CANNABIS :
OUR POSITION FOR A CANADIAN PUBLIC POLICY

REPORT OF THE SENATE SPECIAL COMMITTEE ON ILLEGAL DRUGS

VOLUME I : PARTS I and II


Chapter 9

Use of marijuana for therapeutic Purposes

 There has been renewed interest in the issue of the use of marijuana for therapeutic purposes in recent years, particularly in Canada. In the wake of an Ontario Court of Appeal ruling which found the provisions of the Controlled Drugs and Substances Act to be unconstitutional pertaining to the therapeutic use of marijuana, the federal Health Minister made new regulations in July 2001 that give people with specified medical problems access to marijuana under certain conditions. Later that same year, an international conference on medicinal cannabis held in The Hague, Netherlands, drew delegates from Canada and several other Western countries.[1] Earlier, in 1999, the National Institute of Medicine in the United States published an assessment of the science base of marijuana and medicine.[2]

However, the scientific community – the medical community in particular – is divided on the real therapeutic effectiveness of marijuana. Some are quick to say that opening the door to medical marijuana would be a step toward outright legalization of the substance. Witness the following two quotes, the first of which is from a former director of the National Institute on Drug Abuse (NIDA) in the United States:

 

It is primarily the political muscle of the marijuana legalization proponents that today creates the motivation to do additional research on marijuana smoke. […] There is one explanation for the strident insistence of marijuana legalization proponents that only smoked marijuana will do as ‘medicine’. They appear to be determined to have sick medical patients smoking marijuana in the public eye. They want that outcome because that act legitimizes the use of marijuana by changing the common public perception of marijuana from a harmful drug to a useful medicine. [3]

 

Although many who champion medical marijuana use do so on compassionate grounds, with the firm conviction that smoked marijuana provides benefits unavailable by other means, much support comes from those who advocate the liberalization of drug policy and the decriminalization of drug use. [4]

It is true, as Professor Mark Ware pointed out in his testimony before the Committee, that in the current legal and political context, it is difficult to conduct studies and, more importantly, do so without being influenced by the heated debate over marijuana.

 

Let us look at the effect that current drug policy has had on our understanding of cannabis. All our data on the health effects of cannabis have been collected under a paradigm of prohibition. This may seem self-evident but it constitutes an important source of bias. In examining the health effects of cannabis, an estimate of the use of cannabis in the healthy population is important. […] Surveys of illicit drug use are notorious for poor response rates. It hampers our ability to draw conclusions on what cannabis does, if we don’t really know who is doing it. It is important to estimate the size of the bias, and the effect it has had, and good research will always try to minimize it. However, in my experience of critically reviewing the literature on cannabis effects on health, examples exist where important estimates of risk are based on studies which have inappropriate control selection. […] The question therefore changes from ‘how has cannabis policy affected health?’ and becomes ‘has cannabis policy affected our understanding of the health effects of cannabis?’ [5]

 

It is also true that the issue of medicinal marijuana challenges us on the very concept of modern medicine and its links with the pharmaceuticals industry, since research on cannabinoids has already led to the development of synthetic THC compounds. Drug companies are known to have played a major role in international negotiations leading to the adoption of the first international conventions on the control of psychoactive substances.[6] Moreover, the marijuana plant itself, because it cannot be patented, is of no interest to major pharmaceutical research groups.

Beyond the scientific “proof” that marijuana is effective and the prospect of physicians prescribing marijuana with sufficient confidence, many people believe, based on personal experience, that marijuana has a direct impact in terms of improving their well-being with minimum adverse effects. That view is what led to the creation of “compassion clubs”, organizations that distribute marijuana to growing numbers of clients. One of the questions this raises is how much evidence is needed before people can be allowed to freely use marijuana to relieve a medical condition. Indeed, do we have to think of marijuana in strictly medical terms?

