Health Committee on Sept. 15th, 2017

[Don Davies, NDP, Vancouver Kingsway, BC]

We heard Mr. Webber comment today that he's never been in a dispensary. I think he's probably not alone on that in this committee. I have the benefit of being in Vancouver, where I've had the ability to tour several dispensaries, including the Compassion Club and some licensed facilities.

We as parliamentarians are studying this bill, and we have to make recommendations to this bill about all sorts of issues. We have not toured dispensaries. We have not toured licensed producer facilities or compassion clubs. Do you think it would be helpful for the parliamentarians on this committee to actually get out in the community and tour some of these facilities in order to help us evaluate whether this bill is good as it is or whether it could be amended?

[Dana Larsen]

I think that would be very worthwhile. To get an understanding of what's really happening and of the limitations of the laws that you're trying to pass and the limitations of the ability to enforce the laws you're trying to pass, I think it would be very important to see what's actually happening at the grassroots level, and also really to see the people who are benefiting from accessing dispensaries and how it improves their lives and how it benefits our local communities.

There are all kinds of dispensaries. I'm not saying every one is run perfectly by any means, but from what I see, people are glad to have dispensaries. The dispensaries benefit them and provide a lot of positive results. I think it would be very worthwhile to see what's happening at the grassroots level and what people are doing and to understand that the current cannabis laws are already being ignored pretty much all across the country to varying degrees. If you're not going to take that into consideration when you pass these new laws, they're going to be a failure, because we will continue to ignore these laws, and the courts will back us up on that.

You talk about the rule of law. Some people would say that we have a moral obligation to break unjust laws, that when laws are punishing people who do not deserve to be punished, when laws are based on racial bigotry and ignorance of how these laws were founded, that we have a moral duty to break those laws. I personally am glad to have been able to provide cannabis medicines to those who need them. I believe I am improving people's lives every day, and we will continue to do so.

[Don Davies, NDP, Vancouver Kingsway, BC]

Some have suggested that once this legislation is in force and it legalizes simple possession and a few other things, that we as a Parliament should take steps to pardon those who have been convicted of crimes that this legislation will render to no longer be crimes. What's your view on that?

[Dana Larsen]

I think we should go further than that. If I were in charge, I would put GST on cannabis and for the first few years, I'd put that money into a fund to make reparations to those Canadians who have been unjustly imprisoned or had their lives negatively affected by cannabis prohibition.

I really think that the legalization of cannabis should begin with an apology to the cannabis culture and to cannabis users for a hundred years of punishment and incarceration and harassment and demonization that were entirely undeserved. Not for me personally but for the people in Canada who have suffered from this, I would like to see not only a pardon but an apology and some kind of restitution made. These laws have been unjust from the beginning and they remain so today. We've known for decades that these laws do not work and that they're a failure, and it's a real shame that people are still being arrested every single day.

A guy spent three nights in jail recently for a couple of grams of cannabis in Canada. It should be shocking to the conscience of parliamentarians that laws are in place that put people in jail for three days for a couple of grams.

They say that the time of greatest growth of cannabis use in Canada was in the 1960s, at a time when there was a six-month mandatory sentence for possession and a seven-year mandatory minimum sentence for growing or importing any quantity of cannabis. That was the time of the highest increase of cannabis use in our country's history. The idea that these laws have an impact on people's behaviour, and that if you say that you can't smoke cannabis anymore, we're all going to stop is entirely backwards. Now we're living under mandatory minimums that were passed by Stephen Harper in Canada. Those haven't stopped the proliferation of dispensaries at all.

I think you need to acknowledge the limitations of what Parliament and the police can do in this kind of a situation and write laws, craft laws, that acknowledge those and take those into consideration.

[The Chair, Liberal, Bill Casey]

Your time is up, Mr. Davies.

Now we go to Mr. Oliver.

[John Oliver, Liberal, Oakville, ON]

Thank you very much.

One of the advantages of this model we're using is that it is an excellent model for us to hear from many witnesses in a condensed time frame. I think this is the seventh time we've actually been able to do another round of questions, which often in our normal set-up we don't have time to do. It has been a good process for us.

