EVIDENCE

Standing Committee on Health NUMBER 067 1st SESSION 42nd PARLIAMENT Thursday, September 14, 2017 Le jeudi 14 septembre 2017 Standing Committee on Health CANADA [Recorded by Electronic Apparatus] EVIDENCE September 14, 2017 Committee Edited Evidence * Table of Contents * Number 067 (Official Version) Official Report * Table of Contents * Number 067 (Official Version) Témoignages * Table des matières * Numéro 067 (Version officielle) 67 14 09 2017 2017/09/14 08:35:00 House of Commons Comité permanent de la santé Standing Committee on Health HESA Chair Mr. Bill Casey 42 1

(0835) [ English ]

The Chair (Mr. Bill Casey (Cumberland—Colchester, Lib.)) :

Seeing quorum, we will call our meeting to order. This is meeting number 67 of the Standing Committee on Health. We are doing our study on Bill C-45 on cannabis. Today our panel is focused on prevention, treatment, and low-risk use. I welcome all of our guests who are here both by video conference and at the table. As individuals, we have here today Michael DeVillaer, assistant professor and policy analyst at McMaster University, and by video conference, Mark Kleiman, professor of public policy at the Marron Institute of Urban Management at New York University. Welcome.

From the Canadian Nurses Association, we have Dr. Lynda Balneaves, a registered nurse and medical and non-medical cannabis researcher, and Karey Shuhendler, policy adviser, policy advocacy and strategy. From the New Brunswick Medical Society, we have Dr. Serge Melanson, by video conference from Moncton. From the Nova Scotia Department of Health and Wellness, we have Dr. Robert Strang, chief medical officer of health, by video conference from Halifax. Thanks very much. We'll start with 10-minute introductory remarks from each organization. Then we'll go to questions from the members.

We'll start with the Canadian Nurses Association, Dr. Balneaves.

Ms. Lynda Balneaves (Registered Nurse and Medical and Non-Medical Cannabis Researcher, Canadian Nurses Association) :

Karey will be starting our presentation today. Thanks.

The Chair :

Ms. Shuhendler.

Ms. Karey Shuhendler (Policy Advisor, Policy, Advocacy and Strategy, Canadian Nurses Association) :

Thank you, Mr. Chair. Good morning, Mr. Chair, and members of the committee. My name is Karey Shuhendler. I'm a registered nurse and policy adviser for the Canadian Nurses Association, the national professional voice representing more than 139,000 registered nurses and nurse practitioners. I'm pleased to be here today with Professor Lynda Balneaves, registered nurse and medical and non-medical cannabis researcher, who will be able to answer questions that are more technical in nature.

Professor Balneaves currently serves as an associate professor in the Rady faculty of health sciences college of nursing at the University of Manitoba, and is a nursing leader in the fields of shared treatment decision-making and complementary and integrative health care. She has published and presented on topics related to knowledge translation, integrative oncology, treatment decision-making, and medical and non-medical cannabis. At the outset, I would like to thank the committee for studying this important issue and for inviting CNA to provide its recommendations.

Legalization of non-medical cannabis will impact public health, and as such, requires a preventative approach to reduce the health risks and social harms associated with cannabis use. CNA welcomes the federal government's work to table Bill C-45 , which would guide the legalization, regulation, and restriction of access for non-medical cannabis. CNA supports the passing of the bill and believes that legalization is an excellent option for addressing the harms of cannabis.

CNA recently conducted a national survey of nurses to assess the readiness for legalization, determine knowledge gaps and resources needed, and collect input on the sections of Bill C-45 that pertain to the scope of CNA's work.

While the two-month survey remains open until tomorrow, preliminary results indicate that a majority of nurse respondents favour the government's move toward legalization, and that the focus should be on preventing access and associated harms for young persons through a variety of mechanisms, including considerations around packaging, labelling, display, promotion, and sale of cannabis and cannabis accessories. Legalization can support the regulation of quality, dose, and potency, while minimizing social harms as well as the costs of prohibition.

In addition, legalization can improve access to research potential harms or medical benefits. In reviewing the bill, CNA was pleased with the moderate public health approach taken on the complex issue of cannabis legalization. In its current form, Bill C-45 promotes the removal of harms associated with the prohibition model, while recognizing the need to protect vulnerable populations, including youth. CNA has provided four recommendations for amending the proposed legislation, all of which are outlined in our brief.

We encourage the committee to include all of CNA's recommendations in its final report, including those related to the sale and promotion of cannabis and cannabis accessories, and considerations around promotion and use related to alcohol. Cannabis should not be treated in the same way as alcohol. The harms of alcohol use and current alcohol policy can be downplayed at times and should not necessarily serve as the model for cannabis policy simply because it is already established. Additionally, cannabis is different in that there are therapeutic indications and particular formulations for medical use.

Thus, medical access should not be forgotten in the wake of legalization. While these other recommendations are not the focus of our presentation today, we would be pleased to answer any questions on the full range of recommendations put forth in our brief. This morning we would like to focus on two of the four recommendations, namely, those related to youth criminal penalties and the inclusion of a comprehensive public health approach to the legalization of non-medical cannabis. Our first recommendation, regarding youth criminal penalties, is specific to clause 8 and related subclauses.

These state that a young person, aged 12 to 18, in possession of one or more classes of cannabis the total amount of which, as determined in accordance with

schedule 3, is equivalent to more than five grams of dried cannabis, is guilty of an indictable offence, is liable and/or guilty of an offence punishable on

summary conviction, and is liable to a youth sentence under the Youth Criminal Justice Act. Not only can a criminal record limit an individual's ability to travel to certain countries, it can also lend itself to considerable social harms. For youth in particular, a criminal record can be a barrier to volunteer opportunities, which are often required by school curriculums, and can play a role in scholarship decisions. A criminal record can also reduce career opportunities and contribute to poverty and poor health outcomes.

Legalizing cannabis while maintaining criminal penalties for youth can disproportionately disadvantage young people, particularly those from marginalized or racialized communities, potentially barring them from opportunities to equitably advance and contribute in our society. Given the evidence that 21% of 15-year-olds to 19-year-olds in Canada have used cannabis in the past year, such legislation could potentially impact a large number of youths. Alternatives to a traditional punitive approach to addressing both minor crime as well as problematic substance use have demonstrated success.

Examples such as drug courts, which use a restorative justice approach, offer an alternative to traditional justice processes. These models offer full engagement and accountability of the offender, and help to address the broader range of contributing issues such as poverty, health, or social justice issues that may have brought the person to commit the offence in the first place.

(0840) Consider a 15-year-old struggling with problematic cannabis use caught possessing more than five grams for personal use. He uses non-medical cannabis to self-medicate for undiagnosed anxiety and depression which is exacerbated by the stress associated with living in poverty.

Would criminalizing possession or even imposing a significant fine help this teen, or would he be better served through a drug court system with a restorative approach, where the teen can be accountable in his own healing, provided with opportunities to link with health and social service organizations to address the root causes of poverty, and offered treatment services to address undiagnosed mental health and substance use issues?

With this in mind, CNA recommends that youth possession of cannabis not be subject to criminal penalties, that the government use a restorative justice approach as the guiding principle for addressing youth possession, and that such depenalization eliminate current or future repercussions for youth by removing the provision under clause 8 and related subclauses of the cannabis bill. Our second recommendation is for the government's investment in a public health approach to cannabis, including a comprehensive public education program.

CNA strongly supports the recommendations made to the federal task force on cannabis legalization and regulation to learn from other jurisdictions, such as Colorado and Washington, and to invest in comprehensive public health and education programs including those related to cannabis use while driving well in advance of legalization. Canada spends more than one billion dollars annually to enforce cannabis possession laws, arresting about 60,000 Canadians for simple possession, and this accounts for about 3% of all arrests.

Legalization should remove significant social harms as well as the financial costs associated with enforcement under the current model of prohibition. With this in mind, CNA recommends that once legalization is in place, the government use a portion of the savings from enforcement and/or revenue from sales to invest in initiatives that contribute to positive health and social outcomes.

Such investments should include tools, training, and guidelines to support public education programs for cannabis harm reduction strategies, programs for substance use prevention and treatment, and research to better understand the harms of non-medical use, as well as the potential benefits of medical use. Cost estimates for these measures can be derived from jurisdictions where cannabis has already been legalized, from public education campaigns that have been launched, and from current federal government investments in public education related to tobacco use.

Nurses are the largest group of health care providers in the country and are often a person's first point of contact with the health care system. As such, nurses are well positioned to contribute to the development and delivery of this kind of health education. Results of a Nanos Research poll commissioned by CNA in August of this year, which will be tabled, note that more than nine out of 10 Canadians support or somewhat support nurses educating Canadians on the risks associated with non-medical cannabis use.

Preliminary results of CNA's national survey of nurses noted that 49% of respondents indicated that they felt comfortable initiating a conversation or responding to patient concerns about the risks associated with non-medical cannabis use. Based on these results, CNA is committed to providing additional educational resources on non-medical cannabis to support nurses caring for people across the continuum of care. I would like to close by emphasizing that the legalization of cannabis is an excellent opportunity to reduce harms associated with non-medical cannabis use, but we must get this right.

CNA encourages the committee to urge the federal government to incorporate all of the recommendations put forward by CNA. Thank you.

The Chair :

Thank you very much for your contribution. Now, by video conference, we will go to Dr. Serge Melanson with the New Brunswick Medical Society.

(0845) Dr. Serge Melanson (Doctor, New Brunswick Medical Society) :

Thank you and good morning. My name is Dr. Serge Melanson. I am the chief of staff and an emergency room physician at Moncton Hospital here in New Brunswick. I'm speaking today on behalf of the New Brunswick Medical Society, a professional association representing more than 1,600 physicians in New Brunswick. As a professional association, we believe that we have a key role to play in advocating for improvements to health care delivery in New Brunswick. We have led the way in various initiatives, such as the promotion of team-based health care delivery.

We have also been successful in promoting healthy living initiatives and policy changes to protect youth from health hazards such as smoking and the use of tanning beds. We recently launched a campaign to make New Brunswick one of the top three healthiest provinces in the next 10 years.

We've also collaborated with schools to improve healthy food choices, and we have promoted the mandatory use of ski helmets to prevent head trauma. [ Translation ] I would like to thank the House of Commons Standing Committee on Health for inviting me to speak today to the concerns of the New Brunswick Medical Society about the legalization of marijuana for recreational use.

In June this year, our organization published a position paper on the recreational use of marijuana, which included recommendations to the Government of New Brunswick on an appropriate framework to limit the harmful effects of marijuana use on New Brunswickers. We also want to inform the public about the health issues associated with cannabis use, and we recently launched an information campaign for the public on marijuana use. [ English ] Like tobacco and alcohol, cannabis use can lead to negative health impacts.

While Canadians will have the choice to consume marijuana legally in little less than a year from now, it is essential that they understand the risks. Making cannabis legal does not make it safe. We understand that the goal of the federal government in legalizing and strictly regulating cannabis is to decriminalize use of the drug and reduce illicit sales of the substance, but we believe there are still substantial concerns to address when it comes to the particulars of legalization.

