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Panel provides guidelines for safe cannabis use


How do you minimize the health impacts of marijuana in a country where it is legal to smoke – or otherwise consume – the drug?

As Canada approaches full legalization on July 1, 2018, a blue-ribbon panel of experts has provided an evidence-based answer to that thorny question and, on Friday, they will release a set of “lower-risk cannabis-use guidelines.”

The research, published in the American Journal of Public Health, is essentially a list of practical tips for current and potential marijuana smokers.

The guidelines begin with the statement that the health risks of cannabis – including impairment, pulmonary damage and neurological impacts – are most easily avoided by abstaining.

“It’s a bit of a mandatory, prophylactic statement, but it’s true,” said Dr. Benedikt Fischer, senior scientist at the Institute for Mental Health Policy Research at the Centre for Addiction and Mental Health in Toronto.

“Cannabis is not benign and people should not assume that it’s perfectly safe because it’s being legalized,” he said.

“But, ultimately, legalization should make it easier for cannabis users to make smart choices,” Dr. Fischer added.

About 15 per cent of Canadians – including roughly 30 per cent of adolescents and young adults – report using cannabis in the past year, according to surveys.

The guidelines are aimed principally at helping them reduce potential health risks.

The recommended measures include:

Delay using cannabis until adulthood: The researchers say that there is strong evidence that cannabis can affect the developing brain, so it is best delay use until after age 18, or even 21. The earlier someone starts smoking marijuana, the greater the potential harms, according to the research;

Avoid smoking cannabis products: Much of the harm comes from combustion, so users should favour safer methods such as vaping, bongs, edibles and drinkables. They should also avoid mixing cannabis with tobacco;

If you smoke cannabis, avoid harmful practices such as deep inhalation and breath-holding, which intensify the absorption of both psychoactive components and hazardous by-products;

Choose lower-risk cannabis: The researchers say high-potency products (meaning high THC content) such as “skunk” and “wax dabs” are best avoided;

Limit and reduce use: The greater the intensity and frequency of cannabis consumption, the higher the health risks. If you’re going to smoke cannabis, the guidelines recommend doing it occasionally, such as on weekends;

Don’t use synthetic cannabinoids: Products such as K2 and Spice are much more powerful and the effects are more severe than organic cannabis, so they should be avoided;

Don’t drive or operate heavy machinery: The guidelines recommended that users not drive for at least six hours after smoking or otherwise consuming cannabis and be especially cautious if they combine marijuana and alcohol;

Avoid cannabis altogether if you have a family history of mental illness (particularly psychosis) or if pregnant.

Dr. Fischer, who is also lead author of the guidelines, said it’s up to individuals to decide if and how they use cannabis, but it’s up to government and public-health officials to facilitate making smart choices.

For example, he said that good labelling is essential so users can know the THC content of products.

The guidelines stress that education is also required if people are going to be expected to make reasoned choices.

The dangers of driving while stoned should be heavily publicized, as was done with drunk driving.

While many other drugs, both legal and illicit – from alcohol to opioids – pose more health risks than cannabis, the guidelines stress that is not a reason for the risks to be ignored, and that harm reduction measures need to be embraced.

“Cannabis use carries with it real health risks and mitigating those risks for Canadians – particularly young Canadians – must be the first priority,” said Dr. Laurent Marcoux, president-elect of the Canadian Medical Association.

The guidelines are endorsed by a number of health groups, including the Canadian Medical Association, the Canadian Public Health Association and the Canadian Centre on Substance Use.

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‘Just because it is legal doesn’t mean it is good’: Obstetricians worry about marijuana law


The group that represents obstetricians and gynecologists in Canada is watching the pending legalization of marijuana with concern, saying there is growing evidence suggesting its use by pregnant mothers negatively affects brain development in their fetuses.

“Our worry is that because it is made legal, people may think it is not a problem,” said Dr. George Carson, president of the Society of Obstetricians and Gynecologists of Canada.

“While it will be legal, the SOGC’s position is that we believe there are adverse effects on brain development from marijuana consumption until the brain development is finished, which is not until the early 20s. It is legal, but should be strongly discouraged.”

Of further concern is that marijuana is widely promoted among some as an anti-nauseant during early pregnancy.

“There are safe and more effective medications for nausea in pregnancy” said Carson. “My hope is that it is not used because of the adverse effects on brain development.”

