Prevention Update

As one component of a harm reduction approach, a drug checking or testing service enables people who use drugs to find out about the contents of their pills and powders before they ingest them. The idea behind drug checking is that a small, high-risk group of individuals will use substances despite the associated health risks or unknown harms associated with taking illicit drugs. Providing people who use drugs with information about what they are taking can help them make informed decisions and avoid the potentially life threatening effects of certain drugs (e.g., fentanyl overdose or opioid poisonings).

Insite, North America’s first legal supervised injection site, has been offering drug checking services as part of a pilot study to test the effectiveness of this harm reduction strategy, as well as to get a better understanding of the contaminants commonly found in illicit street drugs.

So far, there is limited evidence available to show whether or not drug checking is effective. However, the evidence that is available suggests that drug checking can reduce harms associated with substance use, but studies like the one going on at Insite are needed to validate these findings.

Initial results of the Insite pilot reveal that 86% of all drugs tested were positive for fentanyl — the dangerous drug responsible for hundreds of fatal overdoses in Canada alone. This finding is enough to show that fentanyl contamination is a serious health concern for those using illicit drugs — especially heroin. Insite will continue to offer drug checking services for several months so that staff can evaluate whether it is effective at helping clients and reducing harms. The results will dictate the future of drug checking services at Insite and probably elsewhere in Canada.

The results at Insite will also contribute to a growing evidence base that will guide future decisions on the opening of supervised injection sites in other communities across Canada, and also whether drug checking services should be made available as part of a harm-reduction strategy.

Drug checking is one part of a much larger strategy. To effectively prevent harms associated with drug use, other forms of prevention like education and awareness are important first steps. It is also important to pair drug checking with opportunities for trained professionals to talk with individuals who choose to use substances, and make sure the limitations of drug checking are fully explained and that results can be interpreted accurately. By providing easy access to substance use treatment programs and access to naloxone kits to treat overdoses, comprehensive harm reduction strategies can help minimize the harms associated with substance use.

For more information, see this article on the Vancouver Coastal Health website.

How common are edible marijuana products?

The legalization of marijuana has become a popular topic of discussion for Canadians, as the federal government has said that changes are coming to the legal status of marijuana in Canada.

With all the buzz surrounding our marijuana legalization, head shops and retailers have opened ahead of new laws. However, dried, cured marijuana flowers — the typical substance bought, sold and smoked on the street — is not the only product one can get at these shops.

Edible marijuana products — brownies, cookies, candies, infused beverages and so on — are becoming more and more popular as a way to get high. These products look a lot like their marijuana-free counterparts, making them hard spot, so people are choosing them if they want a more subtle way to get high. But because these products look just like any other brownie, candy or chocolate bar, they can be eaten by children and adults without them knowing about their contents or possible effects.

How common are edible marijuana products?

Between January 2013 and December 2015, there were 430 cases of human exposure to marijuana brownies, candies, cookies, beverages or other foods reported to the National Poison Data System (NPDS) in the United States. The number of calls reported increased over time throughout the study, and the majority of the reported cases, not surprisingly, came from states with decriminalized marijuana laws (i.e., Colorado and Washington).

Are there harms associated with consuming edible marijuana products?

Of all the cases reported to the NPDS, the most common age-groups were those less than five years old, and those between 13 and 19 years old! Edible marijuana products pose real danger to these children; marijuana interferes with normal brain development and children under the age of five and between 13 and 19 years old are undergoing rapid and extensive brain development.

For more information on the effects of marijuana on brain development, check out The Effects of Cannabis Use during Adolescence, a report published by the Canadian Centre on Substance Abuse.

The good news is that no one has died as a results of being exposed to edible marijuana products. The main symptoms reported to the NPDS were drowsiness, tachycardia (fancy way of saying a very fast heart beat), agitation and irritability, and confusion.

While most of the clinical effects associated with exposure to edible marijuana products were minor, the increasing numbers of exposure over time is of major concern. These data are from American sources, and most exposures happened in states that have already relaxed their laws around marijuana consumption. Will the same trends happen in the provinces and territories if marijuana is legalized in Canada?

For more information, see Characterization of edible marijuana product exposures reported to United States poison centers.

Before Canada moves ahead with legalization of cannabis, there are many important things to consider and prepare for in order to minimize the unintended harms associated with cannabis use.

After cannabis was made legal in Washington and Colorado, the Canadian Centre on Substance Abuse (CCSA) met with officials to discuss their experience and published a document, Cannabis Regulation: Lessons Learned in Colorado and Washington State, that highlights many of the unintended consequences and hard lessons learned about cannabis legalization.

Among the many surprises — things that weren’t thought about or expected — was the increase in drug-impaired driving. For example, Colorado reported a 32% increase in the number of marijuana-related traffic fatalities in the year following cannabis legalization. Marijuana-related traffic fatalities can be used as an indicator that more people are driving high.

In Canada, drug-impaired driving is already a very serious issue. How serious? Well, in 2012 the Traffic Injury Research Foundation determined that about 40% of fatally injured drivers in Canada were killed in drug-related accidents. The prospect of drug-impaired driving rates going up if and when cannabis is legalized is a scary one. Although we have developed tools to help detect the presence of alcohol and gauge the level of alcohol intoxication, the same progress has not been seen for detecting cannabis levels or cannabis intoxication; this will surely need to change.

The federal government is assuring the public that it is aware of the increase in drug-impaired driving that has followed recent changes to cannabis law across the globe, and it is working hard to tackle this issue in Canada before any changes to our laws come into effect.

Prevention initiatives will be a critical component to these efforts. Prevention campaigns will be needed to educate Canadians on the risks associated with drug-impaired driving, address some common myths and very clearly explain the relationship between THC (the active ingredient cannabis) and alcohol, because when they are taken together, impairment increases.

These prevention campaigns, and the hard work and planning that goes into them, will need to happen up front — before cannabis laws change.

For more information, see Liberals warned that legal pot may mean more impaired driving.