Health Committee on May 13th, 2014

[Philippe Lucas]

I would suggest that under the new system, the MMPR, it absolutely is the case. I work for a medical marijuana producer and distributor named Tilray, and if we get any adverse reporting at all that comes from the use of our cannabis, we need to report it back to the Canadian government. We have protocols to do that. In fact, since this new program started, we've actually seen recall of two different cannabis strains by two other producers, not because of adverse health effects to the end user but because problems had been found with the quality of that particular cannabis.

Right now in Canada we have the most robust and the strictest regulations around the production and distribution of cannabis that I think you'll find anywhere in the world. There's definitely no lack of reporting under our current system. What we don't have is a lot of patient outcome studies. The Canadian government could play a significant role in that direction by putting funding towards patient outcome studies, looking at the different conditions that we've brought up today.

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

When previous witnesses who talked about the negative effects of marijuana were asked “What are the medical benefits?”, they all told us that more research is needed before conclusions can be drawn.

Do you agree with that?

[Philippe Lucas]

I completely agree that in terms of long-term effects for a lot of the areas that people are using cannabis we absolutely need more research. I think there are certain conditions where we now have ample research to be able to suggest that there is some good going on. We have a strange conundrum here in Canada: we have a court-ordered medical marijuana program. It hasn't followed a normal path. It's tied up with ideological beliefs as well, which makes it challenging for the research to go ahead as we would with any normal pharmaceutical.

Those are the challenges we face at the political level and the challenges we face as researchers as well.

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

We were also told that over the past 20 years, the marijuana that's on the market now has become 10 to 20 times stronger. Would that be a concern to you?

[Philippe Lucas]

I think the evidence is pretty clear that even starting in the seventies, from seizures done by NIDA and governments that track the rates, there was always high-THC cannabis available at the time. I think we've seen an increase in the rates of THC that came with people producing indoors, as opposed to there being an outdoor supply. But there's certainly no evidence of greater harm associated with those higher rates of THC. People tend to self-titrate; they use the amount of cannabis they need and then they stop using it. I think it's a concern, but I don't think we've seen any evidence of an actual public health harm tied directly to those THC levels.

What I can tell you is that right now at Tilray, interestingly enough, one of our top-selling cannabis strains that's being used by patients is a high-CBD strain. It's low in THC. Patients are looking to try different modes and approaches to cannabis that don't involve intoxication necessarily.

I think through a regulated system, whether it be for medical or recreational use, giving people knowledge about what they're using, letting them know what's in it, the level of THC and CBD, is probably the best harm reduction tool we can hand to Canadian medical or recreational cannabis users, so that they actually know what they're getting. On the black market, unfortunately, there are no controls for that. There are no age controls, no quality controls, and that's a problem.

[The Vice-Chair, NDP, Libby Davies]

Thank you, Mr. Lizon. You had almost seven minutes there.

Members, I'll just let you know that we've heard that we may get a bell to go back to the House.

We'll now turn to Mr. Gravelle.

[Claude Gravelle, NDP, Nickel Belt, ON]

Thank you, Madam Chair.

Mr. Lucas, can you tell me what the outcome would be if the government were to remove the medical marijuana program? Would there be more harm done than good?

[Philippe Lucas]

It would cause tremendous harm. There are, as has been suggested, 50,000 Canadian patients enrolled in our federal medical marijuana program. That is the tip of the iceberg of the actual Canadians who are using medical marijuana in Canada. The official estimates are that, among Canadians, between 500,000 and one million—about 2% to 4% of the adult population—currently use cannabis for medical purposes. So our program right now is protecting only a tiny proportion from arrest and prosecution. There's no doubt in my mind that those who are suffering from serious conditions, critically and chronically ill Canadians, would be negatively affected in a very significant way if they didn't have access to a safe source of cannabis.

I've had the opportunity and the privilege to work with patients for a number of years to see the way that it's changed some patients' lives, the way it allows them to live a richer life, the way it allows them to have more peace of mind and relate to their families better at the end of life because they get to use fewer pharmaceuticals, fewer pharmaceutical opiates in particular. It's been a remarkable privilege to be witness to people's healing and their better health outcomes when they use medical cannabis—which, by the way, simply isn't effective for everyone. It seems to help a percentage of the population, but another percentage of the population doesn't seem to benefit from the use of cannabis or doesn't respond well to it. In no way is it a panacea; it's not going to help everyone under every circumstance.