Although more research needs to be done, a growing body of evidence points to negative effects on brain development as a result of marijuana exposure which can potentially affect the executive functions of the brain and behaviour.

The Society of Obstetricians and Gynecologists of Canada is issuing new guidelines on substance use during pregnancy later this year, partly because of the upcoming legalization of marijuana and new research into its effects, and partly because increased use of opioids.

It is also planning to conduct research to get a better sense of substance use during pregnancy, as well as during other times in women’s reproductive lifespan.

Substance use is the second leading killer of women during pregnancy, in part, because of fentanyl, said Jocelynn Cook, chief scientific officer at SOGC. A recent review of research, by Cook and others, noted the increased use of opioids among pregnant women is an emerging trend.

“This rise is purported to be a combination of the frequency of prescribed opioids for pain control in pregnant women, illicit use, and an increase in opioid-substitution programs for treatment of addiction … opioids are now being used by a more diverse population that includes pregnant women.”

“We really want to look at what women are doing now related to substance use — what is happening during pregnancy, what do women believe, what are their behaviours and where do they get their information?”

She said the research is important now because the landscape is changing when it comes to substance use.

“We know that 15 per cent of women drink alcohol during pregnancy, we don’t have the same information around cannabis use … we are scrambling to try to figure out how we can help target those populations.”

Canada has some of the highest rates of cannabis use by adolescents among developed nations. In addition, opioid use is rising rapidly. There are increasing numbers of babies born in Canada who are addicted to opioids because their mothers took them during pregnancy.

Carson, who works in Regina, said opioid use during pregnancy is of growing concern, but can also be an opportunity to improve the health of substance-using women in some cases. Women who are drug addicts tend not to be engaged with health care, he said, but will often seek medical treatment when they are pregnant.

He said getting a pregnant mother who is addicted to opioids into a methadone program can improve her health and her baby’s health.

Although there is a general increase in drug use among pregnant women, cannabis remains the most commonly used illicit substance. Estimates of women who use cannabis while pregnant have ranged from just under two per cent to more than 16 per cent, according to the research by Cook and others. It’s widespread use, the report said, “may be due in part to its reputation as a harmless drug.”


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Before You Conceive: Medications and drugs before pregnancy

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Medications and drugs before pregnancy

Is it safe to take medicine when I’m trying to get pregnant?


Medications that can do harm to a developing fetus usually do so in the first weeks of pregnancy – often before you know you are pregnant. Review the medications you are currently taking with your health care provider when you are planning a pregnancy and before you get pregnant. He or she may advise a different dosage or additional tests to monitor the effect of the medication throughout your pregnancy. Or, you may be advised to stop taking the drug altogether. In most circumstances the right treatment for a condition you have while trying to get pregnant or during pregnancy is exactly the same as the right treatment when you are not pregnant. Don’t stop effective treatment of any medical condition until you have discussed that treatment in your plan to become pregnant with your health care provider.

What about natural or herbal remedies?


Many people assume that natural or herbal products are safer than prescription or over-the-counter medications. However, most natural products have not been tested for safety or effectiveness. And very few have been tested for safety during pregnancy. Be sure to discuss any natural or herbal remedies with your health care provider before taking them.

Can I take something for nausea and vomiting?

Don’t take over-the-counter medicines or herbal remedies for nausea and vomiting without discussing these with your health care provider first. Diclectin® is the only prescription medication approved by Health Canada for the treatment of nausea and vomiting in pregnancy. You can also try ginger, sea bands, and pyridoxine (vitamin B6).

What about caffeine, alcohol, nicotine, and street drugs?


Caffeine. Moderate amounts of caffeine – one to two cups per day – are safe for consumption during pregnancy.

Alcohol. If you are trying to become pregnant, avoiding alcohol is the safest choice. Consumption of high amounts of alcohol is known to have serious effects on your baby (fetal alcohol spectrum disorder). If you need help with alcohol dependency, talk to your health care provider. There is no known safe amount of alcohol during pregnancy. Because drinking alcohol is common and half of all pregnancies are not planned, a woman may have consumed some alcohol before knowing she is pregnant. If the consumption was at low levels, be assured that there is likely no increased risk of adverse outcome. Such low level alcohol consumption is not a reason to terminate a wanted pregnancy.