Our position on legalization is in line with that of the Canadian Medical Association and their recommendations built on Canada's experience regulating alcohol and tobacco. We also support the guidelines developed by the Centre for Addiction and Mental Health for low-risk use of cannabis. One issue of particular concern to us in this discussion, from a prevention and low-risk use perspective, is the proposed minimum age for the legal possession and purchase of recreational marijuana.

We believe very strongly that the proposed age of 18 under Bill C-45 sends the wrong message to young Canadians—that it is safe for them to consume marijuana at that age. There is clear scientific evidence that the brain of a young adult is still developing up to the age of 25 and that marijuana consumption can have adverse effects on brain development. While we would ideally like to see the legal age for recreational marijuana set at 25 in Canada, we recognize that this is not likely feasible and that 21 may be a more realistic age for the prevention of illicit purchase by young adults.

Over the past 14 years of practising emergency medicine in Moncton, I've seen first-hand a significant increase in the amount of cannabis use and its negative health effects in patients presenting to the emergency department, whether it be as the primary cause of their medical problem, something that is worsening an existing chronic disease, or something that may be unrelated to why they're there. I deal with the effects of cannabis use in the ER in a number of situations.

These can be patients experiencing unexpected effects due to cannabis being laced with dangerous chemical additives, patients experiencing a cannabis-triggered issue called cyclical vomiting syndrome, cannabis triggering serious mental illness, and patients experiencing such serious health issues as chronic lung disease as a direct result of cannabis use. I see patients who have consumed cannabis, adolescents and young adults, for the most part, who then go on to develop their first episode of psychosis, schizophrenia, bipolar disorder, and other significant mental health issues.

Teens or young adults consuming cannabis will have a higher likelihood of developing these mental health issues if they continue to consume cannabis. Some young people may also be under the impression that these medical issues are curable. The reality is that these are lifelong diseases. Young Canadians are taking a significant risk in consuming cannabis.

We believe there is a clear association between cannabis use and the onset of psychotic disorders, because the brains of these young adults are still in development. (0850) [ Translation ] Since we know that the recreational use of marijuana will be legalized and that increased use is likely to have an impact on health care, it is important that the provinces and territories have adequate resources to deal with it.

If Parliament adopts Bill C-45 , the Government of Canada will be responsible for ensuring that the provinces and territories are adequately equipped to react to increased pressure on the health care system. In addition, the Canadian government must ensure that the provinces and territories have the resources to adequately measure the impact of legislation to better adapt their awareness and education efforts to the situation, as well as their intervention and treatment services over time.

Research on public health will be needed to measure the harmful effects of increased cannabis use on our communities and our citizens. [ English ] It is also critical that governments at all levels invest the necessary resources to support a strong and ongoing education and awareness campaign. If Canadians are to be presented with the choice to consume legal cannabis, they must have easy and clear information on the risks associated with making that choice.

In closing, I would like to make it clear that a decision by the Government of Canada to legalize the use of cannabis must be advised by these precautionary principles. Government has a fundamental responsibility to protect its population. It is of particular importance, on the legalization of cannabis, for government to ensure that it is living up to its responsibilities to all Canadians. [ Translation ] Thank you.

[ English ]

The Chair :

Thank you very much, Doctor. I just want to say that I live in Nova Scotia but I was treated for cancer at your hospital nine years ago, successfully so far anyway. I had great care, and I just want to say thank you for that. Now, moving to the Nova Scotia Department of Health and Wellness, we have Dr. Robert Strang, chief medical officer of health, by video conference from Halifax.

Dr. Robert Strang (Chief Medical Officer of Health, Nova Scotia Department of Health and Wellness) :

Good morning to the committee, and thank you for the opportunity to speak to you today. I'm appearing on behalf of the chief medical officers of health for the 13 provinces and territories. I'm providing a collective public health perspective, not jurisdictional positions from any of the provinces and territories. My remarks will be focused on this morning's topic of prevention, treatment, and low-risk use, but by necessity will touch base on other topics such as legal age, labelling, and packaging, which have been discussed in other sessions.

I have assumed that by prevention you mean the prevention of population and individual harm in relation to how cannabis is produced, distributed, retailed, and used, the prevention or at least the delaying of onset of use by those below the legal age, and the prevention of harm to populations that may be at increased risk. Prevention is not just about providing information and education about risks and harms. Appropriate education and social marketing can be effective but only if they are part of a comprehensive strategy.

Policy decisions related to how cannabis will be sold, how it will be priced, how it will be labelled and marketed, and the level of availability and accessibility are the most critical when it comes to preventing population harms, preventing harmful individual use, and minimizing underage use. To be more specific, to have the strongest prevention approach, we make the following recommendations: Cannabis should be distributed and sold through government monopolies where the primary objective is protecting public health and safety, and not revenue generation.

As recommended by the task force that advised the federal government, there should be no co-sale of cannabis with tobacco and alcohol products. At the outset, price will need to be set to maximize purchase from the legal market, but over time, price needs to be used as a key tool in decreasing overall demand as well as encouraging consumption of lower-harm products, such as products with lower THC concentration and non-smokable forms.

Product promotion such as advertising, marketing, sponsorship, and product placement, including at the retail environment, needs to be prohibited at the federal level and complemented by similar provincial restrictions. Product packages should be plain with clear and prominent warnings about risk. At the retail level, prepackaged products such as cigarette-type joints should not be allowed as those can facilitate marketing, promotion, and glamorization of cannabis use.

The number, location, and density of retail locations, along with hours of operation, need to be carefully developed to balance access to legal products—and accounting for the current legislation's allowance of personal growing and online or mail order purchases—with prevention objectives. Over the long term, a minimum age of 21 would be better than 18 or 19 at balancing between shifting young adults to legal supplies and decreasing use by those under age 18. I'm going to explain that recommendation a little more, because it is a key point that keeps coming up.

We know that one of the objectives is to move people from an illegal to a legal market. Certainly, setting age 19 or 18 will bring young adults into the legal market in the short term, but if one of our key objectives is to decrease use amongst youth who are under 18, and will always remain underage no matter if the age is 18, if they are using cannabis, they are going to have to access it from an illegal source.

We know from clear evidence around tobacco and alcohol that setting an age of 21 versus 18 or 19 will, over time, have a greater impact on decreasing cannabis use rates and therefore keeping those individuals out of any market for cannabis for those under age 18. If one of our primary objectives is to have a set of circumstances that decreases use of cannabis by those who are underage, we are far better off with an age of 21 than of 19.

Moving along, public smoking and vaping of cannabis should, at a minimum, follow the current approach to public tobacco smoking and vaping, to prevent further normalization of cannabis smoking and re-normalization of smoking behaviours in general.

(0855) The approach to bringing edible and other concentrated and derivative products into the legal market needs to be done extremely carefully to minimize the normalization of cannabis consumption and protect children and youth. With respect to edible products, it must be made clear through legislative requirements that products that contain cannabis plant materials and extracts and active ingredients are not food products. Since it is easier to loosen regulations than to tighten them, the initial regulatory approaches should err on the side of being more restrictive.

Adjustments can be made as time progresses based on comprehensive monitoring and research. Such monitoring and research will need to be adequately resourced and established. Programs that shape social and physical environments to support health and well-being in general, such as supporting healthy pregnancies, enhancing early childhood development, and ensuring adequate housing and income, are all important measures for primary prevention of problematic substance use in general and are and will be important in preventing problematic cannabis use.

Along with this submission, I'm pleased to attach a more detailed position paper from the provincial and territorial chief medical officers of health, as well as the Urban Public Health Network, who are the medical officers of health in urban centres. That more detailed report has been provided to the committee. With respect to treatment, I do not have experience or expertise in the treatment of cannabis use disorders, but I would say that there are no treatment approaches or therapies that are specific to cannabis use disorder.

There is a need for improving appropriate access to treatment of people with cannabis use disorder today as part of the need to improve treatment and access for people with a range of substance disorders. Whether the need for treatment will increase or decrease will really depend on decisions and the implementation of policies that I've discussed previously. With respect to lower-risk use, an updated set of guidelines for lower-risk cannabis use, the development of which was led by Canadian experts, was publicly released in June of this year.

Those guidelines have been endorsed in principle by the council of the chief medical officers of health. In

summary, these guidelines recommend that the most effective way to decrease risk is to abstain; that the older one is when cannabis use is initiated the lower the risk of developing problematic use and adverse health effects over the lifetime. Higher THC concentration products have greater risks, so low THC concentrated products should be used. Synthetic cannabinoids, such as shatter, expose users to more acute and severe risk and should be avoided. To protect lung health, routes of intake that involve smoking and combusted cannabis material should be avoided.

Along with that, methods such as deep inhalation and breath holding that increase the psychoactive ingredient absorption also should be avoided. Frequent or intensive use has the highest risk of harm, so if people choose occasional use, one day a week or only on weekends is recommended. Avoiding driving while using alcohol and/or cannabis is extremely important. Populations that are at higher risk from harm from cannabis and therefore should avoid use are pregnant women, people with a history or close family history of psychosis or substance use disorder.

The combination of risk behaviours, such as early age of onset and frequent use, likely magnifies the risk. These low-risk cannabis use guidelines should form a key part of public awareness and educational initiatives related to cannabis legalization and should be incorporated in product labelling and should inform legalization policy decisions by all three levels of government.

With respect to Bill C-45 , the provincial and territorial chief medical officers of health and Urban Public Health Network recommended in the paper I have provided that this initiative be guided by public health goals and objectives written into a statute. We were very pleased to see the public health orientation adopted by the federal government for this initiative and the explicit articulation of public health objectives as codified in the purpose

section of the act, proposed

section 7. We encourage provinces and territories to adopt similar public health orientation and include explicit articulation of similar objectives in their statutes.

(0900) Last, we suggest that the bill be amended to replace the word “illicit” with the word “illegal”. The term “illicit“ is stigmatizing in nature, and since stigma and discrimination reduction are important aspects of this initiative, we suggest avoiding using the term “illicit” whenever possible. We suggest using the term “illegal” instead, as it is a simple, clear, and unambiguous term that refers to the legal status of possession of the substance and it avoids the stigmatizing nature of the word “illicit”. Thank you for your time and this opportunity. I look forward to our discussions.

The Chair :

Thank you very much for your addition to our report. Now we're going to go to Michael DeVillaer, assistant professor, policy analyst. The clerk is pointing out that we also have Mr. Kleiman, professor of public policy, Marron Institute of Management, New York, by video conference.

Mr. Michael DeVillaer (Assistant Professor, Policy Analyst, McMaster University, As an Individual) :

Mr. Chairman, committee members, I bring to this presentation 40 years of experience in the prevention and treatment of drug problems. I've been a counsellor, a community developer, a teacher and a policy analyst. I think my interest is really in drug policy broadly defined to include alcohol, tobacco, pharmaceuticals, and it's within that context that I view this new drug industry we are establishing. When we think about prevention of drug problems, we usually think of providing people with information to help them make informed decisions.

