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IN FOCUS LEGALIZATION

CROSS- ISSUES: EVOLVING TRENDS AND 4 NEW CHALLENGES

2020 This publication may be reproduced in whole or in part and in any form for educational or non-profit purposes without special permission from the copyright holder, provided acknowledgement of the source is made. The United Nations Office on and Crime (UNODC) would appreciate receiving a copy of any publication that uses this publication as a source.

Suggested citation: In Focus: Cannabis legalization - World Report 2020.

No use of this publication may be made for resale or any other commercial purpose whatsoever without prior permission in writing from UNODC. Applications for such permission, with a statement of purpose and intent of the reproduction, should be addressed to the Research and Trend Analysis Branch of UNODC.

DISCLAIMER The content of this publication does not necessarily reflect the views or policies of UNODC or contributory organizations, nor does it imply any endorsement.

Comments on the report are welcome and can be sent to:

Division for Policy Analysis and Public Affairs United Nations Office on Drugs and Crime PO Box 500 1400 Vienna Austria Tel: (+43) 1 26060 0 Fax: (+43) 1 26060 5827

E-mail: [email protected] Website: www.unodc.org/wdr2020 Acknowledgements The World Drug Report 2020 was prepared by the Research and Trend Analysis Branch, Division for Policy Analysis and Public Affairs, United Nations Office on Drugs and Crime (UNODC), under the supervi- sion of Jean-Luc Lemahieu, Director of the Division, and Angela Me, Chief of the Research and Trend Analysis Branch, and the coordination of Chloé Carpentier, Chief of the Drug Research Section.

Content overview Administrative support Chloé Carpentier Andrada-Maria Filip Angela Me Iulia Lazar Analysis and drafting Kamran Niaz Editing Jonathan Gibbons Graphic design and production Anja Korenblik Suzanne Kunnen Kristina Kuttnig Federica Martinelli

Review and comments The World Drug Report 2020 benefited from the expertise of and invaluable contributions from UNODC colleagues in all divisions. The Research and Trend Analysis Branch acknowledges the invaluable contributions and advice provided by the World Drug Report Scientific Advisory Committee: Jonathan Caulkins Afarin Rahimi-Movaghar Paul Griffiths Peter Reuter Marya Hynes Alison Ritter Vicknasingam B. Kasinather Francisco Thoumi Charles Parry

EXPLANATORYKEY FINDINGS NOTES

The designations employed and the presentation of The following abbreviations have been used in the the material in the World Drug Report do not imply present booklet: the expression of any opinion whatsoever on the part of the Secretariat of the United Nations con- alpha-PVP alpha-pyrrolidinovalerophenone cerning the legal status of any country, territory, city APAAN alpha-phenylacetoacetonitrile or area, or of its authorities, or concerning the delim- ATS -type itation of its frontiers or boundaries. Countries and areas are referred to by the names CBD that were in official use at the time the relevant data DEA Drug Enforcement Administration were collected. EMCDDA European Monitoring Centre for Since there is some scientific and legal ambiguity Drugs and Drug about the distinctions between “drug use”, “drug misuse” and “drug abuse”, the neutral term “drug Europol European Union Agency for use” is used in the World Drug Report. The term Enforcement Cooperation “misuse” is used only to denote the non-medical use GDP gross domestic product of prescription drugs. INCB International Control All uses of the word “drug” and the term “drug use” Board in the World Drug Report refer to substances con- trolled under the international drug control INTERPOL International Criminal Police conventions, and their non-medical use. Organization All analysis contained in the World Drug Report is LSD lysergic acid diethylamide based on the official data submitted by Member MAPA methyl alpha-phenylacetoacetate States to the UNODC through the annual report MDA methylenedioxyamphetamine questionnaire unless indicated otherwise. The data on population used in the World Drug MDMA 3,4-methylenedioxymethampheta- Report are taken from: World Population Prospects: mine The 2019 Revision (United Nations, Department MDPV methylenedioxypyrovalerone of Economic and Social Affairs, Population 4-MEC 4-methylethcathinone Division). References to dollars ($) are to dollars, 3-MMC 3-methylmethcathinone unless otherwise stated. 4-MMC 4-methylmethcathinone References to tons are to metric tons, unless other- NPS new psychoactive substances wise stated. PCP P-2-P 1-phenyl-2-propanone PMK piperonyl methyl ketone S-DDD defined daily doses for statistical purposes THC Δ-9 – UNODC United Nations Office on Drugs and Crime

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Developments in jurisdictions with measures regulating the non-medical use of cannabis

of cannabis products for medical purposes had DEVELOPMENTS IN already been allowed in as early as 1999. JURISDICTIONS WITH The objectives of the current cannabis legislation in MEASURES REGULATING Canada are to keep cannabis away from young people (under 18 years of age), to prevent criminals THE NON-MEDICAL USE from profiting from the distribution and sale of can- OF CANNABIS nabis and to safeguard public health and safety by allowing adults (aged 18 and older) legal access to As at December 2019, legal provisions had been cannabis.322 Under the constitutional division of approved in Canada, and in 11 jurisdic- powers in Canada, the federal Government and pro- tions in the United States, including the District of vincial governments have different responsibilities.323 Columbia and the Northern Mariana Islands, to As the provinces historically developed their own allow the production and sale of cannabis products systems to regulate the sale of , a similar for non-medical use. The common feature of the approach has been applied to regulate the non-med- legislation in Canada and in the jurisdictions in the ical use of cannabis products. United States is that most of them allow for-profit To monitor the outcome of the new cannabis reg- industry to produce and sell cannabis products for ulations, the has invested non-medical use. There are some differences in the in a formal system that may eventually help to eval- level of regulation, its implementation and the con- uate their impact and support the further trol of the non-medical use of cannabis (see tables development of policies and programmes. One of 3, 4 and 5 for details on cannabis regulations in each the main measures taken to that end is a cannabis jurisdiction in Canada, the United States and Uru- survey that established a baseline in 2018 and is guay). Moreover, those regulations are implemented repeated every quarter in order to provide objective in different local contexts and influenced by different information on trends in the use of cannabis prod- dynamics, which is likely to have a different impact ucts, both medical and non-medical, as well as on on the development of cannabis markets within each how the legal cannabis market has evolved over time. jurisdiction, on the extent of the non-medical use of cannabis and on other indicators relating to public Following an initial increase in health and safety and criminal justice. It may take 2018, cannabis use appears to have years of regular monitoring of different indicators to stabilized fully assess the outcome and impact of the legisla- At the baseline, in the first quarter of 2018, nearly tion. The sections below therefore do not represent 14 per cent of (12.2 per cent of women an attempt to assess the impact of cannabis legaliza- and 15.8 per cent of men) reported that they had tion, but rather to describe the outcome of one year used cannabis, including cannabis products for med- of implementation of different features of the legis- ical purposes, in the past three months.324 The lation, the status of legislation and the regulation of highest prevalence rates were reported among those the non-medical use of , as well aged 25–34 (26 per cent) and 15–24 (23 per cent). as the developments in Uruguay and selected juris- By the beginning of 2019, the prevalence of use in dictions in the United States. the past three months had increased to 17.5 per Legalization of the non-medical cent, and it remained close to that level until the use of cannabis in Canada third quarter of 2019 (17.1 per cent). While the 322 Canada, Ministry of Justice, “Cannabis legalization and reg- In 2018, the Government of Canada passed the ulation”. Available at www.justice.gc.ca/eng/cj-jp/cannabis. , which permits the commercial pro- 323 See table at the end of the present chapter. duction and sale of cannabis products for 324 It should be noted that prevalence of use in the past three non-medical use by people aged 18 and older. The months is not a measure generally used in the World Drug Report. The information on past-three-month prevalence is new legislation and its supporting regulations came presented here only because it is the period of monitoring into effect on 17 October 2018, although the use and reporting established by Statistics Canada.

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Fig. 1 Use of cannabis in the past three Fig. 2 Use of cannabis in the past three months in Canada, 2018–2019 months across provinces in Canada, third quarter of 2018 and third quarter 35 of 2019 30 35 25 30 WORLD DRUG REPORT 20 25 15 20 10 15

Prevalence (percentage) 5 10 0 5 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Prevalence (percentage) 2018 2018 2018 2018 2019 2019 2019 0 15 to 24 25 to 34 35 to 44 45 to 54 Nationwide 55 to 64 65 and older Scotia Nova Source: Statistics Canada, “National cannabis survey 2018 and Columbia British 2019”. Edward Prince Note: The quarters on the horizontal axis refer to the times at which the survey was conducted. Data refer to cannabis use for Q3 2018 medical and non-medical purposes in the past three months. Newfoundland and Labrador Q3 2019

Source: Statistics Canada, “National cannabis survey: third prevalence of cannabis use in the past three months quarter 2018 and 2019”. rose in most age groups in 2019, the most marked Note: Data refer to cannabis use for medical and non-medical pur- increase was observed in the oldest age group (65 poses in the past three months. and older), for which the prevalence nearly doubled in comparison with 2018. There also seems to be a per cent of cannabis users aged 65 and older reported larger proportion of new users among older adults using cannabis for medical purposes (with or with- than in other age groups: while 10 per cent of new out proper documentation for such use). On the cannabis users were aged 25–44 in the second and other hand, nearly 60 per cent of cannabis users third quarters of 2019, more than one quarter were aged 15–24 reported the use of cannabis products aged 65 and older.325 for non-medical purposes, and one third of respond- Cannabis use has increased in all provinces but Man- ents in that age group reported using those products itoba. In most provinces, the increase between 2018 for both medical and non-medical reasons. and 2019 was rather modest. In four provinces, how- Along with the increase in prevalence, the frequency ever, cannabis use increased considerably of cannabis use also increased marginally. At the (Newfoundland and Labrador, Prince Edward beginning of 2018, some 5 per cent of the popula- Island, and New Brunswick). tion aged 15 and older were daily users of cannabis Most young people are using cannabis products; by the third quarter of 2019, this propor- for non-medical purposes tion had increased to 6 per cent. Increases in the proportion of daily users of cannabis were observed There is a considerable level of overlap between the mainly among males, young people aged 18–24 and medical and non-medical use of cannabis products those aged 65 and older. in Canada, although the proportion varies by age group. In the second and third quarters of 2019, 52 Daily or near-daily use of cannabis is more frequent in younger users than in older ones. Nearly 8 per 325 Statistics Canada, “National cannabis survey: third quarter cent of people aged 15–24 and 9 per cent of those 2019”, 30 October 2019. aged 25–44 were daily or near-daily users of

6 Developments in jurisdictions with measures regulating the non-medical use of cannabis

Fig. 3 Distribution of reported reasons for Fig. 4 Use of cannabis in the past three cannabis use among people who used months, by frequency of use and age cannabis in the past three months, by group, Canada, second and third age group, Canada, second and third quarter of 2019 quarter of 2019 12 100 10 90 80 8 70 60 6 50 40 4 Percentage 30

20 Prevalence (percentage) 2 10 0 0 15 to 24 25 to 44 45 to 64 65 and Overall older older 65 and Both medical and non-medical 15 to 24 25 to 44 45 to 64 Medical (with or without proper documentation) Once or twice Monthly Non-medical Weekly Daily or almost daily

Source: Statistics Canada, “Cannabis survey 2019”. Source: Statistics Canada, “Cannabis survey 2019”. Note: The proportion of people between 15 and 24 using cannabis Note: Data refer to cannabis use for medical and non-medical pur- medically was considered unreliable. poses in the past three months. cannabis, compared with 4 per cent of people aged about 50 per cent one year later, and in 2019 nearly 45–64 and nearly 3 per cent of those aged 65 and 30 per cent relied solely on the legal market for their older. Men were twice as likely as women to be daily cannabis (compared with 10 per cent in 2018). or near-daily cannabis users. A commonly observed Many users relied on multiple sources to obtain their pattern of use is that regular and frequent users of cannabis, with about 40 per cent of cannabis users cannabis, such as daily or near-daily users, represent still getting their product from illegal sources. a small proportion of all cannabis users, but they account for the bulk of cannabis products con- In 2019, young people aged 15–24 were more likely sumed. It is estimated that in 2018, for example, than those in older age groups to obtain cannabis around half a million people in Canada consumed from illegal sources, whereas a larger share of older some 810 tons of cannabis, of which half (426 tons) cannabis users relied solely on legal sources; 41 per were consumed by daily or near-daily users and cent of cannabis users aged 65 or older reported another 355 tons by those who reportedly used can- using only legal sources to obtain cannabis, com- nabis at least once a week.326 pared with roughly one quarter of the other age groups. Many cannabis users continue to purchase cannabis from illegal sources While most cannabis users had used more than one product, over three quarters of users purchased and The transition from the illegal market to legal consumed dried cannabis or for smok- sources of cannabis has been a gradual one. The proportion of cannabis users sourcing their products ing. Although the sale of edibles and started from the legal market increased from around 25 per only at the end of 2019, a substantial share of can- cent in the second and third quarters of 2018 to nabis users reported using edible cannabis products (26 per cent), cannabis oil or vape pens (19 per 326 Statistics Canada, “Prevalence of in cent), (16 per cent) and solid cannabis con- Canada”, table 36-10-0597-01. centrates (14 per cent) during the same year.

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Fig. 5 Sources of cannabis among those who Fig. 7 Proportion of cannabis users reported cannabis use in the past three consuming different products, 2019 months, Canada, 2018 and 2019 80% 60 70% 50 60% WORLD DRUG REPORT 40 50% 40% 30 30% 20 20%

Percentage of users 10 10% 0 0% Grown by Illegal Legal Legal Friends Other the user sources sources sources and

or only family Other Edibles another person Second and third quarter 2018 Liquids (non- Liquids concentrates)

Second and third quarter 2019 Hashish orkief or vape pens or vape Solid concentrates Source: Statistics Canada, “Cannabis survey 2018 and 2019”. concentratesLiquid Cannabis oil cartridges Cannabis Note: Multiple responses could be provided by each respondent. Data refer to people who used cannabis for medical and non-medical purposes in the past three months. Source: Statistics Canada, “Cannabis survey 2019”.

Fig. 6 Sources of cannabis among those who Implementation of cannabis reported cannabis use in the past three regulations differs across provinces months, by age group, Canada, 2019 According to the new cannabis regulations, the fed- 60 eral Government of Canada is responsible for setting 50 the requirements for those who grow and produce cannabis, including the types of cannabis products 40 available for sale. For example, the regulations were 30 amended in October 2019 to allow the production and sale of edible cannabis, cannabis extracts and 20 topicals, and the sale of those products began gradu- 327

Percentage of users 10 ally from December 2019. The provincial and territorial governments, for their part, are responsi- 0 Grown by Illegal Legal Legal Friends ble for developing, implementing, maintaining and the user sources sources sources and enforcing systems to oversee the distribution and or only family sale of cannabis. another person 15 to 24 In most provinces, the licensing regime is simi- 25 to 44 lar to that regulating the sale of liquor, and cannabis 45 to 64 is sold through licensed retailers (private sector), 65 and older

Source: Statistics Canada, “Cannabis survey 2019”. 327 On 14 June 2019, the Government of Canada announced Note: Combined data for the second and third quarters of 2019. new regulations for edible cannabis, cannabis extracts and Multiple responses could be provided by each respondent. Data cannabis topicals. Those regulations were published in the refers to people who used cannabis for medical and non-medical Canada Gazette, Part II, vol. 153, No. 13, on 26 June 2019 purposes in the past three months. and came into force on 17 October 2019.

