 Hello, welcome back to another class. I'm Frances Macintosh and the acting associate director of the Health Law Institute. And today's talk is the first of our winter season. As usual, we're going to hear from our speaker until close to one, and then the floor will be open for questions. So our speaker today is Dr. Robert Strang. At his appointment in 2007, other province's first chief public health officer was a cornerstone of the province's initiatives to try to do something about our public health system. And all of Canada had just seen through the mail-in report the deadly and costly consequences of neglecting your public health system. It was highlighted by SARS, tainted blood, Lockerton, North Fabbledford. No one specially commissioned its own review, external review, importantly, and concluded, among other things, that we needed a leader. Under Dr. Strang, our province has developed clear and meaningful standards and protocols on communicable diseases, population health, health equity, priorities, planning, accountability, and evaluation. Thank you so much. Basically, we're on our way to really getting it together. So today we're going to hear from Dr. Strang the complexities that legalizing marijuana has brought to Dr. Strang's office. I'll hand you over to Dr. Strang. Thank you, Connie. Good afternoon, everybody. Public health intervention. There's more people than there are seats, and that's due to the topic, not the speaker I know. But it's also good for your health if you stand up. So if you're so inclined halfway through the talk, if you're seating, maybe exchange seats with somebody who's standing. I know some people need to sit, but it is good to get up out of your seat. So I'm going to talk about the journey we've been on with cannabis legalization. This has been a very fascinating experience and remains a fascinating one where there's still lots to do, the complexities of this. But I'm very interested in the interface between public health and the law, because I have a strong belief that legal tools have the potential to have a significant impact, positive or negative, on the health of a population, which is my field. So I'm very interested in how do we actually strengthen the interface between health and the legal community to do things like consider should substances be legal or illegal? And as we're doing in Canada, a grand experiment of shifting a whole category of substance, cannabis. And it's in its two main psychoactive substances, THC and CBD, shifting them from illegal to legal. And how do we do that? I'm going to talk about the journey we've been on, trying to find a balance of the different objectives in there and where we've landed, but also where we continue to go and some of the challenges moving forward from there. So I didn't get a chance to put on edibles on there, but this is, so the journey started, if you folks are going to recall, we have a prime minister who back in the last federal election made a promise to legalize cannabis. There's certainly been 20 years or more of significant lobbying and efforts to try to do that, but this is so, and I'm a plug for my afternoon seminar this afternoon. It's around a policy discussion. The prime minister then opened a policy window, and so advocacy is all about timing. So before then, there was no appetite. All of a sudden you had a leader and somebody in an elected position who was open to the policy possibility. So then what do we do with that? Government step then was about eight to 10 months later, they created a task force. Folks may have participated in that, led by a former politician and Chief Justice, Anne McClellan, who they went around the country, had consultations with large groups. I participated with a group of government officials from the four Atlantic provinces in an all-day session with them, August of 2016. They had all sorts of online mechanisms for public input. All that work then resulted in the task force report, which was released just before Christmas 2016. And the outcome of that was bill C45, which legalizes cannabis, and then bill C46, which revamps substantively the federal legal framework against impaired driving. I think it's fair to say that if you look at, as we go through the bill, if you understand and have read what's in the task force report, the federal government leaned very heavily on the task force report recommendations. And we were on target for, we were meant to be July 1st, 2018. It's probably good we didn't legalize cannabis on Canada's national birthday. That would have led to some industry issues. But we ended up having October 17th, 2018, that cannabis, or some forms of cannabis became legal. And what I do need to add in there is that there is a commitment by the federal government, and we'll get into this, that no later than October 17th, 2019, edible and concentrated, edible cannabis products and concentrates and what they're calling topicals will become legal as well. So I think it's fair to start where did we land in terms of legal responsibility? So the federal government has retained that it's their legal responsibility, and then with that comes all the responsibility around compliance, enforcement, et cetera, that they're in control of the production and licensing. So if you want to be a legal cannabis producer, there's a whole series of requirements that you have to meet to get a federal license, and you'll be federally inspected. And those same requirements around that exist today for production and licensing of leaf product, dried product will remain intact for edible products. And I'll come back to that because that's important because what it really means is that the only way a restaurant could actually serve cannabis-infused foods is to become a licensed producer. And we'll come back to that. They've also committed that it's the federal responsibility to establish what they call a seed-to-sale tracking system. So how are we going to monitor product, both in terms of how much product is being produced, where is it being distributed, who's buying it, what kind of a recall system do you have to establish to respond based on having a seed-to-sale tracking system that will allow you to do that? They've also indicated that the system for accessing medical cannabis, and I use the word cannabis, not marijuana, even though it's on the slide, because cannabis is a more specific scientific term than marijuana. The medical cannabis system, which has been in place for close to 20 years, roughly, where if you believe you have a medical condition that would benefit from cannabis and you get authorization from a physician, you can then, with that authorization, then access cannabis, medical cannabis, and the only way to access it right now is online and get it delivered to your home. They've maintained that as a separate system from non-medical cannabis system. We'll come back to that, whether that's how, whether those two systems are necessary, the pros and cons, that's one of the issues moving forward. The federal government also set up some rules around what the minimal legal age and around home cultivation, but they then gave the province, shifting to provinces, they gave the provinces the ability to go further if they chose in those areas. The rest of what they would land with the province was really, so the federal government or the production side, the responsibility was then left with the provinces around the wholesale, the distribution, and then the retail model, as well as the rules around public consumption. And then much of the enforcement of this, because that's done through policing, becomes in a provincial and municipal responsibility rather than the production side, but around people who were perhaps accessing and