Past Session:

Proceedings of the Special Committee on
Illegal Drugs

Issue 6 - Evidence for September 17 - Morning Session

OTTAWA, Monday, September 17, 2001

The Special Senate Committee on Illegal Drugs met today at 9:05 a.m. to re-examine Canada's anti-drug laws and policies.

Senator Pierre Claude Nolin (Chairman) in the chair.

[Translation]

The Chairman: I would like to begin the public hearings of the Special Senate Committee on Illegal Drugs. Colleagues, I am very pleased to welcome you today as we resume our work for the fall of 2001.

I would like to take this opportunity to welcome those of you who have travelled here to Ottawa to attend this meeting, as well as those of you who are listening to us on the radio or the television, or on our committee's Internet site.

For those of you who are listening over the Internet, I would like to inform you that you can now see us as well. Indeed, we are continuing the experiment that began back in June. We are using digital cameras to record the proceedings, which allows us to retransmit the video signal. This is a first for a parliamentary committee.

Five senators sit on this committee. Without any further ado, I would like to introduce the senators who are here this morning. The vice-chairman of the committee, Senator Colin Kenny from Ontario, is to my left, and to my far right is Senator Tommy Banks, who represents the province of Alberta. We also have Senator Marcel Prud'homme with us this morning, and as you know, Senator Prud'homme is interested in international matters, and if there is one area of activity where international matters are very much present, it is certainly this particular one.

Some of our members are not here today, and they send their regrets. Senator Rossiter from Prince Edward Island and Senator Maheu from Quebec cannot be with us. I am Senator Pierre Claude Nolin, and I am part of the Quebec contingent in the Senate of Canada. The committee clerk, Mr. Blair Armitage, is right beside me, as well as the committee's Director of Research, Dr. Daniel Sansfaçon.

The first incarnation of the Special Senate Committee on Illegal Drugs was created during the last Parliament. On April 11, 2000, the Senate unanimously voted in favour of striking the first committee on drugs.

I was appointed chairman of the committee. On October 16, 2000, after a great deal of preparatory work, we held our first public hearing. However, when the general election was called last October, the 36th Parliament of Canada ended, and as a result, the committee's business came to an end as well.

In February 2001, as soon as the 37th Parliament began, the Senate began consideration of a motion to reconstitute the committee, and on March 15th, it approved the resumption of the committee's business, without opposition, although with a modified mandate.

[English]

The Senate Special Committee on Illegal Drugs has received a mandate to study and report on the actual Canadian policies concerning cannabis in its context and to study the efficiency of those policies, their approach, and the means as well as the controls used to implement them. In addition to its initial mandate, the committee must examine the official policies adopted by other countries. Canada's international responsibilities with regard to the conventions on illegal drugs, to which Canada is a signatory, will also be examined by the committee. Our committee will also study the social and health effects of the Canadian drug policies on cannabis and the potential effects of alternative policies.

[Translation]

Finally, the committee must table its final report by the end of August 2002. In order to fulfil our mandate properly, the committee has adopted an action plan. This plan has three major steps.

The first step is to gather information. In order to expand our knowledge of this issue, we will be hearing from an impressive range of Canadian and foreign experts from academia, law enforcement, the justice system, the medical system, from social services and from government. These hearings will be held mainly in Ottawa, and from time to time, outside the capital, as was the case last week in Toronto.

The second step of our action plan is to share the knowledge that we will be acquiring. My colleagues and I certainly see this as the most valuable part of the process.

The committee would like Canadians from across the land to learn more about these issues and share the information that we will be gathering. Our challenge will be to plan and organize this system to ensure that this knowledge is made available to Canadians and is accessible.

We would also like to hear the opinions of Canadians on this issue. To do so, we will be holding public hearings in various locations throughout Canada in the spring of 2002.

Finally, the committee's third step will be to look very closely at what guiding principles Canada's public policy on drugs should be based on.

[English]

Before I introduce you to the distinguished experts for today's hearing, let me inform you that the Senate has ordered that all the proceedings of the committee registered during the 36th Parlia ment be included as an integral part of our proceedings.

I also wish to inform you that the committee maintains an up-to-date Web site. The site is accessible through the parliamen tary Web site, which can be reached at www.parl.gc.ca.

[Translation]

A few words about the committee room where we are holding today's meeting. This room is called the Aboriginal Peoples Room, and was built mostly thanks to the efforts of Senator Kenny, in 1996, to pay tribute to the first peoples who occupied the territory of North America, and who today play an active role in the development and expansion of Canada. Four of our Senate colleagues represent these peoples, with pride and dignity.

Today we will be specifically discussing public health. We have invited four eminent Canadian experts and the first one is Dr. Benedikt Fischer, who holds a Ph.D. in criminology and is a Professor at the Department of Public Health Sciences at the University of Toronto. Dr. Fischer will discuss a number of subjects, including the various factors that must be considered when developing a public health approach to the control of cannabis use in Canada.

Our second witness is Dr. Perry Kendall, Medical Health Officer for the Government of British Columbia. Dr. Kendall will speak to us about the options concerning the social control of cannabis in the context of other psychoactive substances, both legal and illegal.

This afternoon, we will be hearing from Dr. Richard Mathias, who is a physician and a professor of health practice at the Department of Health and Epidemiology at the University of British Columbia. He will be giving us a new public health perspective on the use of drugs by Canadians.

Our last witness will be Dr. Colin R. Mangham, Ph.D., the Director of Prevention Source B.C., who will be telling us about the true debate on harm reduction and the use of illegal drugs.

Our first witness, Dr. Fischer, wears four hats at the same time.

[English]

Dr. Fischer is the new investigator for the Canadian Institutes of Health Research. Since 1999, he has been an assistant professor with the Department of Public Health Sciences, Faculty of Medicine, at the University of Toronto. Since 2000, he has been an assistant professor, Centre of Criminology, at the University of Toronto, and since 1997 he has been a research scientist with the Clinical, Social, Prevention and Health Policy Research Depart ment, Centre for Addiction and Mental Health, Toronto, Ontario.

[Translation]

Welcome, Doctor Fischer. Thank you for accepting our invitation, and we also are grateful for your interest in the work of this committee.

[English]

It is possible that some questions may remain from your testimony or from your written material or, indeed, from the testimony of other witnesses today, so if it is agreeable to you we would like to be able to write to you to ask you more questions.

You have the floor.

Dr. Benedikt Fischer, Professor, Department of Public Health Sciences, University of Toronto: Honourable senators, I wish to express my sincere gratitude for having the honour of speaking to you this morning and sharing with you some of my thoughts and some of the products of my work in this particular area. This committee is an important and necessary opportunity for Canada to revisit and review how it currently deals with the control and governance of illicit substances. I should like to give you an overview on some of the key issues and knowledge relevant in informing a public health approach to cannabis use control in Canada, because I think this is the pre-eminent perspective that we should assume. This is the focal point by which our thoughts and efforts in both controlling and providing interventions for cannabis and other substances should be guided.

I have assembled a presentation, which you will see on a series of slides, of issues that are pertinent and relevant to this approach. I will provide a brief overview on these subject matters. If there is need for any in-depth information or more detail, either it may be found in the presentation or additional information may be requested of me if needed.

This is in part what I will talk to you about today. Some of the items on the slides are drawn in part from a policy overview paper that I developed, wrote and published with a few colleagues in 1998 in the journal Policy Options. This is actually based on a collaborative project with colleagues who are part of the Canadian Centre on Substance Abuse drugs policy research group. We published this piece together in 1998, and it is also an additional reference for you.

I shall start by offering a few basic epidemiological pieces of information about cannabis use. Here are some basic numbers about the number of Canadians who use cannabis. Approximately 7 per cent of Canadians have used cannabis in the last year. Among students, the prevalence of use is somewhat higher, at 23 to 44 per cent in the past year. The important point to note about cannabis use is that a small minority of these people - approximately 1 per cent of the adults, about 2 per cent of students - use the substance daily. Eighty per cent of adults use cannabis less than once weekly, which is important knowledge that has filtered into the health effects debate at a later stage. This means that the majority of people who use cannabis on a more casual basis, who smoke pot or smoke a joint occasionally, do so irregularly and much less frequently than, for example, people who consume alcohol or tobacco. This is an important health consideration.

There are a number of negative health effects that have been created in the lab or have been observed with long-term users, to which I will refer in more detail later. There are, of course, health risks and negative health consequences with using the substance, but the majority of those risks only occur under specific circumstances. The majority of the risks are associated with long-term persistent and frequent use, and therefore must be understood as such.

There is at this point agreement that the so-called dependence or withdrawal symptom may arise with heavy chronic users, but it is very much limited to that small population. I will reference a few sources that will illustrate and evidence that. Of course, as with almost any other psychoactive substance, there are positive effects to cannabis as well. Again, I have a whole list here.

You have heard many of the benefits in the debate around medicinal marijuana. This is also important to consider when thinking about the quality of the substance that we are talking about, which has been bedevilled and labelled as an evil substance for so long.

There are considerable medicinal and other benefits to the substance, benefits that materialize at different levels of use, some of which are very unique. We should take those into consideration as well, especially if they provide relief for severely ill or terminally ill people. Currently, in the context of medicinal marijuana, I am glad that the Canadian government has taken initial steps to recognize those benefits and to make appropriate policy arrangements.

There are important and distinct features of cannabis that I would like to underline for you in your consideration and investigation of this particular substance, including the appropri ate policies that surround it in the context of other substances. For example, cannabis is very distinct from alcohol in that there is no evidence of violence associated with cannabis or cannabis use. There is not one single recorded incident of death associated with cannabis or cannabis use, a fact that makes it a very distinct substance from many other illicit substances that we deal with every day in a public health context.

Behind me there is a list of recent, sophisticated peer-reviews on the effects, the harms and the risks of cannabis, which are essentially assembling and synthesizing the state of knowledge in this particular field. Among them is a seminal report by Hall and colleagues from Australia which, in 1994, concluded that the major risks of cannabis use can be significantly reduced by avoiding driving under the influence, by avoiding chronic and daily use, and by avoiding deep inhalation. These were the key factors that allowed us to avoid many of the major harms and risks associated with it.

A seminal WHO and Addiction Research Foundation report, finally published in 1999, concluded, in the most important sentence in this 400 page tome, that on "current patterns of use, cannabis appears to pose a much less serious public health problem than is currently posed by alcohol and tobacco in Western societies." A key review by Zimmer and Morgan stated the same finding.

My colleagues Perry Kendall, Jürgen Rehm and Robin Room and myself made a modest effort in 1997 to compare the health effects on long-term and short-term levels, on individual and social levels, and between different licit and illicit substances. We concluded that cannabis was probably the least harmful substance of all substances in the comparative public health perspective.

The Institute of Medicine released a seminal report on cannabis in 1999. That report states that its harms and risks are fairly limited, especially when compared with many of the other substances with which we are dealing.

The key Roques report, commissioned by the French federal government, executed by probably the finest scholars in pharma cology and drug research in France, eventually came up with a comparison table in which they compared licit and illicit substances on different scales of risks and harms. If you view the second last column of this table - the cannabis column - you will see that the word "faible" appears more frequently in that column than anywhere else in that entire table. That essentially makes it very clear that the risks and harms from cannabis, compared to the other substances, are limited and relatively small.

This is just some of the information from the Institute of Medicine. I will not go into the details on key questions that have been asked again and again over the last 50 or 60 years about the addictive potential: Is it a gateway drug? Is marijuana more dangerous than tobacco? Does marijuana kill people? I would not easily dismiss the evidence and conclusions provided by the finest institute in medical research that we have in the entire world. We are basically doing away with these myths and providing key evidence that the addictive potential of marijuana is very limited. Its danger, compared to tobacco, is very limited; it does not kill people; and it is not a gateway drug.

If you look at the social costs related to the use of cannabis, the seminal study by Single and colleagues conducted in Ontario, you will note in the percentages that the social costs related to cannabis use, compared to other substances, primarily tobacco and alcohol, are very limited. Thus, even on an economic level, the costs are comparatively low.

