Health Committee on Sept. 12th, 2017

[Dr. Kevin Sabet, President, Smart Approaches to Marijuana]

Thank you very much, Chair.

My Canadian wife is very proud of me right now. It is an honour to be in front of you. My mother-in-law is probably even more proud, so that's probably more important. I do want to thank you all for having this deliberative discussion. I wish in the United States we had had a real discussion and debate about this, rather than 30-second TV spots to whoever could fund their message and those were the ones who won, the ones who funded it. This is a much better approach and really, from a personal perspective, I want to thank the government and everyone in Canada for being such a welcoming place and having welcomed my in-laws here from fleeing persecution 35 years ago, 40 years ago. This is a very special place indeed.

As Canada embarks on this discussion as a country already with the second highest rate of cannabis use in the world, I think you have two choices when it comes to this policy change in this arena.

First, lawmakers can listen to public health advocates and people with essentially no financial incentives for policies to pass. This disinterested group grounds its perspective on scientific evidence and the legacy of other legalized drugs. We have already legalized drugs. They're called alcohol, tobacco, and prescription pharmaceuticals. Based on that information, most of these associations, folks working in public health, reject legalization in favour of a modified cannabis reform that would remove criminal penalties, not punish users, but at the same time not normalize, advertise, promote, and essentially commercialize cannabis. I think there has been a false dichotomy set up between you either have to criminalize or you have to legalize. I think that is a false dichotomy.

Now, if that can't be done and the decision has been made, then I would say a policy of discouragement and deterrence centred around strong science-based regulations and messages about cannabis use outcomes is certainly preferred to the policy of putting business people over public health and safety.

Alternatively, you can disregard scientists and not listen to the public health and safety experts, as well as your international treaty obligations under the United Nations, and instead listen to those with a financial stake in promoting, normalizing, and legalizing cannabis. These lobbyists and the interests they represent will make a great deal of money if cannabis is legal. The more people use, the more they will earn. We know the consequences of this approach from the world's experience with tobacco. It was our biggest global public health disaster: denying science on negative effects, promoting the use to children and other vulnerable populations, and manipulating the drug to enhance its addictive effects and thus its profitability.

Sadly, in my country in the United States, we've taken the latter route. It has already produced negative consequences. Although, of course, the full spectrum of negative consequences will not be seen for probably decades to come: mental illness, schizophrenia, psychosis, these things don't happen overnight.

We know that cannabis use is at least up, compared with the rest of the country, in jurisdictions with legalization. A commercial industry rife with lobbyists is regularly undermining proper regulation. Fly into places like Oregon and you see billboards without disclaimers, you see coupons, and you see brightly coloured edibles. These were supposed to be regulated out of the market. There are also concerns with drugged driving.

I've worked on this issue for over 20 years. I look at this from a non-partisan perspective. I've served most recently in the Obama administration where I was privileged to help draft the president's national drug control strategy, which shifted our approach to a public health approach. I've also served folks in other parties. I have advised in the U.K. before and after my Ph.D. studies at Oxford. I am gravely concerned with the direction we're going on this, because modern high-grade cannabis is not the cannabis of old. We've learned to manipulate the THC levels and that is why I co-founded with Patrick Kennedy, the son of the late senator Ted Kennedy, a group called Smart Approaches to Marijuana.

We joined the major public health and safety organizations in flat out rejecting legalization as good public policy, but also rejecting criminalization and the arrest of people for small-time use, but we are very concerned with the kinds of products that cannabis now comes in—in terms of attractive, kid-friendly edibles like candies, ice cream, and sodas—which account for a large portion of the cannabis market in legalized states.

Legalization and industrialization is responsible for these products. Let's be very clear. There is no effective way to mass produce highly potent products without access to the technology and capital that legalization allows.

I'm very concerned that we're seeing former provincial leaders, people in the public good, who have left their positions now, and we're seeing announcements about joining and starting companies and being involved in the cannabis business and using that inside information.

With regard to health, you've heard from people who have studied this much more extensively than I have, such as those from the Quebec association of psychiatrists and others. There is no debate about the negative consequences, the long-term consequences especially, of heavy cannabis use on young people. Canadian youth will be less marketable, frankly, on the global marketplace if use goes up and continues to go up. They will not be able to compete against other countries. I think that is a real issue. I think the workplace is a real issue as is employment safety.