using cannabis outside of the legal framework that becomes a police enforcement issue. I think it's important that the objectives or the purpose of legalizing cannabis is laid out in section seven of the Act and I think it's important to go through that. So as a public health person, I'm very pleased to see that the first objective is to protect the health of young persons by restricting their access to cannabis. So that's a public health and public safety-focused objective, as well as the second bullet, protecting young persons from inducements to use cannabis, so that's about marketing, et cetera. So right away with that purpose statement gives you some idea of why the limitations on marketing, et cetera. The other objective really then comes with creating a legal production system and then a legal market with the objective to try to shift the production and the use of cannabis into that legal market and minimize the illegal market. And one of the outcomes of that should be a reduction of the burden on the criminal justice system by creating legal cannabis. A third objective, kind of a high-level objective is creating a quality control supply. With an illegal market, there's absolutely no way to control the quality and safety of the product and that's by making it legal and all the criteria that go into being a legal producer and all the safety issues, then you have that ability for quality control. And the last objective is, which is actually as you raise public awareness on the health risks. I think this is an important one that now that we have cannabis as legal, we can actually have a much more open and informed dialogue around the risks and any potential benefits of cannabis. Whereas as long as it remained illegal, it was really hard to talk about cannabis in a detailed way in schools, for instance, or engage young communities around a discussion around cannabis. Now we can do that in a much more evidence-informed way. So those are the high-level objectives. So what's actually in Bill C-45? So the federal government set an age limit of 18. So you had to be 18 or older to possess and use cannabis. But again, they gave provinces and territories the ability to go beyond that if they chose. And the amount, so you can possess 30 grams, up to 30 grams of dried cannabis, or they've got formula of the equivalent because what was legalized was fresh, dried oils and then plants and seeds. People who are under the legal age have possessed more than five grams, will be subject to federal legal jurisdiction, so the Youth Criminal Justice Act. They also set a limit that a household and their definition of household was, I don't have a front, but it's fairly broad. So I kind of use people, some of you in the audience will get this from Dallas. So a student house with six bedrooms, that's not six households, it's one household. So in a household, there can be up to four cannabis plants. The draft legislation had some restrictions on size. Though in the consultation and then the back and forth between parliament and the senate, those were removed. And they've had significant restrictions on overall, on marketing and promotion, but it's prohibited to market in any way, market and promote cannabis to people who are under the legal age. As I've said, so the products that October 17th of last year were legalized, dried cannabis, oils, fresh cannabis and plants and seeds. And then as I said earlier, we'll get into some more depth, but I'll just go over the limits in top of the work. They also produce a little bit of wiggle room. So if you were over the limits, but just a little bit, so you have over 30 grams, but up to 50 grams or over four plants, but less than seven plants, then it was just a tickaboo offense. There was no, it wouldn't come under the criminal justice system at all. And then they've, and that then is one that even though it's federal jurisdiction that falls to then local policing actually to enforce that in some way if they choose. And then again, I've mentioned the cannabis tracking system. So I'm just going to touch on impaired driving. And there are probably folks in the room who know more about the impaired driving than I do. I'm in a legal building, so I won't go too far. But I think it's important that these were tied together. So the changes to impaired driving were the, I guess the impetus for that was legalizing cannabis, but the changes are much more, it's not just to accommodate now legal cannabis. They've made a fundamental rewrite of all the laws around impaired driving. And from a public health perspective, I know folks in the room, even folks in the room may have a different perspective, but one of the main things that is in place now is that police no longer need to have some justifiable cause to ask for a roadside breathalyzer test. So they can, as they're doing a roadside check, pulling people over for looking at your license and see if you have your safety inspection, they can say every third car, we're going to ask you to step out and do a breathalyzer. They do not have to have reasonable cause anymore. That certainly is going to be open for charter challenge, but in ongoing conversations with the federal government, they repeatedly say that they feel that is, they'll be successful in withstanding those charter challenges. From a public health perspective, this is actually a really good thing, because what it does is it increases the likelihood of somebody actually who's getting caught if they drive impaired. We still have an ongoing issue, especially about young males with impaired driving. And when we've done focus groups except for with young males, repeatedly they say, we know the risks of driving impaired. We know it's illegal, but they make, in their head, they make a calculus about those risks versus what is the risk of me getting caught. And they know that the risk of getting caught, especially in rural Nova Scotia, is very low. And I just saw something recently that is a shocking about, I think, something about some mad Canada. Eight out of 10 impaired drivers, actually, of those even who are stopped by police, aren't detected. I think that was the number. So this is a significant problem. So increasing the likelihood of being tested by removing the need for any probable cause should significantly increase that internal calculus that people make about, you know, all of a sudden there's a much greater likelihood that I'm going to get caught. Therefore, we are likely to see a reduction in impaired driving and the significant issues around motor vehicle crashes and all the health issues that result from that. I know people say, well, it's infringement of rights and that's a different perspective, but from a public health perspective, this is a good thing. The other key pieces that have been put in there, they've tidied up and removed some, you know, little small changes which make it more efficient. That is my understanding from my colleagues in the Department of Justice. The other key pieces they have now put in the ability for roadside saliva tests and they have certain criteria. If it's just alcohol or just cannabis or a combination of alcohol, cannabis, what actually constitutes a level of impairment? We certainly have to acknowledge that the science around the level of, because what they're measuring through saliva test is the level of THC. And it's well acknowledged that that doesn't, the science is not advanced enough to say if you have a certain level of THC in your body that equates with a level of impairment. Like we have science that governs blood alcohol level. We'll get there, but in the meantime, we have to go on the saliva tests. There are lots of issues because THC persists in the body. It doesn't necessarily