Municipal Resources

The recently announced changes to alcohol regulations by the provincial government will lead to increased availability of alcohol within our communities. The purpose of this document is to highlight the changes to alcohol regulations, and explore opportunities for municipalities to address alcohol consumption and its associated harms at the local level.

1. Retail Expansion of Alcohol Sales

The government is planning to expand the retail availability of alcohol, specifically with sales in convenience and big box stores.

Why Does This Matter?

Extensive research reveals that expansion in the availability of alcohol increases alcohol use and its related harms such as public disturbances, alcohol-related crashes, violence and injuries, alcohol abuse and chronic diseases.

What Can Municipalities Do?

It is important to regulate the availability of alcohol through density and location restrictions. This can be achieved by:

• Introducing site-specific zoning to control locations of liquor sales licensed establishments. This can include minimum distance requirements between establishments and other locations of concern (e.g. schools, community centers).
• Creating policy restrictions that establish limits for the number of liquor sales licensed establishments by neighbourhood.

It is also important to control access to alcohol through licensing and enforcement of private businesses. This can be achieved by:

• Working with enforcement authorities during a liquor license application process. Ensure a formal review process has been undertaken on the basis of protecting public interests and minimizing nuisances.
• Requiring a fee for liquor license applications and implementing mandatory training for liquor sales licensed establishments.
• Investigating public concerns, such as nuisances and property standard violations, in areas with a high number of liquor sales licensed establishments.

2. Designated Public Spaces for Alcohol Consumption

With the recent changes to regulations, municipalities are allowed to create or amend by-laws to designate public areas for the consumption of alcohol.

Why Does This Matter?

Permitting alcohol consumption in public areas will further normalize alcohol use among children and youth and may hinder the public’s enjoyment of these areas. It can also significantly increase the risk of serious injury and death, particularly at beaches, waterways or remote / inaccessible trails.

What Can Municipalities Do?

If a municipality decides to designate a public space for alcohol consumption, controlling access to alcohol is an important tool to protect the health and safety of patrons and the public, and to manage risk and liability to the municipality. This can be achieved by:

• Fencing off the alcohol consumption area to control patron access.
• Requiring sales by SmartServe trained personnel, if applicable.
• Not designating beaches, waterways (e.g. lakes, rivers) or remote / inaccessible trails as the consumption area.

It is also important to control access to alcohol through the enforcement of designated alcohol consumption areas. This can be achieved by:

• Investigating public concerns, such as nuisances and property standard violations, in designated alcohol consumption areas.

3. Tailgate Event Permit Application

A tailgating permit has been created for sporting events, including professional, semi-professional and postsecondary sporting events. The Alcohol & Gaming Commission of Ontario’s new guidelines for tailgate events allow patrons to bring and consume their own alcohol to the event.

Why Does This Matter?

A tailgating event, with its open and free-roaming environment, has the strong potential to normalize harmful alcohol use behaviour, especially amongst postsecondary students.

What Can Municipalities Do?

It is important to establish requirements for the Tailgate Event Permit with the purpose of protecting the health and safety of patrons and the public. This can be achieved by:

• Fencing off the alcohol consumption area to control patron access.
• Requiring sales by SmartServe trained personnel, if applicable.

It is also important to control access to alcohol through enforcement. This can be achieved by:

• Working with enforcement authorities during a Tailgate Event Permit application process. Ensure a formal review process has been undertaken on the basis of protecting public interests and minimizing nuisances.
• Investigating public concerns, such as nuisances and property standard violations, in common tailgating areas.

How Can the Health Unit Support You?

The Health Unit can help your municipality to develop, update or review new or existing alcohol policies or by-laws. The Health Unit can also provide your municipality with resources to support the implementation of alcohol policies or by-laws, including signage, public education and evaluation support.

