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

5:25 p.m.

Member, Cannabis Task Group, Ontario Public Health Association

Elena Hasheminejad

Yes, of course.

5:25 p.m.

Chair, Cannabis Task Group, Ontario Public Health Association

Michelle Suarly

We'd be happy to share it.

5:25 p.m.

Liberal

John Oliver Liberal Oakville, ON

Nobody wants this to be promoted to children in any way or to make it look attractive.

Do any of the other witnesses have any comments on promotion or branding?

5:25 p.m.

Senior Scientist, Institute for Mental Health Policy Research, Centre for Addiction and Mental Health

Dr. Benedikt Fischer

I'll just add here that of course part of the issue or the challenge is that the genie is out of the bottle a bit, because the bill allows private commercial producers, and quite a few of those issues are tied to that. You cannot really have commercial producers without any branding or advertising or whatever, because they need to have a name and they'll use a certain font, etc., right? Part of the genie is out of the bottle a bit, and now the environments, the products, and the advertisements have to be restricted as rigorously as possible.

A key issue that I think you need to address, or that the bill needs to address, is about things like cultural promotion. I read the papers, and there are already cannabis music festivals, culture festivals, movie festivals, and all sorts of other things that we don't necessarily directly associate with typical advertisement and promotion. It needs to be looked at much more broadly and widely.

For tobacco and alcohol, there are the issues of indirect branding and advertising 2.0—virtual world, websites, computers, etc.—which are very difficult to legislate and restrict in the best of circumstances and need to be thought about here. This is a tricky challenge.

Also, of course, we've proposed to distribute this, at least in Ontario, through the LCBO, a public monopoly that we think is very safe and restricted, but at the same time, look at how alcohol is advertised and promoted in those public monopolies. The glossy “buy as much as you can” brochures are everywhere. There are a lot of tricky details still—

5:25 p.m.

Liberal

John Oliver Liberal Oakville, ON

Just to be clear, I read a very limited section here dealing with promotion and branding. There is a whole other section on a prohibition against sponsorship, and a prohibition against some of those kinds of public events you referenced. I was just focusing on promotion packaging bit on this question.

5:25 p.m.

Liberal

The Chair Liberal Bill Casey

Your time is up.

5:25 p.m.

Liberal

John Oliver Liberal Oakville, ON

Thank you very much.

5:25 p.m.

Liberal

The Chair Liberal Bill Casey

That completes our seven-minute rounds.

Now we're going to five-minute rounds, starting with Mr. Webber.

5:25 p.m.

Conservative

Len Webber Conservative Calgary Confederation, AB

Thank you, Mr. Chair. I'll direct this first question to Dr. Levy, who is down in New York.

Because you are a developmental pediatrician and have experience with Boston Children's Hospital and such, I'm curious about the effects of marijuana on pregnant mothers. It was brought up in Michelle Suarly's presentation and hasn't been talked about much around the table here. Are there any studies out there? I know there are not a lot of studies with respect to marijuana and that we need more research, but maybe you can talk a bit about your experience with pregnant women and their use of marijuana and the negative effects that occur from that.

5:30 p.m.

Director, Adolescent Substance Abuse Program, Boston Children's Hospital, As an Individual

Dr. Sharon Levy

I can't say too much because there haven't been adequate studies yet. I personally care for adolescents, occasionally pregnant adolescents, but I don't typically care for newborns. I just want to make that clear. I can tell you that the concern is that marijuana is very fat soluble, so it crosses membranes very well, and going to cross the placenta, and very concerningly it's going to be in very high concentrations in breast milk. So a breast-feeding mother who is using cannabis is going to deliver a much higher dose to her infant than she is ingesting herself. The studies on the impact of what that does, I think they're all—pardon the pun—in their infancy, and I think it's going to take a period of time for us to really understand that.

5:30 p.m.

Conservative

Len Webber Conservative Calgary Confederation, AB

I was going to direct that question to Dr. de Villa as well.

Do you have any thoughts on that particular issue with respect to expectant mothers and the use of marijuana? Do you have any knowledge of studies out there?

5:30 p.m.

Medical Officer of Health, Toronto Public Health, City of Toronto

Dr. Eileen de Villa

To be frank, it's been quite some time since I practised that type of medicine, so I don't know that I have a particular comment to add on that topic. I would suggest to you, however, that even amongst non-pregnant individuals, as I mentioned earlier, there is fairly limited research on this subject largely because it has been illegal in most jurisdictions for quite some time. That's hindered our ability, and, again, speaks to the need for further research.

5:30 p.m.

Conservative

Len Webber Conservative Calgary Confederation, AB

Absolutely. There's still much that we don't know, and research is essential.

5:30 p.m.

Medical Officer of Health, Toronto Public Health, City of Toronto

Dr. Eileen de Villa

And there's much that we do know, right?

5:30 p.m.

Conservative

Len Webber Conservative Calgary Confederation, AB

That's true, too.

5:30 p.m.

