In 2018, Canada was one of the first jurisdictions in the world to legalize cannabis. And in this province, the government of Newfoundland and Labrador implemented policies to regulate its sale and consumption.

But with so few examples of legalization in other areas, how do we know if these new policies are working for the benefit of Newfoundlanders and Labradorians? The goal of Memorial’s Cannabis Health Evaluation and Research Partnership (CHERP) is to find out.

The CHERP team received funding from the Canadian Institutes of Health Research and the Canadian Centre on Substance use and Addiction to evaluate cannabis policy in Newfoundland and Labrador, and measure some of the ways legalization has affected health and public safety here.

Their research touches on several different aspects of legislation. These include finding out how people in Newfoundland and Labrador use cannabis, examining if the ways cannabis is sold meets both users’ needs and government goals, assessing the impacts of legalization on youth and young adults, and exploring the impact of cannabis legalization on Indigenous people and communities.

To make sure the people most impacted by cannabis legislation have a voice in how it’s studied, principal researchers Dr. Jennifer Donnan and Dr. Lisa Bishop of the School of Pharmacy decided on an approach based in diverse citizen and stakeholder engagement. This work has been supported by Memorial's Public Engagement Postdoctoral Fellowship Program, through the Office of Public Engagement.

Dr. Donnan, Dr. Bishop, and postdoctoral fellow Dr. Dina Gaid spoke to The Tandem about their work.

What is it that drew you to research in this field?

Jennifer: The legalization of cannabis is something that has impacted so many aspects of our society. It has forced the public to really re-think how they view cannabis and the decisions they make. This can have real health and safety consequences. It is important to carefully listen to members of our community to truly understand how this shift is unfolding, and how we can respond to prevent any negative consequences.

As a parent, I also want to be sure my children and their peers grow up with the knowledge they need to make informed and safe choices. So engaging with youth, and creating youth-centred education strategies, takes on a more personal meaning.

Lisa: As a pharmacist and researcher, I am passionate about helping those with mental health and substance use needs. Much of my research has focused on youth mental health and wellness. When cannabis became legal, I was naturally drawn to research that focused on the impact of cannabis legalization on public health and safety. I was interested in helping determine how to best protect the health and safety of citizens.

Dina: As a post-doctoral fellow with a knowledge translation focus, I was eager to be involved in public engagement research. I am interested in integrating and examining knowledge translation interventions directed at the general public, especially youth. Because cannabis has been recently legalized, the effect of these interventions has not been studied yet.

Why do you think a citizen and stakeholder engaged research approach is so important to your work?

Jennifer: Taking this approach to our work has brought so much value to the table. When looking at an issue like cannabis legalization, every segment of the population is impacted. Consumers, non-consumers, policy makers, business owners, financing institutions, healthcare workers, educators, human resource professionals, community workers and the list goes on. Everyone has a unique perspective and lived experience and can provide insights and interpretation into the work we do.

Dina: Engaging stakeholders guides us in formulating our research questions. Stakeholders have been involved in many steps of our research projects. Starting from making sure that these research projects are relevant to them, through ensuring that our findings inform their knowledge gaps, to making sure our findings are properly disseminated to our target audiences.

Lisa: Engaging and partnering with the people most impacted by the research leads to research that is much more applicable and valuable. I embrace the value of patient and public-engaged research. This approach has allowed me to conduct research that is more valuable to the people it impacts the most.

How do you introduce your work to the stakeholders and citizens you engage and collaborate with, especially youth?

Lisa: Hearing honest perspectives from youth is critical in informing our research. It starts with an effective recruitment strategy. We disseminate our notices widely, so that we have diverse representation across genders, ages, and geographical locations. We also recognize participants’ value by compensating them appropriately for their time.

We are conscious about making sure they are comfortable, so we train younger people to engage with them. They can use more age-appropriate lingo that is more relatable. Being non-judgemental, respectful, and open to all opinions is essential in gathering honest perspectives.

Jennifer: We have to be particularly careful when engaging with youth. They are impressionable, and we certainly do not want to perpetuate any misinformation, or make it look like we promote cannabis use in any way.

We make sure to take time before any engagement session to carefully review the language we use to introduce the topic, and we prepare for anything that might be shared by youth in those sessions. Being prepared to counter myths about cannabis use in a respectful and non-judgemental way is important.

We also acknowledge that the researchers within our team are parent/teacher age to the youth we engage with. We know that this can make them uncomfortable and less willing to share their thoughts and ideas. For this reason, we try as much as possible to train younger team members, and have gender diversity, to facilitate discussions.

What are some forms this collaboration and engagement have taken?

Lisa: When we formed our CHERP research team, citizens and stakeholders became active members of it. We also formed citizen and stakeholder advisory panels that helped identify priorities, and informed the direction and interpretation of our research.

The Citizen Advisory Panel provides direction, advice, and opinions to the CHERP team. Their purpose is to ensure that our cannabis policy evaluation represents the needs and concerns of people who do, and do not use cannabis.

The Stakeholder Advisory Panel is made up of representatives from relevant stakeholder groups, like the Newfoundland and Labrador Centre for Health Information, Newfoundland and Labrador Liquor Corporation and the Safe Works Access Program. They also provide direction, advice, and opinions, to ensure that the project proceeds with input from knowledge users, like the Department of Health and Community Services and the Newfoundland and Labrador English School District, who have been impacted by cannabis legalization.

