Health Committee on May 1st, 2014

[The Chair, Conservative, Ben Lobb]

Mr. Young, you're up for seven minutes.

[Terence Young, Conservative, Oakville, ON]

Thank you, Chair.

Thank you for being here today.

In movies and on television, marijuana is often a source of humour, and everybody gets the joke when somebody's—they do it with alcohol too—stoned or drunk, whatever. It's all done in great humour, etc., but what we don't hear about and what they don't put in movies, because it's not funny, are the long-term harms, or the short-term harms, that are caused by the use of marijuana.

Prescription drugs have to be proven safe before they can be sold, before they can be licensed and get a number to sell them in Canada, and that's for a very good reason. That's because they're inherently dangerous. They're powerful. They affect the body and they can cause harm. In fact, all prescription drugs can cause adverse effects, but marijuana has never been proven safe at a clinical standard, at least not that I've heard of, and if you've heard differently I'd like to hear that.

It's the only drug that I know of that is in fact allowed to be sold legally, prescribed by judges, because it's judges who have said, “You have to let people have it.” For the people who are using it, I don't know of any clinical evidence that it benefits them. There's lots of incidental evidence, but of course, the primary effect of marijuana is euphoria. People feel better. It makes you feel euphoric, so it's hard to do a clinical trial or provide clinical evidence that it's providing a medical benefit.

So what we're trying to do here is find what evidence there is of risks and harms, because it's hard for the users themselves to judge it, because they have good reason to take it. They're in pain or they're terminally ill and it makes them feel better. It's the only drug I know that's allowed to be used without evidence that it's safe. Shouldn't any drug that Canadians take be proven clinically safe before they're allowed to buy it and use it?

[Hilary Geller]

Thank you for the question.

It is true that when it comes to dried marijuana, the regime that exists is as a result of various court decisions over the years, and it is true that dried marijuana has not gone through the clinical trials, etc., and the rigorous process that is required for any other prescription medication in this country.

I will just mention that there are two drugs that contain extracts or derivatives of cannabis that have been through that process and are approved under the Food and Drugs Act. They're called Sativex and Cesamet. So there are cannabis-containing products that are available, that have gone through the usual process.

When it comes to dried marijuana, Health Canada has prepared, with the assistance of an expert advisory committee, a review of the evidence that does exist—the various studies and some limited clinical trials—in an attempt to offer to health care practitioners what information does exist, but it is very limited.

[Terence Young, Conservative, Oakville, ON]

Thank you.

You made a comment that there's evidence that marijuana is getting stronger, and I know because there was lots of marijuana in my high school, Bloor Collegiate, when I grew up in Toronto. It was everywhere. In fact there was a lot of LSD around, too. That's when I originally became aware and concerned about the health effects, because I saw my own friends fall by the wayside and drop out of school. Some of them never really came back. Some of them never really recovered, but that's also incidental.

I know that the police told me.... In 1997, I presented a private member's bill as a member of provincial parliament to try to keep drugs out of the schools. They said it's 20 times stronger, the marijuana, than the marijuana my generation had experimented with in high school.

We heard this morning that 20.3% of our youth use this powerful drug at least once a year, and that in grades 9 and 10, where their judgment is really the most immature, or perhaps you could say the poorest, 25% had smoked it in the last year, and 10% to 12% three times in the last 30 days, which would be, I guess, termed as frequent users. So it gets particularly dangerous when they interview these youth and they don't think there are any serious risks. They're not recognizing any risks, including the risk of driving, and we know a significant percentage of young people smoke marijuana and drive automobiles or other kinds of vehicles.

Can you comment on the general health risks to these young people from marijuana?

[Hilary Geller]

Thank you very much.

In general, the health risks to young people have to do with their developing brains. It's a combination of the fact that it can—through a complex interaction, which the scientists will be able to explain to you much more specifically—have long-term lasting structural effects on their brains, which could then have long-term lasting effects in terms of their executive functioning, etc., as they go through their lives.

What is also, as you alluded to, extremely concerning is their lack of knowledge and information about those risks. It's always a mistake to speak anecdotally, but I have a 15-year-old who will say quite openly, “Everybody knows smoking tobacco's stupid, but what's the problem with pot?” I think she is just simply reflective of her generation. I have seen some information and literature that suggests that the myths among youth are prevalent. It's not just about it being harmless. Some of them actually think it's healthy, perhaps a cure for cancer.

They simply just do not understand the facts, through no fault of their own. I think the particular harms for youth are a relatively new and emerging science. I think the consensus—as with anything in science—needs time to develop, needs repeated trials. But I was struck at the round table that the minister had yesterday, where the scientists said the debate is over.

