This brief provides a preliminary synthesis of Canada’s experience with cannabis legalization in the first year of retail sales. The brief focuses on evidence available to indicate progress against the public health and safety objectives of the Cannabis Act.

Canada’s relationship with legal cannabis is evolving. The market is still developing, and the pending introduction of new product formats means that Canada can expect to see considerable changes in both retail and consumer behaviour at least into the next year.

The National Cannabis Survey* indicates that Canadians’ use of cannabis has been fluctuating both before and after legalization among both youth and adult age groups. However, the changes in use have varied by reporting quarter.

More people are trying cannabis following legalization. Since legalization, those trying cannabis for the first time are more likely to be older (e.g., 45 years of age and up) compared to those trying for the first time before legalization.

More information is needed to better understand the nature of any increases in use, including whether the older population is seeking products with higher CBD due to beliefs about possible health benefits.

The National Cannabis Survey also indicated a significant decrease in Canadians accessing cannabis directly from the illegal market or from friends and family following legalization.

Revenues from cannabis sales have been significantly lower than anticipated.

The legislated three-year review of the Cannabis Act provides an opportunity for critical review of the nature and implementation of the regulations, and to make course corrections.

Looking forward, priority areas for education about lower-risk use include the difference between ingested and inhaled products, and the effects of impairment on driving and in the workplace.

The Cannabis Act permitted the sale of cannabis within a legal regulatory system as of October 17, 2018.

The federal government is responsible for issuing production, processing, import/export, testing and research licences.

The provinces and territories are responsible for retail sales and distribution. Each province and territory established a unique approach, with considerable variation among them in terms of public versus private sales, licensing, number and distribution of retail stores, oversight bodies, pricing and taxation, supply, and places of consumption, for example.

Cannabis legalisation in Canada: Year one observations

The UN Common Position on drug policy is available here.

In November 2018, the UN System CEB adopted the ‘UN system common position supporting the implementation of the international drug control policy through effective inter-agency collaboration’, expressing the shared drug policy principles of all UN organisations and committing them to speak with one voice. The CEB is the highest-level coordination forum of the UN system, convening biannual meetings of the heads of all UN agencies, programmes and related institutions, chaired by the UN SecretaryGeneral. The CEB’s mandate dates back to the early days of the formation of the UN system, when ECOSOC in 1946 requested the UN Secretary-General to establish a standing committee to coordinate the activities of the multiple specialised entities of the UN system. The resolution led to the establishment of the Administrative Committee on Coordination (ACC), the predecessor of today’s CEB.

The 2000 Millennium Summit represented the first significant streamlining of inter-agency structures, away from individual programme areas, and focusing on cross-sectoral policy objectives, such as sustainable development and gender mainstreaming. It marked ‘the beginning of a new phase, where the organizations of the system now have, in the United Nations Millennium Declaration, a single overarching policy framework, to which they are individually and collectively committed’. The CEB, the new name given to the ACC in 2001, ‘intended to reflect this new state of play and this collective commitment’: ‘The expression “Chief Executives Board” rather than Committee is meant to reflect the transition from a collection of organizations that come together to “compare notes”, to a collegial body whose participants share a collective responsibility for nurturing the new reality that the system has come to represent’.

The subsequent 2005 World Summit Outcome Document called for ‘stronger system-wide coherence’ by strengthening linkages between the normative work of the UN system and its operational activities, and invited the UN Secretary-General ‘to launch work to further strengthen the management and coordination of United Nations operational activities so that they can make an even more effective contribution to the achievement of the internationally agreed development goals, including the Millennium Development Goals’.9 In response, UN Secretary-General Kofi Annan set up the High-level Panel on UN System-wide Coherence, which published its report with recommendations in November 2006 under the title ‘Delivery as One’, focusing on the areas of development, humanitarian assistance and the environment. The work of the UN ‘is often fragmented and weak’ and, according to the Panel: ‘Inefficient and ineffective governance and unpredictable funding have contributed to policy incoherence, duplication and operational ineffectiveness across the system. Cooperation between organizations has been hindered by competition for funding, mission creep and by outdated business practices’. The Panel also called on the CEB to review its functions ‘with a view to improving its performance and accountability for system-wide coherence’, because although the CEB ‘has led to some improvement in interagency coordination […] the Board’s potential has been underexploited and its decision-making role has been underused’.

