Thank you, Mr. Chair. Thank you to the committee for the invitation to speak on this important topic. It's really an honour for me to be here.
I'm a scientist who has worked on the cannabis plant for more than 18 years. My research is mainly on the biochemistry and genetics of this very fascinating plant, and I'm very familiar with its cultivation, both in a scientific context and then in the new commercial industry we have in Canada. I'm also an adjunct professor in the botany department at the University of British Columbia and am the founder and CEO of a cannabis testing and biotechnology company in Vancouver called Anandia Labs.
There's a lot to speak about, but I've confined my comments specifically to the subject of cultivation of cannabis, hopefully to educate and eventually answer some of your questions.
I think it is fundamentally important that this legalization include the ability to grow cannabis for personal use. I was happy to see that Bill included some provision for this. The cultivation of plants is a foundational aspect of human culture. In fact, the advent of agriculture via the domestication of plants has been one of the key forces in the creation of human societies.
Cannabis has been grown by humans for thousands of years as a source of food, fibre, and drug. Given the long-standing relationship between humans and cannabis and the fact that we will soon be allowing adults to consume it legally, it is important that the allows Canadians to grow the plant. The absence of personal cultivation from the act, as for example might occur if the provision were stripped from Bill C-45 in response to pressures from law enforcement, would surely lead to Canadians facing fines or charges for the simple act of planting seeds.
I also think we are dealing with a relatively small number of people who may choose to cultivate, since most consumers of cannabis would rather purchase from a store. This is the same situation as with the home-brewing of beer or making wine. I suspect we will not see apartment buildings overrun by cannabis gardens.
The fact that Bill includes allowances for personal cultivation doesn't mean everything is fine. There are a number of points that cause me concern. Bill C-45 restricts the number of plants that can be grown for personal use, with a limit of four plants per household. I see the purpose of this restriction in that the ability to grow larger numbers of plants might result in diversion into an illicit commercial market. Indeed, all the limits of plant cultivation, including plant height, plant number, and seed possession limits, appear to have reduction in diversion as their main goal. However, these limits expose the awkwardness of applying strict legal definitions to a living organism, a plant, and might criminalize Canadians who are simply gardening.
The proposed limit of four plants per dwelling doesn't take into account the practical challenges in growing plants or the biological characteristics of cannabis. As I think every gardener or farmer knows, plants are difficult to grow and might fail to thrive or might succumb to disease. In growing tomatoes, one might sow a dozen seeds on a windowsill and select the foremost robust plants to transplant to the garden.
Cannabis plants may be male or female, with the male plants unusable as a drug. Without cross-seeds, which are a proportion of the seeds that are available, 50% of the plants will be males and therefore discarded. In many cases, cannabis cultivators maintain so-called “mother plants” to be used as a permanent source of cuttings, producing so-called “clones”, which are vegetatively propagated cuttings to be used for growing, and then have one or two plants in flower at one time. In my opinion, the cultivation limit should be adjusted to account for these non-flowering and non-producing plants required for normal cultivation practices. In fact, Bill already distinguishes between non-flowering and flowering plants. Therefore, I would propose that the act be amended to allow adults to grow perhaps 10 plants in total, of which four may be in flower. This allows cultivators the flexibility to grow for personal use without running afoul of the law.
I also want to address the limit on plant height of 100 centimetres, or about three and a half feet. Cannabis is a highly variable species, and I have seen plants of 30 centimetres that are flowering, and others that are several metres tall. The limit of 100 centimetres is potentially problematic from the perspective that cultivators might break the law simply by providing fertile soil and water and then going away for a week's vacation. Their plants might grow from 95 centimetres to 105 centimetres during that time. I wonder what the goal of the 100 centimetre limit is, which was also contained in the legalization task force report. Is it to reduce the amount of cannabis that each Canadian is capable of growing so they don't go on to sell it, or is it to reduce the visibility of plants grown on private property?
If it is the latter, I think this is best dealt with by municipal bylaws. If it is the prevention of diversion to the so-called black market, I would suggest that achieving this through enforced pruning is quite silly, and that the 100-centimetre height limit should be removed.
I also wanted to comment on the awkward treatment of cannabis seeds in Bill . Cannabis seeds are individually smaller than a peppercorn, weighing about 15 milligrams each and are devoid of cannabinoids such as THC. Yet schedule 3 of Bill C-45 indicates that one seed is equivalent to one gram of dried cannabis. One gram of dried cannabis may contain up to 250 milligrams of THC and is fully usable as a drug.
Bill proposes that this is equivalent to a single small seed that is not useable as a drug at all. The possession limit in public is therefore 30 seeds or about a thimbleful. Since there will be limits on the number of plants that can be grown, this equivalency factor seems very arbitrary. Cannabis seeds for the purposes of personal cultivation should not be restricted at all.
The cannabis act also makes a distinction between illicit and licit products, which also applies to seeds and plants. Under the ACMPR, our current medical regulations, patients and licensed producers may only purchase seeds and clones from licit sources, yet most of the patients choose to source their seeds and clones from the Internet, store displays, and trade with other growers. All of these are considered illicit.
Licensed producers are also under very tight restrictions on the access to cannabis genetics used for starting their commercial operations. As any plant breeder will tell you, genetic diversity is important. The genetic diversity of cannabis is important for its future breeding and improvement.
We need to make sure that the regulations—I respect the fact that this may not be in the act itself but in regulations arising from it—need to allow broader access to sources of cannabis genetics without criminalizing growers who use their own heirloom seeds as starting materials.
On the commercial side, licensed producers also need to access a rich supply of cannabis genetics, which now exists in Canada and around the world.
I have a brief comment on quality-control testing. My laboratory in Vancouver does a lot of this work. Cannabis can be safely grown at all scales, and the cannabis produced by home-growers is no more dangerous than the tomatoes, basil, and lettuce that others grow at home. There are always hazards inherent in gardening, and careful application of fertilizers, manure, and pest control products is always advisable. That said, allowing everyone access to accurate quality-control testing by certified testing labs will help to ensure the safety of the product. This is currently the case for patient growers under the ACMPR, and access should be continued and expanded under legalization.
The last point I'd like to make is from my perspective as a scientist who has done research on cannabis for many years. My request to the government as legalization and regulations are crafted is to allow our scientists to work on cannabis. Cannabis is a plant that in many ways has been left out of mainstream science because of prohibition and restrictions on research. As far as I know, there are currently no Canadian university labs licensed to grow drug-type cannabis or marijuana. So we have more than 200,000 authorized patients as well as 56 or 58 licensed producers, and yet our universities are lagging behind.
On Monday in this panel, Dr. Mark Ware made a strong statement about Canada's leadership in cannabis research from plant science to clinical trials and epidemiology. I echo his thoughts and add that if we allow cannabis to be grown in our homes and sold in our stores while keeping it out of our university, government, and private-sector labs, then we will not maximize the benefits and reduce the negatives arising from legalization.
Mr. Chair, I conclude by saying that I support this bold policy move. The time for legalization has come. Bill is not perfect, but I am sure your committee will recommend changes for improvement.
Thank you very much.
Good morning. As a lawyer, it's always hard to confine oneself to 10 minutes; I'll do it.
To use the metaphor yesterday of travelling on the plane, I've been on this plane for almost 45 years. There have been a number of times when I thought we were going to run out of gas, with various other proposals that have come up in that 45 years, but I think we are coming in for a good landing. It's certainly not a perfect landing, from my point of view, but I think it's going to be a safe landing. We will have some bumps, obviously, along the road.
My experience with this started not long after I was called to the bar in 1972, when the interim Le Dain commission report was tabled. It recommended that the government hybridize, create summary conviction and indictable offences for trafficking back then. It's only just being proposed now, some 45 years later. It recommended the maximum penalty be five years imprisonment, not 14, as you are proposing now, some 45 years later.
In terms of the public education issue, there are studies that go back to 1894, the Indian hemp drugs commission, and you can take seven or eight royal commissions that led up to Le Dain before that. There is more information out there about cannabis than any other drug, if you want to use it for public education, which I understand is one of the concerns.
I was born in Montreal, but after a couple of years, my father, who got a degree in agriculture from McGill, went out to the colonies, so I grew up in central Africa. It wasn't long before I realized that some of the Africans smoked something called dagga, which was cannabis. Years later, my father told me that if he saw a marijuana plant up in around the tobacco plants, he would pull it up and throw it on the ground, as he was a consultant on the growing of tobacco.
I grew up in a situation where there wasn't this concern about cannabis as a problem. When I came back to Canada and started practising law in the early seventies, it wasn't long before I was in front of judges who would drink booze after court and pop Valium, but they would actually sentence people to prison for simple possession of cannabis and lecture them about it. The hypocrisy of what was going on, at that period of time, was something that certainly motivated me, in terms of the cases I was doing.
In those early days, we didn't have people growing marijuana. The market was coming in from Los Angeles, as Arlo Guthrie said, or we used to get it from Thailand, Colombia, and so on. They were all big import cases. It was only over time, with the ingenuity of Canadians, people figured out how to grow it indoors and create something called B.C. Bud, which became popular. We became an export economy after we had been an import economy for years.
I can remember one of my first growing cases was a young man who decided to grow a few plants out in his yard in Clearbrook, B.C. The police didn't know how to operate their own camera, so he helped take the pictures for them. When we went to court, they were actually dragging the plants along the floor and people were scooping up the material behind them. That was in the mid-seventies. That was the nature of what was going on, in terms of the production of cannabis in those early days, which has of course changed substantially ever since.
In those early days, I used to have drug squad, other police officers, and fellow lawyers come up to me and tell me I was trying to ruin a good thing by speaking out and that saying it was crazy for us to use prohibition on this subject. Now, at least I have the police coming up to me often, saying that they hope we win. Things have changed considerably since those old days.
I was counsel in R. v. Malmo-Levine and R. v. Caine, which was the challenge to prohibition, which went to the Supreme of Canada in about 2003. I incorporated the BC Compassion Club Society about 20 years ago and it's had senators, members of parliament, and many others go through it and compliment it on the way it operates, including the recent task force. I was also counsel in Allard.
You should have a five-page summary that I put together, as well an appendix, which are the excerpts from the court on the issue that you've asked me to address, which is the household cultivation.
I should step back and give you history, which some of you are probably aware of. When the BC Compassion Club Society first started, the patients had an authorization under section 53 of the narcotic control act, which at that time authorized practitioners to give, sell, administer, or prescribe any narcotic to a patient for a medical condition that they were treating them for. That was the basis for the Compassion Club, which was checked out by the police and everything in those days, and allowed to continue.
Subsequently, there was the Parker case here in Ontario, which determined that a medically approved patient had to be given reasonable access. When the government of the day ultimately determined that the marihuana medical access regulations, MMAR, was the way to do that, and that compelled people to.... The only source was for them to grow for themselves or have someone grow for them.
While we attempted to convince the government in those days that they should allow somebody to grow more so we would have fewer grows, they said you can grow for two, instead of one. We went back to court to say we should be able to have more in one place than just one or two grows, and they said you could have four. We did make efforts to try to have people grow for more people so we'd have fewer home-grows, but the number of home-grows went to some 38,000 by March of 2014.
That was the situation we were faced with when a new government decided it would introduce the marihuana for medical purposes regulations and take away that right to grow or the designated grower, which had existed for some 10 years. We went to court and got an injunction from Justice Manson in March of 2014. That basically allowed those who had a grow licence under the MMAR to continue to do so, as long as it was valid on September 30, 2013, and their authorization to possess had to be valid on the date of the injunction, which was March of 2014.
We then continued with the case, and ultimately Justice Phelan, in the Federal Court, ruled that indeed the new regulations were unconstitutional because they failed to provide reasonable access. The evidence from the patients was that they would go to a licensed producer, maybe get what they wanted the first time, and then get on a waiting list and be waiting to receive, in the mail, their medicine, which they needed. It wasn't working.
The evidence established that the patients voted with their feet and went to the dispensaries. There were only a few of those in the early days, the Compassion Club being one of them. However, suddenly there was a huge increase in the number of dispensaries, because those people in the business of trying to sell cannabis and make money out of it figured out that this was where to go. The same then happened here in Ontario, particularly in Toronto. The surge in dispensaries occurred, and it established—I think as Jonathan Page said earlier—that most people don't want to grow for themselves or have somebody grow for them, they want to be able to go to a store to purchase and get information and not just wait to get it in the mail. That's the current situation.
I have a minute, so I'll just jump to the topic.
In the context of that case, which deals with the entitlement of medically approved patients to have reasonable access and includes their ability to grow, we were faced with the police, Corporal Holmquist, and Chief Len Garis from Surrey, vocal opponents of home-grows, going on about fire, mould, public safety, and so on. We established, as we do in trials after examination and cross-examination of the witnesses, that they lacked credibility totally. Justice Phelan found that Holmquist was totally biased and not to be credited, as was Chief Garis. We clearly established that all of these things in a legal market can be reasonably and safely done. All of the evidence they relied upon was from the illicit market, where people were cutting corners, staying underground, and not complying with anything.
Today, the inspectors I deal with in local government tell me that the last thing they want is to go back to those old days.
The big issue nowadays is not a great problem in terms of fire, electrical safety, mould, and so on. They're very easy to deal with. The most common complaint is smell, so stinking out the neighbourhood or not impacting your neighbours is the critical thing that needs to be addressed.
I want to very quickly, then, close by saying that Mr. Dickie and I managed to chat a bit before coming in. He represents the apartment owners and I support what he says in the sense that, again, you don't want to allow people to do things where they may put their neighbours at risk or impact negatively on their neighbours. But you can't just sit back and say, well, then, we're going to prohibit it, because that will not work. It hasn't worked for as long as I've been practising.
I think you're going to have to look at Washington state community gardens, or something. Most people don't have a dwelling-house, as the act defines it, with some land surrounding it, and so on. You're going to have to figure out something so that they'll be encouraged to do it in a safe place. We do have bloom boxes, which are engineered solutions, but most people can't afford them and they'll take up most of the apartment.
