Pills, liquor, and pot:

From handcuffed to hindered

Photo credit: Matthew Brodeur via Unsplash

Note from the editor: this is the final instalment in a three-part series. Part one focuses on how prescription drugs are promoted in Canada, while part two discusses the promotion of alcohol.

When cannabis was legalized in Canada in October 2018, it wasn’t to ease the burden on the justice system, to reduce the number of criminal offences associated with the drug, or even to increase government tax revenue. Justin Trudeau’s Liberal government was clear from the start that the primary reasons it was legalizing cannabis were in the interest of public health and safety: to make cannabis less available to minors, and to displace the illicit market.

When it comes to the potential harms associated with underage cannabis consumption, whether you’re a physician or a tinfoil hat-wearing skeptic, the fact remains: before legalization, Canada held the leading spot among 29 of the world’s most advanced economies for youth use of cannabis, with as many as one third trying it before the age of 15. The Canadian Centre on Substance Use and Addiction (CCSA) reported in 2018 that although use among youth aged 15 to 24 had declined over the last 10 years, consumption by that group was nearly three times higher than by those over the age of 25. Given the research on how early exposure to cannabis may affect developing brains, one can understand why regulating and age-gating cannabis was an important step for the government to take.

Though it is early, so far, their public health and safety approach seems to have been somewhat successful in making cannabis less appealing to young people: a Statistics Canada report found that between 2018 and 2019, cannabis use among 15 to 17-year-olds fell from 19.8 per cent to 10.4 per cent. (The same cannot be said for the government’s goal of taking business from the illicit market, as the growing gap between legal and illegal prices means the majority of consumers still prefer to buy from an unregulated source.)

But in maintaining such a strict health and safety approach with regard to adult consumption of the substance, one could argue that the public’s understanding of cannabis and its various properties and potential uses is lacking considerably. Cannabis, unlike prescription drugs and alcohol, is not marketed to Canadians on TV screens or through magazines; we are not exposed to it at sporting events and our doctor’s certainly aren’t recommending the newest brands (or cultivars) in place of the generic medication we’ve been taking for years—because promoting cannabis is more or less prohibited by the Cannabis Act.

Granted, licensed producers have been creative with ways to market their brands to consumers over the age of 19, and certain provinces have implemented marketing licences to enable some level of business-to-business and business-to-consumer messaging. But advertising, in the traditional sense, is virtually nowhere to be seen.

In endeavouring to compare and contrast the marketing regulations around prescription medication, alcohol, and cannabis, and the harms associated with their use, it’s important to point out the Venn diagram in which these intoxicating substances coexist: while prescription drugs are (most often) used for medical purposes, and alcohol is used for recreational reasons, cannabis falls into both circles. This nuance has an impact not only on our societal perception of cannabis, but on the messages we receive about it from government, corporations, lobbyists, healthcare professionals, and other experts—and more often than not, their dialogue focuses on the recreational use and potential harms of cannabis, rather than its medicinal applications.

To understand why the federal government has enacted such strict regulations around cannabis advertising, one might consider how experts have sized up regulations around prescription medication and alcohol to date: Inside the Jar spoke with several who said they consider the existing advertising policies around these substances to be abject failures. Some have speculated that the government isn’t interested in repeating the same mistake with cannabis.

If we prescribe to the notion that it is easier to give than to take away, taking a restrictive approach to legislating messaging around an inebriating substance, in which regulations can be revisited and perhaps loosened accordingly, makes sense.

For myriad economical, social, and historical reasons, restructuring advertising laws around prescription medication and liquor would be incredibly challenging for policymakers. Despite the impact substance-related messaging has on the public health and safety of the population, amending these regulations is also something that Canadians simply might not care for. (As public policy professor Cheryl Camillo explained in part two, as humans, we don’t like to give up benefits, and react much more strongly to loss than to gain.) If we prescribe to the notion that it is easier to give than to take away, taking a restrictive approach to legislating messaging around an inebriating substance, in which regulations can be revisited and perhaps loosened accordingly, makes sense.