Smoking. Smoking by either partner reduces fertility. Individuals having difficulty getting pregnant can increase their chances of conceiving by quitting smoking. Smoking cigarettes during pregnancy exposes the baby to many toxic chemicals and is one of the most preventable causes of poor pregnancy outcomes (e.g., low birth weight, stillbirth, preterm birth). Since smoking causes significant negative effects on the fetus, it is best to quit before you become pregnant. Quitting or significantly reducing the number of cigarettes smoked while you are pregnant causes no adverse effects on the pregnancy, and is beneficial to both you and the baby. Talk to your health care provider for help in managing your cravings.

Street Drugs. Street drugs are never safe for use, particularly before or during pregnancy.

It is never too late to reduce or eliminate consumption of alcohol, nicotine, or street drugs.

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New Website:

OBGYNThe Society of Obstetricians and Gynaecologists of Canada (SOGC) is pleased to announce the release of an exciting new website,, to inform women who are pregnant, or planning to become pregnant about the relevant evidence-based information they need for a healthy pregnancy (2017, June 20).

“This site covers questions from A-Z including important facts on nutrition, vaccination and the impact of the environment on pregnancy,” says Dr. Jennifer Blake, CEO SOGC. “In this era of fake news, women are looking for credible information. Our website incorporates the most recent clinical guideline data with practical advice from a committee of medical experts.” Research shows time and time again that when pregnant women are well informed about their needs and the needs of their growing baby, they will have healthier full-term pregnancies.

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Click to visit the website!

The Psychiatric Morbidity of Women Who Give Birth to Children with Fetal Alcohol Spectrum Disorder (FASD): Results of the Manitoba Mothers and FASD Study

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To investigate differences in physician-diagnosed psychiatric disorders between women who gave birth to children with a fetal alcohol spectrum disorder (FASD) diagnosis (study group) compared to women who gave birth to children without FASD (comparison group).

We linked population-level health and social services data to clinical data on FASD diagnoses to identify study group (n = 702) and comparison group (n = 2097) women matched 1:3 on date of birth of index child, region of residence, and socioeconomic status. Regression modeling produced relative rates (RRs) for outcomes.

Mothers who gave birth to children with FASD had higher adjusted rates of substance use disorder (RR, 12.65; 95% confidence interval [CI], 8.99-17.80), personality disorder (RR, 12.93; 95% CI, 4.88-34.22), and mood and anxiety disorders (RR, 1.75; 95% CI, 1.49-2.07) before the pregnancy of the child. These mothers also had higher adjusted rates of maternal psychological distress during pregnancy (RR, 5.35; 95% CI, 4.58-6.35) and higher rates of postpartum psychological distress (RR, 1.71; 95% CI, 1.53-1.90). These women also had higher adjusted rates for antidepressant prescriptions before, during, and after the pregnancy.

A significant psychiatric burden exists for women giving birth to children with FASD. Clinicians should recognise the high rates of psychiatric concerns facing mothers who give birth to children with FASD and should offer treatment and support to these women to improve their health and well-being and prevent further alcohol-exposed pregnancies.

For full study please visit: 

Happy Father’s Day!: What Men Can Do To Help Prevent FASD

20150615125959-stay-at-home-dads-entrepreneurship-daughter-child-hugWith Father’s Day fast approaching, here are some helpful ways that Dads and Dads-to-be can help to support alcohol-free pregnancies!

Take a ‘pregnant pause’. If your partner,
friend, sister, co-worker or another woman you
know is pregnant, you may want to consider taking
a ‘pause’ from drinking as a way of showing support.
Whether it’s for a month, three months or the entire
pregnancy, remaining alcohol-free can be helpful and
encouraging for many women

Be a good host. When entertaining friends or
family or having a night out, offer non-alcoholic
beverages and avoid pressuring women to drink
(pregnant or not). Some women continue to drink
alcohol during pregnancy because they have a hard
time saying ‘no’ when it is expected that they drink in
certain social situations or when they haven’t told others
about their pregnancy. As a host offer ‘mocktails’ and
other non-alcoholic options for drinks, and make sure
that everyone feels part of the fun whether or not they
are drinking alcohol.

Minimise harms. Most of us don’t drink on our
own — our drinking habits are shaped by those
around us. Support a ‘culture of moderation’ by taking a
look at your own drinking and working to minimize any
harmful effects that your own drinking might have on
yourself or others. Taking a look at Canada’s Low Risk
Drinking Guidelines is a good place to start (www.ccsa.