mean you're impaired. Somebody who's never used cannabis before and somebody who uses cannabis daily, the same level of THC produces a different level of impairment. But we have to start somewhere. And I think the police are working to say how do we implement this in a very practical way that really the focus on people who are acutely and very highly intoxicated with THC, that we detect them and get them off the road. And one of the things that Nova Scotia, that many other provinces have done is along with the federal law, Bill C46, they're establishing roadside sanctions. So under provincial legislation, somebody who is impaired, deemed to be impaired, you can just get them out of the car and pound the vehicle, et cetera. The objective is to get them off the road as quickly as possible and keep people safe. So now let me move to Nova Scotia. So throughout 2016, early 2017, there was all this back and forth between where is the federal government going to land, because we need to know where the federal government is going to land before we could know how we're going to deal with some issues in Nova Scotia. But one of the first things we did, if you remember I went through the section 7 of the Bill C45, if those are the federal objectives, what are then are the provincial policy objectives? And we were able to, I believe it's a success by establishing these objectives and we actually have them written into the preamble to the provincial legislation, which is, I believe, important. But again, the provincial objective, the first objective is protecting public health and public safety, as well as, as you can see, the objectives around establishing a legal market and minimizing organized crime. We did have an objective of national or regional consistency. I don't believe we were very successful in that. There's quite a patchwork and a difference if you go from province to province around. Minimum age is fairly consistent, but certainly the rules of public consumption and what the retail model is, is there's significant differences. So at the end of the day, in the province, we will establish one new piece of legislation, the Cannabis Control Act. And there's been substantial amendments to accommodate legal cannabis, first of all, the Liquor Control Act, which actually allowed the creation of the Nova Scotia Liquor Corporation to actually legally be the only entity that's legally allowed to sell cannabis in Nova Scotia. Our Smoke Free Places Act, which was built around initially tobacco smoke, but we had several years ago, it was really to accommodate hookah, but also knowing that there was a lot of public consumption of cannabis, even though it was illegal, but the change in there, which has prior to the federal moves, had already made the consumption of, sorry, the smoking or vaping of cannabis in public spaces and indoor workplaces illegal. And then changes of the Motor Vehicle Act to accommodate impaired driving, and then there's some other pieces of legislation that really had to make changes in language, not intent and implications to accommodate legal cannabis. So where did we land on some issues in Nova Scotia? So first of all, although the federal minimum age was 18, and a number, certainly the public health community, myself included, were saying, really what makes sense from a legal age, from a protecting public health would actually be 21, but we landed at 19, and that is a compromise between public health objectives, but knowing that there was concern that the higher you go, if one of your objectives is to get people from an illegal market to a legal market, and older teenagers and young adults or the age group where there's the highest use of cannabis, well, if the higher you set the minimum age, the more likely you're keeping people in actually in the illegal market. So the compromise was 19, and most other provinces, and there's three that are 18 and the rest are 19. Nova Scotia, the decision was made that the only authorized retailer of legal cannabis is the Nova Scotia Liquor Corporation. I believe that's up to 11 stores now. One of them is the standalone, the rest are combination stores, and there's discussions underway about how many stores ultimately do we need. I think the initial number of nine was really landing on what was feasible to get built or renovated and actually get opened by, what was July 4th and October 17th. There's certainly a recognition that's probably not enough, but this was a feasible number to actually get up and going. There's also an online capacity, so you can order online, so you have to first go into a store or give age verification that you then use in subsequent purchases when you can order online. Some other provinces have followed this model. A number of other provinces, Ontario is transitioning, Alberta went to a private model, and some are a mix. Nova Scotia was the only province, even though the Federal Task Force, their recommendation was not to co-locate tobacco and cannabis, because concerns around facilitating co-use. Nova Scotia chose to build basically a store within a store model. Other than the one standalone, the rest of them are a cannabis store within the alcohol outlet. But we have to follow provincial regulations on this, so people under 19 cannot go in the stores. They're not visible from outside of the store, and you can't take your cannabis out of the store and then go get some wine and purchase both together. I believe you can take wine in and then purchase both together, but you can't take the cannabis out. You have to purchase it in the store. And there's a whole bunch of in-store kind of public awareness and information that's there as well. We revised the smoke. We used this opportunity to really be pushing forward and expanded public outdoor places that are covered under the Smoke Free Places Act. So prior to this, the Smoke Free Places Act prevented essentially the burning of any combustible product in an indoor public place or an indoor workplace or anywhere outdoors that was in four meters of an entrance or an air intake. We have under this Provincial Smoke Free Places Act, we've now actually expanded that. So sports, basically recreational area, sports field, trails, beaches, provincial parks. Use of tobacco and smoking of tobacco and cannabis isn't allowed. However, in provincial parks, we have allowed for some of the campsites will be allowed to be designated smoking campsites. And that's under the, I guess, the thinking on that is that those are people's temporary homes and so we need to allow them to smoke in their temporary home if they so choose. We also gave provinces, I'll get into this a bit more, the province gave the municipality the ability to go further and we'll talk about HRM in a minute. The provincial decision was made though for youth who, as you remember, the federal government said if they're over five grams, they're under federal jurisdiction, but they're left at the provinces. So youth with, or people, minors who have small amounts of possession, that's a provincial jurisdiction and they'll either just simply have the product confiscated, they may get a ticket or restorative justice. I think the Department of Justice is working out the details of that with police departments. We maintained the federal limits on how much can be grown in a house, but we also gave the ability, so landlords or rental properties, landlords have the ability to ban the growing of cannabis if they so choose within their rental property and they also have the ability to ban the smoking of cannabis as well. And as I mentioned earlier, there's administrative, provincially led administrative sanctions and impaired driving. So a bit more around the cannabis consumption because it is