Public Health Approach to Marijuana

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Public Health Approach to Marijuana

• Presentation to BC Civil Liberties Association
  Conference
• BEYOND PROHIBITION
• Dr. Brian Emerson, Medical Consultant
• Ministry of Health Services, BC
• Brian.emerson_at_gems1.gov.bc.ca

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Outline and Key Messages

• Public Health Approach
• Provides a comprehensive, integrated, evidenced
  based approach to the prevention.
• Ethical Framework
• Explicit ethical principles are needed to guide
  decision making.
• Leadership
• Needed and needs to be supported, at all levels!

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Definition of a Public Health Approach
An approach to an issue that focuses on health
promotion, health protection, and the prevention
of disease, injury, disability, and premature
mortality in populations.
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A public health approach uses a multi-level
systems approach to minimize individual and
community harms while maximizing benefits of all
interventions. A public health approach operates
within a framework of guiding principles, broad
goals, and specific objectives and strategies.
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Public Health Approach

• Psychoactive substance use issues are similar, so
  similar approaches are needed.
• Current divergent approaches contribute to
  increasing harms.
• A Public Health approach can assist in
  integrating efforts, maximizing effects.

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Spectrum of Psychoactive Substance Use
Dependent
Non-problematic

• use that has become habitual and compulsive
  despite negative health and social impacts

• recreational, casual or other use that has
  negligible health or social impact

Beneficial
Problematic

• use that has positive health, spiritual or
  social impact
• e.g. medical psycho-pharmaceuticals coffee to
  increase alertness moderate consumption of red
  wine sacramental use of ayahuasca or peyote

• use that begins to have negative health
  consequences for individual, friends/family, or
  society
• e.g. impaired driving binge consumption
  harmful routes of administration

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Public Health Approach
Assessment
Policy
Development
Services
Professional Education and Training
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• ASSESSMENT
• Surveillance (measuring, monitoring)
• Health Status and Needs Analysis
• Trend Analysis
• Service Evaluation
• Research
• SERVICES POLICY DEVELOPMENT 
• Government Services Leadership
• Public Health Services Planning
• Public Education Standards
• Prevention Protocols
• Health Promotion Policies
• Health Protection Legislation
  
• Diagnosis UN Conventions
• Treatment Constitutions
• Care Resource Allocation
• Rehabilitation Advocacy
• Professional Education and Training

Public Health Cycle
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Public Health Goal and Objectives

• Goal Maximize benefits and minimize harms for
  individuals, communities, and society.
• Objectives would be developed for education,
  health promotion, health protection, preventive
  measures, treatment and rehabilitation,
  regulation, and enforcement.

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Acute Health Effects

• Psychological mood alteration, physical
  experience, intellectual functions, sensory
  changes, memory, paranoia, hallucinations, mania
• Physical cardiovascular, bronchopulmonary,
  ocular, psychomotor

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Chronic Health Consequences depends on method
and pattern of use, and individual characteristics

• Respiratory chronic bronchitis, chronic cough
• Carcinogenicty - ?lung, mouth, tongue, esophagus
• ?fetal and neonatal consequences
• Cardiovascular consequences
• ?brain function

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Ever used marijuana (McCreary Society, 2004)
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Marijuana use in the past six months (of youth
who have used marijuana - 2003) McCreary Society,
2004
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Canadian Addictions Survey

• The Canadian Centre on Substance Abuse (CCSA) is
  undertaking a national prevalence survey on adult
  alcohol and drug use in Canada
• The Canadian Addictions Survey is jointly funded
  by Health Canada and several provinces
• The survey involves a 30-minute telephone
  interview of up to 125 questions and a base
  sample of 1000 adults (15 years) in each of the
  10 provinces

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Canadian Addictions Survey

• The BC Ministry of Health, in partnership with
  the newly established Centre for Addictions
  Research in BC at the University of Victoria, has
  contributed funding for oversampling in BC
• The BC portion of the Canadian Addictions Survey
  will include 3000 samples, which will
  considerably improve the margin of error and
  allow for more accurate regional disaggregation

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Population Health Effects A large number of
people at small risk may give rise to more cases
of disease than a small number who are at high
risk.
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BC 3,210,000 people over 180.50 daily users
16,050If 1 risk adverse consequence160 If
increase to 9.0 daily users 288,900If 1 risk
adverse consequence2889If increase to 20.0
daily users 642,000If 1 risk adverse
consequences6420
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Ethical Framework

• Why needed?
• Provides the principles, rules of conduct,
  regarding decision making about issues that
  involve a complex interplay of social, political,
  economic, cultural, religious, and scientific
  considerations.

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Ethical Framework

• What?
• Autonomy (self-determination),
• Nonmalfeasance (do no harm),
• Beneficence (promote welfare),
• Utility (greatest benefit to the greatest
  number),
• Natural justice (fairness, equity,
  impartiality).

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Ethical Framework

• General Principles
• "Public policy on psychoactive substances must be
  structured around guiding principles respecting
  life, health, security and rights and freedoms of
  individuals, who, naturally and legitimately seek
  their own well-being and development and can
  recognize the presence, difference and equality
  of others. Senate Committee on Illegal
  Drugs,2002

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Leadership

• Has been called for many times!
• 1994 BC Chief Coroner Vince Caine
• Substance Abuse Commission
• 1998 BC Provincial Health Officer
• Substance Abuse Commission
• 2001 BC Addictions Task Group
• BC Addiction Council

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Leadership

• 2001 Phillip Owen, Mayor, City of Vancouver
  The federal and provincial governments must do
  much more to fulfill their responsibilities with
  respect to drug misuse and the illegal drug
  trade.
• 2002 House of Commons Special Committee
• Canadian Drug Commissioner
• Expand mandate and funding of Canadian Centre
  on Substance Abuse.

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Leadership

• 2002 Senate Committee on Illegal Drugs
• National Advisor on Psychoactive Substances and
  Dependency within Privy Council Office
• Canadian Centre on Psychoactive Substances and
  Dependency
• Monitoring Agency on Psychoactive Substances and
  Dependency

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Conclusions

• Commitment to supporting leadership and action at
  all levels is needed.
• Establish positions and structures mandated to
  take action to demonstrate this commitment.
• A public health approach within an explicit
  ethical framework is needed to guide action.