It is important, even for people who work in the specific areas of pharmacology or health sciences, to look also at the social history of cannabis prohibition and why we have come to such a regime today in the way that we frame and control cannabis. The history, as we know, is always one of the most important factors in explaining the present.

When you go back to Giffen's seminal work, you might be as perplexed as I was when I read for the first time that there was really no good reason, either health or any other obvious natural reason, to prohibit cannabis, as was done by parliamentarians in the 1920s. It was essentially added to the schedule of the then prohibition law without much debate and without much evidence for its dangers or risks. It was added primarily on the basis of U.S. mythology, pamphlets, police reports and lay knowledge - "propaganda" I would call it - that filtered into Canada. That information was received and assumed by some parliamentarians, accepted and translated into an addition to the law, and from that day on in 1923, when it was added to the schedule without any debate, cannabis was an illegal, demonized, prohibited drug in Canada.

One of the key figures in spreading the rumours and mythology about cannabis in Canada was a woman who is actually famous and pertinent to the history of this country. I believe that there is a statue of this woman just outside - Emily Murphy, who was Canada's first female judge. She wrote the book The Black Candle, which was published in 1922. In that book, in talking about the effects of cannabis, Murphy says that users go "completely insane... lose all sense of moral responsibility... become raving maniacs... and kill or indulge in any form of violence... using the most savage methods of cruelty." This type of mythology about the drug we are dealing with persisted for many years.

This rhetoric and, of course, the necessary perceived enforce ment, control and banishment were picked up by the evolving Canadian drug enforcement apparatus in the 1940s and 1950s. Eventually, in the wake and context of the counterculture, the increasing prevalence of cannabis use among certain social groups was the basis for this immensely expanding enforcement, which started in the early 1960s and persisted through the late 1960s and 1970s, and even to the present day.

I will make a few comments about the current legal status - and you probably know all these legal details as well as I do. Under the current Controlled Drugs and Substances Act, it is prohibited for anyone in this country to be in the possession of cannabis. If our enforcement agents find someone in possession of cannabis, even the smallest amounts, for the first time, we - our Parliament and the citizens of Canada - agree that this person might be punished with a fine of up to $1,000 or go to prison for up to six months. This is what Canada - the citizenry and the politicians - agreed upon. If we find someone doing the same thing - in possession of a gram of cannabis in his or her pocket - for the second time, we think that it is appropriate to double the fine and double the time in prison.

In cases of possession above the designated limited amounts of one gram of hashish or 30 grams of marijuana, which are considered personal amounts, we agree that it is appropriate to send people to prison for seven years.

Enforcement practices in Canada are very important as well. How is the law applied? It may surprise you that almost 60,000 people in this country are arrested every year under the drug law for offences that involve cannabis, 39,000 of those arrests being for cannabis possession. Therefore, half of all drug offences enforced in this country are cannabis possession. In other words, half of all the resources spent on drug enforcement in this country, half of the arrests made, half of the offences enforced, are enforced against people who have some cannabis in their pockets for personal pleasure. These are the enforcement realities.

Although we do not have a lot of good research on this, there are enormous discrepancies among the provinces and between urban and rural centres. That also says something about the enormous inequity that exists in the enforcement of cannabis laws in this country. We know from anecdotal and ethnographic research, some of which I have been involved in, that police officers have enormous discretion when they encounter a citizen possessing cannabis for personal use. As someone interested in legal sciences and legal principles, that worries me a great deal because I think it undermines enormously important legal principles.

We have no clear idea about sentencing practices for cannabis possession in Canada either. We know that the majority of first-time offenders receive some form of a discharge, be it an absolute discharge or a conditional discharge, but there is increasing use of conditional sentences through the new condi tional sentencing law. Some people receive a small fine. Some people, however, receive custodial sentences for simple cannabis possession, mostly in conjunction with a criminal record. Often Aboriginal offenders or offenders in other socio-economic or ethnic minorities go to prison because of default of a fine or other sentences related to cannabis. Therefore, people do go to jail for simple cannabis possession on the basis of the mechanics that I have just outlined, which is very worrisome.

Even if people walk out of court with a conditional discharge, it is important to note that they have a criminal record for a minor offence. Although the sentence seems to be benevolent, they have a criminal record that creates an enormous burden and social cost created by the current criminal cannabis control in Canada.

There have been approximately 2 million arrests in the last three decades for cannabis possession in Canada. As an informed estimate, approximately 600,000 Canadians have a criminal record for cannabis possession. They may have received a conditional discharge or a small fine, but they carry a criminal record. We all know the impacts of that for people, especially for young people who are coming out of school, about to start a job, doing an apprenticeship, starting a career or family, or perhaps travelling. The burden of this at the social, professional and economic levels is enormous. It is extremely important to reflect on whether someone who enjoys the pleasure of smoking pot, without harming anyone else, should be barred from travelling to the U.S. for 30 years, from getting into certain professions, or from acquiring citizenship if they are recent immigrants. Is that appropriate?

It currently costs the criminal justice system approximate ly $400 million per year for cannabis enforcement. This is what the taxpayer pays to enforce current cannabis laws. With all this input, the expectation would be that we get a lot of bang for our buck. After all, these are neo-fiscal, neo-liberal times and if we make a big investment we want a large return. I regret that I must disappoint you on this. The evidence of both general and specific deterrent effects of current cannabis enforcement practices is very limited. From empirical evidence, we know that the deterrent effects are minimal if not entirely absent. In other words, those people who want to use cannabis regardless of the severe punishment that currently exists do it regardless.

We have here a long list of efforts that have been made over the last 30 years. These are initiatives of high-ranking political committees, committees that have been assembled by various federal governments, including the very famous and important Le Dain commission in starting in 1969. These commissions have reviewed the evidence on cannabis enforcement and the appropri ateness of the existing control system and have concluded that the current system is not working, is not appropriate, is not effective, and should be changed.

The most important among these is the seminal Le Dain commission report on cannabis issued in 1972 that concluded that we should not go after cannabis users with the criminal law and that cannabis should not be dealt with on the basis of its pharmacology, its behavioural and social effects in the same category as other illicit substances. That commission said that we should do away with the criminal law for cannabis users and that we should find a different control system altogether for this drug because it does not fit in with substances like heroin and cocaine.

In the last 10 years, numerous institutions with legal, pharmacological, addictions, law enforcement, health policy, and medical expertise have said that our law is ineffective, inappropri ate and counter-productive. The list that you see behind me is of institutions that have said this. They include the finest, the most important, and the most outstanding in the fields that are impacted upon by cannabis use, research and treatment. All the major newspapers across this country and across the entire political spectrum have said in editorials that this is not working, that it is not appropriate, that it is anachronistic, and that we must find new ways of dealing with this, and the public agrees.

From public opinion data assembled over the last 10 years, some by Health Canada, we know that more than two thirds of Canadians think that no one should go to jail for cannabis use, and approximately half of Canadians explicitly advocate the decriminalization or depenalization of cannabis use. This has been consistently the case over the last 25 years. In other words, there has been a public opinion message for a quarter century that so far has been ignored by lawmakers and policy-makers.

I do not have to comment on the overwhelming public support by Canadians for penalty-free medicinal use, but this is not the primary subject of this debate, although it ties into it a little bit.

I have a few quick remarks about international treaties. The Honourable Senator Nolin mentioned the relevance of this topic earlier. I think it is important to do a reality check on those issues. They are being brought up often. I have heard many politicians say that they would like to change things and like to perhaps consider some reforms, but the obligations we have under those international treaties do not allow us to do that.

That is wrong. There are several important things to be known about the international treaties. There is a single 1961 convention, and a 1972 protocol, which require signatory countries to prohibit, make punishments available and criminally control certain activities related to illicit substances. However, it is not clear, and it is increasingly challenged, that the single convention actually refers to the personal use of these substances. It very much refers to the cultivation, production, distribution and dissemination of illicit substances, and requires the control of them in a criminal and punishable fashion. This convention is not aimed at the individual user or the use for personal pleasure. It is aimed at the industry, the business, distribution control. The International Narcotics Control Board, the enforcement agency of the international drug treaty, very much confirms this, in that it states in its 1992 report that signatory parties may take the view that it is not required to establish possession or use activities as criminal offences since the obligations only apply to cultivation, purchase, or possession for trafficking. That is very important to know.

Then there is the 1988 Vienna convention. The first five words of that convention are particularly important. The convention refers as well to the control of use and possession, but it indicates, first, subject to its constitutional principles, that each party shall establish as a criminal offence the possession of narcotic drugs for personal consumption. So the first important point is this: "subject to its constitutional principles." If there is anything in a signatory country's constitution, any of the principles enshrined that we have in the Charter of Rights, that objects to the idea of criminalizing the possession or use of certain substances, it is up to the signatories to find ways to reconcile this particular tension. We take our Constitution very seriously, and we should. We should check very thoroughly whether these two requirements are in harmony or what ways would bring them into harmony. The Vienna convention explicitly allows us that.

It further indicates that the parties may provide, either as an alternative or in addition to conviction or punishment, measures for treatment, education, aftercare, rehabilitation or social integration of the offender. Parties may provide either as an alternative or in addition - in other words, yes, you can have laws on the books that say that this is to be criminalized; theoretically, we may want to punish people, but we can provide as an alternative whatever we like. It is up to us to define what kind of treatment we would like to stipulate, what kind of education makes sense for us, what kind of aftercare, rehabilita tion or social integration. The entire world is open for us to translate that into meaning and how we want to deal with people who are using cannabis for personal pleasure. We do not need to punish them at all, not even when reading the international treaties by the letter of the law. Even then, we do not have to punish them criminally or otherwise.

The INCB confirms that very clearly in its interpretation. It says that none of the conventions require a party to convict or punish drug abusers who commit even what has been established as punishable offences. They may deal with drug abusers through alternative non-penal measures involving treatment, education, aftercare, rehabilitation or social integration. I do not know what more you need to find alternative approaches, more appropriate and meaningful approaches, in dealing with cannabis use.

In light of the time that is passing and advancing, I will skim over what is happening in other countries. There is whole slough of what I consider fairly developed, sincere and reasonable political and legal systems, most of them in western Europe but also including Australia, that have over the last 10 or 15 years done away with criminal cannabis possession control, either on the de jure level - in other words, by revising or changing their drug laws controlling cannabis - or on a de facto level, on the level of how they are applying and enforcing their laws. These changes have very consistently come up in different ways. They are being implemented in different ways. They more or less lead to the same realities. These countries have realized that cannabis enforcement and prohibition is ineffective, inappropriate and counterproductive, and have either changed the law or changed the way police enforce the laws, the way prosecutors lay and prosecute charges, or the way judges and courts deal with offenders, or all of the above. Most of the countries that I have listed here, such as Switzerland, Germany, Netherlands - and I want to emphasize that this is not just the crazy Dutch; it is almost the entire European Union at this point and part of the Commonwealth - have revisited and revised their approach to cannabis and have essentially taken the criminal component out of the control systems they have created. A key example is the U.K., which is largely warning people now who are possessing cannabis for personal use. Australia has come up with an expiation notice system where people are getting a traffic-ticket-like citation, non-criminal; it is a small fine and there are no criminal consequences to this particular way of dealing with cannabis possession.

The list goes on and on. Portugal recently changed its law. Belgium is about to do the same thing. Spain has done it for cannabis and almost other psychoactive illicit substances. There is a long list. Canada is increasingly isolated and has fewer and fewer companions in terms of the way it handles cannabis on a personal use level.

Yes, Canada has one big and powerful ally. On the other hand, I think we want to ask ourselves whether this is the right direction to look to in this particular question.

Many people ask, what happens if we decriminalize or alter the law or take away the possibility of throwing people in jail for cannabis use? What happens? Will all hell break loose? Will all our kids smoke up all of a sudden? Will mayhem reign in the streets? The research evidence suggests that nothing will change. The only thing that will change significantly is that the social and economic costs related to cannabis use will be dramatically reduced. Otherwise, levels of use, levels of medical health problems related to cannabis use, as we know from the natural experiments in Europe and Australia where reforms have been initiated, will not really change. The people who smoke, who want to smoke cannabis under a given regime, do it any way. We will not have any additional people on a significant level who will all of a sudden start smoking cannabis just because the law is not as severely punitive any more. It will not happen. People are smarter than that.