We saw in Chapter 7 that the long-term effects of using marijuana, even on a regular basis, are limited and that even the most serious effects, such as lung cancer, have yet to be clearly demonstrated. We also saw that the adverse effects of prolonged use on cognitive function are more prevalent in people who are already vulnerable because of their young age when they started using, for example, or their personal condition (for example, psychotic predispositions). We also saw that, even assuming some tolerance and a certain level of psychological dependency, those effects are minor, the signs of withdrawal minor, and treatment shorter and less often necessary than for other drugs. To a degree, it appears that the psychoactive properties of marijuana, which some see coupled with rejection of society, others with a weak personality and still others with immoral behaviour, make the substance suspect, whether in medical or non-medical applications.

In that sense, the issue of medical marijuana is not so much a question of legalization through the back door as it is a question of open examination of each person’s underlying conception of the “drug”. In a way, it is a prime opportunity to explore our preconceptions and prejudices. Stating, as we did in Chapters 6 and 7, that the psychological, physiological or social effects of marijuana use are by all indications relatively benign says nothing about the therapeutic benefits of the plant in the same way that medical uses of the poppy say nothing about the individual or social harm that can be caused by heroin. Dr. Kalant echoed this view:

 

The separation of the control methods between medical and non-medical use is generally clearly understood. Both heroin and cocaine have limited but recognized medical uses. […] Yet, nobody argues that, because these drugs have some limited medical use, that they should therefore be legalized for non-medical use. […] Cannabis is perhaps the one exception in which possible medical uses are often claimed by some proponents of legalization of cannabis as a justification for legalization for non-medical use. This to me seems quite irrational. There is no logical reason why having a medical use should be any argument at all, either for or against, availability for non-medical use. [7]

 

However, as Dr. Ware reiterated, “the safety of cannabis in humans has been extensively studied, thanks in part to the massive Western cohort of ‘healthy human volunteers’ of the last 40 years. Cannabis may have undergone the most extensive and unorthodox Phase I clinical trials of any drug in history.”[8] While it is true that research protocols to allow medical use of a substance are and must remain rigorous, there is no clear boundary between the two areas of research. This was illustrated to some extent in the review in Chapter 7 of studies on the effects and consequences of marijuana. Indeed, the opposite approach struck us as more common, where, based on the presumed harmful effects of marijuana on psychological and physical health, the therapeutic usefulness of marijuana becomes at least suspect. We take as an example the position of the Canadian Medical Association.

In his testimony before the Commission, current CMA president Dr. Henry Haddad said:

 

While our understanding of all the possible long-term health effects that prolong Canada's use is still evolving, what we do know is troubling. The health risks range from acute effects such as anxiety, dysphoria, or the feeling of being ill; cognitive impairment to the chronic effects such as bronchitis, emphysema and cancer. Canada's youth have also been subject to pulmonary damage comparable to that produced by tobacco use but the effects are much more acute and rapid. Evidence suggests that smoking two or three cannabis cigarettes a day has the same health effect as smoking 20 cigarettes a day. Therefore, the potential long-term health effects of cannabis use could be quite severe.

 

The CMA's concerns regarding the impact of cannabis are in part why we are opposed to the federal government's current medical marijuana access regulations. In our May 7, 2001, letter to the Minister of Health, the CMA noted ‘lack of credible information on the risks and benefits of medical marijuana.’

During discussions on the government's medical marijuana regulations, we highlighted the health concerns and research that indicates that “marijuana is an addictive substance that is known to have psychoactive effects and in its smoke form is particularly harmful to health.''

We have concluded that while benefits of medical marijuana are unknown, the health risks are real. Therefore, it would be inappropriate for physicians to prescribe marijuana to their patients, a position that was supported by the Canadian Medical Association.

[…]

 

The CMA is concerned that this debate concerning decriminalization and the medical marijuana issue has, to some extent, legitimized its use for recreational purposes. It is important that our message to you regarding decriminalization be clear and understood. Decriminalization must be tied to a national drug strategy that promotes awareness and prevention and provides for comprehensive treatment in addition to research and monitoring of the program.