I had a town hall in my riding of Oakville and had a good 100-plus people turn up, just people, the general public, who turned up to talk about the legislation and pros and cons. One gentleman really hit home with me. He was really concerned about second-hand smoke from marijuana. He was worried that if he was exposed to it and he got in a car and drove that he would show trace amounts, and he was worried about different health aspects of it.

Dr. Vandrey, I think you have done a study on second-hand smoke from cannabis on non-smokers. Could you share with the committee some of your findings from that study?

[Prof. Ryan Vandrey]

We ran a research study where we exposed people to second-hand cannabis smoke under different conditions. One was a ventilated room environment, and one was an unventilated environment, and then within the unventilated environment we varied the potency of the cannabis that people were smoking. We found a substantial impact of room ventilation on the amount of exposure.

In terms of drug testing, whether someone would test positive or not after exposure depended on how we were testing and what cut-offs were used, but we did find that in an unventilated environment positive tests would be possible for both urine and blood, as well as saliva or oral fluid. The duration when you could be positive depended on how you were tested and what cut-off was used.

Becoming positive under those circumstances was really limited to the unventilated environment, where the room air was dense with smoke. When the air conditioning or the HVAC system was turned on, people were not impaired and generally tested negative.

Second-hand smoke exposure is a real concern. It's a real thing, but it's hard to be impacted by that unknowingly. Indoor second-hand smoke regulations are appropriate, the same way they are for tobacco use. We have not done the parallel study with vaporization, so we don't really know the level of second-hand exposure with vaped cannabis versus smoked. Then there are obvious limitations beyond that. For the study we did, we exposed people for one hour, one time. That doesn't tell us anything about what happens if they are exposed for a longer period of time, or a shorter period of time but repeatedly. Again, this is an area where more science is needed, but our study demonstrated that you can get a slight intoxication and test positive in an extreme exposure environment.

[John Oliver, Liberal, Oakville, ON]

Thank you very much for answering my question.

Those are my questions.

[The Chair, Liberal, Bill Casey]

That completes our additional round and our normal round.

On behalf of the committee, I want to thank all the panellists. You brought great perspective and different perspectives than what we'd heard, and we appreciate them very much.

I walked down Sparks Street the other night in a cloud of smoke, and I think if somebody had tested me, I would have tested positive by the time I got to the end of the street.

With that, I will suspend the meeting until 10:45. Thank you very much.

[The Chair, Liberal, Bill Casey]

Welcome to our Standing Committee on Health meeting number 68. We're studying Bill C-45, an act respecting cannabis and to amend the Controlled Drugs and Substances Act, the Criminal Code and other acts.

We're now going to focus our panel on medicinal marijuana. Our witnesses today are, from the BC Compassion Club Society, Hilary Black, founder, and Marcel Vandebeek, administrator. From the Canadians for Fair Access to Medical Marijuana are Jonathan Zaid, executive director, and Daphnée Elisma, Quebec representative. From the Department of Health, we have Jacqueline Bogden, assistant deputy minister, cannabis legislation and regulation branch, and David Pellmann, executive director, office of medicinal cannabis.

We're going to ask each organization to give an opening statement of 10 minutes. You can share the time with each other, but the maximum is 10 minutes per organization.

We'll start with the BC Compassion Club Society.

[Hilary Black, Founder, BC Compassion Club Society]

Good morning, and thank you for having me here today.

My name is Hilary Black, and I'm the founder of the first medical cannabis dispensary in the country, founded in 1997. In the interest of disclosure, I am also employed by a licensed producer, but I am here today representing the BC Compassion Club Society, and thank you for having me.

Cannabis legalization will affect some of the most vulnerable members of Canadian society, critically and chronically ill patients. We are offering you seven recommendations in our submission to assist you in prioritizing patient needs. My comments today are focused on three main areas: transitioning the BC Compassion Club Society into the legal market; facilitating affordability; and supporting research. This submission additionally addresses the need for a legal range of products and advertising education restrictions. My colleague, Marcel Vandebeek, will be making some comments about the need to eliminate barriers for small-scale growers.