8 Developments in jurisdictions with measures regulating the non-medical use of cannabis provincial retail stores (public sector) and online. province and territory that allow all three modes, Many provinces have adopted a hybrid model that while Alberta, Manitoba, Newfoundland and Lab- allows either public or private physical retail outlets rador, Ontario and Saskatchewan have allowed together with online retail controlled by regulatory private bricks-and-mortar retail stores. authorities, or a combination of all three. With the By the end of July 2019, about 400 retail outlets exception of the Nunavut territory, all the provinces had been opened across Canada. The opening of and territories allow retail sales of cannabis products retail outlets has been slower in some places than in online. and Yukon are the only others. Ontario, the most populous province in Table 2 Models of cannabis sales in Canada, Canada, with a population of 14 million, began by province and territory with a retail system in which licences were issued to Physical retail Online operators by way of a lottery. At the end of July Public Private retail 2019, the province thus had only 24 outlets, fewer Newfoundland and than 2 outlets per 1 million population, whereas √ √ Labrador Newfoundland and Labrador had the same number Prince Edward Island √ √ of outlets per 500,000 population. The province of Nova Scotia √ √ Alberta permitted the opening of the largest number New Brunswick √ √ of retail outlets, with 176 private retail outlets for a Quebec √ √ population of 4 million. Ontario √ √ Manitoba √ √ After the cannabis regulations were adopted and Saskatchewan √ √ sales began in October 2018, retail sales of non- Alberta √ √ online and in cannabis stores up British Columbia √ √ √ to September 2019 totalled some 908 million Cana- Yukon √ √ √ dian dollars,328 or an average of Can$24 Northwest Territories √ √ (approximately $18) per capita. Although Ontario Not Not Not had the smallest number of retail outlets, it had the Nunavut allowed allowed allowed highest retail sales (Can$216 million), followed by Source: Statistics Canada, “The retail cannabis market in Alberta (Can$196 million) and Quebec (Can$195 Canada: a portrait of the first year”, 12 December 2019. million), by the end of September 2019. Out of the

Table 3 Number of retail cannabis outlets in Canada, by province and territory, July 2019 March May July Population Number of outlets Canada 36,540,268 217 285 407 Newfoundland and Labrador 528,567 26 26 26 Prince Edward Island 150,566 4 4 4 Nova Scotia 950,680 13 13 13 New Brunswick 766,852 21 21 21 Quebec 8,297,717 14 16 18 Ontario 14,071,445 NA 20 24 Manitoba 1,335,396 21 23 23 Saskatchewan 1,150,782 19 26 35 Alberta 4,243,995 75 101 176 British Columbia 4,922,152 16 27 57 Yukon 39,628 2 2 4 Northwest Territories 44,936 6 6 6 Nunavut 37,552 - - -

Source: Statistics Canada, “The retail cannabis market 328 At an exchange rate of 1 to $0.75, this in Canada”. figure would equal $681 million.

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Fig. 8 Retail sales of non-medical cannabis, by provinces, in Canada, October 2018–September 2019

40,000,000 Rest of Canada 35,000,000 Quebec Ontario 30,000,000 Saskatchewan WORLD DRUG REPORT 25,000,000 20,000,000 Canadian dollars 15,000,000 10,000,000 5,000,000 0 July May June April March August January October February December November September 2018 2019

Source: Statistics Canada, “Retail trade sales by province and territory”, table 20-10-0008-01.

Fig. 9 Price of cannabis on the legal and The sale of non-medical cannabis through legal illegal markets, Canada, 2018–2019 sources represents only a portion of the cannabis market, as it appears that a substantial proportion 12 10.65 of users still rely on illegal sources to obtain cannabis 10.25 9.82 10.21 10 (42 per cent in 2019). Moreover, cannabis prices on the illegal market have remained considerably 8 lower (and have been declining) compared with the 6.51 6.23 6.18 5.93 prices on the legal market. In the second quarter of 6 2019, based on 236 submissions, the average price 4 per gram of cannabis on the legal market was Can$10.65, compared with Can$5.93 per gram on 2 the illegal market.

0 Large corporations are investing in the Pre- Fourth First Second cannabis market in Canada legalization quarter quarter quarter (totals) 2018 2019 2019

Average price price Average per gram (Canadian dollars) Although the Cannabis Act introduced a of classes of cannabis licences, including for smaller Legal sources Illegal sources producers, the federal Government requires that a potential supplier have a production facility in place, Source: Statistics Canada, “Quarterly cannabis prices, 2019”. meaning that the supplier will have already made a substantial investment prior to applying for a total of Can$908 million, most sales were made licence.329, 330 Some have speculated that this has through bricks-and-mortar stores (Can$788 mil- contributed to deterring small entrepreneurs from lion), while online retail sales (Can$120 million) applying for licences and may have favoured the accounted for 13 per cent. Direct-to-consumer trade 329 Canada, “Cannabis duty: apply for a cannabis licence from by wholesalers, which includes retail sales by public the CRA” (24 February 2020). sector stores classified as wholesalers, accounted for 330 Transform Foundation, “Cannabis legalisation 1.9 per cent over the same period. in Canada: one year on” (n.p., n.d.).

10 Developments in jurisdictions with measures regulating the non-medical use of cannabis emergence of a market dominated or even monopo- to identify its dynamics and the impact of legaliza- lized by a relatively small number of large, tion on public health and safety, among other multi-billion-dollar businesses.331 There have also outcome measures. Differences in the implementa- been reports of the alcohol, and finance tion of federal legislation in the provinces may also industries investing in companies involved in non- vary in impact and thus require contextual analysis medical cannabis production. For instance, at the provincial and territorial levels. according to media sources, in October 2017 Con- stellation Brands, a major international producer of Latest trends in the cannabis wine, beer and spirits, invested $4 billion to acquire market in jurisdictions in the a 9.9 per cent stake in , the leading United States allowing the non- Canadian producer, to develop cannabis-based bev- medical use of cannabis erages. By the end of December 2019, Constellation owned a 35 per cent stake in Canopy.332 In Decem- In the United States, a total of 33 states, as well as ber 2018, the tobacco company Altria made a $1.8 the District of Columbia, Guam, Puerto Rico and million investment in Cronos Group, a cannabis the U.S. Virgin Islands, had approved or had in production company, giving Altria a 45 per cent place a comprehensive programme for medical can- interest in Cronos.333 Earlier in the year, Molson nabis by the end of 2019.337 As at December 2019, Coors Brewing, another multinational alcohol com- 11 state-level jurisdictions in the United States,338 pany, signed a venture with Quebec-based plus the District of Columbia, allowed the non- HEXO to develop and market cannabis-infused medical use of cannabis, and most also allowed beverages. Market analysts have predicted that the commercial production by for-profit industry.339, alcohol industry will also invest in companies that 340 It is worth noting that all the states that have plan to produce beverages that combine cannabis legalized the non-medical use of cannabis previously and beer and, in particular, they predicted that by had measures in place permitting the medical use the end of 2019 two of the largest cannabis compa- of cannabis. nies in the world would be owned by two of the In addition to , is another state in largest alcohol and tobacco companies.334, 335, 336 which measures allowing the non-medical use of The retail cannabis market in Canada is likely to cannabis were passed through the state legislature continue to evolve as jurisdictions adapt their reg- rather than through voters’ initiatives, as was the ulatory approaches, as supply chains develop and as case in the other states that have legalized the non- cannabis product offerings are diversified. Overall, medical use of cannabis. In May 2019, the Illinois the implementation of permitting the non-med- General Assembly passed the Cannabis Regulation ical use of cannabis in Canada is still in its nascent and Tax Act, which was signed by the state Governor stages, and it may take several years of monitoring to clarify how the cannabis market has evolved and 337 According to the National Conference of State Legislatures, a medical cannabis programme is considered to be compre- hensive if it has the following measures in place: (1) protec- tion from criminal penalties for using cannabis for a medical 331 Ibid. purpose; (2) access to cannabis through cultivation, 332 Ezequiel Minaya, “Pot company Canopy Growth picks new dispensaries or some other system that is likely to be imple- CEO”, Forbes, 9 December 2019. mented; (3) it allows a variety of strains or products, includ- 333 Sean Williams, “Cronos Group’s $1.8 billion investment ing those with more than “low THC”; (4) it allows either from Altria has closed. Now what?”, The Motley Fool, 17 or vaporization of some kind of cannabis products, March 2019. material or ; (5) it is not a limited trial pro- 334 Craig Giammona, “The next big thing is beer”, gramme. For instance, South Dakota and Nebraska have Bloomberg Businessweek, 10 October 2018. limited trial programmes that are not open to the public. 335 Sean Williams, “Altria grossly overpaid for its equity stake 338 In the United States, cannabis is federally prohibited as a in pot stock Cronos Group”, The Motley Fool, 11 December substance listed in schedule I of the Controlled Substances 2018. Act. 336 As presented in Wayne Hall and others, “Public health 339 Home cultivation is not allowed in the state of . implications of legalising the production and sale of canna- The number of allowed in each state varies. bis for medicinal and recreational use”, Lancet, vol. 394, No. 340 National Conference of State Legislatures, “ over- 10208 (October 2019). view”, 17 October 2019.

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in June. The sale of cannabis for non-medical use since 2009, past-month cannabis use (as an indica- began on 1 January 2020. Under the law, adults aged tor of recent cannabis use) among adults aged 18 21 and older are allowed to purchase and possess up and older in both states has increased far more dras- to 30 g of cannabis flower, edibles with a maximum tically than the national average – by some 86 per of 500 mg of THC, or 5 g of cannabis concentrates. cent in Colorado and more than doubled in Wash- Non-residents of Illinois will be allowed to purchase ington, as compared to a 50 per cent increase across WORLD DRUG REPORT half of those amounts. As in some other states, indi- the entire country. This also holds true for other vidual cities, villages and municipalities have the states that have legalized the non-medical use of option to decide whether to allow the non-medical cannabis.343 use of cannabis in their jurisdictions by passing ordi- A similar pattern is seen in the daily or near-daily nances. Nonetheless, local governments may neither use of cannabis. In Colorado, for instance, 7.6 per prohibit home cultivation of cannabis nor “unrea- cent of adults used cannabis for non-medical pur- sonably prohibit” its non-medical use. poses on a daily or near-daily basis in 2017,344 Developments in Colorado and compared with the national figure of 4.7 per cent Washington in the population aged 18 and older. In the 2012– 2013 period, 5.6 per cent of the population aged Colorado and Washington were the first two states 12 and older reported daily or near-daily use in in the United States to legalize the production of Colorado, compared with about 3 per cent nation- cannabis for non-medical use, in 2012. However, wide. While past-month prevalence continues to be prior to legalization, those states and others, such higher among those aged 18–25, the prevalence as California, had various regimes in place that per- among people aged 26 and older has more than mitted or tolerated the production and sale of doubled since 2008/09 in both states. cannabis for medical use, which allowed people with a range of conditions that were not well-defined to In Colorado, while the majority of cannabis users gain access to cannabis. The states of Colorado and (84 per cent) reported smoking in the past 30 days, Washington, for which more long-term trend data half of those users also reported using multiple con- are available, are interesting case studies for examin- sumption methods and cannabis products, including ing the public health and public safety outcomes taking edibles and vaporizing and “dabbing” can- that have emerged in the years since the production nabis concentrates in 2017. of cannabis for non-medical use was legalized. Extent of non-medical use of cannabis Extent of adult non-medical use of among adolescents and Washington One concern about legalizing the non-medical use Colorado and Washington are among the states that of cannabis for adults (21 years and older) is that have had a higher prevalence of cannabis use than its use could also increase access to cannabis and its the national average, even prior to the legalization use among adolescents.345, 346 Based on national of the non-medical use of cannabis. An increase in data, cannabis use among high-school students cannabis use in Colorado can be observed from 2008–2009 onwards, when some of the main agement, vol. 34 (2015), pp. 7-31. increases in cannabis use in Colorado came with the 343 United States, and Mental Health Services proliferation of bricks-and-mortar “dispensaries” Administration, Center for Behavioral Health Statistics and Quality, Results from the National Survey on Drug Use and that openly sold medical cannabis before the legali- Health; and state-level estimates. 341, 342 zation of non-medical cannabis. Nonetheless, 344 United States, Colorado Department of Public Health and Environment, “Monitoring health concerns related to mari- 341 Jonathan P Caulkins and Beau Kilmer, “Considering mari- juana in Colorado: 2018” (2018). juana legalization carefully: insights for other jurisdictions 345 Brendan Saloner, Emma E. McGinty and Colleen L. Barry, from analysis for Vermont”, Addiction, vol. 111, No. 12 “Policy strategies to reduce youth recreational marijuana (December 2016). use”, Pediatrics, vol. 135, No. 6 (June 2015), pp. 955–957. 342 Rosalie L Pacula and others, “Assessing the effects of medical 346 Christian Hopfer, “Implications of marijuana legalization marijuana laws on marijuana use: the devil is in the details”, for adolescent substance use”, Substance Abuse, vol. 35, No. Journal of the Association for Public Policy Analysis and Man- 4 (August 2014), pp. 331–335.