Help change negative perceptions.
When talking about FASD and alcohol use during
pregnancy, avoid being critical of women who do drink
during pregnancy or blame women for not caring about
their babies or for being ignorant. This type of judgment
creates a climate of fear and shame where women can
feel discouraged and avoid seeking help to address
their problems with alcohol. It also prevents us all from
having productive conversations about how to prevent

Be compassionate. For some women,
stopping drinking can be a struggle. Often,
drinking can be a way for women to cope with difficult
life circumstances such as depression or isolation.
Assume that women are doing the best they can and let
them know that you’re willing to help when they’re ready
to make a change.

Be an active role model. Confusion
about what is a safe level of alcohol use during
pregnancy remains. Support pregnant women by telling
family, friends, and anyone offering her alcohol that
there is no safe time to drink alcohol during pregnancy
and no safe amount.

Support pregnant women no matter
what. Pregnancy can be a time of enormous
pressure and scrutiny for women. Women receive
advice and information from health care providers,
websites, friends, family, and even random strangers.
Respect the choices that women make to keep
themselves and their babies healthy. It’s never too late
for a woman to stop drinking during pregnancy or to
make other healthy changes in her life.

Remember that healthy babies need
healthy mothers. During pregnancy, the
effect of alcohol on the fetus is influenced by things like
nutrition, stress, other substance use, and numerous
other factors. Support women’s health before, during,
and after pregnancy. This contributes to a society where
women’s health and well-being is valued in of itself and
all the time rather than only during pregnancy.

Remember that FASD affects everyone.
Many people continue to believe that only certain
groups of women drink alcohol during pregnancy or
are responsible for FASD. Remind people that FASD
occurs wherever pregnant women drink alcohol and
that discrimination prevents us from having frank
conversations about the root causes of FASD and
overall solutions.

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Resource: Mapping the Gaps between Expert and Public Understandings of Fetal Alcohol Spectrum Disorder in Manitoba


Click to download full report


Fetal alcohol spectrum disorder (FASD) is an important social issue in Manitoba fraught with misconceptions and communications challenges. Communicating with Manitobans about FASD is difficult because people’s thoughts about this issue hinge on deeply held and widely shared beliefs about motherhood, substance use, choice, responsibility, and morality. To engage members of the public in thinking about FASD in ways that boost support for the policies and programs that are necessary to address it, communicators need an empirically based framing strategy that anticipates and redirects public thinking.

Communicating effectively about FASD first requires a clear sense of the core concepts that the public needs to understand in order to support the initiatives that evidence suggests will create change. We call this set of concepts the untranslated story of FASD. The untranslated story unites researchers, practitioners, and advocates around a set of core principles that they want to be able to communicate to the public about FASD.

After we distil the principles that need to be communicated, we describe the patterns of thinking that underlie how Manitobans think about FASD. This phase of research investigates how people think about FASD by examining the patterns that appear in how they talk about the issue. Working from over 650 pages of interview transcripts, we identify the common understandings and implicit assumptions that shape how the public reasons about FASD and related issues. This focus on common understandings does not ignore the fact that people also have different ways of understanding this issue. However, analyzing the patterns that are shared across a diverse group of people allows us to develop reframing strategies that will be most effective in changing the public discourse about FASD in Manitoba, ultimately generating support for crucial programs and policies.

This report proceeds as follows:

• We outline the untranslated story of FASD. This set of principles reflects the field’s understanding of what FASD is, how alcohol affects fetal development, why women consume alcohol while pregnant, what the effects of FASD are, and how FASD can be prevented and addressed. This untranslated story represents the content to be communicated to the public with a reframing strategy.

• We describe the cultural models —anthropologists’ term for shared but implicit understandings, assumptions, and patterns of reasoning—that shape how Manitobans think about FASD. We review patterns of thinking related to pregnancy, alcohol use and addiction, social factors, causes and effects of FASD, and ways to address them.

• We then map the gaps between the field’s and the public’s perspectives and describe points at which these understandings overlap and diverge. This analysis highlights the key challenges in communicating about FASD. Seeing the Spectrum: Mapping the Gaps between Expert and Public Understandings of Fetal Alcohol Spectrum Disorder in Manitoba.

• Finally, we present a set of preliminary framing recommendations that emerge from this map the gaps analysis. A description of the methods used in this research, and participant demographic information, can be found in the Appendix.

Click to download report: Manitoba-FASD-Strategic-Meeting-Report-May-2017


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