We have been distributing medicinal cannabis openly and safely for over 20 years. We are a non-profit society with over 11,000 registered patients. We have a subsidized wellness centre. Last year alone we provided 3,400 holistic treatments like massage, counselling, clinical herbalism, and nutritional counselling for little or no cost to our membership. We are a front-line harm reduction organization. Our clients are often marginalized, have numerous diagnoses, mental health issues, and substance issues. They fall through the cracks of the health care system until we catch them.

We have developed a gold standard of education. We know how to maximize benefits, minimize risks, and avoid adverse effects. We offer each member a 60- to 90-minute intake and education session. This is not possible in a pharmacy. Our community supports us, our neighbours, businesses, local police, health care practitioners, and patient organizations. We are a community. We have Christmas parties, picnics, and neighbourhood cleanups.

The courts have repeatedly commended our work. In 2002, the Special Senate Committee on Illegal Drugs toured our facility and recommended that our model be replicated across the country. I was nominated by Senator Pierre Claude Nolin—may he rest in peace—and received a Diamond Jubilee Medal recognizing our significant contribution to Canada. Our model is enshrined into Vancouver's city bylaws with incentives to encourage the replication of our services because our practitioners have up to a three-year wait-list.

Members of the task force visited us last September. You are all also invited to come and visit us. When they released their report, Anne McLellan said that what they learned there, putting aside certain issues of illegality, is that there can be a holistic, wellness-based, street-level approach that serves generally a highly marginalized population, and that this is a model that the report references and suggests the government should take a look at going forward.

Despite this extensive recognition from many levels of government, as cannabis is legalized, we are at risk of becoming more criminalized than we were for the past 20 years. We have a massive responsibility to ensure that the health care of our members is not interrupted, and we respectfully suggest that you share that responsibility with us.

We are a historical medical cannabis institution. We implore you to do everything in your power to protect the roots of this industry. Washington and Colorado prioritized transitioning long-standing medical cannabis dispensaries into the new framework, and we should be following suit.

For decades I have watched patients struggle, choosing between purchasing the medicine that allows them to function and other necessities, such as having groceries in their fridge. The problem is the status of cannabis. It's not an approved medicine. Access has been granted through the courts. It is again a category of one and not treated like other medications, although many patients access it through physician authorization.

This status is problematic for both tax and insurance. Both of these could be solved by creating a fast-tracked regulatory pathway for cannabis to be an approved drug or medicine. For good reason, we do not tax other prescription medications. The courts have stated in Hedges v. Canada that legislation imposing tax on medical cannabis resulted in confusion and uncertainty and needs work.

Another solution is to amend the Excise Tax Act to ensure medical cannabis is zero rated like other medical necessities and prescription medicines to relieve this unjust financial burden.

I'd like to introduce to you Mounia Lahbabi, who has worked at the House of Commons as a parliamentary assistant to MP Peter Julian for over 12 years. She has been prescribed cannabis for her medical conditions diagnosed while employed by the House of Commons, including Crohn's disease, osteoarthritis, and cervical degenerative disc disease. She exhausted standard medical treatments for these devastating conditions, which proved to be ineffective and have harmful side effects. Cannabis immediately eliminated the need for immunosuppressants, steroids, non-steroidal anti-inflammatories, and other pain medications. It relieves her symptoms, which include nausea, insomnia, and debilitating, unrelenting neuropathic and chronic pain. Without cannabis, she can't eat, can't sleep, and she can't function.

The costs of her medication are unaffordable, but she cannot go without it. Her family has racked up thousands of dollars in debt in order to afford her prescribed medical cannabis. Even though medical cannabis lacks a drug identification number, Sun Life, responsible for the administration of claims under the public service health care plan, informed Mounia that they are set up and ready to cover the costs of this necessary therapy once it is in included in her plan.

Now I'd like to introduce you to Mandy McKnight. She's employed by the Canada Revenue Agency. Her son, Liam, is nine years old and diagnosed with Dravet syndrome, a catastrophic form of epilepsy for which there is currently no cure and the prognosis is unknown. Before trying cannabis, Liam had tried over 10 anti-epilepsy medications that failed to control his seizures. He was still suffering up to 80 seizures a day. The side effects from the benzodiazepines and barbiturates were severe, including brain atrophy. Since being prescribed cannabis when he was just five years old, Liam is doing remarkably well and his seizures are more controlled than on any other medication. The cost to the family is over $1,000 a month plus HST. The alternative therapies, which are less effective and come with terrible side effects, cost between $2,500 and $3,000 a month, but they are covered.