I think reasonable regulation is what we want, but we're heading in the right direction.
Thank you, Mr. Casey. I appreciate being invited to speak here, and I'm glad to do so.
As the president, I'm really the executive director of CFAA. I'm also their housing policy analyst and their government relations specialist.
Our association represents the owners and managers of close to one million rental homes across Canada. The total rental sector across Canada consists of close to four million rental homes. They range from close to one million apartments in high-rise buildings, a little under two million apartments in low-rise buildings, and then various other low-rise rental units—duplexes, triplexes—and some 525,000 single-family homes that are rented. You can drive down a street in a city and think it consists of owner/occupiers, but, in fact, depending on your city—in Toronto six or seven of those homes may be rented even though they're single-family homes, and in other cities it may be one or two or three or somewhere in between.
Let me give you a bit about me, as well, as Mr. Conroy did. I'm 61. I grew up in Montreal, and I remember the Le Dain commission. I remember how remarkable it was that the government had given Mr. Le Dain, they hoped, the job of condemning marijuana and what the young people were doing, and Mr. Le Dain and his commission came back and said that non-medical use of drugs was not the biggest problem, and that it was alcohol. It was a little bit shocking to a number of people at the time. As I've grown up, I certainly have experienced people using marijuana, and some of them use it and there's absolutely no harm whatsoever. I know a fine young man who uses it in that way, smokes it once a week, and he's fine. My daughter, on the other hand, also dated a person who was also a fine young man, except that he is now afflicted with schizophrenia, and that may have been brought on because of his smoking marijuana as a teen. There's a whole range of reaction to this and the way it works.
One other bit of personal background is that besides representing CFAA, I am by profession a lawyer. I, in fact, am one of the experts on residential tenancies law in Ontario, and with my law partner I've written one of the leading texts on that subject. So Ontario residential tenancies law I know extremely well. The residential tenancies law of the other provinces I know reasonably well as well.
I'll go back to multiple-dwelling units. Multiple-dwelling units are a living environment that is different from single-family homes. In a single-family home essentially what you do really affects only you and your family. It doesn't affect other people, whereas in an apartment, what you do very much affects other people, and affects your neighbours. That has to do with noise. It has to do with anything that produces smells in your apartment, and certainly safety in your apartment. If as a homeowner you break the rules and don't have a smoke alarm, the people you're going to kill are you and your family. If you don't have a smoke alarm in your apartment, you may very well kill half a dozen people in a building. Landlords are empowered to stop those activities that are safety hazards or that interfere with the neighbours.
It used to be that second-hand smoke fell into the category of an interference that no one could address. People just had to put up with it, but that's not the case anymore. I know we're not here to talk about smoking, so I'll leave that subject, but it is certainly a concern for our members and neighbours of people who will be consuming marijuana by smoking it as opposed to ingesting it.
The various provinces have a number of bans on smoking tobacco. I would certainly hope that they would ban smoking marijuana in those same locations, such as the common areas of apartment buildings in Ontario. But that's a provincial matter and this whole business is very complicated because of the provincial-federal interface.
Our position, as an organization, is that we would like to see more restrictive limits on growing in rented dwellings in order to protect the owners' interests and the neighbours' interests.
At best, we would see a federal ban. It probably doesn't need to be an offence subject to a term of 14 years of imprisonment, but a federal ban would be our first preference. That is because of the fire safety issues with electrical overloads, the humidity—and so, safety to the building—and certainly the smell through cultivation and its impact upon the neighbours.
That would be our first preference. However, I'm here, and all of that is set out in the submission, with information that comes from the website ilovegrowingmarijuana.com. Until 12 months ago I wasn't much of an expert on marijuana, but I certainly went to that site and found it extremely informative. I found what in law one would say are admissions contrary to interest. If the marijuana proponents say there's a problem, well, there's a problem, and they say there's a problem with smell and a problem with electrical, and they say there can be a problem with humidity.
There are ways to address those things, but they all involve changing the physical building, whereas our buildings are not built to do that, and we are not mandated typically to change our buildings to address those things, other than in the case of accommodation under the Human Rights Code for the medical users. For the medical users we may have to do certain things, but for recreational users we're not required to make those changes. At least, we never have been before this law came forward.
In terms of compromises or suggestions, as a kind of fallback position I think our members would be willing to see a regime in which growing was allowed in rented dwellings with the consent of the landlord. Then you could have landlords who had smaller buildings or weren't worried about the ventilation or had good electrical systems who could allow it. Tenants who want to grow would be able to find their accommodation there. On the other hand, landlords who aren't able to deal with this situation, who aren't willing to invest the money, and who aren't willing to disturb their other tenants could decline consent.
Beyond that, the federal legislation could enable the provinces to establish a regime to make that a practical reality. One regime would be a regime the provinces could establish in which the landlord's consent could be dispensed with. In other words, a tenant could come forward and say, “Well, landlord, you're refusing your consent unreasonably. Your building has good electrical, there is no humidity problem, there isn't this problem. My neighbours on both sides of me say it'll be fine.” Presumably, the landlord and tenant board would say they were going to dispense with consent and then provide a solution dovetailing with that. The person could then legally grow marijuana in his or her apartment, subject to size limits.
The flip—again, it could be left to the provinces to decide which way to do it— could be that the provinces establish a regime whereby, if a landlord wished to prohibit growing marijuana in his or her building, the landlord could apply, presumably to the landlord and tenant board, to say, “Listen, my building can't cope with this”—the electrical system, etc., ventilation, a petition of the tenants in the building—“so I should be allowed to prohibit marijuana”.
Again, it'll be a little trickier to do, but we have some pretty smart people in this room and pretty smart people working on this bill. I'm sure a set-up in which the provinces were able to do that fine tuning to address the problems that really do exist and that the Allard decision found would be a positive outcome.
The last thing I'd like to suggest by way of a compromise is this. We are concerned that the four-plant limit is not a sufficient limit. We've heard from Mr. Page that people should perhaps be allowed more than four plants. My concern is that if they're allowed four plants or whatever number and they go to ilovegrowingmarijuana.com, they'll soon find that you can use a screen-of-growth technique. You can put a screen across the top of your plant; as it grows up you can nip it at the top. You can bring it out and you could be filling an area from the end of this desk to past where Mr. Page is sitting or to the end of the table, full of marijuana leaves—off four plants.
Surely that's not a good thing. Surely when the government is thinking and Parliament is considering four plants, you mean four plants—a plant here and here and here—you mean about a cubic yard. We would suggest that as well as whatever plant limit there is, whether it be four, six, or whatever, there be an area-of-growth limit.
We would suggest a cubic metre because that would pretty much cover it. One, it would address Mr. Page's concern about a higher plant; and, two, it would cover a higher plant, two plants in mid-stage, and a small plant. It would admittedly be a little more difficult to administer, but no one is going to be charged with an offence with possibly 14 years of imprisonment if they're growing 1.2 cubic metres. It's going to be pretty clear, if it's more than 1.5 cubic metres, how big it is. The police can take a metre stick, put it there, and take a photograph of the plants as they're growing, and then at the end of the day you can prove in court, whoa, they had a grow area of four cubic metres, or six cubic metres, and that's way beyond the limit.
That would be my suggestion in terms of limiting the amount that is grown.
Thank you very much.
I've given this some thought. Is it that 1.5 metres or two metres would encompass the majority of plants grown now? I think that is the case, so we could double or increase that grow limit by 50%. That would likely catch or encompass more of the typical growing, including outdoor cultivation.
One of the issues is that cannabis is, in a technical term, photoperiod-sensitive, which means that it flowers when it is exposed to short days. If you're growing cannabis inside, you can make those short days occur just by the flick of a timer or a light switch and force it to flower at 60 centimetres, or 80 centimetres, or a metre or more.
Outside, on the other hand, the day length is, of course, determined by the season. With outdoor cannabis production in Canada now, the flowering starts in August and it might continue through September. Depending where we are in the country, in fact, harvest might be some time around Thanksgiving. What's happening during those long Canadian summers is that the plant is getting quite tall. If we allow outdoor cultivation for typical climates in Canada, we might be approaching a two-metre plant height, or even a little taller, by the time flowering occurs.
Of course, as I said, you can enforce pruning, and people can bend their plant down, or something. However, in general, if you have a limit, a plant number limit, if it's four flowering plants and a few more to tidy up the gardening issues as I suggested, that can be the limit. In terms of what people do within those four plants, if it's 1.5 metres or two metres, or even 2.5 metres, I'm not sure we should be that concerned also about the 100 centimetres or a height limit.
The task force came up with the suggestion of 100 centimetres and I was puzzled why that was. I think it had a lot to do with screening plants in cultivation in people's backyards. The height of a typical fence in Canada is about four feet, by city bylaw, and that would screen out those plants at 100 centimetres. As I indicated in my submission, allow the cities to enact those bylaws. I would just toss out the plant height restriction.
I live in the cocoon of British Columbia, where people haven't been charged with simple possession for a long time; the police just seize it. You still see a lot of charges but rarely convictions, unless it's something more than simple possession. In my practice, I don't get anywhere near as many cases as I used to in the old days, even though you haven't legalized it yet. The burden has been reduced.
However, having this maximum of 14 years, hybridized by indictment, and so on, is frankly totally unrealistic in terms of what goes on on the ground. Even in the Saskatchewan Court of Appeal, which is not known to be the most liberal court in the country, the range for trafficking, for example, is 12 to 18 months. Most sentences are up to two years. For tobacco and alcohol, all your maximums are two and three years. This 14-year thing is ridiculous, frankly, and it's problematic because it will increase the burden in the following way.
Years ago, through the sentencing commission, through Parliament here, and so on, we determined that we had to reduce the amount of incarceration because we'd just make people worse most of the time instead of really protecting the public. Therefore, why are you going to put somebody in prison, actual prison, for trafficking in cannabis nowadays? It seems ridiculous.
A judge will introduce something called a conditional sentence order. The conditional sentence order is the last step before having to put you actually in prison. Depending upon levels of denunciation and deterrence, the judge decides whether to put you in prison. A 14-year maximum, because of the 2012 amendments, prevents a judge from doing that.
What does 14 years have to do with it when the court is sitting there saying we think that up to two years is a fit sentence, but we also think you're not a danger to the community, you don't have any violence in your history or anything such as that, so we think you can serve it in the community? The judge can't do it. What do judges do, faced with that now? They'll give probation with conditions to try to structure it like a conditional sentence order.
I really encourage you to listen to what Le Dain said at least 45 years ago and reduce that to five years if you're going to keep a hybridized system.
My hope and expectation is that the cannabis consumers who I have now watched over a long period of time are going to demonstrate to you that they will be able to live under this existing proposed beginning, if I can call it that, and will not create a lot of problems, hopefully, for the criminal courts and others, that we will effectively, in practice, legalize and demonstrate to all of you that you don't need many of these limits that you're worrying about.
Good morning, honourable members. Thank you for the opportunity to make comments on Bill this morning on this important panel.
I'm representing the Canadian Drug Policy Coalition or CDPC, a non-governmental organization comprised of over 70 organizations and 3,000 individuals working to support the development of a drug policy in Canada that is based in science, guided by public health principles, and respectful of human rights.
CDPC supports the passing of Bill and the legal regulation of non-medical cannabis as a way to minimize the social and individual costs of prohibition while ensuring the cannabis policy supports public health and human rights to the fullest extent possible.
Legalizing and regulating cannabis will ensure there is adequate oversight of the complete market of non-medical cannabis including control over dose, quality, potency, marketing, and access. From decades of prohibitionist drug policy in Canada, evidence clearly and unequivocally demonstrates that criminalizing people for possessing and using drugs leads to great social and individual harms. As such, CDPC supports the legal regulation of all drugs within Canada as a route to retaking control of a dangerous, unregulated market for drugs that supports criminal organizations and puts countless Canadians at risk of criminal sanction.
We believe this is the path to minimizing infectious disease such as hepatitis C and HIV, reducing overdose and social stigma, and promoting public health and safety objectives. Similarly, we believe that evidence strongly supports decriminalizing all drugs and further improved public health and public safety.
I would like to make comments this morning on recommendations that CDPC has put forward to this committee in our submitted brief.
First, I'll address the minimum age of access. The cannabis act establishes a federal minimum age of 18 years to access cannabis with provinces having the ability to raise the minimum age as Ontario has done to align with its alcohol age. CDPC supports maintaining the federal minimum age of 18 years in the legislation.
Despite the existing system of cannabis prohibition that has been in place in Canada for decades, there remains a consistent one in three people in the 16 to 25 age range who are active users. In a UN study it was shown that youth cannabis use was lower in countries with more liberal drug policies than in Canada, demonstrating that strict enforcement policies are not a deterrent for young people.
It is unrealistic to conclude that all youth will completely abstain from consuming cannabis regardless of set age limits and sanctions against consumption. Having a minimum age that's too high will maintain the illegal market and put numerous young Canadians at greater risk than the risk to them of consuming cannabis. That approach should be rejected in favour of a public health approach that looks at the entire spectrum of risk to young people from not only the substance itself but the policies as well. Protecting youth must consider the harms to youth of engaging with illegal markets as well as the harms of consuming cannabis, a policy balance that supports a lower minimum age of access.
Second, regarding criminal penalties in youth, the cannabis act prohibits possession of dried cannabis of more than five grams by a young person, creating either an indictable or summary conviction offence, and if convicted, a sentence under the Youth Criminal Justice Act. Notably, the Province of Ontario has chosen to close even the small gap and create provincial crimes for a young person carrying any amount of cannabis.
Seeming to recognize the harms of a criminal record, the cannabis act provides in some circumstances allowances for a peace officer to issue ticketable offences to both adults and organizations. Such allowances, though, are not available to young people.
