Evidence of meeting #66 for Health in the 42nd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was youth.

A video is available from Parliament.

On the agenda

MPs speaking

Also speaking

Jonathan Page  Chief Executive Officer, Anandia Labs
John Conroy  Barrister, As an Individual
John Dickie  President, Canadian Federation of Apartment Associations
Scott Bernstein  Senior Policy Analyst, Canadian Drug Policy Coalition
Ian Culbert  Executive Director, Canadian Public Health Association
Christina Grant  Member of the Adolescent Health Committee, Canadian Paediatric Society
Judith Renaud  Executive Director, Educators for Sensible Drug Policy
Paul Renaud  Communications Director, Educators for Sensible Drug Policy
Peter A. Howlett  President, Portage
Peter Vamos  Executive Director, Portage
Amy Porath  Director, Research and Policy, Canadian Centre on Substance Use and Addiction
Marc Paris  Executive Director, Drug Free Kids Canada
William J. Barakett  Member, DFK Canada Advisory Council, Drug Free Kids Canada
François Gagnon  Scientific Advisor, Institut national de santé publique du Québec
Maude Chapados  Scientific Advisor, Institut national de santé publique du Québec
Gabor Maté  Retired Physician, As an Individual
Benedikt Fischer  Senior Scientist, Institute for Mental Health Policy Research, Centre for Addiction and Mental Health
Bernard Le Foll  Medical Head, Addiction Medicine Service, Acute Care Program, Centre for Addiction and Mental Health
Eileen de Villa  Medical Officer of Health, Toronto Public Health, City of Toronto
Sharon Levy  Director, Adolescent Substance Abuse Program, Boston Children's Hospital, As an Individual
Michelle Suarly  Chair, Cannabis Task Group, Ontario Public Health Association
Elena Hasheminejad  Member, Cannabis Task Group, Ontario Public Health Association

11:35 a.m.

Liberal

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

Just send us the references. That would be great. Thank you.

Mr. Bernstein, I appreciated your comment about the young people. We agree. We do not want young people consuming cannabis. As you say, we know that it affects the developing brain and as well, Dr. Grant, I echo those sentiments. We need to restrict this because we know it's harmful.

I particularly appreciated the comment that if young people are smoking a lot, then the first question we have to ask is why. I practised medicine for 20 years and we do see changes in young people who smoke or consume cannabis. On more than one occasion, I've diagnosed schizophrenia where it was very clear that the onset of psychotic symptoms predated the use of cannabis. Young people were self-medicating with it because they didn't want to talk about their symptoms with anybody. They started hearing voices and felt better when they smoked cannabis.

That's not the whole story, but you're right. I think by a more open dialogue about these things.... We have to ask these people and not just young people, if anyone is consuming a lot of the substance, the first thing we have to ask is why. I think that's very important.

Dr. Grant, in your brief and in your statements here, you said you recommended aligning it with the legal age for alcohol. Knowing what you do about it and knowing what you know about adolescent behaviour and patterns, could you speculate about what would be the result if we put the minimum age at 21 or 25, as recommended by the Canadian Medical Association?

11:40 a.m.

Member of the Adolescent Health Committee, Canadian Paediatric Society

Dr. Christina Grant

The point I was trying to make was that we already know that Canada's youth are experimenting with cannabis at a rate of about 30%, depending on what age. By 15 years of age, 30% of Canadian youth will have already used or will have used cannabis in the last year. The reason the Canadian Paediatric Society has said that we must align the age of legalization for cannabis with other controlled substances, like alcohol, is that they're going to keep using. Setting the age at 21 isn't going to magically reverse those numbers. Then we get into a situation where we're looking at what the balance is of harms and benefits. If we put the age higher at 21 or 25, we are concerned that, should they choose to experiment, which we don't recommend, then we have all these youth and young adults up to 21 or 25 who don't have access to regulated products with known concentrations. That's our concern.

We don't recommend it. We know they're experimenting and it should be the same as alcohol and cigarettes.

11:40 a.m.

Liberal

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

Thank you for that.