Both Mandy and Mounia have had health claims for coverage rejected by their employer.

Give medical cannabis a drug identification number, or something akin to it, perhaps a cannabis identification number, to facilitate fair taxation and insurance. Take care of patients and Canada's public servants. It's the right thing to do. You could lead this government, the country, and the world by including cannabis in the federal public service health care plan. Treat patients with the dignity, compassion, and support that they deserve.

We have an opportunity to be world leaders, expanding the evidence base of benefits and the safety profile of medical cannabis. We are facing an opiate and overdose crisis, and cannabis has tremendous potential as a harm reduction tool. We urge you to invest significant resources in human clinical research in cannabis and cannabinoids, and to prioritize researching into the potential of cannabis in managing pain and as a harm reduction tool for addiction and substance abuse. The Compassion Club has acquired tremendous experience with people who are struggling with problematic substance use. In using cannabis as a harm reduction tool, we have witnessed the potential of high-potency edibles and resins being substituted for recreational and medical opiates, methadone, alcohol, and cocaine. This country needs solutions to the opiate epidemic, and cannabis has incredible potential.

We implore this committee to do everything in its power to transition the community-based, long-standing, front-line harm reduction organization, the Compassion Club, and other long-standing medical cannabis dispensaries, which pioneered the medical cannabis movement and industry, into the new regulatory framework. Please consider the seven recommendations in this submission to improve the care of patients.

Thank you, and I'd like to introduce you to my colleague, Marcel Vandebeek, who will be making some brief comments.

[Marcel Vandebeek, Administrator, BC Compassion Club Society]

Good morning. My name is Marcel Vandebeek. My role during the 19 years with the BC Compassion Club Society has included front-line dispensing of medicinal cannabis for five years, administrative duties for 15 years, and purchasing for 17 years. I have been working with suppliers of the BC Compassion Club to ensure a consistent supply of high-quality medicinal cannabis to our membership.

As my colleague Hilary said, we are a registered not-for-profit society focused on providing holistic health care for those who most need it. We work with small-scale growers, who cultivate specifically for our members at below-market pricing. They have cultivated specialty strains and have amassed a tremendous amount of expertise including that on organic cultivation methods. None are related to organized crime and all have taken on great personal risk to help us meet the needs of our members. We ensure the ideological values of the suppliers we work with and we reject the producers who are solely profit motivated. We have a strict cap on pricing which weeds out those who are not aligned with our mission, vision, and values, and we ask them for small things and donations.

For example, we have a cultivator named Joe, who lived with a serious disability, and grew organic cannabis for us. He used to donate thousands of dollars' worth of cannabis every Christmas to help us gift it to our members in order to help alleviate their financial hardship during the holiday season. He used the small profits to fund a summer camp for disabled children. Sadly, he was raided by the RCMP. He was never charged, but as a result, he was forced to end his summer camp. These are the good, honest, hard-working, law-abiding Canadians this government is looking at as the criminals who must have the industry taken out of their hands. In fact, they're people you should be bringing out of the shadows and into the light.

The current process for applying to be a licensed producer is inaccessible financially to small-scale producers and to small-business people, who are part of what is needed to fill the supply shortages in licit production. The pioneers of the medical cannabis movement and industry will not be included in the legal market unless you dissolve the onerous barriers to becoming licensed.

Thank you for the opportunity to speak to your committee today. We look forward to your questions.

[The Chair, Liberal, Bill Casey]

Thank you for your comments.

We're going to move to the Canadians for Fair Access to Medical Marijuana. Mr. Zaid, you have 10 minutes.

[Jonathan Zaid, Executive Director, Canadians for Fair Access to Medical Marijuana]

Thank you, Mr. Chairman and the standing committee, for your invitation to appear here today.

