Standing Committee on Health Tuesday, May 27, 2014 Chair HESA

Standing Committee on Health Tuesday, May 27, 2014 Chair HESA
Standing Committee on Health
HESA
●
NUMBER 029
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2nd SESSION
EVIDENCE
Tuesday, May 27, 2014
Chair
Mr. Ben Lobb
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41st PARLIAMENT
1
Standing Committee on Health
Tuesday, May 27, 2014
● (0845)
[English]
The Chair (Mr. Ben Lobb (Huron—Bruce, CPC)): Good
morning, ladies and gentlemen. Welcome.
We're in our final meeting of our study on the health risks of
marijuana.
We have two different panels this morning: three members of the
RCMP and then later we have some experts in the field. We have
from 8:45 to 9:25. so I think we should get right into it.
Although the RCMP has always enforced Canadian impaired
driving laws, the Commissioner of the RCMP recently requested the
development of a national strategy to combat impaired driving and to
help change public attitudes about impaired driving. Impaired
driving devastates families and communities, resulting in high cost
to victims, offenders, communities, and governments. Our strategy
will focus on enforcement activities, but also on public awareness,
with the aim to address issues with drug-impaired driving, which is a
growing concern around the world and certainly in Canada.
You have 10 minutes to present and then we'll follow up with our
rounds of questions and answers.
Insp Jamie Taplin (Officer in Charge, Policy and Compliance,
National Criminal Operations, Contract and Aboriginal Policing, Royal Canadian Mounted Police): Thank you for the
opportunity to talk about the work the RCMP is doing to combat
drug-impaired driving and the impact that cannabis has on law
enforcement.
I am Inspector Jamie Taplin, and I work in the operational policy
unit of the contract policing business line. Two areas that are within
my responsibility are the drug recognition expert program and the
RCMP impaired driving strategy.
Joining me today is Mr. Darcy Smith. Mr. Smith is an alcohol and
drug specialist from the RCMP forensic labs. He is also an instructor
for the drug recognition expert program. He's currently leading a
research study to determine if there are roadside screening devices
that will work with the most common drugs that impair driving to
see if these devices will be suitable for use in Canada.
From RCMP federal services is Sergeant Dustin Rusk. He's a
federal policing public engagement officer. I'll be referring to that as
the FPPE. The aim of his program is to be proactive with an
emphasis on prevention within the pre-criminal scope of the criminal
spectrum. FPPE seeks to identify options and sustainable solutions
and highlight gaps where existing public community or private
resources and policies are not aligned, or are not sufficient to provide
support.
Today, I'm going to start by talking a little about impaired driving
more broadly. I'm going to focus on drug-impaired driving, and then
I'll talk a little about what federal policing is doing, and the impact
that cannabis has on law enforcement overall. We'll talk about some
of the initiatives the RCMP is working on to combat drug-impaired
driving, and overall drug enforcement and prevention.
One of the most important factors in deterring impaired driving
and changing the attitudes of those people who choose to drive while
impaired is to have them understand the potentially devastating
consequences that their actions may have on themselves and others,
and also to let them know that there is some risk in being caught.
Building on the great work already under way in the provinces
through engaging our partners in the non-profit sector, other law
enforcement agencies, and other government organizations invested
in road safety, the RCMP hopes to encourage people to choose not to
drive while impaired. We hope to encourage citizens to report
impaired drivers. We would like to increase the likelihood that
impaired drivers will be apprehended before they can cause further
harm in Canadian communities.
Let us look at statistics, and I'll speak about Canadian statistics,
not just the RCMP's. They're from the Canadian Centre for Justice
Statistics. In 2012, there were 84,483 criminal impaired driving
incidents that were by way of charge. While the large majority is
alcohol-impaired driving, about 2% are reported to be by drug
impairment. Interestingly, we're learning that the most recent
roadside surveys and academic studies that are being done and
published are suggesting that drug-impaired driving is quite a bit
higher than the 2% that our statistics show.
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For example, I refer to a 2011 report, “Drug Use by Fatally
Injured Drivers in Canada (2000-2008)”. The report is from the
Canadian Centre on Substance Abuse. They reviewed the accidents
of over 17,000 drivers who were fatally injured. That study indicates
that drugs that can cause driver impairment were found in
approximately one-third of all fatally injured drivers. This is
important to us, because that 33%, roughly, is almost at the same
level that alcohol was found in fatally injured drivers.
One of the other things that was important is when drugs were
found, the most common were central nervous system depressants
and also cannabis.
● (0850)
The age group the study identifies most at risk was young men age
16 to 24, and the drug of choice for them was cannabis.
In another study referring to a 2008 roadside survey with British
Columbia drivers, over 10% of the drivers tested positive for drugs,
with cocaine and cannabis being the most common drugs detected.
In this survey, 10% were found to be using drugs; 8% of drivers had
been drinking; about 15% tested positive for both alcohol and drugs.
There are other surveys out there that indicate, for example, that
17% of Canadian drivers report having driven within two hours of
using a potentially impairing drug.
What's important here is most people know that a person's ability
to drive a motor vehicle is affected by alcohol use, but we have a
study by the CCMTA, the Canadian Council of Motor Transport
Administrators, with what I call rather alarming news. According to
their study, 26% do not believe a driver can be charged while
impaired by cannabis.
The RCMP is concerned about cannabis use, especially by young
Canadians when it comes to driving. I have teenagers myself. I listen
to their conservations. I talk to my son and his friends. It seems
everybody knows that alcohol-impaired driving is bad. Don't drink
and drive. The message has been out there for a long time. But the
issue with drug-impaired driving is not as well understood.
Anecdotally, I hear that teenagers don't feel you can be stoned and
get an impaired driving charge.
I'm going to give you a couple more statistics about a survey that
was done with Ontario students, grades 7 to 12, in 2011. They
reported that cannabis was the most common illicit drug used by
high school students; 22% reported using it over the last year. The
same report notes that cannabis use increases with every grade level,
starting at 7 and going to 12. They note that 12% of drivers in grades
10 to 12, with a G class licence, report driving after cannabis use.
Based on the size of the survey, that 12% represents some 38,000
drivers.
On a positive note, that same survey mentions our efforts to
educate youth are having some impact because the number of
licensed students who drive after using cannabis or who get in the
vehicle as a passenger with a driver who has been using cannabis or
alcohol has gone down.
Part of what we're doing with the impaired driving strategy in the
RCMP is we're trying to create better internal and external
messaging, working closely with RCMP divisions, partner agencies,
May 27, 2014
and special interest groups to discourage impaired driving through
public education and awareness. We're trying to engage youth in
discussions on drug- and alcohol-impaired driving. We're coordinating national enforcement days against impaired driving, supporting
the identification and purchase of new equipment to support alcoholand drug-impaired driving investigations, and to make sure our
training standards for using this equipment are up to date, along with
the training for our standardized field sobriety testing, and also the
drug recognition expert training.
I mentioned very briefly about Mr. Smith's role with our oral-fluid
testing devices. The RCMP is working on a project with the
Canadian Society of Forensic Science's drugs and driving committee. Also, there's funding from the Ontario Ministry of Transportation. We're trying to determine if there are roadside point-of-contact
oral-fluid testing devices that can test for the most common drugs
that contribute to impaired driving in Canada. This, of course, would
include cannabis. We want to determine if these devices can be used
in Canada. The device would be similar to an approved screening
device for alcohol, and would aid in the apprehension of drugimpaired drivers.
On the federal policing side, it's well known that cultivation,
distribution, and exportation of marijuana is a significant source of
revenue for Canadian organized criminal groups, and it provides a
financial base for other organized crime activities as well as
individual criminals.
The RCMP, in cooperation with its partners, continues to be an
active participant in the prevention and enforcement pillars of the
national anti-drug strategy, NADS, which was launched by the
Government of Canada in 2007.
● (0855)
NADS has a clear focus on illicit drugs, with a particular emphasis
on youth. Its goal is to contribute to safer and healthier communities
through coordinated efforts to prevent use, treat dependency, and
reduce production and distribution of illicit drugs, including
marijuana. It encompasses three action plans: prevention, treatment,
and enforcement.
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3
The RCMP is also doing outreach and community engagement in
relation to illegal marijuana use. The FPPE is involved in a range of
initiatives aimed at raising awareness of illicit drugs and their
negative consequences. For example, during the 2012 fiscal year, the
RCMP gave over 3,000 awareness presentations for such programs
as D.A.R.E., drug abuse resistance education; the aboriginal shield
program; racing against drugs; kids and drugs; and drug-endangered
children. These initiatives are youth-centric and encompass the
surrounding community.
police service is really a sad tale of underfunding. I'm assuming that
most of your first nations policing is in B.C. and Alberta, in that area,
so maybe you could find a comparison there.
Periodic updates are undertaken to ensure accurate drug information and to ensure that the program content is geographically and
culturally specific and appropriate. Each initiative includes extensive
information on the harms and risks related to substance abuse, use,
and movement. Marijuana, of course, is included in that.