The transition from the ‘Millennium’ to the ‘Sustainable’ Development Goals in 2015 was accompanied by a policy review of operational activities for development in the UN system, because ‘the integrated nature of the 2030 Agenda for Sustainable Development requires a United Nations development system that works in a coordinated and coherent manner’. The General Assembly also requested the UN SecretaryGeneral to present proposals to improve the collective support of the UN development system for the implementation of the 2030 Agenda, including through a more robust Resident Coordinator system.

Referring to the Secretary-General’s ‘overall vision to focus on root causes and the prevention of crises and vulnerabilities across all pillars’, Deputy Secretary-General Amina Mohammed ‘emphasized that tangible results achieved on the ground benefitting the people that the United Nations system served would be the true test of the reform efforts’. She underscored that the UN system ‘would have to embrace change in order to live up to the ambition set by Member States through the 2030 Agenda and other commitments’ and that ‘a common understanding of the direction of change was emerging towards a better coordinated, integrated and coherent country presence, with real accountability for system-wide results’.

Within this broader UN reform context, and following up on the outcomes of the 2016 UNGASS, the drugs issue came to the agenda of the CEB as one of the cross-cutting issues for which a more coherent approach needed to be developed. The resulting UN System Common Position on drug policy, released in January 2019, commits to ‘supporting Member States in developing and implementing truly balanced, comprehensive, integrated, evidence-based, human rights-based, development-oriented, and sustainable responses to the world drug problem, within the framework of the 2030 Agenda for Sustainable Development’. It supports ‘policies that put people, health and human rights at the centre’ and promotes ‘measures aimed at minimizing the adverse public health consequences of drug abuse, by some referred to as harm reduction’, ‘sustainable livelihoods through adequatelysequenced, well-funded and long-term developmentoriented drug policies in rural and urban areas affected by illicit drug activities’, and ‘alternatives to conviction and punishment in appropriate cases, including the decriminalization of drug possession for personal use’. It also calls ‘for changes in laws, policies and practices that threaten the health and human rights of people’ and ‘to cooperate to ensure human rights-based drug control and address impunity for serious human rights violations in the context of drug control efforts’. The CEB members also committed to stepping up their joint efforts to ‘provide Member States with a necessary evidence base to make informed policy decisions and to better understand the risks and benefits of new approaches to drug control, including those relating to cannabis’.

The CEB Common Position – not a binding document for Member States but a powerful instrument to harmonise the voice and activities of all UN entities – represents a significant step towards improving UN system-wide coherence and can guide the global drug policy debate towards a more health, development and human rights-based approach. Crucially, to ensure that the Common Position does not simply remain a piece of paper, a UN system coordination Task Team has been established to ensure that coherent efforts are undertaken to realise its commitments, and it will serve as an authoritative policy directive to UN Resident Coordinators for implementing drug-related programmes on the ground and assisting Member States in policy development.

Achieving more system-wide coherence under the banner of ‘Delivering as One’ or ‘One UN’, and aligning with the overarching SDG framework has been a particularly difficult challenge in the area of drug policy. This briefing paper reconstructs the long and troubled process that led to the adoption of this ground-breaking UN System Common Position.

UN Common Position on drug policy - Consolidating system-wide coherence

The 2019 update to Harm Reduction International’s flagship publication, the Global State of Harm Reduction, includes updates to some of the key data in the report, including the opening of new drug consumption rooms, availability of needle and syringe programs, and references to harm reduction in national policy documents, among many other things.

The Global State of Harm Reduction is a biennial report from Harm Reduction International. First published in 2008, it involves a coordinated effort across practitioners, academics, advocates and activists to map global data and responses to drug-related harms.

It is the only report to provide an independent analysis of the state of harm reduction in the world and has become the go-to source on global harm reduction developments for researchers and advocates in our sector and beyond.

In November 2019, the Public Health and Social Policy team at Harm Reduction International worked to provide an update one year on from the publication of the Global State of Harm Reduction 2018.

