 Thank you very, very much. It is indeed a pleasure to be here with you. I always enjoy coming to Halifax. There's always a certain energy and enthusiasm in Halifax. I am a nurse by background. And I am a professor of nursing at the University of British Columbia. And as mentioned, I'm also a scientific director for the Institute of Gender and Health. It's interesting because being a scientific director is really supposed to be a half-time job. And the rest of my time is to be involved in science. They expect scientific directors to do science. Which I think is an interesting model, but so often I don't have a chance to talk about my science. So often I'm primarily asked to come and speak about CHR and the Institute of Gender and Health. So I'm a little rusty at this to tell you the truth, but I'm also really pleased to have this opportunity. And I want to talk to you today about work that we've been doing on frequent marijuana use among teenagers. And I think it's an interesting topic for this seminar series because it really does bring together issues of law, ethics, policy and health in interesting ways. And I'm going to string together a number of observations and hopefully they'll make some sense to you. And I'm also hoping to have some dialogue with you about this area. So to begin with, I want to just kind of outline what I'm hoping to do. I want to talk about the complex and contested nature of marijuana use. And I really am going to focus on, because I'm from the Institute of Gender and Health, I always try to exemplify issues of gender and how gender is an important social factor in shaping health and health opportunities and behavior. But I'm going to talk a little bit about gender, diversity and place-based factors that also shape drug use practices and the enactment of policies. And I want to talk about the possibilities of public health approach to marijuana use. But before I begin, I'd like to begin with a social experiment. So here's a social experiment. Get a little nervous now. Put your hand up if you've ever smoked marijuana. Now, I call it a social experiment because for many of you, see, there's already a bit of a Twitter in the room, for many of you you might have thought, should I put my hand up? For many of you, you might have looked around the room and said, well, she's putting her hand up, maybe I should put my hand up too. For some of you, you might have actually thought, well, I'm not putting my hand up, maybe I should put my hand up. And this actually does exemplify the problem that we're having with marijuana use, is that it is an illicit substance, but it is very frequently used. It has got medical status in this country for medical marijuana use. So it's contested. And because of that, I think often we don't know how to have a meaningful conversation. We certainly aren't really good at really forging forward with a good public health approach. So I want to tell you about a second social experiment. I went to get my nexus card. And a nexus card is a card that allows you to cross the border easily into the United States. This isn't me, it's just so. It's an example. It was on the Internet. I took it all, you know, anyhow. So in the context of having my nexus interview by the American authorities, I was asked the very same question. I was asked the question, have you ever smoked marijuana? And I found myself in this very kind of interesting predicament as well. I thought, well, if I say no, I went to high school, you know, in the 70s. Who didn't smoke marijuana? If I say no, they're going to know I'm lying. But if I say yes, am I actually jeopardizing my opportunity to get a nexus card here? So again, I think it illustrates this kind of contested space we're in. So the, okay, excellent question. So the outcome of this was that actually I did decide to say yes. I thought I'm going to take the high road and be honest and say yes, I have smoked marijuana. They did try to drill down into when and how much and in the most recent past. And I did get my nexus card, which is interesting. So I think again, as we think about cross-border policies as well, the implications get kind of complicated. And again, in our most recent, in the most recent elections in the United States, here in Canada we think we're so progressive, but now we are seeing opportunities for marijuana to be legalized in certain contexts. So things are shifting and changing. And I do come from the province of British Columbia where Pat Carney actually proudly stood up in Senate and said that we do grow the best marijuana in the country and was absolutely outraged that BC did not get the contract for medical marijuana. So it's kind of a fascinating time that we live in. But I'm going to today talk about young people in marijuana use. And I think it's interesting, we can kind of giggle about it because many of us actually have smoked marijuana in our past, have had that experience. Many of our friends have. And it's actually not been at all problematic. But indeed there is some evidence that for some people it is a substance, a problematic substance. And so we've been doing work in British Columbia in three communities looking at marijuana use among teenagers and particularly frequent marijuana use. And so I'm going to draw on the evidence and some exemplars from our work today and talking about how really this, how use is really shaped by gendered norms, by place-based factors, and how policy, how we are in this kind of interesting policy conundrum in terms of how to move forward. So it's interesting because I looked at Canada's low risk drinking guidelines. And so you might actually say, well, do we do this for other things like alcohol use? And this is the Canadian Center for Substance Abuse. They actually have guidelines because they realize teens are going to drink. And so they have this guideline that says alcohol can harm the way the body and brain develop. Teens should speak with their parents about drinking. And if they choose to drink, they should do so under parental guidance. Never more than one to two drinks at a time and never more than one to two times per week. They should plan ahead, follow local alcohol laws, and consider the safer drinking tips listed in this brochure. Now, again, so this is an attempt, I think, from a policy standpoint to actually deal with we know that teens are not to be purchasing alcohol, but they actually can consume alcohol under certain circumstances. But this is actually, I think, an example of a very