Health Committee on Sept. 13th, 2017

[John Conroy]

It's a little bit of legalization.

[Don Davies, NDP, Vancouver Kingsway, BC]

If you have more than 30 grams in your possession, you'll be criminally charged. If you have more than four plants, you'll be criminally charged. There are penalties of up to 14 years of imprisonment. If you have more than five grams as a youth, you face some sort of penalty.

In clause 7, one of the purposes of this bill is to reduce the burden on the criminal justice system. Do you see that happening?

[John Conroy]

I live in the cocoon of British Columbia, where people haven't been charged with simple possession for a long time; the police just seize it. You still see a lot of charges but rarely convictions, unless it's something more than simple possession. In my practice, I don't get anywhere near as many cases as I used to in the old days, even though you haven't legalized it yet. The burden has been reduced.

However, having this maximum of 14 years, hybridized by indictment, and so on, is frankly totally unrealistic in terms of what goes on on the ground. Even in the Saskatchewan Court of Appeal, which is not known to be the most liberal court in the country, the range for trafficking, for example, is 12 to 18 months. Most sentences are up to two years. For tobacco and alcohol, all your maximums are two and three years. This 14-year thing is ridiculous, frankly, and it's problematic because it will increase the burden in the following way.

Years ago, through the sentencing commission, through Parliament here, and so on, we determined that we had to reduce the amount of incarceration because we'd just make people worse most of the time instead of really protecting the public. Therefore, why are you going to put somebody in prison, actual prison, for trafficking in cannabis nowadays? It seems ridiculous.

A judge will introduce something called a conditional sentence order. The conditional sentence order is the last step before having to put you actually in prison. Depending upon levels of denunciation and deterrence, the judge decides whether to put you in prison. A 14-year maximum, because of the 2012 amendments, prevents a judge from doing that.

What does 14 years have to do with it when the court is sitting there saying we think that up to two years is a fit sentence, but we also think you're not a danger to the community, you don't have any violence in your history or anything such as that, so we think you can serve it in the community? The judge can't do it. What do judges do, faced with that now? They'll give probation with conditions to try to structure it like a conditional sentence order.

I really encourage you to listen to what Le Dain said at least 45 years ago and reduce that to five years if you're going to keep a hybridized system.

My hope and expectation is that the cannabis consumers who I have now watched over a long period of time are going to demonstrate to you that they will be able to live under this existing proposed beginning, if I can call it that, and will not create a lot of problems, hopefully, for the criminal courts and others, that we will effectively, in practice, legalize and demonstrate to all of you that you don't need many of these limits that you're worrying about.

[The Chair, Liberal, Bill Casey]

All right. That concludes our session on the household cultivation of plants. We appreciate the information you've given us. We continue to learn. I think we've all learned a lot today from your input, so I thank you very much for taking the time to come and participate.

I suspend this meeting now until 10:45 in this room.

[The Chair, Liberal, Bill Casey]

Welcome back to the 66th meeting of the Standing Committee on Health, where this afternoon we're going to have a panel on the age of legal possession and impact on young Canadians, which is certainly one of the controversial discussions and part of this.

I should tell all our witnesses that some of the questions will be in French. We have translation here, so you should just be ready for that and be prepared.

One of our witnesses this morning is the Canadian Drug Policy Coalition, with Scott Bernstein, senior policy analyst, by video conference from Vancouver.

From the Canadian Public Health Association, we have Ian Culbert, executive director. From the Canadian Paediatric Society, we have Christina Grant, member of the adolescent health committee. From Educators for Sensible Drug Policy, we have Judith Renaud, executive director, and Paul Renaud, communications director. From Portage, we have Peter A. Howlett, president, and Peter Vamos, executive director.

Each organization will have 10 minutes for an opening statement, and then we'll go to questions.

We'll start with the Canadian Drug Policy Coalition, by video conference. Welcome.

[Scott Bernstein, Senior Policy Analyst, Canadian Drug Policy Coalition]

Thank you.

Good morning, honourable members. Thank you for the opportunity to make comments on Bill C-45 this morning on this important panel.

I'm representing the Canadian Drug Policy Coalition or CDPC, a non-governmental organization comprised of over 70 organizations and 3,000 individuals working to support the development of a drug policy in Canada that is based in science, guided by public health principles, and respectful of human rights.

