Health Committee on Sept. 11th, 2017

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

In weighing the arguments for and against limitations on edibles, the majority of the task force on cannabis legalization and regulation concluded that allowing edible products offers an opportunity to better address health risks. Edible cannabis products offer the possibility of shifting consumers away from smoked cannabis and any associated lung-related harms.

To our representative from the health department, why did the federal government ignore that recommendation?

[Jacqueline Bogden]

I think the legislation is clear that it contemplates a wide range of products, and that if we are going to meet the objective of displacing the illegal market, we need to be able to provide something that can actually compete with that. This would include a range of products.

It is the government's intention that edibles be made available. As I indicated, we will need a little bit of time to develop those regulations and to consult with industry and others before bringing those into force, but the intention is to do so as expeditiously as possible, following the coming into force of the legislation.

[The Chair, Liberal, Bill Casey]

Thanks very much.

Dr. Eyolfson.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

There were some concerns brought up regarding cultivation at home, particularly with quality control. Where would be the quality control when someone's growing it themselves? What are the safety considerations?

For a very long time, people have been able to brew their own beer and wine at home. Can I ask how similar or different this provision would be from the existing ability to do those activities?

[Jacqueline Bogden]

I will say a couple of things about cultivation at home. The task force recognized in its report that there are many circumstances in which individuals grow a small number of plants, and can do so safely at home. Of course, as the health regulator, we will want to do our part to make sure Canadians are aware of the potential risks associated with cultivating cannabis at home.

Under the current medical access regime, there are provisions that allow people to grow cannabis at home for medical purposes. We undertake extensive education to try to help Canadians be aware of some of the precautions they should take.

For example, we will want to actively encourage Canadians to take measures to protect children from accessing it, whether it's indoors or outdoors. We also encourage Canadians to make sure there's enough ventilation, particularly if they are growing indoors.

You want to be able to remove excess moisture on the plant that could cause mould in your buildings.

If they are going to use chemicals such as pesticides in the growing, we'll encourage them to have a look at the very important information we have available.

Those would be an active part, I think, of our efforts to ensure that if Canadians choose to do this under the new legislation, they are well informed about the things they should take into consideration.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Thank you.

Is Health Canada aware of any widespread untoward events or widespread health problems regarding these pre-existing practices of making wine and beer at home?

[Jacqueline Bogden]

I am not in a position to answer the question that the honourable member has put.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Thank you, that's fine.

I had a town hall on this subject a number of weeks ago, and I was approached by some retailers in my riding who sell accessories used in smoking these products. In the vernacular, they're called “head shops”. In regard to the legislation and promotion of this, they were worried about how this legislation might affect how they do their business and what they might have to do differently under the new legislation.

[Eric Costen]

The question of accessories is dealt with in the proposed legislation, and I think the easiest way to understand what's being proposed is to say that there is no proposal that the government would regulate the production or the manufacturing of those products through this act. However, the sale as well as the promotion and marketing of those activities would be captured. In many instances throughout the act, you'll see that the provisions—for instance, those that apply to advertising and promotion—apply equally to cannabis that will be consumed, as well as to accessories.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Thank you. That's helpful.

I just want to clarify something. I believe I know the answer, but I just want to make sure it doesn't get lost here. Let's say that any given province simply says, “We're not going to be ready by this time. We're not going to do anything. We're just out.” Can someone in that province obtain cannabis through any online or mail-order system?

[Jacqueline Bogden]

This is the question that we were discussing earlier. The legislation is designed so that provinces and territories can occupy that space and be responsible for sale and distribution. In the event that they are unable to do so by the prospective coming into force of the legislation, we will put in place a mechanism whereby the federally licensed producers would be able to provide product directly to individuals in that province or territory.

The government has recognized that it would be very important upon the coming into force of this legislation, when adults are allowed to legally possess cannabis, that there be a legal supply of quality-controlled cannabis available to anyone, right across the country. We will have that ability.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

All right, thank you.

[The Chair, Liberal, Bill Casey]

That completes our session. I want to thank the presenters. I think they've done a great job answering questions.

You've obviously put a lot of work into this new evolution of our development. I think it's amazing what you've done and how you've answered the questions.

I have two quick questions, myself.

Back to households and the ability to grow your own, what happens if a family has two households, a primary residence and a summer home? Does that qualify as two households, or is it one?

Second, can you grow it inside or outside? Is there any regulation about that?

[Jacqueline Bogden]

Mr. Chair, I'll answer the second question and then perhaps turn to my colleague, Madame Labelle, to answer the first one.