[Terence Young, Conservative, Oakville, ON]

Thank you.

Now the one that concerns me the most, because it's potentially the most serious, is the risk of psychosis. I'm looking at a document produced by the Canadian Centre on Substance Abuse, and it refers to the risk of psychosis. I'll just read briefly. “People who use cannabis—especially frequent users—are at increased risk for psychosis and psychotic symptoms.”

Now, people who are suffering from psychosis are detached from reality, can become violent, and can be harmful to themselves or others. Would you please comment on this?

[Hilary Geller]

That is true. I have heard the scientists say that. I understand that it's—as many of these things are—a complex interaction between genetic predisposition, age of onset, frequency of use—

[Terence Young, Conservative, Oakville, ON]

Is genetic predisposition proven, by the way?

[Hilary Geller]

The scientists, I think, will tell you that it's true. Yes, there has to be some genetic predisposition.

[The Chair, Conservative, Ben Lobb]

Thank you very much.

Next up, for seven minutes, we have Ms. Fry. Thank you.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Thank you very much. I wanted to say that we've talked about the scope of the study, and I think that the last questioner sort of moved into the scope of medical marijuana. Obviously, if you're going to speak of marijuana in general, you have to speak of all its usages: medical, non-medial, recreational, etc. I'm hoping that is what is intended in the scope of this study, because we're not saying “medical marijuana”, and we're not saying “with the exception of”. It just said “marijuana”.

I want to ask a couple of questions. For me—and I will put this on the record—it's extremely strange to study the harms and risks of a drug without looking at its benefits. I would have thought that this would have been a better study if we were also looking at benefits, because there have to be some benefits or else Health Canada would not have okayed the two clinical derivatives. There had to be some benefits from it for patients.

So we're not even discussing benefits but I'm hoping that somewhere along the way anybody with any scientific acumen would know that you have to discuss risks and you have to discuss benefits. You cannot speak of one without the other.

I would like to ask you, therefore, a question about the clinical derivatives that you've referred to that Health Canada has okayed, and has a notice of compliance out there, as drugs. There must have been some benefits. I wonder if you could tell me what those benefits were that allowed you to okay the drug. That's the first question.

The second question is this. If we're going to talk about the harms of any kind of substance that is taken broadly.... We have cigarettes and I have yet to see—as a physician—or read or hear that there is any benefit at all of smoking cigarettes, yet cigarettes are legal and they're regulated. Secondly, I think we know that there are some very vague benefits with red wine, but we do know that alcohol is a potent and very dangerous drug. So we made it legal and we regulated it, so that young people can't have access to it.

I want to put marijuana into that context as well. When you have 20% of kids who have been using marijuana at a very young age, that tells me that this drug needs to be regulated in some way, shape, or form, or it will continue to be an underground drug for recreational use. So for me, if we're going to talk about marijuana, and we're going to talk only about its harms, I would think that we need to acknowledge that there are no benefits—or mild benefits in terms of cardiovascular, which has yet to be proven—with red wine, and none at all with cigarettes, yet these two drugs are legal and they are regulated because we believe that they do enough harm, and sufficient harm, that we don't want young people to be using them. I want to put marijuana in that context as well.

I'd like to hear, first, the clinical merits of the derivatives that you talked about, which are drugs. The second question is this. Why is it that we will not consider treating marijuana like we do two useless and dangerous drugs, and therefore, make sure that it's legal and regulated so that we don't have an underground economy going on where young people can get it any time they want?

Those are my two questions.

[Hilary Geller]

Thank you.

I'll just start with the second first, if I might. It's just simply to say that marijuana is regulated in Canada. It's regulated under the Controlled Drugs and Substances Act. It meets the scheduling criteria to be made illegal, with the exception of the medical marijuana program, which is enabled under a special set of regulations.

I'm going to ask my colleague Robert Ianiro to talk about the Sativex examples.

[Robert Ianiro, Director General, Controlled Substances and Tobacco Directorate, Healthy Environments and Consumer Safety Branch, Department of Health]

Thank you for the question.

Thank you, Hilary.

In regard to the two approved products that Ms. Geller referred to as Sativex and Cesamet, I'll just situate things. As I'm sure everyone knows there's a very rigorous process in place for the approval of drug products in Canada under the Food and Drugs Act around safety, efficacy, and quality. Specifically, the two that were mentioned were Sativex and Cesamet.

