Preventing Mission Drift and Commercialization of Government Cannabis Monopolies: Insights From a Qualitative Analysis of Governance Structures in Quebec

Background A government monopoly for cannabis sales may offer public health advantages over more commercial approaches. The monopoly governance and regulatory infrastructure can help avoid overcommercialization and related harms. Aims To examine the governance mechanisms in the cannabis retail monopoly managed by the Quebec cannabis corporation ( Société québécoise du cannabis , SQDC), and how they restrain commercialization and attempt to reduce harms. Methods Thematic analysis of semi-structured face-to-face interviews with 34 key stakeholders from Quebec's public sector, academia, cannabis industry, and civil society. Field observations of government-run cannabis retailers and a review of the Quebec legislative framework. Results Formal and informal governance mechanisms to protect the cannabis monopoly from overcommercialization and reduce cannabis-related health harms were identified. Key formal governance structures include: (1) legislated not-for-profit mission of the SQDC; (2) allocation of SQDC profits to funding of cannabis prevention and research; (3) legislated independent health-focused oversight committee; (4) delegation of regulatory function to health and separation of oversight between health and finance agencies; and (5) the SQDC internal organization. Informal mechanisms include: (1) regular consultations between the SQDC and health ministry; (2) non-binding advice from high-profile health agencies; and (3) wider public opinion. The effectiveness of informal mechanisms is mediated by the SQDC leadership. Although key stakeholders with health backgrounds overwhelmingly viewed governance structures in the SQDC model as superior to the long-standing Quebec alcohol monopoly (SAQ), several weaknesses in the model were identified, including the limited formal powers of the oversight committee and the SQDC personnel’s links with the more profit-oriented provincial alcohol corporation. Conclusion The governance mechanisms adopted in the SQDC model compare favorably against the alcohol retail monopoly in Quebec in terms of reducing substance-related health harms. They could be improved by strengthening the power of the oversight committee, separating SQDC from SAQ networks, and formalizing reporting to the health ministry.