Why Canada’s new Low-Risk Drinking Guidelines should matter to cannabis users
May 24, 2023 By Denis Gertler
On January 17, Canada’s Guidance on Alcohol and Health’s Final Report was released following two years of research. The Health Canada funded report is based on the analysis of 6,000 peer-reviewed studies and replaces the 2011 Low-Risk Alcohol Drinking Guideline.
The previous guidelines identified 15 drinks per week for men and 10 drinks per week for women as low risk. The new guidance recommends no more than one-to-two drinks a week and says that as few as seven drinks per week brings elevated risk of stroke, heart disease and several cancers. The Canadian Centre on Substance Use and Addiction (CCSA), the organization which conducted the research, insists it’s not trying to promote abstinence but provide Canadians “…with the information they need to make well-informed and responsible decisions about their alcohol consumption.”
The guidelines have certainly sparked a debate, much of it unfavourable to the research conducted and the conclusions drawn from it. Pundits and academics alike have pointed out that of those thousands of research papers considered, only 16 were selected for modeling purposes.
The CCSA admits that its evidence base is weak – “the overall quality score of most of the retained reviews was low” – but decided to gut the previous guidelines anyway. Writing in the National Post, Sabrina Maddeaux noted that of the 25 papers on risks related to pregnancy or breastfeeding (one of three areas targeted for analysis), none qualified for risk assessment.
Dan Malleck, Professor of Health Sciences at Brock University, has questioned the CCSA’s exclusive focus on harms without including the benefits of low-to-moderate drinking found by other studies. Malleck also maintains that singling out impacts of alcohol consumption alone disregards contributing lifestyle behaviours, such as drinking in bars filled with tobacco smoke, exposure to toxic chemicals and other relevant factors. Former federal Opposition Leader Tom Mulcair waded in with his opinion column in Journal de Montréal, relaying allegations of CCSA bias by eminent alcohol researchers, cardiologist Dr. Martin Juneau and Dr. R. Curtis Ellison, professor of medicine at Boston University and chairman of the International Scientific Research Forum on Alcohol Research. According to CCSA’s critics, the influence of Tim Stockwell, neo temperance advocate, has been detected in a further effort to disprove “J Curve” effects, which show that mortality risk decreases with moderate consumption before rising with heavy drinking.
Like the University of Ottawa cannabis study I discussed in my last column, the CCSA’s new guidance document trumpets its advice as though it was based on conclusive evidence in a bid to shift public behaviour without drawing attention to the shortcomings of its research. As Maddeaux notes, CCSA acknowledges the limitations of its evidence in the final report, but “…somehow, they weren’t highlighted in media interviews or the summary with colourful graphics most people will see.”
How does this relate to cannabis?
What do the new Low-Risk Guidelines have to do with cannabis, you may ask? Although known mainly for its drinking guidelines, the CCSA’s mandate covers more than alcohol. It addresses a range of substances and behaviours including opioids, cocaine, gambling, methamphetamine, prescription drugs, and cannabis.
A look at CCSA’s website reveals that one-third of its staff offered for interviews, speaking engagements and research projects are identified as cannabis experts. The body has a privileged, long-standing relationship with Canada’s federal cannabis regulator. It’s not a stretch to imagine the organization pitching Health Canada on a similar guidance document to address the harms of cannabis use. I think it’s fair to say that human health has not typically topped the industry’s agenda, except, perhaps with respect to clamping down on contaminated products in the illegal market. Dealings with the Industry Expert Panel currently reporting to the federal ministers of Health, and Mental Health & Addictions further illustrate this point.
Much has been made of the lack of business representation on the panel: and clearly, we need a business champion inside government. But apart from looking at the progress of legalization in deterring criminal activity and displacing illicit use, the Panel was not asked to address industry competitiveness. Its mandate and recommendations will instead consider the impacts of cannabis on marginalized and racialized communities, medical patients, indigenous peoples, youth, and the public at large. Economic concerns are only mentioned within the context of social and environmental impacts, and workplace equity for women and racialized groups.
It is an axiom of change management practitioners that those seeking change should start where the system is, not where they think it should be. And where the system is, broadly speaking, is its concern with Canadians’ health. This is where advocacy should also be focused, to position cannabis as good for Canadians’ overall well-being, and where the news is mixed, to promote balanced advice on managing the risks.
We can start by learning the lamentable lessons of Canada’s Low-Risk Alcohol Drinking Guidelines, by pressing for a credible research agenda and the funding to support it.
Denis Gertler is a regulatory consultant, board member, and former government regulator.
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