It is now well documented that a criminal record contributes to considerable social harms from limiting international travel, diminishing career and volunteer opportunities, exacerbating poverty, and leading to poorer health outcomes, creating stigma, and consuming scarce public resources.
As mentioned, evidence also supports the fact that the potential for criminal sanction is not a deterrent for adolescent use of cannabis. Instead, as was recommended by the task force, achieving the public health and safety goals of the cannabis act with respect to youth should be addressed through education and soft approaches to discourage use as opposed to criminal punishment.
Overwhelmingly, respondents to the task force took the view that the criminalization of youth should be avoided, and that criminal sanctions should be focused on adults who provide cannabis to youth, not on the youths themselves. One such approach might be found in the state of California, where the regulatory scheme provides that young people found possessing cannabis will receive non-criminal infractions, and must attend mandatory education or counselling and perform community service. CDPC recommends that youth not be subject to criminal penalties at all, and that the cannabis act be amended to substitute similar soft approaches to youth drug use, such as counselling and community service. Removing these sanctions of criminality will increase public health and safety, particularly with respect to youth, by decreasing the harm and stigma of criminalization, while still discouraging unlawful use through a balanced and realistic approach.
Additionally, social sharing, which is a common practice among young people, is something the task force recommended be allowed, but it has also been prohibited by the cannabis act through the criminalization of any form of distribution to a young person, with a draconian penalty of up to 14 years in prison. This would penalize an 18-year-old sharing cannabis with a 17-year-old friend, or a parent sharing with his or her son or daughter.
In the case of alcohol, there are clear exemptions to criminalization for adults sharing with their minor children in a private home, and all provinces regard social sharing of alcohol with far less punitive penalties than in the cannabis act. CDPC recommends that social sharing with a young person not be criminalized but rather treated in a similar manner to youth use, with counselling and community service. CDPC further recommends that adults be permitted to provide cannabis to their own minor children in a private residence, similar to alcohol.
My final point concerns social justice. Underlying the legal regulation of cannabis is the notion that our historical policies of criminalizing cannabis have led to unacceptable negative outcomes in Canadian society, including supporting a thriving illegal market for cannabis nationwide, and capturing hundreds of thousands in the criminal justice system for cannabis offences. Criminal law, though, is rarely applied equally, and cannabis prohibition has had a greater negative impact on marginalized communities, people of colour, youth, and indigenous persons. Legislation crafted to repair past policies should also aim to repair the damage done to those punished under an unjust system, including creating opportunities within the new economy and clearing past criminal records.
CDPC recommends two changes to the act to better serve the social justice aims of the legislation. First, prior drug convictions should not be the sole reason for denying a licence to participate in the cannabis economy. Paragraph 62(7)(c) allows the minister to refuse to issue, renew, or amend a federal licence or permit required for participation in the cannabis industry if the applicant has contravened the Controlled Drugs and Substances Act, or committed other drug-related offenses in the past 10 years. This would of course include any drug conviction for activities that would now be legitimate under the new regime. There is no logical reason for creating a specific ground related to drug offences in this provision, compared to any number of past offences that might make a person ineligible for a licence, such as theft or fraud. A preferred approach would be one similar to California's, where prior convictions for non-violent drug offences are actually prohibited from being the sole reason for denial of a licence.
Second, there should be clear mechanisms for those convicted of cannabis-related drug offences in the past to apply for the suspension of convictions on their criminal record, or for cases where sentences are still being served, of having these cases dismissed or re-evaluated under the new legislation. CDPC recommends amendments to the cannabis act that allow for the reconsideration of ongoing sentences and record suspensions for prior convictions.
The cannabis act is a remarkable piece of legislation that forges new policy standards regulating previously illegal substances.
It is important that these new standards be centred on evidence, public health, and the well-being of Canadians young and old. Thank you.
Good morning, Mr. Chair and committee members. Thank you for the invitation to present to you today.
I will preface my comments this morning by noting that, throughout my remarks, my references to cannabis use relate to recreational use, not the use of cannabis for medical purposes.
On behalf of the Canadian Public Health Association, I am pleased that the Government of Canada has committed itself to a public health approach to the legalization and regulation of cannabis. We are further pleased that Bill does in fact embody such an approach.
Different from the publicly funded health care system, public health is the organized efforts of society to keep people healthy and to prevent injury, illness, and premature death. As such, a public health approach is based on the principles of social justice. It pays attention to human rights and equity. It is based on the evidence, and it addresses the underlying determinants of health. A public health approach is organized, comprehensive, multisectoral, and it emphasizes pragmatic initiatives.
As a colleague recently noted, in some ways public health is like that darling child who's always asking, “Why?” In the case of cannabis, we want to know why people use it, so that we can develop policies and interventions that meet their needs. The human relationship with cannabis ranges from abstinence to a spectrum of consumption. This spectrum ranges from beneficial to non-problematic, to potentially harmful use, to the development of use disorders. At the federal level, the legal and regulatory response to cannabis needs to be sufficiently broad to encompass the entire spectrum of consumption, while at the provincial and territorial levels, the response begins to narrow to meet the particular needs of each jurisdiction. Then at the regional or local levels, the response is honed to the specific needs of particular populations.
There has been considerable discussion and unfortunately a lack of consensus regarding the appropriate legal age for the possession of cannabis. The Canadian Public Health Association supports the provisions in Bill establishing the minimum legal age at 18 and allowing provinces and territories to set a higher age, as appropriate, in their jurisdictions. From a practical perspective, it is important and appropriate for provinces and territories to establish a legal age for cannabis consumption that matches the legal age for alcohol consumption. In that way, confusion should be reduced and education efforts can be better coordinated.
While we would prefer that no Canadian use cannabis or any other psychoactive substance, a public health approach recognizes that cannabis will be consumed for a number of different reasons, regardless of efforts to discourage it. You are already familiar with the statistics: 12% of the general population, 21% of youth aged 15 to 19, and 30% of young adults aged 20 to 24 reported in a 2015 survey that they consumed cannabis in the previous year. Since more than one in five youth aged 15 to 19 are consuming cannabis now and we have no reason to believe that rate will change, the responsible policy option is to create a legal and regulated market for cannabis that is accessible to adults 18 years of age and older.
Bill will establish a supply of cannabis of known potency and quality. Currently, anyone consuming cannabis is playing a game of Russian roulette, never knowing the product's quality before consuming it, or if it has been laced with other, more powerful psychoactive substances. From a public health perspective, the Canadian Public Health Association is encouraging provincial and territorial governments to limit the sale of cannabis to government-controlled entities to ensure that the focus remains on harm reduction, not profit.
The prohibition model currently in place in Canada has severely hampered health promotion and harm reduction efforts. The only message we had at our disposal was, “Just say no”, and clearly that has failed. Beyond simple health education, health promotion is the process of enabling people to increase control over and to improve their health. It is our view that legal cannabis sales must therefore be preceded by comprehensive, non-judgmental, non-stigmatizing health promotion campaigns across Canada that have a clear and consistent message. These campaigns must be supported on an ongoing basis and should be complemented by in-person health promotion and harm reduction messaging at the point of sale. We need to normalize the conversation about cannabis, not its consumption.
There are concerns that the legalization will result in significant increases in cannabis use, especially among young people. While the Canadian experience may be different, two recent reports from Washington state both indicate that youth cannabis consumption has remained stable since legalization in that jurisdiction. One of these reports, however, indicates an increase in older adults' cannabis use, while another indicates an increase in the number of people who consume cannabis daily or near daily.
These early reports out of Washington remind us that we need to pay attention to the entire population, with a particular focus on why certain individuals go on to potentially problematic use.
Concerns have also been raised about the impact cannabis consumption has on the developing brain. While the studies quoted are important pieces of the research puzzle, they focus on young people who are daily and heavy cannabis users. I think we can all agree that if a child is consuming a large amount of cannabis on a daily basis, there is a cause for concern. If a child were drinking alcohol heavily on a daily basis, there would be a similar cause for concern. Once again, from a public health perspective we want to know why that child is consuming heavily and daily; then we can focus our interventions accordingly.
At the moment, we lack robust data on the health impacts of casual use of cannabis and we hope that legalization will allow research on that issue to take place. Having understood that people are going to continue consuming cannabis for various reasons and in various amounts, it is crucial that our policies and interventions focus on harm reduction efforts. Harm reduction can take many different forms, including ensuring a product of known potency and quality; effective education and health promotion activities; ensuring that consumers and health and social service providers know about safer consumption methods; and adopting and promoting the lower-risk cannabis use guidelines.
I understand that you have a panel dedicated to that subject later today, so I won't go into these guidelines in detail but I will say that they are an important tool that should be adopted in all jurisdictions.
The Canadian Public Health Association does have one recommendation for an amendment to Bill that I believe one of your witnesses mentioned yesterday. As it currently stands, subclause 10(5) of the bill will result in the crime of possession for the purpose of selling becoming an indictable offence punishable by up to 14 years in prison for those convicted, including young people between the ages of 12 and 18. Clause 8 concerning possession and clause 9 concerning distribution provide similar sentencing options for people over 18 years of age, but permit referral to sentencing under the Youth Criminal Justice Act for those between 12 and 18.
The Canadian Public Health Association's viewpoint is that an option for sentencing under the Youth Criminal Justice Act for young people should also exist under subclause 10(5). In many cases these offences are related to possession for sale by young people to their peers, and the stigma established by such a conviction may cause irreparable harm to their futures, outweighing the actual offence. Care should be taken to apply the proposed rules concerning possession for the purpose of sale to reflect the severity of the crime.
You have also heard calls that we are not ready for legalization. Unfortunately, we don't have the luxury of time, as Canadians are already consuming cannabis at record levels. The individual and societal harms associated with cannabis use are already being felt every day. The proposed legislation and eventual regulation is our best attempt to minimize those harms and protect the well-being of all Canadians. Our first efforts may not be perfect, but perfection is not required as we can modify our approaches as we learn from our experiences. At the end of the day, we all want to do the right thing for the broad range of Canadians who already consume or may choose to consume cannabis for a variety of different reasons.
The Canadian Public Health Association believes that Bill and provincial responses such as Ontario's are steps in the right direction. Key lessons learned from jurisdictions that have travelled this road before us include the following: regulators must have the flexibility to adapt to changing conditions in the marketplace; upfront investments in education and health promotion are essential; law enforcement and public health need to work together; and the interests of the private sector cannabis industry are rarely aligned with the interests of public health.
Dear members of the Standing Committee on Health, I'm an adolescent medicine specialist and associate professor of pediatrics at McMaster University. Thank you for the invitation to speak as a representative of the Canadian Paediatric Society on Bill , specifically regarding the age of legal possession and the impact on young Canadians of the legalization of cannabis in Canada.
I have submitted a summary of the CPS statement on cannabis and Canada's children and youth for your reading. My goal today is to ensure that you have up-to-date scientific information regarding the impact of cannabis use on young Canadians, including young toddlers, and to discuss our society's stance regarding the age of legal possession.
First, there can be no doubt regarding the scientific literature that cannabis use prior to the mid-20s is associated with structural, functional, and harmful effects on the developing brain, as has been borne out in many peer-reviewed studies. There are rigorous studies demonstrating a relationship between regular cannabis use in youth and the increased risk of approximately 40% of developing a psychotic episode. We know that early use, higher doses, and frequent use all contribute to this risk, in addition to other predisposing factors for developing a psychotic illness, such as family history.
There are also studies demonstrating a relationship between regular cannabis use and clinical depression, though results are not as robust as for the psychosis relationship. There are studies indicating that youth with certain anxiety disorders are at increased risk for developing problematic cannabis use that can inevitably interfere with their everyday lives.
Strikingly, one in six adolescents who experiment with cannabis goes on to develop cannabis-use disorder, a psychiatric illness similar to alcoholism, where the drug use interferes with multiple areas of functioning. This can include academics, social and family relationships, and extracurricular activities, all areas that require rich development during the teen years in order to leave them well equipped for life.
For all these reasons, there is no safe age for experimentation with cannabis, and we recommend that young people not consume it. However, adolescence is a time of experimentation. We know that Canadian youth are experimenting with cannabis at the highest rate compared with other countries around the world. The proposed legal cannabis industry in Canada has raised a dilemma regarding the most appropriate age for its legal use, which should minimize harm to children and youth, our most vulnerable population.
On the one hand, prohibiting cannabis until the mid-20s would protect adolescents during a period of critical brain development. On the other, adolescents and young adults are already experimenting frequently with marijuana. Aligning the legal age for cannabis use with that of other legally controlled substances, notably alcohol and tobacco, would help ensure that youth who have attained age of majority have access to a regulated product with a known potency. Also, they would be less liable to engage in high-risk, illegal activities to access cannabis.
Of emerging concern in the United States and in Europe is the number of accidental ingestions of edibles by the toddler age group. Perhaps we all know that edibles are marijuana-infused food products that come in various formats, including cookies and candies. These are highly attractive to young children and often indistinguishable from regular candies, chocolate bars, or baked goods. In Colorado, rates of unintentional ingestion in children less than nine rose by 34% after the legalization of cannabis. More than a third of those cases required hospitalization in a pediatric critical care unit because of overdose symptoms. Most commonly, the toddlers could not breath on their own.
A study from France published this month demonstrated a threefold increase in young children, mostly toddlers, requiring pediatric emergency care presenting with coma and seizures secondary to accidental cannabis ingestion.
Because of the aforementioned concerns, I would urge your committee to consider the following CPS recommendations so that as a society we are able to protect those who are most vulnerable.
First, enact and rigorously enforce regulations on the cannabis industry to limit the availability and marketing of cannabis to minors. These regulations must prohibit dispensaries from being located close to elementary, middle, and high schools, licensed child care centres, community centres, residential neighbourhoods, and youth facilities. Mandate strict labelling standards for all cannabis products, including a complete and accurate list of ingredients and an exact measure of cannabis concentration. Mandate package warnings for all cannabis products, including known and potential harmful effects of exposure, similar to cigarettes, including childproof packaging. Mandate and enforce a ban on the marketing of cannabis-related products using strategies or venues that attract children and youth, such as edibles.