Alcohol is no ordinary commodity. It has substantial health and social costs within our communities, and its consumption is associated with public disturbances and social disruption, violence and injuries, chronic disease, addiction and poor mental health. The recently-announced changes to alcohol regulations by the provincial government will lead to increased availability of alcohol within our communities. These changes include, but are not limited to, expanding alcohol sales to convenience stores, designating public spaces for alcohol consumption, and permitting tailgating at sporting events. The purpose of this report is to highlight the health and social costs of alcohol in Nipissing and Parry Sound District, and explore how the changes in legislation may further impact alcohol-related harms in our communities.

Fact #1:

Between 2011 and 2015, 89 deaths were attributable to alcohol locally.

Why does this matter?

The designation of public areas for the consumption of alcohol will significantly increase the risk of serious injury and death, particularly at beaches or waterways (e.g., lakes, rivers) or remote or inaccessible trails.¹ This would consequently increase liability for municipalities.

Fact #2:

Since 1997, the number of impaired driving incidents investigated by local police have decreased. Last year there were 187 investigations.

Why does this matter?

Liberalization of alcohol controls has been shown to increase alcohol-related traffic accidents.² Additionally, public safety concerns and law enforcement costs may result from the Ontario Government’s proposed tailgating permit. Tailgating events and the designation of public areas for alcohol consumption can increase the use of municipal resources such as police and paramedic services.³

Fact #3:

Since 2002, the number of Emergency Department (ED) visits attributed to alcohol has doubled locally. In 2017, nearly 1,000 ED visits were attributed to alcohol.

Fact #4:

Between 2013 and 2017, 1,522 hospitalizations were attributable to alcohol. Those hospitalizations are classified by most responsible cause below.

Why does this matter?

Alcohol consumption results in an estimated $1.7 billion dollars in direct health care costs and $3.6 billion in indirect costs annually in Ontario.⁴ An increase in either hours of sale or number of alcohol outlets has resulted in an increase in alcohol related disease and injuries, ED visits, and hospitalizations.⁵

Fact #5:

High risk alcohol use can be found across many age groups locally

• Nearly one in three local high school students have a potential alcohol use problem⁶
• Half of all people aged 19 to 24 report binge drinking⁷ at least once per month in the last year
• One in four people aged 45 to 64 years old report binge drinking⁷ at least once per month in the last year

Why does this matter?

The Ontario government is proposing to allow municipalities to designate public areas for the consumption of alcohol. Permitting alcohol consumption in public areas will further normalize alcohol use among children and youth and may hinder the public’s enjoyment of these areas.⁸ The Ontario government is also proposing to expand the retail availability of alcohol to convenience and big box stores. Expansion in the availability of alcohol increases alcohol use and related harms such as alcohol abuse, liver cirrhosis, violence and injuries, alcohol-related crashes, cancers, suicides, and public disturbances.^5,9,10,11 This trend was found in both Alberta and British Columbia following liquor sale expansion.

References

1. Driscoll, T.R., Harrison, J.A., & Steenkamp, M. (2004). Review of the role of alcohol in drowning associated with recreational aquatic activity. Injury Prevention, 10, 107-113.

2. Popova, S., Giesbrecht, N., Bekmuradov, D., & Patra, J. (2009). Hours and days of sale and density of alcohol outlets: Impacts on alcohol consumption and damage: A systematic review. Alcohol and Alcoholism, 44(5), 500-516.

3. Erickson, P. (2010). The dangers of alcohol deregulation: The United Kingdom experience. Public Action Management: Centre for Alcohol Policy.

4. Rehm, J., Patra, J., Gnam, W. H., Sarnocinska-Hart, A., & Popova, S. (2011). Avoidable cost of alcohol abuse in Canada. European Addiction Research, 17(2), 72–9.

5. Myran, D. T., Chen, J. T., Giesbrecht, N., & Rees, V.W. (2019). The association between alcohol access and alcohol‐attributable emergency department visits in Ontario, Canada. Addiction. doi: 10.1111/add.14597.

6. Alcohol use problems are defined using the Alcohol Use Disorder Identification Test.

7. Binge drinking is defined as having five or more drinks on one occasion.

8. Xuan et al. (2015). Youth drinking in the United States: Relationships with alcohol policies and adult drinking. Pediatrics, 136(1), 18-27.