With this in mind, it is also possible to examine the pitfalls and potential problems with this approach. Legalization has forced us to take a closer look at the potential risks associated with use. We spend far more time discussing how cannabis can be harmful than how it can potentially aid a person suffering from anxiety, or substance use disorder, or chronic pain. (This fact is true for thousands of Canadians.) While a blanket ban on advertising may appear to be a suitable way to minimize risks, such stringent limits on all messaging around both medical and recreational cannabis may be a hindrance to patients and consumers alike.

How Canadians use cannabis

If you’ve read parts one and two of this series, you’ll know that Canadians are among the top global consumers of both prescription drugs and alcohol. We also rank high when it comes to cannabis: according to the latest data from Statistics Canada, 16.7 per cent of the Canadian population consumed cannabis in the last quarter of 2019. The most recent data on lifetime use, from Health Canada’s 2012 Canadian Alcohol and Drug Use Monitoring Survey, revealed that 41.5 per cent of Canadians had used cannabis at least once throughout their lives. (In the updated version of this survey, this question is no longer posed.) It is the most prevalently used substance in Canada after alcohol, which was consumed by 78 per cent of Canadians in 2017. On a global scale, Canada’s cannabis consumption rate ranks second only to Nigeria. The latest data shows that slightly more men than women use cannabis, and the highest percentage of consumers fall into the 25 to 34 age group, although this hasn’t always been the case. The 15 to 24 group has historically taken first place.

In 2018, a year Statistics Canada found just over 5 million Canadians consumed cannabis, the majority of consumers (1.8 million) used it less than once a month. This was followed by users who indulged once a week (1.3 million), and then by those who consumed one to three times per month (884,000). Nearly 720,000 Canadians reported using cannabis daily.

A report from the United Nations found that in the years leading up to legalization (2013 to 2017), Canada saw a 40 per cent increase in cannabis use. Despite predictions from health experts and fear mongers alike that legalization would lead to a massive increase in consumption, the number of cannabis consumers has remained largely unchanged. Looking more closely and separating for age, data from StatCan released in spring 2019 showed that the number of first-time consumers, particularly those aged 45 to 64, was up. In the final quarter of 2019, the demographic with the most consumers was those aged 25 to 34, with 26.9 per cent in that age group consuming cannabis. At the end of 2018, about half of Canadian consumers said they used cannabis exclusively for recreational purposes, while a quarter said they used it for medical reasons only. Another quarter said they used it for both recreational and medicinal purposes.

The 2017 Canadian Cannabis Survey (CCS) conducted by Health Canada found that on average, those who reported using cannabis in the last year spent $75 per month on cannabis products for non-medical use. Those who reported using cannabis more frequently (in the past month) spent slightly more, at $88 per month. More data from StatCan shows that Canadians have always been big spenders (albeit considerably less than on prescription meds and alcohol) when it comes to cannabis, and that legalization has had little impact on the amount of money that Canadian households are willing to spend, whether for medical or recreational purposes. In 2015, that total was $5.8 billion. In 2018, the year cannabis was legalized, Canadians spent slightly less ($5.7 billion), but 2019 saw a slight increase to $5.9 billion. (Note that these numbers include purchases on both the legal and black markets, and as such are not exact.)

Canadians like to consume cannabis in a variety of ways, but according to the CCS, our preferred method is smoking: 94 per cent of respondents who used cannabis in the last year said it was their go-to method. Edibles were used by 34 per cent, while 20 per cent opted for a vape pen, and 14 per cent used a vaporizer.

The same survey asked respondents how acceptable they considered the recreational use of cannabis to be. Nearly 30 per cent said they found it to be “completely acceptable”, while 77 per cent said they believed cannabis use could be habit-forming. While respondents indicated that they believed cannabis use could have positive effects on mood, anxiety, sleep, and creativity, most said they thought it could have a negative impact on decision-making, attention, memory, and motivation.

While more and more consumers are slowly transitioning to the legal market to make their cannabis purchases, the majority of consumers are still acquiring cannabis from the black market. StatCan data shows that medical users are more likely to obtain cannabis through legal channels: in the final quarter of 2018, just 26 per cent of non-medical users said they purchased cannabis through legal retail channels, while 86 per cent of medical consumers with documentation from their physician went the mail-order route, or had a designated grower produce it for them. Just eight per cent said they grew it themselves.

