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

12:35 p.m.

Member of the Adolescent Health Committee, Canadian Paediatric Society

Dr. Christina Grant

Well, your point.... I'm not sure exactly what you mean.

12:35 p.m.

Executive Director, Canadian Public Health Association

Ian Culbert

Do you mean smoking cannabis?

12:35 p.m.


Don Davies NDP Vancouver Kingsway, BC

I mean smoking tobacco, smoking anything. I take it that there's a clear causative link between smoking any substance and death. Is that correct?

12:35 p.m.

Member of the Adolescent Health Committee, Canadian Paediatric Society

Dr. Christina Grant

Oh, yes. I wouldn't disagree with that.

12:35 p.m.


Don Davies NDP Vancouver Kingsway, BC

Thank you.

I want to come back to the age issue. I'm not sure where I'm landing on the age issue. It seems to me that there are pros and cons. On the one hand we have to set some limit. We're not going to throw it open to say that any child can have access. There are arguments to link it to the age of legal access to alcohol, but then there are other factors as well.

I want to put to you, Mr. Culbert, this issue. Let's say we pick age 19. Seven out of 10 provinces are already at 19, and 19 has the added benefit of making sure that it's not really going to be in high schools, because overwhelmingly there aren't 19-year-olds in high school, by and large. If we set it at 18, in grade 12 half the class is going to be carrying legally up to 30 grams of marijuana and the rest of the school is not. Also, we have of course the information we have on brain development, so that's one more year of brain development.

Would it not make sense to set 19 nationally across the board, based on those factors?

12:35 p.m.

Executive Director, Canadian Public Health Association

Ian Culbert

CPHA would prefer that the legal drinking age across the country be 19, because we know that with the evidence regarding intoxicated driving and accidents, that one year makes a huge difference. When we once again look at the whole picture, to have alcohol being treated differently from cannabis, it doesn't make a lot of sense to have different ages in different provinces. The education component becomes that much more complicated. It is a false barrier and kids will see through that. They will question that. If they only have to be 18 to drink, why do they have to be 19 to consume cannabis? It's creating that logic of it.

At the same time, I am anticipating that with Ontario and Quebec being border provinces, there will be that disconnect as well. We'll have to start dealing with that the same way we've had to deal with it with alcohol. We would have preferred age 19 across the country, if it matched the legal drinking age across the country.

If I could go back to your previous question, yes, millions of people have died from tobacco smoking. There are no cases of anyone dying of smoking cannabis. Chronic use does have some respiratory issues associated with it, and there have been documented cases of death as a result of edibles. It was—

12:35 p.m.


Don Davies NDP Vancouver Kingsway, BC

Can you tell us where that research comes from?

12:35 p.m.

Executive Director, Canadian Public Health Association

Ian Culbert

That was Colorado state, consumption of cannabis-infused brownies. Now that wasn't the death. The death was the result of the person jumping off a hotel balcony, so it's an associated death, but it wasn't metabolically related to the consumption.

12:35 p.m.


Don Davies NDP Vancouver Kingsway, BC

The purpose of my question was on the metabolic.

12:35 p.m.

Executive Director, Canadian Public Health Association

Ian Culbert

Yes, that's just to clarify.

12:35 p.m.


The Chair Liberal Bill Casey

All right, thank you very much. That concludes our session, our panel.

I want to thank all members on behalf of our committee, especially Mr. Bernstein. I know it's very difficult to be in your position, and we understand that. We appreciate your patience with us. It's hard not to be in the room and still be part of it, but you have done a great job. To all our members, all our panellists, you have all brought your different perspectives and helped us a great deal to understand what we're dealing with.

Thank you very much.

I'm suspending the meeting and we'll reconvene at 1:45.

1:45 a.m.


The Chair Liberal Bill Casey

We'll resume. This is again meeting number 66 of the Standing Committee on Health. We have a panel before us now to discuss the age for legal possession and the impact on young Canadians.

We welcome our guests, and we thank you very much for taking the time to come. I'm going to introduce you, and then we'll have a 10-minute introduction for each, and then we'll go into questions.