In addition, we have an increasing social and cultural acceptance of cannabis as a social and cultural asset, a custom, a ritual. It is much like the way we deal with alcohol. Just as we like to sit around a table on holidays such as today, which is Rosh Hashanah and which is one of many cultural religious events when people come together to have a glass of wine, in many cultures they sit together and have a joint. It is not something that we want to establish across the country, but I do not think we want to punish people who do so for their own cultural reasons.

I want to make a very brief remark about the importance of the role that enforcement agencies have had in perpetuating the current cannabis enforcement regime as we have had it in Canada for the last 80 years. We ought to be a bit wary, perhaps, but certainly aware of the role that police have played in perpetuating the mythology and the realities that we seem to take as the empirical basis for maintaining cannabis laws on the books as they are. It is important to know that our enforcement agencies have benefited dramatically from the criminal status of cannabis throughout the years.

Some of you may or may not know the only reason the RCMP is still with us today and was not abolished in 1925, when it was supposed to be abolished. At that time all police enforcement powers were given to the provinces. The RCMP recognized that the country was in need of a sophisticated national organized drug enforcement apparatus. It seized that opportunity and survived because it persisted and continued to enforce drug laws. This is the only reason the institution of the RCMP is still with us.

If you consider the fact that about 30 per cent of the RCMP's resources are earmarked for drug enforcement, you will notice that it is not easy far an organization like to say from an institutional perspective, "Let's shift our approach to a health approach." There are institutional politics and stakeholder interests going on that are relevant in considering this.

On an anecdotal and ethnographic basis we also know that the existing cannabis possession laws allow a police officer to temporarily detain and arrest an individual merely on the basis of having reasonable grounds to believe that they smell cannabis. This is an important enforcement tool for the police to gain access to certain individuals for search, temporary detainment and so on. That cannot be done with any other sort of offence. Such a tool does not exist. For some people in some enforcement situations, this is an important access tool, which, of course, not many would like to lose. However, we should be aware of that when thinking about the overall approach and the adequacy of that control approach.

What are our options? This is where I want to take a step back. I do not want to start prescribing anything but, rather, to list a few ideas about what could be done on a legal and policy level. We could take cannabis possession out of the criminal drug control law altogether. We could eliminate the cannabis possession clause and try to deal with the issue elsewhere.

We could write a full automatic discharge for cannabis possession into the Controlled Drugs and Substances Act. In that case, the law would still make it illegal to possess cannabis, but it would automatically prescribe for anyone arrested and charged under that offence to be discharged automatically without a criminal record.

We could eliminate the jail option for cannabis possession. This would prevent even the theoretical possibility of people going to prison for the offence.

Under the Contraventions Act, we have a legal means to do something very similar to what the Australians do. In dealing with cannabis possession, they have created a civil or non-criminal ticketing offence.

We could divert offenders to education or treatment. However, in that regard, I want to state a very clear warning about these things: Diversion is a very popular concept; however, just because it is very popular does not necessarily make it effective or appropriate. Cannabis use is an activity with respect to which treatment may not necessarily be appropriate or necessary at all. There are many dangers involved in people being mandated to treatment if they do not require it or if the circumstances of their use does not necessitate any treatment at all. I am wary of general diversion or conditional sentencing provisions.

However, whatever you recommend to the lawmakers, I emphasize education, prevention, and treatment where necessary. This is an important pillar of any step forward we take in that realm. It is important to maintain a punitive approach to cannabis use where its effects or where the effects of use may be harmful to others. Cannabis users should not drive cars or operate machinery. This is where the law is an appropriate means to address deterrence and punishment.

Finally, I ask rhetorically: What is at stake? I think what is at stake is a lot more than the simple mechanical control and governance of this psychoactive substance. What is at stake here is a challenge and opportunity for sensible, effective and efficient law and good government. This has been a problem issue for the longest time. This is very much a point where good government is asked and called for to deal with the health of the population, justice, fairness, and effective law and policy. This will affect a not unsizeable share of the population, in particular young people.

What is at stake are the protection and respect of important constitutional principles, including issues of equality. I referred to the discrepancies in law enforcement and the more de facto effects that current cannabis control has on marginalized socio-economic and ethnic populations. However, this is also an issue of human rights, in terms of equality and fairness in the way we deal with cannabis use versus the users of other psychoactive substances. These are all constitutional issues that require sensible steps, including review of the current effects and where we should go.

There is also an issue of the public's respect and perceived credibility of the law. It is important that our laws are respected and held credible by the general public. To a great extent we have lost that with the current cannabis laws. It is something that ought to be remedied. At this point, we are ignoring the majority of the public on this question.

Finally, we do not need a great deal of new knowledge or research. We have researched this topic to death for 50 years. All the knowledge that we need to answer this question is provided in the Le Dain report of about 30 years ago. What we need now is political leadership.

Senator Kenny: Dr. Fischer, thank you for your presentation today. I should like to start, if I could, with a hypothetical question. Please assume that you have teenage children and suppose that they came to you and said, "Daddy, do you think it would be a good idea if we use pot?" What would your answer be?

Dr. Fischer: I rehearsed my answer last night with my partner. I would rather that people not use marijuana. However, if you do, it should be used as safely as possible. If you are curious, you should find out and make your own decision on the basis of what your experiences and thoughts are, not because I, or the Bible, or any religious pamphlet tells you that it is a bad thing and will turn you into an evil or violent person, as described by Emily Murphy. I want you to make that decision yourself. If you continue to use cannabis, if you take a liking to it, for whatever reason, I want to ensure that you do not have to be afraid of me knowing, or afraid of your doctor knowing. I do not want you to be arrested for it. I do not want your privileges of being a citizen or entering any professional career taken away from you. I want you to stay as healthy and safe as possible while pursuing that particular activity for pleasure. I would want my government to ensure that these conditions are in place. That is what I would say as a parent.

Senator Kenny: The conversation that you had with your partner is replicated in many families. One of the difficulties that I have with your presentation in general is how one should address the broad concern that, given the choice between not using the drug at all or using it in the conditions you described, how does society communicate to young people that, all things being equal, it is probably better not to do so?

Dr. Fischer: How do you resolve that dilemma? If I may answer with a question: How do you resolve that dilemma for yourself in the context of alcohol? I would be much more worried as a parent, being the person that I am with the knowledge that I have, if my children were to become involved with alcohol. Apparently, we seem to be very happy with the fact that it is completely possible and normal for kids to have access to alcohol and liquor stores, and to go into bars to drink without their parents knowing, to drink at parties, to even get drunk and get into a car and either kill themselves or other people. We seem to be fine with that. I have not been to a committee over the last five years that specifically looked into the health consequences or policy challenges of alcohol and children. Alcohol makes children and other people aggressive. It leads to violence. It even kills people. We are not terribly concerned about that.

We have not spoken about tobacco and the many children who are involved with tobacco and doing irreparable damage to their lungs and other organs by smoking in school. We seem to be fine with that. We are taking some action and doing certain things, but no one has come up with a suggestion that we should throw young children in jail for smoking because we think smoking is a bad thing. We would never do that. We are thinking within a public health approach and trying to accomplish the healthiest possible situation and outcome without doing too much damage to the user, stigmatizing or criminalizing them or doing so much harm to their careers that basically their lives are wrecked. This is the public health balance that we ought to find.

I totally agree with you, and I sympathize with all parents who are concerned. If I can reiterate, I would not want my children to get involved with these substances. However, there is a chance they may. They should determine the best decision for them. I would like them to have the opportunity to have those experiences without causing more harm to them than the drug will actually do. I should like other people to have that opportunity as well, and I think this is the challenge for us.

Senator Kenny: With respect, sir, I find your responses unsatisfactory. Your thought process is not very rigorous. To compare marijuana to alcohol does not make any sense. We have laws that deal with alcohol. We have a great segment of the population that is uncomfortable with alcohol and its abuse. If you are telling the Canadian public that children should smoke marijuana because it is okay for them to drink, or because they are drinking anyway, let us just add this to the list, I do not think you will find much support. The same is true of tobacco. There are broad efforts to try to curb youth smoking. There are concerted efforts to communicate to children, to involve them in the process of changing attitudes about smoking.

I do not take any comfort from your answer. I would have hoped that you would have responded: Yes, if you have to use pot, if you feel an urge to use pot, go ahead, but here is some information that will explain to you the damaging parts of using the drug, here are reasons why you should not use it. There should be a public policy program in place that actively discourages people, if it is not a healthy thing to use. Do you support any of that?

Dr. Fischer: I do not see where my answer would have contradicted that.

Senator Kenny: Simply because parents right now are concerned about their children using alcohol and smoking. They are saying that if there is no official sanction somewhere, at least somebody is saying that is not a good idea.

Dr. Fischer: I do not think anyone is opposed to that. I do not think anything that I proposed earlier is challenging that, quite the contrary. We should not forget that our primary signal to the public at this point is that people who smoke cannabis are criminals and should go to jail. This is what our law says. Our law does not say: Go and educate people, go and send them to treatment, send them a pamphlet. That is not what our law says. Our law says that you may go to jail for six months if you smoke a joint. I think we should be clear about that. This is what I am challenging.

What I would like to substitute this particular approach for, simply because I find it inappropriate, ineffective and inadequate, is a regime along the lines that you just described. We should inform young people, older people, anyone who thinks about using cannabis, about its good and bad effects. I include both lists in my presentation. I am not only concerned with the good or the bad effects. I want the public to know all the effects and to be in a position where they can make an informed decision about whether they want to accept or benefit from any of these effects or take the risks of receiving any of the others. On that basis, potential users make responsible and informed decisions. At the same time, the interventions of our policies and laws are effective, cost-effective and in harmony with the guiding principles, constitutional, legal, good health and social policy principles that we have in this country. Many of those are currently violated by the realities of the law and our policies. This is why I am concerned.

This is the main reason why, at this point, despite the fact that many people may advocate a certain position, the way we think about smoking or even alcohol, at the most radical level, some people may suggest that we should just criminalize people who drink, or young people who drink or smoke, because it is so bad for them. We all agree that smoking is bad for young people. Why do we not criminalize smoking the way we do cannabis users? We would never do that. We could not do that for exactly the reasons that concern me and many of my colleagues - the problematic and unacceptable effects and side-effects of our current cannabis control regime.

These things should not be measured with double standards. I do not think we would feel very comfortable about doing this or driving and maintaining this kind of double standard or contradictory policy in many other fields of health or social policy.

Senator Kenny: You mentioned that there was no violence associated with marijuana use. Are there any instances of violence associated with those trying to obtain funds to purchase cannabis?

Dr. Fischer: Not that I would know of. I have not seen any evidence for that in the research literature that I know.

Senator Kenny: You attribute that to the low cost of cannabis?

Dr. Fischer: I would attribute it to the very broad and easy availability and accessibility of cannabis in this country. As well, the pharmacological, behavioural effects of cannabis are sedating and calming, rather than making people aggressive the way alcohol or cocaine does.

Senator Kenny: I was not referring to users in the process of using but in the process of getting.

Dr. Fischer: Yes.

Senator Kenny: The last area that I want to pursue is that of harm-reduction approaches. We find witnesses return to this theme fairly frequently. In the Dutch experiment, we see cafés or places where people can go to obtain cannabis. Statistics show that usage is lower in areas where the drug is made readily available than it is typically in North America.

One area that is fuzzy and that no one has addressed, at least to my satisfaction, is that of wholesaling and distribution and production. I can understand how the cafés work, but I do not understand what sort of system one might put into place to provide for production, wholesaling and distribution without it being problematic.

Dr. Fischer: The Dutch have found a fairly reasonable and simple, straightforward solution for that. The Dutch government at the moment is licensing producers and distributors. In other words, people who grow marijuana in fields or greenhouses must apply for a permit to the Dutch government. I am not sure which level of government but one of the government authorities. The growers are inspected. Certain rules, primarily implemented through regulations, are in place. If they abide by and obey those regulations that refer to quality, auditing, wholesale regulations, then they get a permit.

Usually the permit is temporary. It will specify exactly what is being produced and where it is going, quantities, so on. It is like any other permit or authorization that a production business would receive in this country for other products or services. Occasionally, the growers are audited on those parameters.