[…]

 

The CMA believes that any changes regarding illegal drug policy should be gradual. Like any other public health issue, education and awareness of the potential harms associated with cannabis and other illegal drug use is critical to reducing drug usage. [9]

 

If we were to succeed in showing that the effects are not as bad as had been thought, would it change in any way the issues related to medical use of marijuana? The acute effects identified by the CMA are possible but relatively rare and often the product of personal predispositions, context or a particular crop of marijuana. In fact, the primary acute reactions, the reactions documented by most of the research, are pleasant and help the user relax. If we were to convince the medical association that marijuana is not particularly addictive and that even where it is, the effects are relatively benign, would that clear the way for medical use of marijuana? Aside from the fact that marijuana is only tenuously linked to “drug addiction”, there is by no means consensus in the scientific community on the very notion of drug addiction, viewed primarily as a disease.

The question lies elsewhere – in two places, in fact. First, knowledge of the potentially harmful effects of marijuana says nothing about the qualities of the plant as a medicine. To be sure, knowledge of the secondary effects of drugs, including their addictive potential, is essential to the pharmacopoeia. However, those substances must first be established as drugs, particularly in terms of effectiveness and reliability. Second, the whole issue is broached as if resistance to medical use of marijuana were based not so much on the absence of medical knowledge per se – which is the case to some extent, as we will see later in this chapter – as on the link between marijuana and drug addiction. From that perspective, the issue is quickly resolved: in keeping with the medical maxim “first do no harm”, a physician will not prescribe a treatment the effects of which could lead to an illness at least as serious as the illness being treated in the first place. If marijuana is listed as an illegal drug, banned in some contexts because of its harmful effects and capable of leading to drug addiction, what compelling arguments could be put forward to “save” medical marijuana?

But none of that should matter to physicians or scientists. It is not a question of defending general public policy on marijuana or even all illegal drugs. It is not a question of sending a symbolic message about “drugs”. It is not a question of being afraid that young people will use marijuana if it is approved as a medicine. The question – the only question – for physicians is whether, to what extent and in what circumstances, marijuana serves a therapeutic purpose. Physicians would have to determine whether people with certain diseases would benefit from marijuana use and weigh the side effects against the benefits. If they decide the patient should use marijuana, they then have to consider how he or she might get it. The issue of deciding whether cannabis has therapeutic benefits is obviously clouded by the current legal context on cannabis. This may be inevitable, but those who take public positions on cannabis for therapeutic purposes should say so.

The rest of this chapter is devoted to the history of the use of marijuana for therapeutic purposes and the status of contemporary knowledge of marijuana and synthetic cannabinoids. We then give a brief account of compassion clubs and other organizations that supply marijuana for therapeutic use, as well as various public policy regimes. We conclude with our views on medical use of marijuana. In a later chapter, we discuss which public policy regime would be most appropriate given the status of medical use of marijuana.

 

 


History

 

The therapeutic potential of marijuana has apparently been known since the beginning of recorded history. In fact, marijuana was likely used for medicinal purposes even before its psychoactive properties were tapped.

The medical history of marijuana is closely related to its analgesic properties, as noted by Ethan Russo:

 

Cannabis has a history as an analgesic agent that spans at least 4000 years, including a century in mainstream Western medicine. […] The reasons lie in the remarkable pharmacological properties of the herb and new scientific research reveals the inextricable link that cannabinoids possess with our own internal biochemistry. In essence, the cannabinoids form a system in parallel with that of the endogenous opioids in modulating pain. More important, cannabis and its endogenous synthetic counterparts may be uniquely effective in pain syndromes in which opiates and other analgesics fail.[10]

 

According to Russo, written documents and ethnographic traces of medical use of marijuana have been found in many countries. In China, a second-century medical paper reported that marijuana was used as a surgical anaesthetic. In India, marijuana was been used to treat migraines and chronic pain 2000 B.C. In Egypt, where most scholars thought that marijuana had not been introduced, there is evidence that it had been in use in medicine since the days of the pharaohs; traces of marijuana were found in the tombs of Amenophis IV and Ramses II. Marijuana was apparently used to treat glaucoma and labour pain. Marijuana was administered orally, rectally or vaginally, applied to the skin, inserted in the eyes and smoked.