naive policy approach. I don't know about you, but when I was a teenager, there was no way that I was going to go and consume alcohol under parental supervision. So I think, again, we've got a very naive approach in terms of thinking about who teens are, what they do, and what policy approaches that we should be utilizing. So this isn't going to work for marijuana either. I'll be very clear about that. So marijuana is a contested substance, but I also am going to argue that young people also have a contested status. They also are in between. We on many ways expect them to make rational decisions and be encouraged actually to be responsible. Yet it's many other times we pull back from that and we actually really don't give them the authority over their own lives. And so, again, this creates this kind of interesting tension in terms of how to think about moving forward in this area. So just by way of background in terms of the legal status of marijuana, it was first made illegal in Canada in 1923 with the Opium and Drug Act. And it's interesting, Emily Murphy, so many of us laud the work of Emily Murphy, she actually had a lot to do with this with some of her paper and her writings on what she referred to as the Black Candle because she was very concerned about marijuana and its status and how it potentially could influence Canadian society. And it was because of that that marijuana was listed in part and there were other contextual factors as well in the Opium and Drug Act. In the early 1970s, there were calls for decriminalization of marijuana in Canada and we've seen many cycles about this occurring in terms of the need to decriminalize. And superior and appellate courts have declared that Canada's cannabis laws really have no force or effect. We're all struggling with this question, what should we do with cannabis? And in 2001, Canada became the first country to implement a formal system to regulate marijuana. Now our problem with our medical marijuana system has largely been that the medical marijuana that is produced under that program is terrible. Nobody likes it, nobody likes to use it, it's not good quality marijuana so it's been problematic as well. And it's interesting because despite all of these contested factors there are approximately 40,000 people per year who are charged with marijuana possession. So this is, wow, it's interesting. Again, the situation we find ourselves in. So it's interesting because polls suggest that 66% of Canadians are in favor of the legalization and decriminalization of marijuana. So the majority of people out there actually do think that we've got to kind of get a grip here and start to think about this issue. And in 2007, sorry, this is not as up to date as I'd like it to be, 61% of youth indicated that they have used marijuana at least once. This is a Canadian population-based survey. And 8.2% of youth report using marijuana on a daily basis. Now, so we kind of again have this conundrum. We have marijuana being an illicit substance, we see most Canadians are going, eh, you know, really, but it has a contested status. And we have many teenagers also indicating they've used it and are using it frequently. And so young people in BC, I've done a lot of work in tobacco as well. And in doing a survey and working with kids and teens on tobacco use in British Columbia, they said to us, why are you studying tobacco? None of us can get that anymore. It's hard to get tobacco. Ask us about marijuana. There's something to talk about. So we actually shifted gears after that because we realized while there was something going on here, indeed marijuana was much more easier to acquire than tobacco because we've done such a good job in terms of public health around tobacco. It's not available in stores, it's behind closed doors, we've priced it out of control, we've had a public health approach. So it is, again, I think, demonstrative of kind of this conundrum we find ourselves in. So we decided we would go forth and study and work with young people in communities to really try to understand what was going on. And I've been doing this for about eight or nine years now, talking to teens and trying to think about what we can do about marijuana. And I guess the bottom line is it's complex. And I want to kind of give you a bit of a sense of some of the data out of this work. So I've said it's got an in-between status in terms of its legal status, but it also gets taken up in very interesting ways and is actually approved and actually considered more, I guess, more appropriate in particular conditions. And it's also silenced in particular conditions as well. And I think that's interesting from a policy standpoint. So we've been doing a project called TRACE, Teen's Report on Adolescent Cannabis Experience. I love naming my projects, it's something I do tend to do. Because then when you're talking to people, you just call it the TRACE project. And so what we were really interested in is working in communities and trying to understand the culture and context of frequent marijuana use. So this was an ethnic graphic study to develop a richer understanding of how young people, their schools and communities in which they are in place coincide to generate a set of local social processes that affect cannabis use. And so we were in three communities in British Columbia. Two smaller communities and Vancouver was the other community. And we spent time interviewing teenagers and talking to them and talking to law enforcement, talking to teachers and adults in these communities. And since that time, there's been a few other chapters, but we've been now moving into more of a knowledge translation, trying to think about public health messaging and what we might do about some of this. So it's no surprise and they call it high school. So it's interesting. It is the place where most teenagers spend the majority of their daytime hours. And I do think it is a space that we don't really think about. I don't know, how many of you have walked through high school recently? Yeah, it's fascinating. Whoa, it's really interesting to walk through high schools and see what's really going on there. And it's interesting because even as adults, we don't actually have a sense of what goes on in high schools and what that dynamic is really about. It is a space and place where, unless you're a teacher, I haven't ruled to be there. And that does make sense. It's kind of, I don't know, it's illusory to us about what's really happening there. So we spent