CDPC supports the passing of Bill C-45 and the legal regulation of non-medical cannabis as a way to minimize the social and individual costs of prohibition while ensuring the cannabis policy supports public health and human rights to the fullest extent possible.

Legalizing and regulating cannabis will ensure there is adequate oversight of the complete market of non-medical cannabis including control over dose, quality, potency, marketing, and access. From decades of prohibitionist drug policy in Canada, evidence clearly and unequivocally demonstrates that criminalizing people for possessing and using drugs leads to great social and individual harms. As such, CDPC supports the legal regulation of all drugs within Canada as a route to retaking control of a dangerous, unregulated market for drugs that supports criminal organizations and puts countless Canadians at risk of criminal sanction.

We believe this is the path to minimizing infectious disease such as hepatitis C and HIV, reducing overdose and social stigma, and promoting public health and safety objectives. Similarly, we believe that evidence strongly supports decriminalizing all drugs and further improved public health and public safety.

I would like to make comments this morning on recommendations that CDPC has put forward to this committee in our submitted brief.

First, I'll address the minimum age of access. The cannabis act establishes a federal minimum age of 18 years to access cannabis with provinces having the ability to raise the minimum age as Ontario has done to align with its alcohol age. CDPC supports maintaining the federal minimum age of 18 years in the legislation.

Despite the existing system of cannabis prohibition that has been in place in Canada for decades, there remains a consistent one in three people in the 16 to 25 age range who are active users. In a UN study it was shown that youth cannabis use was lower in countries with more liberal drug policies than in Canada, demonstrating that strict enforcement policies are not a deterrent for young people.

It is unrealistic to conclude that all youth will completely abstain from consuming cannabis regardless of set age limits and sanctions against consumption. Having a minimum age that's too high will maintain the illegal market and put numerous young Canadians at greater risk than the risk to them of consuming cannabis. That approach should be rejected in favour of a public health approach that looks at the entire spectrum of risk to young people from not only the substance itself but the policies as well. Protecting youth must consider the harms to youth of engaging with illegal markets as well as the harms of consuming cannabis, a policy balance that supports a lower minimum age of access.

Second, regarding criminal penalties in youth, the cannabis act prohibits possession of dried cannabis of more than five grams by a young person, creating either an indictable or summary conviction offence, and if convicted, a sentence under the Youth Criminal Justice Act. Notably, the Province of Ontario has chosen to close even the small gap and create provincial crimes for a young person carrying any amount of cannabis.

Seeming to recognize the harms of a criminal record, the cannabis act provides in some circumstances allowances for a peace officer to issue ticketable offences to both adults and organizations. Such allowances, though, are not available to young people.

It is now well documented that a criminal record contributes to considerable social harms from limiting international travel, diminishing career and volunteer opportunities, exacerbating poverty, and leading to poorer health outcomes, creating stigma, and consuming scarce public resources.

As mentioned, evidence also supports the fact that the potential for criminal sanction is not a deterrent for adolescent use of cannabis. Instead, as was recommended by the task force, achieving the public health and safety goals of the cannabis act with respect to youth should be addressed through education and soft approaches to discourage use as opposed to criminal punishment.

Overwhelmingly, respondents to the task force took the view that the criminalization of youth should be avoided, and that criminal sanctions should be focused on adults who provide cannabis to youth, not on the youths themselves. One such approach might be found in the state of California, where the regulatory scheme provides that young people found possessing cannabis will receive non-criminal infractions, and must attend mandatory education or counselling and perform community service. CDPC recommends that youth not be subject to criminal penalties at all, and that the cannabis act be amended to substitute similar soft approaches to youth drug use, such as counselling and community service. Removing these sanctions of criminality will increase public health and safety, particularly with respect to youth, by decreasing the harm and stigma of criminalization, while still discouraging unlawful use through a balanced and realistic approach.

Additionally, social sharing, which is a common practice among young people, is something the task force recommended be allowed, but it has also been prohibited by the cannabis act through the criminalization of any form of distribution to a young person, with a draconian penalty of up to 14 years in prison. This would penalize an 18-year-old sharing cannabis with a 17-year-old friend, or a parent sharing with his or her son or daughter.

