

ofacannabis-useframeworkthatemphasizeslower-riskuseandharmreduction.Eachinstitutionis

differentandyourcampusmayalreadybeworkingonaframeworkorhaverecentlyimplementedone.

Butifyourinstitutionisjuststartingtolookatdevelopingacannabis-useframework,thissectionoffers

someconsiderations.Keepinmindthatthisframeworkshouldbepartofageneralsubstanceuseand

mentalhealthframeworkforyourcampusandifyourinstitutionalreadyhasaframeworkandlower-risk

guidelinesrelatedtotobaccoandalcoholuse,theyshouldbeusedtoshapethecannabis-use

framework.

Step1:ConsiderationsforYourCampusThestrategyandtimeitwilltaketodevelopacannabis-useframeworkforyourinstitutionwilldepend

onavarietyoffactors,includingtheprevalenceofcannabisuseinyourinstitutionaswellasthesizeand

typeofcampus.

Stakeholders

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Developmentandimplementationofacampuscannabisframeworkwillmorelikelybeeffectiveif

someonewithinthecampuschampionstheeffortandhelpsstarttheprocesswithagoal,objective,a

timeline,andadirectivetobringstakeholderstogetherasacommittee.Thiscommitteeshouldconsist

ofindividualswhorepresentyourinstitution’sadministration,thestudentunion,faculty,security,

healthandsafety,clinicalservices,unions,andmaintenance.Consideralsotappingintothe

considerableexpertiseofferedbycommunityhealthandmentalhealthorganizations(suchaspublic

healthunits,theCanadianCentreonSubstanceUseandAddiction,andtheCanadianMentalHealth

Association).

Thedownsideofwiderepresentationonacommitteecanbealackoffocusandownershipofthe

framework.85Thiscanbecompoundedbythesignificanttimethatcanpassbetweenitsdevelopment

andimplementation.Thischallengecanbeminimizedbysettingaspecificandreasonabletimeline,such

assixmonthsforsixmeetings,toworkoutaframeworksuitableforsubmissiontotheinstitution’s

governingbodyorlegaldepartment.Consultationwiththestudentpopulationthroughouttheprocess

ofdevelopment,implementation,andevaluationisalsocriticaltotheframework’ssuccessful

implementation.

Reviewthecurrentclimate

Yourcommittee’sfirststepindevelopingacannabisframeworkwillbetoexamineyourinstitution’s

policiesregardingcannabisandcomparethemtothoseofotherinstitutions.Itwouldalsobegood

practicetoalignyourcannabisframeworkwithexistingcampuspoliciesregardingsubstanceuse.

Considerusingasurveytogaugecannabisuselevels,attitudestowardsandbeliefsaboutcannabis,and

campussupportforaframework.Thiswillalsohelpgatherbaselinemeasuresonwhichtobuildfuture

evaluations.Understandingratesofcannabisuseandotherattitudesonyourowncampuswillhelpyou

developaframeworkthatisspecifictoyourcampus.

Medicaluse

Yourcampus’studentandemployeeaccommodationpoliciesrelatedtotheuseofcannabisformedical

purposesshouldberevisitedtoseeiftheyrequireanychangesinrelationtonewcannabislegislation.

Incorporationofharmreductionlens

85LeavethePackBehind(2011).Tobacco-freeCampusGuide.Retrievedfrom:https://www.leavethepackbehind.org/wp/wp-content/uploads/2014/08/Tobacco_Free_Campus_Guide_web_final.pdf

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Cannabiseducationdesignshouldincludestudentfocusgroupstoensurethattheresultingpoliciesand

educationarerelevanttothem.Forexample,findingsthattheremaybealackofawarenessofthe

negativeeffectsofcannabiswouldpointtotheneedforeducationaboutthehealthandlegal

consequencesofusingcannabis.