That is how the production system and dissemination and wholesale system are staged in that country. It is a unique system, and the Dutch are a step ahead of other countries that are struggling with the questions of possession and use. All the other countries that I have listed must look at this question at some point because it is very clear to all of us that if we have use, we have demand and if we have demand, the people must buy it somewhere.

Senator Kenny: Could you give the committee your source for that information? We have received previous testimony that, to the best of my recollection, implied that the system varied from one part of the Netherlands to another and that delivery depended to a large extent on police turning a blind eye. It seemed to be a much more haphazard approach than the organized, regulated approach that you are describing. Could you give us your sources for that, please?

Dr. Fischer: I should add that this may very well differ from one part of the country to the next in terms of local regulations, but the best thing I can do is put you in contact with some local people who can describe this to you most authentically.

The Chairman: On the question of the Netherlands, on November 19 we will have a full day examining their experience and hearing witnesses from that country.

I have a question about the school-age kids. We heard testimony during the previous Parliament, and this testimony has been adopted as part of our findings through a decision of the Senate. Dr. Mark Zoccolillo of McGill University is doing a major survey of use and abuse of legal and illegal drugs in high schools and by teenagers in Quebec.

Dr. Zoccolillo testified here, with data, that the use of marijuana is increasing, but, more than that, teenagers in Quebec are poly-users of a variety of legal and illegal drugs. In Ontario, do you witness a similar trend with that segment of the population?

Dr. Fischer: We have witnessed similar trends over the last 20 or 25 years. Data will show that use goes up and down and that it corresponds with other substance uses. Tobacco use, alcohol use, use of other substances, goes up and down in this population.

That is a particular challenge for researchers and policy-makers because we do not have a good understanding of what determines those fluctuations. The reasons for teenagers using more cannabis in one summer compared to another are difficult to know. Why are short skirts fashionable one summer and not the next? These things respond to complex cultural and peer-driven pressures that are not rationally explainable.

One of the main things that we do know is that the dynamics and the patterns are not influenced by the severity of the law. We have very good qualitative data showing that school kids are least concerned with the law. They are more concerned with what their friends do or do not do. What is cool? What is happening? What makes sense in the club context or the party context? What are a teenager's perceptions as to the benefit received from this activity in the short term? The long term is not considered as much. Those are the questions that count, and that is where the current system is entirely ineffective.

The Chairman: What are the implications of those findings from your testimony about Ontario and what we have on Quebec? We can only assume the pattern in the rest of the provinces.

Dr. Fischer: This applies even outside of Canadian borders. It is the same in Europe.

The Chairman: What are the implications of those findings on public policy-making? You have just said that the law does not matter. No matter what we do, we cannot influence this.

Dr. Fischer: That must be a very frustrating statement for lawmakers.

The Chairman: We are looking at the problem as lawmakers, of course, but we want to understand, before proposing any alternative, whether there is a need for an alternative.

Dr. Fischer: Yes, there is a need for an alternative. I must defend the law because it still has an important, symbolic value that we should not dismiss. The law has an educational value as well. To a certain extent, I am not a strong believer in deterrence theories. However, it is essential, especially in the social context that I described for young people at the moment, that we find ways to provide and deliver credible, acceptable and effective information and education to this particular group of the population about the pros and cons, the positive and negative effects, the long-term and short-term risks and the implications of using cannabis. In that way, they are able to make informed and responsible decisions on their own.

The Chairman: Who should do that? Actually, some police forces are doing that - going to schools and educating the students.

Dr. Fischer: Why the police? Why would I believe that a police officer, who is trained to chase and arrest criminals and enforce the law, is the most appropriate, informed, knowledgeable and skilled professional to deliver that information about the health risks and effects of psychoactive substances to my child? Would I go to a police officer if I have a problem with my breathing or with my lungs or if I have psychoactive questions? No, I would not, just as I would not go to a doctor if I have a legal problem. This is the reality.

These are the dynamics that have emerged out of the somewhat bizarre and twisted turns of history that surround drug control in Canada. The law enforcement officers entered the train, grabbed it and held on to it, but not because they were the optimally trained professionals to do that. Have you ever looked at a police college curriculum in terms of what police officers are trained to do? They are not trained in the particular areas of knowledge that we require.

We need to have people with an understanding of basic health, behavioural, social and interpersonal matters. Those are fields in which, the last time I checked, police officers do not necessarily specialize, but other professionals do. Parents, teachers, group counsellors, educators, and people who, at large, are respected by young people in professional and other social functions.

I do not want to exclude police officers from that in the larger context, but this is not the group of professionals in terms of what they embody and symbolize, and in terms of the tools that they carry. You do not need a gun, handcuffs or mace for the kinds of things you just described. You need experts who are respected - peers and educators - to do that. I can immediately list three or four professional groups who would be better suited to that task than police officers.

The Chairman: I referred to data on users and the usage of drugs. Of course, in Toronto you have an annual report on drug use. Nationally, the last survey we have is from 1993-94. Do you think we should have a more frequent survey on the use of substances, and who should do that?

Dr. Fischer: My institution will punish me severely if I give you this answer, because my answer should be "Yes, of course, every year, and give us lots of money for it." However, my answer is, "No, not more often than we do at the moment." That is my sincere answer.

We more or less know what's going on. It would be important to do spot monitoring occasionally; we do not need to do a cross-country survey each year. There are survey mechanisms in place in areas across the country that tell us, more or less, or give us an indication, of the trends.

There are no big surprises - whether cannabis use goes up dramatically by 5 per cent or not, is not a key issue. We need to do a proper, selective spot monitoring of what use prevalences are, and especially the associated harms and risks. You mentioned earlier that there is an increase in the trend of X drug use, and there is a combination of certain factors - whether people smoke pot and then get into a car and drive or perform other dangerous activities.

That is the kind of information we need, and we can obtain it through a smart and selective local system of monitoring. We are not doing too badly, at the moment. One of my main concerns is getting the biggest bang for the buck that the government is able to spend. We do not need more research on that.

Senator Banks: Some civilized societies have some laws that are based on things other than the prohibition of activities that lead directly to material loss and that are based on moral compunction. We have many such laws. Dr. Fischer, you said that the problem of cannabis, in particular, is one of health and health management. However, there are people in Canada and elsewhere who believe that drugs that alter the mood or the mind are, per se, simply morally wrong.

That is a different view than the one that I understand you to hold. What would you say to a person who believes that we have made mistakes with respect to liquor and tobacco? I grant you that prohibition, mechanically, does not seem to work, although there are arguments even about that.

These things are simply wrong, and smoking pot is wrong in the same sense morally that shooting heroin in your arm is wrong, even though the social harm may be a great deal less. They are simply, morally wrong. What do you say to a person who believes that?

Dr. Fischer: This is a fundamental and legitimate philosophical position and stance. I, from my personal value system, would take issue with that. If they, for whatever reason, were so convinced, and were able to muster enough conviction and power base that this view would prevail, I would say that they should at least exercise and translate that philosophical stance in accordance with some of our other basic constitutional principles. If drugs are morally wrong and drug use is morally wrong, then they must prohibit all substances, and they would have to deal with the alcohol user in the same way that they would deal with the cannabis user. The use of alcohol would be considered equally wrong, according to that philosophy, as the use of cannabis.

In order to not violate some of our most essential, constitutional principles - among them, equality before the law - they would have to make the approach consistent. This is the moral obligation that would naturally and inevitably emerge out of this particular philosophical stance.

This is one of the constitutional arguments. The basic dilemma and reasoning that, for example, Germany's Supreme Court came up with in 1994 in their landmark verdict on the legality of cannabis prohibition in that country was exactly that argument. People challenged the constitutional double standard and said that the way we are dealing with cannabis as opposed to other drugs violates the fundamental principle of equality of the law, and the court agreed.

Senator Banks: If the possession and personal use of cannabis is decriminalized or made not subject to penal sanction, it would be interesting to see whether there will be another constitutional argument that its production ought therefore to be against the law. If the possession is not against the law, then why should the sale be against the law?

My second question has to do with the medicinal use of cannabis. You said that over 90 per cent of Canadians support the medicinal use of cannabis, but everybody that we have heard so far acknowledges that there is not sufficient formal research that demonstrates, without question, the efficacy of cannabis and its medicinal use. Such studies do not exist. We are told by others that the reason those studies do not exist is that in the United States where they are most likely to be undertaken there is political antipathy towards such studies. Since that is the case, do you think it would make sense for Canada, where 90 per cent of the people support the concept of medicinal use of cannabis, to undertake such studies to determine, in the most careful and scientifically proper way possible, whether cannabis use has medicinal benefits?

Dr. Fischer: I have two minds on that issue. On the one hand, it would be appropriate and necessary to do that to establish the best possible scientific evidence on the medicinal benefits of cannabis. On the other hand, we should also do a reality check on what we are dealing with and think about the driving principles. The people to whom we are currently giving medicinal marijuana are terminally ill people. The majority of them suffer from either the final stages of cancer or AIDS. The majority of them tell us, on whatever basis it may be, that smoking a joint helps either by relieving body function or pain or by just making them feel good. I am a scientist. I believe in scientific evidence and scientific reason. However, I am also a human being. When I see people in the final stages of AIDS or cancer who are getting a relief from smoking a joint, I wonder whether I need a multi-billion dollar industry in perhaps a 10-year research effort to find out whether a joint will be significantly more beneficial to this person than a fancy, expensive drug created synthetically in a lab - if I have a person in front of me who is going to die within the next six months and who tells me smoking a joint would make him or her feel much better? Those two existential bases of being a scientist and a human being are in some form of conflict and tension.

Senator Banks: No one would disagree with you in that respect, but some make claims that cannabis has medicinal efficacy quite outside of palliative care and the relief of terminal symptoms. Since it may be so, surely, as a scientist, you would support finding out whether cannabis has medicinal qualities beyond those uses. It has been used in folk medicine for its medicinal properties for things other than terminal AIDS and terminal cancer by many societies for longer than we know. If it works a little bit in one respect, then we might be able to find other ways in which it works if we refine it and improve its application.

Dr. Fischer: In principle I would strongly support the case for creating that scientific knowledge as long as our efforts and the scheduling of those efforts does not stand in the way of resolving the dilemma that I mentioned earlier.

The Chairman: We have more questions, so we will write to you. We hope in your answer you will provide all your support documentation for the information you have given.

Senator Prud'homme: I thank the members of the committee. I am not a member of this committee. I went through this debate close to 30 years ago, and we went across Canada. You know how divided Canadians were. Wherever we went, there was total intolerance between those who were for and those who were against the issue. I had not been to one public meeting where I had to intervene in a very gentle fashion to cool down the people, the parents. Everybody was afraid or too liberal.

The same arguments can be made, but one has great interest to me. It does not pertain to medicinal use or otherwise. It is what would be the reaction of our neighbour, the United States of America, if were to go along the lines of admitting marijuana usage. As you very clearly said, there cannot be marijuana usage without having people who produce it and cultivate it. They go together. Our friend and neighbour would be upset if we were to go along those lines. I would like you to give me a contrary opinion. That is one of my major concerns before I address the question, the reaction of the United States of America, where they would not hesitate for a moment to close the border or delay for hours by searching every car. I do not think they are as ready to understand what we are trying to do here in Canada. Do you have any reaction to that?

Dr. Fischer: My first reaction would be a sort of philosophical one. I would ask you whether the mouse's morals and values should be determined by those of the elephant. That is a philosophical answer.

First, it is a question of sovereignty. As with many other questions that we deal with on a political level in this country, the deck of cards is not stacked fairly. In many ways, this is an economic, political and legal issue. It is a question of sovereignty. Canada has to state and assert and defend very clearly what it believes - not what it believes the U.S. believes is right but what we believe is right and appropriate.

On the other hand, would the U.S. really do that?Especially and regretfully in this day and age, the U.S. has other great concerns. Is this really something where they would want to shut down the border and hinder and impose -

Senator Prud'homme: By "shutting down," I mean immense delays just as an annoyance, such as searching cars. Canadians would say, "Hey, I come here every week. Why are you searching me?" They would say, "Ask your government, because no one will enter here with marijuana." We have to be practical. We are stuck between the two.

