Health Committee on Sept. 13th, 2017

[Elena Hasheminejad]

I can speak to the education piece and highlighting its importance, as you said. Coming from when I worked the front-line, I have had the opportunity to go out to schools, albeit for many years we had difficulties even going into schools.

The fact that we are moving towards legalization has brought attention to this and allowed us to begin talking about this substance. For those of us who work on the front line, it's not that we haven't attempted to, but there has always been a barrier because it has been an illegal substance. We know that Canadians are among the highest users, and we know from even our fellow colleagues from CCSA that when they are interviewing youth, or even when I see youth up front, the perception is that it's natural, that it's not harmful. That's where the big gap is.

[Colin Carrie, Conservative, Oshawa, ON]

That's the problem.

[Elena Hasheminejad]

Yes, education needs to start. One of the biggest keys to prevention is bringing that education forward, and not just for youth, but for parents, educators, or those who are working alongside youth. They are a population that's important.

However, I think something that also needs to be brought up is that a lot of youth are questioning why we're moving towards legalization. At times it builds up the perception that it's even safer. Even having education on the reasons we are moving towards this can at least help them understand that we're not legalizing this because, as some of them quote in some of these interviews, “it's natural” or “it's a plant”, but for the reasons we have outlined. I think those are very key components in education that need to be started.

I know when we look at different public health units, we are all trying to work together to do the education. I saw the drug-free kit, which we had heard about—

[Colin Carrie, Conservative, Oshawa, ON]

If I could interrupt you—

[The Chair, Liberal, Bill Casey]

The time is up.

[Colin Carrie, Conservative, Oshawa, ON]

—with 290 days before it's implemented, have you received any support from the government?

[The Chair, Liberal, Bill Casey]

Mr. Carrie, the time is up.

[Colin Carrie, Conservative, Oshawa, ON]

Oh, darn.

[The Chair, Liberal, Bill Casey]

Mr. Davies.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thanks to all the witnesses for being here.

Dr. Maté, perhaps I might direct some questions to you first. The Liberal government has asserted that the proper public policy in respect to cannabis is to legalize it to meet a specified set of purposes. The New Democrats agree with the government on this in terms of its being a proper public policy approach.

I want to read you the purposes of why they want to legalize cannabis:

The purpose of this Act is to protect public health and public safety and, in particular, to (a) protect the health of young persons by restricting their access to cannabis; (b) protect young persons and others from inducements to use cannabis; (c) provide for the licit production of cannabis to reduce illicit activities in relation to cannabis; (d) deter illicit activities in relation to cannabis through appropriate sanctions and enforcement measures; (e) reduce the burden on the criminal justice system in relation to cannabis; (f) provide access to a quality-controlled supply of cannabis; and (g) enhance public awareness of the health risks associated with cannabis use.

However, Prime Minister Trudeau has gone on record as explicitly ruling out taking a similar approach to other substances. I'm picking up your comments at the end of your opening statement. In your view, is that a rational position to take?

[Dr. Gabor Maté]

Well, I think there are two worlds: there's the world of reality and there's the world of politics. Somehow the two have to be conjoined. In the realm of politics, I totally understand why the government has taken the very rational step—and for the laudable purposes that you just outlined—of bringing rationality into the marijuana situation. I also understand that for political reasons it would just not be popular and acceptable to a lot of people, due to ignorance and a lot of propaganda over the decades, to bring that same rationale into drug policy in general. From the political point of view, I totally understand it. From the medical point of view, from the human suffering point of view, from the humane point of view, from the point of view of what would best serve prevention, treatment, and healthy judicial system approaches, of course I can't agree with the present reluctance to extend this same broad-mindedness and rationality to the other drugs that are currently illegal.

So, yes, politically it's understandable. From the point of view of what would be best and what would be right and serve the population, no, I can't agree with the present approach.