I would say that in aboriginal communities, as in all of our other
communities, resources are placed where they need to be to get our
work accomplished, and certainly that's one of them. I don't have
numbers or anything like that with me today, but as part of the many
programs we offer.... Certainly there are many, and I would suggest
that most of them could also be implemented in aboriginal
communities.
Mr. John Rafferty: Certainly feel free to get back to us with any
additional information.
Insp Jamie Taplin: Is there anything specific you'd like to
mention?
Sgt Dustin Rusk (Public Engagement Officer, Federal Policing
Public Engagement Program , Royal Canadian Mounted Police):
Yes, the aboriginal shield program. The wonderful thing about that
program is that it's community specific and appropriate to deal with
whatever the issues are in that community. The community takes
ownership and is a driving partner towards dealing with whatever the
issues are with regard to drugs, substance abuse, and violence within
that community, and mobilize together. The police help support the
community to find out what the solutions are to their challenges.
Mr. John Rafferty: Thank you.
In relation to marijuana enforcement, the RCMP at both the local
and federal levels continues to be concerned with the presence of
marijuana grow operations in Canada. The RCMP established a
marijuana grow initiative in September 2011 in order to better tackle
marijuana grow operations. This initiative is based on three
components—awareness, deterrence, and enforcement—and involves collaboration among government agencies, community
groups, businesses, and community members. This past year saw
many successful federal enforcement activities in relation to
marijuana grow operations and organized criminal groups.
That concludes my opening remarks. Sergeant Rusk, Mr. Smith,
and I would be happy to answer your questions.
The Chair: Thank you very much for the presentation.
Our first round goes to Ms. Davies.
Ms. Libby Davies (Vancouver East, NDP): Actually, we'll go to
Mr. Rafferty. He's sharing his time with me.
The Chair: Very good. Thank you.
Go ahead, sir, and welcome.
Mr. John Rafferty (Thunder Bay—Rainy River, NDP): Thank
you, Chair.
Thank you to all three witnesses for being here.
It's a pleasure to be at the health committee. I haven't had the
opportunity to sit on this committee in this Parliament.
I have two questions, and then Libby will ask the next questions.
You talked about the technology. I'm just curious. When you think
about the hardware and the software, and you think about officer
training, is there any idea of what that cost would be, certainly in the
jurisdictions that you're present in?
● (0900)
Insp Jamie Taplin: Unfortunately, I can't answer that. Obviously
there is a cost, but I don't have those numbers with me today. Sorry.
Mr. John Rafferty: That leads to my second question, which is
about aboriginal policing, and in particular first nations policing.
We've heard in other committees, public safety in particular, but
other committees as well, that aboriginal policing in Canada is
woefully underfunded, particularly first nations policing. My
experience in northern Ontario with the Nishnawbe-Aski Nation
Given the economic situation for first nations policing across
Canada, how will these initiatives fit in with that?
Insp Jamie Taplin: There are initiatives that are specific to
aboriginal youth, such as the aboriginal shield program. Dustin, I'm
sure, would be happy to tell you more about that program.
Libby.
Ms. Libby Davies: Thank you very much to the witnesses for
coming today.
I'd like to pick up on a couple of things you said, but I have a
general question first.
As enforcers of the law, and I guess you do your own analysis of
what's going on in terms of laws and enforcement, at what point does
the RCMP come to the conclusion that prohibition when it comes to
marijuana has really failed?
I'm thinking that because we've seen recently that the Canadian
chiefs of police.... Previously they advocated for decriminalization. I
think that was the association of police, but the police chiefs have
advocated more for a ticketing kind of system.
I'm curious as to what the tipping point is in the law as we know it
today. It has basically been an abject failure, whether it's economically or from a law enforcement point of view. It has really not acted
as a deterrent in terms of drug use. It's much better to focus on
education, prevention, treatment, and harm reduction.
I wonder if you could comment on that, that at this point even the
police seem to be saying that we're better to look at a ticketing
regime.
Insp Jamie Taplin: I'll defer to my colleague in federal policing
here to answer that question.
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May 27, 2014
Sgt Dustin Rusk: First of all, I work in federal policing public
engagement. One of the main focuses that we have is to look at
prevention, especially compared to the medical industry. Prevention
is worth so much more than doing any sort of reaction.
With drunk drivers you have a reliable test, a breathalyzer test,
that allows you to get convictions, a very high rate of conviction,
because it's proven to be accurate.
However, when dealing with anything that's in an act—and we
have the Controlled Drugs and Substances Act—that falls under our
mandate to enforce, we have to stick by that, whatever it is.
Therefore, we do enforce the laws appropriately with regard to illicit
substances, whatever they might be under all the different schedules.
● (0905)
Ms. Libby Davies: Do you think it's important that we take a
health approach? For example, I've always been quite interested in
the fact that in school through the D.A.R.E. program, it's police
officers who do the education and prevention. When we do sex
education in the schools, we don't send in cops to do that. Why do
we do it with drugs, when it's really a matter about health and
awareness, what happens to our bodies, and so on, and how we make
choices? It's really only because it's an illegal substance.
There's no such test currently for marijuana. Is that right? Doesn't
that account for your statement that driving while impaired on
marijuana is probably much higher than the 2% reported? Isn't that
the reason, because there's no reliable test and there's no way to
prove it?
I question how effective that approach is. Would you agree that a
health-based approach, particularly to young people based on
prevention, education, and awareness is something that's very
important? Maybe there's a role for police, but it's a health-related
issue, and that's something that's really important to reinforce with
young people.
Sgt Dustin Rusk: Looking at what this whole committee is about,
and I can't speak for Health Canada, but there's definitely the
involvement of a whole-of approach, where all should be involved in
this, especially when we're looking at our youth.
After all, it goes back to one adage, that to have a healthy
community, you also need to have a safe community where people,
especially our young people, can explore their options and be well
informed as to what they need to do to make their choices in life.
Ms. Libby Davies: Do I have a little more time?
The Chair: Twenty seconds.
Ms. Libby Davies: Thank you.
The Chair: Thank you very much.
Next up is Mr. Young. You have seven minutes, sir.
Mr. Terence Young (Oakville, CPC): Officer Taplin, I want to
ask you about some statements you made that actually even shocked
me, and we've been listening about this for weeks.
Please tell me if I have this correct. You said that the Canadian
Centre on Substance Abuse studied 17,000 driver deaths. Is that
correct?
Insp Jamie Taplin: Yes.
Mr. Terence Young: One-third of all drivers who died behind the
wheel of their car had drugs in their blood, and that the most
common one was marijuana. Is that correct?
Insp Jamie Taplin: Specifically, and I'm going to refer to my
notes here, central nervous system depressants and cannabis were the
most common. Marijuana was the most common with the age group
16 to 24.
Mr. Terence Young: Thank you.
Insp Jamie Taplin: It's certainly part of it. Drug-impaired driving
is a complicated investigation and it certainly involves more steps
and different tools than the alcohol-impaired driving investigations.
When I mentioned the 2% that they said were impaired, I'm speaking
generally of drug-impaired driving, not just cannabis.
Mr. Terence Young: Even at the roadside, if a police officer stops
a car, they're trained to sniff for the smell of alcohol on someone's
breath. They can see if their eyes are red and maybe their speech is
slurred. It's not so easy with marijuana. Isn't that correct?
Insp Jamie Taplin: That's correct. One of the programs we offer
is the drug recognition expert program. Mr. Smith is an instructor
with that program. If it's okay with you, sir, I'll just ask him to give a
brief....
Mr. Darcy Smith (General Manager, National Forensic
Services, Royal Canadian Mounted Police): The drug recognition
expert program is designed because of the fact that we do not have
roadside testing devices or the black boxes that everyone is looking
for when we deal with other drugs. When an evaluator goes through
the evaluation process with a subject under the influence of a drug
such as cannabis, the accuracy is quite good.
Mr. Terence Young: That's once they've been arrested and
brought into the station.
Mr. Darcy Smith: They've generally been arrested at that point
because there's the suspicion that there are drugs in the body. An
evaluation is then demanded, and then they're brought in to have the
evaluation done.
Mr. Terence Young: That would have to be at a pretty high level,
because at the roadside, if somebody's just had half a joint or one
joint, it's pretty hard to tell if they've been smoking marijuana. Isn't
that correct?
Mr. Darcy Smith: That depends on what brought them to the
attention of the officer in the first place.
Mr. Terence Young: We've had the myth debunked that our
regulatory system for alcohol is a wonderful success and if we just
decriminalize marijuana, tax it and regulate it, everything will be
fine. A recent CAMH study said that 54.9% of students in Ontario
between grades 7 and 12 drink alcohol illegally on occasion. We
know that binge drinking is a particular problem. So we know that
regulation is a failure.
May 27, 2014
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I served on the Alcohol and Gaming Commission for three years. I
did over 100 hearings. At that time, there was $500 million of illegal
alcohol sold in booze cans, after hours clubs, etc. In Ontario,
although Ontario has one of the best regulatory regimes apparently
in North America, there was still $500 million in bootleg booze. I
haven't been able to get any current figures.