Global State of Harm Reduction 2019

By the House of Commons Scottish Affairs Committee

The rise in drug deaths in Scotland has been relentless, reaching an all-time high of 1,187 deaths last year. This tragic increase over the last two decades shows that a new approach is needed to tackle problem drug use. The UK Government must declare a public health emergency and be open to taking radical steps to implement innovative evidence-based solutions if we are to stand a chance of halting Scotland’s spiralling drug crisis.

The UK Government currently treats drugs as a criminal justice matter. However, the evidence we have heard overwhelmingly shows that the current approach is counterproductive. We therefore recommend that the UK Government adopts a public health approach to drugs, and transfers lead responsibility for drugs policy from the Home Office to the Department for Health and Social Care. We also recommend, in line with this approach, that there should be full protection for people with problem drug use in key equality legislation.

There have been calls to introduce safe drug consumption facilities as part of the immediate solution to Scotland’s drug crisis. Our evidence suggests that these facilities, where people can take drugs in safe and supervised conditions, are proven to reduce overdoses, drug deaths, blood-borne virus infection rates, and public injecting, and witnesses told us that the case for such a facility in Glasgow is amongst the most compelling in Europe. We are therefore disappointed that the Home Office has blocked the proposal despite the overwhelming evidence that they work and has not made the legal changes necessary to allow such a facility to be opened. We therefore recommend that the UK Government brings forward the legislation necessary to allow for the lawful establishment of a pilot safe drug consumption facility in Scotland. If the UK Government is unwilling to do this, we argue that it should devolve the necessary powers to allow the Scottish Parliament to do so.

However, safe consumption facilities and the adoption of a public health approach will not address all the problems caused by the criminalisation of drugs. Going further would require decriminalising drugs. Drawing on international case studies and examples of localised decriminalisation schemes in the UK, we outline clear evidence that decriminalisation is a pragmatic response to problem drug use, and an effective way of reducing stigma and encouraging people into treatment. As such, we recommend that the UK Government commits to decriminalising the possession of small amounts of drugs for personal use.

Throughout our inquiry we heard that the UK Government routinely ignores the evidence on what would be the most effective approach to reducing problem drug use. We call on the UK Government to take an evidence-based approach to drugs policy and accept expert advice.

Finally, Scotland’s drug crisis is not just the responsibility of the UK Government. The Scottish Government is responsible for health delivery, and there is undoubtedly more it could do within its existing powers to address problem drug use. We believe the Scottish Government should improve its response to problem drug use in areas that are already devolved, and that funding for drug-related health services in Scotland must be protected.

Problem drug use in Scotland

The EU Drug Markets Report 2019 is the third comprehensive overview of illicit drug markets in the European Union by the EMCDDA and Europol. The analysis presented in this report spans numerous topics such as the links between drugs and other crimes, the licit economy and society more generally as well as the processes and players involved in the trade, from production and trafficking to distribution. Taking an evidence-based approach, the report reviews the markets for heroin, cocaine, cannabis, amphetamine, methamphetamine, MDMA and new psychoactive substances. It also provides action points to inform policy development at EU and national level. This publication is an essential reference for law enforcement professionals, policymakers, the academic community and indeed for anyone seeking up-to-date information and analysis on drug markets in Europe.

EU Drug Markets Report 2019

Each year, the NGO Delegation to the Programme Coordinating Board (PCB) prepares a report on an aspect of the response to HIV that merits greater prominence, stronger policy perspective and clearer agreement across the United Nations Joint Programme on HIV/AIDS (UNAIDS).

For 2019, the NGO Delegation report focuses on the essential role of people living with HIV and other key populations, women and young people in making Universal Health Coverage (UHC) truly universal as an effective and efficient strategy that benefits all in need, including those most marginalized.

UHC is a critical issue for both the global health agenda and the global HIV response. It has been the subject of discussions and debates at national, regional and international levels. In some of those multisectoral forums, civil society–– including organizations and networks by and for people living with HIV and other key populations, women and young people––have expressed their needs and concerns in relation to UHC.

The forums have included the Thematic Session on UHC at the 44th UNAIDS PCB Meeting in June 2019, the first United Nations (UN) High-Level Meeting on Universal Health Coverage in September 2019, and the associated multistakeholder hearing in April 2019. The High-Level Meeting culminated in the approval of the Political Declaration on Universal Health Coverage.