I'm not going to go through the entire testimony here. I will submit it for the record in terms of, for example, what the National Academy of Sciences has said in my country. The top scientists just met and released the most extensive scientific review that has ever been released in the world on the negative health effects of cannabis. I urge you to consult that. I also urge you to consult the surveys that have been done on youth use around the country. Some of the ones that Andrew referred to talk about the issue of emergency room admissions, and we have data from Colorado and Washington on that as well.

As well as the issue of youth use and emergency room admissions, I think the black market is a serious concern. We are deluding ourselves if we think that major drug trafficking organizations will not exploit every chance they get to have a way to be legitimized through the legal market. We're seeing this in other states. We're also deluding ourselves to think that they will go away and not try to undercut the government price of cannabis. The economies rule the day here in terms of price. The lower the drug price, the more likely someone is to use, and the illegal market can easily undercut the legal market. In fact, a leaked report in March from the Oregon State Police found that 70% of the market for cannabis in that state, which legalized some years ago, is still from the black market. A quote from that report reads:

The illicit exportation of cannabis must be stemmed as it undermines the spirit of the law and the integrity of the legal market...it steals economic power from the market, the government, and the citizens...and furnishes it to criminals, thereby tarnishing state compliance efforts.

In 2016, a Seattle Police spokesman noted that large-scale illegal grows are still prevalent and that they do come across those.

Another issue that was brought up was drugged driving. A study recently issued by the Canadian Centre on Substance Use and Addiction put the cost of impaired driving from cannabis at $1 billion. What will happen if the use of cannabis increases by 1%, by 5%, or by 10% as a result of normalization? We can debate about which datasets are best for drugged driving, but the AAA Foundation for Traffic Safety found a large increase in Washington State, for example, in recent cannabis users getting involved in fatal car crashes. We know from science that cannabis about doubles to triples your risk of a crash because of reduced reaction time, etc.

Costs are very important. Please do not think that there will not be regulatory and enforcement costs under legalization. A lot of people are stunned. They say, “Wait a minute. We thought we were getting rid of enforcement.” Actually, you're not. You will have to invest in the enforcement of the rules that you create. For example, in the U.S., the number one drug of arrest is not heroin, it's not marijuana, and it's not crack. It's alcohol. That's for underage users, DWIs, and public use. If recent surveys of Canadians are of any interest to anybody, I would say I think the public use of cannabis, the nuisance of second-hand smoke, and the issue of multi-home dwellings are going to be very big nuisances, and very big issues. That's why, for example, the apartment associations said what they did, and I agree with them.

As Andrew talked about, it's also not a tax windfall. If you're going to talk about revenues, let's talk about costs as well. You cannot look at one side of the ledger. A bad way to look at any business is to only look at revenues. What are the costs? What are the costs to Canada in terms of drugged driving, public safety, public health, etc.?

Finally, no policy change should occur without a commitment to better data collection. I don't think there has been good data collection, unfortunately, so far in Canada. However, robust data allows us to shape and change policy. There are a lot of things to look at, which I include in my testimony.

As I said, I wholeheartedly agree with the recommendations of most of your health organizations and other associations that realize there will be real victims from this policy change. The government should therefore commit itself to reducing the number of victims as much as possible, and discourage and deter. In summary, slow down. The only people who benefit from speed in this issue are the business people who are really waiting to get rich. There is no benefit at all to going fast on this issue. I share the concerns of provinces like Saskatchewan and Manitoba, who have raised alarm about the issue of age and the speed at which this is going.

I understand that it may be too late, but I still think that forgoing legalization in favour of reducing criminal sanctions and deterring marijuana use is the best way for public health. If, despite the best available evidence showing that it would ultimately harm public health, you do go ahead with legalization, we recommend raising the age limit, as the Canadian Medical Association said, to 25. The brain isn't fully developed until about age 30. The age of 25 seems rational.

Commence a discouragement and deterrence campaign. Limit the profitability of any retail outlets, for example, with government-owned stores that are totally non-profit, and plain packaging. We can't do, unfortunately, no advertising and commercialization in the U.S. because of that little thing called the First Amendment, which we find, and I find, very important and very good. In this case it hurts us in the U.S. because of commercial speech being protected as free speech. Hopefully you can find a way to have reduced commercialization.