Another necessary part of an effective drug prevention program is development of a regulatory framework for drug industry practices. This is a critical part of what we mean when we talk about strict regulation. Alcohol, tobacco, pharmaceuticals, and cannabis are not ordinary commodities. Each year in Canada, alcohol and tobacco alone are associated with approximately 40,000 premature deaths, six and a half million days in hospital and a cost to the Canadian economy of over $30 billion. I want to emphasize that those are annual figures.

The alcohol and tobacco crises have been with us for a long time, so long we don't think of them as crises. Despite our efforts at prevention and treatment, they persist year after year. Recently a new drug epidemic has emerged. The opioid crisis began when a drug company aggressively launched a misleading advertising campaign for an opioid painkiller, oxycodone. The same company is now taking the same drug to the developing world with the same misleading information.

During the campaign to legalize recreational cannabis, Canadians have received repeated assurances that this new industry will be strictly regulated, like other legal drug industries, and that this will provide the needed safeguards of the public's health. A half century of international drug policy evidence tells us it is not so simple. Across our established legal drug industries, we see frequent failures in the striking of that important balance between industry revenue and protection of public health. The result is an enormous amount of harm that stresses our communities, families and treatment programs.

The state of the union is that we have three legal regulated drug industries and three public health crises. Early indications from the emerging legal cannabis industry suggest that it may be on a similar trajectory. Perhaps it is time for a new approach. Many of the decisions in the development of legislation require the striking of that balance, sometimes a choice, between facilitating the success of a new drug industry and protecting public health. The logistics of cannabis legalization, as I'm sure everybody is realizing now, are incredibly complex.

The stakes are high, outcomes uncertain, and caution is wise. Accordingly, I hope that the Standing Committee on Health will assign priority to the protection of public health and the prevention of harm. I will provide four specific suggestions for doing so. The first issue is a minimum legal age for cannabis use. Research shows that young people acquire their cannabis through their network of peer relationships. This is very important. The peer networks of young people, say 15- to 17-year-olds, are more likely to include 18- and 19-year-olds than they are to include 21-year-olds.

Consequently, over the long term, a minimum age of 18 or 19 will, as we've heard, give easier access to cannabis for 15- to 17-year olds than will a minimum age of 21.

(0905) My first recommendation is that the government should choose public health protection over a larger legal market by setting a minimum age of 21. The second issue is the importance of a full ban on advertising and other forms of product promotion. Research shows that advertising increases use of a drug and that increases in use of a drug are associated with increases in related problems. Advertising, even with strict limits, will increase cannabis use and related problems.

My second recommendation is that the government should choose public health protection over market growth by legislating a full ban on all forms of cannabis product promotion. The third issue is the importance of a non-profit model or options for cannabis supply. We already have three legal, regulated, profit-driven drug industries which have not succeeded in protecting public health. We can reduce the risk of creating a fourth by removing the profit motive from cannabis sales.

An essential difference is that a non-profit retail model would serve only the existing market, with no product promotion or product innovation intended to increase the size of that market. My third recommendation is that the government should choose public health protection over market growth by restricting the retail of cannabis to a non-profit organization with public health governance. The fourth issue is the importance of social justice for prevention and treatment.

Between now and the widespread availability of legal recreational cannabis, which will require an amount of time well beyond July 2018, people are expected to continue to “just say no” to the use of recreational cannabis. It is unrealistic to expect that to happen. Charges for simple possession of cannabis amounted to well over 17,000 in 2016. Issuing of more criminal records will continue to have a devastating impact on the social determinants of health of these mostly young Canadians. Prohibition also poses a problem for those who are dependent on cannabis and are seeking treatment to improve their lives.

In my experience as a counsellor, I never encountered a patient who was helped by a criminal record. It actually impeded their efforts. My fourth recommendation is that the government should immediately decriminalize possession of small amounts of cannabis. Mr. Chair, that concludes my prepared statement. Thank you again for this opportunity. I will do my best to address any questions committee members may have.

(0910) The Chair :

Thank you very much. Now we're going to Mark Kleiman, professor of public policy at the Marron Institute in New York, by video conference. Professor Kleiman, the floor is yours.

[ Translation ]

Mr. Mark Kleiman (Professor of Public Policy, Marron Institute of Urban Management, New York University, As an Individual) :

Good morning, ladies and gentlemen. [ English ] It's a great honour to have been asked to address this distinguished body as part of this genuinely historic process. I've been working on cannabis policy for almost four decades now. My firm was the adviser to the Washington State Liquor Control Board as it implemented Washington's cannabis legalization. I would urge you in this process to pay attention to results, not slogans. The case for the legalization of cannabis is not its lack of risk, as we've heard from the other witnesses this morning.

The case for legalization is the inability to control the illicit market and the harm the illicit market does and the fact that lots of people would like to use cannabis and can, in fact, do so harmlessly. There is a tendency in public policy debates and in policies themselves to lurch from one extreme to another. At least in the U.S., we're in the process of lurching from considering cannabis an evil weed to considering it a harmless herb. Unfortunately, each is an imprecise characterization.

For almost any drug, the majority of the users of that drug do so harmlessly, and indeed, with some benefit to themselves. That's what keeps them using it. A minority wind up losing control of their consumption and engaging in problematic use. Tobacco in the form of cigarettes is the one exception to that, where most of the users engage in problematic use. That minority of heavy users, however, accounts for not only almost all the damage involved with the use of any drug but for a large majority of the consumption of that drug.

I don't have the numbers for Canada, but in the U.S., more than half of all the alcohol consumed is consumed as part of drinking binges, even though most drinking occasions are not to intoxication and are harmless. Eighty per cent of the alcohol consumed in the U.S. is consumed by people who drink more than is good for them. We see comparable numbers with cannabis. The goal of legalization, I suggest, ought to be the availability of cannabis to those who want to use it temperately while minimizing the number of people who get in trouble with it; so, access without excess.

As we've heard from others this morning, that is not a goal that is automatically served by a free market, because that same 80-20 rule that drives public health concerns—as I said, 20% of the heaviest users are going to do themselves most of the damage—also drives marketing concerns. If you are in the business of selling a drug that some people become addicted to, they are your best customers. What from a public health point of view is a diagnosis, from a marketing point of view is a target demographic.

That's equally true whether you're British American Tobacco or Imperial Distillery or the Ontario liquor board. If your goal is to maximize the amount of money you make, you're going to focus on cultivating heavy users, and that's precisely the opposite of the public health objective we ought to be serving. There's a widespread belief that we should regulate cannabis like alcohol, as if we've been successful in regulating alcohol. That seems to be an obvious fallacy once you have stated it.

I think it would be wiser, if we're going to imitate some currently illicit market, to imitate the tobacco market, where, short of prohibition, the government makes aggressive efforts to minimize problematic use. That's a policy regime I've called grudging toleration. It seems to me that we ought to be grudgingly tolerating cannabis and not allowing its promotion.

(0915) A key element in promoting or controlling heavy use is price, again, as has been noted. It's important to understand that the natural tendency of the price of cannabis as a legal commodity is toward zero. A joint is a small amount of dried plant matter in a wrapping. The legal product that's closest to that is a tea bag. If we allow a free market in cannabis, the price of a joint will tend toward the price of a tea bag, and that's not where we want it to go. We already see in Colorado and Washington steady and rapid decreases in prices in the legal stores.

My colleagues Jon Caulkins at Carnegie Mellon and Steve Davenport at RAND Corporation estimate that Colorado and Washington legal prices are falling at 2% per month and there's no bottom in sight. The way to counteract that, if you're not going to have a public monopoly, is with aggressive taxation. That cannot be taxation based on retail price, because as the retail price goes to zero, the tax will go toward zero. The right way to tax cannabis, from a policy point of view and a health point of view, is to tax the active agent, THC. We need a specific excise, not an ad valorem tax. It should be substantial.

Something like $50 a gram of THC would more or less maintain current illicit prices in the newly licit market, and that seems to me a reasonable objective. Information is another key element of any prevention policy where we're trying to prevent a substance use disorder. Restricting marketing seems to me a very important idea, not merely because the advertising itself will attract new users, as it's intended to, but because the presence of advertising dollars will influence the editorial content of advertising media.

It's striking that in the U.S., the first mass-market magazine to warn about the dangers of tobacco smoking was Reader's Digest . It wasn't because it was the most progressive or intellectually adventurous magazine; it was because it was the only one that was supported by reader subscription rather than by advertising. Controlling cannabis marketing will have a big impact on the way cannabis is described in editorial content. Every cannabis buyer has to confront some seller, either somebody taking an order over the phone or a clerk in a store.

That point-of-sale contact is the one place where we can make sure of connecting with every consumer. It seems to me that it would be wise to require those people to have training in pharmacology and in substance use prevention so that people, particularly new consumers, aren't getting their first information about cannabis from somebody who sells cannabis for a living and is frequently a very heavy user themselves. Those retail clerks ought to have a professional qualification and a professional obligation to give advice in the interests of the consumer and not in the interests of the store owner.

They ought to be more like pharmacists than packaged goods clerks. There are two things we might want to encourage both at that point-of-sale and in publicly funded information. One is the notion of use to less than intoxication. The striking difference between cannabis today and alcohol today is that most occasions of alcohol use are not to intoxication. That is not the case for cannabis. “Getting stoned” is a common synonym for cannabis use.

It is possible that we might introduce to the population the notion that one might take a puff in order to improve the taste of food, or the sound of music, or the pleasure of conversation rather than having cannabis intoxication as the primary activity one is engaging in. I have no reason to think that this will work, but it's something we could try.

(0920) The other thing I'd like to see emphasized, both at point-of-sale and in mass media, is the importance of abstaining from combination use. Forty years ago in the U.S., cannabis on the one hand and alcohol and tobacco on the other were virtually opposites socially. They represented different cultural forces. Now in the surveys, heavy tobacco use, heavy alcohol use, and heavy cannabis use are all the same population. Through cannabis legalization, one beneficial possibility is that you could substitute for other more dangerous drugs. We undertake policies to encourage that possible beneficial tendency. Thank you.

The Chair :

Thank you very much. Now we'll go to our question period starting with a seven-minute round of questions. We're going to start off today with Mr. Ayoub, who is fresh off a town hall meeting on cannabis.

Mr. Ramez Ayoub (Thérèse-De Blainville, Lib.) :

Exactly, Mr. Chair. I'm going to ask the question in French. You may want to use the earpieces if you need a translation. [ Translation ] Mr. Chair, I just participated in a town hall meeting last night in my region. More than 150 people came to get information. The facts are troubling. Before I tell you about it, I want to point out that I'm very impressed with the panel we have with us this morning. It includes experienced people from various areas of activity.

In my riding of Thérèse-De Blainville, north of Montreal, in the Lower Laurentians, 45% of youths 17 to 24 years of age admit to having used marijuana in the past year. The average for Quebec is 35%. In the case of youths 11 to 17 years of age, that percentage is 28%, while the average for Quebec is 24.9%. Yesterday wasn't a cry of alarm, but I said it was urgent to act. This morning, that urgency is even stronger.

With all due respect to my colleagues opposite, who want to delay things, it is clear that all the approaches that have been taken over the past 100 years have been a dismal failure in terms of preventing cannabis use among young people. The consequences, of which we are speaking at length, are serious. It has been pointed out in particular that the brain continues developing until the age of 25. Yesterday, I was informed of some of the issues that you also raised. For me, the important issue isn't the money, but prevention and the health of our young people.

