This October marks two years since Canada became only the second country to legalize recreational cannabis. Although investors, patients and supporters celebrated this move, few questioned the industry structure or steps needed to deal with the most fervent users. This industry is in danger of steadily devolving into a monopoly dependent on a small addictive user base – unless we make changes now.
To understand how cannabis commodification will evolve in decades, we should look at the structure of similar industries – tobacco and alcohol. Massive seed production needs scale for efficiency. Distribution and marketing are ripe for takeovers by alcohol and tobacco firms that already have the capabilities. Firms will merge to maximize market share and streamline complex supply chains. The industry is bound to concentrate into a handful of powerful companies, abetted by scientists and former policymakers lobbying on its behalf for their respective self-interests.
But what’s scarier is the inequality of consumption. In America, 60 per cent of consumers imbibe less than two drinks per month. But the top 10 per cent consumes 73.85 ounces of alcohol per week – the equivalent to two bottles of wine per day. This addiction saddles we the taxpayers with the (healthcare) bills. A similar phenomenon may exist in cannabis. While detractors will immediately point out the relative safety and less addictive nature of cannabis, prolonged THC use is invariably associated with psychosis, a condition that itself has two to three times the mortality rate and overwhelmingly affects those with low incomes and other comorbidities. While use will likely plateau, cannabis itself is more THC-concentrated than decades ago (a trend that will likely continue) and accessible than ever (just look at the plethora of online delivery services).
There are three strategic priorities we as physicians should advocate for to deal with industrial concentration and potential abuse.
First, set clear limits on stakeholders. From seed to sale, public sector regulation and direct control is crucial to prevent excessive consolidation. This ncludes licenses on the quantity grown per grower, preventing marketing to children and mandating conflicts of interest disclosures from medicinal clinics.
Second, democratize research. I am stunned that we have not discussed more broadly how drug research is structured. Why not address our outdated, costly patent system through a prize system for researchers? Why not take steps to ensure public research can compete with private sector research or at least be able to sell its findings to private firms at fair market prices? Most importantly, how can we make the evidence accessible and interpretable to the public? Democratizing information is the cornerstone of an informed consumer base and fair market.
Third, prevent rampant neoliberalism. Yes, this is a biased political opinion but I feel it must be said: the last 40 years of economic liberalisation and inequality have wreaked havoc on our collective health and left many vulnerable to drug addiction. If we are to limit a future cannabis epidemic, we tax the industry stringently and balance shareholder profits against national interests (employment and health), and protect safety nets for vulnerable patient groups.
As physicians, we are trained to ascertain the aetiology of disease. Concentrations of industrial power and consumer use sow the seeds of a future epidemic. Now is the time to begin flattening that proverbial curve.