Health Committee on Sept. 13th, 2017

[Don Davies, NDP, Vancouver Kingsway, BC]

But again, we've done that for tobacco. We've currently unscrambled that, so why couldn't we?

[Marc Paris]

The harms from alcohol, as I think we'd all agree, are huge to society, just like we know that the health impact of tobacco was hugely difficult. We know there are some dangers and risks with cannabis, so let's not fall into the trap of alcohol.

[Don Davies, NDP, Vancouver Kingsway, BC]

There's a reason I'm pressing on this. I'll venture a thesis. I'm the father of three children who've grown up. Young people are particularly sensitive to hypocrisy. The hypocrisy of seeing us with a differential treatment of alcohol, which I will argue is the real gateway drug and also is responsible for at least as much, if not more, harm.... Again, that's not to minimize cannabis—

[Marc Paris]

No.

[Don Davies, NDP, Vancouver Kingsway, BC]

—it's to place it in its proper treatment.

If we're perceived to not have the same kind of approach to alcohol that we have to cannabis, is there not a risk that that youth are going to look at their parents kicking back with six Scotch on a Friday night and, as someone else said, popping a Valium? Does it not damage credibility when we talk about the harms of cannabis or if we have a different legislative framework in terms of advertising and tolerance? Do we not risk perpetuating that sense of hypocrisy among young people, which will dampen our ability to get our message out?

[Dr. William J. Barakett]

You know, 10% of the population has an inherent inability to drink alcohol in a controlled fashion. These are the people we call alcoholics. There is a genetic predisposition to the loss of control, the cognitive impairments that they suffer from. It's the same kind of cognitive impairment, but there are two different drugs: one with an enormously protracted duration of action, cannabis; and alcohol, with which the next day you're sober, unless you're a daily drinker, in which case you're going to have cognitive impairment.

It's important. You can't nuance these things on the cover of a product where you're going to talk about the problems. I think it's just as important for everybody to understand that what we can say so far is that this is a damaging drug in the developing brain and that it is a risky substance to use in motor vehicle driving. Those are about the only two things we can say right now.

The other thing I would love to be able to say is that if you're an adult recreational cannabis habitual user who is using it a lot—guess what—you have an underlying psychiatric disorder that you are masking. I treat those people. They come in at the age of 30 and 32. They've been smoking for years, and they can't get off it. I discovered that they have underlying ADHD, and for 20% of those with the ADHD, they are coexistently bipolar.

[Don Davies, NDP, Vancouver Kingsway, BC]

Could I ask a quick question? I'm going to run out of time.

It has to do with treatment. One thing in this country, I believe, is that there's an appalling lack of publicly paid for universal access to treatment facilities.

[Dr. William J. Barakett]

Absolutely.

[Don Davies, NDP, Vancouver Kingsway, BC]

People come to see you with this. Are you finding beds for these people, in every case where it's appropriate for them, that are paid for by our public health system, or do we need to ramp up our expenditure in that regard?

[Dr. William J. Barakett]

It needs to be ramped up, but, you see, unfortunately, these one-month treatment centres don't really accomplish a goal. The cognitive impairment is such that during that first month, the poor person doesn't learn anything. That's why there's such a high relapse rate immediately upon departure—

[Don Davies, NDP, Vancouver Kingsway, BC]

I think the standard now is not one month; it's three months to nine months.

[Dr. William J. Barakett]

It has to be three months or six months.

If the person is “fortunate enough” to be on welfare, he'll get into one of the multitude of treatment centres that will take his welfare card in Quebec. If it's somebody who's not on welfare, he's going to have to sublet his apartment and gather the money to go in and pay $2,000 a month, which most people can't afford, especially if they have a drug problem. There's a huge problem of access.

[The Chair, Liberal, Bill Casey]

We're done, Mr. Davies.

We're done, but we have some time. I'm seeking consensus. Is there interest in carrying on? We're actually done our questions, but we're learning here, so is there a consensus to have four more questions at five minutes, if we can fit that in?

All right. We're in.

Dr. Eyolfson.

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

Dr. Barakett, I want to challenge you on one of the things you said in the last round of questioning. You referred to marijuana being a gateway drug. There are definitive textbooks on the subject. We're talking about textbooks that are used in residency and actually for post-graduate fellowships for toxicology—Ellenhorn's Medical Toxicology and Goldfrank’s Toxicologic Emergencies. They're very clear that the concept of marijuana as a gateway drug has never been definitively established. This has also been said repeatedly in multiple scientific journals on addiction in the meantime.

Given that information, what is the basis of the statement you made about marijuana being a gateway drug?

[Dr. William J. Barakett]

The basis is 30-plus years of observing. The basis is also the coming to the fore of studies such as the United Kingdom study I just quoted—published only this year, having terminated in 2016, in which they followed kids from age 15 to 18 and saw a definite correlation in abuse of the three substances, nicotine, alcohol, and illicit drugs.

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

I agree there's correlation. That is why that effect was always described.

[Dr. William J. Barakett]

The coexistence of a psychiatric disorder, most predominantly ADHD, is where the nuance is. When the ADHD goes unnoticed, then the kid self-medicates.

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

I will agree with you completely—

[Dr. William J. Barakett]

When you look at adult addicts, there is easily 50% coexistence of addiction and ADHD.

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

On that, you and I are in complete agreement. There's a large proportion of those addicted to all sorts of drugs that go hand in hand with mental illness. People will self-medicate for mental illness.

This is a different issue—the issue that if you try marijuana, it's the gateway drug to harder things. There are many studies that show correlation; however, there's a difference between correlation and cause and effect. This has been studied for decades. Every time they saw a correlation, there were so many confounding factors and comorbidities that it was never definitively established that marijuana was a gateway drug. To the best of my best knowledge of the literature, that particular point still hasn't been firmly established.

[Dr. William J. Barakett]

Whether it's a gateway drug or not, it is deleterious to the cognitive development of the brain.

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

And on that we agree.

[Dr. William J. Barakett]

On that we agree, and that's all you need to say, because the whole thing about.... What we see is a very high correlation. When I say that every addict who I treat started to use cannabis at the age of 12 to 13, I don't know the mechanism by which it happened, but it's a fact.

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

Oh, yes, I'm saying that, but again, it goes to credibility and to something that Mr. Davies said, that if we're teaching our kids things, we want to make sure it's the right evidence. We want to say the things that are credible that they aren't going to look up somewhere and disprove. The fact that it's deleterious to the developing brain is true, so we can say that definitively. They'll listen to that; it's credible.

But I don't want the message to get mixed with other things where there is so much information out there that says this particular thing.... If one of the things we say is, “Don't do this because it's a gateway drug” and there is lots of evidence—

[Marc Paris]

I agree.