Would you please comment, Officer Taplin, on the naive
assumption that the regulation of alcohol prevents it from getting
into the hands of our youth and what that would mean for marijuana
getting into the hands of our youth if we just legalized marijuana and
regulated it?
● (0910)
Insp Jamie Taplin: I don't have a specific comment on that.
Mr. Terence Young: Mr. Smith, do you have a comment on that?
Mr. Darcy Smith: Our job is to enforce the legislation in place.
Mr. Terence Young: Okay. Officer Rusk, how do minors get
alcohol? Where do they get it?
Sgt Dustin Rusk: That's a very broad question. As mentioned, if
it's a minor, then it's going to be by illegal means. I know in every
province either 18 or 19 is the age to be able to purchase, let alone
consume.
Mr. Terence Young: I can tell you where they get it. We were all
teenagers. They get it from older friends or siblings. They steal it
from their parents' house. If marijuana were legalized and older
siblings and older friends could buy it, that's where they would get
marijuana. Is that not safe to say?
Sgt Dustin Rusk: That could definitely be some of those avenues,
yes.
Mr. Terence Young: You're an investigator. Where would you
look? Doesn't that make sense?
Sgt Dustin Rusk: I'm not arguing with you.
Mr. Terence Young: Okay, thank you.
Mr. Wilks would like to take a bit of my time, Chair, please.
Mr. David Wilks (Kootenay—Columbia, CPC): Thank you
very much.
Thanks, gentlemen, for being here today.
Mr. Smith, has there been a determination through the forensic
labs with regard to THC in the body and a level that will be required
for impairment? Right now, if forming an opinion, a police officer
must ask for a blood sample. That's the only way to do it for
marijuana.
Mr. Darcy Smith: The challenge with cannabis or with THC in
trying to determine an impairment level is the unique pharmacokinetics that cannabis shows in a person's body. It takes time for
marijuana to be eliminated from the body. Even after they are no
longer being impaired by the marijuana, they will still have
measurable marijuana in their blood, or blood THC level in their
system.
Mr. David Wilks: What you're saying is that cannabis, marijuana,
or THC remains in the system, filtrated through fat tissue, for
substantially more time than alcohol does.
Mr. Darcy Smith: That is correct.
5
Mr. David Wilks: Could you be impaired with cannabis much
longer than you could be with alcohol?
Mr. Darcy Smith: The studies that have been done when we're
looking at actual driving studies, or we're looking at laboratory
studies of the impairment effects of cannabis demonstrate that the
impairment of driving skills lasts approximately two to four hours
after the ingestion of cannabis. At the very beginning of the testing
procedure, you may have a THC level of 25 to 50 nanograms per
millilitre of blood. That level falls quickly. In approximately 90% of
the population, within 160 minutes, the level will be below 2.5
nanograms per millilitre. People who are heavy consumers of
cannabis may have residual blood alcohol levels, after not having
smoked for several days, of two or three nanograms per millilitre in
their blood.
Trying to pick a level, and saying that is the impairment level, is
an educated exercise in trying to come up with that level. Some
states, such as Colorado and Washington, have picked five
nanograms per millilitre.
Mr. David Wilks: Thank you.
The Chair: Thank you very much.
Next up, for seven minutes, is Ms. Fry.
Hon. Hedy Fry (Vancouver Centre, Lib.): Thank you very
much, Mr. Chair.
Thank you very much for being here today.
I want to follow up on the issue of traffic accidents related to
cannabis. I have a couple of questions.
Of the people who have been found impaired because they had
been using cannabis, how many used cannabis alone and how many
used alcohol as well? In other words, how is it decided which one
was the one that caused the problem, or whether the cannabis use
creates a bigger hit and more impairment than others?
I'm looking at a 2005 review, from France, of auto accident
fatalities. It showed that the drivers who tested positive for any
amount of alcohol had a four times greater risk of having a fatal
accident than drivers who tested positive for THC in their blood.
You've also said that the impairment that occurs with alcohol is
very different from the impairment that occurs with cannabis, and
that when the levels peak is important. I don't think most people
realize that up to 8 to 16 hours after they've gone on a drinking
binge, or have been drinking a fair amount, they actually show
effects of impairment, in terms of their cognitive skills and their own
reflexes, etc., because alcohol lasts that long in the brain.
Is there any information in Canada with regard to the use of
cannabis alone related to motor vehicle accidents?
● (0915)
Insp Jamie Taplin: I don't know. I don't have any, specifically.
I've done some research, but I have the same access to what you
have.
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We're trying to review as much as we can. Generally, our initiative
is more focused on drug-impaired driving as a whole, as opposed to
specifically for an individual drug. I certainly agree that many of the
studies out there show that if they're using cannabis, they're likely to
use alcohol and cannabis together.
I don't know, Darcy, if you want to comment on the DRE
program, as far as recognizing the symptoms when individuals are
using both substances is concerned.
Mr. Darcy Smith: Polydrug use is one of the biggest challenges
for most of our drivers on the road. It's very rare in samples that
come through my laboratory section in toxicology that we see an
individual drug. There are generally two or three different drugs
involved in the samples that come through.
Most of the studies looking into fatalities show polydrug use. The
roadside survey studies indicate a lot of polydrug use as well. One of
the benefits of the DRE program is that officers are trained to look
for polydrug use. They're taught how the different combinations of
drugs will present, and what they should be looking for. Alcohol is
separated out within the DRE, the drug recognition evaluation, by
doing a breath test first to determine whether or not alcohol is
playing a major role. If the person is blowing over 100, shall we say,
then we probably would move over and do an alcohol impaired with
the individual.
It's very common to find individuals who are providing alcohol
levels of 30, 40, or 50 milligrams per cent who also have additional
impairing drugs on board. Alcohol and cannabis particularly are a
poor combination for driving skills, in that sub-impairing levels of
either drug...that is, if you have a certain level of the drug and it
wouldn't be impairing by itself, you combine them and you show
much more impairment than you would expect to see.
Hon. Hedy Fry: Again, looking at the 2012 study of chronic
cannabis smokers and the physiological changes, what it concluded
was that no significant differences were observed in critical tracking
or divided attention task performance in the cohort of heavy chronic
cannabis users. They found there was very minimal impairment in
terms of psychomotor tasks in the chronic users. But of course, any
amount of alcohol will impair—a glass of wine will impair—if
you're going to drive.
With regard to multi-drug use, among the most common drugs
used are antihistamines or cough medicines. We know those can
impair one quite significantly. Should we therefore test people for
antihistamines and cough syrup when we're checking for their
impaired motor skills when they're driving?
The bottom line is that lots of drugs that people are taking for
bona fide reasons, medications, etc., can impair, yet people get in
their car and drive using antihistamines or cough medicines.
Insp Jamie Taplin: Yes, and that's unfortunate, but it is true.
For the officer on the road, public safety is really what we're
concerned about. It really doesn't matter to the law enforcement
officer if it's illegal drugs or prescription drugs; if the person is
impaired, there will be an investigation. Certainly, with our impaired
driving strategy, one of the areas we want to focus a bit more on as
far as public awareness and education is concerned is on the
prescription drug side.
May 27, 2014
● (0920)
Hon. Hedy Fry: Do you find there has been a decrease in alcoholrelated driving accidents as a result of the number of ads and the
public education by MADD and a whole lot of groups? I have
noticed with young people after graduation, the idea of not drinking
and driving and having a designated driver is there. Obviously, that
kind of education has had an impact. It has taken a while, but it has
had an impact.
If you made something legal, the way alcohol and cigarettes are,
with no discernable benefits I might add, could you not do the same
thing with cannabis, which may have medical property benefits?
Could you not, with education, look at the same kind of outcome as
has happened with the issue of drinking and driving that seems to
have really had a strong impact?
Insp Jamie Taplin: Well, I do like the idea of more public
education to keep our roads safer. Our commissioner says that
everyone has the right to get home safely, and I certainly agree with
that. With respect to legalization, I really can't comment on that.
Hon. Hedy Fry: No, I'm not asking you to. I'm simply saying that
what we have is an example of two legal drugs that have no
discernable health benefit, but a lot of risks attached to them in terms
of personal health and driving. Good education has made a
difference with respect to alcohol use, especially among young
people, because they've now grown up in this kind of world. I mean,
when I was a young person, we thought we would live forever and
we did all kinds of stupid things. But today, we now know that there
is good education, so there may be an argument that good education
works.
How am I doing for time?
The Chair: Unfortunately, you're out of time. Thank you very
much.
Mr. Wilks will take us home. You have about five minutes.
Mr. David Wilks: I want to thank the witnesses for being here
today.
As a retired member of the force, I know that from time to time it
can be awkward to answer these questions through policy and the
requirement to do so. There is one thing I did want to ask you,
Sergeant Rusk. Does the D.A.R.E. program still exist in schools?
Have they ever measured the effectiveness of the D.A.R.E. program
as it starts at the elementary school level?
Sgt Dustin Rusk: D.A.R.E. still does exist. It is one of many
different proactive programs that we do utilize within the RCMP.
There has actually been a recent evaluation out of Penn State, around
the “keepin’ it REAL” curriculum to provide evidence toward it
working more effectively and having it impact positively within
schools.