Thisawarenesscouldbeachievedbytargetingstudents’personalprioritiesandmakingthepotentialfor

long-termconsequencesclear.Forinstance,aneducationcampaigncouldillustratehowthebiological

effectsofcannabisonthebrainandbodycanaffectacademicandathleticperformance.Asocialnorm

campaigncouldprovideinformationontheactualprevalenceofdruguseamongyouthoncampus,thus

bustingthemyththat“everyoneisdoingit.”

Educationshouldbeonepieceofamultifacetedapproachtoprevention.Manyyouthclaimthatalack

ofinformationaboutthepositiveeffectsofcannabismakestheinformationabouttheharmfuleffects

appearoverstated,leadingyouthtodisregardnegativeclaimsentirely.86Presentingabalanced

approachthatshowstheresearchontheharmsaswellasthepotentialsubjectivebenefitsofcannabis

(suchasrelaxation,stressreduction,etc.)wouldbemorepersuasive.

Studentswouldalsobenefitfromevidenceandguidelinesonhowtoreducetheirriskofharmifand

whentheyusecannabis.87Somestudentswillchoosetousecannabisregardlessoftherisks,so

resourceswouldbebetterspenttodecreaseriskybehaviourratherthantryingtoencourage

abstinence.8889

Step2:DevelopingaCannabis-UseFrameworkYourcampuscannabisframeworksshouldbeguidedbythefollowingconsiderations:

1. Thecampuscultureandcontext.

86 McKiernan, A. (2017). Canadian youth perceptions on cannabis. Canadian Centre on Substance Abuse. Accessed from: http://www.ccsa.ca/Resource%20Library/CCSA-Canadian-Youth-Perceptions-on-Cannabis-Report-2017-en.pdf 87CanadianResearchInitiativeinSubstanceMisuse(2011).LowerRiskCannabisUseGuidelines.Accessedfrom:http://crismontario.ca/research-projects/lower-risk-cannabis-use-guidelines88Leslie, K. M. (2008). Harm reduction: An approach to reducing risky health behaviours in adolescents. Paediatr Child Health, 13(1), 53-6.89Poulin, C. (2006). Harm reduction policies and programs for youth. Canadian Centre on Substance Abuse.

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a. Timingofuse.Forexample,thereismountingevidencethatspecificeventsare

associatedwithhigherratesofstudentdrinkingandcannabisuse,suchasorientation

week,Halloween,homecoming,andSt.Patrick’sDay.909192

b. Prevalenceofuse.Differentcampusesanddifferentstudentpopulationswillhave

differentratesofuse.Asidefrompre-legalizationdatafromsurveyssuchastheNational

CollegeHealthAssessment,considerusingacampus-widesurveytofindoutthe

attitudestowardscannabisandusageamongstudentsandstaff.Thisinformationwill

helpinformaneducationandharmreductionstrategyandmessaging.Inlightofthe

lowerprevalenceofcannabisusecomparedtoalcohol,messagesandplacementneed

tobecarefullyplanned.Moretargetedmessaging,usingconversationaland

motivationalapproaches,couldbeusedtoaddressthoseconsideringuseorcurrently

usingcannabisinpotentiallyharmfulways.

c. Identificationofchampionsoncampus.Recruitingamemberofthecampuscommunity

whohasexperiencewithcannabisuse,bothpositiveandnegative,andwhoistrusted

bythestudentpopulationisrecommendedtodelivereducationandharmreduction

messaging.Messagesaboutsafercannabisusecanbedisseminatedindifferentsettings

andthroughvariousvehicles,similartothoseemployedincommunicationsaboutlow-

riskdrinking93.

2. Increasingpersonalconfidenceofstaffandstudentstodiscussproblematiccannabisuse.

a. Usingaharmreductionapproach.Harmreductionbalancescontrolandcompassion

withinaframeworkofrespectforindividualrights.TheLower-RiskCannabisUse

Guidelines72canbeadaptedforstudents.