9. Zalcman, R.F., & Mann, R.E. (2007). The Effects of Privatization of Alcohol Sales in Alberta on Suicide Mortality Rates. Contemporary Drug Problems, 34(3), 589-609

10. Stockwell, T., Zhao, J., Macdonald, S., Vallance, K., Gruenewald, P., Ponicki, W., Holder, H., & Treno, A. (2011). Impact on alcohol-related mortality of a rapid rise in the density of private liquor outlets in British Columbia: a local area multi-level analysis. Addiction, 106(4), 768-76

11. Wilkinson, C. & Livingston, M. (2012). Distances to on- and off-premise alcohol outlets and experiences of alcohol-related amenity problems. Drug and Alcohol Review, 31(4), 394-401.

As a municipality please feel free to save these images to be used for social media posts to inform the public about alcohol by-laws in your community. If you wish to reproduce with your community's logo please email communications@healthunit.ca.

Learn about retail expansion of alcohol sales in your area.

Not all communities have a designated public space for alcohol consumption.

Not every event is a tailgate sanctioned event.

The primary goal of the SFOA 2017 is to protect Ontarians from physical and social exposure to secondhand smoke and vapour. It bans smoking and vaping indoors and in many outdoor public spaces such as sporting areas, children’s playgrounds, school property and restaurant and bar patios. A number of outdoor settings are not currently covered by provincial regulation such as:

• Beaches
• Walking Trails
• Outdoor Festivals
• Municipal Property

The legalization and subsequent inclusion of cannabis and e-cigarettes/vaping under the SFOA 2017 presents an opportunity for municipalities to open and expand your No Smoking bylaws to also include cannabis and vaping. It is also an ideal time to include more of the outdoor spaces where your residents and visitors gather, play and work under the bylaw.

Commercial and Sacred Tobacco: What is the difference?

Commercial tobacco refers to tobacco that is commercially produced for use in cigarettes, smokeless tobacco, pipe tobacco, cigars, hookah, and other products.¹ Commercial tobacco is different from traditional/sacred tobacco that is used and kept sacred by indigenous communities.¹ For the purpose of this resource, all references to tobacco, apply to commercial tobacco only, as traditional or sacred tobacco is typically exempted from smoke/tobacco-free policies.

Why Implement Enhanced Smoke and Vapour Legislation?

Municipalities can positively impact the health of your communities by adopting or expanding a smoke and vapour-free bylaw. Reasons to do so include the following:

Role Modeling:

When people are exposed to others using tobacco or vape products, it creates the impression that the use of these products is common and socially acceptable.² Evidence shows that enhanced smoke and vapour-free policies:

• Support quit attempts by reducing visual cues for smoking and vaping;
• Change perceived norms on smoking and vaping behaviour;
• Reduce demand for smoke and vape products; ² and
• Decrease youth and young adult initiation.

Environmental Threats

Smoking in outdoor areas can contribute to increased litter, pollution, and risk of fire caused by improperly discarded or extinguished cigarette butts, especially in parks and beaches. Cigarette butts are the most littered item and are not biodegradable.³ They remain an ongoing threat to children, wildlife and the environment. Prohibiting smoking and vaping in more outdoor locations will reduce litter; reduce municipal cleanup costs; and free-up taxpayers’ money for more worthwhile initiatives. ⁴

Health Impacts

Smoke and vapour-free outdoor spaces legislation decreases exposure to secondhand smoke. Despite common perceptions that tobacco smoke dissipates outdoors, research has demonstrated that levels of secondhand smoke in outdoor settings can be comparable to indoor levels .⁵ Evidence concludes that even brief exposure to tobacco smoke may cause significant adverse health effects to non-smokers. ⁵

Evidence shows that enhanced smoke and vapour-free legislation:

• Directly contributes to creating a smoke /vapour-free culture
• Reduces the initiation of smoking and vaping among youth
• Reduces the prevalence of tobacco use
• Protects the environment
• Protects against exposure to secondhand smoke and vapour
• Increases the number of people who quit smoking
• Reduces tobacco related morbidity and mortality

Ontario’s Tobacco, Vaping and Cannabis Landscape

Commercial Tobacco

The government of Ontario is committed to ensuring that Ontario has the lowest smoking rate in Canada. According to the Canadian Community Health Survey, between 2005 and 2014, there was a significant decrease in smoking prevalence among Ontarians aged 12 years and older, from 19.6% to 16.1%.Even with this progress, tobacco use continues to be a notable cause of preventable disease and death, and is responsible for an estimated 13,000 deaths in Ontario per year. It kills more Ontarians than alcohol, illicit substances, accidents, suicide and homicides combined.