Now that we are expanding our research to focus on cannabis education for youth, we will be forming youth advisory panels to help direct that part of our research.

Jennifer: In addition to our panels, we have also done some focused engagement sessions. For example, early in our project we hosted a virtual needs assessment. This included workshops with citizens and stakeholders, opportunities for anonymous online comments, and having conversations through open line radio shows. These sessions were instrumental in shaping the priorities and objectives of our work over the next two years.

More recently we have been conducting workshops to figure out how to best use social media as a tool to educate youth about cannabis. We took a more targeted engagement approach here. We invited youth, parents, educators, harm reduction specialists and social media influencers. The information we heard there will be used to inform a social media strategy for our team.

Strong relationships are essential to meaningful engagement. Can you tell me about some of the new relationships you have been forged, or some of the existing ones you have strengthened?

Jennifer: As a new research team, I feel like we have mostly forged new relationships, and there have been so many of those! We find that people have a genuine interest in supporting our research, either as engaged citizens and stakeholders, or as participants providing data for our studies.

One relationship I think has been very meaningful is our collaboration with Canadian Students for Sensible Drug Policy. This is a youth-run program that has made tremendous strides to promote cannabis harm reduction education. Their insights and support will be instrumental as we move forward to develop the DECYDE strategy.

Lisa: One of our initiatives is focused on supporting youths’ cannabis health literacy. Our strategy is called Directed Education on Cannabis for Youth Decision Empowerment, or DECYDE. Through this initiative, we have developed new partnerships with the provincial Department of Education, the Newfoundland and Labrador English School District, the Newfoundland and Labrador Teachers Association, and parents, teachers, and youth.

The DECYDE project is in the early stages of development, so we know that we will continue to forge meaningful relationships with other citizens, stakeholders, and youth as we develop it.

Dina: As one of my responsibilities is to develop knowledge translation strategies to better disseminate the findings of our research projects, I build a collaborative relationship with the Office of Public Engagement office at Memorial. This collaboration was represented in the organization of our webinar series, “Cannabis Crossroads: Growing Knowledge and Weeding Out Misinformation”, which had the goal of educating the public on cannabis risks and safe consumption. 

How has your process shaped your research priorities?

Lisa: Before beginning our research, we conducted a needs assessment. This was to identify the successes and gaps in cannabis policy focused on protecting public health and safety. One priority we identified was the need to better understand how cannabis legalization impacts youth health and safety, and to explore youth education needs.

This led to us conducting research with youth and young adults across the province, both in and out of the school system, which resulted in the DECYDE strategy. Now, stakeholders in the government and school district, people with lived experience, and youth are instrumental in helping us create and evaluate the strategy.

Jennifer: We have also been working closely with our knowledge users in the Department of Health and Community Services. This is how we can understand their priorities as they move forward and revise cannabis policies and regulations.

One priority they identified early on is learning how the 4-tier cannabis retail model is working to meet the goals of cannabis legalization. Newfoundland and Labrador has a unique retail model and they wanted to know the benefits and challenges this model poses. This has shaped a number of research projects to look at this issue from both the retailer and the consumer perspectives.

What feedback have you received from citizens and stakeholders, regarding the structure and process of your research?

Lisa: The feedback from the citizens and stakeholders in our needs assessment was positive and indicated they had a positive experience. They felt they were respected, and believed their input and feedback would be considered. We are appreciative of everyone's time and contribution, as we always make an effort to have an open and respectful environment for people to share their honest opinions and ideas.

Dina: In the fall of 2021, we organized a series of webinars called Cannabis Crossroads: Growing knowledge and weeding out misinformation, to share knowledge and create conversations around safe cannabis use. We received positive feedback and inspiring comments. For example, audiences said, “I learned things I wasn't aware of about legal/illegal supply,” “I liked the diverse speakers from the varying perspectives,” “The presenters were very knowledgeable,” “I liked the specific scientific information provided about impairment levels, and the results of the youth and young adult focus groups,” and “Gave me a better understanding of dosage amounts for medical cannabis and potential applications for medical cannabis.”

Jennifer: When we conducted our workshops about using social media, we found that citizens enjoyed being able to contribute their opinions. Stakeholders also indicated how impressed they were that we could bring such a diverse group of perspectives together to discuss these issues. It was really neat to see social media influencers share ideas and have members of their target audience provide feedback. I am excited for the collaborations we will form in the future to create content to improve cannabis health literacy in our community.

You’ve mentioned that other jurisdictions are looking to Canada as one of the early adopters of cannabis legalization. Have you been able to disseminate knowledge from this project?

Lisa: We have had the opportunity to present virtually at a number of national conferences over the past two years, which has been a great opportunity to share our work. We are also sharing our research in academic journals.

We published two articles in The Conversation, which is a more accessible resource for the general public. One was on cannabis education and the other was on cannabis-impaired driving.

Jennifer: We did a short presentation on our youth engagement work at the Canadian Centre for Substance Use and Addiction fall webinar series. This project resulted in numerous connections and collaborations with other people working in the same area. I am now serving on the YMCA Youth Cannabis Awareness Program, Atlantic committee. We have also connected with programs in the United States and have been able to support one another through sharing of ideas.

Lisa: Follow us on social media where we share pertinent information and findings from our work. Facebook (@cherpCA), Twitter (@cherpCA). More information about the work of CHERP is also posted on our website.