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accommodate in terms of therapeutic use and disability due to substance dependence. Background The World Health Organization (2016) states “Cannabis is globally the most commonly used psychoactive substance under international control. In 2013, an estimated 181.8 million people aged 15-64 years used cannabis for nonmedical purposes globally.” The Government of Canada (2015) states that a UNICEF report published in 2013 ranked Canada highest amongst all nations in terms of rates of cannabis use among youth. The Centre for Addiction and Mental Health (2014) states: “Canada has one of the highest rates of cannabis use in the world. More than 40% of Canadians have used cannabis in their lifetime and about 10% have used it in the past year. No other illegal drug is used by more than 1% of Canadians every year.” The Canadian Tobacco, Alcohol and Drugs Survey from 2015 (as published in 2017) reports similar statistics that over 44% have used cannabis in their lifetime, and over 12% have used it in the past year. Experiences of Other Jurisdictions that have Decriminalized or Legalized Cannabis Within a legal context, “decriminalization” means that it is illegal to use or possess cannabis, for example, but some criminal charges are replaced by fines or other penalties (e.g., a person may be fined for having a small quantity on their person versus being jailed). Legalization of a substance is different. “Legalization” includes allowing certain amounts to be held and grown by a person, and includes the government’s ability to licence, regulate, and tax both the products and sale locations. While approximately 20 countries have decriminalized cannabis, the jurisdictions that have formally legalized cannabis for recreational purposes are the country of Uruguay, and within the United States of America, the jurisdictions of Colorado, Alaska, Oregon, Washington, Maine, Nevada, Massachusetts, Vermont, California, and the District of Columbia (as of July 2018). In Canada, the impact on the workplace of legal use of recreational cannabis is unknown. Legalization will not necessarily change existing workplace policies, but it is generally felt that, at least initially, more people may use cannabis in a regulated market for adult use. 4 Canadian Centre for Occupational Health and Safety HEALTH EFFECTS FROM CANNABIS Composition of Cannabis Cannabis contains hundreds of chemical substances, among which over 100 are known cannabinoids. Cannabinoids are a class of chemical compounds that act on receptors in cells in the brain and body. Delta-9-tetrahydrocannabinol (THC) is the most studied component of cannabis and is the chemical responsible for the psychoactive effect or “high”. Another key component, cannabidiol (CBD) may be useful in treating treatment-resistant epilepsy in children and adults. CBD does not produce a high. Some low THC strains have been used in patients with chronic pain who do not want the psychoactive effect (Goldsmith et al., 2015). Cannabis is most often inhaled as smoke as a dried herbal product, either alone or as a concentrate mixed with tobacco, but it can also be vaporized. The flower of the cannabis plant can be made into a variety of products, including: • dried herbal material (i.e., “marijuana”), • oil (e.g., “hash oil”), • hash (i.e., compressed resin), • concentrates (e.g., “shatter”), or • foods and beverages containing extracts of cannabis (Government of Canada, 2015). Cannabis can also be ingested by pill form or in food, or absorbed through the skin via creams, salves, or skin patches. Impairment Effects on the Body When inhaling cannabis, the chemicals in the smoke pass from the lungs into the blood, which carries the chemicals throughout the body and to the brain. The effects of cannabis are delayed if it is ingested instead of smoked, because the chemicals must first pass through the digestive system. Users have varying sensitivity to the effects of THC. Regardless of method of consumption, the effects are the same. According to Health Canada (2016a), effects may include: • dizziness, drowsiness, feeling faint or lightheaded, fatigue, headache • impaired memory and disturbances in attention, concentration and ability to think and make decisions •
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