90Neighbors, C., Lee, C. M., Lewis, M. A., Fossos, N., & Larimer, M. E. (2007). Are social norms the best predictor of outcomes among heavy-drinking college students?. Journal of studies on alcohol and drugs, 68(4), 556-565.91Kilmer, J. R., Walker, D. D., Lee, C. M., Palmer, R. S., Mallett, K. A., Fabiano, P., & Larimer, M. E. (2006). Misperceptions of college student marijuana use: implications for prevention. Journal of studies on alcohol, 67(2), 277-281.92Buckner, J. D., Henslee, A. M., & Jeffries, E. R. (2015). Event-specific cannabis use and use-related impairment: the relationship to campus traditions. Journal of studies on alcohol and drugs, 76(2), 190-194. 93HealthyMinds,HealthyCampuses(2016).BalancingourThinkingaroundDrinking:Low-RiskAlcoholUseonCampus.Accessedfrom:https://healthycampuses.ca/wp-content/uploads/2015/01/Low-Risk-Drinking-Guide-2016.pdf

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b. Buildingcapacity.Increasethecapacityofcampusstafftoaddresscannabisuseamong

students.Providingstaff,suchasfacultyandresidenceadvisers,withevidence-informed

toolsandresourcesoncannabiswillequipthemtoinformstudents.

c. Cultivatingasenseofcommunity.Promotingaspiritofopennessandexchangeiscritical

tocommunity-building,bynurturingasenseofconnectednessandempathysothat

studentsdon’tfeelalienatedandalone.94

3. Theacademicandpersonaldevelopmentofstudents.

a. Providingstudentswithtoolstomanagestressandmentalhealthchallenges.As

discussedearlierinthisguide,manystudentsreportusingcannabistomanagetheir

boredom,loneliness,stress,anger,oranxiety.Forthisreason,theyneedalternative

approachestomanagenegativeemotionsandtocommunicateabouttheirdifficulties.95

ApplyingtheLegislativeFrameworktoYourCampus

Yourcampuspoliciesrelatedtocannabisuseneedtoalignwith,andbeinformedby,federaland

provincialcannabislegislation.Foracampuscannabisframeworktobesuccessful,thosewhoare

developingandimplementingitwillneedtoengagemembersofthecommunity(suchasstudents,

studentassociations,faculty,supportstaff,andtheexternalcommunity)atallstagesoftheprocess.

Campusesareencouragedtoreflectontheirmandatesandresponsibilitiesandtomaximizetheir

opportunitiestoeducateandsupporttheircommunities.

Somekeyareasthatthecampusframeworkshouldconsiderare:

1. Minimumage

a. Purchasing,possessing,consuming,sharing,andgrowingcannabiswillbelegalforthose

whoare19andolderinOntario.Thisalignswiththeprovince’salcoholandtobaccoage

limits.

2. Possession

a. Forthose19andolder,possessionofupto30gramsofdriedcannabiswillbelegal.

3. Placesofuse

94HealthyMinds,HealthyCampuses(2016).ClearingtheAir:Lower-RiskCannabisUseonCampus.Accessedfrom:https://healthycampuses.ca/wp-content/uploads/2015/01/Cannabis-Guide-2016.pdf95Griffin, K. W., & Botvin, G. J. (2010). Evidence-based interventions for preventing substance use disorders in adolescents. Child and Adolescent Psychiatric Clinics, 19(3), 505-526.

25

a. Theuseofcannabisfornon-medicalpurposeswillbeprohibitedinallpublicplaces,

workplaces,motorvehicles,andwatercraft.

b. Non-medicalcannabisusewillonlybepermittedinprivateresidences,includingthe

outdoorspaceofahome,orinaunitoronabalconyofamulti-unitresidence,subject

toabuilding’srulesorarentallease.

i. Residences

1. Individualcampuseswillbeabletodecideifon-campusstudent

residenceswillbeconsideredprivateresidences.Iftheseresidencesare

currentlysmoke-free,thecampuscandecideifnon-medicalcannabis

willbepermitted.ThisisconsistentwiththeSmoke-FreeOntarioAct

(2017),whichregulatesthesmokingandvapingoftobaccoandmedical

cannabis.