12 Developments in jurisdictions with measures regulating the non-medical use of cannabis

Fig. 10 Use of cannabis in the past month in Fig. 11 Use of cannabis in the past month, by Colorado, Washington and the United age group, Colorado and Washington, States, 2009–2018 United States, 2009–2018 20 35 18 30 16 25 14 12 20 10 15 8 10 6 5

4 Prevalence (percentage) Prevalence (percentage) 2 0 0 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2008/2009 2009/2010 2010/2011 2011/2012 2012/2013 2013/2014 2014/2015 2015/2016 2016/2017 2017/2018 United States Colorado Colorado, 18 to 25 Washington Washington, 18 to 25 Source: United States, Substance Abuse and Mental Health Colorado, 26 and older Services Administration, Center for Behavioral Health Statistics Washington, 26 and older and Quality, Results from the National Survey on Drug Use and Health; and state-level estimates. Note: The prevalence refers to the population aged 18 and older; Sources: United States, Substance Abuse and Mental Health the prevalence estimates for Colorado and Washington per year Services Administration, Center for Behavioral Health Statistics are based on a two-year average (e.g., 2015/16, 2016/17, and Quality, Results from the National Survey on Drug Use 2017/18). and Health; and state-level estimates. remained stable overall, whereas the risk perception mated to be the highest among twelfth grade of the occasional use of cannabis declined in the students, with one in four students in that grade United States over the period 2012–2018.347, 348 In reporting non-medical cannabis use in the past Colorado, although there has been a decline in daily month. The past-month use of cannabis among elev- or near-daily use of cannabis among high-school enth and twelfth grade students in Colorado students, they are now consuming and exposed to increased from the first round of the survey in 2013 cannabis products with far higher THC content but then declined from 2015; however, it remained than was available or used earlier. In 2017, about higher in 2017 than in 2013. The risk perception 20 per cent of high-school students in Colorado of the use of cannabis also remained stable over the reported non-medical use of cannabis in the past same period among high school students in month; that rate is comparable to the national aver- Colorado. age among high-school students.349 The non-medical While the daily or near-daily use of cannabis among use of cannabis increases in higher grades. It is esti- high-school students in Colorado has declined, the 347 United States, Substance Abuse and Mental Health Services prevalence of occasional users, that is, those who Administration, Center for Behavioral Health Statistics and report having used cannabis one or two times in the Quality, Results from the National Survey on Drug Use and past month, has increased since legalization. Nev- Health. 348 Lloyd D Johnston and others, Monitoring the Future, ertheless, 4.7 per cent of high-school students National Survey Results on Drug Use 1975-2018: Overview, reported using cannabis daily or nearly daily (20 or Key findings on Adolescent Drug Use (Ann Arbor, Institute for more times in the past 30 days) in 2017. Moreover, Social Research, University of Michigan, 2019). although the share of high-school students smoking 349 The data on high-school students in Colorado is taken from the “Healthy Kids Colorado Survey” and the national data cannabis declined from 92 per cent in 2015 to 84 from the “Youth Risk Behaviour Survey”. per cent in 2017, there was an increase in the share

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Fig. 12 Colorado: trends in past-month use of cannabis among high-school students, United States, 29 2005–2017 10th grade, Colorado 29 High10th Schoolgrade, Coloradooverall, United States 292927 10th11th10thHigh grade,Schoolgrade, Colorado Coloradooverall, United States 27 HighHigh11th SchoolschoolSchoolgrade, Coloradooverall,overall, ColoradoUnitedUnited States States 2925 10th11th grade, ColoradoColorado 2727 11th12th11thHigh grade,schoolgrade, ColoradoColoradooverall, Colorado 2925 10thHigh Schoolgrade, Coloradooverall, United States 2723 HighHigh12th schoolschoolgrade, overall,Coloradooverall, ColoradoColorado WORLD DRUG REPORT 2525 High11th schoolSchoolgrade, overall, Coloradooverall, United United States States 2723 12th12th grade,grade, ColoradoColorado 2521 11thHigh schoolgrade, overall,Coloradooverall, Colorado Colorado 2323 12th grade, Colorado 2521 High school overall, Colorado 21212319 12th grade, Colorado

Prevalence (percentage) 2319 17 Prevalence (percentage) 191921 17 Prevalence (percentage) Prevalence (percentage) 21 17171915

Prevalence (percentage) 1915

17 2013 2015 2017 2005 2007 2009 2011 2013 2015 2017

Prevalence (percentage) 1515

17 2013 2015 2017 2005 2007 2009 2011 2013 2015 2017 15 2013 2015 2017 2005 2007 2009 2011 2013 2015 2017 2013 2015 2017 2005 2007 2009 2011 2013 2015 2017 15 Sources: Colorado2013 Department2015 2017 of Public2005 Health2007 and2009 Environment,2011 2013 “Healthy2015 2017 Kids Colorado Survey, 2005–2017”; and Centers for

Disease Control and2013 Prevention,2015 2017 “Youth2005 Risk2007 Behaviour2009 2011 Survey”.2013 2015 2017

Fig. 13 Colorado: trends in past-month use of In Washington state, the past-month use of cannabis cannabis, by frequency of use among among high-school students of different grades has high-school students, United States, generally remained stable, although it increases by 2005–2017 grade, with the highest past-month prevalence found 9 among twelfth grade students, as in Colorado. The 8 perception of risk relating to cannabis use among 7 high-school students has also declined since the non- 6 medical use of cannabis was legalized, with nearly 5 three quarters of twelfth grade students seeing no 4 or low risk in trying cannabis a few times and less 3 than half perceiving no or low risk in the regular 350 2 use of cannabis in 2018. Similarly, some 38 per

Prevalence (percentage) 1 cent of twelfth grade students considered that it was 0 fairly easy to get cannabis. Over half of high-school students reported getting cannabis from a friend,

2005 2007 2009 2011 2013 2015 2017 and about 15 per cent reported giving money to Once or twice someone to buy it for them.351 One alarming find- 3 to 9 times ing is that more than half of the twelfth grade 10 to 19 times students who had used cannabis in the past month 20 to 39 times 40 or more times in 2018 reported that they had driven a motor vehi- cle within three hours of using cannabis on at least Source: Colorado Department of Public Health and Environ- one occasion in the past month. ment, “Healthy Kids Colorado Survey, 2005–2017”. The onset of cannabis use at an early age and regular cannabis use among adolescents has been associated of those who reported using edibles with high THC with deficits in learning, memory, reading skills and content (from 28 per cent in 2015 to 36 per cent in 2017) or “dabbing” cannabis extracts and con- 350 United States, Washington State Department of Health, centrates (from 28 per cent in 2015 to 34 per cent “Healthy Youth Survey 2018”. in 2017) in the past month. 351 Ibid.

14 Developments in jurisdictions with measures regulating the non-medical use of cannabis

Fig. 14 Washington: trends in cannabis use Fig. 15 Colorado: cannabis-related emergency in the past month among high-school department visits and hospitalizations, students, United States, 2006–2018 United States, 2011–2017

30 4,000 25 3,500 20 3,000 15 2,500 10 2,000 5 1,500 Prevalence (percentage) 0 1,000

2006 2008 2010 2012 2014 2016 2018 500 8th grade 10th grade 12th grade 0 Emergency Hospitalizations

Rate per 100,000 visits or hospitalizations department visits Source: United States, Washington State Department of Health, “Healthy Youth Survey 2018”. 2011 2012 2013 2014 2015 2016 2017 mathematics.352 Similarly, scientific literature shows that the cannabis users who are most at risk of devel- Source: Colorado Department of Public Health and Environ- oping cannabis dependence have a history of poor ment, “Colorado Association data”. academic achievement, deviant behaviour in child- hood and adolescence, rebelliousness, poor parental is the monitoring of the adverse health consequences relationships and a parental history of drug and alco- of increased exposure to cannabis resulting in emer- 353, 354 hol problems. In Washington state, for gency room visits and hospitalization and the example, 40 per cent of twelfth grade students who development of cannabis use disorders. Emergency reported cannabis use in the past month had lower room visits may be due to acute intoxication, which 355 marks than those who had not used cannabis, is seen more among novice users. Patients may pre- although the role of other factors in mediating can- sent with , panic attacks, public intoxication, 356 nabis use and poor marks cannot be ruled out. vomiting and other non-specific symptoms that Public health outcomes: emergency could be precipitated by the use of cannabis prod- department visits and hospitalization in ucts with varying THC content. This is especially Colorado the case with high-THC edible cannabis products, One public health measure used to assess the out- which delay the onset of severe psychoactive effects come of legalizing the non-medical use of cannabis that a person is unable to regulate.357, 358 Cannabis- related hospitalizations can arise from acute 352 Mary Becker and others, “Longitudinal changes in cogni- intoxication but are mainly a result of cannabis use tion in young adult cannabis users”, Journal of Clinical and disorders.359 In 2017, there were 1,139 cannabis- Experimental Neuropsychology, vol. 40, No. 6 (August 2018), pp. 529–543. 357 Andrew A. Monte and others, “Acute illness associated with 353 As presented in Hall and others, “Public health implications cannabis use, by route of exposure: an observational study”, of legalising the production and sale of cannabis”. Annals of Internal Medicine, vol. 170, No. 8 (April 2019), 354 Michael Lynskey and Wayne Hall, “The effects of adolescent pp. 531–537. cannabis use on educational attainment: a review”, Addic- 358 George Sam Wang and others, “Marijuana and acute health tion, vol. 95, No. 11 (November 2000), pp. 1621–1630. care contacts in Colorado”, Preventive Medicine, vol. 104 355 Lower grades were considered to be as follows: C – average (November 2017), pp. 24–30. grade; D – between 59 and 69 per cent, or below average; 359 The Colorado Department of Public Health and Environ- and F – failing grade. ment has three definitions of cannabis-related hospitaliza- 356 Washington State Department of Health, “Healthy Youth tion and emergency department visits that include at least Survey 2018”. one cannabis-related billing code in up to 30 billing codes

15 2020

Fig. 16 Colorado: cannabis-related emergency however, that figures for emergency room visits and department visits and hospitalizations, hospitalizations also include those for the treatment by age group, United States, 2011– of cannabis use disorders. Nevertheless, emergency 2017 department visits and hospitalizations are based on Emergency department visits billing records in which cannabis use is mentioned. 2,500 The increase in hospitalizations therefore not only WORLD DRUG REPORT reflects the increased exposure of the population to 2,000 cannabis products with high THC content but also increased patient comfort with reporting cannabis 1,500 use. This is likely to increase the chance that a can- nabis billing code is included in the diagnosis of 1,000 patients.360, 361, 362 The highest rates of emergency department visits 500 and hospitalizations are reported among young adults aged 18–25, and the past-month prevalence 0 of cannabis use is also highest in that age group. The 9 to 17 18 to 25 26 to 34 35 to 64 rates of cannabis-related hospitalizations doubled and emergency room visits increased by more than Rate per 100,000 emegency department visits 2011 2012 2013 2014 50 per cent for young adults aged 18–25 between 2015 2016Hospitalizations2017 12,000 2012 and 2017. Moreover, the rates of cannabis- related emergency department visits and 10,000 hospitalizations among older adults (aged 26–34 and 35–64) have also increased substantially since 8,000 the legalization of the non-medical use of cannabis in 2012. 6,000 Public health outcomes: cannabis-related 4,000 poisoning incidents in Colorado and Washington state 2,000 In Colorado, the number of cases reported to poison

Rate per 100,000 hospitalizations 0 centres owing to intoxication or adverse effects relat- 9 to 17 18 to 25 26 to 34 35 to 64 ing to cannabis exposure is low in absolute terms, but has been increasing since 2014. In 2018, there 2011 2012 2013 2014 2015 2016 2017 were a total of 255 such exposure cases. As with the changes in consumption patterns for different can- Source: Colorado Department of Public Health and Environ- nabis products in Colorado, between 2014 and 2018 ment, “Colorado Hospital Association data”. there was a 2.4-fold increase in the number of can- nabis exposure cases related to edibles, mostly among children aged 8 and younger and among children related emergency department visits per 100,000 and adolescents aged 9–17. The increase in reported such visits in Colorado, an increase by 60 per cent cannabis exposure cases involving children is likely since 2012. Similarly, 3,439 cannabis-related hos- pitalizations per 100,000 hospitalizations were 360 Sam Wang and others, “Marijuana and acute health care reported in the same year, a rate that has more than contacts in Colorado”. doubled since 2012. It is important to note, 361 Colorado Department of Health and Environment, “Moni- toring health concerns related to marijuana in Colorado: 2018”. listed for each visit. These codes include accidental poison- 362 Brad A. Roberts, “Legalized cannabis in Colorado Emer- ing by psychodysleptics, poisoning by psychodysleptics, gency Departments: a cautionary review of negative health poisoning, adverse effects and underdosing by cannabis, can- and safety effects”, Western Journal of Emergency Medicine, nabis abuse, cannabis dependence and cannabis use. vol. 20, No. 4 (July 2019), pp. 557–572.

16 Developments in jurisdictions with measures regulating the non-medical use of cannabis

Fig. 17 Colorado: cannabis exposure cases Fig. 18 Washington: cannabis-related incidents reported to poison centres, United reported to the Washington Poison States, 2014–2018 Center, United States, 2014–2018

140 200 120 150 100 80 100 60 Number of cases

40 of incidents Number 50 20

0 0 CBD Other Edible Smokable 2014 2015 2016 2017 2018 cannabis cannabis cannabis products 5 or younger 6 to 12 13 to 20 21 to 59 2014 2015 2016 2017 2018 60 and older

Source: Colorado Department of Public Health and Environ- Source: Washington Poison Center, “2018 annual data report: ment, “Rocky Mountain Poison and Drug Safety data”. cannabis” (Seattle, 2019). to be related to the increasing presence of cannabis underrepresent the actual extent of occurrence of inside the house (5.5 per cent in 2017) and in or such cases in Washington.365 around the house (11.2 per cent in 2017) among In Washington, three fifths of the cases of exposure families with children since 2014.363 Furthermore, to cannabis reported in 2018 were related to it is estimated that in the period 2016–2017 approx- exposure to cannabis alone, while the remainder imately 32,800 families with children aged 1–14 involved exposure to cannabis together with other exposed them to second-hand cannabis smoke or substances, including alcohol. In addition, among cannabis vapor.364 Cannabis exposure cases related the total cases of cannabis exposure, nearly one third to smoking cannabis, although declining since 2016, were due to the ingestion of cannabis edibles, for were reported mainly among young adults (aged which the number of cases doubled from 216 in 18–24) or adults aged 25 and older. 2015 to 420 in 2018. The remaining cases involved Since 2014, the number of calls to the Washington exposure to cannabis due to smoking or the use of Poison Center regarding cannabis-related incidents concentrates.366 has also increased considerably. In 2018, 497 can- Public health outcomes: cannabis use nabis exposure cases were reported, as compared to before and during pregnancy and in the 245 cases in 2014. While calls to the poison centre post-partum stage have increased for nearly all age groups, the largest increase in cannabis-related cases was related to chil- Cannabis use among young women may affect their dren aged 12 and younger (a 2.6-fold increase), as menstrual cycle and their ability to become preg- 367 well as adults aged 21–59 (a twofold increase) from nant. Cannabis use during pregnancy is also 2014 to 2018. Since the reporting of exposure cases associated with low birth weight, low alertness and is voluntary, it is likely that those reported exposures 365 Washington Poison Center, “2018 annual data report: 363 Colorado Department of Health and Environment, “Moni- cannabis” (Seattle, 2019). toring health concerns related to marijuana in Colorado: 366 Ibid. 2018”. 367 Public Health Agency of Canada, Thinking about Using 364 Ibid. Cannabis Before or During Pregnancy? (October 2018).