Looking at the trends in medical cannabis, data from StatCan reveals that in 2015, before the introduction of the Access to Cannabis for Medical Purposes Regulations (ACMPR) in August 2016, just $85 million was spent on medical cannabis across Canada. (Keep in mind this was at a time that fewer than 20 licensed producers had received licenses and were operational. Today, there are over 300.) In 2016, that number rose to $297 million. With all the hype and conversation around cannabis legalization, it continued to grow substantially in 2017 ($584 million) and 2018 ($587 million). By 2019, that number had mushroomed to $618 million.

While this doesn’t make up a significant portion of the total amount of money households spent on cannabis in the last year, it does show that, with legalizing cannabis at the recreational level, Canadians have shown a growing interest in the medicinal properties of cannabis. This is supported by reports from physicians post-legalization, which say they have seen an uptick in the number of patients asking questions about using cannabis in place of traditional medication.

Impacts of cannabis use and misuse in Canada

Dr. Jeremy Rezmovitz, a family doctor operating an independent practice in Toronto, Ontario, is one such physician seeing an increased curiosity around cannabis.

“With the legalization of [cannabis] I think there has been more interest. I think people have more exposure to it now,” he told ITJ by phone. He believes that excessive attention from the media has driven some Canadians to view cannabis as a potential remedy. While he said he wasn’t aware of cannabis working as a cure for any particular illness or disorder, he did acknowledge that it could be “very successful” in managing symptoms for some patients.

“A lot of people suffer from chronic pain—either physical, emotional, or existential pain—and I think marijuana has the ability to manage those pains… I think cannabis could be the right drug, for the right person, at the right time in their lives.”

But, Rezmovitz also said that while he’s seen anxiety sufferers have success with cannabis, he’s also had patients who experience increased anxiety after use, and a few who’ve had “full-blown psychosis” after just one experience with cannabis. He hasn’t dealt with patients directly as their first stop is always the emergency room, but he’s also heard much about cannabis hyperemesis syndrome.

“It comes down to risk. Every drug that you take comes down to risk… from an education standpoint, you need to be aware, and my goal as a health care provider is to inform you of those risks and the benefits and have a shared conversation about it.”

Risk, as Rezmovitz describes, comes with every drug, and cannabis is certainly not exempt.

Health Canada describes some of the short-term health effects associated with cannabis as:

  • Feeling high
  • A sense of well-being
  • Relaxation
  • Heightened sensory experiences

The agency also dedicates significant page space to side effects, adding that cannabis use may cause negative, unwanted, or unpleasant feelings in the body and mind. This can include: confusion, fatigue, anxiety, fear, or panic, and an impaired ability to remember, concentrate, pay attention, or react quickly. It goes on to add, some people may experience paranoia, delusions, or hallucinations.

The effects of smoking cannabis can also include damaged blood vessels, decreased blood pressure, and increased heart rate, which can be risky for those suffering from heart conditions. According to data from the Canadian Institute for Health Information (CIHI), between 2017 and 2018, cannabis was an attributable substance in 15 per cent of all hospital stays, compared to 53 per cent for alcohol, and 12.3 per cent for opioids. The report said hospitalizations caused by cannabis consumption “were often related to symptoms of psychosis or distress”, and children and youth aged 10 to 19 made up the vast majority of cannabis-related hospital stays. There were predictions in 2018 that legal cannabis would lead to an increase in hospital stays and emergency room visits, but in May 2019, the Toronto Star ran a story with the headline, “If cannabis is having any dire health effects, Canadian hospitals haven’t seen them”. So far the number of individuals being admitted to hospital for cannabis-related issues hasn’t seen much change.

Health Canada says long-term use of cannabis can increase one’s risk of dependence, and may have a negative impact on memory, concentration, IQ, and one’s ability to make decisions. These risks appear to be worse if one starts using cannabis in adolescence, and with long-term, regular use. The agency advises against cannabis use by pregnant women or new mothers as it may have an effect on their fetus or young child.