Dr. Fischer: On the other hand, the current realities are not very far from what we are saying anyway or what we are speculating about. Everyone knows that there is so much marijuana produced in Vancouver and British Columbia and that many people have marijuana in their car anyway. The same is true of people entering the U.S. from Mexico. There are border controls. Even if we altered the system of control I do not think that this would get out of hand or that things would change dramatically. We would not all of a sudden have buses and trucks full of marijuana going into the U.S. It would be more or less the same. I do not think there would be an enormous practical benefit for the U.S. to change its approach. There are much more prevailing and pressing and predominant issues for them to use in determining their border policies at the moment than a few people having a few grams of marijuana in their car.

The Chairman: The very question of the U.S.A. being our neighbour and strongest ally is a huge concern for us. On November 5, we will have a U.S.A. day in the committee. We will hear interesting experts who will convey to the committee what is going on. Perhaps, Senator Prud'homme, we will be able to try to find an answer to that concern.

Dr. Fisher, thank you very much. In the last two days of hearings, we invited witnesses to stay because after all the testimony we can open the floor to the remaining witnesses. Sometimes we can find interesting agreements on various matters.

Dr. Fischer: I appreciate the offer and invitation. Regretfully, I have to leave. I cannot be present this afternoon because I must be back in Toronto this evening.

The Chairman: Thank you for your testimony and your answers. We will write to you. If there is any information you think we should receive from you, do not hesitate to write to us. We will kindly read your information.

Our second witness this morning is Dr. Perry Kendall, who has had a 25-year career in public health. He has served as the medical health officer for the cities of Victoria and Toronto as well as for the Province of British Columbia. In addition, he acted as president and CEO of the Addiction Research Foundation of Ontario from 1995 to 1998.

Dr. Kendall, thank you for accepting our invitation. Please proceed.

Dr. Perry Kendall, Provincial Health Officer, Province of British Columbia: It is a privilege to appear here before you. As you said, I have more than a 25-year career in public health. I have had public health responsibilities as a senior medical officer of health in the cities of Victoria and Toronto, and I am currently Provincial Health Officer for the Province of British Columbia. The opinions expressed in this paper are my own and do not represent the positions of any organization, department or government that I am presently with.

As you said, I have also been president and chief executive officer of the Addiction Research Foundation of Ontario, which at that time was Canada's largest research and clinical treatment centre in the area of addictions to alcohol, tobacco, illicit and prescription drugs. During that time, in addition to conversing with individuals from all ranks and users of drugs of many kinds of drugs, I was able to interact with researchers in psychoactive substances, addictions and social policy across North America and to meet researchers from Europe and Australia.

My public health background brings fairly broad experience with policy and public health issues related to alcohol and tobacco and to illicit drugs, particularly where they intersect with epidemics of HIV and hepatitis C over the last decade and a half in Canada and in the cities in which I worked.

The submission I will make today is concerned primarily with the issue of a regulatory framework for Canada and by implication will offer a public health approach to the control of a broad range of psychoactive substances, currently both legal and illegal.

To summarize, others have described the present regime governing cannabis as exemplifying bad pharmacology, bad sociology and bad economics. My analysis leads me to believe that it exemplifies bad law in addition to the other three.

In terms of pharmacology, the classification of cannabis as a narcotic under the Controlled Drugs and Substances Act is simply incorrect, and that is a feature it shares with a number of other illicit substances. Its classification with central nervous system depressants like the opioids and stimulants like cocaine, with neither of which it shares properties, serves little or no taxonomic purpose but serves merely to remind us of the legacy of cannabis inclusion under our Controlled Drugs and Substances Act that was described in detail by Mr. Fischer, starting with the uninformed writings of Emily Murphy in the early 1920s.

In terms of bad sociology, it can be argued that the present control regime not only does not have the deterrent effect that is one of its aims, but it also has a number of unintended and adverse effects: the resulting lack of respect for the law, its creation of rifts in credibility between the adolescent and adult views, and the undermining of more evidence-based prevention measures of three of the areas in which it has adverse effects. The economics of that, in that the present regime inflates prices and profits, has created the incentives of vertical integration by organized crime families to enter the illicit markets. Profits are high, prices are low and quality is improved.

In fact, in B.C., according to the police, the current B.C. marijuana market is about a $6 billion industry and over the last 20 years has gone from a market-garden economy to a highly vertically integrated and highly organized market of which, according to the police, there is control by large crime families.

It may also be that the economic drivers served to bring the markets for so-called hard drugs and soft drugs together, which means that their clientele are introduced to both kinds of drugs.

I believe it is bad law as well, and the present legal framework does not discourage use. It encourages disrespect for the law and has the undesirable effect of mixing markets and undermining preventive and educational programs.

The law is not uniformly enforced between and within jurisdictions.

In B.C. in 1990-99, only 17 per cent of those apprehended with cannabis were charged, versus 78 per cent in Prince Edward Island. The law is viewed as being susceptible to social and ethnic prejudice on the part of enforcing officers, and it has marginal support from top officers as represented by the Canadian Association of Chiefs of Police.

Under the present regulatory regime, possession remains a criminal offence under the Controlled Drugs and Substances Act. Parenthetically, the Controlled Drugs and Substances Act itself was introduced after lengthy debate and many years of moving through the House as a housekeeping bill, and its passage was accompanied by the promise of a subsequent full-scale review of Canada's drug laws, a review that is only now, five or six years later, under way.

As a compromise to objections raised during the lengthy passage of the predecessors of the Controlled Drugs and Substances Act, some attempt is made within that act to diminish the criminal impact of cannabis conviction for simple possession and to distinguish between personal and commercial possession. Leniency can be exercised on small amounts and the conviction for possession of small amounts does carry a criminal record, but I believe without the entry into CPIC of a fingerprinted record. Nonetheless, it is reported that the police laid in excess of 26,000 charges of cannabis possession in 1999. Subsequent convictions will carry severe consequences, with a criminal record for job searches, international travel, et cetera. Mr. Fischer examined some of those implications in broader terms.

Despite policing claims that cannabis possession is virtually decriminalized across Canada, 75 per cent of drug crime in British Columbia in 1998 was cannabis related. Again, the majority of these charges were for simple possession.

We should ask ourselves what it is about cannabis that warrants this treatment. The objective scientific assessment of harms, both individual and societal, that result from cannabis use has been hampered by what I might call an inflationary-deflationary dialectic that accompanies this discussion. Those who oppose any liberalization of the law have a tendency to inflate the hazards of cannabis, and where these are not known, to assume the worst. Conversely, those who favour legalization in their turn tend to minimize or ignore all evidence of suggestion of harm. It is hard to come up with a balanced approach.

Of course, it may be that the matrix of harm is actually irrelevant to the social and political aspects of the debate. I would not like to think that was the case, but clearly for many the cannabis debate has enormous symbolic overtones. You will hear more about that this afternoon.

In any event, we are talking about plant derivatives that contain a number of psychoactive alkaloids. The psychoactive effects are predominantly of mild euphoria and time distortion, though disorientation and panic attacks may occur. The appreciation of music, art and food are said to be enhanced, as is appetite, and this later function seems important for one of the claimed medical benefits in offsetting the effects of the chronic wasting syndrome in AIDS and the prolonged nausea that accompanies chemother apy.

All of the information that I will summarize in the next few minutes comes from a collection of works that were commis sioned by the World Health Organization and published in a monograph by the Centre for Addiction and Mental Health in Ontario and are available.

There are natural ligands of cannabis, meaning natural cannabis-like substances, produced within the human body. Specific cannabis receptors have been found in the brain and the peripheral lymphatic system. Therefore, we know that cannabis has a role to play in human physiology. There is a naturally occurring cannabinoid that has been identified in the human body that has many of the effects of cannabis. Cannabis, or rather, its active ingredients, in contradistinction to alcohol or nicotine have little acute toxicity. If we look at the acute health effects of cannabis, there are no known lethal acute episodes. There is no known lethal acute dose. The other physiological effects on heart rate and blood pressure are somewhat similar to those caused by nicotine in the amount that is smoked in a cigarette. It is generally well-tolerated, although recent reports suggest that in older men cannabis consumption may have a slightly higher risk than sex in precipitating myocardial infarction.

Because the drug is usually smoked, it has acute and chronic effects that are shared with tobacco. These include airway irritation, cough, and probably with chronic use, bronchitis, chronic obstructive pulmonary disease, and lung and pharyngeal cancers. Its impact on the immune system is generally to impair the function of the immune system, but the impact on human health of this impairment is probably minor. We cannot measure it. The effects of cannabis consumption on reproductive health are negative in animal studies. They disrupt male and female reproductive hormonal systems. They have been shown to increase chromosomal abnormalities in animal offspring. This obviously has some relevance to human health. However, human studies have yet to show any measurable adverse impact beyond some evidence of adverse behavioural and developmental impacts on the children of mothers who smoked cannabis heavily during pregnancy. Because of the usual route of administration, low birth rate and prematurity may be associated with cannabis during pregnancy. Clearly, cannabis should be avoided in pregnancy, much the same way as alcohol and tobacco should be avoided in the reproductive years.

The impact of cannabis on cognition is well documented. Short-term memory is adversely affected and chronic use may lead to chronic measurable defects in cognitive functioning. However, this may be more the result of persistent chronic intoxication than impairment in the substance and the working of the brain.

Psychomotor skills are adversely affected by cannabis use. Driving or operating heavy machinery when intoxicated is contraindicated. Again, in contradistinction to alcohol, cannabis intoxication tends to slow drivers down rather than increase their speeds. Similarly, cannabis smokers tend not to be involved in acts of physical violence and aggression, and violence and aggression when intoxicated is reportedly very rare.

Cannabis use may provoke schizophrenic symptoms in those with active schizophrenia or schizophrenic tendencies. Panic attacks and dysphoria are also mentioned in the literature.

There is an amotivational syndrome described in the literature and cannabis is said to induce it, but most researchers have discredited that over the last decade.

The issue of dependence has been disputed, but I think there is good evidence that a cannabis-dependent syndrome can occur in chronic, heavy users. It is of lesser severity than withdrawal from tobacco, alcohol or opiates but, given the prevalence of cannabis use, it may be one of the more common dependency syndromes in western societies, although few individuals ever actively seek treatment for this syndrome.

Concerns have legitimately been raised about the effects of cannabis consumption on adolescent development. As use tends to peak in late adolescence, this is an important consideration. The adverse effects that have been noted include an association with risk of discontinuation of high school, job instability and progression to the use of harder drugs.

The degree to which these associations are causal is very controversial. Alternative hypotheses are that cannabis use, like adolescent alcohol use, early onset of sexual activity, and tobacco smoking, are in fact markers for other risks of adverse social conditions and have nothing to do with the cannabis itself.

Research undertaken by the Addiction Research Foundation in 1997 in Ontario, research that included a broad series of focus groups throughout the province with groups of high school students, seemed to show that the occasional use of cannabis - and most of them were occasional users - by well-integrated, middle-class, predominantly white youth carried few if any harms. It was in fact associated with high-performing, socially well-adapted adolescents. But in contradistinction, solitary school- day use was clearly and accurately perceived by most of those kids to be a loser activity.

The focus groups told us a lot about what kids thought about our actions in trying to dissuade folk from using cannabis and the educational initiatives that we were putting in place and, in fact, provided some answers to questions you posed to Dr. Fischer earlier on. Some people were not viewed as credible messengers. That depended largely on the age of the respondents, but, by and large, police and teachers and many adults were seen as being uninformed and passing on inaccurate and biased information. On the other hand, there was a clear desire for accurate information that tended to convey what the kids themselves have seen and learned from the cannabis use of their own selves or of the individuals around them.

One of the down sides of our current activity in terms of the education campaigns is that all of our messages were being thrown out. If some of our messages were perceived as being either deliberately or accidentally inaccurate, all of the informa tion was thrown out, both the accurate and the inaccurate information. So kids were going forward blithely dismissing what were true scientific or social messages and just throwing them out with the inaccurate ones as well.