May 27, 2014
HESA-29
Mr. David Wilks: Would you agree that whether it be the RCMP
and/or other police forces across Canada that do make a concerted
effort on attempting to educate the youth starting at a relatively
young age—D.A.R.E. probably starts at grades 5 or 6, in that general
vicinity...? Would you agree with that statement?
Sgt Dustin Rusk: D.A.R.E. is one brick that is built up in the
foundation of resiliency for kids to make informed decisions. As
we've all talked about here, education is such a key factor for anyone
to seek out. Looking at other agencies, other partners, be they
community based, be they provincial, territorial or federal, they all
have a stake in our young people and in making sure they have
access to the best education to inform the decisions they can make.
Mr. David Wilks: Thanks.
Unless it was attached to a student driving and then our becoming
involved in an impaired driving investigation, we wouldn't really see
that analysis, so I wouldn't really have much to add there.
The Chair: Thank you very much.
That concludes our first panel this morning.
We're going to suspend for a couple of minutes and allow our
guests to leave. Then we're going to cue in through the video
conference, and carry on.
Just to answer Mr. Young's question about who sells it to the kids
in high school, from my experience in Clinton, it's usually the guy
that failed grade 9 four times who did it.
Back when I was younger, as Ms. Fry mentioned, I was fortunate
enough to do the DET course in 1986 here in wonderful downtown
Rockcliffe. I'm sure things have changed.
I'm curious to hear from Mr. Smith and/or Inspector Taplin. The
common sale of drugs within schools is normally by the joint, $5 a
joint. Historically that hasn't changed.
The concerning part to me is this. I think there's some
misinformation as we've evolved in the drug age that those who
purchase marijuana at or around schools now are taking a significant
chance that the drug is laced with another drug, whether that be
meth, ecstasy, or a lot of things that can be crushed into the joint.
Are there any indications that the levels of THC along with other
drugs being mixed with the marijuana are becoming more prevalent,
less prevalent, or the same as they were from years gone by?
● (0925)
Insp Jamie Taplin: Certainly, as you mentioned, sales of joints in
schools, in my experience as a police officer on the streets of British
Columbia, it was exactly that at the school level.
As far as what's happening in the drug program, Dustin probably
would be the best person to respond to your question. I'll ask Darcy
to think about some of the toxicology results that go through the lab
and if there's anything he can add to that.
Dustin.
Sgt Dustin Rusk: One of the key points to hit upon is that buying
any substance in an illicit manner is a huge risk because you're not
getting it from a regulated source like a pharmacist, or whatever.
Wherever that product may come from, wherever it may be
cultivated or made, there is a huge risk factor with what else could
be going into it.
Again, speaking to regulatory factors such as the CDSA and
others dealing with such substances, anyone takes a risk when
getting something from off the street.
Mr. Darcy Smith: From our perspective, if it comes through one
of our laboratories, it has to be attached with criminal activity. The
sale of joints within the high schools would be more possession for
purpose of trafficking. Then Health Canada's labs do the analysis for
those.
7
Anyhow we'll suspend, and then we'll be right back.
Thank you.
●
(Pause)
●
● (0930)
The Chair: Welcome back, ladies and gentlemen.
We are with our second panel for this morning's meeting.
We have three witnesses, two by video conference and one here in
person. What we'll try to do is hear from the individuals who are
appearing by video conference first while we have our technology
working. Then we can go to our other guest who's with us in person.
Then we'll go through our rounds of questions.
We're pretty well on time. We do have a little bit of business we
need to get to at 10:30 so that leaves about an hour for this panel.
There's plenty of time to get through it.
We're going to start off first with Mr. Asbridge from Dalhousie
University.
Go ahead, sir.
Mr. Mark Asbridge (Associate Professor, Dalhousie University, As an Individual): First of all, thank you for inviting me to
speak to the committee.
I'm an epidemiologist. My research in this area typically focuses
on addictions and injury prevention. I have a particular focus on road
safety and traffic safety.
I'm going to speak to the issue of drug-impaired driving, in
particular the role of cannabis. I also have some other interests as
well. Some of my research is focused on issues around youth, trends
in youth consumption, young adult consumption, this notion of
normalization of cannabis and some of the issues about how we
define problematic or harmful use. I will speak on these if time
permits, and please cut me off, because I can ramble on.
8
HESA-29
It's important when we're talking about these issues in terms of the
health risks related to cannabis to contextualize how cannabis is used
or the nature of the use. It's important to think about cannabis in
some of the same ways we think about alcohol. Not much of the
harm associated with cannabis is linked to what we would call
uncontrolled or irresponsible consumption, and where the potential
for harm is maximized relative to more controlled use where harm is
minimal or non-existent. I want to speak to these issues when I cover
these topics.
In terms of cannabis and driving, there are three or four key points
that I want to get across around the issue. We know from the
experimental research that cannabis, when it's consumed in sufficient
quantities, impairs the cognitive and psychomotor skills that are
necessary for the safe driving of a motor vehicle. This has come out
of an extensive experimental set of studies. Many of the aspects of
driving are impaired, including things like vehicle tracking, reaction
time, attention, and so on and so forth. This is important because we
know from both hospital data and from survey data that rates of
driving under the influence of cannabis have been rising in the last
20 years.
Depending on the survey, self-reported rates of driving under the
influence of cannabis range from one in ten to four in ten youth,
depending on the jurisdiction, who use cannabis and drive within
one to two hours. That's an important threshold, the one to two
hours, because you're going to see the impacts of THC on
impairments on driving performance is going to be within that
narrow threshold of time.
We also know from administrative hospital data that between 10%
to 20% of drivers in crashes—these are individuals in crashes who
are presented to hospital with an injury—test positive for THC. We
also know that about 6% of drivers randomly stopped in the recent
B.C. roadside survey tested positive for THC. Data from Transport
Canada noted that a high proportion of fatally injured drivers also
tested positive for THC. In many of these cases, it's polydrug use as
well, but THC is present.
Finally, a lot of the surveys, particularly among youth and young
adults, that have come out of Australia, the U.S., and Canada,
indicate that self-reported rates of driving under the influence of
cannabis actually have surpassed rates of drinking and driving. They
are higher. This is an area potentially of concern.
The important thing is, from a road safety perspective, how does
the consumption of cannabis prior to driving affect the likelihood of
being in a crash or an accident? We know that recent or acute use,
again, within an hour or two before driving increases the risk of a
crash about twofold. That's generally been supported in a number of
med analyses, which are systematic reviews which are high level
summaries of the evidence that's out there. That has been confirmed
when you measure cannabis in blood.
The key aspect is to objectively measure recent use. The finding is
less clear when it's measured in urine, when you do an analysis of the
presence of THC. That's largely a result of some of the
inconsistencies in measuring the exact timing of consumption
relative to the driving event.
May 27, 2014
The association of cannabis with crash rates also is typically
stronger when you look at more severe crashes involving injury or
death. The evidence is not so clear when you look at less severe
crashes or non-injury crashes.
● (0935)
There also appears to be a dose-response relationship so that the
crash risk is increased at higher levels of THC that are measured in
blood, and that there are strong synergistic effects with alcohol even
at thresholds below those at which each drug would independently
impair someone.
This is a really important issue, but there are still some
discrepancies in the findings. A lot of that has to do with our
inability to have the most perfect studies, for lack of a better word, to
study the issue.
It's really a challenge to study this issue, because in order to
appropriately assess whether cannabis increases the risk of a crash
requires taking samples from individuals not only in crashes, but
individuals who were not in crashes. That's an extremely challenging
issue from a research ethical perspective and logistical perspective:
how do we stop people on the roadside and get them to give us blood
tests so that we can measure cannabis in the roadside population
relative to those involved in crashes? That's a challenging issue.
More work needs to be done in this particular area. We need some
high-quality studies and studies that measure THC in blood, not
urine, and that measure THC, again, in these control samples.
In terms of the legislation, you've probably heard from expert
witnesses on the topic around the current state of legislation for
cannabis and driving in Canada. There are varying policies across
the globe around how we detect and determine impairment. These
policies vary in how cannabis drivers are detected, the methods that
are employed to determine their legal impairment, and then the
associated punishment, whether it's a criminal charge or administrative sanction.
Detection typically takes two forms. One is through an
observation of driver impairment while behind the wheel. You
probably have grounds that a driver is driving erratically and may be
impaired, and therefore you stop them. That's what we use in
Canada. You have the probable grounds that they're driving
erratically and you pull them over. In other countries, they'll do
random stops or spot checks, and assess without specific cause.
May 27, 2014
HESA-29
When you determine impairment, in Canada we have, as you
probably heard, the drug recognition expert program, where we
detect impairment through a series of 12 stages. First is to look for
alcohol impairment, and then move on to other drugs. Other
countries set zero tolerance levels, where any amount of THC
present in the body is indication of impairment. That has some
problems, because of the way you measure THC. If you measure it
in blood, it's a little bit better, but most of the time it's in urine, and
that's not so good, because it could include use that happened weeks
prior. Other countries have per se limits like we do for alcohol,
where you have 80 milligrams per cent for alcohol as a Criminal
Code sanction. There have been suggestions of what that should be
set at. Some places have a range in the 5 nanograms a microlitre, or 7
nanograms to 10 nanograms a microlitre, which would be equivalent
to about a 50 milligram per cent for blood alcohol content. These are
different examples.