But we are urging them to turn to the illicit market and organized crime. These aren't just dealers of cannabis, but of other drugs as well that we want our young people to experiment with even less. The age issue concerns me. If it is decided that, for medical reasons, the required age should be 25, that isn't a problem. In fact, we all agree that using has consequences. However, we seem to be forgetting that, as of age 18, young people are given the responsibility of voting for representatives like us, who pass laws.

Are we going to tell them that they have the right to vote, but that they don't have enough social conscience to make an informed choice for their own health before the age of 21 or, in other cases, the age of 19 or 25? I don't understand the logic of that. Each province is independent in its choice of age. There is a difference between alcohol and cannabis, but are we going to do it for each product that will eventually be on the market? That said, I would like to hear from the nurses. I quite enjoyed Mr. De Villaer's speech. I almost fully agreed with you, although a little less on the age issue.

I would like to know a bit more about these kinds of issues. In terms of the market price, on the street, we were talking yesterday about $20 for 3.5 grams. Price is an important factor. If we offer prices that aren't consistent with the market, we won't change anything. I have used up four minutes, but I can tell you that the last night was very informative. I would like to hear your comments on the age issue, the logic around it and the related consequences.

(0925) [ English ]

Ms. Karey Shuhendler :

Thank you for the question. The Canadian Nurses Association approaches the question of age from a harm reduction perspective. For all of the things that have been discussed over multiple days, as we've been hearing, we feel that they need to be very carefully balanced.

We do recognize that brain development continues to occur until age 25, according to the research, and that there are harms associated with cannabis use, but as we've heard just now and throughout the preceding days, we recognize that setting an age too high could continue to leave the people in Canada who use cannabis the most at highest risk from the harms of the illicit market. That includes the crime associated with purchasing in an illegal market and the harms associated with an unregulated product when you don't know the potency or the safety of what's in there.

Instead of on the age itself, we really think that the emphasis needs to be on educating all members of the population, especially vulnerable people or, potentially, the highest users, by developing education and involving all stakeholders so that you can have a conversation with youth, it's not a paternalistic approach, and they know of the harms and can make an informed decision.

Ms. Lynda Balneaves :

I'll just add to that. It's well established—the stats are well known—that Canada's youth are among the most prevalent users of cannabis around the world. By raising the age, we're potentially still keeping our cannabis use a very “hidden in the shadows” health behaviour. We need to have youth being able to go to health professionals and to talk about their use, to talk about the problems associated with it, and to receive the appropriate education and the referrals to harm reduction programs in order to address problematic use.

We also need to be able to open the dialogue with our youth about the potential harms, many that they may not be aware of. We've seen research that suggests many youth begin to use cannabis in social settings. They see it as almost a social lubricant. They don't associate harms with it. They may not be aware of what the long-term harms are that are related to career and educational attainment, as well as the cognitive development issues and the mental health issues that have been raised by other panellists today.

We need to make sure that we're opening that dialogue and being respectful of youth's ability to make decisions around their health care behaviour.

Mr. Michael DeVillaer :

The only point I would add is that there's something I've found we hear a lot and I find a bit strange. We frequently hear the comment that it's easier for young people to get cannabis than alcohol and tobacco. The reality is that the studies say exactly the opposite. Specifically, I'm talking about the Ontario drug use and health surveys that the Centre for Addiction and Mental Health does now. They've been doing these surveys for 40 years. They know what they're doing with this. Their data show that underage people report that it's easier for them to get alcohol and tobacco than it is to get cannabis.

The reason is that their peers of legal age are their suppliers. In other words, if you're 18, you can get alcohol and tobacco from your 19-year-old peers, but your 19-year-old peers don't have legal access to cannabis, so it's not so easy. I think this is an important part. We really need to look at the data when we hear comments that get people excited and worried. I'll leave it at that.

(0930) The Chair :

The time's up. Ms. Gladu.

Ms. Marilyn Gladu (Sarnia—Lambton, CPC) :

Thank you to all of our witnesses today. I agree with what my colleague across the way has said, which is that young people are smoking cannabis. Whether it's legal or illegal, they're smoking it, so we certainly shouldn't be in a rush to worry about whether it's legal or not. What we should be doing is trying to prevent harm. We've heard over three days this week a consistent message that the key to getting young people to not smoke cannabis is public education, public awareness, and training for them similar to the effort that was done with tobacco, to change public opinion to “grudgingly tolerating”.

I liked that phraseology. That is definitely what's needed. In the two years since the Liberal government announced they were going to legalize cannabis, that public awareness campaign has not appeared. Certainly, that's something that needs to be a priority, but we did see pockets of excellence. We had testimony yesterday from individuals who have brought forward training for parents. I understand, Dr. Melanson from New Brunswick, that you did some public awareness training. I was wondering if you could expand on what your experience has been in Moncton.

Dr. Serge Melanson :

Thank you, Ms. Gladu. Essentially, my first-hand experience as an emergency physician for the past 14 years has been recognizing an exponential increase in the usage of cannabis in patients presenting to the emergency department. Really highlighting your point on public awareness, one of the things I brought up in my address earlier was this concept of a medical condition that's only now starting to become recognized and studied. It's referred to as cannabinoid hyperemesis syndrome or cyclical vomiting syndrome.

This is a condition where mostly young people, young adults, will present themselves to the ER department after days of uncontrollable vomiting, not knowing themselves what the cause might be. After an extensive panel of medical tests are conducted and we conclude that there is nothing medically or organically wrong with them, we then begin questioning them a bit more thoroughly on their use of cannabis and discover, quite often, that they are using cannabis on a fairly regular basis. They themselves often believe that they are well-informed in regard to the harms of this drug.

When we educate them on the likely association of their cannabis use and the cyclical vomiting syndrome, they're often quite surprised. When we provide them with additional information and counselling on how to abstain from cannabis use, we often see this debilitating condition essentially disappear. I think that speaks very much to your point that, as much as people may believe they are aware of the health risks associated with cannabis, there needs to be a more focused effort on providing more relevant and important information to the consumers of this drug.

Ms. Marilyn Gladu :

Very good, thank you. Picking up on one of your points, I would say that potency has been raised as a big concern. The cannabis of today is much more potent than previously. I think it was the nurses society that said it wanted to see really good control over the quality, the dose, and the potency that people are getting. Another way of protecting the public from things that are not well controlled is to get rid of one of the suggestions that's in Bill C-45 , which is to allow home growth.

Home growth has absolutely no quality control on the product, on the potency, on any of these things, and also provides easier access for children. I wonder if the Canadian Nurses Association would like to start, and then we'll let everyone comment on whether they think allowing home growth is a good idea.

(0935) Ms. Lynda Balneaves :

The risks posed by homegrown cannabis mirror some of the risks that we have associated with access to alcohol, tobacco, and pharmaceutical drugs in the home. Again, it really points to the need for public education related to the potential harms of cannabis, particularly to children who may consume it unaware of those risks.

It really points to the need for regulation around self-produced cannabis in terms of the source plants or seeds that will be used as a way of limiting potency, limiting the number of plants and plant material that is available within the home, and ensuring that there's regulation related to storage, labelling, and the use of that product in an edible form that may be, again, more attractive to children. We support regulations related to safe storage and production.

Again, it supports the need for open and non-judgmental conversation between parents and children about what cannabis is, how it can be used safely, and why there are restrictions around use in people who are under the age of 18.

Ms. Marilyn Gladu :

I was really interested to hear about the statistics on what alcohol and tobacco cost us: 40,000 deaths, 6.5 million hospital days, and $30 billion annually. The conversation that we've been having is that we should legalize marijuana and treat it similarly to how alcohol and tobacco have been treated. However, this brings to mind that perhaps those things aren't a success, so perhaps we shouldn't be trying to mirror what was done there. Perhaps we should learn from those, and consider a raised age. One thing I would like to expand on is this idea of the non-profit-driven supply.

We heard this yesterday from our friends from Quebec. I think it was you, Dr. DeVillaer. How would that work in Canada? What do you think that would look like?

Mr. Michael DeVillaer :

It's a really good question. People have written about this. One of the popular models—and the group from Quebec, I think, is very much in favour of this—is something that is found in a number of European countries where they have small co-ops. These are user-run co-ops that pay their staff salaries, but there is no motive to expand membership in any way, no motive to get the current members to use more of the product, and these are key ways of preventing this from becoming a problem. I think people are familiar with co-ops.

There are a lot of people in communities who will join a co-op to get vegetables and so forth. It's really an extension of that very simple concept. The important thing I think it brings is.... All you want to do is simply serve the existing market and not expand it. What we know from decades of research around alcohol and tobacco is that the more you promote a drug through advertising, the more it's used, and the easier you make access, the more it's used. That's how you expand a market. The problem here is that as the market expands, so does the number of people who have related problems.

That's why market expansion is important. The only other point I'll make very quickly is that, again, we have had a very difficult time internationally, not just here in Canada, of regulating our legal drug industries in a way that they achieve that balance of industry revenue and protection of public health. It's much more difficult than most people think.

The Chair :

Professor Kleiman, you signalled a response.

Mr. Mark Kleiman :

If I may, on the age question, it's a very difficult question. It's certainly true that 16-year-olds get their supplies from 18-year-olds, so establishing an 18-year-old age limitation is going to increase use among younger people. It's also true that criminal records are catastrophic, but cannabis arrest is much more dangerous than most patterns of cannabis use. Here is a possible compromise.

In the U.S., states that vigorously enforce their law against direct sales from retailers to people under 21 experience reductions in alcohol use down the age range and in drunken driving down the age range, so that appears to be effective. That needn't be coupled with criminalization of possession or use by people under whatever the legal age is. If you enforce the law on the seller rather than criminalizing the buyer, I think you can get most of the benefit of the age restriction with relatively little of the cost.

(0940) Ms. Marilyn Gladu :

Very good, thank you.

The Chair :

Thanks very much. Mr. Davies.

Mr. Don Davies (Vancouver Kingsway, NDP) :

Thank you, Mr. Chair, and thank you to all the witnesses. Mr. Strang, I want to start with you. I want to quote from the final report of the task force on cannabis legalization and regulation:

Canada's governments, and many other organizations, will need to work quickly to prepare for the implementation of the new system, increasing or developing capacity in many areas relating to production, distribution and retail, quality control and enforcement, and research and surveillance. This increase in capacity will require new resources (human and financial), enhancements to existing institutions and the creation of new ones. Having all elements in place will be necessary for the proper functioning of the regime.

Some provinces are saying they'll have difficulty being fully prepared for the legalization of cannabis on July 1. Given that many of the capacities that I just mentioned will fall to the provinces, does Nova Scotia have any concerns in this regard?

Dr. Robert Strang :

I need to emphasize I'm not here representing the jurisdiction of Nova Scotia. I'm here representing the Council of Chief Medical Officers of Health. But I will say that, like many other provinces, we're working as hard and fast as we can through a complex situation. My last point is that we really need to understand that the current situation, where cannabis is illegal but there's a huge amount of use, is going to continue. If we delay the shift to legalization, it's not going to decrease use. It will actually continue the kind of grey zone we have now where the rules are very unclear.