Medical Officer of Health, Toronto Public Health, City of Toronto

Dr. Eileen de Villa

We do have information, but I agree that there are areas that require further undertaking and study.

5:30 p.m.

Conservative

Len Webber Conservative Calgary Confederation, AB

Exactly.

I'll address this one to Dr. Maté.

You mentioned that you worked down in Vancouver's Downtown Eastside. Is that where your practice was? Of course, we all know East Hastings quite well. I had the opportunity to tour the InSite facility there with a colleague, Dr. Carrie, a few months ago. It is really disturbing to see the number of people there, and throughout the country and the world, who have these addictions.

We had a presenter here just before this present session indicating that as a doctor he felt that marijuana was a gateway drug to harsher drugs.

I just want to know what your thoughts are on that, Dr. Maté. Do you believe that marijuana is a gateway drug?

5:30 p.m.

Retired Physician, As an Individual

Dr. Gabor Maté

I just want to make a comment on your previous question about pregnancy. I think it's an important question. I think that from the medical point of view—and possibly the legislation can consider this—there should be a warning for pregnant women that since we don't know what the effects are since the research does not exist, in general the best policy is to avoid stuff that we don't know the effects of.

5:30 p.m.

Conservative

Len Webber Conservative Calgary Confederation, AB

It's a big experiment.

5:30 p.m.

Retired Physician, As an Individual

Dr. Gabor Maté

That's just the rational thinking, I think, in the absence of good evidence.

As to gateway drugs, the fact that somebody uses marijuana first and then goes on to use something else afterwards, or uses tobacco first and then goes on to use something else afterwards, does not mean that there's a gateway drug phenomenon going on. In fact, we don't even know that there's such a thing as a gateway drug phenomenon. Gateway means that unless you open that gate, the person doesn't go through it and doesn't develop a problem. There's just no evidence for that. It may be the case that a lot of people, before they get into the heavier drugs, will use lighter drugs, if you like, such as alcohol, tobacco or marijuana, but there's not necessarily a causative relationship. What is much more the case is that the people who are driven by their internal discomfort to use any substance at all, are more likely to use other substances in a heavy way or are more likely to use other substances in the same way later on, but this does not mean that the one led to the other. I don't think there's any evidence for basing policy on a gateway drug theory.

5:35 p.m.

Liberal

The Chair Liberal Bill Casey

Okay, thank you.

5:35 p.m.

Retired Physician, As an Individual

Dr. Gabor Maté

I appreciate the evidence from Dr. Levy, from New York that a lot of the adolescents she deals with who have a substance use disorder in general may have used marijuana first, but that doesn't mean there's a causative relationship, nor does it mean that legalization....

And I know, Dr. Levy, you're not suggesting that legalization is a good idea at all. So from the point of view of legislation, I think the gateway drug theory is just not a helpful way to look at it.

5:35 p.m.

Liberal

The Chair Liberal Bill Casey

Thanks very much.

Dr. Eyolfson.

5:35 p.m.

Liberal

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

Thank you very much, Mr. Chair.

Dr. Maté, I really appreciated your comments about having to think about what the best science is, but also having to think politically. I'm a physician, but now, as you've probably guessed, I also have to think politically in my current job. It was kind of amusing to think about that and the way it is part of our deliberations at this level.

One of the things you mentioned earlier—and we've had a lot of discussion about this—is that there are many people with a pre-existing mental illness who then go on to develop a substance use disorder, whether that be with cannabis, tobacco, alcohol, or anything else. Do you believe that if we had better investment in and commitment to primary mental health care and were more effective at treating people at the primary care level, that would be helpful in the primary prevention of a lot of drug use disorders?

5:35 p.m.

Retired Physician, As an Individual

Dr. Gabor Maté

Absolutely. In almost every case of substance use, you can identify something that's present. Often, it's ADHD—and I talk about ADHD because I've been diagnosed with it myself and I know a little bit about it. It could also be depression, anxiety, post-traumatic stress disorder, social phobias, or bipolar disorder, which is typically self-medicated with alcohol. In a lot of cases of substance use there is a pre-existing mental health problem.

Not only that, but, as some of my colleagues have pointed out, the drugs themselves can either cause or exacerbate mental health problems. There is a strong correlation between cause and effect, from which would follow the pertinence of your comment that better mental health treatment, particularly amongst adolescents and children, would tend to reduce drug use. That's my belief, and it makes sense for all kinds of reasons.

Again, the broader question that I've raised a couple of times, which is not to be answered in this context, is what is it about our culture and our way of life that's driving more and more people...? There are studies in Canada and the States every year that show that more and more kids are suffering from symptoms of mental health disorders of all kinds. There is something going on here, and that's a broader social question.

Specifically, when it comes to mental health treatment, the answer is yes. If in the schools we had better recognition of mental health problems, if we recognized that many of the behavioural problems that we're seeing are actually manifestations of inner turmoil, if the schools, for example, could act as screening venues for identifying kids at risk—and we could do this much more broadly on a community basis as well—I think the more we did this, the less substance use we would have to confront.