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As the federal deadline for cannabis legalization draws nearer, work done by O’Brien Institute for Public Health researchers is lighting the way for policymakers in Alberta, and across the country.

When the Alberta government went out looking for evidence — cold, hard facts about marijuana that could inform a made-in-Alberta strategy with respect to federal legalization — back in June of 2016, it came knocking on the door of the O’Brien Institute’s Health Technology Assessment (HTA) Unit, at the ��ݮ����Ƶ����'s Cumming School of Medicine.

The result was the Cannabis Evidence Series, an exhaustive look at cannabis on five key topics: health effects and harms, medical cannabis, advertisement and communication regulations, experience with legalization in other jurisdictions, and the current Canadian context. It is one of the most comprehensive examinations of cannabis compiled along the road to legal marijuana.

“It was a huge piece of work,” says Fiona Clement, PhD, director of the HTA Unit, assistant professor in the Department of Community Health Sciences, and one of the report’s 16 authors. “It consumed our team for four months. By far it’s the biggest evidence synthesis I’ve ever done.”

The work paid off. The document served as a basis for discussion at a recent series of roundtables with dozens of stakeholders. Everyone, from the RCMP and Indigenous groups to municipalities, school boards and Restaurants Canada, discussed everything from minimum age of purchasing, to public consumption, and protecting workplaces.

Since then it has echoed across Canada with copies distributed to other provinces, the federal government and, more recently, the Canadian Institutes of Health Research, which was looking for a way to identify research gaps they could target with a five-year commitment to cannabis research.

It became quite clear when the province first began exploring policy objectives for managing legal cannabis just how complex the issue really was, says Andy Ridge, executive director of policy for the Alberta Cannabis Secretariat. “We knew we needed rigorous, evidence-based reasoning to guide and support our policy decisions, and that’s exactly what the ��ݮ����Ƶ����’s Health Technology Assessment Unit provided us,” he says.

“The Cannabis Evidence Series was used to help inform many of our decisions around protecting public health, and was also incredibly valuable as a publicly facing document to inform and educate stakeholders and everyday Albertans throughout our engagement process. As Alberta, and the country as a whole, moves forward with cannabis legalization, the evidence-based analysis presented in Cannabis Evidence Series will continue to be a marker of sound policy decisions, specifically around protecting and promoting public health.”

Complex, multi-faceted and teeming with public health ramifications, the file was a natural fit for the O’Brien Institute, says its scientific director, Dr. William Ghali. “This is precisely the kind of work that we are trying to do in spades in the O'Brien Institute,” Ghali says. “We are seeking to inform public policy for health through our research and knowledge translation activities. Fiona Clement and her team have done tremendous service to the people of Canada through this work."

For Clement, the journey was eye-opening. The data challenged some widely held beliefs — it’s not a gateway drug, “There is no case for that,” Clement says — and some of her own perceptions.

“One thing that really surprised me was that the locations in the United States that legalized did not see an increase of use in populations,” she says. “So this criticism that we’re going to go hog-wild and be high all the time is not panning out. That was a good thing to observe so we can put that conversation to rest and focus on other things.”

In U.S. states where edible forms of cannabis are more prevalent, “We did see an increase in calls to poison control and ingestion among children under the age of five, admissions to emergency rooms,” Clement says. “Thinking about our own poison control hotline, are we prepared with scripted material for nurses to assess for this? That’s something we could be really proactive about.”

The researchers also found an unsettling trend to underestimate the harms associated with cannabis use: an association with those who are at an increased risk of testicular cancer, for instance, neurocognitive brain changes, poor outcomes after use during pregnancy (low birth weights), and mental health problems including psychosis, mania, and schizophrenic relapse.

“It flags for us there is a need to remind people that it’s not harmless, that there are risks and that responsible use is going to be important.”