My own opinion is that it won't be perfect, but the sooner we move to a legal framework, under which we can then start to work on the other pieces, will create clarity for Canadians, clarity for the health system, and clarity for our criminal justice folks.

Mr. Don Davies :

Dr. DeVillaer, you have recommended that the Canadian government immediately decriminalize possession of small amounts of cannabis. Why?

Mr. Michael DeVillaer :

The first thing is certainly the number—the tens of thousands—of Canadians who are continuing to receive criminal records. As someone has already pointed out, in the great majority of cases, these criminal records will do far more harm than the use of cannabis. This type of decriminalization can be done fairly easily, and it's been done. Canada is actually a bit of an outlier in this regard. There are 32 countries—the last time I looked—that have decriminalized cannabis; that is, they have stopped giving people criminal records for simple possession of small amounts of cannabis.

Even in the U.S. we hear so much about.... I think there are seven or eight states now that have either legalized or are in the process of legalizing cannabis. There are actually twice that number that have consciously decided to choose decriminalization over legalization. That's important. This is something that should have been done a long time ago. I wish it would have been done when this campaign began. I wish it would have begun when the idea was introduced to the House of Commons in June of last year by Murray Rankin .

There is a simple solution to this called the Director of Public Prosecutions Act, and it could be invoked to asked enforcement agencies and crown attorneys to cease and desist charging people with cannabis.

(0945) Mr. Don Davies :

Thank you. Ms. Shuhendler—

The Chair :

Just a second, Professor Kleiman has a—

Mr. Don Davies :

I'll be coming to—

The Chair :

He wants to respond to that question.

Mr. Don Davies :

Okay. Quickly, Mr. Kleiman.

Mr. Mark Kleiman :

This is a question on which I've changed my mind over time. I used to think that punishing users was an important way of suppressing illicit markets, and if that were true, I think I'd still be for it. I think the evidence now is that no country has created enough of a threat on users to substantially decrease consumption. The main impact of punishing users is merely to punish users. This is not merely for cannabis, but also for drugs that we keep completely illegal. I think the practice of punishing drug users is probably a mistake and ought to be abandoned.

Mr. Don Davies :

Thank you. I will be coming back to you, sir, with another question. Ms. Shuhendler, if I heard your evidence correctly, you said that the criminalization approach to cannabis has negative consequences. Is that correct? Did I hear your evidence correctly?

Ms. Karey Shuhendler :

We were speaking specifically to criminalization for youth, but yes.

Mr. Don Davies :

Does the criminalized approach have negative consequences for youth?

Ms. Karey Shuhendler :

Yes.

Mr. Don Davies :

You're probably aware that Bill C-45 retains a criminalized approach.

Ms. Karey Shuhendler :

Yes.

Mr. Don Davies :

It will continue to criminalize things like possession of over 30 grams and cultivation of over four plants. A 20-year-old selling to a 14-year-old would face potentially up to 14 years in prison. Will that approach continue negative consequences on youth, in your view?

Ms. Karey Shuhendler :

I think that's an excellent question. I think, for the purpose of our brief, in the surveying of our nurses across the country, we wanted to focus on the disproportionate disadvantage for decriminalizing for youth. We did not dive further into the excellent points that you raised, that we heard addressed earlier, a few days ago, by this panel. I think a criminalized approach can be dangerous. The role of nurses in this is really to focus on providing an open space for education, so the move toward legalization is definitely a way to do that.

Mr. Don Davies :

Thank you. Is it Dr. Kleiman or Mr. Kleiman? I'm not sure.

Mr. Mark Kleiman :

Mister, please.

Mr. Don Davies :

Okay. Mr. Kleiman, I don't know if I understood your evidence correctly, but I thought I heard you say when you were talking about the tax policy that you recommended the price of $50 per gram. Did I hear that correctly?

Mr. Mark Kleiman :

No, I'm sorry, I meant $50 per gram of THC. For ordinarily potent cannabis in the U.S., which is now about 20% THC by weight, it would be something like $10 per gram, which was the illicit price in the U.S.

Mr. Don Davies :

Thank you.

Mr. Mark Kleiman :

The goal ought to be to not have the price decrease.

Mr. Don Davies :

Thank you for clarifying that. I'll go back to Mr. Strang. I think you mentioned that the public health goal underpinning Bill C-45 is the idea of taking products out of the illicit—I think you prefer the term “illegal”—market. Is that correct?

Dr. Robert Strang :

Yes, the goal is to bring people into a legal market, but a legal market that is driven by the objectives of public health and public safety, not for profit.

Mr. Don Davies :

This legislation would not do that for edibles and concentrates and other products. In other words, on July 1, 2018, those products will still be in the illegal market without any regulation whatsoever on quality, packaging, on anything. We've heard evidence that somewhere between 30% and 60% of the products being consumed by people in North America are some form of creams or nasal sprays or tinctures, or edibles of some type. Would you agree that we should be moving expeditiously to bringing those products into the regulated market exactly for the public health and safety concerns that you mentioned, or should we leave it to the illegal market?

Dr. Robert Strang :

I don't disagree that we need to bring in edibles as part of this, but the world of edibles becomes very complex, and I think it's appropriate that we do this in a staged approach. There are enough complexities right now, as I'm sure you're well aware of from your hearings this week. We need to get through some of the other pieces and then grapple with the very complex area of edibles. Control of consumption, who uses them, workplaces, schools, etc., becomes very difficult, and that requires considerably more thought and policy conversation.

The Chair :

Thanks very much, Mr. Davies. Now we move to Ms. Sidhu.

(0950) Ms. Sonia Sidhu (Brampton South, Lib.) :

Thank you all for being here and sharing your valuable information. My question is for Dr. Melanson. We all know that in 2015 the highest use of cannabis in Canada was among youth, at 21%. Professor Kleiman said there's a huge amount used, no matter whether it's legal or illegal. My colleague did a town hall yesterday and shared the fact that 45% of youth are using now. I did a round table in my riding, and the number who are using has doubled. Dr. Melanson, you said in your statement that you saw a patient in the ER where cannabis was laced with another drug that was more dangerous.

It's life threatening for all of our youth. That is why our government, after extensive consultation with law enforcement, has introduced legislation to legalize, strictly regulate, and restrict access to cannabis. Don't you think this approach is better than when youths are taking laced cannabis? What is your thought about that?

Dr. Serge Melanson :

Ms. Sidhu, thank you for that important question. My reference to the lacing of cannabis was based on my historical experience with the fact that there is currently, as you know, no legalized market for cannabis. I would presume there would be some benefit in having this substance controlled from a safety standpoint, in terms of what additives or not are incorporated into it. I suppose that's also under the assumption that once this substance is legalized the illicit market will entirely evaporate, which I think may not be the case.

I'd also like to point out that there are other significant health risks to youth and young in particular. As you likely already know, the leading cause of death among young people and youth is trauma. We recognize that trauma, whether it be from a motor vehicle accident or high-risk behaviour, is often associated with either alcohol or an illicit drug, including marijuana use. This is also something I've seen substantially, despite seeing all the public awareness in 2017 around the use of alcohol and illicit drugs and high-risk behaviour.

To answer your question, I think there is the potential to see improvements in regard to the mixing of more potent toxic agents in cannabinoids as we see them today. Unfortunately, I don't think that will remove the risks to youth and young people in regard to what kinds of trouble they can get into.

Ms. Sonia Sidhu :

Thank you. My next question is for CNA. Our government made a historic investment of $5 billion throughout 2017 that can ensure mental health support for 500,000 Canadian youth. Mental health resources and research will benefit all Canadians. How will this specific area of funding and research support the government's goal to protect the health of Canadians and minimize the harms of illicit cannabis?

Ms. Karey Shuhendler :

Thank you for the question. Legalizing will remove a lot of the harms of illicit cannabis. On your question about the funding for mental health, that is an excellent investment. We applaud the government's investment in mental health services because they are necessary. There's always room for improvement as well, and as we said in our testimony and our brief, additional investment through either revenue from sales or enforcement savings should go into mental health programs and substance use prevention and treatment programs.

I think that while the $5 billion is a great investment and indicates that there is a need for additional mental health services in Canada, there should be additional money taken from the legalization of cannabis to invest in mental health.

Ms. Lynda Balneaves :

Just to add something for information's sake, I'll be meeting with the Canadian Institutes of Health Research on Monday in Montreal. There will be researchers from across the country who will be discussing the CIHR priorities in cannabis research and the use of non-medical cannabis in Canada, and so there will probably be additional funding specific to research that will look at the social as well as the health effects of non-medical cannabis use following legalization.

(0955) Ms. Sonia Sidhu :

Thank you. My next question is for Dr. Melanson again. How do you see the role of health care practitioners, non-profit educators, community organizations, and other non-governmental organizations providing public education for youth on cannabis? I also applaud the work you are doing for public education, especially on healthy eating for kids. What do you think about public education for youth on cannabis?

Dr. Serge Melanson :

Again, it's about utilizing tools that youth and young people access. Here in New Brunswick—we're the New Brunswick Medical Society—we use electronic formats and also traditional means of getting the message to them that despite the legalization of cannabis there is still some degree of risk in using it. As the other panel members have mentioned a number of times, an informed decision, understanding all risks, is what is key when using legalized marijuana. That is the staple of the message we have provided to the citizenry in New Brunswick thus far.

I would also point out essentially that the educational campaign would need to be sustained, and not simply reflective of what is going on currently, and that a comprehensive strategy between provinces and across the country likely needs to be adopted, to make sure that the message that our young people in particular are receiving is consistent. We don't want to be sending mixed messages.

Ms. Sonia Sidhu :

Thank you. My next question is for Dr. DeVillaer.

Mr. Michael DeVillaer :

Mr. DeVillaer, please. Thank you.

Ms. Sonia Sidhu :

Mr. DeVillaer, Bill C-45 proposes very strict regulation of labelling, advertising, and marketing at the outset of legalization,

whereas alcohol, pharmaceutical, and tobacco products all entered the legal market with much more relaxed regulation. Do you think this will make a difference in our ability to protect public health?

Mr. Michael DeVillaer :

I think there are some positive aspects of Bill C-45 arising from the task force report. For example, it looks as if the direction we're going in is that advertising for cannabis products will only be allowed in places frequented by adults. That would include cannabis retail outlets, perhaps alcohol retail outlets, gambling casinos, maybe in promotions before adult-rated films. There are a number of possibilities there.

I think that presumes that only young people are affected by advertising and marketing, and yes, absolutely we should be trying to do everything we can to prevent marketing advertising reaching young people. We're still not doing it with alcohol, for example. Alcohol advertising is everywhere you look these days, and there's no way of shielding young people from that. Adults will still be exposed to advertising, and we should be very careful not to underestimate the power of that industry to influence behaviour.

Remember, this is the industry which back in the 1960s convinced everybody that smoking these dried leaves in paper would make you more successful socially, and romantically, and career-wise without doing any harm to your health. Half the adult population bought it. I think we're more sophisticated these days than we were back then, and that will help, but adults are still very susceptible to advertising. Advertising works. Public health has been making this statement for a long time now, and we see it's beginning to have an impact.