Starting off, from the Canadian Centre on Substance Abuse and Addiction, we have Amy Porath, director of research and policy. We also have Drug Free Kids Canada, represented by Marc Paris, executive director, and William J. Barakett, member of the DFK Canada advisory council. From the Institut national de santé publique du Québec we have Maude Chapados, scientific advisor and François Gagnon, scientific advisor.

We'll start with Ms. Porath for your 10-minute opening remarks.

1:45 a.m.

Amy Porath Director, Research and Policy, Canadian Centre on Substance Use and Addiction

Good afternoon, Mr. Chair and members of the committee. My name is Dr. Amy Porath-Waller, and I'm the director of research and policy at the Canadian Centre on Substance Use and Addiction, or CCSA.

CCSA was created in 1988. We're Canada's only agency with a legislated national mandate to reduce the harms of alcohol and other drugs on Canadian society. We welcome the opportunity to speak to you today on the topic of age for legal possession of cannabis and its impact on youth.

CCSA's subject matter expertise on cannabis is founded on the research, policy advice, and knowledge mobilization activities that have been the priority area of focus for us since 2008. Accordingly, the issue of cannabis legalization is of great interest to our organization, and we believe we are well positioned to contribute meaningfully to the discussion on Bill C-45.

In respect of time constraints, my presentation today will be brief. CCSA submitted a brief on Bill C-45 in advance of our appearance today, and we would be pleased to cover the areas in the brief beyond the scope of youth and age of legal possession.

As many of you may already know, Canadian youth have among the highest rates of cannabis use in the world. Despite a decrease in use among youth in recent years, cannabis remains the most commonly used illegal drug among Canadian youth aged 15 to 24. Canadian youth aged 15 to 24 are also more than twice as likely to have used cannabis in the past year, as compared with adults aged 25 and older.

Youth are also at greater risk of experiencing harms associated with cannabis use than adults are, because adolescence is a time of rapid brain development. The risks associated with use increase the earlier youth begin to use and the greater the frequency and quantity they consume. Accordingly, delaying the onset of use and reducing the frequency, potency, and quantity of cannabis used can reduce this risk.

An important point that I want to make today is that when we speak of a comprehensive approach to reducing cannabis use among youth, we refer to regulatory tools, but equally important we also speak of a comprehensive, evidence-informed approach to prevention and public education. I will speak more on this latter point soon.

First, minimum legal age of access is an important component of a comprehensive approach to reducing youth cannabis use. Given the number of youth aged 18 to 24 who currently use cannabis illegally, the increased risk of health impacts must be considered alongside the risks associated with the continued use of cannabis obtained outside the regulated market.

Setting the legal limit at 18 years of age at the federal level means that young people will not face adult criminal charges for cannabis possession. Setting the age at 18 also provides the opportunity for the provinces and territories to set additional regulations that can discourage use without the harms of criminal justice involvement.

For example, the provinces may consider increasing the age of cannabis access from 18 to 19 to align with the minimum legal drinking age in most provinces. This provides a consistent message to youth of legal age that we trust them to use impairing and potentially harmful substances in a responsible way.

A second regulatory tool that is an important component of a comprehensive approach to reducing youth cannabis use is pricing. We know that youth are price-sensitive. Evidence from the alcohol literature indicates that standardized minimum pricing is an effective mechanism for reducing overall levels of alcohol consumption and that indexing—or rather, setting the price according to product potency, and in the case of cannabis by level of THC—can incentivize the use of lower-risk products. Certainly, ongoing analyses will be important to ensure that pricing maintains a balance between reducing consumption and encouraging diversion to the illegal market.

In addition to these regulatory considerations, there is also a need for a comprehensive, evidence-informed approach to prevention and public education in order to provide young Canadians with the knowledge and skills they need to make informed decisions about their personal use of cannabis. Accumulating evidence suggests that a multi-faceted approach, one that involves several components, including programming in schools, resources for parents and families, community interventions, as well as mass media, will help to maximize outcomes among our youth. A comprehensive approach to prevention and education also requires proactive and ongoing investment, as well as ongoing monitoring and evaluation to ensure that it has the desired impact.