Sativex is a cannabis-based medicine and it really is indicated quite specifically. It contains both THC and cannabidiol, and it really is indicated for specific treatment, an adjunctive treatment for symptomatic relief of neuropathic pain for adults who suffer from multiple sclerosis. So that is what it is specifically indicated for.

In the case of Cesamet, it is a synthetic cannabinoid, therefore it is manufactured synthetically and it's administered orally. It has antiemetic properties, which have been found to be of value in the management of some patients who are dealing with nausea and vomiting, who are undergoing cancer chemotherapy. Those are two examples of the only two drug approvals that our colleagues in the health products and food branch have approved and given notices of compliance and issued drug identification numbers to. But again, when we speak about the benefits, clearly the indications of those two drugs are quite specific to certain conditions.

[Hedy Fry, Liberal, Vancouver Centre, BC]

How much time do I have?

[The Chair, Conservative, Ben Lobb]

You have just under two minutes.

[Hedy Fry, Liberal, Vancouver Centre, BC]

As are the indications for any medication at all.... They all have benefits and they all have risks, and they are all specifically indicated when you give them to a patient. All I'm saying, therefore, is that there are some benefits, especially in neuropathic pain, as you so eloquently pointed out, and in terms of nausea and vomiting as a side effect of treatment for cancer. So there are positives to it.

I think the issue here, therefore, are the benefits and the harms. Now, there's a study, one study that shows that there may be harms to the developing brain. There are not that many studies that show there are harms to the developing brain. We know that if we weigh that up against what cigarettes do to young people and what alcohol does to young people, I think we might very well look at how we talk about apples and apples, and not single out one particular drug for vilification. I'm just saying there are at least pluses for cannabis in different forms. There doesn't seem to be any that I know of for cigarettes, and there are pretty bad risks with alcohol.

I just wanted to ask you about the concept of regulating. Cannabis is illegal. If you get found with cannabis in large amounts, more than for personal use, you get fined. It's a criminal activity to use it. I'm talking about the fact that it's not a criminal activity to use cigarettes. It's not a criminal activity to use alcohol, which we know have severe risks. So what would be your suggestion? How would you look at the idea of therefore looking at regulating cannabis in the same way in which you regulate alcohol and tobacco, both of which are extremely addictive, as we well know?

[David Wilks, Conservative, Kootenay—Columbia, BC]

I have a point of order.

[The Chair, Conservative, Ben Lobb]

You have a point of order, Mr. Wilks.

[David Wilks, Conservative, Kootenay—Columbia, BC]

Relevance.

[Hedy Fry, Liberal, Vancouver Centre, BC]

It's totally relevant.

[The Chair, Conservative, Ben Lobb]

Well, we're right at the end of this so if you have a brief response, Ms. Geller, go ahead, and then it will be Mr. Lunney's turn. Thank you.

[Hilary Geller]

I would just simply say that we look at marijuana the same way as we look at other substances that can have harms. We have scheduling criteria that we examine the substance against, which include things like evidence of abuse, addiction liability, risks to personal and public health and safety, as well as issues around legitimate use; and marijuana meets those criteria to be scheduled.

[The Chair, Conservative, Ben Lobb]

Thank you very much.

Mr. Lunney, you have seven minutes, please.

[James Lunney, Conservative, Nanaimo—Alberni, BC]

Thank you very much, Mr. Chair.

Well, it's a fascinating subject. I'm sure we're going to enjoy learning more about this interesting subject.

On the subject that Dr. Fry brought up, I would like to comment on that before I go to my questions. I think if we were looking at smoking—you talk about smoking and alcohol, and why shouldn't we regulate marijuana the same way for recreational use—I think that implies that we can't learn from past mistakes. I suspect if we were having the discussion today, knowing what we know about smoking, the tobacco industry would never have been established the way it has. I just make that as a comment. It would be an interesting discussion.

Coming to the subject at hand here, I note that in your presentation you talked about cannabis being the second most commonly used illicit drug among individuals accessing publicly funded treatment services, and that admissions to hospitals in 2008-09 were over 11,000—11,800 admissions—and going up, by 2012-13, to 21,000 admissions linked to marijuana use. Can you comment or elaborate on the nature of those admissions? Are they for psychological states, for confusion or mental problems? What is the nature of those admissions?

[Hilary Geller]

This is relatively new information on the admissions that we received from CIHI. As I understand it, marijuana is a factor that has been brought to the attention of the physician when they're admitted to the hospital. So it's not necessarily the reason that they're admitted, but it is a factor that is affecting what is happening with the patient and is a cause for what is going on. The trend for marijuana—same protocol, same methodology—being either the factor or a contributing factor has increased over the years.