We don't have very good roadside testing technologies. We don't
have a breathalyzer for cannabis. There is some testing that's going
on in Australia, for instance, using saliva tests, using saliva strips,
but they have their own problems. These oral fluid tests have
problems in terms of false positives and false negatives, so the jury is
still out on that particular issue.
Do I have another couple of minutes?
● (0940)
The Chair: You have a minute and 10 seconds.
Mr. Mark Asbridge: I just want to touch on one of the other
areas in which we've done some work, and that is how we define
harmful or problematic cannabis use. A national and international
group I work with has looked at how we define this issue. I know it's
an issue of concern for the committee.
Simply put, there are various tools that are used by clinicians to
assess or screen for problematic use. These tools include the WHO's
ASSIST, for instance, and others, such as the CUDIT, the cannabis
use disorders identification test. These tools are used to identify
people at potential risk for cannabis misuse and problems.
When we look at this issue, we find that these items typically set
the threshold or the bar too low. These items typically identify any
use as being problematic use, so we see them as not very useful
tools. What often gets looked at is simply whether somebody uses
and the frequency of use.
For instance, with the ASSIST tool, you could use cannabis once a
month and be identified as being a problematic or harmful user, and
that would over-screen people from a health care perspective. That
would be a terrible tool to identify problematic use. What gets
excluded are true problems related to use that might be experienced
by the individual. I think we have to be careful when we use these
kinds of tools to identify problematic use, and we must consider
broader issues around real harms that might be affecting the
individual.
One of the things we looked at is that it's maybe more important to
measure the quantity of consumption, as we do with alcohol. We can
draw on the alcohol literature here. Quantity is more important than
frequency. Bingeing is more important than regular use of one joint a
day. It would be more important to look at somebody who smokes in
9
excess of three or four joints in a single sitting at more irregular
intervals or at somebody who uses multiple joints in a particular day.
Drawing on the alcohol literature, I think quantity is something that's
not considered strongly enough when we're looking for problematic
and harmful use.
I have a lot more to say, but I'll leave my points right here and
answer questions.
The Chair: Thanks very much, Mr. Asbridge.
Next up is Mr. Wood.
Welcome. Thank you. We know it is early out your way, but thank
you again.
You have 10 minutes to present.
Dr. Evan Wood (Director, BC Centre for Excellence in HIV/
AIDS, Urban Health Research Initiative, As an Individual):
Good morning. Thank you so much for giving me the opportunity to
speak. I have some brief prepared remarks and then I'd be happy to
take any questions.
By way of introduction, I'm a professor of medicine at the
University of British Columbia. I hold a Canada research chair in
inner city medicine. I am the medical director for addiction services
at Vancouver Coastal Health and I'm an American Board of
Addiction Medicine accredited addiction medicine physician.
Today I will summarize some of the health harms of cannabis at
the individual and public health levels and hopefully offer some
insight into how these harms can be mitigated.
In recent years research has concluded that cannabis can
contribute to some health harms, although I think in many instances
these have been overstated, and I'd be happy to talk about in which
instances I think they have been. As previous presenters have noted,
while these health harms are a matter for concern, especially among
vulnerable populations, relatively speaking, the health harms of
cannabis in terms of individual health are believed in the scientific
literature and in the medical community to be less serious than those
of tobacco and alcohol.
Most importantly, I should note that cannabis is one of the most
commonly used, certainly the most commonly used illegal drug.
Most users use it infrequently and with no obvious harms to
themselves.
I really come to this issue from a conservative perspective with
respect to government accountability and the need for impact
assessment of taxpayer-funded interventions. As you are likely
aware, despite more than an estimated $1 trillion spent in the last 40
years trying to suppress the drug market in general, cannabis remains
freely available to young people in our society. In many respects it is
more accessible to young people than alcohol and tobacco. There are
statistics from various U.S. government-funded sources, including
the Monitoring the Future study, that show that about 80% of young
people find cannabis easy to obtain.
10
HESA-29
In recent decades, rates of cannabis use have climbed; cannabis
potency has increased, and the price of cannabis has decreased.
Despite our best efforts in public education and law enforcement, it's
clear we've not been able to effectively curb cannabis supply and
demand, and importantly, a violent unregulated market has filled the
void to supply cannabis to consumers.
The Fraser Institute, an economic and public policy think tank, has
estimated that the market for illegal cannabis in British Columbia
may be as large as $7 billion per year. This is more than double the
total revenue from the province's agricultural, forestry, and fishing
sectors combined. The well-intentioned efforts to reduce the
availability and use of cannabis by making it illegal, like alcohol
prohibition before it, has had a range of unintended consequences in
terms of its contribution to organized crime. It's important not to
separate the cannabis market from other illegal industries. For
instance, the RCMP has done a very nice job describing how the
export market for cannabis to the United States contributes in a
substantial way to the importation of cocaine and guns into Canada.
Economists considering this issue have helped me understand that
this is just simply the laws of supply and demand; that is, any
consequential intervention into the cannabis market that in any way
reduces supply will have the perverse effect of driving up the price
of cannabis and incentivizing new individuals to get into the
marketplace. In light of the harms of cannabis use and the social
harms of cannabis prohibition the question is: what should be done
next?
It's commonly argued that rates of cannabis use would be higher if
law enforcement measures such as these were not in place, which
raises the question: should anti-cannabis provisions be strengthened?
Importantly, the scientific evidence does not supply this approach. A
survey of UN member states that looked at how aggressively antidrug laws, including anti-cannabis laws, were enforced demonstrated
that there's no association in per capita rates of use in relation to how
aggressively anti-cannabis prohibition are enforced.
● (0945)
Quite the contrary, settings with softer laws with respect to
cannabis, such as the Netherlands, where cannabis has been de facto
legalized, are lower than in settings where anti-cannabis prohibitions
are aggressively enforced, at least traditionally, such as the United
States.
While you've already heard from other speakers that the cannabis
available on our streets is more potent than ever before, it's important
to note that this has happened despite escalating expenditures aimed
at reducing the cannabis supply. Our best efforts to limit supply and
demand have not been successful. As a result, cannabis is freely
available throughout the country in an unregulated way and to the
benefit of organized crime.
As a physician and researcher, I stand with leading public health
bodies, including the Health Officers Council of British Columbia
and the Canadian Public Health Association, which have argued that
we should be looking at the taxation and strict regulation of adult
cannabis use as the best way to wage economic war on organized
crime, and certainly to have the potential to better protect young
people from the free and easy availability of cannabis that exists
under prohibition.
May 27, 2014
I'll stop there. I'm happy to answer any questions that members of
the committee may have.
The Chair: Thank you, Dr. Wood.
Next up we have Mr. Jutras-Aswad. Sir, you have 10 minutes.
Dr. Didier Jutras-Aswad (Assistant Clinical Professor, Psychiatric Department, Université de Montréal, As an Individual):
I want to thank the committee for inviting me to talk about what, in
my opinion, is probably one of the most controversial but also very
scientifically challenging topics in mental health. Talking about
mental health and addiction, psychiatrists leading the addiction
psychiatry unit at the Centre hospitalier de l'Université de Montréal,
also leading a laboratory focusing on the endocannabinoid system
and the neurobiology of addiction....
I have the chance to follow, I think, an amazing group of highly
skilled very renowned researchers that probably talked about a lot of
different aspects of the risks related to cannabis. Therefore, I'll be
able to focus on a very specific aspect of cannabis and risk that's
related to that substance. That is basically the content of cannabis,
which in my opinion is one of the very important factors to take into
consideration when trying to understand the risks that can be related
to cannabis.
As a general introduction, one thing that is very interesting at this
point in science related to cannabis is actually the growing
understanding we have of the neuroscience of addiction, and more
specifically the understanding of the endocannabinoid system, which
is what we now understand to be main compounds that are found in
cannabis, namely THC. I think that understanding really allowed us
to get a better sense of what the short-term and long-terms effects of
exposure to cannabis are. Also, the emerging knowledge that we
have now, that we'll talk about very soon, is about the content of
cannabis, which is a very complex substance.
As you probably have heard, there are different outcomes that
have been assessed in relation to cannabis exposure. Obviously,
there are some very specific outcomes related to mental health that
have been very well studied, including: the relationship between
cannabis exposure and psychosis; between cannabis exposure and
the risk of developing addiction to that substance but also other
substances; the relationship between cannabis exposure and the risk
of developing anxiety and depressive disorders, as well as
developing learning and cognitive problems.
In the last five to ten years, probably more the last five years, in
the neuroscience world and also the clinical and the addiction
psychiatry world, the growing knowledge that really highlighted and
put a new light on the association between cannabis exposure and
various outcomes is the fact that clearly all are not equal in front of
cannabis exposure. By that I mean, very clearly, when you look at
the general population who are not vulnerable from a mental health
or even a genetic perspective, the exposure to cannabis is quite rarely
related to very severe long-term negative effects, including mental
health.