The Political Declaration on Universal Health Coverage sets out Member States’ conceptual understanding of and political commitments to UHC. The text has been criticized by some in civil society for not explicitly naming key populations who are crucial to the HIV response, such as gay men and other men who have sex with men, people who use drugs, sex workers and trans people. That omission–– especially when compared to the Declaration's naming of "all children, youth, persons with disabilities, people living with HIV, older persons, indigenous peoples, refugees and internally displaced persons and migrants"––risks rendering certain populations invisible in UHC.

Another criticism of the Declaration is that it lacks a practical performance framework that will make results transparent and measurable.
In addition, the text fails to mention key conditions for ending the AIDS epidemic, such as the decriminalization of all key populations, a matter that is critically important to both key populations and the entire HIV response.
The Political Declaration does, however, provide a starting point for:

educating communities about why UHC is important to the HIV movement; ▪ raising awareness about health as a human right; and

initiating advocacy actions to strengthen government commitments to UHC and ensure that UHC at the country-level is truly universal.

Globally, the Declaration provides a consensus tool through which stakeholders can hold governments to account and advocate for action, including for ensuring that UHC is truly universal.

The 2019 NGO Delegation Report builds on the foundations laid thus far for UHC, while looking ahead to its next phase, when the Political Declaration will be operationalized. During that phase, countries will contribute to the achievement of Sustainable Development Goal (SDG) target 3.32 and several other targets by accelerating the development and implementation of UHC plans, packages and partnerships.

To support this, the NGO Delegation report goes beyond civil society’s previous advocacy messages ("what we need from UHC") to a more forthright approach ("what we bring to UHC").

The report focuses in particular on the contributions of organizations and networks led by people living with HIV and other key populations, women and young people, which have played a unique and essential role in responses to HIV, and whose work can now be replicated, adapted and scaled-up in the context of UHC and other areas of health.

The 45th Meeting of the PCB is one of the first major international gatherings to take place since the UN High-Level Meeting on Universal Health Coverage. This report seeks to maximize this opportunity and the leadership role of the Joint Programme and Member States by:

increasing understanding, and illustrating good practices and lessons learned about the significant contributions which communities, organizations and networks of people living with HIV and other key populations, women and young people can make to UHC, based on their experiences of responding to HIV; and

reconfirming existing PCB decision points and recommending new ones, so the Joint Programme can support those contributions within the operationalization of the Political Declaration and the fulfilment of a truly universal UHC.

If it is to be truly universal - Why Universal Health Coverage will not succeed without people living with HIV and other key populations, women and young people

This report argues that power in fact rests in the hands of the people, as can be seen in countless local, national and international movements to redistribute power and bring greater attention to neglected issues.

Mass movements to redistribute power often have humble beginnings, born out of desperate need or simmering injustice—sparks of frustration that ignite infernos of change. In the early days of the HIV response, grossly insufficient leadership and medical care ignited a global civil society movement. It was the loud and persistent voice of people living with HIV and key populations at high risk of infection that accelerated the pace of research on antiretroviral medicines and drove down their prices, and it is that same determination that continues to expand the provision of affordable, life-saving treatment to millions of people around the world living with HIV.

Power to the people

By Mary Clare Kennedy, Kanna Hayashi, M-J Milloy, Evan Wood, Thomas Kerr

People who inject drugs (PWID) experience elevated rates of premature mortality. Although previous studies have demonstrated the role of supervised injection facilities (SIFs) in reducing various harms associated with injection drug use, including accidental overdose death, the possible impact of SIF use on all-cause mortality is unknown. Therefore, we examined the relationship between frequent SIF use and all-cause mortality among PWID in Vancouver, Canada.