We will be speaking on behalf of two organizations, Canadians for Fair Access to Medical Marijuana, also known as CFAMM, and the Arthritis Society. I am the founder and executive director of CFAMM, a national non-profit organization focused on the needs of medical cannabis patients. The Arthritis Society is Canada's principal health charity providing education, programs, and support to the over 4.6 million Canadians living with arthritis. Over the past two years, the organizations have collaborated extensively on important issues surrounding medical cannabis research, access, and affordability. The brief submitted to the committee is a joint submission between the two groups, and any follow-up can be done with me or Janet Yale, CEO of the Arthritis Society. You may recall Janet recently appeared before this committee on other issues including national pharmacare. I would also like to introduce Daphnée Elisma, CFAMM's Quebec representative and a member of our patient advisory board. She'll present in French momentarily. First, I'd like to share a bit about my personal story.

So much of what we hear about cannabis is focused on the harms and risks, which of course are important issues, but my experience and the experience of many other patients is quite the opposite. On April 22, 2007, at the age of 14, I woke up with a constant headache that still remains today, 24-7. This neurological condition known as new daily persistent headache is said to be one of the hardest pain conditions to treat. After trying over 40 prescription medications and all other therapies, I was nearly ready to give up. I had no quality of life. I could not leave the house due to noise sensitivity and low energy. I dropped out of grade 8 and struggled throughout high school. I finally turned to medical cannabis. It helped reduce painful flare-ups and allowed me to sleep. Although not a cure, the effective symptom management enabled me to concentrate and be successful in my academic studies. I advocated for insurance coverage, and was the first in Canada to be successful in getting insurance coverage for medical cannabis in this manner.

Medical cannabis patients are often looked at as stereotypical stoners, yet to me, Daphnée, and the patients we represent, effective symptom management translates to increased quality of life and functionality. Cannabis is a medicine. There are over 200,000 authorizations for the use of cannabis as a therapy to manage a variety of health conditions, including seizures, pain, insomnia, nausea and vomiting, and side effects from prescription medications.

Although there is legal access to medical cannabis, many challenges are still associated with its use. We need more research. Access to various product forms and retail distribution is an important issue, and affordability remains one of the most pressing concerns facing patients.

As the government progresses with legalization, one of the primary goals is to reduce consumption. Although laudable for recreational purposes, the government's goal ought not to be to restrict access to medical cannabis, a medicine, but rather to ensure a safe, reliable, and affordable supply for those who medically require it.

We will be highlighting three issues today: the importance of a distinct regulatory framework, research, and affordability, which Daphnée will speak to. Although we need more research, a recent review by the U.S. National Academies found substantial evidence for the use of cannabinoids in conditions including chronic pain, MS, and chemotherapy-induced nausea.

The two most studied cannabinoids are THC and CBD. THC, the cannabinoid that causes the stereotypical high associated with cannabis, has medical properties including analgesia. CBD, a non-impairing cannabinoid, which has been shown to have anti-inflammatory and anticonvulsant effects, also limits the impairment and side effects caused by THC. Many patients use these two cannabinoids in combination to gain the most effective symptom management while limiting potential impairment. Again, for most people using cannabis for medical purposes, this is not about getting high, but rather effective symptom management and increased quality of life.

Cannabis is a legitimate medication and it must be treated that way. It is important that it be treated that way in a distinct regulatory framework. In crafting Bill C-45 we want to commend the government for recognizing the need to maintain a separate and distinct regulatory approach for medical cannabis, and we want to make sure that this is maintained. Beyond the government's constitutional requirements to provide reasonable access to cannabis for medical purposes, we believe cannabis and patients' needs are best suited to be addressed in a distinct regulatory framework. Moving forward beyond Bill C-45, it is important that the government prioritize and adequately support the needs of patients by addressing their unmet needs.

Of course research is a very important issue. There is an enormous deficit of properly funded research and Canadian clinical trials in the therapeutic use of medical cannabis. This creates barriers to patient access, as many physicians express reluctance to authorize medical cannabis in the absence of robust, peer-reviewed research.

The lack of scientific and clinical research has also been cited by Health Canada as a key reason why medical cannabis is not yet regulated as a therapeutic product, which affects the ability of patients to access medical cannabis through private or public drug plans. In particular, more research is needed in terms of dose, indication, and form. To that end, we have asked, as part of budget 2018, for the federal government to commit $25 million over five years to support medical cannabis research. This investment would go a long way towards expanding the evidence base for medical cannabis, and it's a small amount compared to the $274 million already proposed for enforcement.