May 27, 2014
HESA-29
What is clear now is also the fact that there are some factors that
can really increase the risk of developing very significant negative
effects when someone is exposed to cannabis. Among these factors,
one is definitely genetics. When you look at all the data on the
relationship between cannabis exposure and psychosis, certainly
there are genetic factors that will definitely modulate the risk of
developing psychosis when you're exposed to cannabis. Among
other factors, obviously, is age. Probably other researchers have
talked about the fact that age will definitely modulate the risk of
developing, for example, cognitive problems when you're exposed to
cannabis. The younger you are when exposed, the longer will be the
term you'll probably have cognitive problems.
One of the factors, which is why I'm here and what I want to talk
about today, that will clearly modulate the risk associated with
cannabis exposure and other cannabinoids is actually what is found
in cannabis. For a long time the main focus has been on THC, which
in laboratory settings has been associated with a lot of the outcomes
that I talked about—cognitive problems, psychosis, anxiety, for
example—but now we have a really good understanding, actually a
better understanding, of other cannabinoids that are found in
cannabis. Clearly, there is not only THC. For example, there's
cannabinol and also there's cannabidiol.
Why I talk about this is that all of these other cannabinoids that we
find in cannabis are very different from THC. I'll give you an
example. Clearly, when someone comes into a laboratory...and
groups around the world have shown that when someone comes into
a controlled setting and are administered THC in sufficient dosage,
you'll see cognitive problems. You'll see psychotic symptoms. You
will see anxiety symptoms very easily. On the other hand, when
someone in a controlled setting is administered another cannabinoid,
for example CBD, cannabidiol, you see very different effects. I'll
give an example.
● (0950)
In the lab, when you administer THC to someone at a significant
dosage, you will induce symptoms very similar to schizophrenia. If
you pre-treat these people, these subjects, with cannabidiol, you can
decrease the symptoms of psychosis. That's just to give you an
example of how this drug is very complex, but different compounds
will have a different effect.
That has very important implications in terms of how we
understand the risks associated with cannabis, but also what kind
of data we need to really be able to get a better sense of what the risk
is associated with cannabis and also how to deal with changes in the
laws and how we'll deal with, for example, therapeutic cannabis, if
we were to go that way in society.
I think the implications are very important. First, I think the
assessment of clinical effects and the risks associated with cannabis
can only be made accurately if THC and CBD contents are taken
into account, because depending on the ratio of CBD and THC, the
effect of that substance can vary widely and very importantly.
The therapeutic use of cannabis is not a topic I talk about, but
there is clearly some therapeutic potential for that substance as a
whole, and it can only be made in a scientific evidence-based manner
with rigorous control of the THC and CBD content. We know that
each substance has a very specific effect, and if we want to use them
11
in a therapeutic manner, we have to be able to control that, just as we
do with all other medications.
In terms of research, I also think that significant research effort
should be devoted to examining and discriminating the specific
effect, but also the risk associated with THC and CBD. Studies
looking at cannabis risk and therapeutic properties should consider
THC and CBD content when looking at that association.
In terms of recommendations, if I can make some, as a general
statement I think it's crucial to underline that much remains to be
understood in regard to the deleterious effect of cannabis. The risk
can only be truly understood by taking into account all the factors
that can modulate that risk. Again, all are not equal in front of
cannabis exposure. One of the major issues that needs to be solved is
the understanding of the specific effects of the various cannabinoids
that can be found in that substance, mainly THC and CBD.
In terms of regulation, I think that definitely the content ratio of
CBD and THC should be taken into account as part of any regulation
regarding cannabis, both for recreational purposes and for medical
therapeutic use.
I also think that compound simple with high CBD and low CBD
should be considered for now as potentially safer in the absence of
more definitive data, based on what we have available in terms of
scientific data on the effect of both compounds.
I definitely think that research related to other cannabinoids,
including cannabidiol, but also cannabinol and other cannabinoids—
there are dozens in cannabis—should be facilitated, including by
alleviating some of the burdens that are related to the study of that
substance. It's pretty amazing at this time that for a researcher, it's
much more difficult to study specific compounds, specific
cannabinoids, in an evidence-based, very strong scientific manner
than it is to study a substance such as cannabis that will have a very
different content. It is really difficult to study it as a medical
compound for medical use.
I also think that regulations that pertain to other cannabinoids,
including CBD, should be revisited. Actually, cannabidiol, which is
anti-addictive, does not induce psychotic effects, is not abused on the
street, is considered as dangerous and as addictive in terms of
scheduling in terms of regulation as substances like THC that can be
addictive, or other substances such as cocaine or heroin.
I'll be happy to take questions.
● (0955)
The Chair: Thank you very much.
We're going to go into our first round. Ms. Davies, go ahead,
please.
Ms. Libby Davies: I'd like to direct my questions to Dr. Wood.
First of all, thank you so much for getting up so early. I think there
are at least three of us on the committee who have an appreciation of
how early you had to get up to present to us today from Vancouver.
I know you've done a lot of research and you also have a lot of onthe-ground experience in Vancouver. This study that we're doing is
quite restrictive in that it's only looking at the harms and the risks of
marijuana use.
12
HESA-29
I have three questions that I want to ask you, and I hope you can
answer each of them.
Relative to a whole number of substances, whether it's alcohol,
tobacco, prescription drugs, or other drugs that are illegal, would you
consider marijuana to be a lethal drug?
Dr. Evan Wood: Do you want me to take them one at a time?
Ms. Libby Davies: Yes, one at a time. I have two more questions
after this one. We have seven minutes for back and forth, so we'll just
keep our eyes on the time, too.
Dr. Evan Wood: Very quickly, a great deal of study has gone into
looking at the relative harms of different psychoactive substances
and pharmaceutical drugs. As I made clear during my remarks, there
is broad scientific consensus, and I think people would be way
outside that consensus if they were to place cannabis as being more
harmful than alcohol and tobacco. Certainly, alcohol and tobacco are
much more addictive and toxic.
In terms of cannabis, you're asking if it could be lethal. In terms of
the physiologic properties of cannabis and the prevalence of use,
those types of reports are almost non-existent in the literature. With
confounding factors of poly-substance use and other things, cannabis
itself is relatively safe. I agree with the former presenter and have
personally seen individuals who have become psychotic from using
high-dose cannabis, but that's a transient effect of cannabis
intoxication. I've never seen anyone with persistent effects of that.
I think it's important to note that alcohol, during intoxication and
withdrawal, could make people psychotic.
So relatively, certainly it's much safer.
● (1000)
Ms. Libby Davies: Thank you, Dr. Wood.
I'll go to my second question.
I don't know if you are familiar with Kevin Sabet, from Florida.
He presented as a witness at the committee. In fact, he has been
widely quoted. He has an emphasis on a project called SAM, smart
approaches to marijuana. I've been reading some material that
disputes his credibility in terms of scientific evidence and whether or
not he has peer-reviewed material.
I wonder if you are familiar with his work, and whether or not you
have an opinion as to the credibility of the conclusions he presents.
Dr. Evan Wood: Yes, I know Kevin's work. Kevin tends not to
conduct original research and is not part of the scientific community
that's actively working in this area. He is known to work with policy
groups favouring a shift from outright prohibition to a sort of
prohibition light. I wouldn't place Kevin in the group of highly
credible scientists who are working in this area who are taking a bit
more of a nuanced approach.
Ms. Libby Davies: Does he have peer-reviewed papers that
you're aware of?
Dr. Evan Wood: I haven't seen original scientific work from
Kevin. I believe he has published commentaries and articles of that
nature, but not work such as that presented today funded by the
Canadian Institutes of Health Research, or my own work, funded by
the U.S. National Institutes of Health.
May 27, 2014
Ms. Libby Davies: So he would be more of a commentator than
someone who's actually done scientific research.
I have a third question, and you did partly address this in your
comments. We're talking about substances that to varying degrees all
provide harm. Probably the thing that we do every day in our lives
that is one of the greatest risks is driving a car, right? We use seat
belts. We try to mitigate the risks and promote a safe environment.
In your opinion, what provides better control and safety when it
comes to marijuana? Is it prohibition, or is it regulation?
Dr. Evan Wood: That's a really good question. I think it's
important for people to understand that there is a middle ground
between prohibition and legalization. I alluded to the Health Officers
Council of British Columbia, and the Canadian Public Health
Association, which believes that the strict taxation and strict
regulation of adult cannabis use would wage economic war on all
the organized crime groups that control this market and better protect
young people from the free and easy availability of cannabis. That's
certainly my opinion as well.
Ms. Libby Davies: To follow up on that, one of the issues that
Mr. Sabet puts forward as the reason we need to continue with a
prohibition model is the higher potency of THC content over the
years. It just strikes me that if we did have regulation just as we do
for smoking or alcohol, that's something we could actually regulate.
It would then produce a less harmful health risk. We could regulate
in terms of adult use, as opposed to youth using.
In terms of regulation, I know the medical officers did a lot of
work on this, but how do you actually see a regulatory regime in
terms of managing the risks and harms?