All researchers agree, however, that intoxication interferes with academic prowess. Recent studies seem to demonstrate measur able though reversible drops in IQ associated with heavy, persistent cannabis use and that engagement in illicit activities carries substantial risks, especially perhaps for youth whose connections to the school community are tenuous at best.

There remains the fear that cannabis acts as a gateway drug. Consumption of marijuana, it has long been argued, is the first step on the slippery slope to experimentation and later habituation to hard drugs. While it is true that it is rare to find a heroin or cocaine user who did not first use cannabis, the vast majority, more than 95 per cent of cannabis smokers, do not progress to harder drug use. For drug progression, the hypothesis that the sequence to use of drugs like ecstasy, speed, cocaine or heroine, reflects a direct effect of cannabis on the brain is really the least compelling theory.

A far more likely explanation is that cannabis use may be one of many social and cultural factors, including family relationships, peer influences, social attitude and beliefs, and youthful rebelli ousness that are associated with a higher likelihood of the use of other substances as well. In other words, the same factors that contribute to cannabis use may lead a smaller number of individuals to experiment with illicit drugs. This is borne out by the fact that early onset of cannabis use and other risk behaviours, including drop-out from school and not feeling a part of your family or your community, are some of the predictors of riskier use and onset of harder drug use in later life.

This probably explains the link between cannabis use and lower professional academic achievement and other personal and social problems. It may also be, as I alluded to earlier, that someone who purchases cannabis is entering an illegal drug market and a dealer who sells cannabis may also offer other drugs, so that a naive purchaser of one drug comes into contact with other drugs. Having discarded the prevention methods that we have tried to inculcate in earlier years, the user is tempted to try other drugs because they dismissed the claims of associated harms when they dismissed the claims of harms that we were seen to have put forward in an exaggerated fashion for cannabis.

In addition, we should note that both tobacco and alcohol usually precede the use of cannabis. Public health practitioners have claimed that tobacco is in fact the gateway drug and not cannabis.

In summation of the effects, there is little doubt that consumption of cannabis has adverse effects on the health of Canadians. However - and it is a significant "however" - the document that was commissioned by the WHO concludes that intermittent use of cannabis is probably less hazardous than use of tobacco and alcohol and, at present levels of consumption, less of a public health problem than alcohol or tobacco with which it shares certain characteristics.

Dr. Fischer gave you some of the metrics on the costs of alcohol, tobacco, illicit drugs and cannabis on health care costs.

In B.C., for example, in 1992, of the total number of hospital days attributed to illicit drug users, those that are attributed to cannabis are less than 3 per cent. That percentage would be smaller now because of the explosion of HIV and hepatitis C resulting from illicit injection-drug use.

To summarize, the WHO has prepared a document comparing the adverse effects on health for heavy users of marijuana, alcohol, tobacco and heroin on a number of harms - traffic and other accidents, violence and suicide, overdose deaths, HIV and liver infections, liver cirrhosis, heart disease, respiratory diseases, cancers, mental illness, dependency addiction, and lasting effects on the foetus. On the table, a single star indicates a less common or less well-established effect. A double star indicates an important effect. This is the basis of the summary on which we say that marijuana, in comparison to other licit and illicit drugs, is a relatively minor impact.

You will notice that dependence and addiction have been given the benefit of the doubt, given that a double single star shows a well-established impact, although not all researchers would agree with that.

If the social and legal structures against the use of cannabis are justified mainly by the health risks and the costs to society, we must ask why we treat cannabis so differently from alcohol and tobacco when the metric of harm so clearly weighs against the latter legal substances. There is a very valid point that, as a society, we do not wish to add additional harmful substances to our list of licit substances, but we should ask whether our regulatory framework is effective in discouraging use and whether it is proportionately fair in its application as a deterrent. While we are also determined to discourage underage alcohol consumption and the smoking of tobacco, we do not inflict the same degree of criminal sanctions on youth who are found imbibing these two substances, this despite our evidence that, at present levels of use, the risks to health and costs to society from the misuse of alcohol and the use of tobacco far exceed those of cannabis.

The kids we talked to in those surveys and the kids I have talked to in schools I visited see the discrepancy between illicit and licit drugs - one being legal and the other being illegal - as significantly hypocritical. They can see lawmakers who are puffing on cigars and drinking a scotch or a cognac; yet their attempts to achieve a similar state of internal pleasure with cannabis are criminalized. This is a major rift between the worldviews of the young and of the older lawmakers.

One way of assessing the deterrent effect of a law would be to look at the trends in cannabis use. Consistent provincial and national data are lacking, but there are some longitudinal surveys we can look at, particularly in Ontario, that are consistent with the findings from the U.S. and some of the spotty surveys from the Canadian provinces in showing a 20-year trend of increasing use during the 1960s and 1970s, with use peaking in 1979, where reported use in the last month was about 32 per cent among youth. This occurred despite a 670-fold increase in cannabis related convictions over that same period of time.

The peak in use was followed by over a decade of steadily decreasing use. The lowest levels of use ever were recorded in 1991, at around 11 to 12 per cent, after which time use has again risen to 25 per cent in 1998, although it has not reached the levels that we saw in the late 1970s.

The most recent data shows that among high school aged respondents, use is highest in grade 11, where in Ontario it was reported at 42 per cent and in B.C., among Vancouver's grade 11 students it was reported at 57 per cent. This trend has been seen, as Dr. Fischer said, in Australia, the U.S., the Netherlands and in some other European countries. In the Netherlands, it rose from 3 per cent in 1988 to 11 per cent in 1996.

It is important to note, however, that the majority of users in Canada use the drug sporadically or experimentally and only 2 per cent of students report weekly use in surveys asking for use over the past four weeks.

This increase in use, as I said, has been seen in all countries. What we are starting to see now, however, is a levelling off. I think the latest Ontario data shows a levelling off of those high levels. The U.S. data seems to show a levelling off of use. In the Netherlands, we actually have reports that use is starting to decline, the other side of the curve coming down.

When one talks about cannabis and the Netherlands, there is a significant amount of reportage about the de facto decriminaliz ation in the Netherlands being followed by increases in use. You will also hear that decriminalization in Alaska and Australia was followed by increases in use. This is true. What those individuals who were reporting increases in use post-decriminalization do not point out is that the same increases in use were being seen in contiguous nations and states where either decriminalization was not part of the agenda or the regimes were made harsher. What we are seeing is a general social trend to use increasing and then decreasing, which, I would agree with Dr. Fischer, seems to have little to do with the actual regulatory regime in which the use is occurring.

In concert with this rise in use is a reported drop in the perceived harms of cannabis. Most recently in Canada, we have seen an increasing public tolerance of personal cannabis use and, if you like, a softening of attitudes toward the compassionate use of cannabis in the medical setting. Indeed, the populist view has been reinforced by a series of court decisions affirming the right of access to cannabis for medical use and the development of a research framework into legal supply.

The questions you were asking about cannabis proving to be effective in conditions other than chronic wasting syndrome or anti-nausea with epilepsy and neuromuscular diseases, et cetera, are being researched at the moment. One hopes that the answers are forthcoming. Thus, if cannabis use has evolved in palliative conditions, we might know what that role will be.

I would conclude from the above that the Canadian regulatory framework has had marginal, if any, impact on overall levels of use. The conclusion is supported by a number of studies that have examined the impact on relaxation and in some jurisdictions, a subsequent reimposition of the criminal sanctions within regula tory frameworks, notably the U.S., the Netherlands and Australia. Professor Eric Single, who has presented to your committee, and other colleagues have written extensively on the topic and the findings are quite consistent and robust between jurisdictions.

There is little evidence to support the contention that a more liberal framework for cannabis has resulted in increased use or cost. In jurisdictions that have relaxed legal frameworks, enforcement costs have measurably decreased. The lack of demonstrated pent-up demand is a critical point to note as one of the more cogent arguments against any relaxation of our present framework is that it would lead to increased levels of consump tion and increased harms to individual in society.

In addition to the costs of law enforcement, the policy of cannabis prohibition entails other social costs. Large numbers of predominantly otherwise law-abiding young citizens are arrested and prosecuted each year. Many would otherwise not have criminal records or the associated negative impacts on schooling, employment and family discord. An additional consideration that applies not only to cannabis offenders but to society as a whole is the encroachment on individual rights and freedoms in order to facilitate drug enforcement.

If we conclude, as the Le Dain commission did 30 years ago, that we can achieve the social goals of constraining use and avoiding harms without the need for including cannabis within a criminal law framework, what then would be a reasonable alternative? There is a model that the committee can examine, a model that can be extended to include a societal response for a number of psychoactive drugs, both licit and illicit, that will provide options for reducing the harms not only from the drugs but also from the regimes of control that we put around them.

Many analysts assert that the collateral damage from our present regimes of drug control now cause more harm than they prevent. Explosive epidemics of HIV and hepatitis C in injection drug users are frequently cited as examples.

In 1998, the medical health officers of British Columbia wrote a paper. One of their recommendations is that the federal government should amend the Controlled Drugs and Substances Act to provide for control of legal availability of certain schedule 1 drugs in a tightly controlled system of medical prescription within a comprehensive addictions management system, pos session of small amounts of controlled drugs should be decriminalized, importing and trafficking offences should remain, and the enforcement of them should be improved.

The framework within which you could examine possible regulatory regimes owes its origins in 1984 to a British psychiatrist called Marks. He called the simple framework, "The Paradox of Prohibition." Essentially, it suggests that the harms from a drug as well as the demand for that drug can be plotted on a U-shaped curve on the vertical access and the regulatory regime can be described on the horizontal axis. At the top of the two arms of the "U," both demand and consumption for the drug are maximized, as are the harms that occur. The harms at the prohibition end of the regulatory continuum include not only the direct effects of the drug or its adulterants, but also the harms that result from unsafe consumption patterns, infections, overdose, death, the crimes committed to access the drugs, the social costs from courts and jails, the personal costs from criminal records, the costs associated with corruption of police forces and the opportunity costs from law enforcement.

Marks cites the era of prohibition in North America as an example. It is true that the amount of alcohol overall that was consumed in the U.S. did go down during the prohibition era, but the harms from it multiplied. While we saw cirrhosis of the liver going down, over 1,000 people were killed by the law enforcement agencies through collateral damage. These were not bootleggers. What we know already about the bootleggers is that their turf wars clearly contributed to these figures.

Other writers now cite the present war on drugs in the United States as an even more compelling case of black market gangsterism and the harms of prohibition. At the other end of the regulatory scale is the absolutely free market, with no constraints on the commercial production and distribution of a product. The gin mills and epidemic intoxication of Hogarth's England probably come closest to meeting Marks' description of epidemic intoxication, where the slogan was "drunk for a penny, dead drunk for a tuppence."

Marks postulated that in the centre, at the bottom of the "U," is a place where the extremes of prohibition or the full free market play were modulated and where access consumption could be moderated and harms from both consumption and control regimes minimized. In the public health field, we call this the public health approach. At this centre point, at the bottom of the "U," in today's regulatory environment, you tend to find the most regulated of the legal drugs, those that are controlled and prescribed by professionals through the means of prescription. Our legal psychoactive drugs, tobacco and alcohol, occupy niches to the right of the curve.

Interestingly, tobacco has slowly been moving back, from the right-hand side and a completely free market, to the centre over the last two decades, while alcohol, having escaped from the prohibition at the extreme left of the curve, has been moving through the strictly regulated and controlled state monopoly that characterized the Canadian alcoholic beverage market in the 1960s and is now steadily moving toward the right-hand end as the government and the drinks industry seek more and more to normalize it as a product. In the last five years, we see advertising restrictions being lifted, Sunday and late-night sales, credit card stores, and the disbanding of some provincial government monopolies while others have moved to put beer and wine into corner stores.

At the same time, harms from alcohol consumption are arguably decreasing. We have come to acknowledge that for adults in the fifth decade and older the health benefits have actually swung in favour of moderate consumption. It remains to be seen, however, whether the increased access to alcohol has been as favourable to the young and the dysfunctional drinker as it has been to the older drinker.