The legislation would allow indoor or outdoor cultivation. Of course, I'll also acknowledge that provinces and territories or municipalities could exercise their own authority to put in place additional controls, which might restrict it to growing indoors.

On your first question, I'll ask Madame Labelle to answer that.

[Diane Labelle]

Bill C-45 proposes that adult individuals be able to cultivate up to four plants in their dwelling house. That could be indoor or outdoor cultivation, as we've heard, and it has to be where they ordinarily reside, so this becomes a question of fact. If they ordinarily reside at their cottage for seven months of the year, that may be where their dwelling place is. If it's in downtown Ottawa that they normally reside for seven months of the year, then that would be their ordinary residence.

[The Chair, Liberal, Bill Casey]

Thanks very much.

With that we'll thank our presenters. We're going to suspend the meeting until 10:45.

[The Chair, Liberal, Bill Casey]

We will reconvene our study on Bill C-45. We have a panel of federal, provincial, and territorial representatives as well as some representatives from the pharmaceutical industry. We certainly want to welcome everybody. We welcome the Honourable Anne McLellan, senior adviser for Bennett Jones, as an individual; Michael Spratt, criminal lawyer; Mark Ware, associate professor, department of family medicine, McGill University; from the Canadian Association for Pharmacy Distribution Management, Mr. David Johnston, president and chief executive officer; and from the Canadian Pharmacists Association, Dr. Shelita Dattani, director, practice development and knowledge translation.

My understanding is that the Honourable Anne McLellan and Mr. Ware are going to split their time.

You have 10 minutes between you, and you can fight out how you want to divide it.

[Anne McLellan, Senior Advisor, Bennett Jones LLP, As an Individual]

Mr. Chair, we thought we had 10 minutes each.

[The Chair, Liberal, Bill Casey]

The clerk says it's okay.

[Anne McLellan]

Oh, good.

[The Chair, Liberal, Bill Casey]

See how easy we are.

We want to hear all we can, so we'll start with you.

[Anne McLellan]

Great. Thank you very much, Mr. Chair.

Good morning, everyone. Let me say it is a great pleasure to be back in the parliamentary precinct. I must say I am amazed at the transformation of the Wellington Building. It's a very impressive building. It didn't exist in its present form when I was here.

As you've already heard, I'm Anne McLellan. I served as chair of the task force on cannabis legalization and regulation. I'm here today with Vice-Chair Mark Ware to share a brief overview of the work and the recommendations of the task force. Our mandate was to consult and provide independent advice on the design of a new legislative and regulatory framework.

The outcome of this work is our report, “A Framework for the Legalization and Regulation of Cannabis in Canada”, which we provided to the Ministers of Justice, Public Safety, and Health, as well as to all Canadians, on December 13, 2016. Our report contains more than 80 recommendations. Our advice details safeguards that we believe are important to achieve the objectives set out by the government to better protect the health and safety of Canadians by regulating access to cannabis.

We spent five months travelling across the country and hearing from Canadians, including representatives of indigenous communities, parents, youth, activists, growers, and patients who use cannabis for medical purposes. We spent time with experts and organizations, which shared diverse perspectives and helped us to appreciate the complexity of legalization and regulation. We met with officials from provincial, territorial, municipal, and indigenous governments, who emphasized the need for close collaboration amongst all levels of government.

We travelled to Colorado and Washington and spoke to officials in the Government of Uruguay—the only other country to have legalized access to cannabis—to hear directly from those who have had first-hand experience enacting systems for legal access to cannabis. We also received close to 30,000 responses from experts, organizations, and Canadians who took time to respond to our online questionnaire.

Through your committee hearings, you will, like us, hear a variety of thoughtful, informed, and passionate perspectives on myriad issues relating to legalizing and regulating cannabis. These perspectives will in some cases contradict one another. In considering the experience and expertise of those with whom we consulted, we sought to strike a balance between implementing appropriate restrictions in order to minimize the harms associated with cannabis use and providing adult access to a regulated supply of cannabis. Further, we wished to reduce the scope and scale of the illicit market and its social harms.

We also concluded that it is appropriate to proceed with caution. We are only the second nation to move forward in this way, and we were told by those who have gone before to expect surprises. While there are important lessons to be learned from other jurisdictions, designing and implementing a national Canadian system is a unique undertaking. This balanced and cautious approach, with a focus on protecting public health and safety, helped dictate where the task force ultimately landed on some of the more controversial issues.

I would like to highlight two issues that help illustrate our approach.

It came as little surprise to the task force that setting a minimum age for the purchase of cannabis was the subject of much discussion during our consultations. The task force's deliberations on the issue reflected this, and we gave serious consideration to the various recommendations, ranging from 18 to 25 years of age.