time in high schools talking to teenagers. And what we found is that marijuana use is a concern for teachers and administrators. They are concerned about it, but they don't know what to do. So one teacher told us that kids are smoking before school, kids are smoking before lunch. The timing seems real really crappy. They start early, they go the whole day high, and really don't get a lot accomplished. Now, it was interesting because at a number of the schools, the way they would deal with marijuana use is they would actually suspend the kids. So if you were caught smoking marijuana, you would be suspended from high school. But this also led to a very interesting kind of problem because the teachers knew that if I was going to suspend this kid, I was really setting them adrift. And this was going to be very problematic for them. So rather than suspend the kids, they would ignore the problem. They would actually prefer to not deal with it, not have to talk about it, not even have to mention it. Because if they did, it would then become an actionable matter within the school system. So many of the students that we talked to also admitted to using marijuana frequently and coming to class stoned. And what we often saw, we actually saw visible use of marijuana outside the schools. You'd walk into the school and you'd see kids, and you can imagine this hanging outside on the edges of the tree-lined areas smoking marijuana. And so you could tell this was happening. It was apparent. And the school authorities were doing a variety of things to try and deal with this problem. They were putting up walls and barricades and doing all sorts of things. But again, all that was doing was driving the problem further afield so kids who were smoking frequently would actually tend school less frequently. Now, it's interesting, you might say, well, what's the big deal with marijuana use? But here's an 18-year-old who was telling us that I started smoking a couple of months after my 12th birthday. Since that, it sort of snowballed. It was once or twice a week, then four times a week, you know, until it got to the point where we were skipping out of school so we could go smoking dope in the morning and then at lunch. So this is not for all teens. This is a subset of kids who really are smoking frequently. Four, five times a day. And so it is interfering with their lives. It is interfering with their engagement in school activities. And indeed, it's interfering with their engagement in the social world with their families and friends as well. So again, I think there was a conundrum here that we need to be thinking about why is this happening for these kids? And here's an example from a girl, a 16-year-old. Well, I smoke it every morning so I can actually get out of bed. And it gives me that boost of energy to just get up, to get ready for school. I drive to school with a couple of friends and we'll smoke a couple of joints and then I'll be stoned for lunch and halfway through I'll be burnt out. And then once the class starts, I'll be normal again. I won't get high or anything. And then after school I'll smoke again. Some, or a lot, laughs. And depending on the day and then at night I'll have a bowl to myself and go to sleep. So again, you can see how much this is a part of this young person's life. And we could ask ourselves what's going on here. And this is part of the backstory. What we have found is that kids do smoke marijuana for a variety of reasons. But probably most troubling to us is that a number of them are smoking frequently like this because they do have unaddressed emotional issues that are not being dealt with by the health system or the school system. And they also have very effectively taken up the discourse of medical marijuana use to actually manage. And they actually are managing their health and emotional problems through marijuana. And so it's, again, because, and who can blame them? Who can blame them? But I think it points to the need for us to really start to think about the role of marijuana in our society. So here's teachers' responses and this is about what they did. And I've kind of spoken to this point already. In one case I just told them, I picked it up right away and I just said I don't think today is a good day for you to be here. Why don't you come back when you don't look at your stones so much? So this is a very interesting mixed message to this young person. It's like, don't look like you're stone and you can be here. But it's not really engaging in a discussion and really no ability on the part of teachers to actually have a conversation about what's happening for you. Why are you smoking? What's going on? And again, in part, because it's an illicit substance, how do you have that conversation? Another teacher said, I said I can't have you in my class stones. It's just totally unacceptable. I'm sorry, but I can't have you here so don't come. Again, instead of dealing with what might be behind the scenes, we end up in this kind of reactive mode. And I'm not saying this is happening in every school system and there are some fabulous systems out there that actually are trying to shift the way we think about these issues. But I do think it is problematic. The other thing that we found is that in our work with teenagers that many of them actually, because it is so acceptable in their families, they have parents who are smoking, they actually told us there's a normalization that's occurring there. We talk to young girls who talk about being paid in marijuana instead of cash for babysitting. It is part of the currency of the day. So we've got to recognize that this is taking place in communities and think about on the one hand how to have a conversation. So the silence is quite profound and I think the silence happens on two levels. One is around the need to use marijuana. So what's underlying frequent marijuana use in particular for teenagers? And the secondly is around the amount of use. I hope you're shocked at these kind of quotes of young people using so frequently. It is problematic and we do need to think about it. So we're not talking about a kid who has a joint on a weekend. We're talking about kids who are really taking up and utilizing marijuana because it is serving a particular role in their lives. The problem though is that teens often perceive that there's an avoidance of this issue on the part of the teachers. And I think silence is actually saying it's okay in so many ways. And I think that again we've got