 So, the last speaker for this session before we open the floor and the internet to Q&A is from the Ministry of Health, but the Ministry of Health in BC, British Columbia, beautiful part of the world. And it's a real privilege to have Dr. Brian Emerson here because he's come a long way. He's been involved in the Ministry over there looking at how to regulate psychoactives. He's been involved in various health committees discussing what the issues are and the opportunities for reform. It's a real privilege to have him here. Please put your hands together for Dr. Brian Emerson. Thank you very much, Grant. And hopefully you can hear me and my voice is a bit scratchy, but I'll try to speak closely to the microphone. And my timekeeper is here. So, initially, I'd like to just indicate that I'm printing from the perspective of a health physician and I work with a group of public health physicians in British Columbia called the Health Officers' Council of British Columbia. This group has been working on regulation of psychoactive substances, including tobacco and alcohol, illegal substances. For a number of years now, really with the focus on how do we reduce the harms of prohibition and employer health to regulate psychoactive substances? Okay. Physicians usually have to do a disclosure, so I'm going to disclose that I've not received any remuneration or other compensation for this presentation. Star Trust has paid for my travel and some nights of a hotel accommodation. So the outline, I'll speak about harm reduction, talk about some regulatory perspectives from other parallels, talk about the health officer council regulation framework, and then some international examples which have somewhat been already covered. So harm reduction from a BC perspective is that it's a pragmatic response that keeps people safe and minimizes their harms. It really is a focus on the harms not on the use. That is a key element in the public health perspective. It also acknowledges active role of drug users in the programs and really has a focus on enhancing skills, knowledge, and resources and supports individuals, families, and communities. Consumer product regulation is not new although certainly the approach in New Zealand to regulate psychoactive substances as a consumer product is new, but governments are quite used to regulating food products, consumer products like paint, cleaning products, electrical devices, pharmaceutical devices, and in Canada we have natural health products regulation as well. Prohibition and criminalization is not regulation. That's a key point. Prohibition really prohibits the use of substances and it is a criminal law, not a regulatory approach, and as stated earlier by Ethan Adelman, it results in many harms. So really a criminalization prohibition approach, its focus is on behavior and people, not the products. The New Zealand approach and the consumer product legislation I've mentioned before is a focus on products. That's a real paradigm shift in terms of drug control. The harms of prohibition, I'm not going to go through all of these. I think, again, Ethan hit on a lot of them. I should mention that I'm aware of these slides are going to be made available to people who want to attend, so this information will be available to those who want to get at it. But there's a long list of harms of prohibition. A key one is the stigmatization and discrimination aspect of the criminalization approach. In fact, I refer to this as state sponsored stigmatization. When we talk about marginalized vulnerable groups, in fact stigmatizing people through criminalization further marginalizes them and makes them even more vulnerable, so it's very refreshing to see an approach that doesn't take a stigmatization and discrimination approach to people who are using substances. This is a bit of a busy slide. I'm not going to go through it all in detail, but the key point is that public health focuses on the determinants of health and there's a whole range of determinants of health, but with respect to the outline, there's the supply chain, the demand chain, and part of that is, of course, driven by a whole range of biopsychosocial influences. Those things were, that was a good trick, wasn't it? I don't know how that happened. We'll get back there. A key element is availability, which leads to a whole range of harms and benefits in the end result. The key point on this slide is the law can influence a whole range of determinants, right, from the supply side, the demand side, availability, consumption and use, and the harms and benefits. A number of legal tools that can be brought to bear, the Psychoactive Substances Act in New Zealand is one. There are a whole range of other types of legislation that can be brought to bear in this. So I think in terms of the key point for the presentation, regulation is a hugely important aspect of harm reduction. And New Zealand has started to explore some of the regulatory tools, but there are a whole range that could be brought to bear. So public health-oriented regulation operates within a framework of guiding principles, broad goals, assumptions and specific objectives. Some of the key assumptions are that both medical and non-medical use has a long history and will continue. New substances and variations will be continued to be produced and we need to effectively manage these substances. And evidence-based coordinated multi-sectoral public health-oriented strategies are effective. So if you buy into these assumptions, it takes you down a path of regulation. There's a range of principles, and I heard some of the principles behind the act. And from the public health perspective, a key element in one of the principles on this list is informed consent about harms and benefits. And the whole idea of ensuring that people over 18 have the information they need to make the decisions about whether to use these products is absolutely critical. Another list of principles here, I'm not going to go through them all, but one I'd like to highlight is that there needs to be consideration for and respect for the spiritual, traditional and therapeutic use. There's a range of elements that substances will provide from a therapeutic, therapeutic, beneficial perspective as well. Many of these substances can have spiritual and traditional uses which needs to be respected. Key principles include compassion for people directly or indirectly affected. And as I said, that's counter to the principle of criminalization, which is stigmatization. Evidence is key, regulation intensity should be based on harm potential, and variations that pose the least risk should be the most available. Another list of principles really highlights on the importance of rational, respectful discussion and consensus building. The key elements in terms of inclusion and consultation are critical in this group of principles. So public health-oriented regulation, is that 10 minutes? Wow, it's got lots of time. Focuses on availability control, accessibility control, and demand reduction. And some of the availability control elements include, for example, government monopolies, licensed retailers, production sales qualities, we've heard these elements described in the New Zealand approach. Accessibility control, certainly the age of 18, is important, but requiring retailers to check age if people are under 25 is a good safety measure. Demand reduction is, some of the elements in there include, require provision of information, labeling, bans on product promotion, such as advertising, branding, and sponsorship. High control regulations can include allowing home production, but allowing strict regulation of commercial production, product standards, and quotas. Again, the purchase consumption and use controls include legal age and impaired driving loss. So some key touchstones that the Health Officer Council has identified in terms of whether you've got effective policy and regulation from a public health perspective include, is it clear, comprehensive, coherent, and connected? Is it feasible, practical, and affordable? Is it easy to understand, straightforward to implement, and encourages components? And is it supportive of improving the determinants of health? And I referred to that sort of webby-looking diagram of the determinants, and does the legislation support health and well-being? This slide is a bit of a graphic of what Ethan was talking about in terms of the health and social problems. With prohibition, you get illegal market, gangsterism, with corporate profit motivation, you end up with high harms due to legalization with few restrictions. Public health tries to achieve the low point of harms at the bottom of the U-curve. So right now we've got heroin, cocaine, methamphetamine, and cannabis prohibited, really much in the control of the illegal market, gangsters, tobacco and alcohol on the corporate profit regulated side of things. And what we're trying to do is move the regulation of heroin, cocaine, methamphetamine into a public health low harm position, lower the tobacco and alcohol harms by moving them more to more tightly regulation, bring cannabis over into a much more regulated market, and allow for medical cannabis. Sorry. I'm glad that comes back. So the international experience, I think we've heard about the international experience from Ethan, so I'm going to skip that because I think the discussion is very important, but there's certainly regulation and the international forum has shown certainly no increase in harms and in fact decreases in harms. So there's positive experience from the international experience. And then promising international experience, as was mentioned, Uruguay, Colorado and Washington have legalized cannabis, and of course the New Zealand experience with this new psychoactive substances act is very promising and the world is watching. I've included the references and the websites, which as I said, the slides will be available. And I think if I've wrapped up early, that's good because more discussion is better than me yacking away.