Health Committee on May 8th, 2014

[Dr. Tony P. George]

I think it probably depends on how it's done. The probable path is that legalization would suggest there's some need for control. I suppose commercial interests would probably respond to assisting Health Canada and the Canadian government by ensuring that, in a legalized framework, the quality and constituents of the marijuana were under control. So I suppose that would be equated with a commercial aspect.

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

We'll agree to disagree on this.

I think decriminalizing or legalizing it would not in fact control any forms of THC or cannabinoids, because you would still have the black market. This is still a multi-billion dollar business, whether it's for the Hells Angels or any other—

[The Chair, Conservative, Ben Lobb]

We have a point of order here.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

I respect my Conservative colleague a great deal—

[The Chair, Conservative, Ben Lobb]

Pardon me for just a second. Go ahead.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

I respect my Conservative colleague from across the way a great deal. However, I think we are studying marijuana's health risks, not its commercialization. My Conservative colleague's remarks and comment are off topic, because we are studying the health risks, not the commercialization and criminal use of marijuana.

[The Chair, Conservative, Ben Lobb]

Well, those are fair enough comments.

We have a minute left for Mr. Wilks.

Go ahead, sir.

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

Thank you very much, Mr. Chair.

I'll maybe qualify some of my comments, by saying that in my twenty years as a police officer and three years as a undercover drug officer, I was also qualified before the Supreme Court of British Columbia with regard to the amounts required for trafficking and being able to identify marijuana without having it being sent to a lab. I believe that when we talk about decriminalization and legalization, it is imperative to understand that when we go down that road, we cannot control the THC levels specific to the black market.

Dr. George, I'm curious to understand the difference, as you understand it, between decriminalization and legalization. If you are aware of it, would you agree with the Canadian chiefs of police, who are looking for a ticketable offence with regard to small amounts of cannabis/marijuana?

[The Chair, Conservative, Ben Lobb]

It was for Dr. George?

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

Yes.

[The Chair, Conservative, Ben Lobb]

A brief response, maybe a 30-second response, please. We're up on the time.

[Dr. Tony P. George]

In my statement I said that there are particular subsets of the population, young people, and those in particular who may be at risk of psychiatric disorders, where I think we could have a bit of a coalescence of views. I think if there was a ticketing system that diverted people into getting evaluation and treatment, and not incarceration, I think that would be a positive step forward. I don't think our views are that opposed.

[The Chair, Conservative, Ben Lobb]

Okay. Very good.

Ms. Bennett, welcome to the committee. You have seven minutes, please.

[Carolyn Bennett, Liberal, St. Paul's, ON]

Thank you very much.

I thank all the witnesses.

I was very pleased that we were having an adult conversation about this based, hopefully, on evidence, but I was quite concerned that our medical colleagues are again having to deal with the fact that there is no evidence on so many things, when obviously the Government of Canada has a responsibility for funding and to get that evidence. As a physician who knows that many of my patients were using marijuana in order to not use what we now have come to find might be and have been proven to be more harmful pharmaceuticals, I have to say that we actually need to provide physicians with the evidence.

Expert advisory committees still don't have evidence with which to advise. I think it is becoming clearer and clearer from multiple sclerosis and so many of these other drugs, that patients have seen—and there has been huge anecdotal evidence from those of us who felt obligated to listen to our patients—what works and what doesn't work. Actually, we're very impressed with what happened.

In listening to the witnesses, it's also interesting that really what's been cited in terms of schizophrenia and predisposition is a genetic predisposition that I think we are now hearing about all pharmaceuticals and all medications: that in the future of personalized medicine we will be able to identify people at certain risk of various medications. Again, I think that kind of research is imperative right now.

I think we've also heard that it's the delivery system of the cannabis or the THC that is of concern to the physicians in terms of health concerns, and that for the vaporized or other delivery systems for the people who need this medicine to be able to function in society, we have evidence that they would prefer to use a different delivery system. That a lot of them don't want to smoke has been very educational, but I think what we've also heard from the witnesses is that there's a need for more education on risks and also a need for more regulation in terms of what people are actually getting.

It's very clear that if the government is in charge of regulating this product, people would actually know what they're getting, and again, if you can get a clean, regular product, why would you go to the black market? My Dad was 93 when he died, previously a policeman, and he didn't understand why all of this was criminalized. He thought this was a therapeutic conversation that needs education and regulation, and that it's the role of society to be doing this.