somewhat confusing. So I mentioned what we did provincially, gave municipalities the additional ability to go further and HRM, and there's been, I think, two or three other municipalities that have followed their lead, said that outdoor, there will be no smoking of, or vaping of cannabis or tobacco on any municipal outdoor property except where it is designated that you can smoke. And I know there's lots of confusion about that and there's issues about while it's there, but nobody's enforcing it, but I think we have to be patient with this. To me, this is an important, and I was pushing for this, I'll be honest, provincially. I think this is a very important step around creating a community where non-smoking is the norm. Because up until HRM, Pastor Bylaw, the public norm, we made significant progress in reducing smoking rates, significant progress in creating non-smoking is the public norm, but our overall messaging was that it's okay to smoke in public except where we tell you you can't. What HRM has down now has flipped it around and the public norm is that you can't smoke except where we tell you you can. I think that's an important difference in terms of changing the kind of social norm we have around smoking. So we'll see, but there's lots of issues around that, but that's where we've gone at HRM and I think it'll be interesting to see how they roll this out, especially when we get into the summer. One of my big concerns was as we get into nicer weather, we have public events and festivals, et cetera, I always said do you really want to be able to take your family downtown somewhere or to some public event and somebody can stand beside you and light up a joint? And under the provincial laws, you would be able to. So the HRM has gone further than that. So let's go on. So legal forms of cannabis. Where are we at now? The left-hand side, that's what was legalized by perhaps before October 17th of this year, the federal government's also going to legalize edibles, extracts, and topicals. So topicals are creams, lotions, anything or anything that goes on your skin, hair, et cetera. The extracts are concentrated products. They're also for not sure what the reason is, but they're also shifting the cannabis oils under these new three components under the regulatory framework. Sorry that's a little bit small. I had to crowd a lot of information. Part of this was that they identified that there's some unique public health implications for these new products. Certainly, edible products have a higher risk of over-consumption. An edible product, the THC, has a much significantly longer time of onset than smoking or raping. People don't normally understand this, and in certain some of the states, U.S. states have gone before us, they've seen a significant increase in overdose intoxications, people who maybe take a muffin or a brownie or whatever, and then they 30 minutes later, it's nothing's happening and they take more. And then once it starts to kick in, they're in an overdose state. So that's an issue or an over-consumption. There's also an issue about accidental ingestion, and we've had one issue that I'm aware of that's been in the media here in Nova Scotia of a child not knowing it was a cannabis product. I think it was just the normal chocolate barnated. So that's an issue we have to be aware of. And as we introduce edibles onto the market, some of my colleagues from Food Safety are here. We have all the issues around maintaining food safety with this new kind of class of food products. We also know the extracts. So that the extracts are the concentrates. These are very highly concentrated forms of cannabis that they're allowing on the market, but because of the high concentration, they have unique risks to them themselves, and we actually don't know a lot about them. So there's some concern on having these products on the market, but I guess the justification is, like other things, they're already in the illegal market. Let's bring them into the legal market and have a better ability to understand them and control them. And in all the issues around, there's some safety issues around producing concentrates that there's some kind of safety issues around explosion and flammable, et cetera. The other thing is, though, that even though there's some risks, if you look at the low-risk cannabis use guidelines, which are based on if you choose to use cannabis, here's how you can do it in a way that reduces your risk, one of the key points in those guidelines are to actually use a non-smoking, vaping form of cannabis. So from that perspective, if we can create products of cannabis which help people shift from a non-smoking, vaping form of consumption, there's likely to be overall public health benefits from that. The other issue, which is really market-driven, is that you listen to anybody in the industry that the one demographic that's likely to increase their use of cannabis is people of my age. And overwhelmingly, they are looking for non-smoking, vaping forms of cannabis. So astutely, if we want to bring that demographic into the legal market, then we have to have products that they're going to want to access from a legal market. So I won't go through all the details, but the proposed regulations around the sort of edibles are around. So it's important to know that the only type of edibles that will be allowed to be legally sold, and I think it's important to just to clarify that, it's currently loud since October 17th of last year. It's perfectly legal to buy cannabis and then make your own edibles at home. You just can't sell them. What's been made legal is actually the production and sale of cannabis edibles. But they're going to have to be prepackaged and shelf stable and single serving packages. And coming back to whoever produces these is going to have to have a cannabis production license and meet all those federal criteria. Essentially what the federal government has said no to a restaurant sector of producing fresh cannabis infused foods. So they're opening the door to edibles but opening it in a cautious way, which again from a public health perspective is a good thing. There's all sorts of regulations around the different food products and the limiting amount of THC, all sorts of criteria around they have to follow the plain packaging rules and cannabis labels on products. They can't be oriented to children, the types of foods and the marketing. And there's a lot of restrictions around the overall or on the packaging and marketing that has to be there. As well as regulating the other kind of components that can go in there and anything, any edible product that's made has to be made and all the regulations adhere to existing food safety regulations on the Canadian food inspection. So I'm going to end up so that's where we are today and certainly where we are right now with Edible, the federal government has produced a discussion paper with all the details that I just talked about that's out for consultation and where it's certainly Nova Scotia. I see it all. I represent the Department of Health and Wellness on a steering committee on cannabis legalization and we're in the process of developing Nova Scotia's response to that consultation. And there are going to be, you know, so there'll be all the provincial, territorial governments, all sorts of public groups and the public itself that will get to respond and so we'll see where the federal government lands but we are going to have Edible cannabis products in the near future. One of the early issues that kind of, I think we need to pay attention to moving forward, one of these to me, the main one is can we maintain a balance between protecting public health and public safety and opening up a legal