2. Privatelandlordsmayhavetherighttoprohibitsmokingorvapingof

cannabisinsidetheirproperties.TheSmoke-FreeOntarioActbans

smokingcannabisincommonareasofapartmentbuildingsinthesame

wayasitbanstobaccointheseplaces.

3. Ifaresidenceoncampusallowsconsumptionofnon-medicalcannabis,

thesmokingandvapingofnon-medicalcannabiswillstillbeprohibited

inallindoorcommonareas,includingelevators,hallways,parking

facilities,partyorentertainmentrooms,laundryfacilities,lobbies,and

exerciseareas.

4. Therearenoprovincialrestrictionsonstudentresidentsofmulti-unit

dwellingsconsumingcannabisinoutdoorcommonareas,unlessa

postsecondarycampusfurtherrestrictsthis.Privatelandlordscouldalso

seekindependentlegaladviceonrestrictinguseintheseareas.

ii. Workplaces

1. Workers,includingstudentsparticipatinginexperientiallearning

opportunities,areprohibitedfromconsumingcannabisatanysitethat

isaworkplace,accordingtotheOccupationalHealthandSafetyAct.

2. UndertheOccupationalHealthandSafetyAct,anyonewhois

performingworkwhentheyareunableorunfittodososafelycanbe

consideredahazardtotheworkplace,themselves,orothers.

26

Employers,supervisors,andotherworkersarerequiredtoaddresssuch

adangertoprotectworkplacehealthandsafety.

3. Campuspolicyshouldaddresshowtheinstitutionwillrespondincases

whereanemployeeisbelievedtobeusingorisundertheinfluenceof

cannabis.

4. Campusesshouldrevisetheirexistingpoliciesonsubstanceuseinthe

workplacetoreflectnewlegislation.

iii. Growingcannabis

a. Theprovinciallegislationcurrentlypermitsadultstogrowatotalofup

tofourcannabisplantspersingleresidence.However,thiscouldchange

dependingonthefinalapprovalofthefederalbillanditsrelated

amendmentswithrespecttogrowingcannabis.

b. Acampusmayhavenumerousresidencesonitspropertieswhere

cannabiscouldbegrownlegally.Assuch,itisuptothecampus

administrationtodecideifthiswillbepermittedoncampusresidence

dormroomsandtostatesoinitscannabispolicies.Residencegardens

areconsideredtobepublicspaces.

4. Enforcement

a. Therewillbelimitedspaceswherecannabiscanbeusedlegallyonanypostsecondary

campusintheprovince.

b. Campusesneedtoconsiderhowtheycanbesteducatesecurityandstudentservices

employeesaboutthenewcannabislegislationandrelatedcampuspolicies.

c. Legaladviceshouldbesoughtwhendeveloping/amendingcampuscannabispolicies.

d. TheSmokeFreeOntarioActimposespenaltiesforconsumingnon-medicalcannabisin

public.Theseincludeafineofupto$1,000forafirstoffenceandupto$5,000for

subsequentoffences.Campusesneedtodecideifpenaltieswillbeimposedandthrough

whichprocesstheywilldoso.

5. Retailanddistribution

a. RecreationalcannabiswillonlybesoldthroughtheOntarioCannabisStoreandits

onlinenetwork.

b. TheGovernmentofOntarioselectedstorelocationsbasedonestablishedguidelines,

includingminimizingproximitytoelementaryandsecondaryschools.

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Step3:ImplementingandEvaluatingYourFramework

Foracampuscannabis-useframeworktobeimplementedeffectivelyitmustbetheresultofaprocess

thatinvolvesasmanypartnersaspossiblewhoareinvestedinitssuccess.Mechanismsalsoneedtobe

inplacetomonitorandrespondtofeedbackthroughoutthisprocess.

