Québec's public, not-for-profit cannabis distribution regime: a comparative analysis, three years in

Cannabis legalization initiatives have yielded different retail sales regimes. Quebec’s (Canada) provincial authorities have opted for a singular public, not-for profit, monopoly. The objective underlying this choice is to transition cannabis consumers to the legal system without favouring cannabis consumption and associated risks. Three years after its initiation, it is of interest to compare public health outcomes in Quebec with those of other jurisdictions.

Administrative data sources and the evaluative literature are combined to compare Québec’s regime with those of Uruguay, three US States (Colorado, Washington and Oregon), and three Canadian provinces (British-Columbia, Ontario and Newfoundland-and-Labrador). The analysis proceeds in two steps. First, public health outcomes are considered across four categories: cannabis consumption; consumption of other psychoactive substances; social perceptions of cannabis consumption and associated risk factors and; mortality, morbidity and their risk factors. Second, the potential roles of five categories of commercial and regulatory determinants (price, products, place, promotion and governance) of these public health outcomes are discussed.

Compared with other jurisdictions, Québec’s ‘cannabis consumption’ indicators appear favourable. Incomplete or inconsistent evidence regarding ‘consumption of other psychoactive substances’, ‘mortality, morbidity and associated risk factors’, and ‘social perceptions of cannabis consumption and associated risk factors’ impede robust comparisons in these regards. Favourable outcomes are probably related to regulatory choices regarding cannabis products, place (the retail environment), and governance. Promotion-related regulatory choices could also possibly explain part of the differences, but to a lesser degree of certainty. Price-related choices could possibly have played an inverse role.

The analysis presented suggests links between some favourable outcomes in Quebec and some regulatory choices concerning the commercial determinants of cannabis use and risks. In order for comparisons to prove more robust, research efforts should be pursued to address knowledge gaps and inconsistencies regarding the links between cannabis distribution regimes features and public health outcomes.