You also wrote about public education campaigns and that this has to be part of it. Again, we agree that Bill C-45 has to include robust public education, particularly directed towards our young people.

We've seen public education campaigns in the past that were, to say it charitably, a little clumsy. I think we can all remember laughing at the ad with the fried egg in the pan, "This is your brain on drugs". We know that just did not resonate with anybody as an effective deterrent. What would be the most effective way of transmitting to young people that this is something they shouldn't be doing?

11:40 a.m.

Member of the Adolescent Health Committee, Canadian Paediatric Society

Dr. Christina Grant

That's getting a little bit outside my area of expertise, to be honest, but I guess I have a couple of important points that I mentioned in my brief. We need to partner with youth leaders and public health agencies, and we need to have clear messages in preparation, and not just sort of last minute, for what's going to happen should this go through next summer. We need to make sure that there's adequate investment in getting the word out. I agree with Peter Howlett and Ian Culbert that there needs to be more of a conversation.

There are a lot of myths around cannabis use for youth. When you ask youth, as we often do as pediatricians and adolescent medicine specialists in our offices, you will hear they're getting a lot of information from cannabis YouTube channels and different lobby groups, but there are no clear messages around what the risks are. One in six will develop a cannabis use disorder. There are actually structural and functional changes seen on MRI related to cannabis use. Those messages aren't out there.

11:40 a.m.

Liberal

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

Thank you.

11:40 a.m.

Liberal

The Chair Liberal Bill Casey

Ms. Gladu.

11:40 a.m.

Conservative

Marilyn Gladu Conservative Sarnia—Lambton, ON

Thank you, Mr. Chair.

Thank you to all of our witnesses for appearing today.

I'm going to start with some statistics that Mr. Culbert and Ms. Grant shared: 12% of Canadians and 30% of youth are consuming cannabis. We've heard a lot about what cannabis consumers want and need, but I think, in the interest of balance for this bill, we have to look at this another way, and that is that 88% of Canadians, i.e., the majority, are not consuming. How do we protect their rights to not be exposed to increased harm, such as second-hand smoke, drug-impaired drivers, and schizophrenic and psychotic youth? Similarly, 70% of young people are not consuming cannabis. How do we protect them so they don't start consuming?

We heard some suggestions in previous panels, so I want to talk about those two suggestions and then get input from each of you on whether you think those ideas would be good.

The first is in terms of public education. We heard from Washington State, where they have about seven million people. They're spending $7.5 million a year on public education and have seen that as a great deterrent. For us in Canada with 30 million people, I would suggest that the $9 million that the Liberal government has come forward with will not be adequate or timely in order to address that. I think we need more public education, and we need it sooner.

The second suggestion is that in order to give the right message to children about how much cannabis is good for them, the legislation should say that people under the age of 18 should possess zero, but that any amount that is possessed would then be a ticketable offence instead of the language that is in here.

I'm interested to hear from all of you on whether you think either of those two suggestions are good, as well as your comments. We'll start at the left and go to the right.

11:45 a.m.

Executive Director, Portage

Dr. Peter Vamos

I think one of the things that concerns us is messaging. You can interpret recreational marijuana to suggest a lifestyle or that marijuana is comparable to a sport. We know from the data that it's potentially physically and psychologically harmful and lends itself to misuse. What we would like to see—and perhaps the bill can reflect that—is a change in messaging. It's not a question of legalizing or not legalizing. It's just a change in the presentation.

11:45 a.m.

President, Portage

Peter A. Howlett

I feel that the harm that the abuse or the extreme use of cannabis can create is evident. We live with it all the time. We have 500 young people a year going through treatment. Most of them have cannabis as a precursor drug or their main drug of choice.

As Mr. Vamos just said, it's about addressing the question of messaging, trying to affect culture, making it not a cool thing to do, developing the story or narrative to point out that this is very damaging to you and very damaging over a term.

11:45 a.m.

Conservative

Marilyn Gladu Conservative Sarnia—Lambton, ON

Let's just stick to my two questions. Do we think that we should have more education sooner? Do we think that we want to send a message of zero possession for those under 18?