I am interested in the physicians, maybe, and particularly the physicians who have been interested in the prevention. Take a drug like Champix, where we've actually ended up killing patients or having patients suicide in unbelievable numbers, in terms of the FDA study. How do you put this study where we're only looking at risks and harms.... I still don't understand how a parliamentary committee can look at only one side of an issue. Can you tell me, compared to the risks associated with pharmaceuticals, where cannabis and THC rest in terms of the real risks that come from approved pharmaceuticals to the people of Canada?

[Dr. Bernard Le Foll]

To whom are you addressing the question?

[Carolyn Bennett, Liberal, St. Paul's, ON]

I guess you'd be a good person to start with, because a lot of you have been involved with the anti-nicotine drug trials. I think you were all pretty concerned about what happened after it had been approved.

In terms of post-market surveillance, we found that we don't do a good job on post-market surveillance, and a whole bunch of people died when trying to come off a drug. I just think we should put this study in perspective in regard to where the pharmaceutical industry is and why there has been no research on this drug because there's no pharmaceutical company pushing studies for this kind of evidence.

[Dr. Bernard Le Foll]

Yes. I can comment on this.

For the pharmaceuticals the situation is clear, because there are expert groups like the FDA or Health Canada that will evaluate the benefits risk. It is also true that these risks, when it's done, when the product comes to the market, may evolve with pharmacovigilance and as side effects occur in populations. That is something that needs to be done at the beginning, but also repeatedly over time.

The issue with cannabis is that it's not a product that can be patented, because it's a natural plant, so there has been limited interest by pure pharmaceuticals to do research on it. That's why we have much less research done on the cannabis product, as compared to cannabinoid, in the form of pharmaceuticals.

We now have cannabinoids that are on the market. Those products have been shown to have a good benefits ratio, and that's why they get approval and are approved for human use.

I think the issue, as you pointed out, is that with cannabis it is in smoked form, so that if you put this product to the same standard as a pharmaceutical, it will never get approved because there is so much toxicity from the inhalation route. Then the benefits risk becomes immediately not in favour of the product. That's why I think the enteric routes of delivery are critical here.

[The Chair, Conservative, Ben Lobb]

I'm sorry, Ms. Bennett, we are over time, but thank you.

Mr. Young, your seven minutes now.

[Terence Young, Conservative, Oakville, ON]

Thank you, Chair.

With regard to the previous questioner, my colleague from across the floor, I hope that our doctors are warning their patients what we have heard at this committee, that marijuana can lead to psychosis, schizophrenia, deadly heart arrhythmia, and double the risk of vehicular accidents; and can lead to addiction, cancers, and permanent damage to the prefrontal cortex of their brains. I hope that's what our doctors are telling patients, that is, the doctors who are prescribing marijuana or are asked questions about it.

Dr. Le Foll, you said that the more widely a drug is used, the more impact it has on society, and that in terms of harm, alcohol is second after tobacco because of the rate it's used.

So conceivably, if marijuana is used at a higher rate, for example at the same rate alcohol is, it could over time be proven, by epidemiological studies, to be as deadly as alcohol or tobacco. Is that correct?

[Dr. Bernard Le Foll]

It is correct that if the use increases to very high levels, then it may produce much more harm, but we are far from the rates of prevalence of tobacco and alcohol.

[Terence Young, Conservative, Oakville, ON]

I understand, but I said that if it were used at the same rate as alcohol, it could conceivably be proven to be just as deadly.

[Dr. Bernard Le Foll]

Yes. I would think the analogy with tobacco may be better, but because of the damage caused it is probably in the same type of order. Yes. I agree. If you add widespread use, the damage will be higher compared to what we see right now.

[Terence Young, Conservative, Oakville, ON]

Thank you so much.

Dr. George, you said youth are five to ten times more vulnerable to schizophrenia when they use cannabis. We also heard, in previous days, that marijuana users have double the risk of vehicular accidents.

Do you ever prescribe marijuana for anyone? Why or why not?

[Dr. Tony P. George]

I do not prescribe marijuana. I'm not licensed to do that. I have had some clinical situations where I have had patients with mental health disorders who were heavy cannabis users, and I tried to put them on other cannabinoid drugs such as nabilone, which is Cesamet, in trying to reduce their cannabis use.

[Terence Young, Conservative, Oakville, ON]

Thank you. So just to reduce harm, but not to introduce the drug to treat any condition?