Although we fully support enforcement and research into the risks associated with recreational cannabis use, we believe it's necessary for the federal government to invest in research specific to the medical use of cannabis. This is an urgent and vital step towards further understanding and recognizing the legitimate medical use of cannabis and ensuring the sustainability of a distinct regulatory framework.

In terms of improving access, in addition to the continuation of mail order and personal production, we believe that pharmacies should have exclusive authority to retail medical cannabis, and that further product forms should be made available. Sales through pharmacies would go towards improving affordability, including the elimination of sales tax based on the Excise Tax Act, and increasing the potential of insurance coverage.

Pharmacists will help ensure that patients across the country receive reliable education on safe and effective use from trained health care professionals with regulatory oversight. While retail and distribution decisions are largely provincial competencies, in order for pharmacy distribution to happen, the access to cannabis for medical purposes regulations will need to be amended.

I will now pass it to Daphnée to discuss affordability.

[Daphnée Elisma, Quebec Representative, Canadians for Fair Access to Medical Marijuana]

After over a decade at Health Canada and as a lawyer, I advocate for patients who use medicinal cannabis. In fact, I use cannabidiol, or CBD, to successfully ease the complex regional pain syndrome that I suffer from as a result of breast cancer treatment.

The issue of low rates is a major challenge for the patients we are representing here today, as medicinal cannabis is the most effective medication to treat their illness.

First, we recommend that cannabis for medical purposes be tax-exempt. When a patient purchases prescription drugs and medical necessities, they are exempt under federal law. Since medicinal cannabis meets those criteria, the government should allow the removal of sales tax, making it more affordable.

Next, we are calling for policies and programs to facilitate the coverage of medicinal cannabis costs under public and private regimes. We recommend that the government approve cannabis as a therapeutic product, including giving it a drug identification number, to facilitate reimbursement.

Basically, patients who use cannabis to treat their physical or psychological condition feel discriminated against. The government makes a distinction between these patients and those who use conventional medications, such as opioids, to treat the same disease. As a result, the patient is often forced to use an opiate instead of cannabis because it is less affordable.

Taxation and non-reimbursement of medicinal cannabis represent undue hardship for patients. Improving the rights of patients who use medicinal cannabis must remain at the heart of the discussions.

I would like to thank committee members for giving me the opportunity to address them today.

[The Chair, Liberal, Bill Casey]

Thank you very much.

Now we go to Ms. Bogden. Welcome back.

[Jacqueline Bogden, Assistant Deputy Minister, Cannabis Legalization and Regulation Branch, Department of Health]

Thank you, Mr. Chair.

Thank you for the opportunity to appear before the committee again this morning. I will ask for the committee's understanding. I've had a bit of a cold in the last few days, so my voice is not as good as on Monday, but I will do the best I can.

My colleague Mr. David Pellmann is responsible for the office of medical cannabis. As public servants, we are responsible for administering, on behalf of Health Canada, the current regulatory framework that enables Canadians to have access to cannabis for medical purposes.

I'd like to provide the committee with an overview of the regulatory framework, focusing on four areas. One is how the current framework is designed, how it works, and the number of Canadians who presently benefit from it. Two, I will outline the robust requirements and controls that apply to licensed production of cannabis, which are designed to protect public health and safety. Three, I will describe some of the key improvements that Health Canada has made to the program over the last six months. Finally, I will outline why and how this framework would be preserved under the proposed cannabis act that is before you.

Canada has had a system of access to cannabis for medical purposes in some form since the late 1990s. The regulatory regime was put in place following a court decision that determined that the Government of Canada must provide some lawful means for Canadians to access and possess cannabis for medical purposes. The framework has evolved considerably over time as the government has introduced improvements and has responded to a number of court challenges and decisions.

Most recently, in April 2016, the Federal Court determined that the regulatory framework that was in place did not provide individuals with reasonable access to cannabis for medical purposes. In this instance, “reasonable access” was defined as having access to available and affordable cannabis.