Data were derived from 2 prospective cohort studies of PWID in Vancouver, Canada, between December 2006 and June 2017. Every 6 months, participants completed questionnaires that elicited information regarding sociodemographic characteristics, substance use patterns, social-structural exposures, and use of health services including SIFs. These data were confidentially linked to the provincial vital statistics database to ascertain mortality rates and causes of death. We used multivariable extended Cox regression analyses to estimate the independent association between frequent (i.e., at least weekly) SIF use and all-cause mortality. Of 811 participants, 278 (34.3%) were women, and the median age was 39 years (IQR 33–46) at baseline. In total, 432 (53.3%) participants reported frequent SIF use at baseline, and 379 (46.7%) did not. At baseline, frequent SIF users were on average younger than nonfrequent users, and a higher proportion of frequent SIF users than nonfrequent users were unstably housed, resided in the Downtown Eastside neighbourhood, injected in public, had a recent non-fatal overdose, used prescription opioids at least daily, injected heroin at least daily, injected cocaine at least daily, and injected crystal methamphetamine at least daily. A lower proportion of frequent SIF users than nonfrequent users were HIV positive and enrolled in addiction treatment at baseline. The median duration of follow-up among study participants was 72 months (IQR 24–123). In total, 112 participants (13.8%) died during the study period, yielding a crude mortality rate of 22.7 (95% CI 18.7–27.4) deaths per 1,000 person-years. The median years of potential life lost per death was 34 (IQR 27–42) years. In a time-updated multivariable model, frequent SIF use was inversely associated with risk of all-cause mortality after adjusting for potential confounders, including age, sex, HIV seropositivity, unstable housing, at least daily cocaine injection, public injection, incarceration, enrolment in addiction treatment, and calendar year of interview (adjusted hazard ratio 0.46, 95% CI 0.26–0.80, p = 0.006). The main study limitations are the limited generalizability of findings due to non-random sampling, the potential for reporting biases due to reliance on some self-reported information, and the possibility that residual confounding influenced findings.

We observed a high burden of premature mortality among a community-recruited cohort of PWID. Frequent SIF use was associated with a lower risk of death, independent of relevant confounders. These findings support efforts to enhance access to SIFs as a strategy to reduce mortality among PWID. Further analyses of individual-level data are needed to determine estimates of, and potential causal pathways underlying, associations between SIF use and specific causes of death.

Supervised injection facility use and all-cause mortality among people who inject drugs in Vancouver, Canada: A cohort study

From South Africa to Myanmar, from Brazil to Kyrgyzstan, women are resisting the war on drugs. Killings, criminalization, incarceration, denial of medical care, and social stigma are just a few of the effects the war on drugs has had on communities around the world. It targets particular groups, with gender-specific impacts. The war on drugs is clearly a feminist issue.

Yet the effects of repressive drug policies on women, trans and gender-diverse people are rarely discussed in feminist spaces.

Our purpose with this documentation is to share AWID’s experience of strengthening relationships and building trust between feminist movements and women who work on humane drug policy in Eastern Europe and Central Asia (EECA) region, and supporting the inspiring global movement-building process led by women who use drugs

We are keen to share this experience because it has been a valuable and deep learning process for AWID as an organization. We believe this process could be useful to groups and movements involved in other cross-movement conversations, and to strengthen relationships and build new alliances.

How feminism can be enriched by the experiences of women who use drugs

How we designed a movement-support process with women who use drugs

The key learnings we drew from this experience

It is critical for feminist movements to develop awareness of the gendered, racial and class aspects of repressive drug policies and the associated criminalization and stigmatization of people who use drugs.

Harm reduction movements intersect with movements of sex workers, people living with HIV, racial justice, and LGBTQI+ movements, among others.

We must expand what feminist logistics mean to us, and make feminist spaces more accessible, safe and welcoming for women who use drugs. This is a particularly important lesson for us in AWID, as an organization that hosts convenings.

We are honored to share our learnings and experience. It has been an incredible opportunity to build new relationships with a growing and inspiring movement led by and for women who use drugs and are affected by drug policies. We have learned a lot, and hope you will too!

Feminist movements and women resisting the war on drugs

By Julian Santaella-Tenorio, Natalie S.Levy, Luis E.Segura, Pia M.Mauro, Silvia S.Martins


Cannabis use disorder (CUD) prevalence among people reporting past-year cannabis use declined from 2002–2016. We examined whether similar reductions in CUD were observed among people reporting daily/almost daily cannabis use. We expected that CUD prevalence among people reporting daily/almost daily use would not decrease.


We used 2002–2016 National Survey on Drug Use and Health (NSDUH) data, including 22,651 individuals using cannabis 300+ days in the past year. CUD was defined using DSM-IV criteria for cannabis abuse and/or dependence. Age categories included: 12–17, 18–25, and 26 + . Annual prevalence of CUD, cannabis dependence, cannabis abuse, and each individual abuse/dependence items accounted for the complex survey design. Differences in trends over time were examined by age group.