to figure out how to begin to have the conversation. So one student expanded, but really in the school there's no teachers that talk about it or unless they're saying the dogs are coming. They had sniffer dogs coming to the school or something like that is not really discussed. Teachers don't discuss it up here. I don't know why. So they would bring sniffer dogs into the school to kind of sniff out the lockers but they wouldn't actually kind of deal again with the issues at hand. So I'm going to shift gears here because the other part we have to put at least one little gendered nub in here. The other thing that's really interesting is that marijuana use is a highly gendered practice as well. So we do see boys smoking marijuana more than girls do and that's for a variety of reasons. There actually might be sex-based factors at play. We don't actually understand it very well in terms of whether males and females actually respond to the components of marijuana differently. But we do know that there are a number of factors that actually cause, you know, stoner boy kind of culture to take place and also kind of provides messages to girls that it's not appropriate for them to smoke marijuana because they become too giggly and inappropriate. So there's certain kinds of social norms at play that actually kind of reinforce boys and marijuana use. So, and I think Anderson, this is just a quote from the work of Anderson, which she really drove the point home. Employing a critical approach to researching gender and drug use asks us to study substance use more carefully and to recognize the impact of social and cultural constructions of masculinity and femininity on individual and group drug use. So we were really interested in gendered norms and how they were playing out for boys and girls around marijuana use in our study and have written a paper about this as well. So, you know, if you ask teenagers to talk about gender, they say, well, I don't know. It's really actually hard. It's one of, again, one of those things that is so much a part of our lives, but it's hard to recognize how it is a gendered practice. But here are a few examples. Yeah, I've never seen a chick, one of them, be a stoner. For some reason, I have a lot of trouble seeing a girl smoking pot. I mean, it seems to be more like a guy thing to me. I mean, I know it's not, well, maybe it's more of a guy thing, but I know the girls do it and stuff, but I just have trouble seeing that, I guess. And again, it's interesting here, we do tend to see in our conversations with teenagers about examples of boys smoking socially and in groups more and girls actually like the girl who woke up and had a puff before she got out of bed smoking alone and hiding it more. So here's another quote from a girl because we see it working both ways. I think guys do it more to get high and girls do it more to fit in. So here's another theory about gendered practices. I think I don't know that for sure, but that's my perception because you see a lot of the preppy girls up at the school smoking pot and they just shouldn't smoke pot. They don't even inhale it. It just doesn't look right. It just doesn't look right. It's not that right type of person. So now we see an example of the right type of person smoking marijuana. And so you can see how it becomes embedded in culture and context, how certain kind of girls and certain kind of boys smoke marijuana and get reinforced for doing so and actually get reinforced by their peers for doing so. So if we're going to actually understand policy, practice, education, we do need to understand these dynamics as well. So it's interesting because I'm also very interested in kind of how broader social discourse is. So this is a slide that's exemplifying a broader social discourse and it says, you can't read it very well, go to work, send your kids to school, follow fashion, act normal, walk on the pavement, watch TV, save for your old age, obey the law, repeat after me, I am free. I kind of like it anyway because I do think there is a broader discourse out there that we also know is shaping marijuana use and we were also interested in trying to understand, you know, to kind of step back and going, well what are the messages and how are we reinforcing, might be reinforcing marijuana use or how does it get taken up? So in the final phase of my presentation today I want to talk to you about a media analysis that we did because we were also interested in understanding the media's role in terms of thinking about marijuana use. So we did a discourse analysis of Canadian newspaper reports and so we took the main newspaper reports and we did a word search. This is a problem, just a brief theoretical or methodological note here. If you want to do a word search for marijuana you've got to use all these other terms like pot and weed, but you get all the gardening articles, right? It's a problem. So this actually took a lot longer than you think. So we had to weed through thousands of articles to come up with our sample and actually indeed came up with a sample of a couple thousand articles over a ten year period and we were interested in looking at, so we did a quantitative and a qualitative analysis and this is from some of the qualitative analysis and this is about what we call privileged normalization, that it's okay for certain people to smoke marijuana and I think that's again part of the dynamic in society at the present time. So we were interested in describing dominant messages and trends related to marijuana in a population of Canadian national newspaper stories over a ten year period and so I just want to kind of give you a sense so it's no surprise and kids are taking this up in terms of the way the messages they're getting because I think there are broader societal messages that are also influencing this. So what we learned from looking at these papers is that marijuana use is sanctioned for particular groups and I'll tell you a bit more about that and that the negative consequences of use are associated with violence and crime. So often the crime story might include the fact that they were stoned at the time or that they were selling marijuana or selling other drugs but there's no health story out there at all about marijuana. No one really wants to talk about health and that was kind of interesting to us as well. And I think the other thing that was interesting is that particular Canadian values and perspectives suggest that a progressive view that marijuana use is