[Don Davies, NDP, Vancouver Kingsway, BC]

Well, I'm just wondering, because we've heard lots of evidence about cannabis and its health impacts, the undesirability of using it, it's impact on young people, yet we, as a Parliament, are trying to provide a rational system that recognizes that, while people are using it, we may as well regulate it and ensure that organized crime is not involved it it and that there are safe amounts of it. Of course, I come from Vancouver, where the opioid crisis is raging. We're on track this year to have more deaths than last year, which was in itself a record, from fentanyl and other opioids, and it strikes me that a similar approach.... If this is the right approach to cannabis, I'm struggling to find out what the differentiation would be with the other drugs.

[Dr. Gabor Maté]

Well, yes, I agree with you. In the United States, a presidential commission recently reported that every three weeks they suffer the equivalent of a 9/11 because of opiate overdoses, and yet the overall policies are not changing. There's a real contradiction between what's happening in the real world and what's happening in the realm of politics.

I will be in Ottawa, I think, in November. An event is scheduled, I believe, with the participation of the former health minister, now indigenous affairs minister, Jane Philpott. I trust that if the event goes forward, we will be talking about this material. I totally share your impatience and frustration with the lack of congruence. The fact is that with all substances that we've talked about today—marijuana included—the licit substances like tobacco and alcohol can have deleterious negative effects. It's not a question of anybody saying that these things are good; it's a question of asking what's the most rational policy towards them. Just as we've learned with alcohol what prohibition costs, to great cost; just as we should have learned by now about the impact of prohibition on opiates and other drugs; and as the impact and the irrationality of prohibitive approaches on marijuana are just being finally realized, I hope at some point we get to the stage of rationality when it comes to drug policy in general. I wish for that no less fervently than you do.

[Don Davies, NDP, Vancouver Kingsway, BC]

In a May 2017 interview you conducted with Jaisal Noor, you said, “the fundamental assumption that informs the legal approach to drugs, is that drug use—and particularly addiction—is a choice that people make”.

[Dr. Gabor Maté]

Yes.

[Don Davies, NDP, Vancouver Kingsway, BC]

The current U.S. attorney general, Jeff Sessions, recently made a statement about how we had to go back to the 1980s and to Nancy Reagan's “just say no” approach. He thinks that's the way to prevent drug use: if people are just told how bad drugs are, they'll stop using them. The public conversation on drugs simply does not take into account the realities of why people use and get addicted in the first place. In your view, Dr. Maté, what are the realities of why people use drugs and get addicted in the first place, and how would that inform public policy?

[Dr. Gabor Maté]

This also pertains to the present discussion on marijuana and prevention. If Mr. Sessions is right, that those policies of telling people that drugs are bad and not to use them at any age work, why does the United States have five or 10 times as much heroin use as it did 10 years ago? In other words, the current situation more than amply demonstrates the failure of that kind of approach.

The reason people use drugs—and I indicated that to some degree with marijuana.... If you ask young people what they get from it, they'll tell you what they get from it. They'll get a sense of social connection. They'll get a calming of their minds. For certain conditions like ADHD, it actually has a soothing effect that they crave. Heroin is a painkiller. It soothes emotional and physical pain. Stimulants make people feel more alive, more present, more vivacious, and more vital.

The real question is, why is it that people have emotional pain? Why are so many young people anxious? Why are so many young people depressed? Why are these numbers going up and up and up? Why are more and more kids diagnosed with ADHD, which itself is a risk factor for addictions of all kinds, particularly a marijuana addiction?

Those answers are not to be found in individual people; they are to be found in social factors. When I'm talking about prevention, our prevention approaches really have to address those social factors: what's happening in the schools, what's happening in the homes, and what's happening in the culture.

I know that this legislation can't address those questions in any comprehensive or even deep way, but I certainly concur with all my colleagues who said that this should be a public, monopoly-based system. I also concur with everything they said about how the money being made from it should not go into funding highways or anything else. It should go into funding programs that help prevent the social conditions and the social pressures that drive young people into drug use. In other words, if we're going to have a monopoly here, let's use the income from that to actually address the real issues as to why kids are using drugs.

Finally I'll say—and I've written about this in one of my books—that the problem with exhorting kids not to do stuff is, one more time, that the kids who are listening to adults are at much less risk, and the kids who are at high risk are not listening to adults because of what's happened in their lives.