From 2002–2016, the prevalence of CUD among people reporting daily/almost daily cannabis use decreased by 26.8% in adolescents, by 29.7% in ages 18–25, and by 37.5% in ages 26 + . Prevalence of DSM-IV cannabis dependence decreased significantly among adolescents (-43.9%) and young adults (-26.8%) but remained stable in adults 26 + . Reductions in most dependence items were observed in young adults, with less consistent patterns in adolescents and adults 26 + . Prevalence of DSM-IV cannabis abuse decreased overall and for each abuse item across all age groups.


Contrary to expectations, CUD prevalence decreased significantly across all ages reporting daily/almost daily cannabis use between 2002–2016. Cannabis dependence prevalence decreased for adolescents and young adults and was stable only among adults ages 26+ reporting daily/almost daily cannabis use. Potential drivers of this decrease should be further explored.

Click here to read the full article (restricted access).

Cannabis use disorder among people using cannabis daily/almost daily in the United States, 2002–2016

This is the second edition of our annual report on how New Zealand is dealing with alcohol and other drugs. While we are doing well in some areas, in others there is significant room for improvement.

More than 70 deaths have been linked with synthetic cannabinoids since mid-2017. The death rate has dropped in recent months, but there is no room for complacency. Synthetic cannabinoids continue to cause significant harm across the country, and dangerous new substances still regularly enter the market.

Alcohol is still the most harmful drug in New Zealand. Twenty percent of New Zealanders drink hazardously, and it’s the substance most people seek help for. Alarmingly, alcohol is more affordable now than in the 1980s. The Government must prioritise minimum prices, and phase out alcohol advertising and sponsorship.

Methamphetamine use is an ongoing issue: August 2019 saw the biggest methamphetamine seizure on record. While overall use remains low, across the total population methamphetamine causes huge amounts of harm in some communities.

Māori continue to suffer disproportionately from the harms caused by alcohol and other drugs, bearing the brunt of our criminal justice approach to drug use, with high rates of arrest and conviction.

However, there is a lot to be hopeful about.

A new amendment to the Misuse of Drugs Act, passed in August, means Police may only prosecute for possession and use of drugs if it is ‘required in the public interest’. They must determine whether a health-centred or therapeutic approach would be more beneficial to the public interest than a prosecution. How this will affect prosecution rates remains to be seen, but we’re hopeful low-level drug offences will decrease, or be eliminated altogether.

We’d like to see a massive overhaul of our outdated drug laws. Next year’s cannabis referendum is a great opportunity: people are still being arrested and convicted for cannabis. In the past decade 45,665 people were convicted of a cannabis offence, and 6,583 of those were sent to prison. We look forward to moving towards health-focused legal regulation.

State of the Nation 2019: A stocktake of how New Zealand is dealing with the issue of drugs

The recent deaths of 6 young people at music festivals in Australia connected to MDMA has led to local calls for the introduction of drug checking services (sometimes called ‘pill testing’ in Australia and drug safety testing in the UK) to assist people who use drugs to make safer decisions about the drugs they intend to consume.

Drug checking services both vary in the primary purpose of the testing; who conducts the analyses and how; the range of quantitative or qualitative analytical methods used; who disseminates test results and how; where testing is located; whether test results go directly to consumers or via an intermediary; and the level of engagement with other stakeholder.

Evidence supports on-site rapid ‘real time’ testing where drugs are also sourced on-site, mostly directly from people who use, and information is provided direct-to-consumers and emergency services onsite, as well as via broadcast alerts to attendees through social media and other channels.

There is also evidence supporting approaches where drugs are primarily sourced from drop off sites and medical incidents, with results provided via stakeholder meetings, alerts broadcast through social media and other channels.

Although evidence is still emerging, there is research showing that drug checking alters behaviour of people who use drugs. They are more likely to consume less when the drug profile differs from expectations. Drug-checking services also alter drug markets in positive ways and provide valuable information to front-line emergency services.

Further research is required to determine the effectiveness of drug checking to reduce hospitalisations and fatalities as a result of drug taking, but the limited research available is promising.

Publications