In the case of alcohol, there are clear exemptions to criminalization for adults sharing with their minor children in a private home, and all provinces regard social sharing of alcohol with far less punitive penalties than in the cannabis act. CDPC recommends that social sharing with a young person not be criminalized but rather treated in a similar manner to youth use, with counselling and community service. CDPC further recommends that adults be permitted to provide cannabis to their own minor children in a private residence, similar to alcohol.

My final point concerns social justice. Underlying the legal regulation of cannabis is the notion that our historical policies of criminalizing cannabis have led to unacceptable negative outcomes in Canadian society, including supporting a thriving illegal market for cannabis nationwide, and capturing hundreds of thousands in the criminal justice system for cannabis offences. Criminal law, though, is rarely applied equally, and cannabis prohibition has had a greater negative impact on marginalized communities, people of colour, youth, and indigenous persons. Legislation crafted to repair past policies should also aim to repair the damage done to those punished under an unjust system, including creating opportunities within the new economy and clearing past criminal records.

CDPC recommends two changes to the act to better serve the social justice aims of the legislation. First, prior drug convictions should not be the sole reason for denying a licence to participate in the cannabis economy. Paragraph 62(7)(c) allows the minister to refuse to issue, renew, or amend a federal licence or permit required for participation in the cannabis industry if the applicant has contravened the Controlled Drugs and Substances Act, or committed other drug-related offenses in the past 10 years. This would of course include any drug conviction for activities that would now be legitimate under the new regime. There is no logical reason for creating a specific ground related to drug offences in this provision, compared to any number of past offences that might make a person ineligible for a licence, such as theft or fraud. A preferred approach would be one similar to California's, where prior convictions for non-violent drug offences are actually prohibited from being the sole reason for denial of a licence.

Second, there should be clear mechanisms for those convicted of cannabis-related drug offences in the past to apply for the suspension of convictions on their criminal record, or for cases where sentences are still being served, of having these cases dismissed or re-evaluated under the new legislation. CDPC recommends amendments to the cannabis act that allow for the reconsideration of ongoing sentences and record suspensions for prior convictions.

The cannabis act is a remarkable piece of legislation that forges new policy standards regulating previously illegal substances.

It is important that these new standards be centred on evidence, public health, and the well-being of Canadians young and old. Thank you.

[The Chair, Liberal, Bill Casey]

We'll be moving on to the Canadian Public Health Association with Mr. Ian Culbert, executive director, for 10 minutes.

[Ian Culbert, Executive Director, Canadian Public Health Association]

Good morning, Mr. Chair and committee members. Thank you for the invitation to present to you today.

I will preface my comments this morning by noting that, throughout my remarks, my references to cannabis use relate to recreational use, not the use of cannabis for medical purposes.

On behalf of the Canadian Public Health Association, I am pleased that the Government of Canada has committed itself to a public health approach to the legalization and regulation of cannabis. We are further pleased that Bill C-45 does in fact embody such an approach.

Different from the publicly funded health care system, public health is the organized efforts of society to keep people healthy and to prevent injury, illness, and premature death. As such, a public health approach is based on the principles of social justice. It pays attention to human rights and equity. It is based on the evidence, and it addresses the underlying determinants of health. A public health approach is organized, comprehensive, multisectoral, and it emphasizes pragmatic initiatives.

As a colleague recently noted, in some ways public health is like that darling child who's always asking, “Why?” In the case of cannabis, we want to know why people use it, so that we can develop policies and interventions that meet their needs. The human relationship with cannabis ranges from abstinence to a spectrum of consumption. This spectrum ranges from beneficial to non-problematic, to potentially harmful use, to the development of use disorders. At the federal level, the legal and regulatory response to cannabis needs to be sufficiently broad to encompass the entire spectrum of consumption, while at the provincial and territorial levels, the response begins to narrow to meet the particular needs of each jurisdiction. Then at the regional or local levels, the response is honed to the specific needs of particular populations.

There has been considerable discussion and unfortunately a lack of consensus regarding the appropriate legal age for the possession of cannabis. The Canadian Public Health Association supports the provisions in Bill C-45 establishing the minimum legal age at 18 and allowing provinces and territories to set a higher age, as appropriate, in their jurisdictions. From a practical perspective, it is important and appropriate for provinces and territories to establish a legal age for cannabis consumption that matches the legal age for alcohol consumption. In that way, confusion should be reduced and education efforts can be better coordinated.