market? I think we have done not perfect but a reasonable balance of that, allowing illegal product, but things like the significant restrictions on marketing, on the plane packaging, limited amount, limited types of Edible products, those are all good for protecting public health. But there's certainly a huge push on groups and industries who want to make money off the sale of cannabis. So I'm not sure over time that governments are going to be able to resist the heavy, push to commercialize and with commercialization comes marketing, comes hype on the non-evidence-based health benefits, all that kind of stuff, like we have for our all, like we have fought 40, 50 years to try to roll back on tobacco. So this to me is one that as a public health person that we need to keep a very close eye on and one that actually worries me over time. Along with that is that the question I have is we're trying to build monitoring, what I call monitoring systems. So are we tracking all the outcomes? What has happened in the health system, in the justice system, in community services, in society? What are the outcomes that we would anticipate changing from cannabis legalization and are we investing enough to actually monitor those? Because the monitoring is really important for us to say, are we finding the right balance between protecting public health and safety? And I'm not sure we are. We're not very good in many ways in our government systems. We usually make a policy decision and then we forget about what it takes to actually get data and information and not just a national survey, but we actually need data that you can actually, from national to provincial to local, all the way down to individual communities. We're trying to build that in Nova Scotia and where we participate in a federal provincial territorial group, but this is one again that I'm not sure that we've got the right investment and attention on this and it's fundamentally important. This is a grand experiment. We have an obligation to evaluate that experiment, both for Canadians, but also the whole world was looking at us and what evidence are we going to generate from this? Some of the implications of edibles. Edibles is the one, I guess it's complex, but there's going to be lots and lots of pressure. The federal government is open the door cautiously, but there's a lot of pressure. They're being lobbied heavily from the restaurant sector who want to serve cannabis infused, whatever. There's going to be a whole push on this, as well as a whole push from what I call the wellness industry that wants to promote all sorts of natural health products that we are sold today and promoted. All good for your health, but there actually isn't any evidence that supports that they actually have the health outcomes that they're claimed to have. Especially when you get into the edibles and the topicals, those are really what the wellness industry is going to try to push or push even further. I think, again, this is an area, edibles are going to be really hard to resist all those pressure. The other piece is that where are the edibles going to be sold? Because once we move beyond that NSLC, well, NSLC is not, perhaps doesn't want to deal with edibles, then who does get to sell them? And once we open the sale of edibles, where do you stop? So there's real implications around increasing access, increasing marketing, which then further normalizes the use of cannabis. Where the intent of cannabis is not to increase, in any of the policy objectives, there's no way there that says to increase the number of Canadians who are using cannabis. But there's real possibility of, especially as we open the door to edibles on that. There's a whole conversation about what's the future of medical cannabis, do you keep a separate stream? Despite all the anecdote, and there is quite a bit of anecdote out there, there's only a handful of medical conditions where there's even a reasonable amount of evidence that using cannabis and either THC or CBD actually has a health benefit. So how do we actually do the research and can we hold back the demand and the marketing while we build that evidentiary base? I'm not sure we are going to be able to because that horse is kind of somewhat out of the barn. But despite all the health claims, there's not a lot of evidence. However, there's a few places. I think there's a big interest in how to, what's the role of cannabis in chronic pain? Both in terms of treating chronic pain, I think that's an area of active research. But what potentially could the role of cannabis be in shifting people from opioids, which we know have significant harms to perhaps a less harmful? I don't know the answer, but I think that's things, those are questions we need to be actively exploring. I have a lot of concerns around the co-use of alcohol and cannabis, and that's something we need to try to actively discourage. But there's lots of issues around legalizing cannabis, what's going to happen around the consumption. And this, I'll come back to the monitoring piece. We need to look at just cannabis, but we should be looking at how is the use of a whole range of products, legal, tobacco alcohol, any illegal, other illegal substances? Because it could be if we looked at cannabis and say, let's say two years from now, we see the use of cannabis in young people has gone up. And we say, oh, that's a bad thing. But if that's at the same time, and this is possible, the use of alcohol, which is declining, continues to go down, and that maybe young people are shifting from alcohol to cannabis, that may be a net benefit. So we need to look at this carefully. And then the last piece, because it's a legal crowd to some extent, there are lots and lots of, lawyers are going to make a lot of money in the next decade off this issue. There's a lot of potential legal challenges, not just in impaired driving, but all the whole federal regulatory environment. People who perhaps are desired to be a part of the legal market is not allowed under the federal or provincial regulations are going to challenge that. There's all sorts of issues here. So there's lots and lots to learn. So I think my main message is lots of good things have happened. We're opening to the door fairly cautiously. There's some warning signals that we need or areas of concern that we need to pay close attention to. So this is a grand experiment that we need to be prepared to monitor and then adjust as time goes on to build a better evidentiary basis. So thank you. And now we get to move into... So you talked a little bit about the restrictions around marketing, especially to young people. Why are those restrictions in place for alcohol as well? Perhaps they should be. From a public health perspective, yeah. So one of the things we need to talk about is that we've introduced plain packaging and significant restrictions for tobacco. As we legalize cannabis, we're doing this pretty close to the same. Why are we 180 degrees different from alcohol? And so, yes, we have to recognize that alcohol is our number one drug of choice in Canada and it produces a huge amount of harms. But it's a topic we can't really have... For many, many reasons, it's a whole other lecture or seminar around why we can't make progress in alcohol policy because for a collective society, we don't want to go there. It would be federal jurisdiction. Alcohol would be basically the same where the production and all the rules around marketing, etc. were a federal environment. Who sells it and how it can be used in a public space or provincial or provincial? Thank you. So many of your committees look at it as you probably know. You get measurable levels of THC from the second hand in our law firm. And THC is