These short and long-term effects may not affect all consumers in the same way or to the same degree, but they do have an impact on Canadian society. The CCSA’s comprehensive 2014 data on the costs and harms associated with substance use shows that year, cannabis use cost Canadian taxpayers $2.82 billion in healthcare, criminal justice, lost productivity, and other direct costs, with the majority ($1.76 billion) being spent on the criminal justice system. (For comparison’s sake, the same year saw taxpayers spend $14.64 billion on costs and harms associated with alcohol, and $11.97 billion on those associated with tobacco.)

We’ve all heard the concerns around use from the government during the lead-up to legalization. Many of us who consume cannabis regularly, and may have consumed it since we were teenagers, have doubts about the validity behind some of these warnings. But it’s not just consumers who wonder whether the government is exaggerating the potential harms associated with cannabis, while understating the harms associated with other substances. Experts who have studied the impacts of substance use on society have also pointed out that some of the predictions made by government, law enforcement, and medical professionals turned out to be based on fear, not science.

“We do have a pretty solid take on the risks or harms that cannabis poses to most Canadians. On an acute level, the largest risk is around operation of heavy machinery, and on a chronic level, the risk of cannabis is really around dependence, and around quality of life,” Dr. M-J Milloy, a research scientist and epidemiologist with the BC Centre on Substance Use (BCCSU), told ITJ by phone.

According to the federal government, the risks associated with driving under the influence of cannabis are still largely ignored by the general population, and are thought to be overstated by those who use cannabis: the CCS conducted in 2017 revealed that at least half of cannabis users didn’t think that use affected their driving that much, while a fifth of respondents said it didn’t affect them negatively at all. The same year, there were 3,489 drug-impaired driving violations reported in Canada, though these violations account for driving impaired by other types of drugs as well, not just cannabis. Research shows that after cannabis use, one’s risk of getting into a motor vehicle accident is increased by up to three times. The 2019 National Cannabis Survey revealed that a total of 15 per cent of respondents who had a driver’s licence and used cannabis admitted to getting behind the wheel within two hours of consuming cannabis at least once in the last year.

Despite fears that legalization would lead to more motor vehicle accidents, StatCan data shows that the number of individuals who chose to get behind the wheel after consuming cannabis remained unchanged in 2019. Early reports from the RCMP also show that six months into legalization, there was no spike in cannabis-impaired driving charges.

“I think that fears that legalization would lead to a tsunami of cannabis-related traffic accidents have largely, thankfully, turned out to be false,” said Milloy when asked whether potential risks associated with using cannabis were overstated by policymakers.

“I think unfortunately that the legalization debate and process has revealed that many Canadian policymakers and politicians have only a tenuous grasp on the scientific evidence, and indeed ignore it or exaggerate it or pervert it where it serves their purposes.”

To back up his point, Milloy drew a comparison between two issues Ontario Premiere Doug Ford faced near the end of 2018: “It was very telling that as his government was failing to put in place a system to sell cannabis, Ford was pushing his idea to sell alcohol for a dollar a beer—when the direct cost of that strategy, selling alcohol at that price, wildly outstrips any public health costs that might be related to legalizing cannabis.”

“I think unfortunately that the legalization debate and process has revealed that many Canadian policymakers and politicians have only a tenuous grasp on the scientific evidence, and indeed ignore it or exaggerate it or pervert it where it serves their purposes.”

At the very bottom of the federal health agency’s information on the effects of cannabis consumption is a short blurb referencing the potential therapeutic effects of its use. A link to a page for healthcare professionals sources over 1,600 studies related to the medicinal uses of the plant, discussing everything from asthma and anxiety to pain and palliative care. With nearly 400,000 registrations under Canada’s ACMPR, it’s clear that cannabis consumption improves the quality of life of at least that many Canadians (remember that not everyone has a mailbox or credit card to access the federal mail order program, and many still access products for medical purposes without a recommendation from their doctor). But without being assigned a drug identification number (DIN), it cannot be considered a prescription-based medication. This is part of the reason why the vast majority of insurance companies won’t cover it, and why you’ll never see an ad for a medical cannabis company or brand in a magazine at your doctor’s office.