acceptable in the right circumstances. So again on the one hand I think we have this notion that it is appropriate in this particular context. So here's a few of these kind of discourses that we think are particularly interesting. One is about elite privilege. So reporting marijuana use by celebrities and athletes. You'd be amazed how many stories there are in newspapers that suggest and these are the football players the Cheech and Chongers the other movie stars who can freely admit that they smoke marijuana and it's normalized for social elites and typically men not women. And so these are musicians, athletes and other celebrities. In contrast there's also a gender privilege we talked about gender that gender buys some stories about women's marijuana use. So obviously we see language like only bad girls monster mothers morally problematic individuals particularly women smoke marijuana. And they're not presented as women but instead are represented as being particularly problematic in some way. The other thing is this defining of the underclass or the othering of marijuana users in news reporting. And usually issues of race and ethnicity start to come into play. So these are the other people who smoke marijuana. It's not, you know, it's not the kind of the majority. So all of a sudden we see in stories references to racialized groups to other minority groups coming into play in terms of their status or their so-called outlaw or sub-cultural group membership. Again interesting to pay attention to. And then finally the discourse on Canadian identity really was linking marijuana use to Canadian values. You know, we're liberal, we're progressive, you know, we need to be thinking about the place of marijuana in society. And in particularly we would contrast this to American context. It's interesting this was done before the American election most recent American election. I think many of the results of the most recent American election have caught us off guard with thinking anew about what the status is, what our quote-progressive status is in Canada. So I guess I'm pointing this out to really get you to think about how broader it's not just about individual places and spaces, but also how these broader discourses are influencing how we take up and understand marijuana use. So I think that these themes are important to consider because they play a role in shaping how the public and policymakers think about marijuana. You know, the media plays a very important role in kind of informing us about what we should think, how we should act, what is important. And the tone of debates about marijuana as a criminal, legal and public health issue, where does it get placed? And I guess we're concerned that it hasn't been put into a public health context to any great degree. It's primarily been discussed as a legal matter. The consequences have been talked about in terms of grow operations, etc. But actually, if you really look at the science, there's a lot of things we actually don't know about the health effects of marijuana. So I do think that we do need to fill the public health vacuum. I think we need to figure out what we're going to do about this and how we're going to talk about it. And one of the things that we're interested in doing is trying to figure out what we can do in relation to this. So, you know, if you ask a kid to talk to you about marijuana, their biggest source of evidence is Google. And right now, that's where they're going to learn about it. And when we talk to them, they can tell us all the great websites and what they're learning. But the quality of that evidence is problematic. The other thing that's again, it puts us in a very awkward space is that the evidence is confusing. In some context there are some benefits. In other contexts, there are some harms. And in other contexts, you know, just like alcohol use, using alcohol infrequently isn't going to hurt any of us. So it's confusing. And I think the fear in terms of engaging with young people in particular is that if we start to talk about it and we actually indicate that there's not good evidence out there, that somehow they're going to start all smoking marijuana. So what do we do? What do we do about this? So I do think we are interested in reducing potential harms related to cannabis use. And I think it really is going to really call on us to actually trust young people to make good decisions and provide them with the evidence. Actually help them, you know, think through the evidence. So if our intention is that young people are going to minimize the harms related to cannabis use, we need to understand how they engage in weighing this evidence. So we've been doing work for the last two years bringing teenagers in and having them read the scientific literature to see, to really kind of understand, you know, how do they take up the scientific evidence related to this? Can they understand it? Can they use it to inform decisions? And how do they think about this? Because I think that's actually a bit of the nub of this as well is that we want to give young people prepackaged messages like just say no. And in that context we feel like somehow you know, because they can't understand the complexity of it all. So we're interested in a really a harm reduction strategy that's aimed at supporting young people so that they can become equipped to weigh reliable evidence, to think about what the evidence is to weigh it and make appropriate decisions. So we're not, right now, we know kind of a no-win game to actually really find there is no middle ground here in a way in terms of saying it's good or it's bad under what conditions. I think that what we need to do is equip young people to understand the role of marijuana in our society to think about what the evidence is and to make decisions. And indeed when we do that with young people they can indeed come up with some very clear recommendations. So in talking to them here's one young person who said I thought doing the research would kind of help us find the yes and no's, but it actually didn't. It made us more confused. But we did learn more of the why. It could be a yes or it could be a no. So I think those that are really valuable towards finding the conclusions, trying to weigh the evidence, trying to understand what's happening. And here's another young man. I pick out the parts that I find interesting. He's reading, you know, he's reading papers in BMJ and Nature and it's a challenge for me to read these papers. I pick out