“Are you ready to order?”
“Everything looks delicious, but I think I’ll go with the chef’s tasting menu.”
“Can I interest you in the cannabis pairing to heighten your meal experience?”
On 17 October 2018 marijuana will become legal and will join alcohol as a recreational drug available to adult Canadians. Through an extensive and exhausting search (I Googled it) I discovered that the legislative framework for nonmedicinal cannabis use is outlined in the Cannabis Control and Licensing Act. The Liquor Distribution Branch will be the wholesale distributor of nonmedicinal cannabis in BC and will run the provincial cannabis retail stores. The Liquor and Cannabis Regulation Branch will also be responsible for licensing and monitoring private nonmedicinal cannabis stores.
I gleaned the following facts from the Cannabis Control and Licensing Act and can’t help but make some parallels to alcohol consumption in our province. Adults may possess up to 30 grams of cannabis in a public place. If we assume half a gram per joint, that is the equivalent of carrying around five cases of beer or 10 bottles of wine. The Act prohibits cannabis use where smoking is prohibited, plus other places where children commonly gather. It doesn’t say anything about walking down the street or toking up outside office buildings, stadiums, theatres, etc. In contrast, I’m pretty sure I’m not allowed to start chugging my wine in these locations. According to the Act, adults may grow up to four marijuana plants per household, but not if they have a day care. Notably, there isn’t a law that prohibits “Toddler Care R Us” from getting their children to make homemade wine. I discovered that the Motor Vehicle Act has also been amended and a driver can be suspended by a DRE for suspected marijuana use (your prostate is a little big, so give me your keys). DRE in this case stands for “drug recognition expert.” The police bring in Cheech or Chong to look you in the eye and exclaim, “Dude, you are so stoned!”
I am confident that the rules will evolve as there will definitely be an adjustment period for this new legislation. I’m curious if in coming years cannabis will be woven into our social fabric as much as alcohol is. “Honey, remember we are going to the Smiths’ for dinner tonight. Should we pick up some of that Indica Bob likes?” Will people go to cannabis tastings or on cannabis tours? Will restaurants offer cannabis-infused menu items or after-dinner marijuana treats? Will marijuana become part of attending sporting events? I have already heard about alcohol producers rolling out beverages laced with cannabis.
One of the government’s stated reasons for cannabis legalization is an attempt to remove the criminal element from its production. To achieve this end, cannabis will have to be priced reasonably to discourage development of a for-profit black market. This brings up the question of quality. Will the commercial product eventually outdo individual growers, as it has in the alcohol industry? Most would have to agree that people who make wine for a living do a much better job than the average garage vintner. As a result, will people be willing to pay a premium for quality, like they do for high-end Scotch, vodka, tequila, etc.?
More relevant to physicians is the effect that legalization of nonmedicinal cannabis will have on medicinal marijuana use. I mused about this issue in my June 2017 BCMJ editorial. Unless the price of the medicinal product is significantly less than the nonmedicinal one, I think this industry is in trouble. If a consumer can select from a wide range of reasonably priced quality products in a government store, why would they bother getting a prescription from their physician? The only reason I can think of is if some drug plans start listing marijuana as a covered benefit. The physician-staffed medicinal marijuana specialty clinics also seem to be in jeopardy. Why would an individual attend such a clinic when they can pop into their local cannabis store and purchase whatever they need? I’m not aware of any specialty medicinal alcohol clinics. “You were right Doc, that whiskey you recommended really does help my arthritis.” Perhaps there will be some business in advising individuals about cannabis that is high in cannabidiol (CBD)—the proposed therapeutic ingredient—and low in tetrahydrocannabinol (THC)—the psychoactive ingredient. I am skeptical that CBD oil will be a big seller in the non-medicinal stores, but I could be wrong.
I remain concerned about the long-term health impacts of nonmedicinal cannabis legalization, particularly among young people. The Act limits cannabis use to individuals 19 and over in most provinces, but similar legislation hasn’t restricted alcohol use in minors, and with the new law the amount of accessible marijuana in our communities will likely increase.
Like many of you, I will be an interested spectator as this new direction of recreational drug use unfolds in British Columbia.
Above is the information needed to cite this article in your paper or presentation. The International Committee
of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally
accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.
About the ICMJE and citation styles
The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.
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For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org