Second, adequately fund public education campaigns to reinforce that cannabis is not safe for children and youth by raising awareness of the harms associated with cannabis use and dependence. These campaigns should be developed in collaboration with youth leaders and should include young opinion leaders.
Finally, send a strong message to the public that cannabis has neurodevelopmental risks by considering limiting the concentrations of THC in cannabis that 18- to 25-year-olds can purchase legally.
Thank you for the invitation to speak to the House of Commons about this very important act, the issue of youth use, the age for legal possession, and the impact on our young Canadians.
Cannabis prohibition has been an abject failure. As the executive director of EFSDP, I want to see educational policy and reform come from a place of progressive change, where students, parents, teachers, health care professionals, and mental health providers work together to provide a quality of schooling that reflects a place where what is learned is lived and is based on solid scientific evidence, and where truth matters.
More and more, for a variety of reasons, it has become society's role to educate, and to provide support for parents and children. Educators have a responsibility to be esteem-builders. Bill has some good intentions, but the cannabis act will not prevent youth from using cannabis. It should not subject them to further harms from the law itself.
Educators understand that despite its increasing ubiquity, research suggests that young people's attitudes towards cannabis are ambiguous. Many have conflicting positions and negative attitudes towards its use. This is not surprising considering the complexity of the substance. Unlike alcohol and tobacco, two substances almost exclusively limited in purpose to recreational use, cannabis can be used both recreationally and medically, although the line between the two is blurred.
To increase the understanding about the issues cannabis can pose to the health and well-being of young people, drug reform educators believe we should be educating them not only about the substance's possible negative effects, but also its positive ones. This can be achieved using evidence-based, unbiased, and holistic information, where truth matters.
The ubiquity of cannabis is a major health issue. Youth need to gain factual knowledge about cannabis so that they are able to make informed decisions about cannabis and its use in order to mitigate possible harm. We agree with the task force that 18 is an appropriate age for legal use. However, some EFSDP members agree with the 2002 Senate report that 16 is also appropriate.
As a society, we need to remove many misconceptions that are perpetuated by eight decades of prohibition. Educators must find common ground. As some people continue to push the prohibitionist agenda, educators are becoming more aware that teens are more at risk from alcohol, pharmaceuticals, and opioids. Neuroscientist Marc Lewis wrote a book called Memoirs of an Addicted Brain. He discusses in detail how cannabinoids are natural brain chemicals. I quote:
The cannabinoid receptor system matures most rapidly, not during childhood, not during adulthood, but during adolescence. So it wouldn't be surprising if cannabinoid activity is meant to be functional during adolescence, more functional than any other period of the life span. As far as evolution is concerned, adolescents might well benefit from following their own grandiose thoughts, goals, and plans. By doing so, and by ignoring the weight of evidence - on sheer inertia - piled up against them, they would greatly amplify their tendency to explore, to try things, to imbue their plans with more confidence.... The evolutionary goals of adolescents are to become independent, to make new connections, and to find new territory, new social systems, and most of all, new mates. The distortions of adolescent thinking might be precisely posed to facilitate these goals.
Adolescents ignore most of what parents think, most of conventional wisdom, and are spellbound by their own ideas. They follow chains of logic that nobody else finds logical, and voice excessive allegiance to their own predictions about how things will turn out. Even when they're not stoned, adolescents live in a world of ideation of their own making and follow trains of thought to extreme conclusions, despite overwhelming evidence that they're just plain wrong.
In 2001, I was offered a position as a first nation administrator in northern British Columbia. Not only was this experience life altering, but it was one that made me realize how ordinary Canadian educators and citizens have no idea what misfortunes, tragedies, and adversities many indigenous young people experience by the time they reach adolescence, how many deaths, what abuse they endure, and what despair they feel. I met Dr. Maté, a well-known drug addiction expert and author of In the Realm of Hungry Ghosts and Hold On to Your Kids.
He said, about the despair first nation youth feel, the self-loathing plagues them, the barriers to a life of freedom and meaning they have to face, that it is the educator who must always remember this: Don’t ask why the drug, ask why the pain.
At the core of unresolved traumas passed from one generation to the next, along with social conditions that induce further hopelessness, I witnessed untold, multi-generational traumas in several aboriginal communities. Native history resonates in aboriginal youth with their brilliant art, their dances, their music, and their wisdom. Maté said when educators see their first nation peers, they witness “their humanity, grandeur, unspeakable suffering and strength”.
Cannabis law enforcement has been shown to be racially biased. The “from school to prison pipeline” is real. Jail cells cannot be the new classroom. Our aboriginal youth are suffering. We must stop targeting marginalized people of colour, and we must learn to understand trauma and its multiple impacts on human mentality and behaviour. I agree with Dr. Maté that “the best-meaning people can unwittingly re-traumatize those who can least bear the pain and loss”.
EFSDP's goal is to promote an alternative to failed, punitive drug policies. As hard as we try, we will never convince 100% of youth to say no 100% of the time. If we can clear up the underlying problems, there will be less incentive for young people to use drugs as a way of coping with the stresses they face.
Thank you, and I welcome your questions.
Hello. My name is Paul Renaud. I'm very thankful for the opportunity to be here today.
While my wife Judith was principal of the band school in Bella Coola, B.C., I was hired by the Nuxalk Nation as their EDO or economic development officer. As EDO I had the chance to meet many locals and hear their stories. It soon became clear that there was not much job opportunity there, and many people were living on social assistance, even as alcohol and drug use seemed ramped up, particularly as pharmaceuticals were paid for by the government and children were also medicated under doctors' orders.
One day I decided to go to court, which was being held quarterly in the basement of the band administration building. I was astonished and dismayed by how much of the court's time was being taken up by cannabis offences and how many of the plaintiffs were young, in their teens and twenties. It seemed a cruel use of the judiciary. At the same time, it was clear to me that cannabis was being used by many in the community to help avoid alcohol, but because of the risks of having consumed cannabis, people were reluctant to talk about it.
Because cannabis shows promise in treating a wide variety of ailments, it will, like pharmaceuticals, be prescribed to children to be administered in schools, just like other drugs. This context provides the basis for some very important education about cannabis: it is primarily medicine.
As has already been noted by many, the line between recreational and medicinal use is not clear. Gabor Maté's definition of addiction is any behaviour that has negative consequences that one is compelled to persist in and relapse into and crave despite those negative consequences. With this in mind, the possibility of any person's—including a young person's—using cannabis to avoid alcohol or other more harmful drugs and having a positive outcome may not fit the definition of addiction and certainly should not be considered an offence. Youth cannot be criminalized for alcohol possession. What sense does it make to criminalize them for cannabis?
There seems to be mounting evidence, which some may call anecdotal, that cannabis is useful in avoiding other, more harmful substances. I've heard people say that this is not really quitting, just switching one drug for another. While that may be somewhat true, the principle of harm reduction is sound, and wherever abstinence may not be achievable, a reduced use of a more harmful substance may be a positive outcome.
The average age among first nations people is very young compared with the rest of Canada. Any laws or public health policies that affect young people will affect first nations youth disproportionately, just as incarceration rates also show.
The Government of Canada, led by , has indicated a willingness to engage with first nations in a deeper, more meaningful, and productive way. Because nations are so plagued by substance abuse issues and already have many people using cannabis, they may benefit—
Mr. Chairman and distinguished members of the committee, Portage, of which I'm the president, has been in existence for nearly 50 years, treating adolescents, adults, pregnant addicts, mothers with small children, indigenous communities, and mentally ill drug dependents, and has provided in-prison programming and programming in some 15 other countries. Portage is here today not to debate the merits of legalizing marijuana but rather to register our concerns about the collateral impact of Bill on youth in general, and substance-abusing youth in particular. We will offer some recommendations on how these risks might be mitigated.
This past April, Health Canada released a paper that reported that marijuana is an addictive substance with significant possible impacts on both mind and body of the users, and that continued frequent and heavy use is likely to cause physical dependency and addiction. Anthony reported that, using DSM-IV criteria, between 8% and 10% of adult users, and 16% of adolescent users, fit the cannabis dependency criteria. As a further risk factor, future lung cancer in heavy cannabis users of military conscription age in the United States is discussed by Callaghan, Allebeck, and Sidorchuk in their 2013 work. The American College of Pediatricians, in an article entitled “Marijuana Use: Detrimental to Youth”, of April 2017, reports a number of studies on potential causal relationships between heavy marijuana use and a number of non-infectious illnesses such as long-term impacts on the cardiopulmonary system.
Aside from these risks caused by heavy marijuana use, there are also a number of studies described by the American College of Pediatricians showing associations between chronic marijuana use and mental illness. The findings suggest that people who are dependent on marijuana frequently have comorbid mental disorders, including schizophrenia. Some of the studies cited found nearly a 50% increase of psychosis among cannabis users versus non-users. The authors are describing the consequence of heavy, persistent use, but Portage wishes to remind the committee that 16% of young users can be described as such. It is the protection of this significant, highly vulnerable minority that is the focus of Portage's presentation today.
While the proportion of dependent, heavy users to casual users might remain the same, the size of these groups is expected to grow dramatically as a consequence of legalization. In examining some of the evidence since 2007, there has been an increase in marijuana use among young people in the United States attributed to limited legalization and the diminishing perception of drug risks. As of 2014, the number of users aged 12 and up has increased from 14.5 million to 18.9 million. In the United States, 7.3% of all admissions to publicly funded drug treatment facilities were of persons aged 12 to 17. The prevalence of usage among young people is therefore noteworthy.
A study evaluating the impact of the legalization of marijuana in Colorado found, in the area of traffic offences, there was a 45% increase in impaired driving between 2013 and 2014, and a 32% increase in marijuana-related motor vehicle deaths. By 2013, marijuana use in Colorado was 55% above the national average among teens and young adults, and 86% higher for the age group 25 and over.
The American College of Pediatricians maintains that marijuana legalization will result in increased adolescent usage, addiction, and associated risks for them. Age-specific data on Colorado cannabis use compared data from two years before to two years after legalization for the age groups 12 to 17, 18 to 25, and over 26. The increases were 17% to 63% higher, while national averages for the same group remained the same or lower. Callaghan, in 2016, cited calculations of the approximate number of cannabis users in Ontario population groups below and above age 25 for 2013 and found that adolescents, young adults, are disproportionately represented among cannabis users.
Research suggests that existing alcohol and tobacco control measures are not likely to prove to be good models for controlling youth access to cannabis after legalization. Despite existing regulations banning distribution or sale to minors, alcohol continues to be widely used by Ontario students at all levels.
The evidence for driving under the influence for those 19 and under is very disconcerting. Up to 18% of those involved in fatal accidents between 2000 and 2007 tested positive for alcohol, drugs, or both. The numbers for those reporting driving under the influence of alcohol or cannabis is similarly high, and those reporting to be passengers in a car driven by someone under the influence are even higher.
As mentioned earlier, the findings of the Colorado data for cannabis-related driver fatalities after the broad commercialization of medical marijuana underlie the concern. In Colorado, experience in restricting access to medical marijuana failed. Of the 12- to 17-year-olds who enter drug treatment programs, 70% to 72% do so primarily for marijuana addiction. Among those, 74% reported using someone else's medical marijuana.
So here we are, on the threshold of legalization, discussing permissible age and denying access through regulation to minors. Something's not right with this picture.
First and foremost, there is the messaging. Marijuana is not a harmless substance. Adolescents are heavily involved with its consumption, and age restriction and control of legal distribution is not likely not to deter them or their suppliers from continuing their practices.
Hopfer, 2014, suggests that in the United States the Surgeon General's 1964 report declaring smoking as harmful may have been the most important substance abuse intervention. It resulted, with the aid of public health stakeholders, in triggering a shift in public perception of smoking followed by a steady decline in smoking. Portage fears that the current message surrounding recreational use, and Bill in general, will produce the reverse phenomena. Has telling adolescents “wait until you're old enough” ever dissuaded the majority of them from doing anything?
I must raise the question of who benefits. There is an assumption that legalization will create a windfall of revenue for the public purse like that from alcohol, which will support an increase of expensive public health education and programming. A finding by Rehm et al. in 2007 suggests the inverse may prove to be true. Their findings suggest that social and economic costs generated by alcohol consumption may possibly be greater than the revenue derived from the production and sale of alcohol. Is there any reason to believe that this will not also be the case for legal cannabis sold through government monopolies?
Portage fails to understand how policing costs would diminish. Under legalization, importation, production, and trafficking would continue to remain criminal offences and would still result in policing and court costs. The same principle applies in other areas. Shifting the debate to age of access and mode of distribution may have clouded the challenges facing our society and our young once the act is implemented. We need to have serious thinking devoted to protecting the at-risk young people, who will continue to become dependent, perhaps in greater numbers.
In terms of recommendations, because we are dealing with a high-risk situation with important consequences for a significant number of vulnerable young Canadians, we cannot proceed with a trial-and-error approach. We have to get it right the first time.
The federal government, as the drafter and promoter of Bill , must ensure that all the provinces have sufficient resources both financially and infrastructure-wise to adequately respond to the collateral physical and psychological health problems the bill is likely to create. The government must legislate strict minimum standards that apply in all jurisdictions and not abdicate its responsibility under the cloak of provincial rights.
We recommend that references to recreational use be eliminated; that the messaging and dialogue be changed to alert parents, educators, and employers to the possible challenges that legalization may create; and that we anticipate and provide for the needs for increase of service for non-infectious diseases.
Distribution should be strictly regulated as to age and amount purchased and should be tracked through a centralized registry. The government should examine the European example of cannabis clubs requiring memberships, on-site consumption only, minimum age, etc., as a mode of ensuring that little of the legal marijuana makes it way to the streets.