Our prevention approaches need to go beyond telling kids not to use stuff. They also have to go to bringing these kids into a healthy relationship with adults so that they will listen to us. That's a big issue.

[The Chair, Liberal, Bill Casey]

Time's up.

Mr. Oliver.

[John Oliver, Liberal, Oakville, ON]

Thank you very much, and thank you for the testimony you've given today.

We've had a number of fairly wide-ranging conversations about different things, but for us as a committee, at the end of day, our mandate is to sit down and actually review the act in a clause-by-clause way to see if it meets the stated objectives or there need to be amendments.

In that regard, one area that we haven't really delved deeply into as a committee yet is this issue of packaging, branding, and promotion. I thought I would spend a bit of time on that with you. I think both the Public Health Agency of Canada and OPHA have proposed the plain packaging. I've certainly seen that for cigarettes, and it's worked very well in certain jurisdictions. I'm just not sure how you legislate it.

I am going to just quickly read what's here in the act around promotion and around branding. See if you think it's sufficient or if you have any advice for us as a committee to add more to it.

Under promotion—I'm going to shorten it a little bit, just to make it easier:

17(1)...it is prohibited to promote cannabis...

(a) by communicating information about its price or distribution;

(b) by doing so in a manner that there are reasonable grounds to believe could be appealing to young persons;

(c) by means of a testimonial or endorsement, however displayed or communicated;

(d) by means of the depiction of a person, character or animal, whether real or fictional; or

(e) by presenting it or any of its brand elements in a manner that...evokes a positive or negative emotion about...a way of life such as...glamour, recreation, excitement, vitality, risk, or daring.

Those are all the ways you can't promote.

Under branding, it says a person may promote cannabis by displaying a brand element, like Players versus—I don't even know what the brands of cigarettes are—either on the product or on a thing that is not the product, not cannabis,

17(6)...other than

(a) a thing that is associated with young persons;

(b) a thing that there are reasonable grounds to believe could be appealing to young persons; or

(c) a thing that is associated with a way of life such as one that includes glamour, recreation, excitement, vitality, risk, or daring.

Those are pretty clear limitations. It's sort of a name and maybe a colour, and in cigarettes there's not even colour used in plain packaging. Are those provisions sufficient, to your mind, around promotion and around branding, to strictly prohibit anything that would make this product appealing to young people? Are there any reactions to that?

[Dr. Eileen de Villa]

It it sounds like that list has most of the elements covered. I'd have to reflect on it a little more, but the notion is to follow the evidence that has been used and been shown to be impactful with respect to plain packaging as it applies to tobacco. I think we have some experience with that, which can be used to inform the committee in its deliberations on this particular issue.

[John Oliver, Liberal, Oakville, ON]

Thank you.

[Elena Hasheminejad]

I'm going to echo that, but I have just one thing to point out.

Again, we would have to look at this a little more in depth, but I know that even when we've looked at some of the lessons learned from Colorado and Washington, they stated that individuals express that when there is the legal option to getting cannabis, they prefer that rather than going illegal.

I know there has been a discussion of finding a balance with branding and marketing and thinking that if we don't have that, then where is the competition? Or individuals go for that branding piece, like they do with cigarettes. But as we have learned from the lessons with tobacco, as my colleagues have pointed out, on the benefits of plain packaging and what we have seen, and knowing that in other jurisdictions that have legalized cannabis individuals are still taking that route to promote that, plain packaging is something that I think—

[John Oliver, Liberal, Oakville, ON]

In your experience of plain packaging, do those prohibitions...? You can't just say “plain packaging”. I don't think that's a legislative term. You have to be more descriptive. Do these cover off the plain packaging in your mind, or do you think there are specific elements that should be added to those prohibitions?

[Elena Hasheminejad]

To what you read out from the bill? Again, I would probably have to look into that a little more. I know that—

[John Oliver, Liberal, Oakville, ON]

If you wouldn't mind, if anything comes to mind later, I would love to see anything you would have on this.