measurable in survival for 61 days. Has any work been done for Canadians who are traveling? And maybe going to countries where this is illegal and if they do a survival test and they're in a common smoking area, they actually have measurable levels. It takes 61 days to get out of your system. I'm not aware of any of that specific work. I would say that that's an issue today or it was an issue a year ago. Before illegalization, there was very common to smell cannabis as you walked around the streets of Alifax. That was an issue before. I think a more relevant issue is what do you do about if you're a legal cannabis user and you disclose that when you cross the border or if you have cannabis product, what do you do with that? I'm not aware of any countries where as part of the entry they test your saliva. We know that in the U.S. across the U.S. border they ask you to use cannabis. What do you say as a Canadian now? Is your legal age and you choose to use cannabis? Do you lie? Do you say yes? Are there questions that the federal government continues to explore and work through in the international forum? Can you give us a couple of little screenings and we'll see separately the argument around lessons learned from smoking and alcohol in the struggle for the provincial? I think one of the ones from is we have to pay attention to what's the number in the location of retail sites. The more and so we go tobacco which we are sold in every convenience store in gas station. Alcohol we still have, I don't know what the number is but we have far more NSLC outlets that don't sell cannabis and then now we've opened the door more to private as well. So we know that good evidence on tobacco and alcohol that the greater the number and especially the density, like the density of outlets and downtown Halifax and the location especially as it relates to schools those can actually drive youth consumption of tobacco and alcohol. So we have to pay careful attention to it's one of the issues moving forward finding the balance. What's the number of sites that you need to have so Nova Scotians if you want them to buy from the legal reasonable access knowing that they can be online how many fixed sites do we need to have but also learning from and where those sites going to be located. So I think that's an interesting one moving forward that we have to continue to work actively, we can't be passive but actively make sure are we always asking ourselves are we getting the right balance between creating a legal market and protecting youth especially. So any attention being paid to the public office to increase single-use plastics going along with the legalization of cannabis whereas once you are getting the time when there is a plastic bag now there is a very large, heavy plastic container wrapped up in a paper bag and that increase trash production as well. The only thing I know that's certainly been made an issue and NSLC is aware of that what they're I haven't been involved in any conversations of any active plan to reduce the packaging but it's certainly an issue that they're well aware of. Again some of that is driven by the federal requirements because the package has to be a certain size to accommodate and this will be true for edibles. They have to be prepackaged they have to be a certain size even though the regulations will allow kind of like the fold out labels but they have to be a certain size of the labeling and signage rules that are required that's a good point I mean I think the main issue is that there's been a shortage of supply especially certain of the more popular in the meetings I've been at some of the more popular product supplies product lines. That's across the country I mean that was to a large extent that was to be expected. This is we're standing up a new industry the federal government had very aggressive timelines I mean even though they said October 17th it wasn't until April-May of last year where we even knew where the federal government was truly landing and at that point we were still looking at July 1st and then we had to stand up a retail model as well as the industry the producers had to then ramp up new producers had to do all the stuff that they needed to do so they had to get a license so yes there's an access a supply access issue but we need to be patient and say this isn't a short-term piece we need to look long-term and yes over time the supply the economics will kick in and the supply will be there to meet the demand does that answer your question? I've heard both from a public health perspective when Nova Scotia chose to co-locate people with an alcohol use disorder and the implications for them there is a robust online model and I don't know the answer I'm not an IT person in any way, shape or form is there a legitimate concern about your public your private security because you have to put in a bunch of personal information and credit card and all that kind of stuff I don't know the answer to that and I'm just worried about the concerns of the public so I'm not aware of anything that says that you have to use a smoking or vaping form if you're somebody with chronic pain or another health issue in fact many of those people don't use they choose to use another form so I think there's other ways that people can access use cannabis even in a public form all my discussions with the government is that we need to distinguish between smoking and vaping forms of consumption and other forms because they controlling animals saying that it's illegal to eat my muffin on grand parade at lunchtime is totally unenforceable and it's unreasonable there's no harm to anybody else but if I was sitting there smoking a joint there is second hand exposure so I think there's that piece on it but it's we had the same issue to raise when we moved forward 20 years ago on protecting public spaces it's a balance of protecting the collective's health versus the rights of an individual so I would argue even if you have a dependency on cannabis or maybe using cannabis for a chronic health condition do you have a right to consume that in a way that puts other people at risk and I would say no but especially because there are other ways that you can consume there's alternative ways you can consume that product that don't create those risks for others so I don't think it's unreasonable of all to what HRM has done and where we've landed in fact I very much in favor what they've done because as I said earlier changes the public norm in the discussion that now non-smoking is the norm sure I'm going to come over here and I see your hand up over there too I'm just wondering if you're aware of there being discussions or considerations to have safety sort of within the home for example a secondhand smoke have the children in the home or levels of impairment or caregiver with kids in the home or if you come up in safety issues are you aware or have there been discussions about those kind of issues plants in the home with kids, pets so I think certainly if you look at the information that's online and I said maybe I missed that one more slide there's our cannabis website and through that the Nova Scotia Cannabis website we have linked to a whole range from the federal government to the Canadian Center for Addiction and Mental Health a range of things one of the things you could get to on the federal side is some issues around plants and kids and pets as we have active conversations right now as we move forward with edibles one of the key messages is going to be around safe storage it should be treated like the same you do with any prescription any prescription medication you got to store it and handle it carefully so those messages we've had long standing messaging ultimately