CCSA has conducted focus groups with youth to understand their perceptions of cannabis and cannabis use. In these discussions, youth told us that they want information about risk that is linked to tangible outcomes, and they want harm reduction strategies so that they can reduce those risks if they decide to use cannabis. The evidence indicates, and we've heard directly from youth, that they want to hear both sides of the story on cannabis, both the benefits as well as the harms. To that end, education and prevention initiatives need to incorporate what we've heard from youth in order to be impactful.

We also know that youth continue to hold fast to certain misperceptions about cannabis, including the perception that everyone is using cannabis all of the time. We've also heard from our youth focus groups that while they recognize that drinking and driving is dangerous, they don't view cannabis in the same way.

We know from our focus groups as well as from the broader research literature that young people are influenced by the Internet, the media, and public discourse on cannabis. Clear, consistent, and factual information that addresses myths and misperceptions is therefore essential, to cut through the many sources and types of information and messages that youth are exposed to about cannabis on a daily basis. Such information will help to establish actual social norms that lower rather than promote the use of cannabis.

We also know from our research that youth want to receive information from sources they trust who can speak credibly about cannabis. Depending on age, this includes parents and educators, but perhaps most importantly it also includes peers. A comprehensive approach to prevention, therefore, means providing the needed training, resources, and consistent messaging for parents, educators, health care providers, coaches, youth allies, as well as peers. It also involves providing young people with the skills to critically evaluate the information they are receiving. This can include digital and media literacy.

It's also important for a comprehensive approach to include targeted messaging regarding high-risk cannabis use in order to assist young people in making informed decisions and reducing harms. This includes information about the effects of frequent and heavy cannabis use, use at an early age, use in combination with other substances—because we know youth often use other substances in combination—use by youth with mental health conditions, as well as use by young women who are pregnant.

In conclusion, regulations, prevention, and public education can work together to promote healthy decisions among youth by increasing awareness of risk and awareness of strategies for risk reduction. Effective prevention and public education requires clear, accurate, and consistent messaging that is targeted and relevant to the key audiences, and it needs to be delivered by trusted messengers.

I would like to thank the committee for the opportunity to speak today on this issue of vital importance to Canadians. I will be pleased to respond to your questions.

1:55 p.m.


The Chair Liberal Bill Casey

Thank you, Doctor.

Now we'll go to Drug Free Kids Canada and Mr. Paris for 10 minutes.

September 13th, 2017 / 1:55 p.m.

Marc Paris Executive Director, Drug Free Kids Canada

Thank you, Mr. Chair.

We welcome the opportunity to address this panel and to comment on the establishment of a minimal age for the possession of cannabis and its impact on young Canadians.

Drug Free Kids Canada is a non-profit organization devoted to educating parents about drugs, raising public awareness issues surrounding drug use, and facilitating open conversations between parent and teen in order to ensure that all young people will be able to live their lives free of substance abuse.

With me today is DFK advisory council member, Dr. William Barakett, from the Clinique Medicale in Knowlton. He is a family practitioner, clinician, and expert in addiction and chronic pain, with over 35 years of experience of dealing with families and youth facing substance use disorders.

We are here before you today to make the case that whatever the minimum age for cannabis possession will be, actively protecting the mental and physical health of youth—keeping our kids safe from harm—must be a main priority of the government. We acknowledge and respect the recommendations that have been made on the minimum age requirements by others on this panel and publicly, but we have chosen to minimize the time we spend talking about the effects of cannabis on the teen brain. We know the evidence is there.

Rather, we have chosen to use our time to address a fundamental question in society today. What are the underlying reasons young people turn to cannabis in the first place?

For DFK, the issue is not at what age cannabis is less harmful, but why kids are consuming it at all. Dr. Barakett is here to talk about his hands-on experience as a front-line worker. He'll also explain some of the reasons kids consume cannabis and the consequences of addiction affecting them and their families.

1:55 p.m.

Dr. William J. Barakett Member, DFK Canada Advisory Council, Drug Free Kids Canada

Thanks, Marc. As you indicated, I started in medical practice in 1972. Soon after that, I got involved in addictions because nobody else was doing it and I felt a great need.

Over the years, countless people have passed through my hands, and with great success. I've developed certain keys, certain techniques, and perhaps sharing these with you will help you to understand the dilemma we have with youthful use of cannabis. I have a certification in addiction medicine, and I hope that these practical comments will help to feed the creation of a public education program, which even has to precede the legalization.

