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.