what people choose to do in their home that's around kids but we have part of our public health messaging is for long smoke outside and that continues around with cannabis except though that people like who now might go outside for a cigarette smoke but can't do that because it's not a designated area so they're more likely to smoke within the home and kids are there so that's why we need to have other alternative forms of consumption that again they're consistent with the lowest cannabis use guidelines as well as minimizing those second hand effects of smoking and vaping so I think putting in regulatory environments as well as public awareness campaigns that actually drive people if you will to a non-smoking vaping form of consumption if they choose to use or a good thing there's another question over here I was wondering as there continues to be a growth in the health and social effects of cannabis if we gather more more evidence are there any mechanisms in place for policy to reflect that any new evidence to gather? So I think that would absolutely be through monitoring and adjusting our regulatory environment so if as we get more evidence around the health conditions which I think could be benefited I think one of the questions are going to be how do people access that do we still need to maintain a medical stream and drive people that way or do we just I think by answering your question the whole legal framework has to be open as evidence emerges we can't just I don't think anybody is under any belief that this is going to stay written in stone for the next decade it will change over time Alan you had your hand okay was that and then I'll come back to you Alan yes I just wanted to I think so I think then we need to do they not do that just because they're marginalized or homeless do they not deserve the same steps that help them and supports to help them protect their health so I don't think we just throw up our hands that they have to use cannabis and we have to give them some kind of right I certainly recognize those unique challenges so my answer to you would be then we have to work harder in our homeless shelters and homeless populations with nicotine replacement therapy and other supports to deal with the mental health issues which are often driving their use of cannabis or other substances not to kind of throw up our hands and say we have to accommodate their use of cannabis they deserve far more supports from a health and social sector to help minimize that use we need to like cannabis for things okay to use so it's okay to not it's okay to not it's not okay well I think they would have the same ability in HRM to to use at one of the does it aid smoking sites I recognize the challenge but I think we need to from my perspective is look at it in a way that what kind of were they lacking in health and social supports that maybe brings them to a place that they're a greater level of equity for a whole bunch of other issues and areas to the rest of the people even in HRM just to follow up on the question come over here have there been do you know or does anybody know if you've been in cases for child protection lots have been brought to bear when parents are smoking and smoking can't get to being a non non non non world yeah I mean that would seem I like the obvious relative to the situation I don't I don't something there's not to me we have we've banned smoking in cars and actually we've also banned smoking cannabis in any cars but we haven't gone to that whether it's tobacco or cannabis to actually say if you have children in the home you can't smoke we do that in a more educative kind of approach CA might be on child protection social order absolutely say you cannot use the under the influence of smoking around your kids so they would enforce that it makes a little difference to them that it's now legal so they would enforce that I was just wondering if the province planning to revisit the retail model in the years so let's say it's another province that took the or public route there's nothing written in there and I didn't have part of no conversations that said it's the retail model that we will retain forever it's the whole piece of the discussion has always been the table that we need to create a regulatory environment that opens the door cautiously with the ability to adjust to the environment that's with the ability to adjust and change and perhaps expand as we get more evidence and experience so it may well be that at some point down the road in fact that's a topic of active conversation right now what's going to be the retail model for edibles are edibles going to be only in NSLC are we going to create kind of a cannabis cafe model where you could go in and purchase non-alcoholic beverages non-cannabis foods prepackaged single-serve cannabis products that you have to consume in the location you can't leave or are we going to create a whole bunch of other retail options so we're actually going to allow the sale of edible cannabis in pharmacies in convenience stores and I'm just making this up in farmers markets what exactly the retail model will look like to accommodate cannabis is actually a topic of open conversation with the government right now and not just the Nova Scotia government everywhere the last piece I'll say is that we need to it's a great opportunity, a natural experiment let's look at the impact especially on youth cannabis consumption in Ontario, Alberta who have a private model versus BC that's got a mixed versus Nova Scotia and other provinces that have a government controlled because I venture to say that based on all the decades of evidence and other substances as soon as you open it up to a private model you're going to increase consumption rates let's look at the for cannabis and hopefully are any policy decisions around where we go with the retail model we'll be informed by some of these natural experiments comes back to my point about monitoring the contrast between the various forms of the contrast of consumption smoking, vaping edible oil and one would assume smoking and vaping have a second hand impact vaping might be better than smoking but it's just so yeah there's smoking and vaping so they have rapid onset because you inhale it and it gets into the vast blood system that's in your lungs and out throughout your body so there's rapid onset but there is that whole that second hand piece and then you typically have a more rapid decrease in the drug in your blood system as well so then you're looking for more potentially the other piece around smoking vaping which is important especially for young people we know that the modeling behavior of smoking just seeing young people seeing somebody smoke and that modeling behavior actually is important for driving youth experimentation and then moving to ongoing regular use so that's another piece about the whole public spaces and not reintroducing the modeling of smoking behavior back into our public spaces edibles as I said they have certainly a longer onset and lasting in the body and then the other forms are I think you know there's lotions and creams and all those kind of pieces that again I think they have a longer onset but for many people they're much more acceptable as I said people my age and older that's the form they're by and large looking for so I'm not an expert in that sort of cannabis detail all these products but I think the big difference is the visibility and the second hand effects of smoking vaping is vaping less harmful than smoking whether we're talking about tobacco or cannabis probably but many of the same carcinogenic products that are in vape they're in tobacco also in vape inhaling and there is growing evidence that what vaping produces