“I think more attention should be paid to the probably quite beneficial experiences of those 400,000 Canadians who are using it through the authorized system, and probably many millions more who are doing it the non-authorized way, either the legal regulated market or the legacy market,” said Milloy. He added that the research he and his colleagues are conducting at the BCCSU has found that cannabis can play a beneficial role in the lives of those who are experiencing substance use disorder, and he’s hopeful that their work is part of a “new wave” of cannabis research. He called Health Canada’s reforms around cannabis research “an early win of legalization.”

“I hope that the evidence, which is already coming out… will lead to a greater discussion of therapeutic cannabis use, in Canada and around the world,” he said.

It seems that legalization has called on us to take the potentially dangerous effects associated with cannabis use more seriously—but in doing only that, we are quietly negating any and all potentially beneficial effects that the substance has on Canadians, whether they use cannabis for medicinal or recreational purposes. Cannabis may not have the deep historical connection to Canadian society in the way that alcohol does but with legalization, it has become part of our identity, certainly from a global perspective. Even prior to October 2018, we have had an international reputation for our successes with the plant for some time. Canada became the first country to legalize the medical use of cannabis way back in 2001, and we have produced substantial research on the subject since. It would be hard to argue against the fact that the roots of legalization really began with the movement for medical access to the plant. But where our historical and cultural connections are largely embraced in advertising and messaging around alcohol, they are shirked by parts of the legal cannabis industry and particularly by the federal government.

While many Canadians evaded the prohibition of alcohol and engaged in bootlegging immediately after liquor was banned, illicit cannabis production and consumption didn’t become prominent in Canada until the 1960s, when parts of the country became popular destinations for Americans fleeing the draft. Where liquor prohibition didn’t last (at least on the national level) for a long period of time, and the narrative about it’s negative impact on our lives has remained secondary to its supposed positive impact on our ability to relax and socialize, the longer illicit history of cannabis and its vilification for almost a century means we still perceive it in a negative way, despite it now being legally available. This belief was reflected in the CCS: the majority of respondents said that alcohol was the most socially acceptable substance, with 56 per cent saying alcohol use is “completely socially acceptable”, where just 28 per cent of respondents said the same about using cannabis for non-medical purposes.

It will take time for our beliefs to catch up to reality. We have a long way to go when it comes to reconciling the messages around cannabis, alcohol, and prescription drugs with their actual impacts on society. Too often, these messages are tainted by feelings of nostalgia, entitlement, and greed, rather than science.

“As an epidemiologist who is interested and concerned about the public health impacts of different substances, I think the inescapable conclusion, no matter how you cut the data, is that on a societal level, the harms that flow from alcohol use are much greater than the harms of smoking cannabis,” said Milloy.

“That leads to the question of, are these substances being regulated appropriately when it comes to marketing and advertising? And I think, it’s inescapable that were we to just start over today, we would put much greater restrictions on alcohol than we currently have.”

Cannabis advertising in Canada (or lack thereof)

The Cannabis Act makes it very clear: “Unless authorized by this Act, it is prohibited to promote cannabis or a cannabis accessory or any service related to cannabis”. This includes sharing any information about price or distribution, by communicating in a way that might be appealing to youth, by way of testimonials or endorsements, by depicting people, characters, or animals, and by using messages that may evoke feelings of “glamour, recreation, excitement, vitality, risk or daring”. Other restrictions include:

  • Promotion that is false, misleading or deceptive or that is likely to create an erroneous impression about its characteristics, value, quantity, composition, construction, design, etc.
  • Publishing, broadcasting or otherwise disseminating prohibited promotions
  • Promotion using foreign media
  • Displaying brand elements or names on a facility used for a sports or cultural event or activity
  • Engaging in inducements

The penalty for violating promotional provisions is a monetary fine of up to $1 million.

