Andrew D. Hathaway

INJURY RISK ASSOCIATED WITH CANNABIS AND COCAINE USE

The purpose of this paper is to review the results and limitations of studies of injury risks associated with cannabis and cocaine use. Three types of fatal and non-fatal injuries are considered: injuries due to collisions, intentional injuries and injuries in general. Four types of studies were reviewed: (I) laboratory studies, (II) descriptive and analytic epidemiological studies on the prevalence of cannabis or cocaine use through drug testing of those injured, (III) studies of non-clinical samples, and (IV) studies of clinical samples of drug users. The research that utilized drug tests showed similar proportions testing positive for cannabis in fatal and non-fatal injury groups, and for collisions, violence and injuries in general. By contrast, large differences in the average proportions testing positive for cocaine were found among these same injury groups. For example, 28.7% of people with intentional injuries (primarily homicides) tested positive for cocaine, while 4.5% of injured drivers tested positive. Studies of non-clinical samples have shown that both cannabis and cocaine use are related to intentional injuries and injuries in general. Results indicate higher risk for all types of injuries among cannabis and cocaine clients in treatment. Strengths and limitations of the different types of studies are discussed. More rigorous studies are needed which should focus on ruling out alternative explanations for relationships between drug use and injuries.

Cannabis normalization and stigma: Contemporary practices of moral regulation

Cannabis (marijuana) has undergone a normalizing process as indicated by high use rates, social tolerance, and broader cultural acceptance of its use in many countries. Yet, consistent with its status as a banned drug, users still face the threat of legal sanctions and experiences of stigma that challenge the assumptions of the normalization thesis. In this paper we shed light on extra-legal forms of stigma based on in-depth interviews with marijuana users (N = 92) randomly recruited in the city of Toronto. Notwithstanding indications of a normalizing process in respondents’ understanding and experience of use, mainstream conventional perspectives about cannabis as risky, even marginal or deviant, were prominent as well. The findings are interpreted with reference to Goffman’s (1963) theoretical distinction between normalization and the more apt description of normification reflected in the attitudes of marijuana users. Consistent with the latter term, these data indicate that stigma is internalized by users which results in the active reinforcement and performance of established cultural requirements emphasizing self-control.

A Canadian perspective on cannabis normalization among adults

Once associated with ‘deviant’ subcultures, the use of cannabis is now common across Canadian society. This has led some to argue that cannabis use is becoming normalized in Canada with important implications for drug policy, law enforcement and public health. This article takes up these issues, reporting the results of a qualitative study involving 165, socially integrated, adult cannabis users in four Canadian cities (Vancouver, Montreal, Toronto and Halifax). The aims of this study were twofold; first, we sought to contribute to recent efforts to extend the analysis of normalization and its associated features from adolescent and young adult populations to older adults, with a particular focus on cannabis. Second, we wished to respond to recent calls for greater analysis of both the social and structural determinants of normalization, as well as its contingent, ‘micro-level’ features. Our examination of these diverse dimensions revealed significant changes in the meaning and status of cannabis use in Canada. Although some social and personal stigmas remain, our research suggests they are largely confined to the immoderate, ‘irresponsible’ use of cannabis, while more ‘controlled’ use among adults appears all but de-stigmatized. This process has involved changes in the ways risks associated with cannabis use are characterized and managed; shifts in the ways adult cannabis users seek to moderate their use; as well as broader social and cultural shifts in the meanings associated with cannabis in Canada. We conclude with a discussion of the potential impacts of these developments for drug policy debates in Canada and elsewhere.

Drug Reform Principles and Policy Debates: Harm Reduction Prospects for Cannabis in Canada

Contrasting the official harm reduction aims of Canadas 10-year national drug strategy with the actual evolution of the Controlled Drugs and Substances Act, the authors find little evidence of harm reduction, and much of sustained and punitive prohibition. The example of the criminal sanctions currently being applied to cannabis possession offences serves to illustrate the limits of what can be achieved in reducing the impact of criminalization when the fundamental ban on personal use and access is retained. Theoretically informed by constructionist analyses of the styles and strategies of social problems discourse, a moral basis of drug use entitlement is expounded from which rational reform might be more fruitfully argued. Despite its official mandate in Canada to develop more pragmatic drug policy alternatives, the harm reduction movement, posing public health solutions based on empirical analysis, is nonetheless needful of a rhetorical foundation by which to denounce prohibition as a morally objectionable intervention in the private lives of individuals.

Driving Behavior Under the Influence of Cannabis or Cocaine

Objective. The purpose of this study is first to describe perceptions of driving under the influence of cannabis or cocaine among clients in treatment and, second, to assess whether these perceptions are related to the frequency of driving under the influence of cannabis or cocaine. Methods. A questionnaire was administered to clients in treatment for abuse of either cocaine or cannabis, many of whom also had a problem with alcohol; additional groups of clients consisted of those in smoking cessation and gambling programs (N = 1021). Open-ended and close-ended questions were used to assess self-reported effects of cannabis or cocaine on driving and frequency of driving under the influence of cannabis, cocaine, or alcohol. Results. Two dimensions of driving behavior under the influence of cocaine or cannabis were found in both qualitative and quantitative analyses: 1) physical effects and 2) reckless styles of driving. Common physical effects for both drugs were heightened nervousness, greater alertness, and poorer concentration. In terms of driving behavior, cautious or normal driving was commonly reported for cannabis, whereas reckless or reduced driving ability was frequently reported for cocaine. When comparing negative physical effects and reckless style of driving with frequency of driving under the influence of cannabis or cocaine, increased negative physical effects from cannabis were inversely related to frequency of driving under the influence of cannabis (p = .001), but other relationships were not significant. Conclusions. The findings indicate that both cannabis and cocaine have detrimental but different effects on driving. The negative physical effects of cannabis may reduce the likelihood of driving under the influence of cannabis.