The bill should rescind the right to purchase for convicted traffickers, people with substance abuse treatment histories, people with significant acute psychiatric diagnoses, or those found to be driving under the influence.
We should invest massively in prevention, education, and treatment resources to meet the augmented demands likely to arise as a consequence of the legalization of cannabis.
Thank you, Mr. Chairman.
Thank you to all of our witnesses for appearing today.
I'm going to start with some statistics that Mr. Culbert and Ms. Grant shared: 12% of Canadians and 30% of youth are consuming cannabis. We've heard a lot about what cannabis consumers want and need, but I think, in the interest of balance for this bill, we have to look at this another way, and that is that 88% of Canadians, i.e., the majority, are not consuming. How do we protect their rights to not be exposed to increased harm, such as second-hand smoke, drug-impaired drivers, and schizophrenic and psychotic youth? Similarly, 70% of young people are not consuming cannabis. How do we protect them so they don't start consuming?
We heard some suggestions in previous panels, so I want to talk about those two suggestions and then get input from each of you on whether you think those ideas would be good.
The first is in terms of public education. We heard from Washington State, where they have about seven million people. They're spending $7.5 million a year on public education and have seen that as a great deterrent. For us in Canada with 30 million people, I would suggest that the $9 million that the Liberal government has come forward with will not be adequate or timely in order to address that. I think we need more public education, and we need it sooner.
The second suggestion is that in order to give the right message to children about how much cannabis is good for them, the legislation should say that people under the age of 18 should possess zero, but that any amount that is possessed would then be a ticketable offence instead of the language that is in here.
I'm interested to hear from all of you on whether you think either of those two suggestions are good, as well as your comments. We'll start at the left and go to the right.
In the area of public education, your first point is a great idea. We're definitely in favour of having evidence-based education at a young age about what drugs are, the various social scenarios where you might find yourself involved in drugs, the harms of drugs, and why people take drugs and report feelings of benefit or otherwise, in medical use or otherwise.
Having a discussion from a very early age based on evidence, rather than myth and scare tactics, is good. I grew up under “just say no” and the egg in the frying pan, and here I am testifying to the House committee on legalizing drugs. I don't think those messages work in the way they're intended to. Basing it on evidence and also, where possible, having young people themselves as the educators and talking about their own experience would make it more effective.
On your second point around the ticketable offence, again as Mr. Culbert said, ticketing is preferable to criminalization. In the best scenario, we would create a social framework where it's not necessarily a punitive approach against young people, but more working with them about use.
Having the floor of no tolerance, zero possession, isn't realistic. That would incentivize police to go after just minor things, hassling young people. If someone is smoking in public, it could be confiscated, and the peace officer could say, “Don't do this”, but ultimately I don't think there should be any process at zero tolerance to be effective.
Good afternoon, Mr. Chair and members of the committee. My name is Dr. Amy Porath-Waller, and I'm the director of research and policy at the Canadian Centre on Substance Use and Addiction, or CCSA.
CCSA was created in 1988. We're Canada's only agency with a legislated national mandate to reduce the harms of alcohol and other drugs on Canadian society. We welcome the opportunity to speak to you today on the topic of age for legal possession of cannabis and its impact on youth.
CCSA's subject matter expertise on cannabis is founded on the research, policy advice, and knowledge mobilization activities that have been the priority area of focus for us since 2008. Accordingly, the issue of cannabis legalization is of great interest to our organization, and we believe we are well positioned to contribute meaningfully to the discussion on Bill .
In respect of time constraints, my presentation today will be brief. CCSA submitted a brief on Bill in advance of our appearance today, and we would be pleased to cover the areas in the brief beyond the scope of youth and age of legal possession.
As many of you may already know, Canadian youth have among the highest rates of cannabis use in the world. Despite a decrease in use among youth in recent years, cannabis remains the most commonly used illegal drug among Canadian youth aged 15 to 24. Canadian youth aged 15 to 24 are also more than twice as likely to have used cannabis in the past year, as compared with adults aged 25 and older.
Youth are also at greater risk of experiencing harms associated with cannabis use than adults are, because adolescence is a time of rapid brain development. The risks associated with use increase the earlier youth begin to use and the greater the frequency and quantity they consume. Accordingly, delaying the onset of use and reducing the frequency, potency, and quantity of cannabis used can reduce this risk.
An important point that I want to make today is that when we speak of a comprehensive approach to reducing cannabis use among youth, we refer to regulatory tools, but equally important we also speak of a comprehensive, evidence-informed approach to prevention and public education. I will speak more on this latter point soon.
First, minimum legal age of access is an important component of a comprehensive approach to reducing youth cannabis use. Given the number of youth aged 18 to 24 who currently use cannabis illegally, the increased risk of health impacts must be considered alongside the risks associated with the continued use of cannabis obtained outside the regulated market.
Setting the legal limit at 18 years of age at the federal level means that young people will not face adult criminal charges for cannabis possession. Setting the age at 18 also provides the opportunity for the provinces and territories to set additional regulations that can discourage use without the harms of criminal justice involvement.
For example, the provinces may consider increasing the age of cannabis access from 18 to 19 to align with the minimum legal drinking age in most provinces. This provides a consistent message to youth of legal age that we trust them to use impairing and potentially harmful substances in a responsible way.
A second regulatory tool that is an important component of a comprehensive approach to reducing youth cannabis use is pricing. We know that youth are price-sensitive. Evidence from the alcohol literature indicates that standardized minimum pricing is an effective mechanism for reducing overall levels of alcohol consumption and that indexing—or rather, setting the price according to product potency, and in the case of cannabis by level of THC—can incentivize the use of lower-risk products. Certainly, ongoing analyses will be important to ensure that pricing maintains a balance between reducing consumption and encouraging diversion to the illegal market.
In addition to these regulatory considerations, there is also a need for a comprehensive, evidence-informed approach to prevention and public education in order to provide young Canadians with the knowledge and skills they need to make informed decisions about their personal use of cannabis. Accumulating evidence suggests that a multi-faceted approach, one that involves several components, including programming in schools, resources for parents and families, community interventions, as well as mass media, will help to maximize outcomes among our youth. A comprehensive approach to prevention and education also requires proactive and ongoing investment, as well as ongoing monitoring and evaluation to ensure that it has the desired impact.
CCSA has conducted focus groups with youth to understand their perceptions of cannabis and cannabis use. In these discussions, youth told us that they want information about risk that is linked to tangible outcomes, and they want harm reduction strategies so that they can reduce those risks if they decide to use cannabis. The evidence indicates, and we've heard directly from youth, that they want to hear both sides of the story on cannabis, both the benefits as well as the harms. To that end, education and prevention initiatives need to incorporate what we've heard from youth in order to be impactful.
We also know that youth continue to hold fast to certain misperceptions about cannabis, including the perception that everyone is using cannabis all of the time. We've also heard from our youth focus groups that while they recognize that drinking and driving is dangerous, they don't view cannabis in the same way.
We know from our focus groups as well as from the broader research literature that young people are influenced by the Internet, the media, and public discourse on cannabis. Clear, consistent, and factual information that addresses myths and misperceptions is therefore essential, to cut through the many sources and types of information and messages that youth are exposed to about cannabis on a daily basis. Such information will help to establish actual social norms that lower rather than promote the use of cannabis.
We also know from our research that youth want to receive information from sources they trust who can speak credibly about cannabis. Depending on age, this includes parents and educators, but perhaps most importantly it also includes peers. A comprehensive approach to prevention, therefore, means providing the needed training, resources, and consistent messaging for parents, educators, health care providers, coaches, youth allies, as well as peers. It also involves providing young people with the skills to critically evaluate the information they are receiving. This can include digital and media literacy.
It's also important for a comprehensive approach to include targeted messaging regarding high-risk cannabis use in order to assist young people in making informed decisions and reducing harms. This includes information about the effects of frequent and heavy cannabis use, use at an early age, use in combination with other substances—because we know youth often use other substances in combination—use by youth with mental health conditions, as well as use by young women who are pregnant.
In conclusion, regulations, prevention, and public education can work together to promote healthy decisions among youth by increasing awareness of risk and awareness of strategies for risk reduction. Effective prevention and public education requires clear, accurate, and consistent messaging that is targeted and relevant to the key audiences, and it needs to be delivered by trusted messengers.
I would like to thank the committee for the opportunity to speak today on this issue of vital importance to Canadians. I will be pleased to respond to your questions.
Thanks, Marc. As you indicated, I started in medical practice in 1972. Soon after that, I got involved in addictions because nobody else was doing it and I felt a great need.
Over the years, countless people have passed through my hands, and with great success. I've developed certain keys, certain techniques, and perhaps sharing these with you will help you to understand the dilemma we have with youthful use of cannabis. I have a certification in addiction medicine, and I hope that these practical comments will help to feed the creation of a public education program, which even has to precede the legalization.
Cannabis use in this presentation is predominantly about high-THC products. It does not include medical cannabis, which is predominantly cannabidiol or CBD. It's very important to make that distinction.
Teens often begin by using cannabis to relieve the anxiety of adolescence, naturally, and as a result of peer pressure, but beyond the recreational use, for some youngsters cannabis is a form of self-medication for an underlying disorder, either mental or emotional. The most common is attention deficit disorder, with or without hyperactivity. This provokes an anxiety and a feeling of inadequacy in youth. When they take cannabis, it calms this anxiety, but unfortunately it also diminishes their capacity for attention, compounding the problem.
ADHD and addiction are coexistent in at least 50% of cases. I can say that many of the youth I treat had an underlying ADHD problem that was not being treated. When I treat it, we get success.
Other coexistent psychiatric disorders include generalized anxiety, latent psychosis, post-traumatic stress, and bipolar disorder. All of these conditions exist in adolescence and are all too frequently missed by their treating physicians. They need to be diagnosed and treated, or otherwise the teenager will continue to self-medicate.
The parents of a habitual cannabis-using teenager and the physicians who treat them are well aware of the characteristic cognitive impairments affecting memory processing, reasoning and judgment, execution of tasks, insight, and time perception. These impairments become more pronounced with the duration and intensity of use and they require many months to resolve after stopping. A retardation of the emotional maturation process ensues, which is normally not completed, as you know, until the age of 25, in normal circumstances.
If addiction develops, as it will in a minimum of 17% to 25% of adolescent users, one also sees the features of addiction: a loss of control of the quantity of use, with the failure to recognize adverse consequences of use and craving leading to obsessional use. The withdrawal syndrome after cannabis cessation, which includes irritability, insomnia, and disorganization, lasts about two weeks. That plays a role in the difficulty of cessation.
Beyond that, the months required for the resolution of the cognitive impairment caused by the cannabis use contribute to a second phase of withdrawal as the person awakens to a reality that is entirely foreign and frightening, causing them to experience panic and anxiety, which often requires enormous support, including medication. The sort of behaviour we'll see is the 18-year-old who stops using, has not gone through his normal evolutionary growth from 13 to 18, and reverts to 13-year-old behaviour.
There are not many longitudinal studies to prove what is regularly observed and what I'm talking to you about. They are appearing, however. The National Institute on Drug Abuse in Washington, D.C. has produced considerable work—by Nora Volkow amongst others—and they've been cited elsewhere. A new study undertaken by NIDA in 2016 on the adolescent brain and cognitive development should bring more evidence to light.
A 2016 study in the U.K. looked at the pattern of cannabis use during adolescence and its link to harmful substance use later. In over 5,000 teens followed from the ages of 13 to 18, the study measured the amount of nicotine, alcohol, and illicit drug use. When they reached the age of 21, the study collated all of the data and found that the problematic use of nicotine, alcohol, and illicit drugs occurred 20% of the time in those using cannabis, and it was at an intensity at a rate related to the intensity of their cannabis use.
These are very telling studies that finally are being done. It's the sort of thing that we've perceived for years, but only now are they coming to light. Unfortunately, more money needs to be spent in order to aliment your public education program.
The rising problem of addiction to illicit substances and diverted prescription drugs in adolescents and adults directly correlates with the high level of regular cannabis use as well. Regardless of age, the vast majority of the people we treat for substance use disorder started with cannabis use in early life. Every single heroin addict, cocaine addict, and speed addict who I treat at 20, 30, 40, or 50 years of age started to use cannabis at the age of 12 or 13. In the case of teens caught up in the opioid crisis, for every teenager I see who is sniffing Hydromorph Contin, an enormous quantity of opiates, every single one of them started with cannabis. That's because of their loss of ability to discern danger.
As has been stated, adolescents will procure and use cannabis regardless of the legal restraints. With that in mind, the creation of an elaborate public education program is primordial.
Thank you, Dr. Barakett.
Canadian youth have the second-highest rate of cannabis use worldwide, which is already very problematic, this even before recreational cannabis becomes legal. Cannabis is the number two substance used by teens after alcohol, with just over one in five teens, or 21%, using at least once. However, as teens grow older, consumption rises to over one third—actually 37%—in grade 12.
Whether the minimum age for recreational cannabis consumption is set at 18, 21, or 25, it's not going to matter much if we don't equip parents and kids with better approaches to dealing with drug use. Drug Free Kids Canada has already begun prevention education campaigns, but much more will be required.
We already have produced a brochure that has been distributed, with 100,000 copies, and a multi-million dollar, multimedia national campaign to support it has been running since mid-June. It will end at the end of September and will be repeated next fall until January 2019.
A recent study has allowed DFK to assess the value of prevention to society. The lifetime cost to society of one teenager suffering with addiction is $450,000. This amount factors in health, law enforcement, and loss of productivity, but not the human cost to individuals and families.
The benefit of DFK's prevention messaging, which encourages parents to engage in meaningful conversations with their kids about drugs, has been demonstrated to have protected 700 teens from substance abuse every year. If the cost to society of an addicted teen is $450,000, then DFK's prevention education messaging has saved Canadians close to $2 billion during our six years in operation.