There are exceptions for those who are authorized to produce, sell, or distribute cannabis, but only if their communication is:

  • Addressed to an individual over the age of 18, identified by name
  • In a place where young people are not permitted by law
  • Telecommunicated and reasonable steps have been taken to ensure the person receiving the promotion is over the age of 18
  • Done in a prescribed place or a prescribed manner

The prohibition on advertising does not apply to business-to-business promotions—those who are authorized to produce, sell, or distribute cannabis, or provide a service related to cannabis, are permitted to direct messaging at any person who is authorized to do the same, but not to a consumer, whether directly or indirectly.

Much of what influenced the laws around cannabis promotion came from the federal Task Force on cannabis legalization, which held consultations with a wide variety of industry stakeholders and looked to the laws in jurisdictions with existing cannabis legislation to develop suggestions for Canada’s legal framework. It also considered the successes and failures of Canada’s laws around tobacco and alcohol. A discussion paper by the force outlined this approach:

“When considering how best to minimize harms associated with marijuana use, it is helpful to consider the two different approaches taken in controlling tobacco and alcohol use. In the case of tobacco, the overall objective is to reduce or even eliminate use for all Canadians. In contrast, the overall objective with respect to alcohol is to promote responsible use amongst adults, and to prohibit use amongst youth…. Given that the majority of harms related to marijuana use appear to occur in select high-risk users (e.g., youth) or in conjunction with high-risk use practices (e.g., frequent use; highly potent products; impaired driving), an approach that draws lessons from both tobacco and alcohol control should be examined.”

It goes on to suggest that limiting the active promoting and marketing of marijuana is crucial to preventing wide-spread use or “normalization” of cannabis consumption, and that putting laws in place that more closely resemble promotional regulations around tobacco would better protect “impressionable youth”.

“The Government of Canada takes cannabis marketing and advertising, including marketing and advertising that may reach youth, very seriously,” Tammy Jarbeau, senior media relations representative with Health Canada, said to ITJ in an email on behalf of chief public health officer Dr. Theresa Tam.

“The Task Force heard strong support from, among others, educators, parents, youth and the public health community for comprehensive marketing restrictions for cannabis similar to those for tobacco. Such restrictions were considered to be necessary because the evidence from the Department’s experience with tobacco and alcohol suggests that partial restrictions send mixed messages about use,” she wrote.

“The Task Force agreed with the public health perspective that, in order to reduce youth use and inducements to using cannabis, strict limits should be placed on the promotion of cannabis… They were concerned that the presence of any cannabis promotion could work against youth education efforts, and that partial restrictions on advertising and marketing would make it challenging to avoid advertising that reaches, or is appealing to, youth.”

Former B.C. health minister Terry Lake spent two years as the vice president of corporate social responsibility at Hexo Corporation, a Quebec-based licensed producer. In an interview with ITJ, he questioned the federal government’s commitment to taking a risk-based approach to substances, and said he thought the scale of different approaches “does not reflect their relative risk to health”.

“If you want to take a science-based approach to all these different substances, then do that, but don’t say you’re taking a public health approach to cannabis, and then take the exact opposite approach to alcohol,” he said. In addition to being inconsistent with existing legislation for other inebriating substances, Lake said the ban on all cannabis marketing and advertising makes it challenging for consumers to be informed.

“While I understand [the approach], I think it does hurt consumers as well as industry, because you can’t really provide the adequate information to consumers, so you don’t really have an informed consumer as much as you could if you had a better ability to talk about your product,” he said. Not being able to differentiate from one product to the other, or the inability to discuss products in a comparative way, “does hinder consumer choice and informed consumer use”, according to Lake.

The other argument the former veterinarian and Kamloops, B.C. mayor made was that such strict limitations on messaging make it difficult for licensed producers to compete with illicit operators. If you’re trying to keep cannabis out of the hands of kids, prohibiting advertising that might encourage them to pick up a joint before they are of legal age makes sense. But, if you are trying not only to compete with, but displace a multi-billion-dollar illicit market with decades of experience not to mention consumer loyalty, eliminating all traditional forms of potential consumer incentive is akin to shooting oneself in the foot.

“The legal industry simply can’t compete with the black market because they have no restrictions on the way they talk about their product, or the way they market their product. You’re not accomplishing one of your major goals if one set of regulations around marketing and describing your product is so restrictive that it’s impairing your primary objective.”