We see prominent health journalists, André Picard, for example, writing about the way alcohol is so aggressively promoted and advertised. Even within the advertising industry, Terry O'Reilly is an icon in the Canadian advertising industry, and he was recently making some comments in his programs about the way in which alcohol is very aggressively targeted toward women. CAMH data shows that alcohol use among women is increasing just as it is among men. This is why I proposed that we really do everything we can to completely ban advertising of all kinds. Plain packaging is very important.

I'm glad to see that being talked about. With regard to retail outlets, one of the things I would like to see is a plain packaging approach to retail outlets as well, because of the principle that a pack of cannabis or whatever, as with cigarettes, is an ad. Every time somebody pulls it out, it's an ad. Plain packaging minimizes that to a significant degree, and I would like to see that same thinking applied to retail outlets as well.

(1000) Ms. Sonia Sidhu :

Thank you.

The Chair :

That completes our seven-minute round. We'll go to a five-minute round starting with Mr. Webber.

Mr. Len Webber (Calgary Confederation, CPC) :

Thank you, panellists. Dr. Melanson, I find it interesting your talking about cyclical vomiting syndrome and how you attribute that to marijuana use, yet people going through chemotherapy and having nausea issues tend to go to marijuana to eliminate the nausea. I find it interesting that it affects some people one way and some people the other way. Do you have any comment on that at all?

Dr. Serge Melanson :

It's a very excellent question, Mr. Webber. I think that really underlines our lack of understanding of what the scientific value of cannabis truly is and its perhaps beneficial or harmful effects. You quite accurately pointed that out. Also, as a practising physician, I myself will often encounter patients who will give testimonials to the effectiveness of cannabis with reducing nauseousness; yet during the same work shift, I will perhaps encounter a young person who is in the midst of a cyclical vomiting syndrome.

To be quite honest, the medical literature is not clear on what the physiological reasons for that are, which I think should give us great pause in regard to whether we are going to expect the increased usage of this substance in our communities and not fully understand its medical implications or health implications. I think it really underscores the importance that research will play going forward in regard to studying the effects not only from a population-based standpoint but also from a medical physiological standpoint. We need to make sure that is heavily promoted.

Otherwise we will continue to operate in the dark, as it were, regarding the true effects of this substance on one's health.

Mr. Len Webber :

Thank you for that. I agree. Mr. Kleiman, I have a question for you. You mentioned that you were quite involved with Washington state and their legalization process. Is it Washington state that did not allow home cultivation? Is that true?

Mr. Mark Kleiman :

That is correct. Washington allows home cultivation for people with medical recommendations, but not for people who merely want to use it for non-medical purposes. That contrasts with Colorado, which does allow homegrown.

Mr. Len Webber :

It's Colorado that allows homegrown for recreational use. Is that—

Mr. Mark Kleiman :

Yes. They've had a big problem with people who want cannabis to be sold out of state using a chain of people purportedly home growing as a cover for illicit cultivation, essentially. I was a big fan of home growing to start with, based on the theory that you shouldn't push people into a market for something that they could do for themselves. I think it turns out that the regulatory problems around home growing were harder than I thought they would be. Therefore, the Washington approach now looks more sound than the Colorado approach.

Mr. Len Webber :

Do you see Colorado going down that road because of the problems eliminating home cultivation?

Mr. Mark Kleiman :

I know they're moving toward restricting the number of plants. A cannabis plant can produce a wide variety of amounts, but if you allow people to grow six plants, they can produce a fair amount for export.

Mr. Len Webber :

Thank you. I'd like to get the thoughts of others as well with regard to home cultivation. I'll start with Robert Strang. What are your thoughts on home cultivation?

Dr. Robert Strang :

I have two thoughts. It certainly creates a number of problems around continuing to normalize cannabis as totally socially acceptable. In Nova Scotia, we have had meetings with owners of rental properties and there are a number of substantive and real concerns, from their perspective as property owners, about tenants who are growing and the impacts on multi-unit dwellings. However, I also think we have to be realistic. People are going to grow cannabis whether we say it's legal or not, so that becomes a bit of a conundrum around enforcement. Overall, I think it would be better to have cannabis produced, bought, and sold through a well-regulated legal market and minimize other sources.

(1005) Mr. Len Webber :

Ms. Balneaves.

Ms. Lynda Balneaves :

Related to homegrown, I just want to share some research. We've done the national survey of people that are using cannabis for medical purposes and there's been an overwhelming sense that people that have been exposed to self-production prefer that as a route for their medical use because they have control over the product, for one. Many of them are quite good amateur botanists, in terms of developing a product that is able to address the symptoms or health conditions that they're using it for.

It also allows them to have ready access to their medication versus waiting for it through the mail system that currently exists. Again, it goes back to my point about the importance of regulating home grows, so that we ensure the safety, not only for the people within the home, but for their neighbours and for the larger community. I also want to make a quick comment on your comment around hyperemesis syndrome. I just want to point out that the legal status of cannabis has made it very difficult, as a researcher, to actually conduct research on cannabis.

In order to actually do a clinical trial of cannabis, it can take up to two to three years in order to gain approval through Health Canada to gain access to the actual substance. Many of us in the research community are quite excited by legalization because hopefully, it will open the door to the much-needed research that needs to take place.

Mr. Len Webber :

That's interesting.

The Chair :

Your time is up. Now we'll go to Mr. Oliver.

Mr. John Oliver (Oakville, Lib.) :

Thank you for your testimony this morning. Mr. DeVillaer and Dr. Melanson, I want to go back to age limit and the advice you gave. I totally understand the health lens you've applied to this and the recommendation that the age limit be set at 21. I want to do a really quick backdrop for you, because you are speaking to a federal act and not a provincial act right now. Federally, the definition of youth is 12 to 17 years of age.

You would be charged and convicted, if you were under 17, under the Youth Criminal Justice Act, and your name would be kept private and the record would be sealed or destroyed after set time frames. Federally, at the age of 18 you would be charged as an adult, and if you were convicted, you would have a criminal record that's a public record. If we took your advice federally and moved the age limit to 21, then 18-, 19-, and 20-year-olds would be subject to criminal charges and would have public criminal records.

I think the intent of the federal legislation is to protect adults from that, so people 18 and over would be legally allowed to possess cannabis up to a certain amount. It's a minimum age, so provincially or territorially, they could go to a higher age. They could say 21, and in that case, 18-, 19-, and 20-year-olds who were caught in possession of marijuana would be charged under the provincial charges acts. It's a fine, a ticket, or a seizure. There would be no criminal record. Think ticketing or liquor licence charges. It seems to me that this is a better solution.

Is your advice of 21 really aimed at provincial-territorial age limits, or is it really your belief that the health consequences for 18-, 19-, and 20-year-olds are so extreme that they should be subject to criminal charges at the federal level? Given that view, do you think the advice at the federal level is still correct, that it should be 21 before we legalize it?

Dr. Serge Melanson :

I'll say a few things. Mr. Oliver. On your point that the New Brunswick Medical Society and I take a view of this through the lens of health care, that is essentially the lens through which we view most things. Your points on the legal ramifications, however, are very well taken. I'd like to point out a few things you've brought up, the first of which is that I think the scenario you've laid out would seem entirely reasonable, as long as our provincial jurisdictions are under the same understanding and exert that same degree of responsibility when applying their legislation.

Second, in regard to the balance of criminality versus the health care risks, we've heard from a number of panellists here today on potential compromises or options that could be struck. I would like to point out, however, that the demographic you laid out, 12 to 17 and then 18 to 21, unfortunately also tends to be the demographic in which we very much see the first episodes of significant mental health problems.

(1010) Mr. John Oliver :

Just to be clear on the demographic, the federal definition of youth is 12 to 17. Eighteen-year-olds and older are adults.

Dr. Serge Melanson :

Agreed. I'm trying to point out that this demographic also represents, from a health perspective, the demographic in which we see major mental health problems first begin. I think the medical literature is quite clear.

Mr. John Oliver :

I understand the health consequences. I'm coming back to your advice to this committee to move the age limit for legalization to 21 versus giving that advice to your Province of New Brunswick or the Province of Ontario. Understanding the health risk, I think the committee has heard lots about that. I'm trying to get right to your advice. Do you want the committee to change the age limit to 21? Is that still your advice, given those criminal charges consequences?

Dr. Serge Melanson :

As you've pointed out, yes. We stand very strongly on the age of 21 and would not be prepared to lower that for fear of the health implications. As you also pointed out, it would seem as though there are legal abilities to get around the criminality, as long as the local and provincial jurisdictions were able to co-operate in doing so.

Mr. Michael DeVillaer :

My view is that this is part of the reason I supported decriminalization as the first—

Mr. John Oliver :

I have one other question. Decriminalization doesn't deal with the black market. It doesn't deal with the right to licence and regulate the production of marijuana. It leaves the country in a much more difficult state. We're really dealing with legalization in this bill, not decriminalization.

Mr. Michael DeVillaer :

Yes, I understand. Let me clarify what my suggestion is. I'm not suggesting decriminalization replace legalization. I'm proposing that as a first step, which will then offer a lot of benefits to making legalization simple. I say let's decriminalize; let's make this a little simpler, and then proceed with legalization as we're doing it. I think there's a popular expression in emergency medicine, “First stop the bleeding.” The bleeding in cannabis law reform are all these young people having their futures compromised with criminal records. Let's fix that, and then take our time working on legalization.

There are no recreational cannabis emergencies. We should take as much time as we need to get this right.

Mr. John Oliver :

Thank you for that.

The Chair :

Your time is up. Dr. Carrie.

Mr. Colin Carrie (Oshawa, CPC) :

Thank you very much, Mr. Chair. I appreciate my colleague, Mr. Oliver's, questioning. It bodes the question, and maybe I'll ask Dr. Melanson this one. Why wouldn't we simply decriminalize up to 21, then make it legal over 21? Do you think that might be a solution? Make it a ticketable offence, because nobody wants to see a youth have a criminal offence that follows them through their life. With what we've heard through testimony, maybe that's not even practical right now, but why wouldn't we decriminalize up to age 21 and just make it legal over 21? What are your thoughts on that?

Dr. Serge Melanson :

From a legal standpoint, I think that sounds perfectly reasonable. We would have to make sure that the messaging to our young people, young adults, which is also being lost in this discussion, is that by setting the age we are also taking into consideration the legal ramifications but are not condoning the use under that age. Your point is well taken, and I think it's worth the merit you've suggested.

Mr. Colin Carrie :

I want to thank the witnesses today. I am a little frustrated, because the Liberals are rushing this through. I think you are quality witnesses and I like to hear from you, because this is transformational. We all realize there's no other country that's really gone this route. It's a big experiment. It's complex. What we've heard from most witnesses, even though people are anxious to get it through, what's more important is getting it right. We take your point well where you say government's responsibility is to protect its citizens, particularly the youth.