As a society, we need to demonstrate to our youth that there are better ways to deal with personal or mental health issues than turning to cannabis or other substances. We believe that parents can be central to changing the relationship that kids have with drugs, and we are here to educate and support them. We want to help parents build stronger resiliency in their kids to deal with the realities teens face in the 21st century.
At this point, we know about the negative consequences of cannabis. Let's make sure we provide effective education and prevention awareness strategies well before legislation occurs, with ongoing messages that are consistent and clear, to ensure that our youth are protected.
We must remind you of the government's pledge to allocate a portion of the revenues to prevention and education. This is the only way to make sure that young people are equipped to make informed decisions on a substance known to be detrimental to their health and well-being but soon to become legal.
I would like to thank Dr. Barakett, the DFK advisory council, and this committee for allowing us to present our point of view.
Mr. Chair, thank you for inviting us to present the work of the Institut national de santé publique du Québec, the INSPQ, on the legalization of cannabis. At the institute, we are always interested in sharing our expertise with our colleagues across Canada, something we did last winter with a presentation to the FPT program on the legalization of cannabis. We also hosted webinars at pan-Canadian hearings and a conference on the legalization of cannabis at the Canadian Public Health Association in Halifax last summer. We will continue to present our work today, and we hope that you will benefit from it.
The INSPQ is a parapublic body created by the Government of Quebec. It is a scientific expertise and reference centre with a mission to support Quebec's minister of health and social services, regional public health authorities and institutions in carrying out their public health responsibilities. It is in this capacity that we have presented work for many years on alcohol and tobacco, and now on cannabis. All have a rather important point in common, and we will come back to that in our presentation.
The marketing of psychoactive substances is an important part of the equation to reduce harm and prevent their use. We have been interested in alcohol for a long time in terms of its commercialization, and essentially in the history of public health with respect to tobacco and the tobacco industry. This is a public health problem that we have been trying to contain for 70 years. We have decided that our comments today on Bill will deal with these commercial issues. For my part, I will strictly present our position on the minimum age for access to cannabis, which is part of the strategy to contain marketing, and Maude Chapados will address other issues later.
INSPQ's position on the age of access to cannabis reflects a recommendation we made to the Quebec authorities, which is to set it at 18 years of age, so that it is consistent with the legal age for alcohol and tobacco in Quebec. In the next few minutes, I will try to explain the reasons for our position.
First, according to the scientific literature, we know that raising the age of access to 21 years could significantly delay the age of initiation to cannabis. It is a disadvantage for public health to have a slightly lower age of access. On the other hand, there are many advantages to keeping this age of access lower. If we assume that legalization can have beneficial effects, it would be nice to also have it benefit people aged 18 to 21 if our intent was to take a position for access at 21 years.
If you haven't followed our work, I would point out that the institute recommended that the Quebec authorities set up a non-profit distribution system. Whether it is run by the public or private sector, we have stressed that it be non-profit. Whether it is run by the government or by non-profit organizations, we want the primary mission of the system not to be to make a profit, but to prevent and reduce harm. That is the direction we've taken. So there may be disadvantages in raising the age of access to cannabis.
Assuming that our distribution system fulfills its mission of preventing and reducing harm, 18 to 21 year olds should benefit in at least two ways. The first is the prevention of use and the reduction of harm. It would have to apply to the 18 to 21 age group if we are thinking of eliminating this category of the bill.
In terms of harm reduction, we have done a lot of work on substance quality assurance, for example. We want the quality of the substances to be controlled so that they are also safe for 18 to 21 year olds. By raising the legal age of access to cannabis, we believe that this would, at least in part, eliminate access to a quality-controlled substance for this age group, which does not seem to be so appropriate.
If you understand this correctly, the age of access to cannabis is an important issue, but it is only part of a set of concerns we have at the institute about psychoactive substances, and on their marketing in particular.
I have spoken to you about alcohol and tobacco, but the reason this situation is of such great concern is the same as in the case of cannabis. In Colorado, there was intense commercialization and the impact on consumption habits could be observed, overall and by age group. That concerns us directly today. Among youth aged 12 to 17, from 2009—when cannabis was first commercialized in Colorado—to 2014, declared usage in the past thirty days rose from 10% to 12.5%. Among young people aged 18 to 25, usage rose from 26% to 31%. In other words, in the two age groups that we are specifically interested in today, declared usage in Colorado rose by 25% and 20% respectively. Yesterday, I believe, you heard from stakeholders from Colorado and Washington. In those states, there has been an impact on emergency admissions and traffic accidents involving persons whose THC level was tested. The repercussions on the health system are immediately evident.
Before concluding, I would like to point out that it is not simply a matter of age. The system established in Colorado led to intense commercialization. Based on our analysis, it is this emphasis on the commercialization, marketing and advertising of cannabis that led to the results observed.
I will now give the floor to my colleague Ms. Maude Chapados, who will speak to other aspects of Bill which, in our opinion, warrant examination.
Beyond setting a minimum age, preventing cannabis use among young people depends in large part, as my colleague said, on establishing a strict legal framework for this product, which we consider to be no ordinary commodity, as certain public health stakeholders would say.
The creation of environments where the use of psychoactive substances is not stimulated or normalized is one of the best approaches to prevention. The measures taken by the provinces and territories with regard to authorized sale and consumption sites will be decisive in creating these environments. Certain measures in Bill , however, and its subsequent regulations, will also be very important for the commercialization of cannabis, in particular among more vulnerable populations such as young people, be they under or over the age of majority.
The INSPQ would therefore like to take this opportunity today to repeat certain analyses that it presented in its brief submitted in August in order to ensure a better framework for marketing practices.
Research on commercial practices in the tobacco and alcohol industries shows to what extent sophisticated marketing strategies can affect consumption and the associated health problems. Research also shows that young people are particularly easy to influence. That is why the INSPQ is calling for an immediate ban on all forms of advertising and brand promotion, which raises four specific concerns related to youth and the bill under consideration.
First, packaging that is neutral and that provides information to allow for an informed decision on the nature of the product should be immediately required. Given that packaging is itself a tool for promoting the substance, the prohibition in clause 26 on packaging that could be appealing to young persons is neither clear nor sufficiently strong. The consultation report on plain packaging for tobacco products that was published in January 2017 should certainly be informative in this regard.
Second, promotional items should not be tolerated. Hats, socks, T-shirts and cups with hemp leaves or brands of medical cannabis on them are already popular, especially among young people, and help normalize cannabis. The display of a brand on “other things”, as provided in clause 17(6) of the bill, opens the door to branded derivative products. Once again, the prohibition intended to ensure that “other things” are not associated with or appealing to youth remains vague, and this brand promotion practice should be banned.
Third, clause 17(2) allows brand promotion in areas where minors are not permitted, which raises the same problem as packaging and derivative products. First, we know that minors often frequent such places. Young adults aged 18 to 25 are the group with the highest percentage of users. Moreover, we wonder whether the legal age should be raised. The fact that this group of young people can be exposed to advertising in bars, for instance, is inconsistent with a public health approach. This kind of promotion can not only encourage the use of cannabis, but also insidiously incite customers to consume cannabis and alcohol at the same time, which is a very high-risk behaviour, as you will agree, particularly as regards transportation safety.
Fourth, any effective strategy to regulate brand promotion and advertising should ideally include the Internet. Bill prohibits the publication and broadcast of advertising in the press and on radio and television, but is silent on measures to regulate this on the Internet. Yet it is mainly on digital platforms that youth and industry are already active, and this reality warrants particular attention in future regulations.
In short, there is reason to consider setting the minimum age above the age of majority. To the extent that the age of majority is a determinant of the age of initiation, this raises consistency issues as regards alcohol and tobacco, substances that are equally or more toxic than cannabis. Setting a minimum age above 18 for cannabis should therefore be part of a broader discussion of psychoactive substances and, indeed, of the age of majority.
In the meantime, the INSPQ maintains that certain provisions of Bill and its subsequent regulations can be amended or clarified in order to reduce the commercial promotion of cannabis to young people.
We hope that the considerations presented today will be helpful in this regard.
Thank you very much for being here today and for your presentation.
Just as an opening comment, we're at the midway point of our week of studying the bill. At the end of the day, the committee will have to go through a line and clause-by-clause review of the bill.
There were three principal objectives, in my mind, for why the legislation was brought forward. One was to get these drugs out of the hands of our youth, or at least reduce their access to it. The second was to reduce the function and role of the black market and organized crime, and to at least reduce their access to this space and the revenues from it. The third was a public health agenda, which was to ensure that the production of cannabis for consumption was done by licensed facilities so that we understand the safety of the product and the toxicity or the dosage of the product as it's being prepared.
Most of the presentations we've heard seem to be in agreement with the legislation, but they are in disagreement about how the balancing of those three objectives takes place, particularly the first one and the second one, so I want to tease it out a bit more.
For instance, Dr. Porath, I didn't hear it clearly today, but I think that in the past you've had a recommendation that a standardized minimum pricing to reduce consumption would be a recommended strategy, a sort of national minimum pricing, right? If that's not the case, I apologize, but I understand that's something you guys have said. You get to the point, then, where organized crime knows exactly the lowest price their competitors will go to, so they can do a price thing.
We've heard from other witnesses that if the licensed market doesn't produce the variation in drugs, including in even some of the most distilled or high-potency products, youth will seek them out. Again, it leaves that window open for the black market to offer alternatives and to showcase with packaging and whatnot.
Could you speak a bit to that balance? I understand that from your perspective a particular health focus can lead us down one path, but then it opens up this other competitive window of black market access, which we're also trying to deal with. It's the duality of the act. Can you talk about your views and how you would see those better balanced?
I'll call our meeting number 66 back to order.
Now we have a panel here to discuss prevention, treatment, and low-risk use of cannabis. We welcome our visitors by video conference and those who are present.
I'll go through an introduction.
As an individual we have Gabor Maté, retired physician, by video conference from British Columbia.
Then we have, from the Centre for Addiction and Mental Health, Benedikt Fischer, senior scientist, Institute for Mental Health Policy Research. Hopefully we also have Bernard Le Foll, medical head, addiction medicine service, by video conference from Toronto.
Do we have him?
I don't think we have him. We have an empty chair.
From the City of Toronto we have Eileen de Villa, medical officer of health, Toronto Public Health.
Thanks very much for coming.
As an individual we have Sharon Levy, director, adolescent substance abuse program, Boston Children's Hospital, by video conference from New York.
Welcome. Thanks for taking the time to help us with this.
From the Ontario Public Health Association we have Michelle Suarly, chair of the cannabis task group, and Elena Hasheminejad, a member of the cannabis task group.
Welcome, and thanks very much.
We're going to open with 10-minute opening statements. I understand that some of you are splitting your time, but we'd like to try to keep it to 10 minutes.
I'm going to offer Dr. Maté, retired physician, to open up with a 10-minute opening statement.
If you would like to, give us an idea where you stand.
Thank you for including me in this conversation. It's a pleasure to be here.
I worked for 12 years in the Downtown Eastside of Vancouver, which I think is notorious throughout North America as the continent's most concentrated area of drug use; and right now I travel extensively internationally to speak on addiction and related issues.
In terms of cannabis, first of all, I welcome the legislation that's going to bring some rationality to the policy around this substance. Drug laws in general—and I'll refer to that later—are quite irrational, in the sense that they have no connection to logic and very little connection to science whatsoever.
When it comes to marijuana, it's a substance that's been around for a long time. I think the first archaeological evidence of its use by human beings goes back 4,000 years, and it was first mentioned in a medical compendium published in China in 2,700 BC, so that's how long its use goes back.
In modern times, it was well known to the British in India, where physicians studied it and found it to be helpful in tempering nausea, relaxing muscles, and treating pain. As a matter of fact, Queen Victoria herself was prescribed marijuana for menstrual cramps, so the medical use of the substance and what you might call its recreational use go back a long time.
In terms of its addictive potential, it's just a misbelief that the plant is either in itself addictive or that it's a gateway plant for other addictions. If there's a gateway substance to addiction, it's tobacco, because most people who end up addicted to anything have used tobacco first. But it's not a question of gateways. The fact about any substance, whether it's marijuana, heroin, alcohol, food, or stimulants like cocaine, is that most people who try it even repeatedly never get addicted, but a minority will.
The question always becomes whether the substance is addictive. The answer is yes or no. In itself, nothing is addictive, and yet potentially everything is addictive. Whether something becomes addictive or not depends very much on the individual susceptibility. Now those susceptibilities may be to some extent genetically determined, but for the most part I don't think that's where the answer lies. I think fundamentally that substances that people use serve a function in their lives.
If you take the case of ADHD, for example, it's well known that kids with attention deficit hyperactivity disorder are more likely to use marijuana. Why? Because it calms the hyperactive brain. Very often addictions are self-medications; they begin as self-medications.
Marijuana also soothes anxiety. Now does that mean therefore it's benign? Not necessarily, because some people will start to self-medicate and they start using it to the point that now it creates a problem in their lives. Now it's an addiction. So the question of a substance being addictive is not to do with the substance itself, but whether or not a person uses it to the degree that creates a negative impact on their lives. Like any other substance, marijuana can do that, so it's neither true that it's addictive, nor is it true that it's not addictive. Again, it's a very individual matter, and the question is how we approach that.
First of all, we have to approach it rationally. This may be shocking or surprising to non-medical personnel, but legal substances like tobacco and alcohol are medically far more harmful than almost any of the illegal substances. For example, if you take 1,000 people who are heavy smokers or heavy drinkers and compare them to 1,000 people who use heroin in a non-overdose amount every day, and you look at those people 10, 15, or 20 years later, you will see that there's going to be much more disease and death in the alcohol and tobacco users than amongst the heroin users. This is especially true for marijuana.