Allmembersofthecommunity,includingstaffandstudents,needtobeeducatedonthedetailsofthe

frameworkusingavarietyofchannels,includingtheschool’swebsite,socialmedia,studentandstaff

handbooks,andorientationmaterials.Simplemessageswillhelpdrivehometheimportanceofthe

frameworkandofeveryone’scooperation.

Considerdoinganeducationblitzatthebeginningofeachacademicterm.Agraduatedbutconsistent

approachtoeducationandhealthpromotionwillbemosteffective,asisuseofdifferentstrategies.For

example,awarenesscampaignscanbeusedalongsidesocialmediapromotionduringorientationweek.

Partofensuringthatyourcannabis-useframeworkiseffectivewillinvolvefocusingonthesafetyand

wellbeingofallcommunitymembers.Todothis,yourinstitutionwillneedtodevelopanevaluation

processthatmeasuresindicatorsofimplementationsuccess.Thisevaluationcouldbeintegratedwith

yourbroaderevaluationofprograms/initiatives,includingthoserelatedtosubstanceandalcoholuse,

andmentalhealth.Suchindicatorscouldinclude:

● Adherencebystudentsandstaff.

● Awarenessofframeworkcomponentsamongstaffandstudentsaswellascannabisusersand

non-users.

● Perceptionsofenforcement.

● Rateofcomplaints.

● Impactoncannabisuseamongdifferentgroups(forexample,students,staff,men,women,

variousagegroups).

● Frameworkobjectivesmet.

● Levelofsupportforpotentialchangestotheframework.

Finally,foranyframeworktobeconsideredeffective,itshouldbewellreceivedbyallitsconstituents.It

isimportanttocontinuerevisitingandupdatingitwheninputisreceivedfromcampusmembers,

whetherfaculty,academicadvisors,counsellors,studentservicesprofessionals,orstudents.

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CONCLUSION

Thisguideisalivingdocument.Therecommendationsarebasedoncurrentevidence,butcannabisuse

inCanadaisachanginglandscape.Asmoreresearchemerges,someoftherecommendationsinthis

guidemaychange.Thisdocumentwillalsobeupdatedasnewresourcesthatmaybehelpfultoyouare

created.Ascampusesbegintodeveloptheirpoliciesandframeworksrelatedtocannabisuse,wewould

liketoincludetheminthisdocumentaswell.Wearealwaysexcitedtohearofnewdevelopmentsand

ideasfromcampuses,sopleasesendthemtousatinfo@campusmentalhealth.ca.

.................

Additionalresources:

1) “SubstanceUseContinuumModel.”TheCaringCampusProject.http://caringcampus.ca/resources/2) “SensibleCannabisEducation:Atool-kitforEducatingYouth.”CanadianStudentsforSensibleDrugPolicy:

https://cssdp.org/sensiblecannabistoolkit3) “LanguageofAddiction.WordsMatterFactSheet.”-TheCanadianCentreonSubstanceUseandAddiction.

http://www.ccsa.ca/Resource%20Library/CCSA-Language-of-Addiction-Words-Matter-Fact-Sheet-2017-en.pdf

4) “SubstanceAbuseinCanada:TheEffectsofCannabisUseinAdolescence.”TheCanadianCentreonSubstanceUseandAddiction.http://www.ccsa.ca/Resource%20Library/CCSA-Effects-of-Cannabis-Use-during-Adolescence-Report-2015-en.pdf

5) “Canada’sLower-RiskCannabisUseGuidelines.”TheCanadianResearchInitiativeinSubstanceMisuse.http://crismontario.ca/research-projects/lower-risk-cannabis-use-guidelines

6) “SubstanceUsePreventionandHealthPromotion.”TheCanadianCentreonSubstanceUseandAddiction:http://www.ccsa.ca/Resource%20Library/CCSA-Substance-Use-Prevention-Health-Promotion-Toolkit-2014-en.pdf