Dr. Evan Wood: This has been a huge area of scientific inquiry
with respect to looking at other substances, particularly tobacco and
alcohol. How they're regulated, how they're supplied, in what
potency, the outlet density you allow, and prohibitions on
advertisement and promotion all can have a huge impact upon rates
of use and related harms. That science could be lent to a regulated
market for the taxation and regulation of the adult use of cannabis.
Certainly, things like potency or, as a prior speaker described, the
relative potency in terms of cannabinol and THC are all things that
can be controlled. The increasing potency of cannabis, we have to
recognize, has emerged under prohibition, and there's the increased
sophistication of the market in that context. We've totally handed
over regulation to illegal bodies, and many of us strongly believe
that if we take control of this market, we can regulate this type of
thing.
● (1005)
Ms. Libby Davies: Thank you very much.
The Chair: Thank you, Dr. Wood.
Next up for seven minutes is Ms. Adams.
May 27, 2014
HESA-29
Ms. Eve Adams (Mississauga—Brampton South, CPC): Dr.
Jutras-Aswad, in very plain language, can you explain to me what a
psychotic episode looks like and what a schizophrenic episode looks
like?
Dr. Didier Jutras-Aswad: Actually, they're different things. You
can have psychotic symptoms that include hallucinations, obviously,
and delusions and ideas outside of the reality. That can actually occur
in a lot of different kinds of circumstances, such as when you're
severely depressed or when you have schizophrenia or a very severe
psychotic disorder that is a more long-term disorder, but also when
you're exposed to certain substances that can induce psychotic
symptoms, such as, actually, cannabis, or cocaine, or a lot of other
different drugs.
Ms. Eve Adams: Thank you.
I'm not sure if you're aware of a study from 2011 conducted by the
Canadian alcohol and drug use monitoring group. It's a survey they
ran, and it showed that in the last year.... They measured how many
folks actually used marijuana. In 2004, 14% of the general
population—they're extrapolating—had used marijuana at some
point in the previous year, but by 2011 it was down to 9.1%. That's a
statistically significant decrease. It's also a very sizable decrease. It
seems as though it was much more popular in 2004 but was very
much diminishing in popularity by 2011.
I guess we're somewhat concerned that all of a sudden this has
become a political football, and people are trying to throw this out on
the front pages and so on, when in fact there isn't this big clamouring
for legalization or the ability to sell marijuana at every corner store.
I'm particularly concerned about what the impact would be on the
developing mind, about what those health consequences are.
This is actually our last day of testimony for this study. What
we're struggling to find is independent scientific evidence that really
speaks to the effects and the impact on individuals' health of using
recreational marijuana, especially on developing minds. That study
said that the overall population is really not using marijuana quite so
much, but it did find, however, that youth really are using marijuana,
and some of the numbers are really, really high. In the past year,
cannabis use by youth was 21.6%, or three times higher than that of
adults.
I guess the concern is that if you were to make marijuana readily
available at variety stores and simply say that you needed to be a
certain age in order to purchase it, similar to cigarettes.... I think we
could all say realistically that we've seen teenagers smoking
cigarettes, so somehow they have them in their possession. Have
you undertaken any research on young participants, 13-, 14-, or 15year-olds, to see what the health consequences are of recreational
marijuana usage, or are you aware of any studies or science on this
issue?
Dr. Didier Jutras-Aswad: I'm not sure if I understand the
question. Is it about the availability of the drug, or whether the
change in the law would make it more available for youth? Or is it
about what the long-term effects would be?
Ms. Eve Adams: With regard to health, it's about whether you're
aware of any science that has actually looked at the impact on the
developing brain of using recreational marijuana. I assume that in the
studies you were referencing they were of consenting adults over 18
13
or 19 years of age, but is there any science out there about what the
impacts would be on the brain of a 12-year-old or a 13-year-old?
Dr. Didier Jutras-Aswad: Yes, there are data. As I said, actually,
it is quite clear, as Dr. Wood mentioned in some way.... The data for
now shows that in general and for the general population the risk
associated with cannabis actually is relatively minor in some ways,
when someone is not vulnerable, but there are clearly some factors
that would put people more at risk. As I mentioned, there's genetics,
but clearly the age and youth....
One of the data we have now is about the cumulative
consequences of exposure to cannabis. One of the factors that will
actually increase the risk of having cognitive problems associated
with cannabis is the age of exposure. Some studies that have been
conducted are basically saying that when the exposure occurs before
15 or 16 years of age, the effect on cognition can be much more
important and much more long term than when the exposure occurs
at an older age, let's say, or in adulthood, for example.
● (1010)
Ms. Eve Adams: Would it surprise you that, according to the
study, the average age at which someone first tries cannabis is 15.6
years? You're saying that this is a critical period of time. This is the
average, which means that many more people try it at a later age, but
many people try it at a much younger age. Is that of concern to you?
Dr. Didier Jutras-Aswad: There are two things. Is it surprising?
Not really. We know that cannabis is among the first substances used
when someone starts using drugs, with tobacco and also alcohol. We
know that cannabis will be one of the first drugs used by youth in
general. We also know that the peak from an epidemiological
standpoint, although I'm not an epidemiologist, is indeed during
adolescence or early adulthood; so it's not very surprising.
Is it of concern? As I said, the younger the exposure the more
likely someone is to have long-term consequences from cannabis
exposure. Obviously, if that peak occurs later in life during
adulthood when the brain is well developed, more solid, and less
flexible, we might think that the burden associated with cannabis
exposure might decrease.
Yes, it is concerning that it occurs at a young age, rather than
exposure occurring later.
Ms. Eve Adams: Finally, let me turn to pregnant women.
Currently, possession is obviously not legal. If it were readily
available in variety stores.... I think we've all been concerned, when
we see women drinking or smoking when they are pregnant. There
are a number of studies now showing that there are some significant
impacts on the infant.
Can you speak to those impacts, please?
Dr. Didier Jutras-Aswad: We have much better data on the
impact of exposure during pregnancy for alcohol and tobacco, for
sure, but we have emerging data for the impact of cannabis exposure.
14
HESA-29
I have to say, though, that all the research in that area is very
difficult to conduct, just for ethical reasons. Obviously you cannot
expose a woman and do a controlled placebo study, but the data we
have now—from the human study from Brain Bank, for example,
but also from animal models—show that cannabis can have some
impact on brain development for the fetus and also in the long term.
Obviously, as I said, the younger the exposure, including during the
fetal life, the more important the long-term consequences can be.
Again, that research field is at its beginning, and it's a very
difficult one to study for ethical reasons.
Ms. Eve Adams: I imagine it would require self-disclosure.
Dr. Didier Jutras-Aswad: Yes. We can talk about it for a long
time, but obviously disclosure is a main problem for the validity and
quality of the information reported by women saying whether or not
they have used cannabis. It's a huge problem to conduct a really
good study in that field.
The Chair: Ms. Bennett, you're up for seven minutes, please.
Hon. Carolyn Bennett (St. Paul's, Lib.): Thank you all.
I'm afraid that our track record at parliamentary committees, with
this government being able to use its majority to put in
recommendations and even confine studies such as this in a narrow
way and then replace what was heard with what they have already
predetermined would be the recommendations of a committee
hearing, means that I would prefer to use my time, particularly with
Dr. Wood and Dr. Jutras-Aswad, for you to make very clear what, if
you were writing the report for this committee, the recommendation
would be.
We've heard from Dr. Wood that free and easy access under
prohibition is not a good thing. The Canadian Public Health
Association has recommended an approach with taxation and
regulation. We've heard that there needs to be more research, and
more research around even the kind of research we're doing on
personalized medicine, genetic predisposition. I'm afraid I'm old
enough that, as a physician in the emergency department at the
Wellesley Hospital in Toronto, we saw people having psychotic
breaks from having seen The Exorcist, because they were
predisposed in some way.
I would like to give you both the time to tell us, if you were
writing the recommendations for this committee around this study
and the broader study that we wished it were, what those
recommendations would be, so that the people of Canada will know
what this committee heard when they see the weak recommendations
that will come out because this Conservative majority continues to
use its majority to replace what was heard from the witnesses.
It is very important that you tell us now what needs to be in this
committee report.
● (1015)
Dr. Evan Wood: Just listening to the conversations this morning
and watching the debate in society around this issue, I think the
biggest challenge for people, including members of the committee
whose comments this morning reflected concerns for adolescents, for
unborn children, and drug-impaired driving, is that, while all of these
concerns are valid, in my opinion, they are worsened by prohibition.
All the organized crime, grow ops, home invasions, and fires where
May 27, 2014
these grow ops exist are all a natural consequence of prohibition in
the same way that all the organized crime, corruption, and violence
emerged under alcohol prohibition.
For people who are sincerely concerned about young people,
fetuses, and all of the harms to our society from this massive
unregulated cannabis industry, I just encourage them to pause, take a
deep breath, and acknowledge the fact that cannabis is more freely
and easily available to young people than alcohol and tobacco are,
and that, if we strictly and with a great deal of government
intervention, regulated the adult use of cannabis, we could probably
address many of these harms and at the same time do away with the
forbidden fruit phenomena that is also a natural consequence of
prohibition with young people wanting to use cannabis because
we've made it illegal.
