Health Committee on Sept. 13th, 2017

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

Dr. Barakett, something you said really resonated, and we talked about this earlier today with some witnesses. You have some underlying problems with why they are consuming substances. In my medical career, we talked about people who actually had psychiatric illnesses that predated their cannabis use, drug use, and self-medication. It's analogous to when we were told by our mothers to not sit too close to the TV because we'd need glasses. Why didn't we ask why they were sitting so close to the TV in the first place? It's one of the things we need to look at. You're right that if they're abusing any substance, we need to be looking into why this has been happening. The drug abuse is only going to make it worse, but you have to remember to deal with two problems now: what got them there in the first place as well as the issue. Thank you for helping to underline that.

In another committee we talked to some colleagues in the States about this. Whenever we'd mention anything about research in cannabis, everyone would look uncomfortable and change the subject because, federally, of course, it's still illegal and heavily stigmatized. We need more research, as you said. We need a lot more research. Do you feel that the legalization is going to remove some of this stigma and stimulate more research into the subject, both from an addiction standpoint and with regard to its use medically?

[Dr. William J. Barakett]

I should hope so. The research is also going to be in the direction of medical cannabis, because we're flying by the seat of our pants. We know it works. I'm involved in the Quebec cannabis registry. I have 220 patients to whom I prescribe cannabis oil, predominantly CBD, for chronic painful conditions. To my amazement, these people have dropped their opioids like stones. They've stopped taking them. They're far better relieved. We have a number of different illnesses that benefit from it, but we don't have the neurobiological research to demonstrate to us what exactly we're doing, so it's a trial-and-error thing.

On the research, I mentioned a couple of things, including the United Kingdom study in which they followed 5,000 kids aged 13 to 18. The National Institute on Drug Abuse has launched a study on the development of the brain in adolescence. There's also all the other work that Nora Volkow of NIDA has done.

All of this stuff has to be brought to the fore and told to people. We used to have, in the 1980s and 1990s, commercials about smoking that were so enormously successful. The most notable was the cigarette that hung limp, because of smoking causing impotence. People remember it, and the smoking rates are down phenomenally. We need to bombard the public with this kind of thing.

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

Okay, thank you.

Madam Chapados, you talked about how you believe that there should be plain packaging for all cannabis products. You also recommended that it not be advertised in places like bars because you don't want that combination of cannabis and alcohol in the same place. That part of it I agree with completely.

We heard some testimony in regard to branding, that the people who take intoxicants have something in common with those who consume alcohol, that there is a sense of, as it were, brand loyalty. We do know different brands of alcohol will have different labels. Some witnesses thought that if you had plain packaging, which would have these items look pretty much like the black market, it would be hard to differentiate, or you wouldn't have the same loyalty, and users might have more brand loyalty, as it were, to the marked product. How would you respond to that?

[Maude Chapados]

Plain packaging is a major topic of discussion between the industry and the public health community. Ways of designing packaging to differentiate these products from illegal products are being explored. We can already see the first statistics for tobacco, for Australia and France in particular. We can see a link. There is a range of measures. There are advertising campaigns, but specific measures can affect perceptions in particular. The choice of colour can affect the perceived taste of the cigarette. This fact has also been made known publicly. I am referring to motivations to quit smoking. If a cigarette package is white, pink or brown green, the perception is that the cigarettes do not taste as good. The effect is unconscious. In short, it is a complete, comprehensive approach that combines various measures.

There is also the issue of young people. In Quebec, the “Enquête québécoise sur le tabac, l'alcool, la drogue et le jeu chez les élèves du secondaire”, a survey of tobacco, drugs, and gambling among high school students, revealed that the rates of declared use have fallen dramatically since 2000. In 2000, the rate was 41%, but just 23% in 2013. This is a significant difference. The reason for this drop in declared use of cannabis is not clear.

Have these young people become dependent on other substances? That could be. On the other hand, we must recall that Quebec undertook a major campaign in the late 1990s to denormalize smoking and also implemented tobacco legislation. So we cannot establish a causal relationship. The use of tobacco in bars in Quebec is another issue. It is prohibited by law to promote cigarette brands in bars. The question is then why this would be allowed in the case of cannabis.

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

That's a very good point.

On a completely unrelated note, I'm glad to hear you referencing Australia. We're getting some propaganda from the tobacco industry saying that the plain packaging experience in Australia hasn't worked. But, again, I'm glad to hear someone corroborating that this does work. On that unrelated note, thank you very much.

I believe that's my time.

[The Chair, Liberal, Bill Casey]

It is your time. Thank you very much.

That completes our seven-minute round. We are going to our five-minute round starting with Dr. Carrie.

[Colin Carrie, Conservative, Oshawa, ON]

Thank you very much, Mr. Chair.

Again, thank you to the witnesses. So little time, so many questions.

I just want to start, though, by commending Drug Free Kids Canada for the booklet. The government has had two years now, it's their own mandate, and it's a little disappointing. I think Colorado called the government out for a lack of funding being allocated to these public education campaigns. We're all aware of how important that is and the importance of getting it out ahead of time, so kudos to you guys for taking that leadership role.