the parts that I find interesting and I read those. And then I also look at the graphs first because they're well organized and interesting. And I find the relevant sections of text that actually elaborate on those graphs and I conform my own thought process because I'm reading through it in my own way. So again I think this idea that they can't pay attention to this, they can't, you know, weigh the pros and cons, think about the evidence is again problematic. So we've been working with young people and they've actually come up with a list of what they think are appropriate public health messages for marijuana use and this is what they've told us. And these are kids who have used marijuana and those who have not. It's better to stay abstinent than to suffer the potential consequences. Okay, but do you think there are consequences? That kind of makes sense to me. It's best not to resort to marijuana when life isn't going well. There's always help available. That's a good message. That's interesting because that kind of speaks to some of the other context in young people's lives. Initiating marijuana use before adulthood is a lot more dangerous than beginning it at a later age. Again prudent because there is scientific evidence to suggest that there is a role of marijuana in brain development. They're reading that and they're kind of thinking delay, harm reduction. Marijuana affects everyone differently both physically and mentally. Okay, it's good to know that. If you choose to use it, make sure it only impacts your life, not the lives of others. Again, they're understanding the context of marijuana use. Know your source. There may be a lot more in the dose than just marijuana. The higher the dosage, the more severe the impairment and finally know the risk. Make informed decisions use responsibly. Now I'm not saying this is the perfect set of public health messages, but I think what I'm pointing to is that I think we can fill the void. I think we can begin to have a conversation and it's not just about either saying marijuana is okay or not okay, but really thinking about how it is used, how it's taken up much like alcohol, much like tobacco understanding it and having a conversation and I think it is it's in between status as an illicit substance that really has blocked that from happening. So I think we need to move away from just say no. That ain't working. I'll tell you that right now. It is not a good message because they know they've got parents who smoke marijuana. This isn't working. So we need to meaningfully engage with young people. We need to acknowledge the state of the evidence and we actually need more research on marijuana. It's shocking what little evidence actually is there. Silence is a response and there are a number of unmet needs of young people in Canada right now and I think in part the frequent marijuana use in particular is symptomatic of an unmet need and I think drug use policy can privilege particular people and particular forms of use and I think it's interesting for us to think about that as well. So I'm going to stop there and I'd really love to hear from you and engage in a discussion with all of you. Thank you. I'm going to manage the questions for you. Great. I think there's one in the back there. I'm just wondering whether or not there is any studies done that need teenagers to marijuana use and actually their grades and the reason why I ask is because it seems as though I've only been in high school in those six years and I remember being in high school and students being removed from their classes because of the marijuana use and I feel like being removed from the class was more of a problem for the marijuana use itself because they aren't engaging with everybody else doing the score, failing their exams and is it actually the marijuana use that we're breaking down the grades or is it actually the removed from the class so I'm just curious about any research on that. There is evidence that particularly frequent marijuana use is correlated with poor academic performance as is other type of drug use. There's pretty good evidence on that. It's interesting because a lot of the young people we talked to thought that they actually were able to pay attention more and that their cognitive skills were improving but that's probably not the case. For some, I'm pointing to the psychiatrist in the room, I think for some it actually might relieve some anxiety for them so they're able to function in maybe a more relaxed way so they feel better about their thought processes but you're right but that then gets compounded by the fact that they are being removed from school and their other issues might not be being paid attention to so absolutely it's interesting, I should say there are some fabulous programs now around not removing kids from school so I don't want to suggest that it is still happening in a number of school districts but there are a number of schools now that are really beginning to engage in a much more fulsome dialogue with kids around their use, why they use, what's going on in their lives so thanks. I was wondering if any of your research looked at knowledge of legal status so what did they think the legal status of the drug was and because I think the just say no message is actually not the message that they think is out there they don't think that it's prohibited and so I wondered how the mixed legal status affected their behavior A lot of them actually did not know it was illicit, they actually did not understand that because it was used so frequently by the adults around them and because again I think there is confusion on our messaging in the medical marijuana program so it's kind of again so they were confused about that and a lot of them did have incorrect information so again I think to help them understand that context is important as well so I'm glad you raised that thank you. Is there a conflict between the way people feel about marijuana use and the reality of it do you think legalization is a necessary step in order to open up this dialogue and create a space for health promotion you know I knew someone was going to ask me that question I'm really torn about it you know in British Columbia there are a lot of people who are making a very compelling case related to the criminal element and the public health harms that are coming because of the criminal element that is associated with marijuana trade and that is very compelling but I'm also very cognizant of you know I remember