Good morning, everyone. My name is Dr. Mark Ware and I served as vice-chair of the task force on cannabis legalization and regulation.
I am pleased to be able to address the committee today. I hope to be able to provide some suggestions from the time when I was the vice chair of the task force and also to draw parallels with my professional experience.
I believe that my greatest value to the committee can come from providing a researcher's perspective on the state of evidence surrounding cannabis, including its potential harms and benefits; outlining some of the challenges that the evidence may present to you as you explore some of the issues; sharing some of the considerations and conclusions from the task force's examination of how access to cannabis for medical purposes might be impacted following legalization; and finally, highlighting the importance of research in supporting sound public policy.
As a clinical physician specializing particularly on pain management, I have been studying cannabis for medical purposes for a long time. I have been able to witness for myself the paradigm shift in Canadian culture that has brought us to the point at which we intend to implement a framework for legal cannabis. This is a really remarkable change, but it is important to remember that it was a long process that started in 1996, with the legalization of hemp. This culminated in a regulatory framework on cannabis for medical purposes during the 2000s.
Through my own research and through many of the conversations the task force has had with experts across Canada, it has become evident that there is a wide variety of thoughtful, often diverging, and at times very colourful perspectives surrounding cannabis. I have learned that no one has a monopoly on the truth about cannabis. This is a theme that Ms. McLellan noted and it is something that I think is worth reiterating.
As you venture through this week of hearings, you will hear many perspectives. Ideally, all of our clinical decisions, as well as policy recommendations, would be based on clear, well-documented evidence. However, the task force recognized through our many conversations and readings that cannabis policy lacks comprehensive, high-quality research in many areas. On many issues, there is little doubt that the evidence is often non-existent, incomplete, or inconclusive. This is why we framed our recommendations as evidence-informed rather than evidence-based.
This is particularly evident when examining the harms of cannabis use. You will hear reference to studies that demonstrate associations between frequent cannabis use and mental illnesses, such as psychosis, and other studies that speak to the short-term effects on memory, attention, and psychomotor function, yet there is also agreement that many individuals suffer from a variety of serious medical conditions and may derive therapeutic benefit from cannabis, especially in relation to pain management.
In the course of the next few days, you will hear a great deal about associations between cannabis and a number of health-related outcomes. You will probably already have your own prior perceptions about some of these issues. You will no doubt rapidly become aware that for many of these associations there is uncertainty. Even among the scientific community, there is debate around the strength and the directions of these associations.
One aspect that I have been particularly struck by in considering the evidence on cannabis use is the lack of consistency on quantifying use. We talk of frequency of use—daily, weekly, monthly—but rarely of the potency of the cannabis itself. THC content varies enormously in cannabis preparations, yet is rarely considered in epidemiological and research studies. However, it is hugely important in terms of understanding the effects on the brain and other behaviours.
This is where legalization and regulation is likely to have an important impact. We will be able to accurately quantify cannabis use. Knowing what people actually use will allow us to learn the language of cannabis potency and concentrations in terms of THC or CBD percentages or milligrams per dose. This will allow for more informed research, and as a result, a more informed public.
This divide between the potential risks and the potential benefits is one of the factors that the committee will have to consider when it examines a number of topics and hears different points of view.
You will discover that there is no universal solution that can clarify all those points of view. The fact is that current research does not lead to a consensus. It is important to understand and accept that fact.
The case of access to cannabis for medical purposes is a notable example of divergent views. On the one hand, there are those—notably patient groups—with the view that a separate system for medical cannabis is necessary to preserve their relationships with health care practitioners and their access to specialized medical cannabis products. They stress that they use cannabis out of necessity, not choice, and they fear that their needs and access rights would not be accommodated under a single system.
On the other hand, we heard, primarily from representatives of the medical community, that there is no need for a dedicated medical cannabis system since the end of prohibition will mean that those who need access to cannabis for medical purposes will be able to do so through the general cannabis market. Given the lack of evidence and concerns about being responsible for authorizing the use of a substance that is not an approved medicine, they did not want to play the role of gatekeeper moving forward. Others pointed to the challenges of administering and enforcing a dual system.
Ultimately, weighing the different perspectives and using the principles of caution and balance, the task force determined that the most reasonable course of action was to preserve the medical system in its current form and re-evaluate its need in five years, once the legal system has had a chance to become established. The lack of consensus in different areas highlights the need for more research to ensure systematic monitoring, evaluation, and reporting, not only to better understand and mitigate risks associated with problematic use but also to understand the potential benefits of use.
The task force heard compelling accounts from patients who told us of the benefits they experienced from cannabis use, as well as from researchers in the medical community who called for more evidence to better understand its therapeutic potential. Both physician and patient interests would be served by advancing science and clinical research on the therapeutic uses of cannabis and associated cannabinoids. There is tremendous strength across Canada in terms of research capacity, from plant sciences to psychiatry, from neuroscience to nursing, from clinical trials to community practice. The Canadian discussion about cannabis legalization has already fostered communities of researchers to discuss the research and education agenda needed to support and inform the changing policy. There is an opportunity for Canada to take a leading role internationally in addressing questions that are of global importance.
Canada is embarking on a new path, a path that will provide us with opportunities to conduct additional research in order to better understand the detrimental and the beneficial effects of cannabis. As the body of probative data grows and is better understood, we can learn those lessons and consider them as we implement our programs and policies, in order to better protect public health and safety.
I feel that this is a unique and exciting opportunity for Canada to become a world leader in the area.
Taking all of the consultations of the task force into account, we provided our report to the ministers, and I provide my comments to you today with the conviction that Canada is well positioned to undertake this work carefully and safely.
Thank you.