Long-term studies show that over time marijuana users just don't suffer significant consequences, with one significant exception, and I hope the committee takes this into account, which is that there's a very persuasive study out of Britain that showed that if adolescents use marijuana extensively during the period of brain development, that can actually have deleterious effects on their long-term psychosocial and cognitive functioning. In other words, while it's true that marijuana is not as harmful as the already-legal substances of tobacco and alcohol, it's also true that if it's used extensively during the stage of brain development in adolescents, it can have negative long-term effects.
The question is how to address these problems. The trouble with adolescents and marijuana is that even when the substance has been completely illegal, as it has been up until now, it has not stopped adolescents from using it. In fact, it's the easiest thing to get for almost anybody aged 12 onward.
I don't know what, in the legislation, can possibly address that issue. I don't know what legal measures can stop the use by adolescents. In other words, when we're looking at prevention, we really have to look at why people use a substance, what's in the culture that's driving their use, and how we can address those issues.
Unfortunately, when it comes to drug prevention strategies, the idea of telling kids that stuff is bad for them just doesn't work. The reason it doesn't work is that the kids who will listen to adults are not at risk; the kids who are really at risk are not listening to adults. The real issue is how do we create conditions in our homes and our schools so that children will actually listen to what adults tell them. Without that connection, that trust on the part of the adolescent, they will simply listen to their peer group far more closely than to adults.
There is such a thing as marijuana addiction, and I'll define addiction as any behaviour, substance related or not, that a person craves doing, finds temporary pleasure in, or enjoys, and finds relief temporarily from, but which causes negative consequences in the long term and the person can't give it up. That is what an addiction is.
When it comes to treating any addiction, simply trying to address the addiction itself is inadequate, because there's always a reason why people use a substance or engage in a certain behaviour. When you ask somebody why they use marijuana, they'll say it makes them more relaxed. When you ask somebody why they use heroin, they'll say because they won't feel emotional pain.
In other words, the real problem is not the use of the marijuana or the heroin, the real problem is the emotional pain that person feels. The real problem is the overwhelmed state of their brain. In other words, the addictions are always a secondary attempt to solve a problem. Addiction treatments in this country, I have to say, for the most part don't address the real issues. Addiction treatments, for the most part, address the behaviour of addiction but not the underlying causes of it—not the underlying purposes that the individual finds in their behaviour. Those treatments will be insufficient.
When it comes to prevention, I think we have to look at what conditions in this society promote substance use in large numbers. If we look at the statistics for children, the number of kids who are anxious and depressed, alienated, troubled, or diagnosed with this, that, or the other thing is going up and up all the time. Every year the statistics are more and more dire. That's the real issue.
The drug use is a secondary phenomenon. It's those primary issues in our society that are driving the mental discomfort of our youth that we have to address. Those are broad social questions.
When it comes to treatment, again it's a question of how do we address the trauma, stress, and emotional distress of individuals who then use substances to soothe those factors. Again, we have to look into causes rather than just behaviours. I don't know where I stand in my 10 minutes. I'd like to bring it to a close.
I'm going to say that I'm encouraged by Parliament's willingness to take a rational perspective towards something about which our attitude has been completely unscientific and irrational. I just hope that the same open-mindedness and willingness to be realistic will soon be extended to drug policy in general, because all the irrationality that has characterized marijuana policy in this country for decades still characterizes opioid policy, for example. The current epidemic of opioid overdoses could be addressed effectively, but only if we take science and experience into account and only if we actually look at the evidence.
Some years ago I was asked to speak to a Senate committee on an omnibus crime bill and I said to the honourable senators that as a physician I'm expected to practise evidence-based medicine, and that's a good thing. When it comes to drug laws, I wish Parliament would practise evidence-based politics, because the evidence internationally is that the current approaches to drug use normally do not work. They make the problem worse.
Thank you for your attention. I'm very encouraged to see this moving forward and I hope there will be more to follow.
Thank you, honourable members. It's great to be here and to share some thoughts with you.
My name is Benedikt Fischer. I'm a senior scientist at the Institute for Mental Health Policy Research at CAMH, and chair in addiction psychiatry of the Department of Psychiatry at the University of Toronto.
I will share my opening remarks with my colleague, Dr. Le Foll. I will speak to you primarily from the public health perspective, and he will speak primarily from the clinical perspective on treatment.
I have worked on cannabis epidemiology, interventions, and policy for almost 20 years. Let us generally say that we very much welcome the federal government's initiative towards legalization of cannabis use and supply with strict regulations, because we believe—and we have stated this clearly in our 2014 CAMH policy framework—that this is the best way to improve public health and the safety outcomes related to cannabis use. We have said that before it was politically popular on the federal level.
On cannabis use, I'll make a few substantive comments. Cannabis use is not benign in terms of health risks. Cannabis use is associated with a number of different acute and chronic health risks. I will not repeat those; they're very well documented in the scientific literature.
This is a panel on prevention and treatment interventions. I'll elaborate a bit on the prevention side. In the intervention field, we typically distinguish between primary and secondary prevention, primary prevention being general prevention, and secondary or targeted prevention being aimed at users to reduce concrete use-related risks for adverse outcomes.
Let me emphasize that primary prevention for cannabis, especially under legalization, is an important facet of policy and interventions. Let me emphasize that abstinence from cannabis use is still the safest and most reliable way to avoid and reduce the risks of use.
However, we have a large number of Canadians—about 15% of the adult population, but up to 40% to 45% of youth and young adults—who've made the decision, for whatever reasons, to be users. So we have to combine our efforts on the prevention side both to keep the true abstinence rate as low as reasonably possible and to do everything we can to reduce the risks and harms among those large populations of people who've made the decision to actually use. That really, in essence, is the main practical challenge under legalization.
Given that the majority of use is concentrated in the 15-to-29 age group—in other words, youth and young adults—we have to ensure that this sizable population of young Canadians makes it through that cannabis use period into mid- and late adulthood with as little and the most limited health and social harms as possible for legalization to succeed as a public health intervention. That's essentially the quintessential challenge under legalization policy for the benefit of public health.
To elaborate a bit on the secondary or targeted prevention side with some examples, secondary prevention is of course a very broad realm or range of efforts that relate to a lot of different details of how legalization is designed and implemented. In other words, these are things such as what do we sell, where do we sell, who do we sell to, and how do we control distribution, but they're also things like avoiding the promotion and advertising of cannabis, and also pricing policy. All those kinds of aspects of the organization of legalization as it is enacted, as we know very well from data from alcohol and tobacco policy, are extremely powerful levers in terms of the risks and harms that we want to avoid. A lot of these details—or the devil that is in those details—are very relevant to the kinds of outcomes that legalization policy will produce and entail.
I'll just give a couple of examples. What will be extremely relevant for those kinds of risks and harms is what products are sold. We should avoid selling high-risk and high-potency products. At the same time, things such as edibles should be allowed, because they bear the potential to reduce, for example, smoking-related harms.
We should categorically not allow any kind of commercialization through advertising or promotion that leads to higher use and higher harms. As we know from alcohol and tobacco, we should keep distribution in public monopoly hands.
Pricing and taxation is enormously important, but not in a static way. It needs to be flexible so that we can adjust to organize demand and supply.
I'm personally concerned about restricting cannabis use—and potentially production through home growing—to private homes. It's not in the good interest of public health.
Finally, there's also the potential to reduce risks and harms among cannabis users through behavioural choices they make. That's exactly the conceptual basis of the lower-risk cannabis use guidelines that we launched in June from an international committee of scientists, published in the American Journal of Public Health and endorsed by the federal and five leading national health organizations. This is one ready tool for targeted prevention among users, as part of a comprehensive prevention strategy that we're happy to help with.
I'll hand it over to my colleague, Dr. Le Foll, to speak on issues of cannabis disorder and treatment.
Honourable members, thanks for the opportunity to talk about the treatment of cannabis use disorder. By way of introduction, I am a clinician scientist working at the Centre for Addiction and Mental Health. I practise addiction medicine. I have done research on the impact of cannabis, doing studies on cannabis administration in human subjects as well as clinical trials studying a treatment approach for cannabis use disorder.
I would like to start by describing a variety of clinical presentations we can see. We can have subjects presenting with cannabis intoxication. The symptom may be euphoria, but it can be also tachycardia, impaired judgment, and psychiatric complications associated with intoxication. I'm talking here primarily of physiological symptoms and psychosis symptoms.
There is no overdose associated with cannabis, so it's much less risky than opioids, which can lead to death.
There are also a clear symptoms that can occur when a subject discontinues exposure to cannabis after regular prolonged use. There is a typical cannabis withdrawal syndrome. It presents with anxiety, dysphoria, sleep disturbance, irritability, anorexia. Cannabis withdrawal can be distressing, but it's not life threatening. Even so, we know that withdrawal symptoms make cannabis cessation more challenging and that these symptoms are associated with a higher risk of relapse.
The main challenge is the loss of control over the use of cannabis. This can develop in a fraction of users and can result in an addiction problem. Currently in the field, we are defining this as cannabis use disorder. Cannabis use disorder is characterized by a pattern of cannabis use that causes clinically significant distress or social impairment resulting in negative consequences such as the inability to stop using.
Previously the field was using the terminology of “abuse” and “dependence”, with dependence being the most serious form of addiction. The research based on epidemiological surveys clearly indicates that 7% to 9% of those who use cannabis during their lifetime will develop a dependence at some point in their lives. There is a fraction of people who will lose control of their use and will develop cannabis use disorder. It is estimated that the fraction is 30% to 40%.
It is important to realize that those numbers are lifetime numbers, which means that you have subjects who will experience problematic cannabis use only for a restricted period of time in their lives and who will get over this kind of problematic use without necessarily requiring specialized treatment. This is currently seen as a growing problem, however, because we see more and more people coming to addiction treatment who require treatment for cannabis use disorder or who have addictions associated with cannabis.
I would like to make it clear that at this point the number of subjects coming for addiction treatment with cannabis use disorder as the main reason is very small compared with the number of subjects who seek treatment for alcohol or opioid addiction.
Treatment of cannabis use disorder can be performed in an out-patient setting, but sometimes patients can be treated as in-patients or in a residential setting, but usually that is more for the subjects who have concurrent psychiatric or polysubstance use. It is recommended that the treatment provider evaluate precisely the treatment goals of the patient and understand that these goals may vary greatly. Some subjects may want to be completely abstinent; others may want to reduce their level of use or avoid risky use.
That's okay. I'm fairly flexible with the title, although I did work hard to get it.
Good afternoon, and thank you, Mr. Chair and members of the committee, for the opportunity to speak with you today.
As you heard, I am Dr. Eileen de Villa, and I am the medical officer of health for the City of Toronto, where I serve the 2.8 million residents of our very fine city.
I should point out that my comments here today represent not just my views, but also the views of Toronto Public Health and the Toronto Board of Health and are restricted to the proposed legislation for non-medical cannabis.
Just to kick off, I'd like to say that we do support the goal of Bill to provide Canadians with legal access to cannabis and, in doing so, ending the practice of criminalizing people who consume cannabis for non-medical purposes.
As you've heard from presenters thus far, the science on cannabis is indeed still emerging. We do know that it's not a benign substance. We know that it's a psychoactive substance with known harms of use. It's therefore imperative, in my opinion and in that of my organization, that the development of a regulatory framework be guided by public health principles to balance legal access to cannabis with reducing harms of use.
As you've heard already from some of the other witnesses before you today, there is health evidence that shows that smoking cannabis is linked to a number of health conditions, respiratory disorders, including bronchitis and cancer. It's also known to impair memory, attention span, and other cognitive functioning. It impairs psychomotor abilities, including motor coordination and divided attention. These are relevant public health concerns because of their connection to impaired driving in particular.
You've also heard that heavy cannabis use during adolescence has been linked to more serious and long-lasting outcomes such as greater likelihood of developing dependence and impairments in memory and verbal learning. In addition, the risk of dependence increases when use is initiated in adolescence, as rightfully pointed out by Dr. Maté.
As you may know, motor vehicle accidents are the main contributor to Canada's burden of disease and injury when it comes to cannabis. A recent study revealed that many Canadian youth consider cannabis to be less impairing than alcohol; however, as mentioned earlier, the psychoactive effects of cannabis can negatively affect the cognitive and psychomotor skills needed for driving.
In addition to strengthening penalties for impaired driving by amending the Criminal Code as put forward in Bill , preventing canabis-impaired driving will require targeted public education. It's my understanding that the Government of Canada is preparing a public campaign to raise awareness about drug-impaired driving. Toronto Public Health would recommend that the government use evidence-informed messaging targeting youth and young adults in particular and launch this campaign without delay.
Further, I would recommend that the government support municipalities, provinces, and territories with local initiatives to discourage people from driving after consuming cannabis.
In its final recommendations to the government, the task force on cannabis legalization and regulation expressed concerns about the reliability of predicting impairment based on levels of THC, the main psychoactive compound in cannabis detected in samples of bodily fluids. These concerns have also been raised by other organizations, including those in the United States. I would recommend that the government make further investments in research and refinements to technology to better link THC levels with impairment and crash risk for developing evidence-informed standards.
The stated key objective of Bill to prevent young people from accessing cannabis is central to adopting a public health approach to the legalization of cannabis. We must apply lessons learned from tobacco and alcohol in developing the appropriate policy framework at all orders of government to prevent young people from using cannabis.
As mentioned by my colleague, evidence about tobacco advertising shows that it has an impact on youth smoking and that comprehensive advertising bans are most effective in reducing tobacco use and initiation. Personally, I welcome the requirements in Bill that maintain existing promotion and marketing rules in place for tobacco, including restrictions on point of sale promotion. We would also like to see these restrictions strengthened to include advertising in such venues as movies, video games, and other media, including online marketing and advertising, which are accessible to youth. Further, additional research on the impact of marketing and promotion is essential for making evidence-informed amendments to regulations and to develop prevention strategies. Federal funding should be targeted to this area.