Defend the rights of non-users and the victims, the children, the vulnerable populations. Where will the marijuana stores show up? Will they be in the rich neighbourhoods or will they be in the most vulnerable ones? That's a huge issue. In the United States there are eight times as many liquor stores in poorer communities of colour. I think Canada should listen to business groups, housing associations, and medical associations, as you are now, before formulating any policy. Commit yourself to a robust data collection effort.

Thank you.

[The Chair, Liberal, Bill Casey]

Thank you.

We'll now go to questions. We have a seven-minute round to start with.

Can you hear me now, Ms. Weeks?

[Kristi Weeks]

Yes, I can.

[The Chair, Liberal, Bill Casey]

Perfect, and we can hear you. That's excellent.

We'll start with you, Mr. Ayoub.

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

Thank you, Mr. Chair.

I listened very carefully to each of your presentations, which were very interesting, particularly because of their varied perspectives.

For the benefit of our fellow Canadians, I am truly interested in protecting our young people and our future. I was jotting down a few notes and I was thinking that a head-in-the-sand policy is not a solution.

Right now, we have studies and statistics. Despite the dearth of data, they show that young people use marijuana. Nothing is being done with respect to young people's current use. That's troubling. Nothing has been done in years; this sort of problem has not been addressed. We are picking up the pace because there's an urgency. It is not because we want marijuana to be legal, but because there is an urgency in addressing the situation of our young people. If we do nothing, we'll continue to have the same sort of results.

So I would like to hear what Ms. Weeks, from Washington, and Mr. Freedman have to say. What was your first motivation for legalization? What were the related challenges? Nothing is done easily or overnight. However, challenges come with solutions and solutions come with challenges.

I would have liked to hear you talk about the motivations and the ensuing solutions. You touched on it in the beginning. Please be brief, because I have only seven minutes and I have other questions for you afterwards.

Mr. Freedman, you may start.

[Andrew Freedman]

Very briefly, motivation is hard when it's a vote of the people. I mean, there are 50 reasons why people chose to legalize. I would say that Governor Hickenlooper's number one priority was to make sure that we did not see an increase in youth use at the rollout and that over the long term we would see a decrease in youth use.

One of the things we see in the Healthy Kids Colorado survey, which is a survey of about 17,000 kids, points to your exact question, which is that over time, we are simply seeing a decrease in the perception of risk in the use of marijuana. That is absent legalization. That's a simple trend line over the last 15 years. I think kids are more likely to go the Internet to learn about marijuana than they are to listen to either a trusted adult or, for that matter, to the government.

That being said, our goal—our hat over the wall, the thing we were reaching for—is to do what the Federal Drug Administration did with tobacco in America, which was that there are messages that work and programs that work. It's not necessarily scare tactics that are the long-term solutions to this, but rather engaging kids in meaningful and helpful ways with behavioural health specialists, after-school programming, and conversations that meet them at the level they would like to be met at.

I'm not telling you that I know what the future will look like. I'm telling you that the future we're planning on is to see a decrease in youth use by decreasing access through drug dealers and by getting the message right and getting every lever we have to pull pulled in the right direction to see that fewer youth are using marijuana.

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

Ms. Weeks, I'm not sure whether you can hear me. Do you have any comments?

Do you hear us?

[Kristi Weeks]

I can.

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

If you want to answer, you can give us a short answer, please.

[Kristi Weeks]

To save time, I would echo most of what Mr. Freedman said. His situation in Colorado is very similar to Washington's in terms of how it was an initiative of the people. It wasn't a government action. I think the reason that people voted for it was to decriminalize what they considered to be petty crimes that were overly impacting persons of colour.

As for what we've seen since legalization and sales, particularly among our youth, we have not seen an increase in youth use. We have seen that same decline in perception of risk that Mr. Freedman talked about. What we've also seen, and what our kids are reporting through our Healthy Youth survey, is that they're finding marijuana harder to get now. That's important, because the stores are obviously not selling to kids, and we are seeing some kind of reduction.