Cannabis use in this presentation is predominantly about high-THC products. It does not include medical cannabis, which is predominantly cannabidiol or CBD. It's very important to make that distinction.

Teens often begin by using cannabis to relieve the anxiety of adolescence, naturally, and as a result of peer pressure, but beyond the recreational use, for some youngsters cannabis is a form of self-medication for an underlying disorder, either mental or emotional. The most common is attention deficit disorder, with or without hyperactivity. This provokes an anxiety and a feeling of inadequacy in youth. When they take cannabis, it calms this anxiety, but unfortunately it also diminishes their capacity for attention, compounding the problem.

ADHD and addiction are coexistent in at least 50% of cases. I can say that many of the youth I treat had an underlying ADHD problem that was not being treated. When I treat it, we get success.

Other coexistent psychiatric disorders include generalized anxiety, latent psychosis, post-traumatic stress, and bipolar disorder. All of these conditions exist in adolescence and are all too frequently missed by their treating physicians. They need to be diagnosed and treated, or otherwise the teenager will continue to self-medicate.

The parents of a habitual cannabis-using teenager and the physicians who treat them are well aware of the characteristic cognitive impairments affecting memory processing, reasoning and judgment, execution of tasks, insight, and time perception. These impairments become more pronounced with the duration and intensity of use and they require many months to resolve after stopping. A retardation of the emotional maturation process ensues, which is normally not completed, as you know, until the age of 25, in normal circumstances.

If addiction develops, as it will in a minimum of 17% to 25% of adolescent users, one also sees the features of addiction: a loss of control of the quantity of use, with the failure to recognize adverse consequences of use and craving leading to obsessional use. The withdrawal syndrome after cannabis cessation, which includes irritability, insomnia, and disorganization, lasts about two weeks. That plays a role in the difficulty of cessation.

Beyond that, the months required for the resolution of the cognitive impairment caused by the cannabis use contribute to a second phase of withdrawal as the person awakens to a reality that is entirely foreign and frightening, causing them to experience panic and anxiety, which often requires enormous support, including medication. The sort of behaviour we'll see is the 18-year-old who stops using, has not gone through his normal evolutionary growth from 13 to 18, and reverts to 13-year-old behaviour.

There are not many longitudinal studies to prove what is regularly observed and what I'm talking to you about. They are appearing, however. The National Institute on Drug Abuse in Washington, D.C. has produced considerable work—by Nora Volkow amongst others—and they've been cited elsewhere. A new study undertaken by NIDA in 2016 on the adolescent brain and cognitive development should bring more evidence to light.

A 2016 study in the U.K. looked at the pattern of cannabis use during adolescence and its link to harmful substance use later. In over 5,000 teens followed from the ages of 13 to 18, the study measured the amount of nicotine, alcohol, and illicit drug use. When they reached the age of 21, the study collated all of the data and found that the problematic use of nicotine, alcohol, and illicit drugs occurred 20% of the time in those using cannabis, and it was at an intensity at a rate related to the intensity of their cannabis use.

These are very telling studies that finally are being done. It's the sort of thing that we've perceived for years, but only now are they coming to light. Unfortunately, more money needs to be spent in order to aliment your public education program.

The rising problem of addiction to illicit substances and diverted prescription drugs in adolescents and adults directly correlates with the high level of regular cannabis use as well. Regardless of age, the vast majority of the people we treat for substance use disorder started with cannabis use in early life. Every single heroin addict, cocaine addict, and speed addict who I treat at 20, 30, 40, or 50 years of age started to use cannabis at the age of 12 or 13. In the case of teens caught up in the opioid crisis, for every teenager I see who is sniffing Hydromorph Contin, an enormous quantity of opiates, every single one of them started with cannabis. That's because of their loss of ability to discern danger.

As has been stated, adolescents will procure and use cannabis regardless of the legal restraints. With that in mind, the creation of an elaborate public education program is primordial.

2 p.m.

Executive Director, Drug Free Kids Canada

Marc Paris

Thank you, Dr. Barakett.

