Benedikt Fischer and colleagues described changes in cannabis consumption and harms among adolescents following non-medical cannabis legalization in Canada.1 They fittingly recommended measures to reduce the persistently elevated and high-risk cannabis use.1
We want to emphasize that measures addressing high-risk cannabis use should be prioritized. Pertinently, comparative risk assessments have underscored that the cannabis-attributable burden of disease primarily stems from high-risk cannabis use in the form of cannabis use disorder.2
Lending additional support to our viewpoint are latest observations of students from the Ontario Student Drug Use and Health Survey. Our prior assessment indicated an increased likelihood of cannabis use (past month), daily cannabis use (past month), and cannabis dependence (past three months) following non-medical cannabis legalization based on surveys conducted between 2001 and 2019.3
The most recent iteration of the survey, conducted five years after non-medical cannabis legalization, suggests that the increased likelihood in the abovementioned patterns of consumption may have subsided in some and persisted in others. Indeed, cannabis use (14% vs. 11%; p < 0.01) decreased while daily cannabis use (2% vs. 2%) and cannabis dependence (3% vs. 4%) remained stable between 2019 and 2023.4 The initial spike observed in cannabis use may reflect experimentation, given the increased novelty and availability of cannabis products. However, the sustained daily cannabis use and cannabis dependence warrant additional measures. These entail a scale up of evidence-based interventions to facilitate access to treatment, and identification and application of policy levers to shift the distribution of consumption towards less harmful levels.
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