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

You brought up an important point. On our side of the border, students and young people say that it is easier for them to get marijuana than cigarettes or alcohol. Alcohol can often be found at home or purchased at specialty stores, which are regulated. That's what we are trying to do with marijuana. There are a number of solutions but they have not yet been identified or finalized for the various aspects being examined.

Once again, I'm wondering about the age. There are many other products that are legal now and for which a legal age should be established. Why set the age at 25 for marijuana? Of course, the brain is not fully developed until then, but alcohol and cigarettes can be consumed throughout life, and the effects are immediate and cumulative.

For an adult, it is a matter of choice, and also a matter of public health and education. Every time we discuss this issue, the word “education” comes up more often than “regulation”. When you educate people, regulation ultimately seems to be less of a trigger.

Does education come up a lot? Do you think it would be a long-term solution to the legalization of marijuana?

[Andrew Freedman]

Thank you.

I would say that education is one of eight or nine levers that go a long way towards seeing a decline in use. An important lesson that we learned from tobacco was that, for a very long time, almost a decade, for kids the perception of risk was very high for tobacco before we saw a decline in use. I think one of the things to keep in mind is that maybe, for an adult, knowing the long-term health effects is an important message. For a kid, who's not looking to what their life is going to be like in 30 years, it might not be as important.

I do agree. I think education is an absolute necessity here. I would urge that all education also comes with focus group testing with kids about what actually matters to them and what message—even if they believed it—would actually lead to a change in behaviour. Looking for that towards implementation, I'm absolutely sure that the public health specialist has more to say on that than I do.

[The Chair, Liberal, Bill Casey]

Your time is up unless anybody else wants to answer that.

[Kristi Weeks]

I would just like to say one thing.

[The Chair, Liberal, Bill Casey]

Yes, go ahead, Ms. Weeks.

[Kristi Weeks]

I would just like to say that one of the particular challenges we find with marijuana that we're not going to find with alcohol or tobacco is the fact that it does have perceived medical uses. It's very hard to educate children that it is bad for them or that it will disrupt their brain pattern when they're also seeing that it's medicine. How can it be bad? That makes it different from tobacco and alcohol, requires a different message to them, and is a little more of a challenge.

[The Chair, Liberal, Bill Casey]

Mr. Sabet.

[Dr. Kevin Sabet]

Just to make it clear, maybe others were, but I certainly am not arguing to put our head in the sand on this. I think I would suggest that lawmakers ask themselves if everything has been done to reduce cannabis use as much as possible: prevention campaigns, health campaigns, educating doctors and pediatricians, early interventions and treatment. What has been done? Have we exhausted all of those avenues before we go down an unknown path that is very difficult to reverse?

We all know the harms of tobacco. Prohibiting it is almost impossible. Alcohol is the number one public health issue in terms of affecting other people more than anything else, but it's very difficult to reverse. Before going down this path, which is going to be very hard to reverse—although you can make modifications along the way—have we exhausted all those other options first?

[The Chair, Liberal, Bill Casey]

Thank you very much.

Ms. Gladu.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Thanks very much, Mr. Chair.

Thank you to all of our witnesses. I'm going to start with Ms. Weeks.

On your comment previously about how young people are finding it harder to get a hold of cannabis, I think that may be in part due to the fact that Washington did not implement a home-grow part of this whole situation. I'd like to get some information from those who did implement home-grow.

I think, Mr. Vasquez, you might be able to share some experiences that Colorado had in terms of implementing home-grow. We heard testimony earlier that there were issues or tensions. Could you tell us some of the difficulties you had with that?

[Marco Vasquez]

In Colorado we have several different layers of legalization. We have medical commercial, we have recreational commercial, and then we have the caregivers and patients who grow their own marijuana plants in a residential setting.

Then under amendment 64, we have the ability for anybody 21 or over to grow his or her own six plants. What we see there is a number of people coming together and doing what we call co-op grows. What we've seen in Colorado is a saturation of marijuana. Marijuana is readily available, readily accessible through the commercial markets, but also the grey and black markets. I think that our youth and people in Colorado would say that they have no problem at all in getting cannabis.

Many of the youth who are getting cannabis are getting cannabis from the regulated market. What I mean by that is, a parent or grandparent will go in and legally purchase cannabis in a store, take it home, and then the kids and grandkids are getting it from their parents and grandparents.