Furthermore, we know that labelling and packaging are being used for promoting tobacco and tobacco brands. While I appreciate that Bill prohibits packaging and labelling of cannabis in a way that could be appealing to young people, a key omission in the act is a requirement for the plain packaging of retail cannabis products.
In a recent report, the Smoke-Free Ontario Scientific Advisory Committee identified plain packaging as a highly impactful tool for reducing tobacco use. The requirement for plain and standardized packaging for tobacco is currently being proposed in federal Bill , and we recommend you do likewise for cannabis.
Fundamental to a public health approach for legalizing access to cannabis is regulating retail access. I am pleased with the Province of Ontario's recently announced intent to establish a provincially controlled agency for the retail sale and distribution of non-medical cannabis, separate from that for alcohol. A government-controlled retail and distribution system that is guided by public health objectives and social responsibility will ensure better control of health protective measures for cannabis use. I also urge your government to direct other provinces and territories to establish a retail and distribution system that is guided by public health principles and social responsibility.
I commend the government for not legalizing access to cannabis-based edible products until comprehensive regulations for its production, distribution, and sale have been developed. The experience in the United States cautions us of the challenges posed by edible cannabis products, including accidental consumption by children, overconsumption due to the delay in feeling the psychoactive effects, and in ensuring standardization of the potency of cannabis in edible products.
I would now like to draw your attention to some of the limitations of the existing cannabis research. While there is growing evidence about the health impacts of cannabis, some of the research findings are inconsistent or even contradictory, and causal relationships have not always been established. There is still much that we don't know. Most of the research to date has focused on frequent, chronic use, and the results must be interpreted in that context. More evidence is needed about occasional and moderate use, as this comprises the majority of cannabis use. I therefore urge you to earmark funding for research related to the full range of health impacts of cannabis use, in particular for occasional and moderate consumption.
Evidence-informed public education will be imperative for implementing an effective health-promoting regulatory framework for cannabis. There is an opportunity to promote a culture of moderation and harm reduction for cannabis that may extend to other substance use, especially among young people. The Government of Canada has stated its plan to pass Bill by July 1, 2018. However, in the meantime, Canadians continue to be arrested for possession of cannabis. Criminalization of cannabis use and possession impacts social determinants of health such as access to employment and housing. Given that cannabis possession will soon be made lawful in Canada, I urge you to immediately decriminalize the possession of non-medical cannabis for personal use.
In closing, I would like to reaffirm that Toronto Public Health supports the stated intent of Bill and recommends strengthening the health promoting requirements in the bill. I appreciate the complexity of building a regulatory framework for non-medical cannabis. Given that we're still learning about the impacts of cannabis use, the legal framework for cannabis must allow for strengthening health promoting policies while curtailing the influence of profit-driven policies. I look forward to ongoing consultations with the Government of Canada on the evolving policy landscape for this important public health issue.
Thank you for your attention.
Thank you very much for the opportunity to comment on Bill an act respecting cannabis and to amend the Controlled Drugs and Substances Act, the Criminal Code and other acts. As a developmental behavioural pediatrician and a researcher in the field of adolescent substance use, I'm concerned about the potential impact of these changes, specifically on the health of children and adolescents.
I've served as the chair of the American Academy of Pediatrics' national committee on substance use and prevention, and I've been the director of the adolescent substance abuse program at Boston Children's Hospital since its inception in 2000. Over the past 17 years, I've evaluated and treated hundreds of teens with substance use disorders, and while many of my comments have already been said in one form or another, I'd like to speak from personal experience.
Cannabis is an addictive drug that's particularly harmful to developing adolescent brains. Teens that consume cannabis have poorer life outcomes on a number of measures. They have more mental health disorders, including depression, anxiety, and psychosis. As a group, they complete less school and are more likely to be unemployed or underemployed than are their peers. These harms are distinctly different from the harms of use of other substances, such as tobacco, alcohol, and opioids, but they're no less serious or consequential.
As the director of an adolescent substance use disorders program serving youth aged 12 to 25, I work regularly with children and young adults who use cannabis. In fact, more than 90% of patients we see in our program have a cannabis use disorder. While almost all of them started their drug use histories with cannabis, few stick to one drug alone. Almost all of our patients in treatment for heroin addiction first used cannabis, and most use it very heavily.
We've treated a number of teen cannabis users who've developed schizophrenia right in front of our eyes, and who will never be able to care for themselves or live independently. We don't know what would have happened to them if they hadn't used cannabis, but the science and the statistics made us wonder if they might have had a different life had it not been for a completely preventable risk factor.
More commonly, we see again and again adolescents whose cannabis use more subtly impedes them. Two patients with similar histories paint a very clear picture of cannabis addiction. Both were good students in high school and were accepted to elite universities, where they began using cannabis heavily and ended up failing out. Both blame their changing academic status on heavy cannabis use. All four of their parents have been devastated. One of the fathers confided about adjusting his own hopes and expectations for his son. A few short years ago, he had envisioned his son becoming a successful professional. Now, he simply hopes he'll be able to function well enough to support himself.
The list goes on and on, with many adolescents that I care for falling short of their own educational goals, being underemployed, and struggling with mental health disorders while their families watch and wonder about their future.
Bill would prohibit the sale or marketing of cannabis to adolescents and young adults under the age of 18, and legalization is often proposed as a mechanism to reduce youth access by taxing and regulating cannabis, raising the price, eliminating the black market, and making shop owners gatekeepers. This approach has failed with other substances in the past. Marketing restrictions have historically been of limited utility when tested against the potential for substantial profits. While it's illegal for tobacco companies to market cigarettes to children, the familiar story of Joe Camel is a good example of how pernicious advertising can be.
In the U.S., the experience in Colorado, which was one of the first two states to legalize cannabis, is instructive. The number of teen users in Colorado increased by 20% in the two years immediately following legalization, while falling by 4% in the rest of the country. As a developmental pediatrician and also the parent of two teenaged children, I do not find these findings at all surprising. The retail sale of cannabis serves to normalize use. Teens are very responsive to cultural trends. When cannabis use is condoned, teens are more likely to use it. To argue otherwise is simply unreasonable from a developmental perspective.
In the U.S., evolving cannabis policies have resulted in changes to cannabis itself. The concentration of THC, the main active ingredient in cannabis, has increased dramatically over the past three decades, exposing users to higher levels of this drug than ever before. That's one of the reasons the science has been so tricky to pin down, because the product is actually changing. New edible products, including cookies, candies, and sodas have appeared on the market and are sold under the umbrella of marijuana.
Now, this market expansion is to be expected, because creating new and improved products is a tried-and-true technique for boosting sales, constantly inviting new users to try, and old users to add, new products to their repertoire.
Dabbing, a newly popular way of using cannabis, results in extremely high blood levels of THC. Higher THC exposure produces more euphoria and also causes more medical problems. In our clinical practice, kids are coming in with new problems that we rarely saw 10 years ago. Cannabis hyperemesis syndrome, which causes recurrent vomiting, was once rare but is now quite common in our practice. Psychiatric symptoms and complaints have also increased. Many of our patients have heard voices, experienced delusions, or become anxious and paranoid with cannabis use. In a study that our group is currently conducting in our primary care centre, more than 25% of cannabis users report that they've hallucinated while using cannabis, and more than 30% report having been paranoid.
As a pediatrician, I find these numbers terrifying. While there's been limited study of these questions in the past, our clinical experience suggests that these rates are increasing, just as would be expected with ever-increasing drug exposure.
Drawing from my experience as both a researcher and a clinician, I'd like to offer the following suggestions. First off, I recommend delivering clear messages to youth that avoiding cannabis use is best for their health. The American Academy of Pediatrics and the Canadian Paediatric Society both oppose marijuana legalization, and encourage parents, health care providers, teachers, and other adults to give clear and unambiguous guidance to children.
Campaigns that educate the public in an attempt to prevent use or delay initiation could be beneficial. For example, the Truth Initiative campaign that targeted tobacco use was remarkably successful in shifting the public perception of tobacco from glamorous to repulsive. Rates of tobacco use plummeted over the past 20 years with the stigmatization of smoking. Cannabis is well known as a psychoactive substance that's particularly detrimental to developing adolescent brains. Although misconceptions that cannabis is “healthy because it's natural” or “safe because it's legal” have cultural traction, they're false. They require ongoing strong messaging of evidence to the contrary.
Age restrictions are effective at reducing youth substance use. In the U.S., the enactment of the National Minimum Drinking Age Act, which effectively raised the drinking age to 21 in all 50 states, resulted in a 16% reduction in motor vehicle accidents. This was as a direct result of lower alcohol consumption. Canada, which has a lower drinking age, also has the highest rate of problem alcohol use in the Americas. These facts support higher minimum age limits as a good public health strategy.
Innovations to cannabis-based products are public health risks, particularly for adolescents. It may be that addictive substances need completely new policy approaches. Novel regulatory schemes that control or eliminate profits, control prices, and conduct surveillance at both the individual and population level should be considered. This type of approach would be expensive and would require unprecedented collaboration between branches of government and other sectors of society. History and current evidence suggest that simply legalizing cannabis and giving free rein to the industry that it will engender would be to entrust private industry with safeguarding the health of the public, a role that industry is not well designed to handle.
Finally, we need more clinicians trained to treat adolescents with cannabis addiction. This will require financial support. With the legalization of marijuana in Canada, there will be a pressing need for health care providers specialized in youth addictions and treatment of adolescent substance use disorders. I am pleased to report that the first physician to acquire specialized training in pediatric addiction medicine in all of North America is a Canadian. They are currently training at Boston Children's Hospital. Much more support and many more funded training spots and training programs are needed.
Thank you for listening and for the opportunity to address this panel.
We're going to alternate.
Good afternoon, Mr. Chair, and committee members. Thank you for the opportunity to appear before your committee.
My name is Michelle Suarly, and I am representing the Ontario Public Health Association in my capacity as chair of the task group for cannabis. I am pleased to be joined by my colleague, Elena Hasheminejad, who is a member of the task group.
The Ontario Public Health Association, or OPHA, is a non-profit, non-partisan association that brings together those from the public and community health, academic, voluntary, and private sectors who are committed to improving people's health. Many of our members, whether they are public heath nurses like us or from other fields, are working on the front lines to promote and improve public health in their communities.
OPHA has been championing prevention, health promotion, and protection since its creation over 68 years ago. Our mission is to provide leadership on issues affecting the public's health and strengthening the impact of people who are active in public and community health throughout Ontario.
Our task group encourages the federal government to adopt a public health approach to cannabis regulation to allow for more control over the risk factors associated with cannabis-related harms. Based on evidence that the risks of cannabis are higher with early age of initiation and/or high frequency of use, a public health approach would aim to delay the age of initiation of cannabis use, reduce the frequency of use, reduce higher-risk use, reduce problematic use and dependence, expand access to treatment and prevention programs, and ensure early and sustained public education and awareness.
We advocate that the federal government apply the health equity lens and recognize the role played by the social determinants of health, understand those who are most likely to be affected by the legalization of recreational cannabis, and support corresponding strategies to mitigate impacts.
Elena will now highlight OPHA's recommendations.
I'd like to start off by indicating our support for the federal task force on cannabis legalization and regulation's objective to protect young Canadians by keeping marijuana out of the hands of children and youth.
As I'm sure has been shared with you today and throughout this week, Canadian youth have one of the highest reported rates of use among developed countries, which we know is concerning, because research has found that the brain continues to develop until the early twenties.
To protect young Canadians, it's important that we consider some of these prevention measures. Health Canada recognizes that tobacco packages have been powerful promotional vehicles for the tobacco industry and has stated that it is committed to introducing plain packaging, which a lot of my fellow colleagues have also highlighted today.
We recommend that the same regulations be put in place for cannabis products as well. We recommend clear and restrictive requirements for the mitigation of the sale and promotion of products to youth, consideration of unintended exposure, and retail licensing requirements. We recommend that all cannabis and cannabis containing product labels include clearly displayed THC and cannabinol content, evidence-informed health warnings, harm reduction messages, and information on accessing support services.
Although plain and childproof packaging may reduce the risk of unintended exposure through regulation, it would not effectively reduce the risks for edibles. Children may mistake edible products as regular food when these products are not enclosed in their packaging. With that in mind, we recommend that regulations regarding edibles consider the impact of products manufactured that resemble candies, cookies, gummies, and other products typically marketed to children.
Last, given that a significant proportion of cannabis users are young adults, we encourage the federal government to facilitate discussions with all levels of government to ensure that the minimum age is consistent. A consistent minimum age would eliminate cross-border variation, which would limit the effectiveness of minimal legal age regulations in protecting young people.
I supported all along a publicly controlled, public monopoly distribution system. Whether LCBO stores alone will be the best system, I think is in question. I question that personally.
I advocated for a hybrid model between public, LCBO-based sales and community storefront outlets primarily for the following reason. The success of legalization will, to a large extent, hinge on the what extent to which we can effectively bring current consumers from illegal markets and sources to legal sources, in practice—not on paper or in theory. In other words, if we design a distribution system now that is perfect on paper but is too strictly regulated, too sterile, too aloof from the realities and wishes and preferences, as subjective as these may be, of current users, then they will not go there, but keep buying illegal, hazardous, risky products from illegal markets and sources. Legalization will fail. It will have succeeded maybe in abstract theory, but it will have failed in practice. This is a crucial hinge variable of the success of this, whether we can bring users, all of them or as many as possible, from illegal markets and sources to the legal markets. Therefore, that part of the equation needs to succeed.
At this point, we don't know perfectly how to do that best and well. We have good theoretical ideas. I think some of the ideas are a bit misguided as currently designed, probably being overly restrictive and too sterile, but it remains to be seen. We need to try to see what happens, and if necessary, adjust. That may have to be a little, that may have to be a lot, but we have to bring people into legal distribution systems. If that doesn't happen, if we don't succeed, legalization, to a large extent, as a public health venture, will fail.