Because this is a panel on prevention, treatment, and low-risk use, I want to get back to that topic, so I think I'll ask this question again, and it's for Dr. Melanson, and maybe Dr. Strang. The government's had two years to invest in public ad campaigns that raise awareness about cannabis. They've had two years to set up a data system for collection of data, also ongoing data collection. They've had two years to set up research. They've had two years to figure out how to bring people who are having problems with addiction into treatment modes. They've had two years for education.

What we want to do is make sure we get this approach right to protect particularly our youth. Do you think the government has missed two years of raising awareness on this issue, and do think that waiting until after it's legal is the wrong and unsafe approach? Dr. Melanson, I'll start with you and get your comments on that.

(1015) Dr. Serge Melanson :

Thank you again, Mr. Carrie. I agree with certain [ Technical difficulty—Editor ]

Mr. Colin Carrie :

Wow. We finally had a witness who agreed with me.

Voices: Oh, oh!

The Chair :

Dr. Melanson, I don't know if you can hear us or not, but we've lost you. Can you hear us?

Mr. Colin Carrie :

Well, Dr. Strang, maybe you could agree with me partially.

Dr. Robert Strang :

I'm one of the senior officials from Nova Scotia on the FPT senior officials working group that has been working for over a year. From the outset we have been putting forward the need for a robust conversation with Canadians around cannabis and around the coming changes in the legal status of cannabis. There certainly is a lot more work to do on that, and it has been somewhat slow. I do need to make a comment, though, that we're spending a lot of time talking about education and social marketing campaigns.

Those are necessary, but frankly, and the example of tobacco was used earlier, we have not reached the levels of tobacco use in Canada from education and social marketing campaigns, from telling people about the risks of tobacco. We have reached those levels because of using other policy levers around price, significantly limiting advertising of tobacco, and moving forward on smoke-free places and other pieces.

My point is that while we do need social marketing and education campaigns—those are necessary—but if we actually don't control access and price and advertising those things, then all those social marketing campaigns will be a waste of money.

Mr. Colin Carrie :

I take your point because you mentioned we do need a comprehensive strategy, because that is my point. We're 290-odd days out if the Prime Minister is going to keep this promise. It appears to me that with the federal government, with this bill and with the announcements they've made, none of the resources that are required have trickled down to the provinces and territories to help set up data collection, research, treatment, and education, which are part of the comprehensive approach. I'd like to maybe ask—

The Chair :

I think we should go back to Dr. Melanson. I'll ask him to finish his answer.

Mr. Colin Carrie :

If he's there.

The Chair :

Dr. Melanson, you're back.

Dr. Serge Melanson :

Yes, I'm back. Sorry for the technical difficulties. I will be very brief. I wanted to point out that our experience here in New Brunswick has been, as you pointed out in your question, that the medical societies have needed to take a leadership role in this over the past year or two, and I would hope that our local governments as well as the federal government will be quick to catch up to the work that we're attempting to do in educating our public. We've needed to do this from a leadership standpoint because there seems to have been a bit of a vacuum in regard to getting the word out sooner rather than later.

Mr. Colin Carrie :

With this approach, this panel, as I said, is about treatment, prevention. We keep hearing that if a young person 12 to 17 possesses over five grams, they can be criminally charged. If an adult possesses 31 grams, they can be criminally charged. Maybe I could go across the panel. Do you think there should be a decriminalization amount? I would start with the nurses.

The Chair :

We have to have a quick answer here. We're over time, so just give us a brief answer.

Ms. Karey Shuhendler :

The CNA does think that decriminalization is a strategy to help to reduce harms of related substance use.

Mr. Michael DeVillaer :

Yes, I think 30 grams is a reasonable amount, and that anything over that might be subject to something more than just confiscation, but not a criminal record.

The Chair :

Okay, we have to end it there, Dr. Carrie. We'll move to Dr. Eyolfson.

Mr. Doug Eyolfson (Charleswood—St. James—Assiniboia—Headingley, Lib.) :

Thank you, everyone, for coming. Dr. Melanson, we share a common professional background. I'm a recovering emergency physician from Winnipeg. I practised for 17 years there. One of the things you said about what we have to be prepared for, and correct me if I misunderstand, is you predicted that we would be seeing increased use of cannabis after legalization.

(1020) Dr. Serge Melanson :

Thank you for the question, Dr. Eyolfson. My understanding from other jurisdictions is that by decriminalizing and legalizing cannabis, those districts have seen increased reported use of cannabis, whether that actually translates in actual usage.... But I think the evidence would support that districts that have done so have increased the reporting of the use of cannabis.

Mr. Doug Eyolfson :

All right. The reason I ask is that we had some testimony from Washington and from Colorado that actually said the opposite. They said that there was a brief increase, but that was transient and that, particularly around young people, the use among young people several months afterwards plateaued back to pre-existing levels, which were very near the national average. One of our witnesses from Colorado suggested that the latest numbers show that it had actually gone down about 12% among young people since legalization.

Dr. Serge Melanson :

That's interesting. In fact, that probably would give me pause to go back to my own references, which I'm afraid I don't have available, but perhaps I would defer your questions to the other members of the panel who have, perhaps, a bit more experience and may be able to reference their experience in other jurisdictions, as well.

Mr. Doug Eyolfson :

Mr. Kleiman, working in the American system, what are the statistics that you're familiar with, particularly with Colorado and Washington?

Mr. Mark Kleiman :

We need a number of clarifications here. I'm sorry. Both Colorado and Washington had wide open cannabis sales under the medical guise before they formally legalized for non-medical use. At the beginning of their legal full commercial availability, prices in the “recreational” stores were much higher than prices in the medical outlets. So the primary consumers in the early days of legalization, both in Washington and in Colorado, were out-of-staters and a few respectable people who didn't want to go to a physician and get a phony medical recommendation.

The price decrease that we've now seen is not reflected in the data that's being quoted. On a national basis in the U.S., adult use, heavy use of cannabis has soared over the last two decades so that we've now gone from about a million people who are heavy daily users to nearly eight million people who are heavy daily users, but all of that increase has been among adults. The adolescent numbers have been absolutely flat. What explains that stability in adolescent use is an interesting question.

One hypothesis is that the decrease in tobacco use among adolescents, which is correlated with cannabis use, is pulling cannabis use down with it. I think the answer, both in Washington and Colorado, is if you're looking for the impacts of legalization, it's way too soon to tell.

Mr. Doug Eyolfson :

Thank you. Mr. Kleiman, you were concerned about the falling legal prices. You suggested that we have a high tax and increase the price of legal cannabis to discourage its use. Did I misunderstand you, or was that what you said?

Mr. Mark Kleiman :

That's correct; a high tax to the equivalent in state monopoly retail. An alternative, as has been suggested by others, would be getting commercialization out entirely and allowing co-ops to do it, and then you could regulate those prices.

Mr. Doug Eyolfson :

Yes. Just yesterday one of our witnesses from Colorado and a witness from Washington agreed that their price has actually fallen well below that of the black market. In fact, what is happening is that the share of the legal market versus the black market is decreasing steadily. The latest data they have, which is a little bit old, shows that in Colorado the legal market is 70% of the market. They're crunching some numbers now, but our witness yesterday suggested that it's likely that close to 90% of the market in Colorado is now legal.

Mr. Mark Kleiman :

Yes, if you're thinking of the in-state market. I don't know the numbers from Colorado. We estimated about two-thirds was legal in Washington state, a growing share for the legal market, which you would expect. As legal prices fall, the illicit market is going to disappear. It's simply not possible to produce illicitly at competitive prices with commercial licit production.

Mr. Doug Eyolfson :

Do you still think it is a better thing to tax it and keep the price high? Would we not be better at driving out the illegal market by keeping the price low?

Mr. Mark Kleiman :

I think you want the legal price to be somewhat below what the illegal price would have been. That should be adequate to get rid of the illegal market. The thing that hasn't been mentioned here is the necessity for enforcement. You essentially have what's now a tax evasion market. If you have a high tax and don't enforce that, then you're going to have entrepreneurs come in and sell untaxed cannabis as they sell untaxed tobacco. If you're going to have rules, you need to enforce them. It seems to me that ought to be part of the planning for this policy. The prices should be lower than illicit prices, but not so low as to encourage heavy substance use.

(1025) Mr. Doug Eyolfson :

Thank you.

The Chair :

The time is up. Mr. Davies.

Mr. Don Davies :

Thank you. You know, on our fourth day of hearings, it's quite apparent that one of the major focuses of the testimony and the attention of committee members has been the impact of cannabis and cannabis legalization on young people, on youth. We've heard that Canadian youth are among the highest users of cannabis in the world, perhaps the second highest. We've heard about the impact on their health and their career prospects and the impact of legalization and criminalization on them. We've heard about brain development. We've heard that they apparently suffer from holding myths and misinformation about cannabis.

We've heard advice from people about how to effectively talk to young people about cannabis. We've heard different thoughts about their access to cannabis and whether they do or don't have easier access to cannabis than liquor. We've heard about their attitudes towards cannabis, yet we haven't heard from a single young person at this committee. Millions of Canadians use cannabis and have acknowledged it. They use it today, have used it, and will continue to use it.

The parliamentary budget officer has estimated that somewhere between five million and seven million Canadians will use cannabis once this legislation comes into force, and of course, millions of Canadians, I think, voted very clearly last election for a legalized approach to cannabis, yet we haven't heard from a single, ordinary Canadian at this committee. We have large, established producers of cannabis in this country right now that have been responsible, for I think a decade, for producing cannabis for the medicinal market.

Dispensaries across this country, both in Ontario and British Columbia, and maybe in other provinces, have been very actively serving the market, mainly while politicians and police forces have quietly ignored them. We haven't heard from a single producer of cannabis or the dispensaries about their experience over a decade.

Finally, this legislation, we've heard, also seems, by design, to be excluding edibles and concentrates and non-smokable cannabis products, despite the health concerns and despite the obvious contradiction that the very purpose of this bill is to bring products out of the illicit market, to get rid of organized crime, and to regulate these products for the health and safety of Canadians, yet we haven't heard from a single producer of those products.

I think these are very important stakeholder groups, and I believe that it's important to hear from them for the committee's full consideration of the most comprehensive evidence on this legislation. Therefore, colleagues, I wish to serve notice that I am going to be moving the following motion, to be debated at some convenient point later in the day, because I want to give my colleagues a chance to think about it. The motion will read as follows: “That pursuant to Standing Order 108(2), this Committee meet for an additional two days for the purpose of the consideration of Bill C-45,

An Act respecting cannabis and to amend the Controlled Drugs and Substances Act, the Criminal Code and other Acts , and that the chair be empowered to coordinate the witnesses, to a minimum of 32 witnesses (eight per stakeholder group), the resources, and scheduling necessary to complete this task in accordance with the following guidelines:

(1) Witnesses are to represent the following stakeholder groups in four two-hour panel blocks per day: (

i) existing Canadian licensed producers and dispensaries; (ii) producers of edible cannabis products and other non-smokable forms of cannabis; (iii) ordinary Canadians who made a written submission to this committee regarding Bill C-45; (iv) young Canadians, 15 to 24 years;

(2) That witnesses for each panel block be allotted as follows: two Liberal, one Conservative, one NDP;

(3) That witnesses be directed to prepare oral remarks for 10 minutes in length, and that the witnesses be invited to submit written statements prior to appearing;

(4) That the meetings be held prior to September 30, 2017.” Colleagues, to conclude, the purpose of this is not to hold up these hearings. I'm mindful of the government's timeline. It is September 14. I believe that we are meeting next week to hear from ministers. I want to give the clerk and the chair and the parties time to put their witnesses in, but I think extending these hearings for another week and a half to hear from these important groups would be very important.