We recognized the increased risks associated with use of cannabis at an early age. Research suggests that cannabis use during adolescence may be associated with negative effects on brain development, yet we also know that adults 18 to 24 are the segment of the population most likely to consume cannabis. Nearly 30% of that age cohort reported past-year cannabis use in 2015. Setting the bar for legal access too high could result in a range of unintended consequences, such as leading young adults to continue to purchase cannabis on the illicit market where, among other things, there are no quality controls.

We heard—and you discussed these earlier with public servants—that the criminal prohibitions that exist today and have existed for more than 90 years have had little success in preventing access to cannabis and dissuading people from its use. In 2016, 80% of cannabis-related offences were for possession, which in turn led to 18,000 charges for cannabis possession. We also heard about the negative stigma of arrest and the potential lifelong consequences for those young adults who have criminal records for simple cannabis possession.

In proposing a federal minimum age of 18 and respecting the interests of provinces and territories to set a higher age if they choose, we aimed to balance the need to protect minors with the objective of reducing the illicit market. Based on our study, the task force also concluded that an age limit alone was insufficient to discourage and delay cannabis use. We recommended that robust preventive measures such as sustained public education along with smart regulation would better control access and use by young adults and mitigate health risks.

A second issue that garnered significant debate, with compelling arguments both for and against, was the issue of home cultivation. On the one hand, we heard concerns about the health and safety risks of home cultivation, the challenges of providing adequate oversight, in particular as it related to children, and the potential ease with which it could be diverted into the illicit market. However, it became clear to us that these concerns pertained most particularly but not exclusively to large-scale clandestine grow operations, not small-scale home cultivation.

We also heard arguments in favour of allowing home cultivation, premised on the belief that it can be done safely and responsibly with appropriate limits and safeguards. Ultimately, the task force recommended allowing a limited home cultivation of no more than four plants per household along with a prohibition on dangerous manufacturing processes, reasonable security measures, especially in relation to children, and oversight by local authorities. In our view, this recommendation accounted for the noted health and safety concerns and provided a framework for enabling small-scale cultivation for personal use by law-abiding adults much like what we currently see with the home brewing of alcohol.

In no way should our recommendations on home cultivation be interpreted as condoning large-scale clandestine grow operations, which we all have seen reported in the media and which cause significant risks to the health and safety of Canadians, including law enforcement and other first responders. On both these issues—age and home cultivation—we heard divergent and passionate views, as you will. Our recommendations reflect a belief that Canada, in embarking on this new path, must be both smart and pragmatic.

We must also look to those who have already gone down the path of legalization, few though they are. It is encouraging to examine the experience of Colorado, one of the trailblazers in cannabis regulation. Colorado Governor John Hickenlooper and Attorney General Cynthia Coffman recently wrote to U.S. Attorney General Jeff Sessions to provide a progress update that dispelled some of the misconceptions surrounding legalization.

They noted that, despite the fears of many, cannabis use among youth following legalization has seen no statistical significant increase, and I'm happy to report the same is true in the state of Washington when you look at its most recent stats. This was due in large part to strong regulatory provisions to help prevent use, such as age verification requirements and prohibitions on advertising, packaging, and products that appeal to children, and a robust public education campaign that highlighted the consequences of use.

Similarly, while initial data demonstrated a rise in cannabis-related emergency visits, the most recent data in Colorado shows a reversal in this trend. This reversal is, again, the result of targeted public education campaigns regarding the risk of use, and the necessity for safe use and storage. For example, all edible cannabis product packaging in Colorado must be childproof and resealable.

While there is no guarantee that Canada will experience similar outcomes, it is nonetheless encouraging to see that some of the concerns raised initially around cannabis legalization do not appear to be borne out by the most recent evidence in Colorado. Canada can learn from these experiences that through sound policy, robust public education, and enforcement of the regulatory regime created, many of the perceived risks of legalization can be mitigated.

I have often said that it will be critical that the government remain vigilant and be prepared to course-correct as evidence and experience indicate. There will be unforeseen challenges and unintended consequences. Only through careful and close monitoring and a willingness to be flexible and adaptable will it be possible to respond effectively to issues as they emerge.

Thank you, Mr. Chair, I look forward to questions and comments.

[The Chair, Liberal, Bill Casey]

Thank you very much and I'm sure you're going to get some good ones.

Dr. Ware.

[Dr. Mark Ware, Associate Professor, Department of Family Medicine, McGill University, As an Individual]

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.

[The Chair, Liberal, Bill Casey]

Thank you very much for your comments. They outline our challenge quite nicely.

Mr. Spratt, you have 10 minutes.