While we would prefer that no Canadian use cannabis or any other psychoactive substance, a public health approach recognizes that cannabis will be consumed for a number of different reasons, regardless of efforts to discourage it. You are already familiar with the statistics: 12% of the general population, 21% of youth aged 15 to 19, and 30% of young adults aged 20 to 24 reported in a 2015 survey that they consumed cannabis in the previous year. Since more than one in five youth aged 15 to 19 are consuming cannabis now and we have no reason to believe that rate will change, the responsible policy option is to create a legal and regulated market for cannabis that is accessible to adults 18 years of age and older.

Bill C-45 will establish a supply of cannabis of known potency and quality. Currently, anyone consuming cannabis is playing a game of Russian roulette, never knowing the product's quality before consuming it, or if it has been laced with other, more powerful psychoactive substances. From a public health perspective, the Canadian Public Health Association is encouraging provincial and territorial governments to limit the sale of cannabis to government-controlled entities to ensure that the focus remains on harm reduction, not profit.

The prohibition model currently in place in Canada has severely hampered health promotion and harm reduction efforts. The only message we had at our disposal was, “Just say no”, and clearly that has failed. Beyond simple health education, health promotion is the process of enabling people to increase control over and to improve their health. It is our view that legal cannabis sales must therefore be preceded by comprehensive, non-judgmental, non-stigmatizing health promotion campaigns across Canada that have a clear and consistent message. These campaigns must be supported on an ongoing basis and should be complemented by in-person health promotion and harm reduction messaging at the point of sale. We need to normalize the conversation about cannabis, not its consumption.

There are concerns that the legalization will result in significant increases in cannabis use, especially among young people. While the Canadian experience may be different, two recent reports from Washington state both indicate that youth cannabis consumption has remained stable since legalization in that jurisdiction. One of these reports, however, indicates an increase in older adults' cannabis use, while another indicates an increase in the number of people who consume cannabis daily or near daily.

These early reports out of Washington remind us that we need to pay attention to the entire population, with a particular focus on why certain individuals go on to potentially problematic use.

Concerns have also been raised about the impact cannabis consumption has on the developing brain. While the studies quoted are important pieces of the research puzzle, they focus on young people who are daily and heavy cannabis users. I think we can all agree that if a child is consuming a large amount of cannabis on a daily basis, there is a cause for concern. If a child were drinking alcohol heavily on a daily basis, there would be a similar cause for concern. Once again, from a public health perspective we want to know why that child is consuming heavily and daily; then we can focus our interventions accordingly.

At the moment, we lack robust data on the health impacts of casual use of cannabis and we hope that legalization will allow research on that issue to take place. Having understood that people are going to continue consuming cannabis for various reasons and in various amounts, it is crucial that our policies and interventions focus on harm reduction efforts. Harm reduction can take many different forms, including ensuring a product of known potency and quality; effective education and health promotion activities; ensuring that consumers and health and social service providers know about safer consumption methods; and adopting and promoting the lower-risk cannabis use guidelines.

I understand that you have a panel dedicated to that subject later today, so I won't go into these guidelines in detail but I will say that they are an important tool that should be adopted in all jurisdictions.

The Canadian Public Health Association does have one recommendation for an amendment to Bill C-45 that I believe one of your witnesses mentioned yesterday. As it currently stands, subclause 10(5) of the bill will result in the crime of possession for the purpose of selling becoming an indictable offence punishable by up to 14 years in prison for those convicted, including young people between the ages of 12 and 18. Clause 8 concerning possession and clause 9 concerning distribution provide similar sentencing options for people over 18 years of age, but permit referral to sentencing under the Youth Criminal Justice Act for those between 12 and 18.

The Canadian Public Health Association's viewpoint is that an option for sentencing under the Youth Criminal Justice Act for young people should also exist under subclause 10(5). In many cases these offences are related to possession for sale by young people to their peers, and the stigma established by such a conviction may cause irreparable harm to their futures, outweighing the actual offence. Care should be taken to apply the proposed rules concerning possession for the purpose of sale to reflect the severity of the crime.

You have also heard calls that we are not ready for legalization. Unfortunately, we don't have the luxury of time, as Canadians are already consuming cannabis at record levels. The individual and societal harms associated with cannabis use are already being felt every day. The proposed legislation and eventual regulation is our best attempt to minimize those harms and protect the well-being of all Canadians. Our first efforts may not be perfect, but perfection is not required as we can modify our approaches as we learn from our experiences. At the end of the day, we all want to do the right thing for the broad range of Canadians who already consume or may choose to consume cannabis for a variety of different reasons.