Dr. Harold Kalant, who presented to you earlier on in your hearings, has written much on psychoactive substances. One of his works investigated whether it would be possible to derive a regulatory scheme based solely on the pharmacological and physiological effects of the drugs themselves. He concluded that our knowledge base was insufficient, but that, even if we had the knowledge, cultural values and symbolism play as much a part in what we bless and what we curse and that it is probably futile to try and take a purely objective approach.

The Senate has given us the opportunity to try and bring rationality to the irrational world of intoxicants. Even if we do not achieve perfect rationality, I propose that we can do much better than the inconsistent and ineffectual regulatory regime that we have in place today.

Returning to Mark's continuum, I cite the work of a colleague back in B.C., Mark Haden, who proposed a number of options for regulatory control along the continuum. He has actually noted seven, but, in fact, you can expand or contract upon that number.

On the one hand, you would have legalization and promotion without any restrictions in a free market. As you move back across the spectrum, you have legalization with product restric tions around packaging, marketing, purity, methods of sale, advertising, et cetera. Then you have legalization with product and customer restrictions - age of purchase could be limited, the volume of purchase, proof of residency, times of access, et cetera. Then you could have availability on a prescription basis, then decriminalisation - that is, maintain illicit status but remove the criminal sanctions. Then you could have de facto criminaliz ation - ignoring the existing laws - or you could maintain the present prohibited status.

In a more focused proposal with a narrower scope, the Canadian Centre on Substance Abuse national working group on addictions policy in 1998 looked at regulatory requirement for cannabis and proposed a series of liberalized alternatives that would maintain its illegal status. These included a fine-only option, a civil offence option, a diversion option and an option to devolve the whole problem to the provinces.

Following that analysis, the group made a series of recommen dations, the first of which was that the severity of punishment for cannabis possession charge should be reduced - specifically, that cannabis possession should be converted to a civil violation under the CDSA.

The group also recommended that diversion of offenders to treatment should be available to heavy users or those experiencing problems from the use of illicit drugs. They recommended that any change in the law should be accompanied by an evaluation of subsequent levels of use and harms and that any change in the law that reduced consequences for cannabis users should be accompa nied by strong messages that this does not signal reduced concerns with the potential problems caused by cannabis use.

This seems to be a sensible, if somewhat conservative, package of recommendations - decriminalization and evaluation as opposed to legalization - and one that would probably sit well with the majority of Canadians, including policing and public health authorities.

However, a cautionary note should be sounded. If Canada did adopt this recommendation, we should be concerned and thus take steps to avoid the situation in Australia, or to repeat that situation, where the imposition of a cannabis expiation program actually led to a net widening effect, because the police now ticketed individuals that they had previously ignored.

Many of those so ticketed failed to appear to pay their fines, and subsequent numbers entered the criminal justice system for non-payment of fines and subsequently received criminal convic tions. There was an unintended result in that the number of persons criminalized is as large, or perhaps larger, than before the measure was implemented.

One might ask whether in view of what we know about cannabis in comparison to alcohol and tobacco a stricter regime could be justified. Could the state not control license production and retailing? Could the state not put in place strict limits on access and age, geographic and quantity restrictions, et cetera? When I first came to Ontario in 1972, if I wanted to buy a bottle of wine I went to an anonymous outlet, where I consulted a list of products, wrote my request on a piece of paper, handed it to a clerk, who disappeared into the background and returned with a brown paper bag for me, and paid for my purchase and went away.

This would also allow the government to collect taxes that could be directed to education and treatment. This approach is supported by a number of my colleagues in British Columbia. While this might be eminently sensible, my judgment is that it is possibly not acceptable at the present time. Among other considerations are Canada's obligations under international treaties, although I note that the UN international drug control program noted that none of the conventions require a party to convict or punish those who commit such offences, even when they have been established as punishable, and that alternate measures may always substitute for criminal prosecution.

In respect of cannabis control, with some reservations the pragmatic approach would be the recommendations from the CCSA policy advisory group, but the facts and the analysis of the issue indicate that we could do better than that, if we had the initiative to try.

The Chairman: It is my understanding that the third last paragraph would be your recommendation. Is that correct?

Dr. Kendall: Yes.

The Chairman: However, in consideration of the political environment, you believe that the achievable recommendation is the 1998 recommendation?

Dr. Kendall: At a minimum, the achievable recommendation is the one from 1999.

Senator Banks: Dr. Kendall, you included strict limits on access in that recommendation. What would those limitations be and for whom? Would they be similar to the age restrictions for tobacco, and alcohol?

Dr. Kendall: One could create any kind of regime around the age limitations - geographic limitations, the number of outlets, how the outlets are licensed and regulated, the amount of product that can be sold and the state of the person to whom it is sold. It would be similar to the current system for alcohol, for example.

Senator Banks: However, it is extremely ineffective in the case of tobacco.

Dr. Kendall: If one wanted to limit the number of outlets that sold tobacco, it would be more effective to limit the sale to pharmacies, rather than put the outlets in corner stores. Pharmacists are licensed and they can move the product behind the counter. They have much more at stake in limiting the access to whom they sell the product than the corner store owner would have.

Senator Banks: Early on in your presentation you said that, in 1999, there were 26,000 convictions for possession. Dr. Fischer said 36,000 earlier today. Would you let us know later which of those figures is correct, or what their respective sources were.

Dr. Kendall: I said in excess of 26,000 charges laid, so we should get together and clarify the figures.

Senator Banks: I ask that because I am not sure how effective it is to apply numbers, but it is handy if they are consistent.

I would appreciate your letting us know. It is for our absolute certainty that the basis of what you suggest is the impropriety of the inclusion of cannabis in the present regime, as it is set out in the Controlled Drug and Substances Act. You said that it was improperly included along with some other things, and I would ask that you let us know your professional reasons for those comments.

With respect to the question of gateway, my kids have weathered the storm, but I am concerned now about my grandchildren.

The niceties of determining whether the gateway aspect of cannabis exists because of some physiological lead-in, on the one hand - which, we are told, does not exist - or on the other hand because the same guy in the trench coat at the edge of the school will be selling it and might, as has been the case, we are told, lace A with a little bit of B for an introduction or even for an addiction to begin is a nicety with which I am not concerned.

However, if I were a grandparent, a parent or a concerned person at any level, any likelihood that cannabis use can lead, for whatever reason, to the use of other drugs would be a concern to me. Do you think we can make the distinction between how that introduction might occur? Is it not the case, at least in the present regime, that illicit drugs are all available from criminals, by definition, and so there is a mix? I think the word both you and Dr. Fischer used was "mix," the availability of those things. Can we seriously say an introductory factor is not involved there?

Along the same lines, we have heard from scientists, doctors and people in the medical field that, clearly, demonstrably and irrefutably cannabis is not a gateway drug. We hear from police officers that are on the street and deal with this every day of their lives that clearly, irrefutably and undoubtedly cannabis is a gateway drug. Whom do we believe? How do we decide whom to believe? Are the policemen right, the men on the street dealing with it every day, or are the scientists right, who say there is no physiological evidence that it exists?

Dr. Kendall: The scientists and the police are talking about two different things in many respects. From the police perspec tive, somebody who breaks one law is likely to break another law. From the police perspective, they are in the downtown core dealing with the individuals. They have a perspective similar to the one I had when I was working in a street-front clinic and all of the youth I saw in that clinic had sexually transmitted diseases. It was relatively easy for me to draw the conclusion that all youth are sexually active and all youth have sexually transmitted diseases because that was the group I saw. I was seeing only a small proportion of all youths in my universe. The inferences the police draw from the people they see are valid for the people they may be seeing, but they are not seeing a representative portion of the population of youth.

The argument for cannabis as a gateway drug physiologically was that taking cannabis did something to one's brain and it created a hunger for other drugs. That hunger could be satisfied only by taking stronger drugs and more of them. That is the classic gateway theory, which is nonsense.

However, when we put drugs together and teach kids that all drugs are as bad as each other, we tend to put the markets together. We should not be surprised when kids experiment with one drug and find it did not drive them mad. They did not wake up the next day with a strong dependency syndrome. Their friends were coping well with the drugs. Why should they believe it when we say another drug, which is just as illegal, perhaps, in their minds, is worse or harmful? They do not believe that. If anything, they may have a tendency to try that other drug to experiment.

Some of the strongest evidence for that theory comes from the Netherlands, which, with the cannabis cafés and possession of small amounts, they have managed to separate the two drug markets. The prevalent use of the hard drugs, heroin and cocaine, in the Netherlands is much lower than it is in the U.S. or places where those two markets are similar and exist side by side.

Senator Banks: Is it lower than it was before they made that separation?

Dr. Kendall: Yes, and the age of injection drug users in the Netherlands is consistently increasing, showing that they have separated the markets, and they are not getting an induction into the injection drug use community. The existing cohort age is not being reinforced by the younger age groups.

We do not see that in Canada. Where we look at the age of injection drug users, they are consistently young drug users coming into that cohort. We have not managed to separate those markets.

Senator Banks: Therefore, in the present circumstances in Canada, it could be argued, based on what you have just said, that there is the gateway theory in the sense of leading directly from one to the other in order to satisfy a need but there is in the present regime in Canada a connection between the two.

Dr. Kendall: We put the same products in the storefront window in many instances.

Senator Banks: Getting back to my earlier argument, whether or not it is the gateway in the medical sense is almost beside the point. Because we have not separated those things in this country, there is a connection between the use of what you say is a relatively harmless drug, on the one hand, and what are clearly harmful drugs on the other hand.

Dr. Kendall: It is clearly, statistically, a tenuous link. Less than 98 per cent, or two per cent of cannabis users, actually go on to sample the other drugs that may be in the same shop window. From having talked to my 24-year-old when she was growing up, there is some separation of drug markets. The drug markets in the high schools where she was in Vancouver tend to be the soft drugs, cannabis, et cetera, and the downtown markets tend to be the soft and the harder drug markets. The markets are somewhat separated, depending on where you actually come across them.

The focus groups we conducted in Ontario with 46 high schools also showed a tendency for the markets to be mixed in some locations. More generally, the markets would exist for what the demand was, which was cannabis, not the heavier drugs. Most of the kids in high schools looked on hard drug users as something that only losers did, much as they looked on daily cannabis users. There was not a market in the high schools per se.

Senator Banks: The kids are way ahead of us. They have made the distinction.

Dr. Kendall: If we listened to them and what they have told us, we would have a much better prevention program.

The Chairman: I know it is difficult for a scientist to answer this question, but keeping in mind what we already know about cannabis use and trends, is it still a problem from a public health point of view?

Dr. Kendall: It is a much lesser problem than we currently have with alcohol and tobacco. It is a problem for some kids, and we can identify those kids. Those are the kids who failed to receive the full benefits of early childhood development. They are the kids we can identify in the pre-school years as not being ready to learn. They are the kids we can identify in the elementary schools and in the high schools as being the kids who have problems learning and problems with attachment to school and community. We can help them make better choices by giving them skills and by trying to select them for additional help, literacy training and social behavioural training.

The Chairman: Who should do the education?

Dr. Kendall: It is a multiparty state. There is a role for policing. When we are talking about psychoactives and making sensible choices, at a relatively young age, any symbol of authority, a parent, a policeman, a teacher, is believed to be credible. As the kids start get older and start questioning authority, I would use less the authoritarian approach and more the peer, respectful education approach, putting the facts forward, and telling the kids what we hope they will do. One approach will not work for everyone. Certain high-risk kids need a different approach yet again.

I would answer much as Dr. Fischer did. It must be many people giving the information, and the information must be accurate and consistent. There is a place for popular media and for popular culture and for teachers and for parents and for special educators.

The Chairman: In the discussion you had with Senator Banks, you used the expression "integrated market." Is the market integrated because substances are illegal, or should we deduce from your testimony and the answer you just gave to Senator Banks that if one of the substances was controlled but not prohibited, as per personal recommendation, we would not have that integrated market?

Dr. Kendall: My hypothesis is that we would not have that integrated market. That is a researchable question, and we can find that out.

The Chairman: Because of prohibition, you have one milkman distributing not only milk but also ice cream and everything else because everything in the store is prohibited. If one substance were not prohibited, the gateway to harder or prohibited substances would be cut because the interest for such a market would not be there.