is very very fine micro particles 2.5 nanograms that there's growing evidence from the tobacco world that actually those fine particulates have a unique risk for your heart and that shifting in tobacco if you shift from smoking to vaping you don't actually decrease your cardiovascular risk at all because of those micro particles so is vaping less risky in all likelihood yes how much less there's a lot we don't know about vaping yet so that's why I certainly love smoking vaping together and that we should try to move people away from inhaled forms of consumption in general recognizing all of the work that went into normalizing non-smoking in society what is province planning to do around enforcement or smoking marijuana to enforce the smoke and then do you anticipate that there might be an unanticipated effect of increased tobacco smoking as well so the first one I mean the province is going to enforce the Provincial Expanded Smoking Places Act like we have historically we just really through complaint driven and then we have enforcement folks in the department environment who then respond to those and you know for instance we've had discussions with DNR so it was a provincial park and somebody smoking it it'll be the local DNR staff in that park it'll be the first to respond a lot of it where as we've done previously we're really lying on public awareness and going on the belief which has proven so far historically with tobacco to be true that most people will abide by the laws and one of the things I ought to talk about a lot is that we need to make sure people are aware of what the laws are and encourage people to be part of enforcement in a polite way so if somebody smoking cannabis where they're not supposed to let's not just walk past that but just you know encourage people being cognizant of their personal safety just say you know you're not supposed to be smoking cannabis here I think there's a place for that as well don't leave it all to some official agency to to police and enforce there's a couple of hands behind you but I'll get to you so we're actively involved directly with that so they're in the process right now revising the health curriculum and there's been lots of ongoing conversations about adapting the substance use component of that for cannabis legalization as well as awareness about the unique risk of street drugs with opioid contamination etc and introducing that at a very early age appropriate age so yes we're part of the way we're directly involved in those conversations so you had your hand up and then I see you had your hand up too because in Canada they say there's a lot of animals and pharmacists in Canada they say there's a big problem with opioids but to the best of my knowledge on any kind of study on how many Americans come up here to buy Ta-la-la-la-la-la-la-la-la-la-la-la-la-la-la-la a bottle of Ta-la-la-la-la-la-la-la-la-la-la-la-la forms in the U.S. would cost the patient about $150 because they have to go to the doctor so there's still hundred million people here coming up here to buy their Ta-la-la-la-la-la-la-la-la-la-la-la-la everything that's sold to Canada the other thing I don't believe there have been any studies done on the vets in the second Korean who are who are now dying off and a lot of things happen with decreased smoking and increased benzodiazepine use as a place of alcohol but outside I know for my profession people are buying benzodiazepines so they only have to have one $7.50 there when I was at the University one year it was 25 cents and I've watched them up through my career using the psychoactive substances that go off as a price of alcohol and cigarettes now these would just blow right up with me because we're not committed to prevent anxiety and a lot of stress and all this and they used the cigarette which didn't affect your driving didn't affect your working and people are talking about problems the British Long Association has to be used I've been the biggest in the world about 3 years ago smoking marijuana is 20 times the dangerous and the rest majority of it is smoking cigarettes because you're holding contaminants in longer the American Long Association did a study it's 5 to 10 times the dangerous so there's a lot of information out there it's just not the type of information and I don't think it will ever be so there's our response to that is we we're at early days around the health effects of cannabis we need to my other only outcome I'll make you're absolutely right that for far too long we approach things from each class of drug independently so what we need to be doing is looking at a range of legal including pharmaceutical psychoactive drugs any legal drugs and look at the patterns of use collectively and always be much more emphasis on why are why do we have a culture that large numbers of people seek psychoactive substances legally or illegally because that you know even if we as we deal with opioids we're now seeing that there's an increase in benzodiazepine use because people can't so there's all these things but what's underlying it all so that's a whole other topic of conversation but I you're challenging us to think much more broadly in some of these while the effect is the increase on these things you demand that yes to in care driving so there's the breathalyzer and with the every third person you said you pulled over you have a probable cause so what tool of the mechanism is right now for customer can use from care driving so they now have so I'm not unfortunately there's nobody from justice or police here so they have all sorts of strategies around how to do their impaired driving enforcement and I just used every third driver as an example I don't take that and say the police are going to use that and what they now have is that they now have both the breathalyzer for alcohol which they can use without probable cause if they feel that you're impaired with other drugs they have the saliva test and then they have the police officers who with enhanced training in drug awareness that they can bring in so if a frontline police officer I think somebody here is drug impaired they can get back up by one of these drug recognition officers who can then come on scene and do a further assessment on scene and if necessary they can take them and get blood tests if necessary they can go to the point of obtaining blood but as soon as they do they're under the federal criminal code and so one of the knowing that it's a very prolonged process so one of the things is trying to do it early and then apply the provincial administrative sanctions cause that is quicker and essentially deals with the problem which is getting somebody out of their car and off the road in a much more effective manner and doesn't have all the implications of tying things up in the court system as well that's about as far as I can go into that area and not be my area of expertise so anybody over here I might have my back to return you sorry you mentioned that we're the only model where we're co-located with cannabis and alcohol has there been any talk of doing any studies here in Nova Scotia about that co-location and how many people are actually purchasing alcohol and cannabis or has there been no update on that I'm aware of I mean we're working on an overall monitoring program but there's nothing that I'm aware of that it would specifically drive into looking at that exact question time for one it's not like I'm prepared for driving concentrate ahead of us will those type like the saliva test for people to pick up GHC that's been like publicly applying stuff like that well it would be in your blood and therefore in your saliva so yes, yeah I'd ask you to really welcome these and share these comments with us today