7) ClearingtheSmokeonCannabis.ChronicUseandCognitiveFunctioningandMentalHealth.TheCanadianCentreonSubstanceUse:http://www.ccdus.ca/Resource%20Library/CCSA-Chronic-Cannabis-Use-Effects-Report-2016-en.pdf

8) “Parents:Helpyourteenunderstandwhat’sfactandfictionaboutmarijuana.”TheCanadianCentreonSubstanceUseandAddictionandParentActiononDrugs.http://www.ccdus.ca/Resource%20Library/CCSA-Marijuana-Fact-and-Fiction-Infographic-2016-en.pdf

9) “UsingEvidencetoTalkAboutCannabis.”InternationalCentreforScienceinDrugPolicy.https://d3n8a8pro7vhmx.cloudfront.net/michaela/pages/61/attachments/original/1440691041/Using_Evidence_to_Talk_About_Cannabis.pdf?14406910412001

10) “CannabisLegalization.LearnWhatWillandWon’tbeLegalinOntario.”GovernmentofOntario.https://www.ontario.ca/page/cannabis-legalization

11) “CannabisTalkKit:HowtoTalkWithYourTeen.”DrugFreeKidsCanada.https://www.drugfreekidscanada.org/wp-content/uploads/2017/06/34-17-1850-Cannabis-Talk-Kit-EN-10.pdf

12) “MoreFeetontheground.LearnHowtoRecognize,RespondandReferStudentsExperiencingMentalHealthIssuesonCampus.”TheCentreforInnovationinCampusMentalHealth.https://morefeetontheground.ca/calls-to-action/

13) TheCentreforInnovationinCampusMentalHealthresourceswebpage.http://campusmentalhealth.ca/resources/resource-finder/

29

AboutOurPartners

CanadianMentalHealthAssociation|Ontario

Foundedin1952,theCanadianMentalHealthAssociation(CMHA),Ontario,isanon-profit,charitableorganizationcommittedtomakingmentalhealthpossibleforall.CMHAOntarioachievesitsmissionbybeingaleaderintheevolutionofOntario’smentalhealthandaddictionssystem.Wecontributeourknowledge,resourcesandskillstoprovincialpolicydevelopmentandimplementation.Wepromotementalhealthincollaborationwithothers.Wefurtherequitableaccesstomentalhealthservicesandchampionthereductionofmentalhealthdisparities.Andweserveourbranchesinbuildingtheirgovernanceandleadershipcapacities.CMHAOntarioisadedicatedpartnerwithinthenetworkofCanadianMentalHealthAssociationsatthenational,provincialandlocallevel.CMHAOntarioworkscloselywithits30localbranchesincommunitiesacrosstheprovincetoensuretheutilizationofbestpracticesintheorganization,managementanddeliveryofservicestoconsumersandfamiliesofindividualswithmentalillnesses,dualdiagnosisandconcurrentdisorders.AllCMHAsinOntarioworkinavarietyofpartnershipstoprovideacoordinated,continuumofcareusingthesocialdeterminantsofhealthmodel.

http://ontario.cmha.ca

CentreforAddictionandMentalHealth(CAMH)

TheCentreforAddictionandMentalHealth(CAMH)isCanada’slargestmentalhealthteachinghospitalandoneoftheworld’sleadingresearchcentresinitsfield.TheProvincialSystemSupportProgram(PSSP)atCAMHworkswithcommunitiesandserviceprovidersacrossOntariotomoveevidencetoactiontocreatesustainable,system-levelchangeandtomobilizeimplementationsupportforOpenMinds,HealthyMinds:Ontario’sComprehensiveMentalHealthandAddictionsStrategy.WithofficesinTorontoandacrosstheprovince,PSSPisontheground,collaboratingwithstakeholderstobuildabettersystemthroughourworkinimplementation,knowledgeexchange,evaluation,informationmanagement,healthequityandengagement.

https://www.camh.ca/pssp/

30

MinistryofAdvancedEducationandSkillsDevelopment

https://www.ontario.ca/page/ministry-advanced-education-and-skills-development