E-Cigarettes/Vaping

An electronic cigarette or e-cigarette is a battery powered device that heats a liquid chemical (e-juice) into a vapour that can be inhaled. This is commonly called vaping. E-juice does not contain tobacco, however most of these products contain nicotine which is the addictive substance found in cigarettes. More research is needed to determine both the short and long-term health risks of vaping. Although e-cigarettes may have fewer chemicals than traditional cigarettes, vaping is not harmless.

According to the 2017 Ontario Student Drug Use and Health Survey, vaping among students is outpacing cigarette smoking. Past year e-cigarette use among Ontario’s Grade 7-12 students was 10.7% compared to 7% who smoked cigarettes. The use of e-cigarettes increases by grade, with 9.2% of Grade 9 students and 18.9% of Grade 12 students reporting having used e-cigarettes in the past year.

Vaping is not harmless

• Most e-juices contain nicotine which can be highly addictive
• Nicotine can alter brain development and affect memory and concentration
• Chemicals such as formaldehyde, acrolein, propylene glycol and artificial flavourings are present
• It is unknown what health risks can come from secondhand vapour
• There is growing evidence that youth who vape go on to smoke cigarettes ⁶

Cannabis

The Smoke-Free Ontario Act, 2017 passed in the legislature prohibits smoking or vaping cannabis wherever it is illegal to smoke tobacco products. In addition, cannabis cannot be smoked, vaped or eaten in a vehicle or boat that is being driven or is at risk of being put into motion.

Locations you cannot smoke or vape

You cannot smoke or vape tobacco or cannabis in the following Outdoor Areas under SFOA, 2017:

• on restaurant or bar patios and public areas within 9m of a patio
• on outdoor grounds of specified Ontario government office buildings
• in reserved seating areas at outdoor sports and entertainment locations
• on grounds of community recreational facilities, and public areas within 20m of those grounds
• in sheltered outdoor areas with a roof and more than two walls for use by the public or employees (e.g. a bus shelter)
• on school grounds and all public areas within 20m of these grounds
• on children’s playgrounds and public areas within 20m of playgrounds

Municipal Cost & Enforcement

Implementing and enforcing smoke-free outdoor space bylaws has not been shown to require additional financial and human resources.⁷ In a survey of 37 Ontario municipalities that had smoke-free outdoor space bylaws in place for at least two years (enacted no later than June 1, 2010), the enforcement work activities were addressed within current budgets and workforce. ⁷

Activities undertaken to increase community awareness of the bylaws included: hanging signage; delivering community presentations; and circulating promotional materials (e.g., posters, information in recreation/tourism brochures and on social media etc.)_.⁷

Enforcement activities were also undertaken by current municipal staff (most often by municipal bylaw officers), and generally included responding to complaints and routine inspections, often in the course of officers’ daily travels.⁷ The majority of surveyed municipalities had issued warnings as a result of noncompliance; however, only six had issued ticket(s).

Similar results were found in a review of the Town of Collingwood Playground bylaw enacted in July 2000 and expanded to include public playing fields by 2005. A review of the public’s response to the bylaw found between 2000-2007 there were no complaints, no tickets issued and minimal damage to signage.⁸

To help build voluntary compliance and support for a bylaw community education is important. While voluntary compliance is cost-effective, it is still important for local governments to take enforcement action when necessary. ⁹ Making information available and accessible to the public helps to proactively manage public expectations about enforcement.⁹

Next Steps

By making the effort to enact these protections, each municipality will have more control and ability to influence the societal impacts of smoking, vaping and cannabis. Check out the following resources to get started:

1. Review your municipality’s current No Smoking bylaw to determine how it can be enhanced to give greater protection from secondhand smoke and vapour.
2. Consult Smoke Free Ontario Act, 2017 for further support in guiding bylaw enhancement: http://www.simcoemuskokahealth.org/Topics/Tobacco/Protect-Yourself-From-Secondhand-Smoke/Smoke-Free-Ontario-Act
3. Review a draft model of a Smoke and Vapour-Free Bylaw: http://www.simcoemuskokahealth.org/docs/default-source/jfy-communities/Public-Health-Guidance-for-Municipalities_Cannabis.pdf?sfvrsn=12
4. Determine your Bylaw Education, Communication and Enforcement Plans. This link provides information for health care practitioners supporting municipal bylaw development.
5. Connect with your Public Health Unit for consultation and support.

References

1. Keep It Sacred National Native Network. (2015). Commercial Tobacco. Retrieved online from https://keepitsacred.itcmi.org/tobacco-and-tradition/commercial-tobacco/.
2. Government of Ontario. (2018, May). Smoke-Free Ontario - The Next Chapter. Retrieved online from http://www.health.gov.on.ca/en/common/ministry/publications/reports/SmokeFreeOntario/default.aspx
3. Non-Smokers’ Rights Association & the Smoking and Health Action Foundation (2011). Tobacco-free campus guide. Retrieved online from http://nsra-adnf.ca/wp-content/uploads/2016/08/Tobacco_Free_Campus_Guide_web_final1.pdf
4. Forsythe, J. Physicians for a Smoke-Free Canada. (2010, September). Smoke-Free Outdoor Public Spaces: A Community Advocacy Toolkit. Retrieved online from http://www.smoke-free.ca/pdf_1/Smoke-free%20outdoor%20spaces%20advocacy%20-sept2010.pdf
5. Cameron M et al. Secondhand smoke exposure (PM2.5) in outdoor areas and its correlates. Tobacco Control 2010; 10 (1): 19-23.
6. Centres for Disease Control and Prevention. Retrieved online from https://www.cdc.gov/tobacco/e-cigarettes/youth.html?CDC_AAref_Val=https://www.cdc.gov/tobacco/basic_information/e-cigarettes/Quick-Facts-on-the-Risks-of-E-cigarettes-for-Kids-Teens-and-Young-Adults.html
7. Kennedy et al: Reported municipal costs from smoke-free by-laws-experience from Ontario, Canada. Tobacco Induced Diseases 2014 12:4
8. Ontario Tobacco Research Unit L.E.A.R.N Project. Retrieved at https://www.cancercareontario.ca/en/cancer-care-ontario/programs/clinical-services/population-health-prevention-unit/program-training-consultation-centre
9. The office of the Ombudsperson (2016) Bylaw enforcement: best practices guide for local governments (Special Report No. 36). Retrieved from https://bcombudsperson.ca/guide/bylaw-enforcement-best-practices-guide-for-local-governments/

What is Cannabis?

Cannabis is a psychoactive drug that is used for medicinal or recreational purposes. It comes in many forms (leaves/flowers, oils, edibles, hash etc.). Cannabis can have various side effects, which include pleasant (e.g. relaxed, happy) and unpleasant feelings (e.g. psychosis, paranoia). The two main compounds in cannabis are: THC (tetrahydrocannabinol), which creates a sleepy and hungry feeling, and CBD (cannabidiol) which does not give individuals a high, but is used for medicinal purposes. Different strains of cannabis contain different concentrations/levels of THC and CBD depending on the intended use. Medicinal cannabis must be authorized by a health care professional. Recreational cannabis is used for enjoyment and became legal for purchase in Canada on October 17, 2018.

Cannabis Use in Canada

According to the National Cannabis Survey, 1.8 million Canadians ages 15 and older reported using cannabis on a daily or almost daily basis in the first quarter of 2019. Although this number has not changed significantly following legalization it is still concerning as regular cannabis use is associated with an increase in risk of addiction and mental health issues.