If you are trying not only to compete with, but displace a multi-billion-dollar illicit market with decades of experience not to mention consumer loyalty, eliminating all traditional forms of potential consumer incentive is akin to shooting oneself in the foot.

Lake said prior to legalization, his former organization and 16 other licensed producers as well as the Canadian Medical Cannabis Council and Cannabis Canada worked together to create guidelines for the responsible branding and promotion of cannabis. In collaboration with Advertising Standards Canada, they developed the Adult Use Cannabis Advertising and Marketing Self-Regulatory Guidelines for Licensed Producers. (Note that both the pharmaceutical and alcohol industries are self-regulated when it comes to advertising. In those instances, self-regulation has led to a complete disregard of advertising prohibitions, and almost no oversight or enforcement.)

These guidelines were as follows:

  • Marketing by LPs would only promote brand preference and would not attempt to influence adult non-consumers of psychoactive cannabis products to become consumers
  • Marketing by LPs would not be directed at people under 18 years of age, or below a province or territory’s designated legal age for purchase
  • All advertising messages would contain responsible-use statements
  • To facilitate compliance with these guidelines, LPs would voluntarily opt to submit their advertising messages to Advertising Standards Canada for preclearance prior to dissemination
  • LPs would agree to adhere to the provisions of the Canadian Code of Advertising Standards

“When the industry came together and created a document that advocated for self-regulation, the government didn’t take that seriously,” said Lake of the endeavour. “I think it was a very well-structured and well-meaning approach that would have accomplished more than what we see with the federal government’s approach. You can’t create a strong industry if you don’t have structure in place that allows that industry to do well.”

Hexo, like other licensed producers, tried to find ways to work within existing regulations to promote their brands and products. With restrictions on marketing limiting LPs to taking a business-to-business approach, Lake said Hexo worked with distributors and retailers “as much as possible” to inform them about products.

“With 10 or 11 distributors across the country, that’s very difficult to do,” he said. “It’s time-consuming, it’s costly, and it is not the best way to inform consumers, because you’re not talking to them directly.”

The former VP said the LP’s marketing team thought at first that they could speak directly to consumers through advertisements in age-gated venues, “but it seems even that has been restricted”, which Lake said made little sense to him. (It’s not clear how advertising in areas where youth are not permitted have been restricted. ITJ staff have noted advertisements by Hexo and other producers in bars and restaurants in B.C.’s Lower Mainland in the last several weeks.)

Spotted in a bar in New Westminster, B.C. (Amanda Siebert photo)

While the federal regulations on cannabis marketing are clear about marketing to consumers, there are exceptions within the legislation that permit marketing “in a prescribed place” or “done in a prescribed manner”. Two provinces, B.C. and Alberta, have implemented licensing regimes that play off of this exception, enabling federally licensed producers to promote non-medical cannabis to retail store licensees and the adult public.

In B.C., a cannabis marketing licensee is authorized to promote cannabis and hire employees as marketing representatives. Certain promotional activities are permitted, such as events and activities that invite other marketing licensees and non-medical retail licensees to learn more about the products each represents. Product samples and inducements are, however, not permitted.

In Alberta, companies can apply to become registered cannabis representatives, enabling them to market cannabis in the province. The Alberta Liquor and Gaming Commission prohibits cannabis representatives from providing services, items, or activities to cannabis licensees, while also prohibiting licensees from requesting inducements from suppliers or representatives.

When it comes to marketing to and communication with consumers, Health Canada does not provide advice on what companies are and are not legally permitted to do, nor does it review or approve materials prior to their dissemination. The agency has said it will assess compliance relating to promotional activities on a case-by-case basis, considering the “purpose, content, and context of a communication or message and the intended audience” when making an assessment.

Discussing any of the medical applications of cannabis is clearly prohibited by the Cannabis Act, but in some parts of the country where cannabis clinics are more common than others, like Ontario, medical cannabis consumers are more often subjected to messaging from licensed producers that encourages them to try their products and brands over others.