The Canadian Public Health Association believes that Bill C-45 and provincial responses such as Ontario's are steps in the right direction. Key lessons learned from jurisdictions that have travelled this road before us include the following: regulators must have the flexibility to adapt to changing conditions in the marketplace; upfront investments in education and health promotion are essential; law enforcement and public health need to work together; and the interests of the private sector cannabis industry are rarely aligned with the interests of public health.

[The Chair, Liberal, Bill Casey]

Thank you very much.

Now we go to Dr. Christina Grant, a member of the adolescent health committee of the Canadian Paediatric Society.

You have 10 minutes. I look forward to your comments.

[Dr. Christina Grant, Member of the Adolescent Health Committee, Canadian Paediatric Society]

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.

[The Chair, Liberal, Bill Casey]

Thank you very much.

Now we're going to move to the Educators for Sensible Drug Policy, Judith Renaud, executive director and Paul Renaud, communications director.

I'm not sure how you're going to spread your time. You have 10 minutes between you.

[Judith Renaud, Executive Director, Educators for Sensible Drug Policy]

Thank you for the invitation to speak to the House of Commons about this very important act, the issue of youth use, the age for legal possession, and the impact on our young Canadians.

Cannabis prohibition has been an abject failure. As the executive director of EFSDP, I want to see educational policy and reform come from a place of progressive change, where students, parents, teachers, health care professionals, and mental health providers work together to provide a quality of schooling that reflects a place where what is learned is lived and is based on solid scientific evidence, and where truth matters.

More and more, for a variety of reasons, it has become society's role to educate, and to provide support for parents and children. Educators have a responsibility to be esteem-builders. Bill C-45 has some good intentions, but the cannabis act will not prevent youth from using cannabis. It should not subject them to further harms from the law itself.

Educators understand that despite its increasing ubiquity, research suggests that young people's attitudes towards cannabis are ambiguous. Many have conflicting positions and negative attitudes towards its use. This is not surprising considering the complexity of the substance. Unlike alcohol and tobacco, two substances almost exclusively limited in purpose to recreational use, cannabis can be used both recreationally and medically, although the line between the two is blurred.

To increase the understanding about the issues cannabis can pose to the health and well-being of young people, drug reform educators believe we should be educating them not only about the substance's possible negative effects, but also its positive ones. This can be achieved using evidence-based, unbiased, and holistic information, where truth matters.

The ubiquity of cannabis is a major health issue. Youth need to gain factual knowledge about cannabis so that they are able to make informed decisions about cannabis and its use in order to mitigate possible harm. We agree with the task force that 18 is an appropriate age for legal use. However, some EFSDP members agree with the 2002 Senate report that 16 is also appropriate.

As a society, we need to remove many misconceptions that are perpetuated by eight decades of prohibition. Educators must find common ground. As some people continue to push the prohibitionist agenda, educators are becoming more aware that teens are more at risk from alcohol, pharmaceuticals, and opioids. Neuroscientist Marc Lewis wrote a book called Memoirs of an Addicted Brain. He discusses in detail how cannabinoids are natural brain chemicals. I quote:

The cannabinoid receptor system matures most rapidly, not during childhood, not during adulthood, but during adolescence. So it wouldn't be surprising if cannabinoid activity is meant to be functional during adolescence, more functional than any other period of the life span. As far as evolution is concerned, adolescents might well benefit from following their own grandiose thoughts, goals, and plans. By doing so, and by ignoring the weight of evidence - on sheer inertia - piled up against them, they would greatly amplify their tendency to explore, to try things, to imbue their plans with more confidence.... The evolutionary goals of adolescents are to become independent, to make new connections, and to find new territory, new social systems, and most of all, new mates. The distortions of adolescent thinking might be precisely posed to facilitate these goals.

Adolescents ignore most of what parents think, most of conventional wisdom, and are spellbound by their own ideas. They follow chains of logic that nobody else finds logical, and voice excessive allegiance to their own predictions about how things will turn out. Even when they're not stoned, adolescents live in a world of ideation of their own making and follow trains of thought to extreme conclusions, despite overwhelming evidence that they're just plain wrong.