We also have the diversion that's occurring within the grey and black markets where people are growing their own marijuana in a home setting and then undercutting the price of the regulated market and selling it on the street. The Denver Police Department does quite a bit of enforcement around home-grows on Craigslist. You can go on Craigslist and call up Colorado or Denver marijuana, and you can see dozens and dozens of advertisements where somebody will meet you and sell you marijuana. All of it's illegal, but it is really resource-intensive for law enforcement to try to enforce that type of illegal behaviour.

As I mentioned before, the opiate crisis that we're having here in Colorado mirrors other communities across the country. If you're a narcotics unit, a narcotics commander, how much effort and resources are you going to be putting towards marijuana enforcement when you have heroin, methamphetamines, and other drugs that have people overdosing and dying? For Colorado, marijuana is just a piece of the puzzle, but it is readily accessible here.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Very good.

My next question is for Ms. Weeks.

You mentioned that at one point Washington forced the closing of all the illegal dispensaries. We have a huge number of illegal dispensaries going on in Canada. How successful was that? How did you enforce it? What did you do?

[Kristi Weeks]

It was very successful from a visual standpoint. We no longer drive down our streets and see three or four green crosses along the side of the road. What we are not sure about yet, a year in, is whether they have really closed or have just gone underground. Have they gone to Craigslist? Have they gone fully back into the black market?

We do know that since those stores closed, sales in our retail stores increased in that three-month period around the closure of the dispensaries by about $30 million. Our patient community that was going to those illegal stores started going to the licensed retail stores. If we haven't completely eliminated them, we know we've certainly taken a big bite out of them.

How they were closed was through our law enforcement. They sent out letters saying that you have to close down on this date, July 1, if you don't have a licence with the Liquor and Cannabis Board, and if you don't, we will come in and arrest you. Then on July 1, when a few didn't close, they made a high media event arrest, and everybody else kind of decided to follow the law or go deep underground where we can't find them.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

All right. That's great advice for us.

Mr. Sabet, you talked about the treaties we are in danger of breaching. Could you give us an idea of how you think the United States will view Canada breaching its treaties on marijuana?

[Dr. Kevin Sabet]

I stopped speaking for the United States a few years ago, and I haven't regretted it since.

There are three international treaties—1961, 1971, and 1988—that most countries are signatories to around the world. The drug business doesn't know state borders or provincial or national borders. Obviously, it doesn't know any borders, and that's part of the international global aspect of this whole problem.

I can't speak about the United States, given the fact that in eight states we have allowed the legalization of marijuana. Again, it was a very different process. These are processes by ballot initiative, where Andrew and his boss did not have the luxury of writing those laws or deciding what made sense or what didn't. No doubt, if they did, they would look 100 times better than the current laws do. They're written by interest groups, by the business interests, and passed because they outspent opponents more than 10:1 or 20:1 in messaging. We'll see what happens on the United States' side in terms of where we're going. I'm sure there will be some kind of announcement or discussion of the way this administration is going to be looking at marijuana.

I can tell you that from the treaty standpoint, as someone who's worked with the Commission on Narcotic Drugs for quite some time now, there is certainly room in terms of flexibility in the treaties in terms of the criminalization of possession. In other words, the treaties don't say you have to criminalize possession and people must go to prison. There's a lot of room. You have countries that are very extreme, like Saudi Arabia and some of the southeast Asian countries, that treat small-time possession in a very extreme way. That's how their culture does it. Then you have California. We've had decriminalized marijuana in California, before legalization, for 35 years, and that's not in violation of the treaties. Where it gets very tricky with the treaties is when you now have a government that is sanctioning the trade of marijuana and actually getting involved in it. Then you're talking about where, I believe, the treaties would be breached.

From the United States' point of view, the United States has been able to defend its policy to the U.N. by saying that this is not federal policy. It is a state policy, and the federal government, not the State of Colorado, is a member of the international treaties and a signatory. We're dealing with it the way we can with limited resources. From a federal perspective, though, we haven't violated anything, because we're not going there. Obviously, in the case of Canada, it's different, and I think it's going to be really mental gymnastics to try to think about how we stay within our treaty obligations if we go ahead and sanction the illicit supply of marijuana.