colleagues saying to me you know if we were going to actually create legislation around tobacco for example we would have never created legislation to make it so available we would have thought twice about that so I want to make sure that we're prudent in terms of thinking twice and I am a little bit concerned about the status of the evidence but it's same like same as alcohol use as well so I think there's going to have to be regulation I think that we're going to have to be prudent and think about you know about licensing availability those kinds of things and that's the approach that's being used in the United States and actually I think for young people it would clarify the status I think about the initial comment that I made that indeed tobacco was more difficult for them to access than marijuana I think it would clarify some things and that it would actually give messages to adults as well and actually maybe create a space in place for us to actually research some of the evidence related to potential harms as well because there are harms I mean there is evidence for example especially among not everybody just like alcoholism we don't see everyone who drinks a glass of wine doesn't become an alcoholic but there is a dependency syndrome in marijuana I think it's important to note that you know it's not so great for your lungs it's important to note that there are kind of other harm reduction mechanisms we could be thinking about so that's a long answer to your question so I think there's a lot of things that we need to think about and putting in place to move forward you know if the legalization of it would really solve any sort of problem with health orientation because it would seem like medical marijuana so it wouldn't have the potency that the illicit drug has presently would get off the street which in many instances there's more than just marijuana in the drug so whether the youth would still search for that other or accept the fact that they could now use this if they were at the right age and where there is growing evidence of the link of psychosis with the use of marijuana and depending on your vulnerability it's not everyone that develops that just alone that the uniqueness that help the effect of the drug on the individual I think is holding back the opening up the because it would be a source of income just like tobacco was just like alcohol was that can control those things yeah it's interesting just around your first point you know when prohibition of alcohol was finally lifted in the United States people didn't have gin mills in the basement anymore because it became and actually quality products improved and labeling so I do think actually we probably could have more control of products and the free market would dictate availability I'm not as concerned about that I do think there are ways around that point and it's interesting because I actually I don't know the answer to this question I'm troubled by it as well we also know for example that alcohol, that people who have a very there are particular predisposing factors that will lead certain individuals to have a more likelihood of becoming alcoholics family history being won so but we can give people that information and then they can make free informed decisions about what they should do about that I just think it's an interesting issue but there are consequences as you said for the public purse in terms of health consequences etc so again I think that I think there's a lot of in my view there's a lot of thinking that we need to do and if we move down that road in Canada I think there's going to be a lot of education that we're going to need to do in terms of figuring out our public health messaging figuring out how we engage and being very honest about the evidence gaps as well in the area of increased resources for mental health might be on the road to go if you're going to do something like this because they're linked and you have a question I have just a question about your presentation that is encapsulated in a report or something that you bring up here yeah so I do have, sorry I didn't bring my reference list with me but I do have a number of papers and a few reports for schools and I'd be happy to share those with you so I'll give you my e-mail send me an e-mail how long you carry out these studies and you speak to students who are frequent users do you have any who say that their use is that result and negatively and you would like to start the path that they continue yeah there are some who know they're in trouble and so for example we had we talked to some young people as an example who had been medicated and put on sleeping pills or put on anti-anxiety medications and we're not liking the feeling of those drugs and so then went off those drugs and we're using marijuana to try and manage their symptoms as an example and but they also knew that it was having some consequences it was costing a lot of money it was also it was interrupting it does influence your social behavior and they knew that was happening for them as well and it is it does create some amotivation it's very hard to kind of get motivated to do particular things and they were cognizant of that but they didn't know what else to do and I think we see that in other drug use situations as well people who smoke tobacco frequently know they are in trouble they know that they're going to have a bit of difficulty so there was some awareness I don't think there was just blind ignorance to this issue but I also think it points to the fact that other solutions weren't in place for them and I think this broader issue of mental health and young people is at play and I'm not saying everybody who uses marijuana has mental health problems but that is a core issue that we need to pay attention to I'm just thinking about modeling this on other harm reduction programs where you have a question of criminal law or a success this and so in those cases it's how do people act around that you're not going to change the status of the law but the fact that the act is illegal has an impact not only on people who are engaging in it but what those can do who are around them those structures are policies that are impeding the schools and the teachers from being able to act so for example I was wondering is there an obligation on teachers to have to report unlawful activity and so what is the legal status of the drug what is its impact on the capacities of not the students to act but those around them to act because I