In 2001, I was offered a position as a first nation administrator in northern British Columbia. Not only was this experience life altering, but it was one that made me realize how ordinary Canadian educators and citizens have no idea what misfortunes, tragedies, and adversities many indigenous young people experience by the time they reach adolescence, how many deaths, what abuse they endure, and what despair they feel. I met Dr. Maté, a well-known drug addiction expert and author of In the Realm of Hungry Ghosts and Hold On to Your Kids.

He said, about the despair first nation youth feel, the self-loathing plagues them, the barriers to a life of freedom and meaning they have to face, that it is the educator who must always remember this: Don’t ask why the drug, ask why the pain.

At the core of unresolved traumas passed from one generation to the next, along with social conditions that induce further hopelessness, I witnessed untold, multi-generational traumas in several aboriginal communities. Native history resonates in aboriginal youth with their brilliant art, their dances, their music, and their wisdom. Maté said when educators see their first nation peers, they witness “their humanity, grandeur, unspeakable suffering and strength”.

Cannabis law enforcement has been shown to be racially biased. The “from school to prison pipeline” is real. Jail cells cannot be the new classroom. Our aboriginal youth are suffering. We must stop targeting marginalized people of colour, and we must learn to understand trauma and its multiple impacts on human mentality and behaviour. I agree with Dr. Maté that “the best-meaning people can unwittingly re-traumatize those who can least bear the pain and loss”.

EFSDP's goal is to promote an alternative to failed, punitive drug policies. As hard as we try, we will never convince 100% of youth to say no 100% of the time. If we can clear up the underlying problems, there will be less incentive for young people to use drugs as a way of coping with the stresses they face.

Thank you, and I welcome your questions.

[The Chair, Liberal, Bill Casey]

Thank you very much.

[Paul Renaud, Communications Director, Educators for Sensible Drug Policy]

Hello. My name is Paul Renaud. I'm very thankful for the opportunity to be here today.

While my wife Judith was principal of the band school in Bella Coola, B.C., I was hired by the Nuxalk Nation as their EDO or economic development officer. As EDO I had the chance to meet many locals and hear their stories. It soon became clear that there was not much job opportunity there, and many people were living on social assistance, even as alcohol and drug use seemed ramped up, particularly as pharmaceuticals were paid for by the government and children were also medicated under doctors' orders.

One day I decided to go to court, which was being held quarterly in the basement of the band administration building. I was astonished and dismayed by how much of the court's time was being taken up by cannabis offences and how many of the plaintiffs were young, in their teens and twenties. It seemed a cruel use of the judiciary. At the same time, it was clear to me that cannabis was being used by many in the community to help avoid alcohol, but because of the risks of having consumed cannabis, people were reluctant to talk about it.

Because cannabis shows promise in treating a wide variety of ailments, it will, like pharmaceuticals, be prescribed to children to be administered in schools, just like other drugs. This context provides the basis for some very important education about cannabis: it is primarily medicine.

As has already been noted by many, the line between recreational and medicinal use is not clear. Gabor Maté's definition of addiction is any behaviour that has negative consequences that one is compelled to persist in and relapse into and crave despite those negative consequences. With this in mind, the possibility of any person's—including a young person's—using cannabis to avoid alcohol or other more harmful drugs and having a positive outcome may not fit the definition of addiction and certainly should not be considered an offence. Youth cannot be criminalized for alcohol possession. What sense does it make to criminalize them for cannabis?

There seems to be mounting evidence, which some may call anecdotal, that cannabis is useful in avoiding other, more harmful substances. I've heard people say that this is not really quitting, just switching one drug for another. While that may be somewhat true, the principle of harm reduction is sound, and wherever abstinence may not be achievable, a reduced use of a more harmful substance may be a positive outcome.

The average age among first nations people is very young compared with the rest of Canada. Any laws or public health policies that affect young people will affect first nations youth disproportionately, just as incarceration rates also show.

The Government of Canada, led by Prime Minister Justin Trudeau, has indicated a willingness to engage with first nations in a deeper, more meaningful, and productive way. Because nations are so plagued by substance abuse issues and already have many people using cannabis, they may benefit—

[The Chair, Liberal, Bill Casey]

How much time do you have there, because we've allowed 10 minutes for your organization and we're over that now.