We've also heard of a lack of resources for data collection and the importance of data collection. I want to start with Dr. Barakett.

Do you think that there needs to be an annual report released to the public on marijuana consumption in Canada following legalization? Do you think this type of transparency would help raise awareness? If you look at the government narrative, they're saying one of the reasons they're doing this is to decrease marijuana use by our youth. We've heard from our witnesses that it isn't the case they're seeing in Colorado. We'd like to find out what's working and what's not working. What about these annual reports, do you think they are important?

[Dr. William J. Barakett]

I think they are essential. Really, you're having to put your money where your mouth is. It would be very useful, if we're doing it to help society, for people to understand what cannabis does, the benefits of it on the medical side, which are not yet completely researched, although we certainly have some direction that it is a useful substance, and that high THC substances can have a nefarious effect, especially in developing youth. If we see that there's a rise in use in the under-18s, then we're in trouble. It means that our public education program has not worked.

[Colin Carrie, Conservative, Oshawa, ON]

Do you think being transparent instead of just keeping this data and not even releasing it will help raise awareness?

[Dr. William J. Barakett]

I would think so. Transparency to me is public health. We have to be as transparent as we would be if we were talking about the rates of diabetes. It's essential.

[Colin Carrie, Conservative, Oshawa, ON]

Mr. Paris.

[Marc Paris]

I think if we're using public money to do research for the good of the public, then the public should know.

[Colin Carrie, Conservative, Oshawa, ON]

I agree.

We talked to witnesses before you on this whole challenge. As I said, I think we're all in agreement. We would like to see youth use decrease in Canada. It's way too high, but there don't appear to be any tools in the toolbox, when we look at this legislation. There have been all kinds of opinions. My colleague brought up that for kids between 12 and 17, this bill allows for up to five grams. It is disturbing for some of my constituents to think that 12-year-olds who are in public school, this is grade 6, will be able to have this in their possession for personal use.

She mentioned that maybe it should be a ticketable offence. Nobody wants to criminalize kids. We don't want to have them carry that over. We had a lawyer from B.C. He said most police officers don't even charge kids. They just confiscate it, but it does give them the opportunity to address it and maybe bring it up to parents and teachers.

There's nothing in this bill. They say that they want it to decrease youth use, but there's really nothing prescriptive in here. There are no ideas.

Do you have some ideas? You deal with these kids every single day. For a gateway drug, at that age, what tools can we give our educators and our public health officials so that if there is a problem, we can get kids into some type of program or some type of educational system that will help them?

[Dr. William J. Barakett]

That's a very good question. For most of the youth who are referred to me, it is because they were apprehended at school for possession.

[Colin Carrie, Conservative, Oshawa, ON]

Do you see that as a good or a bad thing?

[Dr. William J. Barakett]

It's excellent. The kids are called out. The parents are called. Then what they say is you have to see your doctor.

Thank you very much for mentioning it, because my pet peeve is that our medical profession has turned a blind eye to addiction for far too long. The tremendous epidemic of opioids we have is not just because we over-prescribed. People weren't over-prescribing on purpose. It was because we had to treat chronic pain. We had nothing good to do it with, so we tried the opioids.

The big problem is that when people become addicted, or kids have alterations in their behaviour pattern because of early onset use of cannabis, the average doctor doesn't know what he's doing. He's never been taught. Medical schools in 2017 still don't teach addiction.

I've been receiving residents, R2s in family medicine, and third-year medical students for the past 35 years. In my practice, they come and spend a month. I am the only exposure to the treatment of addiction they will get in all their medical training.

[Colin Carrie, Conservative, Oshawa, ON]

You said having them called out is actually good.

[Dr. William J. Barakett]

Absolutely. That's because if a kid is 12 years old, and he's using, I'm sorry, but it's not a benign thing. There are going to be consequences, especially a kid that has it at school. He's either selling or he's habituated.

[Colin Carrie, Conservative, Oshawa, ON]

What would you recommend be put into this bill for that?

[Dr. William J. Barakett]

I don't know. I'm not a legislator, but if schools apprehend, I think there should be, not a legal sanction, but a call to the parents, and they would be obliged to consult medically. The big problem is, who are they going to take them to?

[Colin Carrie, Conservative, Oshawa, ON]

Are there any permanent consequences for the kids who are called out now?

[The Chair, Liberal, Bill Casey]

Time is up.

[Dr. William J. Barakett]

No. There's no permanent— They are discharged from school for, say, two weeks, during which time they cool their heels and get the chance to go talk to their physicians.

[The Chair, Liberal, Bill Casey]

Time's up. Thanks very much.

We'll move now to Mr. McKinnon.

[Ron McKinnon, Liberal, Coquitlam—Port Coquitlam, BC]

Thank you, Chair.

It's pretty clear that the key to success here will be public education for youth. You say you have had a multi-million dollar campaign running since June. What has been the nature of that campaign? What are its goals? Are you able to measure its results, and is it working?