think those are your laws that are really going to affect a program like this they can't do anything because they're so worried about their own culpability in light of being seen to endorse it or allow it or so forth which makes them just silent on it in order to avoid or the opposite that they're forced to take action and then what would that mean to so I wondered if you encountered any of those policies or even legal requirements on teachers or schools and I think it's context based in part it's about how it gets taken up in school districts how these regulations get interpreted so I'm not sure about legal status but I think policy status is more what we paid attention to so it's interesting in our school districts we have zero tolerance for example and obviously that is informed by the drug's legal status but I think then it kind of trickles down into school district policy and then it gets interpreted and taken up again in very particular ways so that's why we're interested in going to different communities because there is different dialogue happening in different communities and I totally agree with you I think it is for me at least a lot more about the adults surrounding the circumstances and this kind of conundrum in this one high school that we were in it was kind of a legalistic interpretation of this policy that really put teachers they felt that they were in this conundrum where if they said something the student would be expelled and if they didn't say something they knew their silence was speaking volumes so it's interesting and I do think there are workarounds with this and I think the workaround is to not to actually arm students themselves to provide evidence and arm students themselves so not get into this kind of policing but to talk about these broader issues I think that's the way to have this conversation and I think teachers just haven't been provided with that material so there's an openness to it but nobody's expecting it I think there's a lot more and let's be clear the Canadian anti-drug strategy I didn't talk about that but that is also shaping materials policies it's playing a very important role it was renamed the anti-drug strategy it used to be called the harm reduction strategy and is that implemented into schools or not? it has trickle down effects, absolutely the gender difference you saw in New Zealand and link it to something I was reading recently about research and education in boys and why boys are failing they're disproportionately failing and wonder whether you've made the link with issues around differences in risk between boys and girls but the other piece is differences with respect to future planning because that seemed to be the theory behind this person who's speaking about failing in education it's about a difference about planning for the future and that sort of connected to me in terms of their decision making around marijuana use do you make that link? Do you think it helps understand? I think that there are a number of things at play it's so interesting to really start to dig into this one thing we know that developmentally that boys lag behind girls in terms of their social skills and abilities and so marijuana if you've ever smoked it it kind of makes you giggly and interact it provides an opportunity to interact in a social way it provides an opening for that and because of a developmental lag there might be reasons why boys would get to that substance it also creates a context for risk taking we know that snowboarding skiing, biking, culture it also gets taken up in that regard so I think these things are all linked in terms of masculine performance sense of social skills all those types of things so I think that that's why I think we need to understand it as gendered practice and that's why we need to think about again in terms of the way we engage to make sure we're sensitive to those issues as well I do think that we do have a number of issues we need to think about as well around what's happening to boys in our school systems at the present time and I think this begins to point to some of that as well so thanks for that I was wondering whether there's been any evidence with respect to how the uptake or use of marijuana has affected the uptake or use of other substances like alcohol or tobacco I know you spoke about the gender difference the guy is referring to marijuana the girl is referring to alcohol but what I've seen as a family physician is we went through a generation of kids that had got the message about no smoking but now that they've been turned on to marijuana it's bringing them to smoking as well so not only are they picking up on the marijuana but it's leading them to tobacco abuse which of course is another health concern have you seen that in sort of your researcher excellent question we actually have them work on that and so first of all I think that it is mythology that marijuana is a gateway drug there is no evidence that if you smoke marijuana you're going to start using heroin a lot of heroin users happen to have smoked marijuana in their lives I think that's the issue so I just want to put that out there but we actually have used the language of reverse gateway to tobacco because actually there is some evidence that if you start smoking marijuana you actually might start to smoke tobacco and in some communities you know splits, blunts, you know all of this is part of popular culture so putting marijuana in a cigar, rolling paper mixing it with tobacco mixing it in a bong with tobacco that is all part of practice in different contexts you go to one community, kids are doing that all the time and in another they're not there is also a concern I guess and that's part of the harm reduction messaging as well that we need to be getting kids to think about their exposure to tobacco when they're smoking it with marijuana so I totally and I actually think, yeah, so I think that that's part of this public health story as well absolutely last burning question so thank you very much Dr. Johnson for coming to speak to us on the research it's an important societal issue and you said at the beginning that you would be through public health concerns legal concerns ethical concerns and you've been able to do that as well as public policy so you said that you're going to continue this research so good luck with the rest of your research thank you and we hope that in a couple years you'll be back to Halifax to present it to us thank you so much, thanks for your attention