I know what you're talking about is very important, but in order for us to proceed and get everyone's fair share in, we have to only allow you 10 minutes. We're well over that now. If you could wind up—

[Paul Renaud]

I'll stop there, then.

[The Chair, Liberal, Bill Casey]

That's perfect. Thanks very much. We'll hear from you on questions, for sure.

Now we're going to go to Portage, to Mr. Peter A. Howlett, president, and Dr. Peter Vamos. I'm not sure how you're going to divide your 10 minutes, but you have 10 minutes between you.

[Peter A. Howlett, President, Portage]

Mr. Chairman and distinguished members of the committee, Portage, of which I'm the president, has been in existence for nearly 50 years, treating adolescents, adults, pregnant addicts, mothers with small children, indigenous communities, and mentally ill drug dependents, and has provided in-prison programming and programming in some 15 other countries. Portage is here today not to debate the merits of legalizing marijuana but rather to register our concerns about the collateral impact of Bill C-45 on youth in general, and substance-abusing youth in particular. We will offer some recommendations on how these risks might be mitigated.

This past April, Health Canada released a paper that reported that marijuana is an addictive substance with significant possible impacts on both mind and body of the users, and that continued frequent and heavy use is likely to cause physical dependency and addiction. Anthony reported that, using DSM-IV criteria, between 8% and 10% of adult users, and 16% of adolescent users, fit the cannabis dependency criteria. As a further risk factor, future lung cancer in heavy cannabis users of military conscription age in the United States is discussed by Callaghan, Allebeck, and Sidorchuk in their 2013 work. The American College of Pediatricians, in an article entitled “Marijuana Use: Detrimental to Youth”, of April 2017, reports a number of studies on potential causal relationships between heavy marijuana use and a number of non-infectious illnesses such as long-term impacts on the cardiopulmonary system.

Aside from these risks caused by heavy marijuana use, there are also a number of studies described by the American College of Pediatricians showing associations between chronic marijuana use and mental illness. The findings suggest that people who are dependent on marijuana frequently have comorbid mental disorders, including schizophrenia. Some of the studies cited found nearly a 50% increase of psychosis among cannabis users versus non-users. The authors are describing the consequence of heavy, persistent use, but Portage wishes to remind the committee that 16% of young users can be described as such. It is the protection of this significant, highly vulnerable minority that is the focus of Portage's presentation today.

While the proportion of dependent, heavy users to casual users might remain the same, the size of these groups is expected to grow dramatically as a consequence of legalization. In examining some of the evidence since 2007, there has been an increase in marijuana use among young people in the United States attributed to limited legalization and the diminishing perception of drug risks. As of 2014, the number of users aged 12 and up has increased from 14.5 million to 18.9 million. In the United States, 7.3% of all admissions to publicly funded drug treatment facilities were of persons aged 12 to 17. The prevalence of usage among young people is therefore noteworthy.

A study evaluating the impact of the legalization of marijuana in Colorado found, in the area of traffic offences, there was a 45% increase in impaired driving between 2013 and 2014, and a 32% increase in marijuana-related motor vehicle deaths. By 2013, marijuana use in Colorado was 55% above the national average among teens and young adults, and 86% higher for the age group 25 and over.

The American College of Pediatricians maintains that marijuana legalization will result in increased adolescent usage, addiction, and associated risks for them. Age-specific data on Colorado cannabis use compared data from two years before to two years after legalization for the age groups 12 to 17, 18 to 25, and over 26. The increases were 17% to 63% higher, while national averages for the same group remained the same or lower. Callaghan, in 2016, cited calculations of the approximate number of cannabis users in Ontario population groups below and above age 25 for 2013 and found that adolescents, young adults, are disproportionately represented among cannabis users.

Research suggests that existing alcohol and tobacco control measures are not likely to prove to be good models for controlling youth access to cannabis after legalization. Despite existing regulations banning distribution or sale to minors, alcohol continues to be widely used by Ontario students at all levels.

The evidence for driving under the influence for those 19 and under is very disconcerting. Up to 18% of those involved in fatal accidents between 2000 and 2007 tested positive for alcohol, drugs, or both. The numbers for those reporting driving under the influence of alcohol or cannabis is similarly high, and those reporting to be passengers in a car driven by someone under the influence are even higher.