[Claude Gravelle, NDP, Nickel Belt, ON]

Thank you.

I'd like to go back to the book that you worked on. There was a part on chronic pain. I'm going to read that out and I'd like you to comment:

Cannabis can serve at least two important roles in safe, effective pain management. It can provide relief from the pain itself...and it can control the nausea associated with taking opiod drugs, as well as nausea, vomiting and dizziness that often accompany severe, prolonged pain.

Can you comment, please?

[Philippe Lucas]

No matter what the primary condition is that people use cannabis for, a primary symptom that they always report getting relief from is chronic pain. The primary symptomology beyond that includes better sleep, lower anxiety, and stress relief.

So there's no doubt in my mind that for people in Canada who are trying to seek relief from severe, chronic pain, whether it be due to MS, injury, or other debilitating conditions, cannabis should be a treatment option for them. It's yet another tool that we give to physicians in their tool belt of how to deal with chronic pain, and thankfully, it's less potentially addictive and less potentially harmful than a lot of the other common pharmaceuticals that are used to treat chronic pain.

[Claude Gravelle, NDP, Nickel Belt, ON]

Also in the same book, concerning HIV, it's stated, “The effectiveness of cannabis for treating symptoms related to HIV/AIDS is widely recognized.” How widely recognized is it?

[Philippe Lucas]

I think it's indisputable at this point. The amazing thing is not only that it helps people treat the symptoms of the disease, but that it helps people treat the symptoms and the side effects associated with the treatment, so what we see are actually better treatment outcomes.

The same is true for people with hepatitis C. They tend to have better treatment adherence. In other words, it allows them to go through the treatment more successfully and stay on treatment, therefore saving lives and public health costs in the interim.

[Claude Gravelle, NDP, Nickel Belt, ON]

How much more time do I have?

[The Vice-Chair, NDP, Libby Davies]

You have about a minute.

[Claude Gravelle, NDP, Nickel Belt, ON]

Also from the book, on gastrointestinal disorders, is this statement:

The effectiveness of cannabis and its derivatives for treating gastrointestinal disorders has been known for centuries. Recently, its value as an anti-emetic and analgesic has been proven in numerous studies and has been acknowledged by several comprehensive, government-sponsored reviews, including those conducted by the Institute of Medicine...the U.K. House of Lords Science and Technology Committee, the Australian National Task Force on Cannabis, and others.

Can you comment, please?

[Philippe Lucas]

In my experience, for the treatment of conditions that are otherwise orphan conditions, we don't have a lot of good treatment modalities, including conditions such as Crohn's disease, irritable bowel disease, or irritable bowel syndrome. Cannabis appears to be a very effective treatment modality. There have been very few clinical studies and very little clinical research done on this, but certainly we know, by the large use by patients who suffer from GI conditions, that this seems to be an effective and potentially...well, it certainly is a popular treatment modality.

[Claude Gravelle, NDP, Nickel Belt, ON]

Thank you.

[The Vice-Chair, NDP, Libby Davies]

Thank you very much.

Thank you, Mr. Gravelle.

We'll now go to Ms. Adams.

[Eve Adams, Conservative, Mississauga—Brampton South, ON]

Thank you, Madam Chair. It's nice to see you in the chair.

Mr. Lucas, I apologize that you're suffering from hepatitis C. Thank you very much for coming forward today to share your testimony.

I'd like to put this question to both of you individually. Can you tell me if you know of any health risks of the recreational use of marijuana? What would they be?

[Philippe Lucas]

I think that ultimately you would have to have concerns...well, I think that everyone has concerns over youth use of cannabis. I think that's the primary concern I have, both as an adult and a former high school teacher and child care provider. So I think that any policies that can help us keep it out of the hands of youth are going to have a net beneficial effect. I don't think that criminalizing our youth is a good way to do that, but I do think—

[Eve Adams, Conservative, Mississauga—Brampton South, ON]

What age—

[Philippe Lucas]

—that a public health-centred policy would be useful.

[Eve Adams, Conservative, Mississauga—Brampton South, ON]

At what age would you say that you would have no concerns whatsoever that there would be no health risks for the recreational use of marijuana?

[Philippe Lucas]

I've never said that there was no health risk at all associated with the recreational use of cannabis. It's an intoxicant and, like any intoxicant, it carries a potential health risk.

[Eve Adams, Conservative, Mississauga—Brampton South, ON]

What are those health risks, then?