17 2020

Fig. 19 Colorado: cannabis use among pregnant, doubled, while daily or near-daily cannabis use post-partum and breastfeeding women, nearly quadrupled among pregnant women from United States,2014–2017 2002 to 2017.372 18 While data on cannabis use among pregnant women 16 are not available for Washington, cannabis use

WORLD DRUG REPORT among women in Colorado before and during preg- 14 nancy and in the post-partum and breastfeeding 12 stages increased in the 2014–2017 period, and the 10 increase in cannabis use in the three months before 8 pregnancy was statistically significant. Cannabis use 6 during pregnancy was also reported by 7.2 per cent 4 of expectant women in 2017. The combined data

Prevalence (percentage) from the 2014–2017 period showed that cannabis 2 use during pregnancy was significantly higher among 0 women aged 15–19 (15.9 per cent) than among 3 months During Post-partum Post-partum before pregnancy and currently women aged 20 and older, as well as among moth- pregnancy breasfeeding ers with less than 12 years of education (13.6 per cent) than among those who had had 12 years of 2014 2015 2016 2017 education (9.3 per cent) or more (4.8 per cent).373 Public safety outcomes: cannabis-related Source: Colorado Department of Public Health and Environment, “Preg- nancy Risk Assessment Monitoring System (PRAMS)”, data 2014–2017. driving under the influence and traffic fatalities other neurodevelopmental effects on newborns. In Research has shown that people driving under the addition, cannabis use by the mother in the post- influence of cannabis are likely to experience impair- partum and breastfeeding stages may impact the ment of key driving skills, including reaction time, infant’s growth and health.368, 369, 370, 371 tracking ability and target detection.374, 375 There may also be impairment of cognitive skills, such as National data in the United States suggest an judgment, anticipation and divided attention, as increase during the 2002–2017 period in past- well as of executive functions, such as route-planning month cannabis use, daily or near-daily use of and risk-taking.376 Other research has also shown cannabis and the number of days of cannabis use that, compared with a sober person, a driver who is among women aged 12–44, including those who under the influence of cannabis is likely to overes- were pregnant. The past-month use of cannabis timate his or her impairment and tends to compensate by typically driving more slowly and 368 Mohammad R. Hayatbaksh and others, “Birth outcomes following other cars at greater distances, although associated with cannabis use before and during pregnancy”, Pediatric Research, vol. 71 (February 2012), pp. 215–219. 369 Sheryl A. Ryan and others, “Marijuana use during preg- 372 Nora D. Volkow and others, “Self-reported medical and nancy and breastfeeding: implications for neonatal and non-medical cannabis use among pregnant women in the childhood outcomes”, American Academy of Pediatrics, vol. United States”, JAMA, vol. 322, No. 2 (July 2019), pp. 142, No. 3 (September 2018). 167–169. 370 Kimberly S. Grant and others, “Cannabis use during preg- 373 Colorado Department of Public Health and Environment, nancy: pharmacokinetic and effects on child development”, “Pregnancy Risk Assessment Monitoring System (PRAMS)”, Pharmacology and Therapeutics, vol. 182 (February 2018), data 2014–2017. pp. 133–151. 374 Rebecca L. Hartman and others, “Cannabis effects on driv- 371 See, for example, the advisory issued in August 2019 by ing lateral control with and without alcohol”, Drug and the United States Surgeon General on the use of cannabis, Alcohol Dependence, vol. 154 (September 2015), pp. 25–37. its effect on the developing brain and cannabis use during pregnancy. Available at www.hhs.gov/surgeongeneral/ 375 Richard P. Compton, “Marijuana-impaired driving: a report reports-and-publications/addiction-and-substance-misuse/ to Congress” (Washington D.C., National Highway Traffic advisory-on-marijuana-use-and-developing-brain/index. Safety Administration, 2017). html#use-pregnancy. 376 Ibid.

18 Developments in jurisdictions with measures regulating the non-medical use of cannabis they may still be a hazard on the road.377 A driver Fig. 20 Colorado: driving under the influence under the influence of alcohol, by contrast, is more of drugs, United States, 2014–2018 likely to underestimate the impairment and take 1,600 more risks while driving. Moreover, cannabis can 1,400 have an additive effect with alcohol to increase the driver’s impairment and thus cause even more lane 1,200 weaving and increase the likelihood of 1,000 378 accidents. 800 A contentious issue between people who are for and 600 Number of cases against the legalization of cannabis remains whether 400 it has had an impact on driving under the influence 200 of cannabis and caused fatal car crashes. The evi- dence remains inconclusive, as within the United 0 2014 2015 2016 2017 2018 States there have been no differences in cannabis- or alcohol-related traffic fatalities between states that Cannabis only have and have not legalized the non-medical use of Cannabis with other substances cannabis.379 As different research contributions have Total driving under the influence also shown, it is difficult to quantify the effects of Source: Data from the Colorado State Patrol, as reported in cannabis on road accidents, as cannabis is often used Rocky Mountain High Intensity Drug Trafficking Area, The Legalization of Marijuana in Colorado: The Impact, vol. 6 (Sep- in combination with alcohol, which increases the tember 2019). challenge of determining the influence of cannabis itself on road traffic accidents.380 Moreover, studies Driving under the influence of cannabis was not on THC levels and degrees of impairment have tracked in Colorado prior to 2014. Notwithstand- found that the level of THC in the blood and the ing all the caveats discussed above, the total number degree of impairment do not appear to be closely of cases of driving under the influence of drugs related; peak impairment does not occur when THC nearly doubled in Colorado between 2014 and concentration in the blood is at or near peak levels. 2018. During that period, the number of cases in In addition, when a blood sample is collected from which drivers were under the influence of cannabis a driver suspected of cannabis-impaired driving, the alone or in combination with other drugs and/or collection may not occur until hours after the inges- alcohol also increased by 50 per cent. Nearly one tion of cannabis, whereas THC levels in the blood quarter of the cases of driving under the influence decline exponentially.381 As there are currently no reported in 2018 involved cannabis alone, and three evidence-based methods to detect cannabis-impaired fifths of cases involved cannabis in combination driving,382 those factors and other issues related to with other substances (especially alcohol). the roadside testing of people under the influence of cannabis, as compared with testing for alcohol, Starting in 2014, data on traffic fatalities in Colo- make it challenging to determine the extent and rado showed a marked increase in the number of trends of driving of driving under the influence of traffic deaths in which the driver tested positive for cannabis and its involvement in fatal traffic crashes. cannabis use. Over the period 2009–2013, there were 53 traffic deaths on average per year in which the driver tested positive for cannabis, a figure that increased to an average of 110 such deaths in the 377 Ibid. period 2014–2018, and the proportion of fatalities 378 Hartman and others, “Cannabis effects on driving lateral with drivers testing positive for cannabis doubled control with and without alcohol”. over the period 2009–2018. However, toxicology 379 Hall and others, “Public health implications of legalising the production and sale of cannabis”. analysis has shown that car crashes in which the 380 Ibid. driver was found to be under the influence of can- 381 Compton, “Marijuana-impaired driving”. nabis frequently involved other drugs, in particular 382 Ibid. alcohol.

19 2020

Fig. 21 Colorado: traffic deaths related to Fig. 23 Washington: number of cases of cannabis, United States, 2006–2018 driving under the influence of drugs and alcohol, United States, 2011–2018 700 2,500 600 2,029

2,000 1,710

WORLD DRUG REPORT 500 1,614 1,605 1,348 400 1,327 1,229 1,500 1,222 300

Number of of deaths Number 1,000

200 21% 21% Number of cases 18% 18% 15% 14% 13% 11%

10% 500 9% 7% 6% 100 6%

0 0 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2011 2012 2013 2014 2015 2016 2017 2018

Total fatalities Source: Washington State Patrol, as cited in “Monitoring impacts of recreational marijuana legalization: 2019 update Fatalities with drivers testing positive for report”. cannabis (as a percentage of total fatalities)

Sources: Data from the National Highway Traffic Safety Admin- In Washington, driving under the influence of drugs istration, Fatality Analysis Reporting System, 2006– 2018; and Colorado Department of Transportation, 2012–2018, as and alcohol is considered the number one contrib- reported in Rocky Mountain High Intensity Drug Trafficking uting factor in fatal crashes and is involved in nearly Area, The Legalization of Marijuana in Colorado. half of all traffic fatalities. However, in that state, reporting on such cases does not differentiate between cannabis and other drugs.383 The number Fig. 22 Colorado: toxicological results for of reported cases of driving under the influence of other drugs found in drivers involved drugs has increased by more than 60 per cent in in fatal crashes who tested positive for cannabis, 2018 Washington since 2014. Although not so recent, data on drivers involved in fatal crashes who tested positive for alcohol or drugs 11% in Washington during the period 2008–2016 show 25% that 44 per cent tested positive for two or more substances.384 Of those substances, the most common one was alcohol, followed by THC, while 29% alcohol and THC formed the most common poly- drug combination involved in fatal crashes during that period.

35%

Cannabis only Cannabis and alcohol 383 Washington State, Statistical Analysis Center, “Monitoring Cannabis and other drugs (excluding alcohol) impacts of recreational marijuana legalization: 2019 update report” (July 2019). Cannabis, alcohol and other drugs 384 Washington Traffic Safety Commission, “Marijuana use, alcohol use, and driving in Washington State: emerging Source: Rocky Mountain High Intensity Drug Trafficking Area, issues with poly-drug use on Washington roadways” (April The Legalization of Marijuana in Colorado. 2018).

20 Developments in jurisdictions with measures regulating the non-medical use of cannabis

Fig. 24 Washington: fatal crashes involving Fig. 25 Colorado: reported property and violent 160 alcohol, cannabis and other drugs, crimes, United States, 2008–2018 160 160140 United States, 2008–2016 160140 180,000180,000180,000 30,00030,00030,000 160140120 120 160,000160,000160,000 100140 25,00025,00025,000 140120 140,000140,000140,000 120100 12010080 120,000120,000120,000 20,00020,00020,000 10080 1008060 100,000100,000100,000 60 15,00015,00015,000 Number of cases 80 80,00080,00080,000 806040 Number of cases 40 60,00060,00060,000 10,00010,00010,000

Number of cases 2060 6040 40,00040,00040,000 Number of cases 20

Number of cases 40 5,0005,0005,000 200

40 Numberof violent crimes Number of violent crimesNumber of violent crimes 0 20,00020,00020,000 20 Numberof property crimes Numberof property crimes Numberof property crimes 00 0 00 0 200 2008 2009 2010 2011 2012 2013 2014 2015 2016

0 2008 2009 2010 2011 2012 2013 2014 2015 2016 0 2008 2008 2008 2009 2009 2009 2010 2010 2010 2011 2011 2011 2012 2012 2012 2013 2013 2013 2014 2014 2014 2015 2015 2015 2016 2016 2016 2017 2017 2017 2018 2018 2018 Cannabis2008 only2009 2010 2011 2012 2013 2014 2015 2016 2008 2009 2010 2011 2012 2013 2014 2015 2016 Cannabis2008 only2009 2010 2011 2012 2013 2014 2015 2016 PropertyPropertyProperty crimes crimes crimes ViolentViolentViolent crimes crimes crimes OneCannabis drug only (other than alcohol or cannabis) Cannabis only CannabisOne drug only (other than alcohol or cannabis) Source: Colorado Bureau of Investigation. AlcoholOne drug only only (other than alcohol or cannabis) One drug only (other than alcohol or cannabis) OneAlcohol drug only only (other than alcohol or cannabis) MultipleAlcohol only substances (any combination of In empirical terms, there have been increases in some Alcohol only alcoholAlcoholMultiple andonly substances drugs, including (any combination cannabis) of types of crime in both Colorado and Washington alcoholMultiple and substances drugs, including (any combination cannabis) of in the past few years. In particular, Colorado has Multiple substances (any combination of Multiplealcohol and substances drugs, including (any combination cannabis) of alcohol and drugs, including cannabis) seen an increase in property crimes since 2015, and Source:alcohol “Marijuana and use, drugs, alcohol including use, and cannabis) driving in Washing- ton state: emerging issues with poly-drug use on Washington crimes against the person and aggravated assaults roadways”, Washington Traffic Safety Commission (April 2018). have increased in Washington since 2016, but it is difficult to attribute those increases to the legaliza- Crime and the non-medical use of tion of the non-medical use of cannabis. cannabis in Washington and Colorado In Colorado, the number of reported property Two diverging paradigms have emerged with regard crimes rose by 16 per cent in the 2014–2018 period, to the impact of cannabis legalization on crime. One while the number of reported violent crimes suggests that cannabis users are more likely to increased by one third. commit violent and property crimes than those who In 2018, more than half of the violent crimes do not use cannabis, and that legalizing the non- reported in Colorado involved assault, followed by medical use of cannabis would result in an increase non-consensual sex offences (28 per cent) and rob- in the number of regular cannabis users, thereby bery (15 per cent), whereas 60 per cent of the increasing the risk of young people engaging in vio- property crimes involved larceny.387 Similarly, in lence and delinquency.385 In the other paradigm, it Washington there was a 19 per cent increase in prop- is believed that legalizing the non-medical use of erty crimes, of which half involved larceny or theft cannabis will lead to a decrease in violent crime in the 2014–2018 period, while the number of rates, as individuals’ violent tendencies may be sup- simple assaults and aggravated assaults increased pressed by the consumption of cannabis.386 more sharply (by 20 per cent and 47 per cent, Nevertheless in addition, the vulnerability of the respectively). cannabis trade, as a cash-based business, could also create incentives for crimes such as burglary, shop- lifting and robbery.

385 Ruibin Lu and others, “The cannabis effect on crime: time- series analysis of crime in Colorado and Washington State”, Justice Quarterly (October 2019). 386 Ibid. 387 Colorado Bureau of Investigation data 2018.