In Assyria, Babylonia and Arcadia, marijuana was apparently used as an analgesic to treat migraines and menstrual pain and for its psychoactive properties. Evidence of marijuana use to control labour pain has also been found in Palestine and Israel. The Greeks and Romans used marijuana for general pain control and specifically for gout and rheumatism. In the Muslim world, there are references to therapeutic use dating back to the ninth century.

In the mid 17th century, western medicine discovered the medicinal properties of marijuana. A compendium of plants published in 1640 in England made reference to marijuana being used in the form of a paste containing essence from the plant and other ingredients. In France, the work on hemp published by Mercandier described a number of uses: dried and applied as a plaster, it eased the pain associated with tumours; boiled and applied as a plaster, it helped ease the pain of rheumatism, gout and various muscle inflammations; crushed into a powder and mixed with butter, it soothed burns. In his classification of plants, Linnée recognized the medicinal properties of marijuana as a pain reducer.

Medical use of marijuana became more widespread in England in the middle of the 19th century when the plant was brought back from India. Even the personal physician of Queen Victoria, Russell Reynolds, used it: he treated his celebrated patient for dysmenorrhea throughout her adult life using cannabis extract. In an 1868 paper, he wrote that unlike opiates, marijuana could be used today without causing problems tomorrow.[11]

Between 1890 and 1940, English, Irish, French and then American physicians and pharmacists testified in different ways to the usefulness of various marijuana preparations in relieving pain. One British pharmacologist even reintroduced the smoking of marijuana in 1899, pointing out that smoking was particularly useful if an immediate effect was desired.[12]

Marijuana is still part of the pharmacopoeia, at least informally, of many countries in southeast Asia. Marijuana use in India was recently described as follows:

 

Charas is the resinous exudation that collects on the leaves and flowering tops of plants (equivalent to the Arabic hashish); it is the active principle of hemp; it is a valuable narcotic, especially in cases where opium cannot be administered it is of great value in malarial and periodical headaches, migraine, acute mania, whooping cough, cough of phtisis, asthma, anaemia of brain, nervous vomiting, tetanos, convulsion, insanity, delirium, dysuria, and nervous exhaustion; it is also used as an anaesthetic in dysmennorhea, as an appetizer and aphrodisiac, as an anodyne in itching of eczema, neuralgia, severe pains of various kinds of corns, etc. [13]

 

It is also used in Colombia, Jamaica and Brazil.

It is tempting, of course, enamoured as we are with our modern science, to dismiss these traditional uses as “home remedies” – and the stuff of quacks. However, the fact that marijuana has been used so long for the same types of condition, that it has sometimes been described so accurately, that it has transcended cultures and histories, and that modern medicine suggests that marijuana could in fact be useful in treating the chronic pain associated with various medical conditions should stop us from being too cynical about these “old-fashioned” uses.  


Contemporary knowledge  

Two questions strike us relevant here. The first is whether marijuana in fact has the therapeutic effects that have been ascribed to it traditionally and more recently in the personal stories of people suffering from chronic pain and other conditions. If those benefits are real, the second question, altogether different and based on different criteria, is whether marijuana should be considered a drug.

 

Therapeutic uses

Knowledge of the mechanics of cannabinoids and the endogenous cannabinoid system allows a number of observations to be made. Generally, and bearing in mind what was written in Chapter 5, the action of cannabinoids can be described as follows:

 […]the overall effect is that of a cellular inhibition rather than cellular activation. It settles down nerve firing through a number of different types of reactions, primarily through changes that lead to changes in the flow of ion channels, which changes the firing behaviour of the cell which then changes how it communicates with other cells down the line.