Despite the fact that regular cannabis has remained stable (pre- and post-legalization), weekly and occasional cannabis use has increased in Canada following legalization. This is important to note as it has been theorized that even acute use of cannabis may have a harmful impact on the respiratory system. At this point in time, however, this is unclear.

The National Cannabis Survey also found that 15% of cannabis users with a valid driver's license reported driving within two hours of consuming cannabis. This is concerning as cognitive and motor abilities required to drive safely are negatively affected for up to three hours after consuming cannabis. Cannabis use impairs judgement and slows reaction time putting individuals at a greater risk driving related injuries and fatalities.

According to the Canadian Cannabis Survey, Ontarians who reported cannabis use in the last three months increased from 14% in the first quarter of 2018 (pre-legalization) to 20% in the first quarter of 2019 (post-legalization). Ontario was the only province to see an increase but it is unclear why that is (potentially more people comfortable using and reporting?).

Looking at data from the Ontario Student Drug Use and Health Survey (2015), it was found that approximately 1 in 5 grade 7-12 students in Ontario reported using cannabis in the previous year. This is important to note as brain development is not complete until the age of 25 and consuming cannabis at an early age can impact neural development, and subsequently decision making, attention span, and the ability to learn new things.

Cannabis Use in Nipissing and Parry Sound Districts

According to the Canadian Community Health Survey 10.9% of individuals in our region reported using cannabis in the past year. To further this, the Local Community Cannabis Survey that was conducted by the North Bay Parry Sound District Health Unit, found that three-quarters of surveyed individuals reported using cannabis before age 19. As I mentioned previously, this is concerning as brain development is not complete until the age of 25 and even acute exposure can have a negative impact on individuals (e.g. attention, memory).

Health Promotion

Health promotion aims to address the broader conditions that influence our health (e.g. social and physical environment, personal coping skills). The Health Unit can support initiatives in your communities related to substance use including cannabis via a health promotion lens. For example, we can support community development work where individuals with lived experience or who are allies can get involved in promoting health thereby strengthening community action. This could be through awareness campaigns, events and advocacy work related to substance use (in this case specifically cannabis use).

Through health promotion initiatives we also aim to build knowledge and skills of community members and partners through workshops and trainings (e.g. importance of delaying use, health impacts etc.).

In addition, we can help support the development of policies which improve health and create supportive environments (e.g. smoke-free beaches). Our goal is to provide a comprehensive approach to health issues including cannabis use.

Overview of Current Legislation

The Cannabis Act (2018) is the regulatory framework set out by the federal government with respect to legal cannabis use in Canada. The Act states that:

• the minimum age to consume cannabis in Canada is 18 years of age (can be increased by provincial government).
• four plants can be cultivated per household.
• individuals can possess 30g of cannabis on them for personal use.

The Cannabis Act also contains information related to production, distribution and sale of cannabis in Canada. In addition, it outlines restrictions on advertising and promotion to youth. Criminal penalties associated with breaking law and import/export as well as distributing cannabis to youth are also included. The Act further outlines strict quality and safety requirements around cannabis.

With the onset of legalization came changes to the Criminal Code of Canada. These included changes are related to the possession and trafficking of cannabis, and impaired driving offenses (i.e. how much THC you can have in your system while driving).

The Cannabis Control Act (2017) set out by the provincial government establishes restrictions related to the sale, distribution, purchase, possession, cultivation, propagation and harvesting of cannabis in order to protect public health and safety as well as protect and restrict access to youth. The Cannabis Control Act also deters illicit activities through appropriate enforcement and sanctions, and provides for approved educational programming that is culturally appropriate and used as an alternative to enforcement and sanctions.

Two other pieces of provincial legislation include the Ontario Cannabis Retail Corporation Act (2017) and the Cannabis License Act (2018) which relate specifically to requirements around retail outlets. The Alcohol Gaming Commission of Ontario (AGCO) will be speaking to these pieces of legislation later.