“Licensed producers of medical cannabis are paying millions of dollars to cannabis clinics across the country in exchange for patients who register their marijuana prescriptions with the companies, corporate documents and interviews reveal,” reporter Tom Blackwell wrote in the National Post in January 2019.

“What just three years ago was a controversial, but sporadic, practice seems to have become a routine part of the pot business, where medicine and commerce are increasingly intertwined.”

The common practice of providing “kickbacks” to clinics encourages clinic staff to suggest certain licensed producers over others to patients who are looking to acquire medical cannabis through the federal mail-order system. Some companies refer to these payments from LPs as “educational grants” that enable them to pass information about cannabis onto patients. Many view this as an unethical business practice.

Providing information to consumers about cannabis is necessary, whether they intend to use it for recreational or medical purposes, but neither of these approaches—completely banning advertising, or paying clinic staff to be corporate messengers—hit the mark. Consumers want to know more about the products they are purchasing and using; they don’t want to feel clueless, but they also shouldn’t be subjected to messaging from clinics that receive financial incentives from licensed producers, who find themselves between a rock and a hard place.

Where Health Canada and Canadians stand on substance-use related marketing

While it’s unlikely we will see changes made to the Cannabis Act anytime soon, especially when it comes to marketing, it is encouraging to know that the federal government is, at the very least considering making changes to existing policies around alcohol.

Through email correspondence with Jarbeau of Health Canada, ITJ asked exactly how seriously the federal government takes the relative harms associated with substance use, particularly because their current policies regarding prescription drugs, alcohol, and cannabis, are not, as both Lake and Milloy said, reflective of a science-based approach.

“The Government of Canada is deeply concerned about problematic alcohol use, which can have significant and widespread health, social and economic consequences for individuals and communities,” Jarbeau wrote. (She declined to provide information on Health Canada’s stance with regard to the advertising of pharmaceutical drugs, or the impact these substances have on Canadians, though she did indicate that the opioid crisis is a priority for Health Canada.)

Jarbeau noted that in 2019, the federal health agency conducted a nation-wide consultation for the Canadian Drugs and Substances Strategy, which asked for feedback on the advertising and marketing of alcohol.

“By far the biggest issue when it comes to substance use… is the widespread and far-reaching normalization of alcohol consumption in so many segments of culture and society,” wrote one respondent.

According to Health Canada, many respondents said that the normalization of problematic drinking “is supported by the high prevalence of inescapable advertising and marketing of alcohol, including efforts that target women and youth.”

Suggestions made to the agency included implementing federal legislation such as an Alcohol Act, taking a public health approach similar to cannabis and tobacco, and using evidence-based practices to reduce the harmful effects of alcohol consumption. This could include adjusting taxation, making stronger regulations around where alcohol is physically available, and placing “strict controls” on marketing.

Using this feedback, “Health Canada and the Public Health Agency of Canada will continue to identify ways to address alcohol-related risks and harms,” said Jarbeau.

According to Milloy, restricting the availability of alcohol by increasing price would be the most effective way to reduce harms associated with its consumption.

“These are more important moves than talking about commercials and advertising and that sort of stuff,” he said. He said preliminary evidence around substitution seems to suggest that when cannabis is legalized, alcohol consumption and sales are reduced.

“What makes many of us public health scientists hopeful about the effects of cannabis legalization, is that, if we could even move the needle a little on alcohol consumption in our society, in my view we would see tremendous benefits, in terms of health, public health, and social health. And that would happen because we legalized something—not because we decided to convince people that it was better to smoke a joint than to use alcohol.”

On prescription drugs, respondents suggested that more research was needed to clarify guidelines and practices around prescriptions, particularly for the use of opioids for chronic and acute pain. Some called for information sharing between physicians and pharmacists to better monitor which prescriptions are being filled, where they are being filled, and how often they are being filled, while others supported the idea of medication-assisted treatments for those suffering from substance use disorder.

The consultation also received some feedback regarding cannabis: a small number of respondents expressed concern about the lack of information on cannabis, “including the benefits and harms associated with its use”. While many respondents called for tougher alcohol regulations, “few respondents expressed concern about the potential impacts of cannabis legalization”.