As mentioned earlier, the findings of the Colorado data for cannabis-related driver fatalities after the broad commercialization of medical marijuana underlie the concern. In Colorado, experience in restricting access to medical marijuana failed. Of the 12- to 17-year-olds who enter drug treatment programs, 70% to 72% do so primarily for marijuana addiction. Among those, 74% reported using someone else's medical marijuana.

So here we are, on the threshold of legalization, discussing permissible age and denying access through regulation to minors. Something's not right with this picture.

First and foremost, there is the messaging. Marijuana is not a harmless substance. Adolescents are heavily involved with its consumption, and age restriction and control of legal distribution is not likely not to deter them or their suppliers from continuing their practices.

Hopfer, 2014, suggests that in the United States the Surgeon General's 1964 report declaring smoking as harmful may have been the most important substance abuse intervention. It resulted, with the aid of public health stakeholders, in triggering a shift in public perception of smoking followed by a steady decline in smoking. Portage fears that the current message surrounding recreational use, and Bill C-45 in general, will produce the reverse phenomena. Has telling adolescents “wait until you're old enough” ever dissuaded the majority of them from doing anything?

I must raise the question of who benefits. There is an assumption that legalization will create a windfall of revenue for the public purse like that from alcohol, which will support an increase of expensive public health education and programming. A finding by Rehm et al. in 2007 suggests the inverse may prove to be true. Their findings suggest that social and economic costs generated by alcohol consumption may possibly be greater than the revenue derived from the production and sale of alcohol. Is there any reason to believe that this will not also be the case for legal cannabis sold through government monopolies?

Portage fails to understand how policing costs would diminish. Under legalization, importation, production, and trafficking would continue to remain criminal offences and would still result in policing and court costs. The same principle applies in other areas. Shifting the debate to age of access and mode of distribution may have clouded the challenges facing our society and our young once the act is implemented. We need to have serious thinking devoted to protecting the at-risk young people, who will continue to become dependent, perhaps in greater numbers.

In terms of recommendations, because we are dealing with a high-risk situation with important consequences for a significant number of vulnerable young Canadians, we cannot proceed with a trial-and-error approach. We have to get it right the first time.

The federal government, as the drafter and promoter of Bill C-45, must ensure that all the provinces have sufficient resources both financially and infrastructure-wise to adequately respond to the collateral physical and psychological health problems the bill is likely to create. The government must legislate strict minimum standards that apply in all jurisdictions and not abdicate its responsibility under the cloak of provincial rights.

We recommend that references to recreational use be eliminated; that the messaging and dialogue be changed to alert parents, educators, and employers to the possible challenges that legalization may create; and that we anticipate and provide for the needs for increase of service for non-infectious diseases.

Distribution should be strictly regulated as to age and amount purchased and should be tracked through a centralized registry. The government should examine the European example of cannabis clubs requiring memberships, on-site consumption only, minimum age, etc., as a mode of ensuring that little of the legal marijuana makes it way to the streets.

The bill should rescind the right to purchase for convicted traffickers, people with substance abuse treatment histories, people with significant acute psychiatric diagnoses, or those found to be driving under the influence.

We should invest massively in prevention, education, and treatment resources to meet the augmented demands likely to arise as a consequence of the legalization of cannabis.

Thank you, Mr. Chairman.

[The Chair, Liberal, Bill Casey]

Thank you.

Now we'll start our first round of questioning, of seven minutes for questions and answers, with Dr. Eyolfson.

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

Thank you, Mr. Chair.

Thank you all for coming.

Mr. Howlett, I wonder whether you could at some time in the near future provide the source of some of your information regarding Colorado. We have correspondence from the Attorneys General of both Colorado and Washington State regarding impaired driving and also the use among youth. They tend to indicate the opposite of what you have said in this. Certainly for driving the initial spike appeared to be due to improved detection methods that didn't exist before. Also, the effective use by youth after legalization has pretty much plateaued at what was the national average. This seems to be in contradiction of what you are saying.

[Peter A. Howlett]

Would you like a response now, Mr. Eyolfson?

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

Very quickly, yes. I have limited time, but, yes.

[Dr. Peter Vamos, Executive Director, Portage]

Mr. Eyolfson, the data comes from the impact study compiled by the Rocky Mountain High Intensity Drug Trafficking Area study and that is—

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

What was the organization that performed that study?

[Dr. Peter Vamos]

That is....in several papers written by Harold Kalant. I'll send you the exact—