21 2020

Fig. 26 Washington: reported property crimes legalized the non-medical use of cannabis.389 More and crimes against the person (includ- than half of the studies, however, have shown that ing assault), United States, 2012–2018 cannabis and alcohol are substitutes, meaning that 120,000120,000120,000 350,000350,000350,000 the increased use of one substance reduces the use of the other.390, 391 Other researchers have also sug- 300,000300,000300,000 100,000100,000100,000 gested that cannabis, especially cannabis for medical

WORLD DRUG REPORT 250,000250,000250,000 80,00080,00080,000 use, may serve as a substitute for alcohol, tobacco 200,000200,000200,000 and other drugs, including prescription drugs.392, 393 60,00060,00060,000 150,000150,000150,000 A study on the impact of cannabis legalization on 40,00040,00040,000 100,000100,000100,000 alcohol sales in Colorado, Oregon and Washington, 20,00020,00020,000 50,00050,00050,000 the three states with the longest history of legal non-

00 0 00 0 Numberof property crimes Numberof property crimes medicalNumberof property crimes use of cannabis, showed that there was no evidence that legalization had had any impact on

2012 2012 2012 2013 2013 2013 2014 2014 2014 2015 2015 2015 2016 2016 2016 2017 2017 2017 2018 2018 2018 the sale of spirits or on total alcohol sales, which are

Number of crimes against the person the against crimes of Number person the against crimes of Number person the against crimes of Number generally considered a good proxy for alcohol con- PropertyPropertyProperty crimes crimes crimes CrimesCrimesCrimes against against against the the the person person person sumption in the United States. The study showed AggravatedAggravatedAggravated assaults assaults assaults that the per capita sale of spirits had increased by SimpleSimpleSimple assaults assaults assaults 3.6 per cent in Oregon, 5.4 per cent in Washington and 7.6 per cent in Colorado in 2018, after the Source: Washington Association of Sheriffs and Police Chiefs, annual reports 2012–2018. measures allowing the non-medical use of cannabis were implemented in those states. Consistent with national trends, per capita sales of beer had declined Has legalization led to substitution by 3.6 per cent in Colorado, 2.3 per cent in Wash- between cannabis and alcohol? ington and 3.6 per cent in Oregon. The sale of wine increased by 0.7 per cent in Oregon, declined by One of the claims made with regard to the outcome 3.1 per cent in Washington and increased by 3.2 of legalizing the non-medical use of cannabis at the per cent in Colorado. Overall, per capita sales of state level has been that it would substitute for, and alcoholic beverages were fairly stable, as they therefore reduce, alcohol consumption and would increased by 1.7 per cent in Colorado, declined by thus have a positive impact on the substantial harms 0.2 per cent in Washington and declined by 0.5 per caused by alcohol. Most of the research on whether cent in Oregon.394 cannabis and alcohol are substitutes for, or comple- ments to, one another has comprised econometric analyses of the effects that small changes in alcohol and cannabis prices have had on the consumption of either substance.388 All of the studies conducted on the topic have generated mixed results. 389 Ibid. 390 Ibid. A small proportion of studies have shown that alco- 391 Meenakshi Sabina Subbraman, “Substitution and comple- hol and cannabis are complementary to each other mentarity of alcohol and cannabis: a review of the litera- ture”, Substance Use and Misuse, vol. 51, No.11 (September – that is, the increased use of cannabis also leads to 2016), pp. 1399–1414. increased use of alcohol and vice versa – while other 392 Philippe Lucas and others, “Cannabis as a substitute for studies have found no relationship between the two alcohol and other drugs: a dispensary-based survey of substi- substances. Studies of trends in alcohol sales data in tution effect in Canadian medical cannabis patients”, Addic- tion Research and Theory, vol. 21, No. 5 (November 2012), states that have and have not legalized the non-med- pp. 435–442. ical use of cannabis have found no evidence of a 393 Amanda Reiman, “Cannabis as a substitute for alcohol greater increase in alcohol use in states that have and other drugs”, Journal, vol. 6, No. 35 (December 2009). 394 David Ozgo, “Impact of retail marijuana legalization on 388 Hall and others, “Public health implications of legalising the alcohol sales in Colorado, Washington state and Oregon” production and sale of cannabis”. (January 2019).

22 Developments in jurisdictions with measures regulating the non-medical use of cannabis

Can medical cannabis help to address living, social interactions, lower pain self-efficacy the epidemic in the United and higher levels of generalized ) States? among the 24 per cent who also used cannabis daily or less frequently than among those who did not In the face of the opioid epidemic in the United use cannabis. Moreover, individuals who used can- States, it has been suggested that medical cannabis nabis on a near-daily basis were less likely to products can help to address the high rates of opioid discontinue opioid use than participants who use for pain management and thus to reduce the abstained from cannabis use.399 prevalence of opioid use disorders and opioid over- dose deaths.395, 396 In many studies and reports, individual testimonies have been taken as evidence of the effectiveness of A substantial number of randomized control trials cannabis for pain relief. In the debate surrounding have shown that medical cannabis products could the medical use of cannabis, different cannabis prod- be an effective alternative to for pain man- ucts (smokable, edible or concentrates) for which agement. However, one major shortcoming of those the dosages and contents are not standardized are clinical trials is that they were conducted with can- often confused with medical cannabis products, such nabis products that differed from the medical as synthetic THC () or con- cannabis products currently available in different taining synthetic THC and CBD, which have gone jurisdictions in the United States, thus limiting the through the manufacturing and processing safety applicability of the findings to the general popula- protocols that pharmaceutical companies must tion.397 In addition, only limited information is follow when mass-producing pharmaceutical available on the efficacy, doses, routes of administra- products.400 tion or side effects of commonly used and commercially available cannabis products in the Nevertheless, using an Internet-based survey con- United States.398 ducted in 2017, one study examined opioid substitution among respondents with a history of With regard to cannabis products substituting for ever using cannabis who self-reported the use of opioids as pain relief medication, it is considered opioids in the past 12 months. Out of the nearly that the are not suffi- 9,000 respondents, 5 per cent reported ever using ciently powerful to palliate acute pain or to manage cannabis and had used opioids in the past year, . For example, only in very specific cases among whom 43 per cent had used opioids daily have preparations containing THC, such as dron- and 23 per cent had used cannabis in the past 30 abinol and nabiximols, been shown to be effective days. Although the results are based on a small in the management of neuropathic pain in patients number of respondents, of the 450 who reported suffering from multiple sclerosis. A long-term lon- ever using cannabis and past-year opioid use, 41 per gitudinal study among people who were prescribed cent reported a decrease or cessation of opioid use opioids showed greater pain severity and pain inter- as a result of cannabis use, 46 per cent reported no ference (pain effects on sleep, working ability, daily change in opioid use and 8 per cent reported an increase in opioid use.401 395 Hall and others, “Public health implications of legalising the production and sale of cannabis”. Similarly, ecological studies have shown that states 396 Paul J. Larkin Jr., and Bertha K. Madras, “Opioids, over- with legislation in place regarding medical cannabis doses, and cannabis: is marijuana an effective therapeutic response to the opioid abuse epidemic?”, Georgetown Journal had lower rates of opioid overdose deaths than states of Law and Public Policy, vol. 17, No. 2 (August 2019). that did not have such laws. One such study looked 397 Bia Carlini, “Role of medicinal cannabis as substitute for at mortality rates in California, Colorado and Wash- opioids in control of chronic pain: separating popular myth from science and medicine” (Seattle, United States, Alcohol ington from 1999 to 2010, and the results suggested and Drug Abuse Institute, University of Washington, Febru- ary 2018). 399 Larkin Jr., and Madras, “Opioids, overdoses, and cannabis”. 398 National Academies of Sciences, Engineering, and Medi- 400 Ibid. cine, The Health Effects of Cannabis and : The 401 Julie H. Ishida and others, “Substitution of marijuana for Current State of Evidence and Recommendations for Research opioids in a national survey of US adults”, PLoS ONE, vol. (Washington, D.C., National Academies Press, 2017). 14, No. 10 (October 2019).

23 2020

that there was an association between medical can- could be effective in pain management.407 The issue nabis laws and low rates of opioid overdose mortality of whether increased accessibility of cannabis could in those states.402 However, another study in which reduce the medical and non-medical use of phar- the same data and methods were used as the earlier maceutical opioids and their negative impact study and the analysis was extended through 2017 remains inconclusive.408 found that the original analysis and conclusions were WORLD DRUG REPORT not valid for the period beyond 2010. In fact, the Developments in the regulation association between state medical cannabis laws and of the non-medical use of can- opioid overdose mortality reversed direction, from nabis in Uruguay minus 21 per cent to plus 23 per cent, and remained positive even after accounting for recreational can- In 2013, the Government of Uruguay approved nabis laws in those states. The authors concluded legislation (Law No. 19.172) regulating the cultiva- that the analysis of the data did not support the tion, production, dispensing and use of cannabis interpretation that broader access to cannabis, either for different purposes, including non-medical use. for medical or non-medical purposes, was associated In accordance with the legislation, Uruguayan citi- with lower opioid overdose mortality.403, 404 zens or foreigners with permanent residence aged 18 and older can obtain cannabis for non-medical 405 As summarized in a recent , the ecological purposes by registering with the national Institute studies that have shown an association between can- for the Regulation and Control of Cannabis and by nabis use and reduced opioid use (substitution) or choosing one of three options: (a) purchase in low rates of opioid overdose mortality have major authorized pharmacies; (b) membership of a club; limitations: the opioid overdose deaths in a state or (c) domestic cultivation.409 The quantity of can- may not reflect the behaviour of individuals who nabis permitted per person, obtained through any use medical cannabis; it is difficult to control for of the three mechanisms, cannot exceed 480 g per confounding factors when state-level data on opioid year. Initially, the Government of Uruguay set THC overdoses is used; and the studies do not control for content at 2 per cent and CBD content at 6–7 per differences in state policies and programmes that cent. In 2017, the Government introduced two new are likely to increase or decrease opioid overdose varieties, with a maximum THC content of 9 per deaths. Moreover, many of the studies have over- cent and CBD content of no less than 3 per cent.410 looked the proliferation of as a driver of opioid overdose mortality in the United States, Overall, the implementation of the law has been which may negate any potential effect of medical gradual; as at January 2020, five companies had cannabis on overdose deaths.406 It can only be con- been granted licences to cultivate, produce and dis- cluded that additional research might help to tribute cannabis products for non-medical use in identify a range of alternative non-opioid medica- the country. However, those products only include tions and non-pharmacological treatments that dried flower, since psychoactive edibles and extracts are not allowed in Uruguay. Seventeen pharmacies 402 For instance, see Marcus A. Bachhuber and others, “Medical had been licensed to dispense cannabis for non- cannabis laws and opioid analgesic overdose mortality in the medical use, and 39,423 people had registered to United States 1999–2010”, JAMA Internal Medicine, vol. acquire cannabis from those pharmacies. In the 174, No. 10 (October 2014), pp. 1668–1673. 403 Chelsea L. Shover and others, “Association between medical period July 2017–October 2019, out of over cannabis laws and opioid overdose mortality has reversed over time”, Proceedings of the National Academy of Science of 407 Larkin Jr., and Madras, “Opioids, overdoses, and cannabis”. the United States of America, vol. 116, No. 26 (June 2019), 408 Hall and others, “Public health implications of legalising the pp. 12624–12626. production and sale of cannabis”. 404 Another study that arrived at similar results is Gregory 409 See also World Drug Report 2018: Analysis of Drug Mar- Schuster, “Medical marijuana laws and opioid overdose kets–, , Cannabis, Synthetic Drugs (United deaths in the United States” (2019). Nations publication, Sales No. E.18.XI.9 (Booklet 3)). 405 Hall and others, “Public health implications of legalising the 410 John Hudak, Geoff Ramsey and John Walsh, “Uruguay’s production and sale of cannabis”. cannabis law: pioneering a new paradigm” (Washington 406 Schuster, “Medical marijuana laws and opioid overdose D.C., Centre for Effective Public Management, Brookings deaths in the United States”. Institution, March 2018).

24 Developments in jurisdictions with measures regulating the non-medical use of cannabis

Fig. 27 Non-medical use of cannabis, Uruguay, In the 2018 survey on drug use in Uruguay, it was 2001–2018 estimated that around 12 per cent of men and 5.8 35 per cent of women had used cannabis in the past month, with a total past-month prevalence of 8.9 30 per cent among the population aged 15–65, or about 25 158,000 users.415 This reflects an increase in the 20 past-month use of cannabis by more than one third 15 since 2014, while use of cannabis in the past year 10 increased by more than 50 per cent over the same period. 5 Prevalence (percentage) 0 In 2019, the highest past-month prevalence of can- 2001 2006 2011 2014 2018 nabis use was reported among young people aged 19–25 (20.8 per cent), followed by those aged 26–35 Lifetime prevalence (16.4 per cent). According to the survey, about Past-year prevalence 25,500 people were estimated to be daily or near- Past-month prevalance daily users of cannabis − 9.9 per cent of those who reported cannabis use in the past year (13.1 per cent Source: Uruguay, Junta Nacional de Drogas, Observatorio Uruguayo de Drogas, Encuesta Nacional en Hogares sobre of males, 5.2 per cent of females) − whereas more Consumo de Drogas, 2016 and 2018. than one third of regular cannabis users were con- sidered dependent.416 670,000 cannabis transactions, around 3,350 took However, the impact of the provisions regulating place in pharmacies, with 60 per cent of those sales the non-medical use of will in urban centres.411 It is estimated that out of the become evident only in the coming years, once more total number of cannabis users registered with the information on the outcome measures related to pharmacies, some 89 per cent had purchased can- public health and public safety are made available. nabis at least once, with monthly purchases ranging between 15 and 17 g by October 2019.412 However, it would seem that the pharmacies currently do not cover the demand of registered users, especially in parts of the country where there is a greater concen- tration of registered cannabis users.413 By January 2020, a total of 7,834 people had reg- istered for domestic cultivation of cannabis, and 145 cannabis clubs with a total membership of 4,298 people had been registered. Thus, a total of approximately 51,555 people had access to the regu- lated cannabis market in Uruguay at that time,414 which is still a relatively small share of the overall population of cannabis users in the country.

411 Uruguay, Instituto de Regulación y Control del Cannabis, “Mercado regulado del cannabis: informe VIII”, 31 October 2019. 412 Ibid. 415 Uruguay, Seventh national household survey on drug use 413 Ibid. (National Drug Observatory and National Drug Council, 414 Uruguay, Institute for the Regulation and Control of 2018). Cannabis website, January 2020. 416 Ibid.