Canadian youth have the second-highest rate of cannabis use worldwide, which is already very problematic, this even before recreational cannabis becomes legal. Cannabis is the number two substance used by teens after alcohol, with just over one in five teens, or 21%, using at least once. However, as teens grow older, consumption rises to over one third—actually 37%—in grade 12.

Whether the minimum age for recreational cannabis consumption is set at 18, 21, or 25, it's not going to matter much if we don't equip parents and kids with better approaches to dealing with drug use. Drug Free Kids Canada has already begun prevention education campaigns, but much more will be required.

We already have produced a brochure that has been distributed, with 100,000 copies, and a multi-million dollar, multimedia national campaign to support it has been running since mid-June. It will end at the end of September and will be repeated next fall until January 2019.

A recent study has allowed DFK to assess the value of prevention to society. The lifetime cost to society of one teenager suffering with addiction is $450,000. This amount factors in health, law enforcement, and loss of productivity, but not the human cost to individuals and families.

The benefit of DFK's prevention messaging, which encourages parents to engage in meaningful conversations with their kids about drugs, has been demonstrated to have protected 700 teens from substance abuse every year. If the cost to society of an addicted teen is $450,000, then DFK's prevention education messaging has saved Canadians close to $2 billion during our six years in operation.

As a society, we need to demonstrate to our youth that there are better ways to deal with personal or mental health issues than turning to cannabis or other substances. We believe that parents can be central to changing the relationship that kids have with drugs, and we are here to educate and support them. We want to help parents build stronger resiliency in their kids to deal with the realities teens face in the 21st century.

At this point, we know about the negative consequences of cannabis. Let's make sure we provide effective education and prevention awareness strategies well before legislation occurs, with ongoing messages that are consistent and clear, to ensure that our youth are protected.

We must remind you of the government's pledge to allocate a portion of the revenues to prevention and education. This is the only way to make sure that young people are equipped to make informed decisions on a substance known to be detrimental to their health and well-being but soon to become legal.

I would like to thank Dr. Barakett, the DFK advisory council, and this committee for allowing us to present our point of view.

2:05 p.m.


The Chair Liberal Bill Casey

We'd like to thank you for presenting it.

Now we'll move to the Institute.

Madam Chapados, are you going to make the presentation, or will Mr. Gagnon?

2:05 p.m.

François Gagnon Scientific Advisor, Institut national de santé publique du Québec

I'm going to start and she's going to finish.

2:05 p.m.


The Chair Liberal Bill Casey

Okay. That's perfect.

2:05 p.m.

Scientific Advisor, Institut national de santé publique du Québec

François Gagnon

Mr. Chair, thank you for inviting us to present the work of the Institut national de santé publique du Québec, the INSPQ, on the legalization of cannabis. At the institute, we are always interested in sharing our expertise with our colleagues across Canada, something we did last winter with a presentation to the FPT program on the legalization of cannabis. We also hosted webinars at pan-Canadian hearings and a conference on the legalization of cannabis at the Canadian Public Health Association in Halifax last summer. We will continue to present our work today, and we hope that you will benefit from it.

The INSPQ is a parapublic body created by the Government of Quebec. It is a scientific expertise and reference centre with a mission to support Quebec's minister of health and social services, regional public health authorities and institutions in carrying out their public health responsibilities. It is in this capacity that we have presented work for many years on alcohol and tobacco, and now on cannabis. All have a rather important point in common, and we will come back to that in our presentation.

The marketing of psychoactive substances is an important part of the equation to reduce harm and prevent their use. We have been interested in alcohol for a long time in terms of its commercialization, and essentially in the history of public health with respect to tobacco and the tobacco industry. This is a public health problem that we have been trying to contain for 70 years. We have decided that our comments today on Bill C-45 will deal with these commercial issues. For my part, I will strictly present our position on the minimum age for access to cannabis, which is part of the strategy to contain marketing, and Maude Chapados will address other issues later.

INSPQ's position on the age of access to cannabis reflects a recommendation we made to the Quebec authorities, which is to set it at 18 years of age, so that it is consistent with the legal age for alcohol and tobacco in Quebec. In the next few minutes, I will try to explain the reasons for our position.