The policy has been a failure. It's been an extreme burden to
taxpayers. It has been a taxpayer investment that has resulted in the
growth of organized crime. It simply has not worked, and we
shouldn't continue to pour money into this failed exercise.
We should be having a thoughtful conversation about taxing and
regulating the adult use of cannabis as a strategy to address all of
these harms that we've been dealing with for a long time. It's going to
take a lot of courage for any government to do this, but I certainly
encourage our current government to approach this in a thoughtful
way and look to be innovative instead of making the same mistakes
that we've made in the past.
Dr. Didier Jutras-Aswad: I go back to what I said earlier that, in
general—and in general is very important—cannabis is rarely
harmful, but there are some specific people for whom cannabis may
be harmful, and there's also a very specific aspect of cannabis,
including the ratio of THC and CBD, that should be taken into
account.
That being said, obviously there will always be people who use
cannabis. If we want to decrease the burden associated with cannabis
use, we have to be able to protect those who are vulnerable, but also
be able to control what is in the substance and be able to actually
make sure the messages sent to society in general are accurate, but
also can be said clearly.
The question is how we could regulate to protect vulnerable
people to make sure that...for the general population for which
cannabis is not harmful, it would not necessarily prevent them from
doing something that is harmful, but how we could protect those
people and control what is in the substance. That question is
obviously outside of my specific knowledge. What I can say from a
clinical standpoint is that regulating and controlling what is in the
substance is obviously not something that is done by drug dealers
who sell the drug on the street, and it is not done by criminal
organizations that would actually put the cannabis on the market.
That's very clear to me.
May 27, 2014
HESA-29
The second point is for me to be able to conduct more accurate
research on the specific effect of the different chemicals that can be
found in cannabis. Also a very important thing for me is to
differentiate therapeutic use from the law and regulations regarding
cannabis use for recreational purposes.
Those are two very different reasons and topics which, in my
opinion, are sometimes mixed together in the population, but also
among politicians and even scientists.
● (1020)
Hon. Carolyn Bennett: People do see cannabis as their medicine
for very serious medical conditions, such as MS in a lot of my
patients. Therefore, you'd think that, in personalized medicine in the
future of health and health care in Canada, research on personalized
medicine, including THC and cannabinoids, is important.
Dr. Didier Jutras-Aswad: As for therapeutic use, I think more
research is needed. If you were to use a compound as a medication,
then just as for any other kind of medication, you have to know as a
scientist but also as a doctor what is in that medication. Sorry to use
this as an example, but if I had a bag full of pills, not knowing what
is in those pills, I would not give any to one of my patients.
To be able to use something for medical use, you have to know
what's in it. The regulation does not allow for that when using
cannabis for therapeutic purposes.
The Chair: Thank you very much, Ms. Bennett. Your time is up.
Now we're going to Mr. Lunney, for seven minutes.
Mr. James Lunney (Nanaimo—Alberni, CPC): Thank you to
all of the witnesses for contributing today.
Way out there in Halifax, is it Dr. Asbridge? Is it doctor or mister?
Mr. Mark Asbridge: I'm in Toronto, actually, and it's mister.
Mr. James Lunney: Oh, you're in Toronto.
Mr. Asbridge, you mentioned in one of your comments about a
study that showed 6% tested for THC in B.C. I think you were
referring to a roadside test. Were those accidents that you were
referring to? How was that test done? Was it saliva, urine, or blood?
Could you clarify that for me, please?
Mr. Mark Asbridge: Yes. That was the B.C. roadside survey.
There have been a couple of iterations of that. This was the 2010
version. It was random stops at the roadside. These were not drivers
in crashes. It was determined with an oral fluid sample.
Mr. James Lunney: I think you said there were problems with
reliability.
Mr. Mark Asbridge: A little bit, small problems.... It generally is
pretty good but there are some false positives and false negatives, as
with most tests.
Mr. James Lunney: Impaired driving is certainly a concern in
terms of public safety. There's compelling evidence that in Colorado
there are a lot of accidents related to marijuana use and
hospitalizations related to these crashes have been going up. I just
want to leave that for a minute and go in another direction.
I want to go back to Dr. Jutras-Aswad. Well, I go back to Dr.
Kalant from University of Toronto who spoke here. He's a professor
of pharmacology. He particularly emphasized the fact that those who
15
start young have the greatest impairment, the risk of depression later,
risk of motor vehicle accidents.
We had other evidence, in fact, of impairment in cognitive
development, from functional MRI, that in fact there's delayed
myelination in the frontal areas, where higher executive functions are
developing, where reasoning, problem solving, decision-making...
areas that can affect adolescents later in life...even maternal smoking
has an impact; it's measurable later in life.
In your review of some 120 studies that looked at different aspects
of the relationship between cannabis and the adolescent brain.... That
is a concern to a lot of us here because it seems they're starting
young. They may be choosing their career path unwittingly at a very
young age because they're going to impair their ability to do higher
executive functions with their brain that would require greater
cognitive engagement.
You talked about the association between cannabis and subsequent addiction to heavy drugs and between cannabis and psychosis.
I would like you to expand a little bit on that because your time was
limited earlier.
Dr. Didier Jutras-Aswad: There are obviously two different
questions here. One is the relation between cannabis and subsequent
addiction to other substances, which is also known as the gateway
theory, which has been studied and reported on for a number of
years. It basically says that a lot of studies have shown that a vast
majority of people will go on to use cocaine, heroin, or what are
called hard drugs. When you look back at their story of substance
use, they started by using cannabis, or quite often cannabis will be
on the path of using other drugs. That has led to this idea that maybe
cannabis was leading to other addictions that obviously as for all or
most other outcomes what has been shown actually.... It's pretty
much a similar story to psychosis. Indeed there is some data showing
that cannabis may have some impact on how the brain will develop
that could put someone at an increased risk of developing an
addiction.
Obviously there are other much more important factors involved
in developing addiction to other drugs.
The other thing we have to take into account goes back to what I
was saying, that, in general, cannabis is not related to long-term
harmful consequences. Most people or even most adolescents who
use cannabis will not go on to use harder drugs. From
epidemiological data, we know there's a minority of people who
will go on to use other harder drugs, but still, cannabis is along the
way. We know there is some neurobiological effect of early cannabis
exposure that could increase in some ways the risk of developing
other addictions.
16
HESA-29
As for psychosis, and again to put it briefly, what is known now is
that cannabis per se is probably not itself a cause of schizophrenia or
of long-term psychotic disorders. What we know now is that
cannabis can act as a stressor or as a trigger for people who have a
vulnerability with respect to psychosis; when exposed to cannabis,
they will go on to develop schizophrenia, for example.
● (1025)
Mr. James Lunney: You talked about the areas of the brain
affected by cannabinoids and by cannabis; areas that govern our
learning and the management of rewards and motivate behaviour,
that are engaged in those functions of decision-making, habit
formation, and motor function. Those things are developing in
adolescence. When we talk about a genetic expression, I mean,
genes are turned on and off by external factors in many cases.
Are you aware of the impact of maternal smoking or picking it up
in the home—there's a lot of talk about second-hand smoke in other
capacities—where there's marijuana in use and the kids are growing
up in that environment? In your research, are you aware of any
connections between maternal smoking or environment affecting the
kids growing up in that environment?
Dr. Didier Jutras-Aswad: I would not be able to comment on
that from a scientific perspective, other than on fetal exposure to
cannabis through maternal smoking, as I responded earlier.
Mr. James Lunney: Dr. Jutras-Aswad, you talked about the
medical use. This study is not about medical marijuana, per se, but
the other factors in marijuana. Because of this perception that
marijuana is harmless and well tolerated, it hasn't adequately been
studied in terms of the full range of compounds in marijuana and the
impacts they have. I think you made that remark to Dr. Bennett about
May 27, 2014
an unknown quantity there, the mixtures, the numbers, the potency
of marijuana.
To go back to the Le Dain commission, I guess it was, the
potencies way back in that era 20 years ago were 1%, maybe 2%.
Currently, they’re at 10% to 15%, and some are as high as.... Where
I'm from on Vancouver Island, we have Lasqueti Gold out there.
Somebody referred to the widespread production of marijuana in
British Columbia. Some of that is very high potency, even up to
30%. At least we've heard evidence that it can be as high as 30% in
some productions. We're talking about something that has a hugely
different impact from what earlier generations experienced.
Can you comment on that aspect, of the range?
The Chair: You are over time, sorry.
Mr. James Lunney: Really?
The Chair: I'm sorry to tell you that.
Anyway, ladies and gentlemen, we're pretty close to the time when
we want to get into committee business. What we'll do is thank our
guests today for taking the time. I know they're very busy. Thank
you.
We're going to suspend for a minute or two and that will allow us
to reconvene at half past and get into committee business. Then,
we'll have about 15 minutes for that.
We'll suspend the meeting and we'll be back in a couple of
minutes.
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