25 CROSS-CUTTING ISSUES: EVOLVING TRENDS AND NEW CHALLENGES 2020

19 WORLD DRUG REPORT Can$10.56 Manitoba of Cannabis Act 30 g or equivalent of Manitoba (LGCA) Safe and Responsible Retailing Safe and Responsible Retailing Home growing is not permitted Home growing Manitoba Liquor and Lotteries (MBLL) Liquor, Gaming and Cannabis Authority Gaming and Cannabis Authority Liquor,

19 (CCLA) Can$9.32 30 g or equivalent British Columbia Cannabis distribution Act (CDA) Cannabis control and licensing Act and licensing Act Cannabis control plants per household, but the plants plants per household, but the Adults can grow up to four cannabis up to four cannabis Adults can grow must not be visible from public spaces must not be visible from Liquor and cannabis regulation branch Liquor and cannabis regulation

19 Yes (AGLC) Alberta regulation Can$10.96 30 g or equivalent 30 g or equivalent Gaming, Liquor and Cannabis Gaming, Liquor and Cannabis Albertal Gaming Liquor and Cannabis Albertal Gaming Liquor and Cannabis Gaming, Liquor and Cannabis Act and Gaming, Liquor and Cannabis Act

18 Cannabis Act Cannabis Act personsal use Federal law (solid or liquid) cannabis product October 17, 2018 solvents are not used solvents are 7.5 g of concentrates 7.5 g of concentrates 150 g of fresh cannabis 150 g of fresh 450 g of edible product 30 cannabis plant seeds 2100 g of liquid product Government legalislation 30 g or equivalent of legal 30 g or equivalent of legal 30 g dried or equivalent i.e., 30 g dried or equivalent i.e., and at home if organic and drink at home if organic Grow from licensed seeds four licensed seeds four from Grow Cannabis products such as such as food Cannabis products cannabis plants per residence for cannabis plants per residence

Regulations for the legalization of non-medical use cannabis in Canada

Home Home cultivation Legal process possession quantity Title Date implemented Regulatory authority Personal Interpersonal sharing Retail transaction limit price retail Average per gram (2019 average, Cannabis Stats Hub (13-61-X) Minimum age Table 4

26 Cannabis - Regulations for legalization

per gram Manitoba public places) Wholesale mark-up on Wholesale mark-up on gram mark-up plus 9% per cent gram mark-up plus 9% per cent non-medical cannabis, a $0.75 per non-medical cannabis, a $0.75 per in public places (including enclosed in public places (including enclosed Private retail stores and online sales stores Private retail mark-up applied on top of the $0.75 mark-up applied on top of the $0.75 Smoking and vaping cannabis is illegal Smoking and vaping cannabis is illegal

seedling online sales as for liquor Trim $0.22/g Trim Federal taxes Flower $0.75/g British Columbia Same as Federal Law In cars, areas frequented by by frequented In cars, areas Retail licensing regime similar similar Retail licensing regime Private and provincial retail stores, stores, retail Private and provincial Seed and seedling : $0.75/seed or Seed and seedling : $0.75/seed or Edibles to be allowed within a year children, or tobacco restricted areas or tobacco restricted children, 7.5% provincial sale tax in addition to sale tax in addition to 7.5% provincial

sales Alberta cannabis stores of base amount of base amount of base amount Licensed retailers Edibles as yet not allowed Advertising allowed inside Advertising allowed inside Trim: $0.225/g plus 17.8% $0.225/g plus 17.8% Trim: In cars, areas frequented by by frequented In cars, areas No promotion, packaging or packaging or No promotion, Flower: $ 0.75/g plus 16.8% Flower: $ 0.75/g plus 16.8% Seed: $0.75/seed plus 16.8% Seed: $0.75/seed plus 16.8% information is presented clearly information is presented appealing to young people, and appealing to young people, and ensuring that important product ensuring that important product labelling that could be considered labelling that could be considered 16.8% of deductible amount when 16.8% of deductible amount when children, or tobacco-restricted areas or tobacco-restricted children, Private retail stores, provincial online online provincial stores, Private retail delivered (total applicable rate 24.3%) delivered Ad Valorem Additional Rate 7.5% plus Additional Rate 7.5% plus Ad Valorem

ml of the oil Trim $0.75/g Trim Federal law Flower $0.25/g Seed $0.25/seed presented clearly presented cannabis product the cannabis products Seedling $0.25/seedling orally, rectally, vaginally or vaginally or rectally, orally, 1 g in each discrete unit of unit of 1 g in each discrete when delivered to purchaser when delivered No promotion, packaging or packaging or No promotion, products and and Cannabis edible products yield quantity of 10 mg THC Cannabis oil must not exceed a Cannabis oil must not exceed a Dried cannabis to be consumed by inhalations must not exceed by inhalations must not exceed Federal Ad Valorem Rate 2.5% of Rate 2.5% of Federal Ad Valorem labelling that could be considered labelling that could be considered dutibale amountof cannabis product dutibale amountof cannabis product maximum yield of 30 mg of THC per maximum yield of 30 mg THC per that important product information is information is that important product stamp that needs to be fixed on Excise stamp that needs to be fixed on Products intended to be "administered intended to be "administered Products must not exceed a maximum topically" must not exceed a maximum appealing to young people, and ensuring appealing to young people, and ensuring Licensed producers. Each province has an has an Each province Licensed producers. concentrates legal for sale October 2019

on use Advertising Restrictions Cannabis excise duty Cannabis excise duty rates in provinces and territories Taxation (Department of Finance, Canada) Maximum Maximum THC content Commercial Commercial production Commercial distribution on edibles Restrictions Restrictions

27 CROSS-CUTTING ISSUES: EVOLVING TRENDS AND NEW CHALLENGES 2020

WORLD DRUG REPORT 19 Can$14.45 sion (NTLCC) 30 g or equivalent NWT Liquor Stores, NWT Liquor Stores, provincial online sales provincial Northwest Territories Cannabis Legalization and Cannabis Legalization and Regulation Implementation Act Grow up to four cannabis plants per household Grow North West Territories Liquor & Cannabis Commis - Territories North West

19 (NLC) Can$10.61 30 g or equivalent Private retail stores, stores, Private retail Cannabis Regulations provincial online sales provincial up to four cannabis plants Newfoundland and Labrador Newfoundland and Labrador A private dwelling can contain A private dwelling can contain Control and Sale of Cannabis Act Control New Foundland and Labrador Newfoundland and Labrador Liquor Corporation Newfoundland and Labrador Liquor Corporation

19 Can$11.36 Corporation and online sales rate locked space New Brunswick 30 g or equivalent Cannabis Control Act Cannabis Control Cannabis Management Cannabis Management Cannabis NB retail stores stores Cannabis NB retail Can grow up to four plants at up to four plants at Can grow enclosure at least 1.52 metres high at least 1.52 metres enclosure Cannabis Management Corporation Act Outdoor plants must be located behind a locked Outdoor plants must be located behind a locked primary residence. Plants must be kept in a sepa - primary residence.

Maximum THC content production Commercial distribution Commercial Restrictions on edibles Advertising Interpersonal sharing Retail transaction limit price retail Average per gram after tax Legal process Title Date implemented Regulatory authority Minimum age Personal possession quantity Home cultivation

28 Cannabis - Regulations for legalization

19 Act cannabis plants 30 g or equivalent Cannabis Control Act Cannabis Control purshaser Prince Edward Island Prince Edward Trim:$0.225/g Flower: $0.75/g Provincial cannabis committee Provincial Seed/seedlings $0.75 Cannabis management corporation Cannabis Management Corporation Cannabis Management Corporation A household is permitted to have four A household is permitted to have four Northwest Territories private property or residendce private property

Illegal to smoke everywhere except except Illegal to smoke everywhere 7.5% of the dutiable amount when delivered to to 7.5% of the dutiable amount when delivered

19

Ontario residence Act, 2017 Act, 2018 of Ontario 30 g or equivalent

Alcohol and Gaming Commission Alcohol and Gaming Commission Cannabis Statute Law Amendment Cannabis Statute Law Amendment Cannabis, Smoke-Free Ontario, and Ontario, and Cannabis, Smoke-Free Road Safety Statute Law Amendment Road Safety Statute Law Amendment Adults can grow up to four plants per up to four plants per Adults can grow

purshaser Trim:$0.225 /gm Trim:$0.225 Flower: $0.75 /gm Seed/seedlings $0.75

private property or residence private property Illegal to smoke everywhere except except Illegal to smoke everywhere New Foundland and Labrador 19 home 7.5% of the dutiable amount when delivered to to 7.5% of the dutiable amount when delivered Nunavut Commission Cannabis Act 30 g or equivalent Nunavut Liquor and Cannabis Nunavut Liquor and Cannabis

whether plants can be grown at at whether plants can be grown regulate government can regulate Territorial Cannabis Statutes Amendments Act

purshaser Trim:$0.225/g 19 Flower: $0.75/g New Brunswick Seed/seedlings $0.75 personal use Nova Scotia private property or residence private property 30 g or equivalent plants per household Cannabis Control Act Cannabis Control Illegal to smoke everywhere except except Illegal to smoke everywhere No limit on home storage for Nova Scotia Liquor Corporation 7.5% of the dutiable amount when delivered to to 7.5% of the dutiable amount when delivered Adults can grow up to four cannabis up to four cannabis Adults can grow

Restrictions on use Date implemented Regulatory authority Taxation Legal process Title Cannabis excise duty rates in Cannabis excise duty rates in and territories provinces (Department of Finance, Canada) Minimum age Personal possession quantity Home cultivation Interpersonal sharing Retail transaction limit

29 CROSS-CUTTING ISSUES: EVOLVING TRENDS AND NEW CHALLENGES 2020

purshaser WORLD DRUG REPORT Can$11.19 7.5 % of the 7.5 % of the Trim:$0.225/g Flower: $0.75/g certain public spaces Seed/seedlings $0.75 Prince Edward Island Prince Edward retail stores and online sales stores retail Illegal to smoke everywhere except except Illegal to smoke everywhere dutiable amount when delivered to to dutiable amount when delivered Four dedicated government-owned private property, some exceptions for some exceptions for private property,

Ontario Can$10.53 online sales base amount base amount private property 19.3% of base amount applicable rate of 26.8 %) Government retail stores and and Government stores retail Flower: $0.75/g plus 3.9% of Flower: $0.75/g plus 3.9% of Trim: $0.225/g plus 19.3% of $0.225/g plus 19.3% of Trim: Seed/seedling: $0.75 seed plus Seed/seedling: $0.75 seed plus Illegal to smoke everywhere except except Illegal to smoke everywhere able amount of a cannabis product able amount of a cannabis product 7.5% plus 19.3 % of the duti - when delivered to a purchaser (total (total to a purchaser when delivered -

Nunavut Can$13.71 Can$13.71 base amount base amount * not for 2019 cable rate of 26.8%) 19.3% of base amount ated online store or by phone ated online store Trim: $0.225/g plus 19.3% of $0.225/g plus 19.3% of Trim: Seed/seedling: $0.75 seed plus Seed/seedling: $0.75 seed plus Flower: $0.75/g plus 19.3% of Flower: $0.75/g plus 19.3% of where tobacco may be smoked where Illegal everywhere except for areas except for areas Illegal everywhere delivered to a purchaser (total appli - to a purchaser delivered amount of a cannabis product when when amount of a cannabis product Currently through government-oper through Currently 7.5% plus plus 19.3% of the dutiable 7.5% plus 19.3% of the dutiable

Can$10.93 Federal law personal use Nova Scotia Trim: $0.225/g Trim: Flower: $0.75/ g Seed/seedlings $0.75 delivered to purshaser delivered Sale of edibles illegal under where tobacco may be smoked where Designated NSLC stores or online Designated NSLC stores Illegal everywhere except for areas except for areas Illegal everywhere 7.5 % of the dutiable amount when 7.5 % of the dutiable amount when Edibles can be produced at home for at home for Edibles can be produced

Maximum THC content production Commercial distribution Commercial Average retail price per gram price per gram retail Average after tax Restrictions on use on edibles Cannabis excise durty rates in Restrictions Restrictions Advertising Taxation and provinces territories territories (Department of Finance, Canada)

30 Cannabis - Regulations for legalization

19 sales Yukon Can$10.36 regulation act regulation 30 g per purchase Cannabis control and and Cannabis control Four plants per household Yukon Liquor Corportation Yukon Cannabis Yukon retail store retail Cannabis Yukon Cannabis Licensing Board (2019) Cannabis Licensing Board Government retail stores and online and online Government stores retail 30 g of dried cannabis or equivalent

19 sales Can$10.68 per household Saskatchewan Gaming Authority (Saskatchewan) Act Cannabis Authority Cannabis Authority The cannabis control The cannabis control The cannabis control (Saskatchewan) regulations Limit of four cannabis plants grown Limit of four cannabis plants grown under the Saskatchewan Liquor and under the Saskatchewan Liquor and 30 g of dried cannabis or equivalent Private retail stores, provincial online online provincial stores, Private retail

18 sales Quebec Can$7.88 personal use coise du cannabis Licensed producers 30 g in a public place 30 g per visit at Société 30 g per visit at Société québécoise du cannabis québécoise du cannabis Cannabis Regulation Act 150 g in a private residence Société québécoise du cannabis Société québécoise du cannabis Prohibited to cultivate cannabis for to cultivate cannabis for Prohibited Government retail stores and online and online Government stores retail Act to constitute the Société québé -

19 Act Can$11.19 online sales corporation Four dedicated Four dedicated cannabis plants. 30 g or equivalent Cannabis Control Act Cannabis Control Cannabis management Cannabis management Prince Edward Island Prince Edward Provincial cannabis committee Provincial Cannabis Management Corporation Cannabis Management Corporation government-owned retail stores and and government-owned stores retail A household is permitted to have four A household is permitted to have four Minimum age Personal possession quantity Home cultivation Commercial distribution Commercial Average retail price per gram price per gram retail Average after tax Maximum THC content production Commercial Date implemented Regulatory authority Interpersonal sharing Retail transaction limit Restrictions on edibles Advertising Legal process Title

31 CROSS-CUTTING ISSUES: EVOLVING TRENDS AND NEW CHALLENGES 2020

Yukon WORLD DRUG REPORT residendce Trim: $0.225/g Trim: Flower: $0.75/g private property or or private property Seed/seedlings $0.75 delivered to purshaser delivered Illegal to smoke everywhere except except Illegal to smoke everywhere 7.5% of the dutiable amount when 7.5% of the dutiable amount when

amount amount residendce product when when product Saskatchewan private property or or private property cable rate of 13.95%) 6.45% of base amount 7.5% plus plus 6.45 per cent 7.5% plus 6.45 per cent Seed/seedling: $0.75 seed plus Seed/seedling: $0.75 seed plus Illegal to smoke everywhere except except Illegal to smoke everywhere Trim: $0.225/g plus 6.45% of base $0.225/g plus 6.45% of base Trim: Flower: $0.75/g plus 6.45% of base Flower: $0.75/g plus 6.45% of base delivered to a purchaser (total appli - to a purchaser delivered of the dutiable amount of a cannabis of the dutiable amount a cannabis

Quebec Trim:$0.225/g Flower: $0.75/g CEGEP campuses Seed/seedlings $0.75 delivered to purshaser delivered for areas where tobacco may be tobacco may be where for areas smoked, excluding university and smoked, excluding university and Illegal to smoke everywhere except except Illegal to smoke everywhere 7.5 % of the dutiable amount when 7.5 % of the dutiable amount when

Trim:$0.225/g Flower: $0.75/g certain public spaces Seed/seedlings $0.75 delivered to purshaser delivered Prince Edward Island Prince Edward Illegal to smoke everywhere except except Illegal to smoke everywhere 7.5 % of the dutiable amount when 7.5 % of the dutiable amount when private property, some exceptions for some exceptions for private property,

Restrictions on use Taxation Cannabis excise durty rates in Cannabis excise durty rates in and territories provinces (Department of Finance, Canada)

32 Cannabis - Regulations for legalization

21 $14.00 Nov-16 Maine Question 1 Not specified Not specified Voter initiative Voter Not set initially 2.5 oz (70.8 g) 2.5 oz (70.8 g) 5g concentrate Twelve seedlings Twelve same restrictions place August 2017 Market/commercial 2.5 oz. of marijuana Yes for home grow. Not Not for home grow. Yes Six mature plants, twelve plants, twelve Six mature cultivation. Cultivation for cultivation. Cultivation for Conservation and Forestry owners can prohibit home home owners can prohibit immature plants, unlimited plants, unlimited immature Department of Agriculture, Department of Agriculture, permitted for retail marijuana permitted for retail identification number. Property Property identification number. Take effect on 7 January 2017; on 7 January 2017; effect Take view and tagged with personal view and tagged with personal regulation for business to be in for business to be in regulation amount of seedlings away from amount of seedlings away from medical purposes not subject to medical purposes not subject to

21 None None Market Nov-14 to adults cultivation 2 oz (57 g) Initiative 71 Voter initiative Voter Not applicable Not applicable Not set initially 28.5 gm or less Six plants per person; District of Columbia February 2015: Personal February 2015: Personal possession, consumption, possession, consumption, Not applicable; considering Not applicable; considering Twelve plants per household, Twelve six of which can be flowering separate legislation to regulate separate legislation to regulate commercial production and sale and sale production commercial