In response to this decision, a little over a year ago, Health Canada introduced a new regulatory framework, which is called the access to cannabis for medical purposes regulations. Under this new regime, Canadians who have the authorization of their health care practitioner can access cannabis in one of three ways. The first is by purchasing quality-controlled cannabis from a federally licensed producer, where individuals register directly with the licensed producer and the product is delivered securely to their home, either through the mail or by courier. Individuals also have the option to register with Health Canada to produce a limited amount of cannabis at home, or to designate someone to produce it for them.

As I mentioned, Canadians must have the authorization of their health care practitioner in order to access cannabis for medical purposes. Health Canada believes that the decision to use cannabis for medical purposes is one that is best made by a health care practitioner and his or her patient.

On its website, Health Canada provides information designed specifically for health care practitioners. The department also works closely with provincial and territorial regulatory authorities, which in turn provide guidance to the health care practitioners in their jurisdiction.

Health care practitioners are authorizing cannabis as a treatment for a wide range of symptoms associated with medical conditions, including nausea in patients undergoing chemotherapy, loss of appetite and weight loss associated with HIV/AIDS, and pain and spasticity associated with multiple sclerosis and arthritis.

At this time, under the new regulations, there are more than 210,000 active authorizations for the use of cannabis for medical purposes. Of this number, 200,000 active registrations are with federally licensed producers, where individuals purchase their product directly from them, and 10,000 individuals are registered with Health Canada to produce a limited amount of cannabis at home, or to designate someone to do it for them.

The number of client registrations with licensed producers is continuing to grow, at a rate of approximately 9% a month, since licensed production began in 2013. The number of health care practitioners who are authorizing the use of cannabis has also grown steadily. There are now 10,000 health care practitioners authorizing use, which is double the number from June 2015.

I would now like to describe briefly the system of regulated production of cannabis in Canada. There are currently 58 producers who are licensed to produce cannabis for medical purposes. These producers are the only legal commercial source for regulated, quality-controlled cannabis for medical purposes in Canada.

The regulatory framework sets out a series of strict requirements that must be met to protect the health and safety of Canadians and the integrity of the legal system. For example, licensed producers are required to use good production practices in their facilities, such as a sanitary program and a dedicated person responsible for quality assurance. They must test each and every lot for mould, bacteria, and other potential contaminants before those products can be released for sale to the public. Licensed producers must also test each lot for THC and CBD potency, and those results must be displayed on the label.

In terms of preventing diversion to the illegal market and ensuring the integrity of the legal system, all licence holders, directors of a corporation, and senior personnel in the facility must have a security clearance. This security clearance involves a criminal record check as well as a law enforcement record check to identify any known associations or affiliations with organized crime. In addition, all facilities must have physical security and inventory control measures to prevent theft or diversion.

These standards and controls are backed by rigorous compliance and enforcement. Last year, Health Canada inspected each facility an average of seven to eight times, conducting roughly 275 inspections. These inspections verify that good production practices are being met, the test results for all products that are produced, that only authorized pesticides are being used, and review inventory records and the security control measures that are in place in the facilities.

I will also note that Canada's system of regulated production of cannabis is recognized internationally. We receive frequent visits and calls from other countries for advice on our patient-focused approach, strict licensing regime, and compliance and enforcement program.

I will now outline some recent improvements to help ensure that Canadians continue to have reasonable access to cannabis and can have confidence in the quality-controlled supply of cannabis for medical purposes. In May of this year, Health Canada announced it will require all licensed producers to conduct mandatory testing of all cannabis products for the presence of unauthorized pesticides. In addition, Health Canada is conducting unannounced inspections of all licensed producers and randomly testing lots and products for unauthorized pesticides. Also in May this year, Health Canada added additional resources and introduced a number of improvements to streamline the licensing of producers and enable increased production of cannabis, while maintaining quality control and oversight. These measures will also help ensure that a legal, quality-controlled supply of cannabis would be available should the proposed cannabis act be approved by Parliament.