Identity Formation, Marijuana and “The Self”: A Study of Cannabis Normalization among University Students

Over the past half-century, as use of marijuana has become more widespread in Canadian society, there are indications of a normalizing process in societal reactions and experiences of use. Among other research avenues, these trends suggest a need for further exploration of young people’s understandings of how they make the choice to use or not and how decisions relate to presentation of the self. This study draws on interviews with 30 undergraduates recruited from a larger online survey of respondents at the University of Guelph, ON, Canada. In probing their perceptions of the use of marijuana, we often found that trying/using “pot” was the default option, whereas choosing not to use required more conscious effort. With specific reference to Goffman’s contribution to a situated understanding of the self, our findings are interpreted with emphasis on further theoretical development of the normalization thesis and on the role of marijuana in identity formation among persons in the process of transition to adulthood.

Marijuana medicine and Canadian physicians: Challenges to meaningful drug policy reform

There are modest indications of movement in the glacial reform of Canada’s marijuana prohibition. A sign of formal progress is the legal exemption for seriously ill medical users under Health Canada’s evolving Marihuana Medical Access Regulations (MMAR). Several hundred patients have now been approved through an application process that requires support from a medical practitioner or specialist. Physicians are constrained from complying with the MMAR by the highly conservative stance of the Canadian Medical Association (CMA), while the Canadian Medical Protective Association – the body that acts as legal advocates for doctors – maintains a view toward marijuana that, applied to any other drug, would make prescribing even the most routine therapies difficult. On the other hand, it is not clear that physicians really take much interest in their patients’ marijuana use. This article examines the conflict between patients who choose to self‐medicate with marijuana and the community that governs physicians in Canada. It draws on findings from two studies that, respectively, explore doctors’ views on marijuana and the experiences of patients who self‐medicate with cannabis. The inherent conservatism of the medical community – reinforced by lack of interest in how such use might benefit some patients – militates against more learning or widespread acceptance of the use of cannabis as medicine. Nonetheless, the authors argue, doctors ought not to perpetuate the ignoble tradition of ‘Don’t ask – Don’t tell’.

Medical Marijuana, Community Building, and Canada’s Compassionate Societies 1

Marijuana’s use as medicine is now legal in Canada for patients who meet strict compassionate use guidelines. Most who self‐medicate, however, still do so on their own terms, without government approval or the guidance of physicians. In this unregulated climate, “compassion clubs” outside the law play a vital role in the provision of safe access and therapeutic knowledge about medical marijuana. Operating on the margins of society, these outlets fulfill another purpose in creating a community among persons who are often highly marginalized themselves. Club membership provides a group identity, empowerment, and restorative supports over and above the marijuana use itself. The authors examine the role of compassion clubs in the lives of patients who choose to self‐manage their pain and suffering by using marijuana. This supportive function of the clubs will be contrasted with the overly restrictive, formal system of supply under Canada’s evolving Marihuana Medical Access Regulations (MMAR).

A nuanced view of normalisation: Attitudes of cannabis non-users in a study of undergraduate students at three Canadian universities

Abstract Aims: To critically investigate the extent of normalisation of the use of cannabis by undergraduate students. To examine the extent of peer accommodation, this paper focuses on attitudes of students who abstain. It sheds light on social meanings of the practice by exploring non-users’ reasons for abstaining in addition to their attitudes, perceptions and experiences of use among their peers. Methods: Respondents were recruited to participate in interviews through an online survey of undergraduate students in social science classes at three Canadian universities. Findings: Peer accommodation of the use of cannabis requires that users exercise due caution and discretion and be respectful of the choices of non-users not to use. Non-users’ attitudes, however, still reflect longstanding cultural assumptions about drug use as a deviant behaviour. Attitudes towards the use of cannabis reflect norms and expectations about gender among other culturally constructed social statuses and roles. Conclusions: Future research should continue to investigate nuances of the differentiated normalisation process. A better understanding of the cultural transformation of cannabis, and other drugs in common use by youth, requires more exploration of the emerging social context and attitudes of users and non-users of the drug.

Profiling Violent Incidents in a Drug Treatment Sample: A Tripartite Model Approach

This research focuses on the qualitatively descriptive accounts of drug-related violent incidents drawn from a treatment sample of 571 substance abuse clients in Ontario. Nearly half (n = 269) had experienced at least one violent incident in the past year, and 91% had used one or more substances prior to the most recent episode. The classification of the explicitly drug-related violent events (n = 176), based on Goldsteins tripartite model, is its first application in an adult drug treatment sample. Although respondents were not criminal offenders, and interpersonal violence related to psychopharmacological effects predominated, economic or systemic linkages related to drug scarcity and the drug market were implicated in one fifth of all occurrences. Alcohol and cocaine were the substances most implicated in all three aspects of the model. Since a drug treatment sample is a high-risk group for violence, interventions that raise awareness of potential for violence linked to not only intoxication but also scarcity conflicts and illicit drug market involvement are warranted. Since most violence occurs in the community, such initiatives may benefit those in treatment and serve as an important public health strategy.