11:45 a.m.

President, Portage

Peter A. Howlett

Yes. The answer to both of those is yes.

11:45 a.m.

Conservative

Marilyn Gladu Conservative Sarnia—Lambton, ON

Dr. Grant.

11:45 a.m.

Member of the Adolescent Health Committee, Canadian Paediatric Society

Dr. Christina Grant

For the first question, yes, we need it to be adequately funded, and I agree with your statement on that: messages need to come sooner. I don't agree with the ticketable offence under 18. That's going to penalize youth and is not helpful.

11:45 a.m.

Conservative

Marilyn Gladu Conservative Sarnia—Lambton, ON

Mr. Culbert.

11:45 a.m.

Executive Director, Canadian Public Health Association

Ian Culbert

There are numerous players in addition to the federal government when it comes to education, so $9 million is a good start. Obviously, there are all the provinces and territories, and we have to differentiate between the public education component, which comes down to the nuts and bolts of what's going to be legal—where you can buy it, who can buy it, and who can possess it—and the health promotion component, which is the legitimate sphere of the federal government in health matters. We certainly encourage a robust investment there, and one that is focused on conversation.

In 2005 my association was funded by the federal government to do a project that was about getting parents talking to their children about cannabis use and driving. It was about having the conversation. It was non-judgmental and non-stigmatizing. It was just about breaking down some of those barriers.

There are a lot of misconceptions on both sides about cannabis use and the product itself that need to be broken down, making sure parents have access to those valuable resources that tell the whole story. Kids aren't stupid. You can have a conversation with them and that's what I meant about needing to normalize the conversation, not the use. We haven't even normalized the conversation about alcohol use, and that's the socially accepted substance.

There's a lot of work to be done, because we're seeing a big societal shift as far as what the norms around drug use are in this country.

We do support ticketing as opposed to those minors having a criminal offence.

11:45 a.m.

Conservative

Marilyn Gladu Conservative Sarnia—Lambton, ON

Very good.

Mr. Renaud.

11:45 a.m.

Communications Director, Educators for Sensible Drug Policy

Paul Renaud

Yes, I agree with Mr. Culbert. I also feel that eight decades of prohibition have really skewed our information. There has not been much real science done around cannabis, and now that we're moving towards a regulated framework we'll actually be able to use science as a guide.

As we enter the legalization of cannabis, there will be a lot of studies. Obviously, things will be monitored very closely, and we can then at some point have more actual data on which to base changes in policy, to tweak the policy where it may need tweaking.

As for the age restriction, it seems appropriate to me to delegate a certain amount of that to the provinces, as we see differences in the legal age to consume alcohol in different provinces and different jurisdictions. If the age were made higher than the age to consume alcohol, for a lot of us that would not make a lot of sense. It would effectively promote more alcohol use, which, quite frankly, I don't think we want to do.

The incidence of fetal alcohol syndrome is a very profound—

11:50 a.m.

Conservative

Marilyn Gladu Conservative Sarnia—Lambton, ON

In the interests of time, I'd like to get some input from Mr. Bernstein as well.

11:50 a.m.

Senior Policy Analyst, Canadian Drug Policy Coalition

Scott Bernstein

Thank you.

In the area of public education, your first point is a great idea. We're definitely in favour of having evidence-based education at a young age about what drugs are, the various social scenarios where you might find yourself involved in drugs, the harms of drugs, and why people take drugs and report feelings of benefit or otherwise, in medical use or otherwise.

Having a discussion from a very early age based on evidence, rather than myth and scare tactics, is good. I grew up under “just say no” and the egg in the frying pan, and here I am testifying to the House committee on legalizing drugs. I don't think those messages work in the way they're intended to. Basing it on evidence and also, where possible, having young people themselves as the educators and talking about their own experience would make it more effective.

On your second point around the ticketable offence, again as Mr. Culbert said, ticketing is preferable to criminalization. In the best scenario, we would create a social framework where it's not necessarily a punitive approach against young people, but more working with them about use.

