Six months ago, doctors in Boston began noticing a concerning trend: young patients were showing up in emergency rooms with atypical symptoms and being diagnosed with heart attacks.
“The link between them was that they were heavy cannabis users,” Dr. Ahmed Mahmoud, a cardiovascular researcher and physician in Boston, told Canadian Affairs in an interview.
These frontline observations mirror emerging evidence by Canadian researchers showing heavy cannabis use is associated with significant adverse health impacts, including heart attacks, schizophrenia and dementia.
Sources warn public health measures are not keeping pace with rapid changes to cannabis products as the market is commercialized.
“The irony of this moment is that society’s risk perception of cannabis is at an all-time low, at the exact moment that the substance is probably having increasingly negative health impacts,” said Dr. Daniel Myran, a physician and Canada Research Chair at the University of Ottawa. Myran was lead researcher on three new Canadian studies on cannabis’ negative health impacts.
Legalization
Canada was the first G7 country to create a commercial cannabis market when it legalized the production and sale of cannabis in 2018.
The drug is now widely used in Canada.
In the 2024 Canadian Cannabis Survey, an annual government survey of cannabis trends, 26 per cent of respondents said they used cannabis for non-medical purposes in the past year, up from 22 per cent in 2018. Among youth, that number was 41 per cent.
Health Canada’s website warns that cannabis use can lower blood pressure and raise heart rates, which can increase the risk of a heart attack. But the warnings on cannabis product labels vary. Some mention risks of anxiety or effects on memory and concentration, but make no mention of cardiovascular risks.
The annual cannabis survey also shows a significant percentage of Canadians remain unaware of cannabis’ health risks.
In the survey, only 70 per cent of respondents said they had enough reliable information to make informed decisions about cannabis use. And 50 per cent of respondents said they had not seen any education campaigns or public health messages about cannabis.
At the same time, researchers are finding mounting evidence that cannabis use is associated with health risks.
A 2023 study by researchers at the University of Calgary, the University of Alberta and Alberta Health Services found that adults with cannabis use disorder faced a 60 per cent higher risk of experiencing adverse cardiovascular events — including heart attacks. Cannabis use disorder is marked by the inability to stop using cannabis despite negative consequences, such as work, social, legal or health issues.
Between February and April of this year, three other Canadian studies linked frequent cannabis use to elevated risks of developing schizophrenia, dementia and mortality. These studies were primarily conducted by researchers at the Ottawa Hospital Research Institute and ICES uOttawa (formerly the Institute for Clinical Evaluative Sciences).
“These results suggest that individuals who require hospital-based care for a [cannabis use disorder] may be at increased risk of premature death,” said the study linking cannabis-related hospital visits with increased mortality rates.
The three 2024 studies all examined the impacts of severe cannabis use, suggesting more moderate users may face lower risks. The researchers also cautioned that their research shows a correlation between heavy cannabis use and adverse health effects, but does not establish causality.
Budtenders
Health experts say they are troubled by the widespread perception that cannabis is entirely benign.
“It has some benefits, it has some side effects,” said Mahmoud, the Boston cardiovascular researcher. “We need to raise awareness about the side effects as well as the benefits.”
Some also expressed concern that the commercialization of cannabis products in Canada has created a race to produce products with elevated levels of THC, the main psychoactive compound that produces a “high.”
THC levels have more than doubled since legalization, yet even products with high THC levels are marketed as harmless.
“The products that are on the market are evolving in ways that are concerning,” Myran said. “Higher THC products are associated with considerably more risk.”
Myran views cannabis decriminalization as a public health success, because it keeps young people out of the criminal justice system and reduces inequities faced by Indigenous and racialized groups.
“[But] I do not think that you need to create a commercial cannabis market or industry in order to achieve those public health benefits,” he said.
Since decriminalization, the provinces have taken different approaches to regulating cannabis. But even in provinces where governments control cannabis distribution, such as New Brunswick and Nova Scotia, products with high THC levels dominate retail shelves and online storefronts.
In Myran’s view, federal and provincial governments should instead be focused on curbing harmful use patterns, rather than promoting cannabis sales.
Ian Culbert, executive director of the Canadian Public Health Association, thinks governments’ financial interest in the cannabis industry creates a conflict of interest.
“[As with] all regulated substances, governments are addicted to the revenue they create,” he said. “But they also have a responsibility to safeguard the well-being of citizens.”
Culbert believes cannabis retailers should be required to educate customers about health risks — just as bartenders are required to undergo Smart Serve training and lottery corporations are required to mitigate risks of gambling addiction.
“Give ‘budtenders’ the training around potential health risks,” he said.
“While cannabis may not be the cause of some of these negative health events … it is the intersection at which an intervention can take place through the transaction of sales. So is there something we can do there that can change the trajectory of a person’s life?”
It would be interesting to know how many illegal the product producers would be open to legitimately operating a business, if the process to achieve manufacturing certification was less restricted to what exists today. Make it easier for illegal business operations to become legal. Customers are price sensitive with this product just like food products. They will continue to move away from legal cannabis stores to illegal manufactured products and the opportunity to educate will be lost, the same way tobacco has lost the battle because illegal cigarettes are 1/3 the price of legal cigarettes. Another point would be strength regulation. To make it easier for illegal manufactures to become legal manufactures, would provide safety guidelines for product strength and quality control. This was an interesting article and I admit to very little knowledge surrounding health and cannabis use. Educating in high schools is an important place to start.