The goal of the Smoke-free Ontario Act (2017) is to protect Ontarians from physical and social exposure to second-hand smoke and vapour. The Act was updated on Oct 17, 2018 to include cannabis as well as a number of other changes. The Smoke-free Ontario Act now states that smoking and vaping of any substance including cannabis is no longer permitted wherever smoking tobacco is not permitted.

Previous to these changes the following locations were included in the Smoke-free Ontario Act (2017). These included:

• Indoor public places and workplaces
• Schools and where kids gather
• Hospitals and health care facilities
• Specific outdoor areas (20 m from playgrounds, sporting and spectator areas)
• On outdoor grounds of specified government office buildings
• Patios

New prohibited areas in the Smoke-free Ontario Act (2017) include:

• Public areas within 9 metres of any restaurant or bar patio.
• School property and public areas within 20 metres of the perimeter of the school grounds.
• The outdoor grounds of a community recreation facility, and public areas within 20 metres of the perimeter of the grounds (e.g., municipal community centres, hockey arenas, curling clubs).

Role of Municipalities

The legalization and subsequent inclusion of cannabis and e-cigarettes under the Smoke-free Ontario Act (2017) presents an opportunity for municipalities to open and expand their “No Smoking” by-laws to also include cannabis and vaping. It is also an ideal time to expand the number of smoke-free spaces where your residents and visitors gather, play and work under the by-law.

Many municipalities across Ontario now have by-laws that include these spaces.

Municipalities have a role to play when it comes to enforcement of cannabis use. Specifically, municipalities have the ability to enforce by-laws via their municipal by-law officers. Municipalities wishing to develop a cannabis by-law can outline fines associated with first as well as repeated offenses. Local public health units also play a role in enforcing those stipulations outlined in the Smoke-free Ontario Act (2017). I will touch on the role of public health units, specifically, Tobacco Control Inspectors in just a few moments.

Although municipalities cannot restrict the location of cannabis retail outlets through zoning or any other by-laws they can provide input and feedback to the Alcohol Gaming Commission of Ontario (AGCO) when a retail location is proposed. Municipalities may wish to develop a policy to help guide the review of new potential cannabis retail outlets. Some considerations for this policy may be to include:

• Density of Cannabis Retail Outlets: An increase density means an increase in access and potential harm. Outline minimum distances between stores (e.g. City of Calgary enacted 300m separation distance between cannabis stores).
• Density of Cannabis and Alcohol/Tobacco Retail Outlets: Discourage co-use of cannabis and other substances (e.g. alcohol) by enacting minimum distances between outlets (e.g. KFL&A Public Health recommends a 200m separation distance between cannabis and alcohol/tobacco retail outlets).
• Proximity to Sensitive Locations: Prevent role modeling of cannabis use through minimum distances of cannabis retail outlets to youth-serving facilities such as schools and community centres (e.g. The Centre of Addiction and Mental Health suggests 500m between cannabis retail outlets and sites such as schools and community centres).

Little is factually known about the effects of cannabis smoke on lung health. We do know that cannabis smoke irritates the throat and lungs, and contains toxins/carcinogens which can raise the risks for cancer and/or lung disease. At the moment, there is little data on the health risks associated with second-hand cannabis smoke and more research is needed. That being said, there is concern that it could have harmful effects on vulnerable populations like children and the elderly.

In addition, individuals exposed to second-hand cannabis smoke have tested positive in blood, urine and fluids for cannabis. This could prove problematic for some individuals (i.e. drug testing for work, impaired driving).

The consumption (i.e. smoking) of cannabis in public could normalize cannabis in the community. Normalization refers to something becoming a ‘normal part’ of life and is no longer considered potentially harmful. Knowing that children tend to copy what they observe and that normalization of substances can reduce age of initiation, the ability for individuals to smoke cannabis in public poses a significant issue to the health of populations (specifically children and youth). To further this, the normalization of cannabis could pose the risk of renormalizing all forms of smoking (including tobacco). This would be a step backwards for public health. As such, having municipalities develop a cannabis by-law can play an important part in the health and safety of individuals and communities.