Opening of potassium channels with decreased cell firing and closing of calcium channels with decreased release of neurotransmitters or overall cellular inhibition, which quiets things down. Those could have major therapeutic implications in certain clinical situations, such as pain and spasticity. They have implications in settling down nerve firing within pain conducting systems. [14]

More specifically, cannabinoids act on various neurophysiological systems associated with pain, either alone or in combination with the endogenous opiate system.[15] Cannabinoids affect the release of serotonin, which is itself associated with different types of pain, migraines in particular. Anandamide and other cannabinoid antagonists block the release of serotonin and ketanserin, both of which are linked to migraines, suggesting the potential effect of THC. Cannabinoids are also related to the dopamine system, which has been linked with migraines and other types of pain. Further, cannabinoids inhibit prostaglandin, producing an anti-inflammatory effect. Some studies have shown that THC is in that sense a more powerful analgesic than aspirin or even cortisone. Interacting with the endogenous opioid systems, cannabinoids increase the production of beta-endorphins, which reduce the effect of migraines. According to some studies, THC may have greater therapeutic potential than morphine, either because the applications would be more specific in some cases, because in other cases morphine aggravates some symptoms, or because THC lacks the sedative properties of morphine. Moreover, THC may have an antinociceptive effect on the periaqueductal grey. Finally, THC acts as a glutamate blocker and thereby reduces muscle and inflammatory pain.

Italian researchers Nicolodi, Sicuteri and colleagues have recently elucidated the role of NMDA antagonists in eliminating hyperalgesia in migraine, chronic daily headaches, fibromyalgia, and possibly other mechanisms of chronic pain. Gabapentin and ketamine were suggested as tools to block this system and provide amelioration. Given the above observations and relationships, it is logical that prolonged use of THC prophylactically may exert similar benefits, as was espoused in cures of chronic daily headache in the 19th century with regular use of extract of Indian hemp. [16]

In real terms, these mechanisms mean that cannabinoids can be beneficial in a number of situations that involve pain, but not pain alone The following are foremost among them.


·               Emisis: Nausea is a common condition in cancer patients undergoing chemotherapy. As a result of a series of clinical trials involving people who reported using marijuana to relieve their vomiting, synthetic dranobinol (or Marinol) and nabilone (or Cesamet) were developed and tested primarily in the United States and Great Britain beginning in the 1970s. According to Dr. Lynch, “cannabinoids are thought to be modest antiemetics. There are more effective antiemetic agents available. However, because antiemetics work through a number of different mechanisms and because often we need to be able to target more than one mechanism to treat nausea and vomiting, cannabinoids are looking like they may be useful because they may offer us another option.”[17]

 

·               Cachexia: A significant number of people with AIDS/HIV suffer progressive anorexia coupled with weight loss. Some studies show that cannabinoids can help improve their situation, mainly because THC increases appetite. Some reservations have been voiced regarding the harmful effects of smoked THC on the immune system: “More recently, Nieman et al (1993) have shown that cigarette smoking by HIV seropositive individuals is associated with a more rapid development of AIDS because smoking increases the incidence of Pneumocystis carinii pneumonia (PCP).”[18] Others, however, have come to different conclusions: “A particular public health concern surrounds cannabis effects on HIV/AIDS. Four studies among others may reduce related concern. Kaslow et al. (1989) demonstrated no evidence that cannabis accelerated immunodeficiency parameters in HIV‑positive patients. DiFranco et al. (1996) ascertained no acceleration of HIV to full‑blown AIDS in cannabis smokers. Whitfield, Bechtel and Starich (1997) observed no deleterious effects of cannabis usage in HIV/AIDS patients, even those with the lowest CD4 counts. Finally, Abrams et al. (2000) studied the effects of cannabis smoking on HIV‑positive patients on protease inhibitor drugs in a prospective randomized, partially blinded placebo-controlled trial. No adverse effects on CD4 counts were observed secondary to cannabis.”[19]

 

·               Glaucoma: Glaucoma is an eye disease in which intraocular pressure builds because the fluid in the eye has difficulty draining and which leads to gradual destruction of the ocular nerves. Marijuana, in particular paste made from cannabis leaves, has been used to reduce intraocular pressure since ancient times, as we saw in the previous section. Recent studies suggest that marijuana – including smoked marijuana – helps reduce the effects of glaucoma. However, there have been some reservations because of some of the side effects of smoking marijuana (redness and drying of the eyes). In a case study by Russo et al. on four patients who smoked marijuana, one patient with glaucoma stated in court that the marijuana saved her sight.