First, according to the scientific literature, we know that raising the age of access to 21 years could significantly delay the age of initiation to cannabis. It is a disadvantage for public health to have a slightly lower age of access. On the other hand, there are many advantages to keeping this age of access lower. If we assume that legalization can have beneficial effects, it would be nice to also have it benefit people aged 18 to 21 if our intent was to take a position for access at 21 years.

If you haven't followed our work, I would point out that the institute recommended that the Quebec authorities set up a non-profit distribution system. Whether it is run by the public or private sector, we have stressed that it be non-profit. Whether it is run by the government or by non-profit organizations, we want the primary mission of the system not to be to make a profit, but to prevent and reduce harm. That is the direction we've taken. So there may be disadvantages in raising the age of access to cannabis.

Assuming that our distribution system fulfills its mission of preventing and reducing harm, 18 to 21 year olds should benefit in at least two ways. The first is the prevention of use and the reduction of harm. It would have to apply to the 18 to 21 age group if we are thinking of eliminating this category of the bill.

In terms of harm reduction, we have done a lot of work on substance quality assurance, for example. We want the quality of the substances to be controlled so that they are also safe for 18 to 21 year olds. By raising the legal age of access to cannabis, we believe that this would, at least in part, eliminate access to a quality-controlled substance for this age group, which does not seem to be so appropriate.

If you understand this correctly, the age of access to cannabis is an important issue, but it is only part of a set of concerns we have at the institute about psychoactive substances, and on their marketing in particular.

I have spoken to you about alcohol and tobacco, but the reason this situation is of such great concern is the same as in the case of cannabis. In Colorado, there was intense commercialization and the impact on consumption habits could be observed, overall and by age group. That concerns us directly today. Among youth aged 12 to 17, from 2009—when cannabis was first commercialized in Colorado—to 2014, declared usage in the past thirty days rose from 10% to 12.5%. Among young people aged 18 to 25, usage rose from 26% to 31%. In other words, in the two age groups that we are specifically interested in today, declared usage in Colorado rose by 25% and 20% respectively. Yesterday, I believe, you heard from stakeholders from Colorado and Washington. In those states, there has been an impact on emergency admissions and traffic accidents involving persons whose THC level was tested. The repercussions on the health system are immediately evident.

Before concluding, I would like to point out that it is not simply a matter of age. The system established in Colorado led to intense commercialization. Based on our analysis, it is this emphasis on the commercialization, marketing and advertising of cannabis that led to the results observed.

I will now give the floor to my colleague Ms. Maude Chapados, who will speak to other aspects of Bill C-45 which, in our opinion, warrant examination.

2:10 p.m.

Maude Chapados Scientific Advisor, Institut national de santé publique du Québec

Thank you.


Beyond setting a minimum age, preventing cannabis use among young people depends in large part, as my colleague said, on establishing a strict legal framework for this product, which we consider to be no ordinary commodity, as certain public health stakeholders would say.

The creation of environments where the use of psychoactive substances is not stimulated or normalized is one of the best approaches to prevention. The measures taken by the provinces and territories with regard to authorized sale and consumption sites will be decisive in creating these environments. Certain measures in Bill C-45, however, and its subsequent regulations, will also be very important for the commercialization of cannabis, in particular among more vulnerable populations such as young people, be they under or over the age of majority.

The INSPQ would therefore like to take this opportunity today to repeat certain analyses that it presented in its brief submitted in August in order to ensure a better framework for marketing practices.

Research on commercial practices in the tobacco and alcohol industries shows to what extent sophisticated marketing strategies can affect consumption and the associated health problems. Research also shows that young people are particularly easy to influence. That is why the INSPQ is calling for an immediate ban on all forms of advertising and brand promotion, which raises four specific concerns related to youth and the bill under consideration.

First, packaging that is neutral and that provides information to allow for an informed decision on the nature of the product should be immediately required. Given that packaging is itself a tool for promoting the substance, the prohibition in clause 26 on packaging that could be appealing to young persons is neither clear nor sufficiently strong. The consultation report on plain packaging for tobacco products that was published in January 2017 should certainly be informative in this regard.