The question of whether to retain a separate framework for access to cannabis for medical purposes was a key question the government asked the task force of experts on cannabis legalization and regulation to consider. The task force consulted broadly and extensively with experts in public health, law enforcement, patients and advocates, including the others who have joined me at the table today, as well as licensed producers. During these consultations, the task force heard how cannabis is making a difference to Canadians living with serious health challenges such as cancer, HIV/AIDS, multiple sclerosis, arthritis, and fibromyalgia. It also heard about the role that cannabis can play in pain management and palliative care, and the relief that cannabis offers to children with severe forms of epilepsy. Based on its findings, the task force recommended the government maintain a separate medical access framework to support patients. It also recommended that the government monitor and evaluate patients' reasonable access during the implementation of this new legislation and evaluate within five years. The government has accepted the advice of the task force, and the proposed cannabis act that is before you will enable the framework to continue.

In closing, Mr. Chair, I wish to emphasize that Health Canada is committed to enabling Canadians to have reasonable access to cannabis for medical purposes. We will continue to monitor closely, as we do today, and be prepared to take additional measures if necessary. Finally, we will continue to seek the feedback of patients and producers to continuously improve how we administer, and ensure that Canadians are well served by, the program.

We would be happy to answer your questions. Thank you.

[The Chair, Liberal, Bill Casey]

Thank you very much.

Now we'll go to our first round of questions.

We'll start with Mr. McKinnon, for seven minutes.

[Ron McKinnon, Liberal, Coquitlam—Port Coquitlam, BC]

My first question is for Ms. Bogden. Mr. Zaid, in his presentation, has asked for a drug identification number to be assigned to cannabis. I was wondering how that would work, whether there are issues with that, and what would be involved.

[Jacqueline Bogden]

Cannabis can be classified as a therapeutic drug under the Food and Drugs Act. If a company wishes to market a drug in Canada, there is a process they can go through to apply to do so.

Health Canada would review the evidence that is put forward to verify the product's safety, efficacy, and quality. Part of the process involves presenting results of preclinical and clinical studies that have been conducted either in Canada or overseas and details regarding the production and packaging of the drug, and a number of other aspects.

At this time, cannabis itself, in its dried, fresh, or oil form, has not been authorized as a therapeutic product. No company has brought forward an application or the clinical evidence that would be required. However, I would point out that a number of cannabis-based drugs...there are in fact two that have been approved, have undergone the market authorization process, have received a DIN, and as such are available for sale and would be eligible for reimbursement from plans.

[Ron McKinnon, Liberal, Coquitlam—Port Coquitlam, BC]

Apart from those two products, a producer or manufacturer hasn't come forward and said, “Listen, we want a DIN for this product, and here is the evidence”, and so on and so forth. Okay.

Mr. Zaid, can you give us any feedback regarding that? Have you talked to people about applying for such an identification number?

[Jonathan Zaid]

We'd absolutely love to see a drug identification number application put forward by a drug company, but one of the issues surrounding cannabis and what makes it unique is that it's a plant. It's not a patentable molecule, and that's typically what the therapeutic drug directorate regulates.

When talking about cannabis, there's a wide range of indications. Really, it does come back to the research. We need to focus on research specific to medical cannabis. The government has an obligation in this role, we believe, because of the limited patentability of cannabis, to really incentivize research and ensure that we have the research needed to get to that DIN. In the interim, we believe cannabis should be assigned a DIN or something equivalent to start facilitating reimbursement, as it's such a vital issue for patients across the country.

[Ron McKinnon, Liberal, Coquitlam—Port Coquitlam, BC]

It sounds like there's not enough research. It just needs people to enter the formal process to make that happen. You're not aware of anybody having started such a process?

[Jonathan Zaid]

No, not in terms of the application process, but there are definitely some ongoing small-scale clinical trials by some of the licensed producers. It's not nearly to the degree that we would like to see it. We'd also like to see the $25 million invested in CIHR so they can grant it out, so that it's unbiased research and not necessarily sponsored by drug companies.

Really, it does come back to the research. Again, the patentability, as well as the wide range of indications, means that there's a lot of research to be done. It's expensive clinical research. The Arthritis Society held a forum a couple of years ago, brought all the researchers together, and created a report that set out a list of priorities. Now we have the priorities. We know what we need to study. We just need the funding to enable us to do that.

[Ron McKinnon, Liberal, Coquitlam—Port Coquitlam, BC]

I think Ms. Black would like to respond to this.