title: Crude estimates of cannabis-attributable mortality and morbidity in Canada-implications for public health focused intervention priorities.
abstract: BACKGROUND
  Cannabis is the most commonly used drug in Canada; while its use is currently controlled by criminal prohibition, debates about potential control reforms are intensifying. There is substantive evidence about cannabis-related risks to health in various key outcome domains; however, little is known about the actual extent of these harms specifically in Canada.
  
  
  METHODS
  Based on epidemiological data (e.g. prevalence of relevant cannabis use rates and relevant risk behaviors; risk ratios; and annual numbers of morbidity/mortality cases in relevant domains), and applying the methodology of comparative risk assessment, we estimated attributable fractions for cannabis-related morbidity and mortality, specifically for: (i) motor-vehicle accidents (MVAs); (ii) use disorders; (iii) mental health (psychosis) and (iv) lung cancer.
  
  
  RESULTS
  MVAs and lung cancer are the only domains where cannabis-attributable mortality is estimated to occur. While cannabis use results in morbidity in all domains, MVAs and use disorders by far outweigh the other domains in the number of cases; the popularly debated mental health consequences (e.g., psychosis) translate into relatively small case numbers.
  
  
  CONCLUSIONS
  The present crude estimates should guide and help prioritize public health-oriented interventions for the cannabis-related health burden in the population in Canada; formal burden of disease calculations should be conducted.
authors: Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Canada M5S 2S1 Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada V6B 5K3 Department of Psychiatry, University of Toronto, Toronto, Canada M5T 1R8.
authors: Benedikt
authors: B
authors: Fischer
authors: Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Canada M5S 2S1 Institute of Medical Science, University of Toronto, Toronto, Canada M5S 1A8.
authors: Sameer
authors: S
authors: Imtiaz
authors: Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Canada M5S 2S1 Dalla Lana School of Public Health, University of Toronto, Toronto, Canada M5T 3M7.
authors: Katherine
authors: K
authors: Rudzinski
authors: Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Canada M5S 2S1 Department of Psychiatry, University of Toronto, Toronto, Canada M5T 1R8 Institute of Medical Science, University of Toronto, Toronto, Canada M5S 1A8 Dalla Lana School of Public Health, University of Toronto, Toronto, Canada M5T 3M7 WHO/PAHO Collaborating Centre for Mental Health and Addiction, Toronto, Canada M5S 2S1 Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Dresden 01069, Germany.
authors: Jürgen
authors: J
authors: Rehm
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data; D002170:Canada / Q000453:epidemiology; D005260:Female; D006292:Health Priorities; D006801:Humans; D008175:Lung Neoplasms / Q000139:chemically induced / Q000453:epidemiology; D008297:Male; D002189:Marijuana Abuse / Q000150:complications / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control; D001523:Mental Disorders / Q000453:epidemiology; D015980:Public Health Practice; D012307:Risk Factors
keywords: Canada; attributable fractions; cannabis use; health risks; morbidity; mortality; public health
references: Am J Addict. 2007 Sep-Oct;16(5):331-42
references: 17882603
references: PLoS One. 2013 Oct 24;8(10):e76635
references: 24204649
references: Prev Med. 2014 Sep;66:80-6
references: 24945694
references: Am J Public Health. 2014 Jun;104(6):1021-8
references: 24825201
references: Addiction. 2014 Mar;109(3):345-51
references: 24180513
references: Br J Psychiatry. 2008 Nov;193(5):357-63
references: 18978312
references: Drug Alcohol Depend. 2004 Feb 7;73(2):109-19
references: 14725950
references: Am J Addict. 2013 Mar-Apr;22(2):93-8
references: 23414492
references: Cancer. 2007 Oct 1;110(7):1429-35
references: 17724670
references: Lancet. 1992 May 23;339(8804):1268-78
references: 1349675
references: Int J Methods Psychiatr Res. 2006;15(4):181-91
references: 17266014
references: Can J Public Health. 2009 Mar-Apr;100(2):101-3
references: 19839283
references: Traffic Inj Prev. 2010 Jun;11(3):215-21
references: 20544564
references: Lancet. 2012 Jan 7;379(9810):55-70
references: 22225671
references: Arch Gen Psychiatry. 2004 Aug;61(8):807-16
references: 15289279
references: Am J Public Health. 1998 Jan;88(1):15-9
references: 9584027
references: Curr Psychiatry Rep. 2013 Dec;15(12):419
references: 24234874
references: Lancet. 2007 Jul 28;370(9584):319-28
references: 17662880
references: Drug Alcohol Rev. 2007 May;26(3):251-63
references: 17454014
references: J Thorac Oncol. 2008 Dec;3(12):1398-403
references: 19057263
references: Epidemiol Rev. 2012;34:65-72
references: 21976636
references: Drug Alcohol Depend. 2005 Nov 1;80(2):147-59
references: 15899556
references: Arch Intern Med. 2006 Jul 10;166(13):1359-67
references: 16832000
references: Psychiatry Res. 2013 Oct 30;209(3):259-65
references: 23433871
references: Lancet. 2012 Dec 15;380(9859):2224-60
references: 23245609
references: Addiction. 2006 Mar;101(3):373-84
references: 16499510
references: Traffic Inj Prev. 2012;13(1):31-42
references: 22239141
references: PLoS Med. 2009 Sep;6(9):e1000133
references: 19787023
references: Int J Public Health. 2014 Apr;59(2):395-404
references: 24061594
references: Can J Psychiatry. 2006 Aug;51(9):566-74
references: 17007223
references: BMJ. 2012 Feb 09;344:e536
references: 22323502
references: J Subst Abuse Treat. 2003 Jun;24(4):369-76
references: 12867212
references: Can J Public Health. 2011 Sep-Oct;102(5):324-7
references: 22032094
references: N Engl J Med. 2014 Jun 5;370(23):2219-27
references: 24897085
references: Cancer Causes Control. 2013 Oct;24(10):1811-20
references: 23846283
references: Drug Alcohol Rev. 2010 May;29(3):318-30
references: 20565525
references: Drug Alcohol Rev. 2006 Nov;25(6):515-36
references: 17132571
references: Lancet. 2009 Oct 17;374(9698):1383-91
references: 19837255
references: Eur Arch Psychiatry Clin Neurosci. 2009 Oct;259(7):413-31
references: 19609589
references: Alcohol. 2005 Apr;35(3):265-75
references: 16054989
references: Addiction. 2010 May;105(5):817-43
references: 20331573
references: Int Rev Psychiatry. 2009 Apr;21(2):96-103
references: 19367503
references: Addiction. 2002 Mar;97(3):243-7
references: 11964097
references: Biometrics. 1976 Dec;32(4):829-49
references: 1009228