Second, promotional items should not be tolerated. Hats, socks, T-shirts and cups with hemp leaves or brands of medical cannabis on them are already popular, especially among young people, and help normalize cannabis. The display of a brand on “other things”, as provided in clause 17(6) of the bill, opens the door to branded derivative products. Once again, the prohibition intended to ensure that “other things” are not associated with or appealing to youth remains vague, and this brand promotion practice should be banned.

Third, clause 17(2) allows brand promotion in areas where minors are not permitted, which raises the same problem as packaging and derivative products. First, we know that minors often frequent such places. Young adults aged 18 to 25 are the group with the highest percentage of users. Moreover, we wonder whether the legal age should be raised. The fact that this group of young people can be exposed to advertising in bars, for instance, is inconsistent with a public health approach. This kind of promotion can not only encourage the use of cannabis, but also insidiously incite customers to consume cannabis and alcohol at the same time, which is a very high-risk behaviour, as you will agree, particularly as regards transportation safety.

Fourth, any effective strategy to regulate brand promotion and advertising should ideally include the Internet. Bill C-45 prohibits the publication and broadcast of advertising in the press and on radio and television, but is silent on measures to regulate this on the Internet. Yet it is mainly on digital platforms that youth and industry are already active, and this reality warrants particular attention in future regulations.

In short, there is reason to consider setting the minimum age above the age of majority. To the extent that the age of majority is a determinant of the age of initiation, this raises consistency issues as regards alcohol and tobacco, substances that are equally or more toxic than cannabis. Setting a minimum age above 18 for cannabis should therefore be part of a broader discussion of psychoactive substances and, indeed, of the age of majority.

In the meantime, the INSPQ maintains that certain provisions of Bill C-45 and its subsequent regulations can be amended or clarified in order to reduce the commercial promotion of cannabis to young people.

We hope that the considerations presented today will be helpful in this regard.

Thank you.

2:15 p.m.


The Chair Liberal Bill Casey

Thanks very much.

We'll go to our first round of seven-minute questions, starting with Mr. Oliver.

2:15 p.m.


John Oliver Liberal Oakville, ON

Thank you very much for being here today and for your presentation.

Just as an opening comment, we're at the midway point of our week of studying the bill. At the end of the day, the committee will have to go through a line and clause-by-clause review of the bill.

There were three principal objectives, in my mind, for why the legislation was brought forward. One was to get these drugs out of the hands of our youth, or at least reduce their access to it. The second was to reduce the function and role of the black market and organized crime, and to at least reduce their access to this space and the revenues from it. The third was a public health agenda, which was to ensure that the production of cannabis for consumption was done by licensed facilities so that we understand the safety of the product and the toxicity or the dosage of the product as it's being prepared.

Most of the presentations we've heard seem to be in agreement with the legislation, but they are in disagreement about how the balancing of those three objectives takes place, particularly the first one and the second one, so I want to tease it out a bit more.

For instance, Dr. Porath, I didn't hear it clearly today, but I think that in the past you've had a recommendation that a standardized minimum pricing to reduce consumption would be a recommended strategy, a sort of national minimum pricing, right? If that's not the case, I apologize, but I understand that's something you guys have said. You get to the point, then, where organized crime knows exactly the lowest price their competitors will go to, so they can do a price thing.

We've heard from other witnesses that if the licensed market doesn't produce the variation in drugs, including in even some of the most distilled or high-potency products, youth will seek them out. Again, it leaves that window open for the black market to offer alternatives and to showcase with packaging and whatnot.

Could you speak a bit to that balance? I understand that from your perspective a particular health focus can lead us down one path, but then it opens up this other competitive window of black market access, which we're also trying to deal with. It's the duality of the act. Can you talk about your views and how you would see those better balanced?

2:20 p.m.

Director, Research and Policy, Canadian Centre on Substance Use and Addiction

Amy Porath

Yes, certainly.

During my remarks I was talking about how we could draw from our experience with alcohol in terms of standardizing the pricing of the potency of the product. In terms of cannabis, if we could tie in or index the pricing of the THC content, that could help incentivize lower-risk use, so the higher the THC or the potency of the product, the higher the pricing. That's sort of what I was recommending as part of my remarks. If we can draw that lesson learned from the alcohol field, that might be one way to encourage the use of lower-risk products.