21 None None 28.5 g 28.5 g Market Nov-12 $14.14 cultivation cultivation Colorado Not set initially Amendment 64 can be flowering Residents: 28.5 g Residents: 28.5 g state constitution Non-residents: 7 g Non-residents: (Department of Revenue) Six plants, three of which of which Six plants, three possession, consumption, possession, consumption, January 2014: Retail sales December 2012: Personal December 2012: Personal Voter initiative, amendment to initiative, amendment to Voter Marijuana Enforcement Division Division Marijuana Enforcement

21 Yes $12.03 Nov-16 1 oz flower 1 oz flower California Not specified Not specified Voter initiative Voter Proposition 64 Proposition Not set initially 8 g concentrate 11 January 2018 Market/commercial personal possession Licences to be issued by Licences to be issued by Presumably same limits for same limits for Presumably Six plants, away from view Six plants, away from Bureau of Marijuana Control Bureau

21 None None 28.5 g 28.5 g 28.5 g Market $20.00 Nov-14 Alaska cultivation cultivation possession Control Office Control Not set initially Ballot Measure 2 Ballot Measure Alcohol and Marijuana Alcohol and Marijuana February 2015: Personal February 2015: Personal lawful possession or with lawful possession or with possession, consumption, possession, consumption, October 2016: Retail sales views; within property with with views; within property Voter initiative, state statute Voter consent of the person in lawful consent of the person in lawful flowering; not subject to public flowering; not subject to public Six plants, three of which can be of which can be Six plants, three

Regulations for the legalization of non-medical use cannabis in jurisdictions United States

Title Date passed Legal process Date imple - mented/required date of rule adoption Retail pricing Retail pricing structure Average retail retail Average price per gram of medium qualtiy Maximum THC content Source: budzu.com Source: Registration Registration requirements Regulatory Regulatory authority Retail transaction Retail transaction limit Interpersonal Interpersonal sharing Home Home cultivation Minimum age Personal Personal possession quantity Residency Residency requirement Table 5

33 CROSS-CUTTING ISSUES: EVOLVING TRENDS AND NEW CHALLENGES 2020

Maine children purchases based on size establishments WORLD DRUG REPORT appeal to children State-licensed clubs 10% excise on retail marijuana social club) Restricted to those over Restricted to those over 21. Restrictions on false 21. Restrictions on false 1999: Patient registry or or 1999: Patient registry states but not for dispensary states but not for dispensary contain additives designed to contain additives designed to products and edibles may not and edibles may not products or smoking in a state-licensed or smoking in a state-licensed Not permitted in public places Not permitted in public places Licensed cultivators; two types Licensed cultivators; two types recognizes patients from other other patients from recognizes (allowed use in private property (allowed use in private property number of stores; localities may localities may number of stores; identification card; dispensaries, dispensaries, identification card; be developed in regulations. List List be developed in regulations. health benefits. Products cannot cannot health benefits. Products regulate number and location of number and location of regulate make product more appealing to appealing to more make product Serving size and potency limits to Serving size and potency limits to of ingredients packing and labels; packing and labels; of ingredients advertisement or claims of untrue advertisement or claims of untrue State authority may not limit total State authority may not limit total

None None market Not applicable, Not applicable, dispensaries allowed Currently not allowed not allowed Currently no commercial market no commercial District of Columbia (use on private property) 1998/2010: Patient registry; 1998/2010: Patient registry; Not allowed; currently under under Not allowed; currently Not permitted in public places Not permitted in public places Not applicable, no commercial Not applicable, no commercial investigation by city task force.

children facilities Colorado cultivation; Not allowed the age of 21 15% excise tax on 15% excise tax on 2000: Patient registry, 2000: Patient registry, to 3.5% local sales taxes warning labels "keep out of Licensed Licensed cannabis cultivation Licensed retail cannabis stores Licensed retail Not permitted in public places on labels and not attractive to on labels and not attractive to Maximum of 10 mg of THC in Maximum of 10 mg THC in reach of children"; THC symbol THC symbol of children"; reach possession, consumption; 2010: possession, consumption; 2010: of-state patients not recognized; of-state patients not recognized; each individually packed serving; each individually packed serving; commercial production and sales production commercial dispensaries already existed; out- dispensaries already 10% retail marijuana sales tax to marijuana sales tax to 10% retail 2.9% state sales tax Up 2.9% state sales tax Up be decreased to 8% in July 2017 than 30% of the audience under than 30% of the audience under Restricted to media with no more Restricted to media with no more

California consumption ounces on appeal to children Restrictions on false Restrictions on false content List of ingredients and and List of ingredients State-wide licensing of State-wide licensing of - voluntary registration; - voluntary registration; Licensed cultivators and Licensed cultivators and 10 mg THC per serving. 10 mg THC per serving. may exists in the form of may exists in the form of Restricted to those over 21. Restricted to those over 21. Not specified although they Not specified although they dispensaries will begin 2018 cooperatives and collectives; cooperatives and collectives; Warning and potency labels. and potency labels. Warning manufacturers, varying types manufacturers, place unlicensed for such use, place unlicensed for such use, Limits on market concentration harvest. $2.75 per drug weight harvest. $2.75 per drug weight 15% excise on retail, $9.25 per $9.25 per 15% excise on retail, 1996 and 2003; Patient registry 1996 and 2003; Patient registry microbusiness that allow on-site that allow on-site microbusiness Prohibit cannabis use in a public cannabis use in a public Prohibit health benefits. Products cannot cannot health benefits. Products including near schools and other including near schools and other areas where children are present. are children where areas dry weight ounce on flower after dry weight ounce on flower after advertisement or claims of untrue advertisement or claims of untrue

Alaska prohibited prohibited to children is unlawful under 21 years. under 21 years. home cultivation Cannabis use in public Cannabis use in public taxed at $15 per ounce no more than 50 mg of than 50 mg of no more package. Child-resistant Not explicitly allowed or Not explicitly allowed or 1998: Patient registry, no no 1998: Patient registry, Logo or advertisement for Logo or advertisement for licensed marijuana may not licensed marijuana may not $50 excise tax per ounce on $50 excise tax per ounce on Licensed cannabis producers state patients recognized for for state patients recognized manufacturer; other parts of other parts of manufacturer; packaging required. Separate Separate packaging required. Licensed retail cannabis stores Licensed retail school areas, public transport, public transport, school areas, homogenous THC allowed per homogenous THC allowed per 5 mg of THC for single serving, 5 mg of THC for single serving, and contrain presribed warningand contrain presribed facility to retail store or product or product store facility to retail depiction appealing to a person depiction appealing to a person approved conditions but not for conditions but not for approved plant, e.g., stems and leaves are plant, e.g., stems and leaves are dispensaries registration; out-of- dispensaries registration; tion repealed in November 2015 tion repealed promote excessive consumption, excessive consumption, promote warnings on risks, not appealing Earlier ban on in-store consump - Earlier ban on in-store Restrictions on advertisements in Restrictions on advertisements in sales or transfers from cultivation cultivation sales or transfers from dispensary purchases; possession, possession, dispensary purchases;

on use Restrictions Restrictions Medical cannabis Cannabis clubs Commercial Commercial production Commercial Commercial distribution Taxation Restrictions on Restrictions on edibles Advertising

34 Cannabis - Regulations for legalization

21 Jun-19 Illinois 1-Jan-20 HB 1438 residents product or product concentrate Financial and Financial and Department of Department of view by public. 5 g of cannabis 5 g of cannabis acquire half the half the acquire cannabis-infused Medical cannabis Medical cannabis Non residents can can Non residents 500 mg of THC in 500 mg of THC in Legislative process secured and out of and out of secured amount allowed for amount allowed for patients can grow up up patients can grow 30 g of raw cannabis, to 5 plants per house - Professional Regulation Professional hold. Plants need to be hold. Plants need to be

21 None 28.5 g Nov-12 Not allowed state statute Initiative 502 consumption consumption Washington Voter initiative, initiative, Voter December 2012: December 2012: Board (formerly the (formerly the Board Personal possession, Personal possession, Liquor and Cannabis Liquor and Cannabis Liquor Control Board) Liquor Control July 2014: Retail sales

21 Jan-18 No. 86 cannabis Vermont 01 July 2018 1 oz or 5 g of 1 oz or 5 g of immature plants immature Legislative process S.54 (initaited in Feb S.54 (initaited in Feb 2 mature plants or 4 plants or 4 2 mature 2020 to be finalized) (proposed under S.54) (proposed Cannabis Control Board Board Cannabis Control

21 None Nov-14 retailers Oregon Measure 91 Measure dispensaries dispensaries state statute Oregon Liquor Liquor Oregon Voter initiative, initiative, Voter tion, cultivation tion, cultivation At home: 228 g In public: 28.5 g In public: 28.5 g July 2015: Personal July 2015: Personal October 2015 up to October 2015 up to Control Commission Control January 2017: retail January 2017: retail Four plants in flower possession, consump - sales through medical medical sales through sales through licensed licensed sales through December 2016: Retail December 2016: Retail

21 2018 sion of sion of Nov-16 Nevada Question 2 of Taxation 1 oz flower Department Department Not specified Voter initiative Voter Takes effect on on effect Takes 3.5g concentrate place by 1 January place by 1 January erty in indoor or in erty in indoor or Six plants, no more Six plants, no more regulations to be in to be in regulations retail cannabis store retail 1 January 2017 and 1 January 2017 and 25 miles away from 25 miles away from - than twelve on prop landlord and must be landlord enclosed with permis -

21 home Board Nov-16 Question 4 Not specified Voter initiative Voter 5g concentrate 1 October 2017 Massachusetts Commission, and Commission, and 1 oz flower (28.5 g) 1) Cannabis Control 1) Cannabis Control 15 September 2017. 15 September 2017. residence away from away from residence view; 10 oz. of dried view; 10 oz. of dried 2) Cannabis Advisory 2) Cannabis Advisory 6 plants, 12 in a single 6 plants, 12 in a single marijuana permitted at marijuana permitted at Licences issued starting Licences issued starting

21 g)at home household Michigan Licensing and Proposal 18-1 Proposal Voter initiative Voter Department of Department of Regulatory Affairs 6 December 2018 6 December 2019 2.5 oz (70.8 g) on 2.5 oz (70.8 g) on Up to 12 plants per Up to 12 plants per application begin by application begin by Commercial licences licences Commercial person and 10 oz (283 person and 10 oz (283

Title Date passed requirement Residency Minimum age Date Date implemented/ date required of rule adoption Legal process Personal Personal possession quantity Home cultivation Regulatory Regulatory authority

35 CROSS-CUTTING ISSUES: EVOLVING TRENDS AND NEW CHALLENGES 2020

None Market $11.95 Illinois producers consumers. possesion limit same as personal same as personal Medical cannabis products to adult to adult products Licensed marijuana Licensed marijuana Dispensary provides Dispensary provides ment of Agriculture ment of Agriculture apply for adult sale. per package; Depart - dispensary could also dispensary could also Not set but would be Not set but would be nabis-infused product may change maximum may change maximum in each serving of can - level of THC contained level of THC contained Initially 100 mg of THC WORLD DRUG REPORT None stores ducers 28.5 g Market $10.55 Not allowed Washington Not set initially state-licensed retail state-licensed retail sold and purchased at at sold and purchased - Licensed cannabis pro Marijuana can only be Marijuana can only be -

NA apart from car apart from

Vermont exceed 60%. exceed 60%. — not allowed. possession limits Same as personal Same as personal exceed 30% THC. exceed 30% THC. Not clarified in law Not clarified in law tridges for vape pens tridges for vape pens - up a taxed-and-regu Oils — Solid concentrates not Solid concentrates not lated retail marketplace lated retail No provision for setting for setting No provision Cannabis flower not to Cannabis flower not to

None plants 28.5 g Market $10.59 Oregon producers Licensed retail Licensed retail cannabis stores 1 oz dried flower Licensed cannabis Licensed cannabis 16 oz edible form 4 immature cannabis cannabis 4 immature form 10 cannabis seeds 72 oz cannabis in liquid 72 oz cannabis in liquid

Yes $16.55 Licensed Licensed possession population Personal data Personal data Not specified, Not specified, establishment Limits on market Limits on market concentration by concentration by presumably same same presumably limits as for personal limits as for personal collection not required

Yes $14.64 Licensed Licensed Licensed Licensed possession Personal data Personal data Not specified, Not specified, establishments Not set initially Not set initially Not set initially establishments; establishments; presumably same same presumably limit or prohibit the the limit or prohibit limits as for personal limits as for personal localities can regulate, localities can regulate, collection not required operation of businesses

$16.92 Licensed Licensed operating Michigan Massachusetts Nevada concentrate) establishments establishments establishments max of 15 mg of max of 15 mg Yes (2.5 oz with a (2.5 oz with a Yes A municipality may A municipality may Market/commercial Market/commercial Market/commercial limit the number of limit the number of completely prohibit or or completely prohibit

Interpersonal Interpersonal sharing Retail Retail transaction limit Retail pricing Retail pricing structure Commercial production Average retail retail Average price per gram of medium qualtiy Maximum THC content Commercial distribution Source: budzu. Source: com Registration Registration requirements

36 Cannabis - Regulations for legalization

Illinois labelling. warning on consumption packaging and packaging and allowed; similar allowed; similar information and information and legibly displayed person under 21 person under 21 Allowed but with that have false or that have false or consuming; make consuming; make Businesses cannot Businesses cannot tion; depict actual tion; depict actual therapeutic claims; therapeutic claims; minors or children; minors or children; advertisements that advertisements that contain images that contain images that health, medicinal or health, medicinal or can be appealing to can be appealing to restrictions apply on apply on restrictions sales promotions are are sales promotions place advertisements place advertisements misleading claims; or misleading claims; or allowed within 1,000 allowed within 1,000 or public property; no no or public property; Health warnings to be consumption; depict a consumption; depict a ground, public park or public park or ground, advertisements are not not advertisements are library, public transport public transport library, feeet of school or play - - overconsump promote

-

nabis nabis Washington packaging; THC packaging; THC infused products, infused products, Board before sale before Board that billboards and and that billboards Cannabis business Cannabis business serving; child-proof serving; child-proof be approved by the by the be approved signs can no longer signs can no longer State Liquor Control State Liquor Control labelling; marijuana- New rules mandated New rules mandated appealing to children two permanent signs two permanent signs individually packaged individually packaged premises are banned. banned. are premises tain depictions of car contain images of the contain images of the of outdoor ads on the of outdoor ads on the 10 mg of THC in each 10 mg of THC in each cannabis plant or can - toon characters or any toon characters or any products. Cannot con - products. licensees are limited to limited to licensees are packages and labels to packages and labels to depictions that may be depictions that may be - on their licensed prem ises, and all other forms ises, and all other forms under 21 Vermont free samples, or be samples, or be free appealing to minors. appealing to minors. expect no more than than expect no more Advertising could not Advertising could not be allowed where the the be allowed where be deceptive, promote be deceptive, promote Advertising would only Advertising would only 15% of viewers will be 15% of viewers will be licensee can reasonably licensee can reasonably overconsumption, offer offer overconsumption,

children Oregon advertising Commission has Commission has not appealing to not appealing to authority to further authority to further regulate or prohibit or prohibit regulate preapproval process; preapproval Entry sign required on on Entry sign required packed serving; edible packed serving; edible products to undergo a to undergo a products Oregon Liquor Control Liquor Control Oregon Maximum of 10 mg of Maximum of 10 mg exterior of dispensaries; exterior of dispensaries; THC in each individually THC in each individually

