Health Committee on May 27th, 2014

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

Could you be impaired with cannabis much longer than you could be with alcohol?

[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.

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

Thank you.

[The Chair, Conservative, Ben Lobb]

Thank you very much.

Next up, for seven minutes, is Ms. Fry.

[Hedy Fry, Liberal, Vancouver Centre, BC]

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?

[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.

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.

[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.

[Hedy Fry, Liberal, Vancouver Centre, BC]

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.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Do you find there has been a decrease in alcohol-related 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.

[Hedy Fry, Liberal, Vancouver Centre, BC]

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, Conservative, Ben Lobb]

Unfortunately, you're out of time. Thank you very much.

Mr. Wilks will take us home. You have about five minutes.

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

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.

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

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.

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

Thanks.

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?

[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.

[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.

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, Conservative, Ben Lobb]

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.

Anyhow we'll suspend, and then we'll be right back.

Thank you.

[The Chair, Conservative, Ben Lobb]

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.

[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.

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.

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.

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.

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?

[The Chair, Conservative, Ben Lobb]

You have a minute and 10 seconds.