Having the floor of no tolerance, zero possession, isn't realistic. That would incentivize police to go after just minor things, hassling young people. If someone is smoking in public, it could be confiscated, and the peace officer could say, “Don't do this”, but ultimately I don't think there should be any process at zero tolerance to be effective.

11:50 a.m.

Liberal

The Chair Liberal Bill Casey

The time is up.

Mr. Davies.

11:50 a.m.

NDP

Don Davies NDP Vancouver Kingsway, BC

Thank you, Mr. Chair.

Dr. Grant, I want to probe the state of the research on this to separate what we believe and what we know. We've already heard from a number of witnesses the challenges of conducting research in a criminalized environment, wherein there are all sorts of difficulties with doing research. It's hard to have control studies, where we have a group of 15-year-olds smoking cannabis and a group who are not and chart their paths. You have ethical considerations, of course, and the fundamental issue of causation versus correlation.

A recent study from Harvard Medical School and the VA Boston Healthcare System found that:

While cannabis may have an effect on the age of onset of schizophrenia it is unlikely to be the cause of illness....

It also reported:

In general, we found a tendency for depression and bipolar disorder to be increased in the relatives of cannabis users in both the patient and control samples. This might suggest that cannabis users are more prone to affective disorders than their non-using samples or vice versa.

Although intuitively I share the concern that cannabis use in young people is not a good thing and can't be positive—I absolutely believe that—I think it's important that as a health committee we distinguish what we believe from what we know.

Is there, then, a causative element established in literature with respect to cannabis causing mental illness, or is it correlated?

11:55 a.m.

Member of the Adolescent Health Committee, Canadian Paediatric Society

Dr. Christina Grant

First of all, the CPS statement is based on the scientific literature, not on belief but rather on the facts that we have at the time we're reviewing the data. As I mentioned in my brief, the relationship between psychosis and cannabis is complicated.

My understanding of the state of the literature is that we can't say with 100% certainty that it's causative, in the sense that only cannabis use in a young person regularly over years would for sure result in their developing a psychotic illness; however, based on many studies we know that there are a number of different types of psychotic outcomes.

We know from rigorous research that one of the side effects of using cannabis can be an acute psychotic episode. Some youth experience that when they're high. There is another type of acute psychotic episode that can last days to weeks, and often those youth end up coming to emergency rooms, being seen because the psychotic symptoms have lasted beyond the high or the use. We know from research that those youth, if they're followed, have an increased likelihood of about 50% of having another psychotic episode in the future that is not related to cannabis.

I'm not a schizophrenia expert, but from reviewing the literature there is definitely a link between regular, ongoing cannabis use that starts young and continues, and the development of schizophrenia. As I mentioned in my brief, however, it's not that alone. Judging from the literature, for example, the risk of having a psychotic illness in an adult is about 1%. Add regular, ongoing cannabis and that doubles the risk to 2%, which sounds quite low if we think 2% versus 1%. However, if you have a family member who has suffered from schizophrenia or a psychotic illness and your risk as an individual is much higher, then doubling the risk with cannabis becomes significant.

11:55 a.m.

NDP

Don Davies NDP Vancouver Kingsway, BC

Are people who are prone to schizophrenia more likely to seek out self-medication, as Dr. Eyolfson said, or would using cannabis lead to more psychotic episodes? That's the essence of my question. How do we know that the person wouldn't have had psychotic episodes in any event?

11:55 a.m.

Member of the Adolescent Health Committee, Canadian Paediatric Society

Dr. Christina Grant

It's a great question. Schizophrenia isn't my main area of expertise, but there are a number of studies. I'm happy to give you those references. They're referenced in the Canadian Paediatric Society's statement, indicating that it's not that the psychosis came first and then they're self-medicating, but rather the reverse. But it's complicated.

11:55 a.m.

NDP

Don Davies NDP Vancouver Kingsway, BC

Okay, thanks.

I want to just push a little and pursue the issue of edibles. I'm not sure I have your testimony correct, so I want to clear this up. Are you suggesting that this legislation should not legalize edibles?