Individuals who use cannabis can experience a wide range of symptoms including distorted perception (sights, sounds), loss of motor coordination, trouble with thinking and problem solving, impaired judgement, slow reaction time and drowsiness. Consumption of cannabis in public settings such as beaches, for example, could potentially increase the risk of accidents and/or fatalities (i.e. drowning, impaired driving).

Because cannabis has only been legal for a very short period of time we need to turn to other substances and jurisdictions to look at the potential impacts it might have on populations. With respect to alcohol, we know that it is a signification risk factor for drownings across Canada. Given that alcohol causes impairment and impacts decision making skills, judgement and coordination this is not surprising. Cannabis can impact individuals similarly meaning that smoking cannabis on beaches could potentially put individuals at a greater risk for drowning. We know that the Nipissing and Parry Sound Districts have a significant number of lakes so it is of definite importance that by-laws are developed to prohibit cannabis use in areas such as beaches (not just from a second-hand smoke impact but an individual safety point of view as well).

Looking to the United States, we can look to impaired driving statistics and cannabis use. At this point in time, findings (pre-/post-legalization) are mixed (i.e. whether legalization increased DUIs). That being said, we do know that from 2017 to 2018 the Colorado State Patrol noted:

• A 25 per cent increase in marijuana DUI citations.
• A 112 per cent increase in DUI citations involving both marijuana and alcohol.
• In 2018, more than 20 per cent of all DUI citations by CPS involved marijuana.

*Substance is based on trained trooper perception and may not reflect results from toxicology tests.

Despite these numbers being significant, it is unclear if legalization has actually caused an increased in impaired driving (with cannabis). Enhanced detection/training could also be playing a role in this. In addition, while some states have shown an increase in impaired driving following the legalization of cannabis others have shown a spike and then decrease or a decrease only. It is important to note that the data available is all we have at the moment to understand the potential impacts of cannabis and DUIs (increase/decrease). More time is needed to understand what impact legalization may have on local populations. What we do know is that greater access to substances results in increased consumption, which can lead to significant health and social harms/costs so there is the potential for legalization to have a negative impact on driving behaviour.

References

1. Centre for Addiction and Mental Health. (2019). Cannabis. Retrieved from https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/cannabis on May 28, 2019.
2. Government of Canada. (2018). Cannabis act. Retrieved from https://laws-lois.justice.gc.ca/eng/annualstatutes/2018_16/page-1.html on May, 28, 2019.
3. Government of Canada. (2018). Cannabis legalization and regulation. Retrieved from https://www.justice.gc.ca/eng/cj-jp/cannabis/ on May 27, 2019.
4. Government of Canada. (2019). Impaired driving laws. Retrieved from https://www.justice.gc.ca/eng/cj-jp/sidl-rlcfa/ on May 27, 2019.
5. Government of Ontario. (2017). Cannabis control act. Retrieved from https://www.ontario.ca/laws/statute/17c26 on May 28, 2019.
6. Government of Ontario. (2019). Cannabis. Retrieved from https://www.ontario.ca/page/cannabis-laws on May 28. 2019.
7. Government of Ontario. (2017). Smoke-free Ontario act. Retrieved from https://www.ontario.ca/laws/statute/17s26 on May 28. 2019.
8. Government of Ontario. (2018). Cannabis license act. Retrieved from https://www.ontario.ca/laws/statute/18c12 on May 28, 2019.
9. Statistics Canada. (2019). National cannabis survey. Retrieved from https://www150.statcan.gc.ca/n1/daily-quotidien/190502/dq190502a-eng.htm on May 27, 2019.
10. Larose, A. (2018). Community cannabis survey. North Bay, ON: North Bay Parry Sound District Health Unit.
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12. Public Health Guidance for Municipalities on the Implementation and Legalization of Cannabis: http://www.simcoemuskokahealth.org/docs/default-source/jfy-communities/Public-Health-Guidance-for-Municipalities_Cannabis.pdf?sfvrsn=18
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14. Ontario Cannabis Store. (2019). Is second-hand smoke harmful? Retrieved from https://ocs.ca/blogs/cannabis-health-safety/is-second-hand-smoke-harmful#/verify-age/success on May 27, 2019.