Nevada Colorado Not specified depicts actual depicts actual consumption, or consumption, or that contains any that contains any overconsumption, overconsumption, false or misleading false or misleading A licensed marijuana A licensed marijuana establishment cannot establishment cannot engage in advertising engage in advertising statements, promotes statements, promotes applies 70/30 rule from applies 70/30 rule from appeals to minors. Also appeals to minors. Also

regulations regulations. regulations. developed in developed in Restrictions on Restrictions on Serving size and Serving size and Massachusetts List of ingredients to be developed in to be developed in potency limits to be potency limits to be marketing to children marketing to children

Michigan to cannabis to cannabis Restrictions on Restrictions on establishments public signs related public signs related

on edibles Restrictions Restrictions Advertising

37 CROSS-CUTTING ISSUES: EVOLVING TRENDS AND NEW CHALLENGES 2020

3.5%. Illinois concentration. edible products. than a 35% THC than a 35% THC cannabis, such as cannabis, such as higher than 35%. products with less with less products cannabis flower or cannabis flower or not allowed in any not allowed in any THC concentration THC concentration In addition, 6.25% In addition, 6.25% any product with a with a any product local taxes of up to local taxes of up to Consumers may pay Consumers may pay 34.75% depending 34.75% depending Smoking cannabis is sales tax, along with sales tax, along with prohibited under the under the prohibited 25% tax will apply to 25% tax will apply to 20% tax will apply to 20% tax will apply to 10% tax will apply to 10% tax will apply to products infused with infused with products between 19.55% and between 19.55% and Smoke Free Illinois Act Smoke Free on a product's potency on a product's place where smoking is smoking is place where WORLD DRUG REPORT

tax 2015: 2015: the public Not allowed (production, (production, Washington processing, retail) retail) processing, July 2014 to June July 2014 to June 25% at each stage 25% at each stage marijuana in view of marijuana in view of July 2015: 37% sales July 2015: 37% sales It is illegal to consume It is illegal to consume

Vermont Use is limited to Use is limited to smoke free places smoke free in addition to usual in addition to usual Prohibited in street, in street, Prohibited individual dwellings. individual dwellings. alley, park or sidewalk park or sidewalk alley, Oregon Not allowed public is illegal December 2015 local tax up to 3% local tax up to 3% munities to establish munities to establish No tax on retail sales sales No tax on retail 25% sales tax after 5 25% sales tax after 5 Smoking marijuana in Smoking marijuana in January 2016 17% January 2016 17% sales tax in 2017 with sales tax in 2017 with options for local com - from October 2015 to October 2015 to from

sale Nevada on retail sale on retail risking a fine Not specified 10% excise tax 10% excise tax is illegal to smoke in is illegal to smoke in 15% excise on whole - or in a vehicle without or in a vehicle without public, on federal land public, on federal land Cannabis consumption Cannabis consumption is for private use only. It It is for private use only.

3.75% 3.75% Cannot use Cannot use consumption establishments establishments excise on retail where smoking smoking where they may exist in they may exist in Massachusetts that allow on-site- cannabis in a place cannabis in a place tobacco is prohibited Not allowed, although Not allowed, although

of age Michigan 10% excise tax public places that public places that are not accessible to not accessible to are prohibited by person by person prohibited or place where places or place where allowed in designated allowed in designated manages the property, who owns, occupies or who owns, occupies or Not permitted in public Not permitted in public persons under 21 years persons under 21 years

Cannabis Cannabis clubs on use Restrictions Restrictions Taxation

38 Cannabis - Regulations for legalization

Illinois marijuana. August 2013. programme act, act, programme school nurses or school nurses or of those officials consume medical consume medical students who are students who are registered medical medical registered ounces of cannabis ounces of cannabis Purchase limit is 2.5 limit is 2.5 Purchase New law also allows New law also allows patients and permits patients and permits cannabis products to to cannabis products after registering with with after registering students to medicate students to medicate the state, may legally the state, may legally flower every 14 days. debilitating condtion, debilitating condtion, under the supervision under the supervision administrators to give administrators to give Compassionate use of Compassionate use of medical cannabis pilot - doctor's recommenda Eligible patients with a Eligible patients with a tion, with a recognized tion, with a recognized

July 2014: July 2014: Washington 1999 possession no registration or or no registration 1999/2010/2011; 1999/2010/2011; identification card; first stores opened in opened in first stores dispensaries approved dispensaries approved as of November 2012, as of November 2012, 2012: Home cultivation Vermont Oregon home cultivation dispensaries already dispensaries already authorized by law or authorized by law or 1998: Patient registry, 1998: Patient registry, regulated; possession, possession, regulated; existed but not clearly existed but not clearly

Nevada No dispensaries; No dispensaries; programmes are are programmes Nevada paper work substantially similar; substantially similar; patients must fill out patients must fill out 2000: Patient registry 2000: Patient registry or identification card, recognize out of state out of state recognize patients if other state's patients if other state's

not recognized Massachusetts cards; dispensaries, dispensaries, cards; 2012/2013; patient 2012/2013; patient out-of-state patients out-of-state patients registry or identification or identification registry

Michigan dispensation for dispensation for established with established with patients only for patients only for local ordinances; local ordinances; legal protection of of legal protection specific conditions, specific conditions, dispensaries can be dispensaries can be dispensary purchases 2008: patient registry, 2008: patient registry, recognize out of state out of state recognize possession but not for possession but not for

cannabis Medical Medical

39 CROSS-CUTTING ISSUES: EVOLVING TRENDS AND NEW CHALLENGES 2020

Table 6 Regulations for the legalization of the non-medical use of cannabis in Uruguay

Uruguay Legal process Government initiative, national law Title Law No. 19.172 Date passed Dec-13 WORLD DRUG REPORT

August 2014: Personal cultivation Date implemented/ October 2014: Grower clubs required date of rule adoption Mid-2017: pharmacy sales

Regulatory authority Institute for the Regulation and Control of Cannabis (IRCCA) Minimum age 18 Residency requirement Uruguayan citizenship or permanent Uruguayan residency required

Personal possession quantity 40 g per month

Home cultivation Six plants in flower Interpersonal sharing Allowed within the home Retail transaction limit 40 g per month, 10 g per week (sale through pharmacies to registered users) Retail pricing structure Government price control

Average retail price per 265 Uruguayan pesos per 5 g (approx $1.2 per gram) gram after tax

All products are required to indicate that CBD is equal to or more than 3% Maximum THC content and THC is equal to or less than 9%

Registration requirements Yes, with IRCCA for any of the three modes of access Commercial production Licensed marijuana producers Commercial distribution Licensed pharmacies Advertising Prohibited Taxation No tax, although IRCCA can impose tax in the future.

Clubs with 15-45 members allowed to cultivate up to 99 plants, maximum Cannabis clubs 480 g of dried product per member per year

In 2013: Passed (Law 19.172). Decree N° 46/015. Oils under prescription Medical cannabis (CBD) and cosmetics with CBD currently for sale in pharmacies.

40 GLOSSARY amphetamine-type stimulants — a group of sub- problem drug users — people who engage in the stances composed of synthetic stimulants controlled high-risk consumption of drugs. For example, under the Convention on Psychotropic Substances people who inject drugs, people who use drugs on of 1971 and from the group of substances called a daily basis and/or people diagnosed with drug use , which includes amphetamine, meth- disorders (harmful use or drug dependence), based amphetamine, methcathinone and the on clinical criteria as contained in the Diagnostic “ecstasy”-group substances (3,4-methylenedioxym- and Statistical Manual of Mental Disorders (fifth edi- ethamphetamine (MDMA) and its analogues). tion) of the American Psychiatric Association, or the International Classification of Diseases and Related amphetamines — a group of amphetamine-type Health Problems (tenth revision) of WHO. stimulants that includes amphetamine and . people who suffer from drug use disorders/people with drug use disorders — a subset of people who use annual prevalence — the total number of people of drugs. Harmful use of substances and dependence a given age range who have used a given drug at are features of drug use disorders. People with drug least once in the past year, divided by the number use disorders need treatment, health and social care of people of the given age range, and expressed as a and rehabilitation. percentage. harmful use of substances — defined in the Interna- paste (or coca base) — an extract of the leaves tional Statistical Classification of Diseases and Related of the coca bush. Purification of coca paste yields Health Problems (tenth revision) as a pattern of use cocaine (base and hydrochloride). that causes damage to physical or mental health. “crack” cocaine — cocaine base obtained from dependence — defined in the International Statistical cocaine hydrochloride through conversion processes Classification of Diseases and Related Health Problems to make it suitable for smoking. (tenth revision) as a cluster of physiological, behav- cocaine salt — cocaine hydrochloride. ioural and cognitive phenomena that develop after repeated substance use and that typically include a drug use — use of controlled psychoactive substances strong desire to take the drug, difficulties in control- for non-medical and non-scientific purposes, unless ling its use, persisting in its use despite harmful otherwise specified. consequences, a higher priority given to drug use - fentanyl and its analogues. than to other activities and obligations, increased tolerance, and sometimes a physical withdrawal new psychoactive substances — substances of abuse, state. either in a pure form or a preparation, that are not controlled under the Single Convention on substance or drug use disorders — referred to in the Drugs of 1961 or the 1971 Convention, but that Diagnostic and Statistical Manual of Mental Disorders may pose a public health threat. In this context, the (fifth edition) as patterns of symptoms resulting term “new” does not necessarily refer to new inven- from the repeated use of a substance despite expe- tions but to substances that have recently become riencing problems or impairment in daily life as a available. result of using substances. Depending on the number of symptoms identified, substance use dis- opiates — a subset of opioids comprising the various order may be mild, moderate or severe. products derived from the poppy plant, prevention of drug use and treatment of drug use dis- including opium, and . orders — the aim of “prevention of drug use” is to opioids — a generic term that refers both to opiates prevent or delay the initiation of drug use, as well and their synthetic analogues (mainly prescription as the transition to drug use disorders. Once a person or pharmaceutical opioids) and compounds synthe- develops a drug use disorder, treatment, care and sized in the body. rehabilitation are needed. 41

REGIONAL GROUPINGS

The World Drug Report uses a number of regional of Korea, , Japan, Lao People’s and subregional designations. These are not official Democratic Republic, Malaysia, Mongolia, designations, and are defined as follows: Myanmar, Philippines, Republic of Korea, Singapore, , Timor-Leste, Viet Nam, • East Africa: Burundi, Comoros, Djibouti, Eritrea, Hong Kong, , Macao, China, and Taiwan , Kenya, Madagascar, Mauritius, Rwanda, Province of China , Somalia, South Sudan, Uganda, United Republic of Tanzania and Mayotte • South-West Asia: , Iran (Islamic Republic of) and • North Africa: Algeria, Egypt, Libya, Morocco, Sudan and Tunisia • Near and Middle East: Bahrain, Iraq, Israel, Jordan, Kuwait, Lebanon, Oman, Qatar, Saudi • Southern Africa: Angola, Botswana, Eswatini, Arabia, State of Palestine, Syrian Arab Republic, Lesotho, Malawi, Mozambique, Namibia, South United Arab Emirates and Yemen Africa, Zambia, Zimbabwe and Reunion • : , Bhutan, , Maldives, • West and Central Africa: Benin, Burkina and Sri Lanka Faso, Cabo Verde, Cameroon, Central African Republic, Chad, Congo, Côte d’Ivoire, • Eastern : Belarus, Republic of Moldova, Democratic Republic of the Congo, Equatorial Russian Federation and Ukraine Guinea, Gabon, Gambia, Ghana, Guinea, • South-Eastern Europe: Albania, Bosnia and Guinea-Bissau, Liberia, Mali, Mauritania, Niger, Herzegovina, Bulgaria, Croatia, Montenegro, Nigeria, Sao Tome and Principe, Senegal, Sierra North Macedonia, , Serbia, and Leone, Togo and Saint Helena Kosovo417 • Caribbean: Antigua and Barbuda, Bahamas, • Western and Central Europe: Andorra, Austria, Barbados, Cuba, Dominica, Dominican Republic, Belgium, Cyprus, Czechia, Denmark, Estonia, Grenada, Haiti, Jamaica, Saint Kitts and Nevis, Finland, France, Germany, Greece, Hungary, Saint Lucia, Saint Vincent and the Grenadines, Iceland, Ireland, Italy, Latvia, Liechtenstein, Trinidad and Tobago, Anguilla, Aruba, Bonaire, Lithuania, Luxembourg, Malta, Monaco, Netherlands, British Virgin Islands, Cayman Netherlands, Norway, Poland, , San Islands, Curaçao, Guadeloupe, Martinique, Marino, Slovakia, Slovenia, Spain, Sweden, Montserrat, Puerto Rico, Saba, Netherlands, Sint Switzerland, United Kingdom of Great Britain Eustatius, Netherlands, Sint Maarten, Turks and and Northern Ireland, Faroe Islands, Gibraltar Caicos Islands and United States Virgin Islands and Holy See • Central America: Belize, Costa Rica, El Salvador, Oceania (comprised of four sub-regions): Guatemala, Honduras, Nicaragua and Panama • Australia and New Zealand: Australia and New • : Canada, Mexico and United Zealand States of America, Bermuda, Greenland and Saint- • Pierre and Miquelon Polynesia: Cook Islands, Niue, Samoa, Tonga, Tuvalu, French Polynesia, Tokelau and Wallis and • South America: Argentina, Bolivia (Plurinational Futuna Islands State of), Brazil, Chile, Colombia, Ecuador, • Guyana, Paraguay, Peru, Suriname, Uruguay, Melanesia: Fiji, Papua New Guinea, Solomon Venezuela (Bolivarian Republic of), Falkland Islands, Vanuatu and New Caledonia Islands (Malvinas) and French Guiana • Micronesia: Kiribati, Marshall Islands, Micronesia • and Transcaucasia: Armenia, (Federated States of), Nauru, Palau, Guam and Azerbaijan, Georgia, Kazakhstan, Kyrgyzstan, Northern Mariana Islands Tajikistan, Turkmenistan and Uzbekistan 417 All references to Kosovo in the World Drug Report should • East and South-East Asia: Brunei Darussalam, be understood to be in compliance with Security Council Cambodia, China, Democratic People’s Republic resolution 1244 (1999). 43