In support of safe spaces to smoke pot
Public health beats prohibition, say Meaghan Brown and Marilou Gagnon.
Safe consumption of legal and illegal substances is of particular concern to Canada’s nurses. Nurses have been at the forefront of challenging political barriers that restricted the implementation of safer consumption spaces, including supervised injection services. As nurses, we know that the spaces in which substance use occurs and the laws that govern where individuals are permitted to use substances are relevant to the health of both people who use drugs and the broader public.
That’s why we are deeply concerned by Ottawa Public Health’s (OPH) recent position on cannabis.
In response to feedback elicited by the province, OPH submitted a number of recommendations that would impose further restrictions on smoking or vaping cannabis. In a nutshell, OPH hopes that the province will ban smoking or vaping in multiunit dwellings such as condos and apartment units, as well as on balconies. OPH would also like to see designated cannabis lounges outlawed due to public health concerns (for example, the normalization of smoking and secondhand smoke), even if the safety of these lounges would be regulated by the province.
We think OPH’s recommendations are counter to harm-reduction approaches, which are inherently pragmatic, rights-based and informed by evidence developed by research and experts with the hands-on experience. From a harm-reduction standpoint, it would be more beneficial to individual and public health if OPH provided safer options for cannabis use instead of trying to ban it altogether.
Attempting to discourage cannabis use through policies that restrict access to safer spaces may encourage individuals to use it underground and in isolation, or in potentially riskier places (such as cars). Allowing access to such spaces was clearly highlighted in the report of the 2016 Federal Task Force on Cannabis Legalization and Regulation, which considered feedback from almost 30,000 Canadians.
Furthermore, policies developed in the context of cannabis legalization should not exacerbate the social and economic harms caused by decades of criminalization — harms that have been disproportionally experienced by poor, marginalized and racialized communities.
If they were to come into effect, policies informed by OPH recommendations would put the same communities at risk of being targeted, policed and punished through a system of tickets and fines while protecting private property homeowners. In line with the Ottawa Charter for Health Promotion, OPH should support equity-oriented policies that attempt to reduce differences in health among social groups and promote equal opportunities for health. This is what public health and harm reduction aim to achieve.
Public health policies must strike a balance between public protection and respect for individual rights. Secondhand exposure to cannabis smoke is a key rationale for OPH’s concern, and while protecting the public on these grounds has merit, OPH’s proposed recommendations for cannabis smoking and vaping are more consistent with prohibition than legalization.
We need to acknowledge that although second-hand exposure to cannabis smoke may pose potential risks to public health, there are unintended consequences of overregulation. As such, each regulatory decision should be carefully considered according to public and individual safety and proportional to the potential for physical, social and economic harm.
The reality is that without any alternatives for safer use, rules will be broken. Costs for enforcement will remain, diverting from other potential public health efforts including the implementation of policies that could actually encourage public and private safer use.
At minimum, and as recommended by the federal task force, OPH could be proposing frameworks for monitoring and regulation of designated cannabis lounges and working with landlords and property owners to implement designated outdoor consumption areas.