Dr. Kendall: That would be my hypothesis, yes, borne out by some experience in the Netherlands and research.

The Chairman: We will have a full day of hearings on the Netherlands' experience. It will be interesting to hear about the trends on the use of soft and hard drugs in that country, and it is not what we think it is. It will be interesting to hear those witnesses.

You have referred to international conventions. Could you elaborate a bit on our options? The easy answer would be that we would like to do something but cannot. In your remarks, you said that we could go beyond that fast answer and, as the lawyers say, "read in" the conventions and understand the meaning of the text of the convention. Can you elaborate on that?

Dr. Kendall: I was hoping you would not ask me that question.

The Chairman: That is a slippery area.

Dr. Kendall: I am not a lawyer, and I have not made a detailed study of the conventions. However, I would point out that the UNDCP stated in their world drug report in 1997 that none of the conventions requires a party to convict or punish those who commit such offences even when they have been established as punishable. Alternate methods may always substitute for criminal prosecutions. There is an area or doorway there, and I would ask for some aggressive legal advice and options on what this actually means vis-à-vis an international regulatory framework, to see what one could drive through that doorway. As I read it, it opens up the option to move across the spectrum away from prohibition into other control regimes.

The Chairman: You are from Vancouver, and Vancouver is probably the centre of production of marijuana in Canada now. What can you tell us about the reaction from your neighbour to the south?

Dr. Kendall: There have been numerous representations from law enforcement south of the border that the Canadian border is too porous and that Canadian courts have been too lenient in their treatment of cannabis offenders. In response to that, the B.C. RCMP has stepped up enforcement and security.

I do not think that the U.S. is a monolith or that the opinions of the U.S. law enforcement community, or even certain senators, necessarily represent the opinions of a cross-range of American opinion. A number of U.S. states have passed laws decriminaliz ing and allowing for the medical use of marijuana. There is not even a single state opinion, and the federal and state opinions are different. The medical and research communities again are different.

The Chairman: The last part of that answer is really my focus. You maintain a relationship with your professional colleagues on the other side of the border. What is the state of their knowledge and understanding on the subject? Do they have an understanding similar to yours? Of course, we will ask them those questions, but do you think they would go along with your personal recommen dation?

Dr. Kendall: I would say that the majority of health and addictions researchers that I have talked with, and I have not talked with all of them, would favour the public health approach, a kind of middle ground, to try to minimize harms, to measures harms, and to try to bring them down, and not only the harms from the substances themselves and how they are used but also the harms of the regulatory approach. There is strong opinion around this in terms of injection drug use and illicit drugs from both sides of the political spectrum in terms of what the war on drugs is actually doing to the health of the American people.

The Chairman: In the last part of your remarks, you referred to a pragmatic recommendation. That pragmatic recommendation is influenced by principles that are perhaps not scientific but more fed by morals and history. This is my last question, and if you would prefer to answer in writing, please do so. What are the guiding principles that should influence public policy on illegal drugs? Of course, science has a role to play, but what is the role of morals and what should be the role of penal laws? It is a large question; as I said, if you wish to write to us in answer, you are welcome.

Dr. Kendall: I would be happy to follow up in writing. Some of our inherent principles should be around safeguarding personal liberties and respecting other people's choices, and staying away from moral areas where we do things for other people's good rather than concentrating on issues that bring harm to other people. When we try to restrict behaviours and freedoms of choice, it should only be in those areas where demonstrable harms to others can arise from those behaviours. We should seek a variety of means to change those behaviours. I am quite sure that, within the current era, we have strayed far from those principles, and the social controls we put on people's individual choices and what happens to them after they have made those choices within our current control efforts brings far more harm to those and other people than basically moving back along the spectrum and allowing the individual choice and reducing the harms from those choices. We have magnified the harms from the bad choices people make.

The Chairman: No matter what science and the experts are saying, a large portion of the population says that no matter what you are trying to prove or put in as evidence it is morally wrong. Even though reasonably we should say morals should not influence public policy, they do influence the policy-makers. Perhaps Senator Banks would wish to follow up.

Senator Banks: You heard my question of Dr. Fischer earlier. There are laws in this and other countries that are perceived to be civilized that are at least partly based on moral compunction, laws that have to do, for example, with suicide, which say that you may not do anyone else any harm, but that is wrong. Of course, the whole debate around abortion is unanswerable because no one is able to say with any scientific definition when life begins. It could be argued that there are many things that do not harm a third party that are nonetheless precluded by law because of moral compunction. You have not suggested that any other laws that might be based on morality or perceived morality ought to be changed.

Would you briefly address the question the chair put to you about the distinction between a law that exists only because of its capacity to reduce harm to others and a law that says that a certain activity, although it may hurt only you, is morally wrong and therefore against the law. Many people believe that there ought to be, as there are, laws based on moral rectitude alone. Do we, in this case, simply ignore that?

Dr. Kendall: I would argue that the moral value around the substances that we have chosen to call illicit probably comes from a desire to help people be better and not hurt themselves. It was based, I think, on a measurement of the harms and benefits that would result from the use of these substances. You could argue quite cogently now that the harms from the law that resulted from that moral position outweigh the benefits.

Senator Banks: If I can extrapolate from that, ought we, with respect to other drugs, say that there is no morality involved because it does not harm anyone other than those who are dumb enough to shoot is in their arms?

Dr. Kendall: I think there is a morality involved in our current attempts to curtail heroin injection drug use, which has resulted in thousands of unnecessary overdose deaths and scores of thou sands of unnecessary and preventable infections. If one is doing a moral count of harms and goods, speaking morally I would say that our present control regime for injection drug use is fundamentally highly immoral and very unethical because it prevents us putting in place programs and practices that will stop people dying, stop infections and stop other people from getting infected and harming themselves further than they already do.

Senator Banks: Extending the argument, it would make sense in every respect, morally and otherwise, given the balance of the arguments, to decriminalize drug use.

Dr. Kendall: I believe so, yes. You would need to be careful of the regime, and my fellows and I in 1998 put forward a paper that suggested that the tightly controlled medical prescription of certain pharmaceutical substances would be of greater benefit to society and to those addicted individuals than would our current regime with illicit supply of amounts of impure substances. We cannot control it. It is not that we are moving from a situation of no illicit drugs on the streets to flooding the streets with prescription drugs; we are moving, in Vancouver, from a situation where the downtown core is flooded with drugs of unknown purity to a situation where we could potentially control within a medical setting the amount of drug and the impurity of the drug there, thereby restricting the amount of death and disease and diminishing the amount of human misery.

Senator Banks: Getting back to medicinal use, you mentioned that there is research going on. The CBC program Quirks and Quarks was about this subject the other day. On that program was Dr. Donald Abrams, a cancer and AIDS researcher at the University of California in San Francisco who has been trying to conduct clinical trials to learn whether there is in fact medicinal benefit of cannabis based on the empirical evidence that the body produces cannabinoids and on the fact that there are some demonstrable anecdotal uses. The interviewer, Mr. MacDonald, said:

There isn't a lot of good scientific evidence to support the use of medical marijuana. Properly designed, well-conducted clinical trials to determine its effectiveness haven't been done. But that's not for lack of trying.

Dr. Abrams said:

One needs to remember that this is not something that was just discovered today, that marijuana has been used as...a therapeutic compound for millennia. So you know clearly this substance has known therapeutic benefits. You know I always used to say that if the science survived the politics, we'd do our trials. Well you know then I think that's another one of my naivetés, that the science and the politics are so intricately involved and interwoven that....you know, which one is going to survive and triumph remains unclear.

He is talking about the situation in the United States and the lack of political support for research into the question of the efficacy of the medicinal application of marijuana. You said that there is some going on. Are we doing it?

Dr. Kendall: Yes.

Senator Banks: Where?

Dr. Kendall: Health Canada has established funding and parameters for medical research into the medical use of marijuana. I do not know who is actually running the trials, but a series of trials is in progress.

The Chairman: McGill University in Montreal is studying the sedative effect of marijuana. They received a grant for that a month and a half ago.

I would like to go back to Dr. Marks' model. To your knowledge is there any empirical study on that model? Is it merely a proposal or an idea, or it was studied?

Dr. Kendall: No single study has been done. It is an idea and a model. However, there are data points that can be used to substantiate the impacts of different regulatory regimes on different drugs and the impacts that they have on individuals and society as a whole. For example, we could look at the use of tobacco, the number of persons who are smoking, the lung cancers and the heart disease that result from a pure market economy approach and compare that with the reductions in smoking prevalence rates and subsequent heart disease rates demonstrated from data from California. We can see the data from Canada in terms of lung cancers in males that reflects the problems smoking causes for men, which reflect our attitudes toward tobacco and which are reflected, in turn, in the extent to which we promote or do not promote the product or restrict its access. For almost any psychoactive substance, you can look at the impact of different regimes and test them. It is partly the results of that which results in this model.

The Chairman: It is an interesting way to look at the present situation and the possible options and alternatives.

Going back to how morality influences policy making, considering the knowledge that you and your colleagues in the scientific world in Canada have, why is there a gap in what you know and why does it not translate into the general population to modulate the group of individuals who say that, regardless of what they are told, it is morally wrong? It seems that you are providing us with sensible and reasonable information, and I am sure it is not new. Why is it not filtering into the general population?

Dr. Kendall: There are volumes written by sociologists in answer to that question.

I think that information is seeping out. There are strong countervailing interests who fundamentally disagree with some of these approaches for a variety of reasons. Dr. Mathias may touch upon some of those interests this afternoon.

Clearly, in terms of cannabis, for example, the front line police do not want to lose a tool. They see themselves handicapped in the fight against criminals. Having talked with many of them, they do not want to lose what they see as a helpful tool. From my perspective, or that of a scientist, the fact that that helpful tool has a lot of unintended and unwanted consequences and outweighs the benefit of the tool to the policeman is irrelevant. If he loses that tool, he will be upset.

The Chairman: What you are telling us is there are definitely individuals who, in good faith, are opposed to any change because they consider it morally wrong. However, there is a group, which is not in good faith, and they oppose any change because of other interests that have nothing to do with morality.

Dr. Kendall: Yes, for practical reasons. They may be a group who are marketing and selling illicit drugs and making profits that are many times greater than they would get if these drugs were available in a regulatory regime. This group has an interest in maintaining the current state. I am talking about drugs that can be produced for pennies an ounce by pharmaceutical companies and that are now selling for hundreds of thousands of dollars.

Mr. Chairman, might I show two other overheads?

The Chairman: Of course.

Dr. Kendall: The first compares the U.S. with the Netherlands in what are roughly comparable years, those being 1994, 1996 and 1997. It illustrates cannabis use by teenagers. If all other things were equal and you were asked to pick a regulatory regime that minimized cannabis use, you might legitimately look at the country that had the lowest levels of use.

The Chairman: To be fair with trends and population, in all of Europe when we look at the numbers the use of all drugs is lower than in North America. Is that right?

Dr. Kendall: Except for the U.K., where it is higher.

The Chairman: Generally, in Western Europe, including the Netherlands, France, Switzerland, Belgium, Spain, Portugal and Italy, the use of drugs is lower than it is in North America; is that not right?

Dr. Kendall: Yes. I show you this because I think you will hear arguments that the regime in Netherlands has resulted in epidemic drug use and epidemic intoxication. Quite honestly, it is not borne out by the data.

The Chairman: If we have other questions, we will write to you for your response. If you come across some information that you think might be of use to the committee, please provide it to the committee.

[Translation]

Before we adjourn this committee meeting, I would like to remind everyone who is interested in the committee's work that they can read about illegal drugs and find out more by visiting our web site at the following address: www.parl.gc.ca. There you will find the presentations of all our witnesses as well as their biography and all the supporting documentation that they provided to us. The site also has more than 150 links relating to illegal drugs. You can also use this address to send us your e-mails.

On behalf of the Special Senate Committee on Illegal Drugs, I would like to thank you for your interest in our important research.

The meeting is adjourned.

Illegal Drugs (Special)

Proceedings of the Special Committee on Illegal Drugs

Issue 6 - Evidence for September 17 - Morning Session

Proceedings of the Special Committee on
Illegal Drugs