 

·               Spasms and convulsions: The anticonvulsive properties of marijuana that help control epileptic seizures and the antispasm properties that are useful in treating multiple sclerosis are well known in Canada; marijuana use for epilepsy gave rise to the Ontario Court of Appeal decision in Parker. Smoked marijuana and synthetic cannabinoids appears to be effective in controlling these conditions. However, because of the bioavailability of synthetic compounds (between 20% and 30%) and their delayed effect relative to smoked marijuana, patients seem to prefer smoking.

 

·               Pain: The analgesic effects of marijuana in easing different types of pain have also been known since ancient times. We described the analgesic effect of marijuana above. More importantly, marijuana has specific effects on some types of pain that opiates do not.

 

Marijuana as a drug?

In order for a product to be recognized as a drug in the pharmacopoeia, it must meet at least three criteria:

·               Quality: the dosage must be determined based on a constant and known composition that is easy to administer to the patient;

·               Effectiveness: rigorous clinical trials must have demonstrated the effectiveness of the drug; and

·               Safety: studies must show the known and foreseeable side effects of the drug.

 

Because of the lack of rigorous clinical studies using recognized protocols, whole marijuana has not yet met these criteria. There are a number of reasons for this. First, the research protocols needed to test drugs involve double-blind tests with control groups and randomly selected subjects, all conditions that are hard to achieve with marijuana. Second, the current legal climate limits the potential for such studies in terms of both the availability of marijuana and test conditions. Third, the marijuana provided by the National Institute of Drug Abuse (NIDA) for medical research – including research conducted by Health Canada – is of dubious quality:[20] THC concentration may be a determining factor in the quality of the therapeutic effects, yet NIDA marijuana contains only 1.8% to 5% THC. Moreover, weaker marijuana requires more draws and releases more CO than marijuana with a higher THC content. Other cannabinoids are not measured, yet they are known to also have a bearing on the medical properties of marijuana. The paper in which the marijuana is rolled is of poor quality. The marijuana is often more than two years old and may not have been stored under conditions that would preserve all its qualities. Finally, the marijuana contains many seeds and other plant debris. Fourth, it is difficult to control the amount of marijuana actually absorbed by the subjects: the way a person draws on the cigarette, whether or not the person is accustomed to smoking, the subject’s preferences and the length of time the subject inhales are factors which can affect the test conditions and which researchers have not yet been able to measure accurately.

It must also be possible to answer the following and other questions:

·               Is there a difference between synthetic cannabinoids and whole marijuana?

·               What is the optimum marijuana profile in a given situation?

·               Do different doses and different forms of ingestion produce significantly different effects?

 


In recent years, analyses of the scientific literature have been conducted by the Institute of Medicine in the United States and the British Medical Society and in various government reports in England, the Netherlands and elsewhere. The Institute of Medicine concluded that there is evidence of the therapeutic potential of marijuana as an analgesic, antiemetic and appetite stimulant. It noted, however, that smoking is a difficult way to control the ingestion of marijuana and also has side effects related specifically to its carcinogenic potential and the link with respiratory diseases. The institute also found that the psychoactive effects of marijuana are sometimes, but not always, beneficial for some patients. Finally, the institute pointed out that smoking marijuana should not be recommended over the long term because of the potential mental effects, but could be prescribed for persons with terminal or degenerative diseases, where long-term considerations are secondary. In the Netherlands, the National Health Council issued a notice in 1995 stating that scientific evidence on medical use of marijuana was insufficient because of poor research and uncertainty as to the properties of smoked marijuana. The council also noted that marijuana could have therapeutic applications in the following areas: nausea and vomiting related to chemotherapy, appetite stimulation for people with AIDS or cancer, multiple sclerosis and glaucoma. In 2001, the Netherlands created a medical marijuana bureau in the ministry of health and began clinical studies. In England, the House of Lords has taken a position similar to that of the Institute of Medicine in the United States, and the Ministry of Health is currently conducting at least one clinical study.