(1030) I'm going to conclude by saying that I've heard from no one but 50-year-olds and 60-year-olds about how to talk to young people. I think it's time we heard from young people about their thoughts on this bill.

The Chair :

I just have a thought on that. By the end of tomorrow, we'll have had, I think, 96 witnesses, and everybody's had a chance to submit witness lists. I'm not trying to downplay your thoughts on this, but I just want to make it clear that we will have had 96 witnesses as of tomorrow night, and we all had a chance to submit our lists at the opening. I believe that the first chance you'll have to move that is on Tuesday, so we'll look forward to your moving it.

Mr. Don Davies :

Actually, Mr. Chair, I'm not going to get into debate now because I'm just serving notice, but I believe I can move this motion at any time. However, I don't want to interfere with the witnesses' testimony or with colleagues. I want to give my colleagues a chance to think about this. I will say, though, that none of the categories that I mentioned were categories that were identified by the committee to hear witnesses from. I believe that none of the 96 witnesses will actually hear from these groups, and they certainly aren't categories that we were invited to submit witnesses on.

The Chair :

Anyway, your time is up, and I appreciate the notice. Ms. Gladu.

Ms. Marilyn Gladu :

Yes, further to this motion, I wasn't involved in the actual submission of the witnesses, so I apologize, but one thing that really concerns me is that all of the provinces that were invited to come don't want to come. We haven't heard from any of them, and many of them have not fully developed their plans. I would think that we would want to find out from them what's missing in the legislation. I'm incredibly concerned about that. I wouldn't mind adding that to the list of things that Mr. Davies wants.

The other thing is that although I see you have a workplace safety panel, you don't really have any of the companies that might be in a dangerous industry and want to implement some things. That group was also on my list of people I might want to hear from, as well as other countries. I used to visit Amsterdam and, believe me, there's a lot of pot being smoked there. I'd be interested to hear what they've done and perhaps something like that.

The Chair :

We invited almost all of the provinces, but only one agreed to come, which was a surprise to us.

Ms. Marilyn Gladu :

We can compel them, I think.

The Chair :

I want to conclude the meeting. Did you have one...?

Ms. Lynda Balneaves :

I'd just like to say something very quickly. I've done qualitative research where I have interviewed individuals, as has my Ph.D. student, Rielle Capler, across Canada in terms of their use of medical cannabis and their access experiences. I know it may not be 100% related, but we do believe that many people who use non-medical cannabis are actually using it for medical purposes. In talking to those Canadians, number one, they want to bring cannabis use out of the shadows and be able to talk about it with informed, non-judgmental health professionals.

They're open to education about cannabis risks as well as benefits. They want reasonable access to cannabis within their communities, as well as through their health professionals. They want choice in cannabis in terms of the strains, the products, the mode of administration, and the access points. They want their experiences related to cannabis and their beliefs to be respected, and they all recognize that stigma associated with cannabis use is incredibly damaging to open conversations about their substance use.

The Chair :

Thank you very much. I very much want to thank the panellists today. We've had some excellent panellists all the way through this, but you've brought a lot of new information and perspectives to us. We appreciate all the different visions, ideas, and proposals that you've brought to the table, and they will all be considered. Again, I want to thank you all very much for participating. Committee members, I want to tell you that I've just been notified that our colleague, Arnold Chan, passed away. I just wanted you to know that. He suffered for quite a while, and he passed away last night.

(1035) Mr. John Oliver :

Could we have a minute of silence, maybe when we reconvene?

The Chair :

We'll take a minute when we come back at 10:45. Again, thanks very much.

(1035) (1050) The Chair :

We'll reconvene our meeting number 67. As we ended our last session, we learned that our colleague, Mr. Arnold Chan , has passed away. We're going to take just a moment in consideration and remembrance of Arnold. He put up a long fight and passed away last night. Arnold never stopped. He worked right until the last minute. He never slowed down. He was always present. He put up a good fight. [ A moment of silence observed ]

The Chair: Here we are on meeting number 67. We're studying Bill C-45 . We welcome our guests and our panellists. We're pleased to have you. I think we're somewhere near the 80th panellist we've had so far. They've just been incredible panellists. They have brought great knowledge, background, and experience to us. I'm going to introduce our panellists here today. From Brazeau Seller, we welcome Trina Fraser, partner.

From the Department of Employment and Social Development, we welcome Brenda Baxter, director general, workplace directorate, labour program, and Eric Advokaat, senior director, occupational health and safety, workplace directorate. From Fasken Martineau, we welcome Norm Keith, partner. Thank you very much. The way we do this, each organization has a 10-minute opening statement, and then we go to questions after that. We'll start with Trina Fraser.

(1055) Ms. Trina Fraser (Partner, Brazeau Seller LLP) :

Ms. Baxter was going to begin, if that's okay.

The Chair :

Okay.

[ Translation ]

Ms. Brenda Baxter (Director General, Workplace Directorate, Labour Program, Department of Employment and Social Development) :

Mr. Chair and members of the committee, I am very pleased to appear before you to discuss workplace safety. I am accompanied by my colleague Eric Advokaat, senior director of Occupational Health and Safety. [ English ] Responsibility for labour matters in Canada, including workplace safety, is shared between the federal, provincial, and territorial governments. For more than 100 years now, the labour program has been protecting the rights and well-being of both workers and employers in federally regulated sectors, which represent approximately 8% of Canadian workers.

This includes creating and maintaining safe and healthy workplaces. [ Translation ] As part of its mandate, the labour program is equally responsible for the administration and enforcement of the Non-smokers' Health Act. [ English ] Enacted in 1989, the purpose of the Non-smokers’ Health Act and the non-smokers' health regulations is to protect non-smokers from second-hand smoke in federally regulated workplaces, including in the federal private sector, federal crown corporations, designated federal agencies, the Royal Canadian Mounted Police, the federal public service, and Parliament, as well as on certain modes of transportation, such as ships, trains, and aircraft.

The administration of the Non-smokers’ Health Act is the joint responsibility of the Minister of Employment, Workforce Development and Labour and the Minister of Transport. The former is responsible for the act's application to federally regulated workplaces, and the latter for its application to common federally regulated transportation carriers. The Minister of Employment, Workforce Development and Labour is solely responsible for designating inspectors to ensure compliance with the act.

Fines for offences under the Non-smokers’ Health Act range from $1,000 to $10,000 for employers, and $50 to $1,000 for individuals. Since 2007, over the past 10 years, there have been a total of 39 complaints under the Non-smokers’ Health Act, with an average of less than two per year in the past five years. This represents 1% of all of the health and safety complaints under just one part of the Canada Labour Code.

There are very few complaints under this act. [ Translation ] To date, no prosecution has been filed under the Non-smokers' Health Act. [ English ] Since the Non-smokers' Health Act and the non-smokers' health regulations were introduced in 1989, public views with regard to smoking and second-hand smoke have greatly evolved. In 2007, in light of scientific evidence on the danger of second-hand smoke, the non-smokers' health regulations were amended to eliminate provisions allowing for the designation of smoking rooms and areas in federally regulated workplaces.

Since then, all persons, including employees and members of the public, have been prohibited from smoking in any federally regulated workplace and on certain modes of transportation, except in highly restricted smoking areas such as living accommodations or motor vehicles to which only one person has access during a shift. (1100) [ Translation ] More recently, new amendments to the Non-smokers' Health Act were proposed under Bill S-5,

An Act to amend the Tobacco Act and the Non-smokers’ Health Act and to make consequential amendments to other Acts . [ English ] The proposed tobacco and vaping products act, Bill S-5 , would amend the Non-smokers' Health Act to add a prohibition against the vaping of tobacco in federally regulated workplaces and on certain modes of transportation. In addition, the task force on cannabis legalization and regulation recommended that federal, provincial, and territorial jurisdictions extend the current restrictions in place for smoking tobacco to the smoking of cannabis.

As a result, amendments to the Non-smokers' Health Act are correspondingly being proposed through Bill C-45 . Bill C-45 proposes to amend the definition of smoke under the Non-smokers' Health Act to include cannabis. Provincial and territorial governments would be responsible for deciding whether to restrict the smoking and vaping of tobacco and cannabis to other public spaces.

Should both these bills be approved by Parliament, the smoking and vaping of tobacco or cannabis would be regulated under the Non-smokers' Health Act in all federally regulated workplaces and on certain modes of transportation such as trains, planes, and boats where they cross provincial or international boundaries. The changes we are proposing would assist in the protection of employees' health and safety at work under federal jurisdiction purview. Thank you, Mr. Chair.

The Chair :

Thanks very much. Now we'll go to Mr. Keith for 10 minutes.

Mr. Norm Keith (Partner, Fasken Martineau DuMoulin LLP) :

Thank you and good morning. In a moment, I am going to take you to five recommended changes to the legislation. I have advised and represented employers and employer associations on this issue for many years and have written a book on the subject of alcohol and drugs in the workplace. I think these changes are essential if in fact recreational marijuana is to be legalized on July 1, 2018, as the bill proposes. Essentially, at the present time, there is no actual or proposed legislative framework that will be necessary to prevent this amendment from resulting in injury, accident, and death.

I will give a bit of background. I filed this in the brief, and the footnotes are available for the facts I'll provide you with. In Canada, in 2015, the most recent year for which numbers are available, there were more than 232,000 lost-time accidents with 852 fatalities. There are approximately just under 3,000 motor vehicle fatalities every year in Canada. What we know from the Colorado experience is that, at least in the first full year after recreational cannabis was legalized, the number of motor vehicle fatalities, including transportation workers, increased by 225%. It more than doubled.

Unless there is a rigorous legislative framework added, which is not yet proposed in the legislation, tragedy will be the result of this amendment allowing recreational marijuana to be legal in Canada. The other statistics that employers are concerned about are as follows. Ninety-three per cent of businesses deal currently with substance abuse in some form on the part of their workers. This is a serious and important issue. More than 38% of workers' compensation claims are related to alcohol or drug abuse.

The risk of a worker having an injury—again, the footnotes provide the references for the authority—is 2.7 times higher if they're involved in alcohol or substance abuse. The presumption of my submission is that the legalization of recreational marijuana will not only increase social acceptance and use, it will also exacerbate what my clients are seeing already, and that is an increased use with the view that legalization is around the corner.

The courts, in fact the chief justice when I was arguing the Irving Pulp & Paper case, suggested to me and other counsel in that random alcohol testing case that the legislature and Parliament is the better place to establish a comprehensive framework than to deal with this case by case, litigated in the courts and before arbitrators. Let me provide you—and, again, I hope that the brief has been provided to members of the committee—with the five recommendations in our submiss