Dear members of the Standing Committee on Health, I'm an adolescent medicine specialist and associate professor of pediatrics at McMaster University. Thank you for the invitation to speak as a representative of the Canadian Paediatric Society on Bill C-45, specifically regarding the age of legal possession and the impact on young Canadians of the legalization of cannabis in Canada.
I have submitted a summary of the CPS statement on cannabis and Canada's children and youth for your reading. My goal today is to ensure that you have up-to-date scientific information regarding the impact of cannabis use on young Canadians, including young toddlers, and to discuss our society's stance regarding the age of legal possession.
First, there can be no doubt regarding the scientific literature that cannabis use prior to the mid-20s is associated with structural, functional, and harmful effects on the developing brain, as has been borne out in many peer-reviewed studies. There are rigorous studies demonstrating a relationship between regular cannabis use in youth and the increased risk of approximately 40% of developing a psychotic episode. We know that early use, higher doses, and frequent use all contribute to this risk, in addition to other predisposing factors for developing a psychotic illness, such as family history.
There are also studies demonstrating a relationship between regular cannabis use and clinical depression, though results are not as robust as for the psychosis relationship. There are studies indicating that youth with certain anxiety disorders are at increased risk for developing problematic cannabis use that can inevitably interfere with their everyday lives.
Strikingly, one in six adolescents who experiment with cannabis goes on to develop cannabis-use disorder, a psychiatric illness similar to alcoholism, where the drug use interferes with multiple areas of functioning. This can include academics, social and family relationships, and extracurricular activities, all areas that require rich development during the teen years in order to leave them well equipped for life.
For all these reasons, there is no safe age for experimentation with cannabis, and we recommend that young people not consume it. However, adolescence is a time of experimentation. We know that Canadian youth are experimenting with cannabis at the highest rate compared with other countries around the world. The proposed legal cannabis industry in Canada has raised a dilemma regarding the most appropriate age for its legal use, which should minimize harm to children and youth, our most vulnerable population.
On the one hand, prohibiting cannabis until the mid-20s would protect adolescents during a period of critical brain development. On the other, adolescents and young adults are already experimenting frequently with marijuana. Aligning the legal age for cannabis use with that of other legally controlled substances, notably alcohol and tobacco, would help ensure that youth who have attained age of majority have access to a regulated product with a known potency. Also, they would be less liable to engage in high-risk, illegal activities to access cannabis.
Of emerging concern in the United States and in Europe is the number of accidental ingestions of edibles by the toddler age group. Perhaps we all know that edibles are marijuana-infused food products that come in various formats, including cookies and candies. These are highly attractive to young children and often indistinguishable from regular candies, chocolate bars, or baked goods. In Colorado, rates of unintentional ingestion in children less than nine rose by 34% after the legalization of cannabis. More than a third of those cases required hospitalization in a pediatric critical care unit because of overdose symptoms. Most commonly, the toddlers could not breath on their own.
A study from France published this month demonstrated a threefold increase in young children, mostly toddlers, requiring pediatric emergency care presenting with coma and seizures secondary to accidental cannabis ingestion.
Because of the aforementioned concerns, I would urge your committee to consider the following CPS recommendations so that as a society we are able to protect those who are most vulnerable.
First, enact and rigorously enforce regulations on the cannabis industry to limit the availability and marketing of cannabis to minors. These regulations must prohibit dispensaries from being located close to elementary, middle, and high schools, licensed child care centres, community centres, residential neighbourhoods, and youth facilities. Mandate strict labelling standards for all cannabis products, including a complete and accurate list of ingredients and an exact measure of cannabis concentration. Mandate package warnings for all cannabis products, including known and potential harmful effects of exposure, similar to cigarettes, including childproof packaging. Mandate and enforce a ban on the marketing of cannabis-related products using strategies or venues that attract children and youth, such as edibles.
Second, adequately fund public education campaigns to reinforce that cannabis is not safe for children and youth by raising awareness of the harms associated with cannabis use and dependence. These campaigns should be developed in collaboration with youth leaders and should include young opinion leaders.
Finally, send a strong message to the public that cannabis has neurodevelopmental risks by considering limiting the concentrations of THC in cannabis that 18- to 25-year-olds can purchase legally.
Thank you.