Clearly, not enough is known about marijuana to establish it as a drug in the strict sense of the word, and we only have partial knowledge of cannabinoids. Most cannabinoids are a single cannabinoid compound, whereas marijuana contains many substances the effects of which interact to produce the therapeutic effects. Yet researchers have still not specifically identified the role of the various cannabinoids. Patients who use synthetic dronabinol or nabilone-based compounds generally report not feeling the same beneficial effects as when they smoke marijuana. It may take longer for the effects to be felt, and the effects may be less specific. Further, isolating only one of the components of marijuana could, according to some studies, increase the risk of panic attacks and even marijuana-induced psychosis.

 

A significant benefit of whole marijuana is that it can be delivered in smoked format, with a rapid onset of action and a tritable effect by the patient. […] In practice, both patients and oncologists report that smoked marijuana is somewhat more effective than and as safe as the legally available oral cannabinoids. Another major difference between marijuana and THC, besides the availability of a smokeable, titratable delivery system with whole marijuana, is that 9-THC alone can produce the relatively common effects of anxiety disorder and panic attack. […] The adverse effects can also occur with marijuana use, but are felt to be diminished by the presence of cannabidiol, a nonpsychoactive compound with antipsychotic properties. [21]

 

Finally, the cost of synthetic compounds, which is much higher, has to be taken into account.

The advantages of smoked marijuana are that patients can determine the necessary dose on their own and feel the effects more quickly, while limiting the adverse side effects other than the effect on the respiratory system. It should be noted in passing the importance of self-regulation by patients: most of the clinical cases reported and most of the testimony from compassion club representatives agree that patients prefer to use marijuana with a higher THC content than recreational marijuana but only ingest the quantity they need to achieve the calming effects. However, the problems related to specific knowledge of the effectiveness and quality of marijuana limit the ability of physicians to prescribe the appropriate dose. More advanced knowledge of smoked marijuana pertains to the degree of safety, although there is variation in interpretation of the data. We generally concur in the finding of Professor Scholten:

 

Cannabis use for medicinal reasons by patients with a somatic disease is relatively safe, on condition that it is not smoked; when smoked it has the same carcinogenic potential as tobacco. The alternatives are oral administration or inhalation using a vaporiser.

The acute toxicity of cannabis is very low; it is almost impossible to die of an overdose (users would have to eat or smoke their own weight in fresh cannabis, or 7,500 grams of dried cannabis to achieve this). The principal side effects in therapeutic use are psychosis and euphoria. Little is known about this drug’s addictive effect in medical use, though experience with the use of morphine for pain relief has shown that the risk of psychological addiction is low – much lower than when used as a stimulant. As the addictive effect of cannabis is also quite low when used as a stimulant, it may be assumed that this will always be very low in a medical setting.

When estimating the chronic toxicity of cannabis, it should be borne in mind that the doses used in therapeutic applications will probably be lower than those used for "recreational" purposes, decreasing the risks of side effects. [22]

 

Does this mean that medical use of marijuana, smoking in particular, should be discouraged or even banned? The last section addresses this question.

 

 

Current therapeutic practices

 

The main reservations about therapeutic use relate to the lack of comprehensive knowledge based on controlled medical studies and also to the long-term impact on the respiratory system and carcinogenic potential. In some cases, reservations have been expressed regarding the psychoactive properties of marijuana. There is a growing consensus on the therapeutic potential of marijuana, particularly smoked marijuana. While marijuana cannot, strictly speaking, be considered a drug, at least for the time being, it still has therapeutic properties. How then do we classify and regulate it?

Canada, the United States and many other countries have developed a parallel practice of allowing people with certain conditions to use marijuana. The most familiar example in Canada is without question the Vancouver Compassion Club.

In its mission statement, the club advocates a holistic approach to health. It not only supplies marijuana, but also delivers other forms of natural medicine (herbal therapy, acupuncture, massage, etc.). The club is built on the values of compassion, emancipation and complementarity between approaches.

In the six years since the Compassion Club was founded, an intimate knowledge of the therapeutic effects of marijuana has been acquired. The club offers a daily menu comprising seven to ten varieties of marijuana, one or two varieties of hashish, cannabis tincture, and baked goods containing marijuana. It sells marijuana for $3 to $10 a gram, depending on the variety. It currently serves more than 2,000 members/clients.

 

Our members have a huge range of symptoms and conditions such as HIV and AIDS, cancer, multiple sclerosis, arthritis, chronic pain, fybromyalgia, seizure disorders, glaucoma, hepatitis C, anxiety, depression, insomnia, eating disorders and many others. […]

 

It is important that medicinal users have access to a variety of strains, as the effect of cannabis varies depending on which strain is being used and the method of ingestion. Our members are made aware of the differences and can then select the best strain of cannabis to most effectively treat their symptoms.

 

Indica and sativa are the two main varieties of the cannabis plant used as medicine. Many strains are crosses of those two varieties. Within each of those varieties and crosses there are a huge number of individual strains, each with a different cannabinoid profile and effect.

 

According to the anecdotal evidence, the indica strains are a relaxant, effective for anxiety, pain, nausea, appetite stimulation, sleep, muscle spasms and tremors, among other symptoms. The sativa strains are more of a stimulant, effective in appetite stimulation, relieving depression, migraines, pain and nausea. We are now aware of specific strains that are effective for specific conditions and symptoms. Members keep track of their use in order to find the most effective strain for themselves. We also keep close records monitoring members' purchases in order to assist members to track their own consumption and for us to prevent reselling and to encourage responsible use. [23]

 

Having read that testimony and the documents given to us by the club, visited the club’s premises and examined its records, and heard the testimony of other people who work for similar organizations in Montreal and Toronto, we can safely say that there are links between this therapeutic practice and the data produced by research on medical uses of marijuana.

We also observe that this organization, like others that provide a similar service in Canada, keeps detailed records of their clients and their marijuana use; these records allow treatment to be monitored, but could also be excellent material for empirical research. We can only lament the fact that Health Canada has not undertaken clinical research in cooperation with this organization. We share the reservations voiced by Hilary Black regarding the traditional protocols used in research on therapeutic use of marijuana:

 

We created a research proposal with a team of research scientists from Vancouver. However, we were turned down because we refuse to facilitate a study using a placebo or low-quality, low-potency cannabis imported from the US National Institute on Drug Abuse. Any study attempting to prove the efficacy of cannabis as a medicine using such a low-potency herb, or unknown strains such as those currently being grown in Canada by Plant Prairie Systems, is destined to fail. There is no need to import cannabis for research, considering the high quality and huge quantity of cannabis being produced in Canada. The information we could gather is being requested by doctors, patients, pharmaceutical companies, Plant Prairie Systems and Health Canada, yet we are not financially empowered to facilitate this research. [24]

 

No one will deny that research on therapeutic uses of marijuana, whether smoked or synthetic, must continue in an effort to further clarify the key elements of quality, effectiveness and safety. Everyone agrees that we should learn more about the strains and doses appropriate to various conditions. For all that, do we have to think of marijuana as a drug like the other drugs listed in the pharmacopoeia? Do we have to have the same requirements as those applicable to prescribed drugs, or should we relax the rules to view marijuana a natural health product? Were it not for the legal system and the international conventions governing marijuana, would the plant not be considered more a natural health product like other plants and herbs?

Casting the issue in those terms forces us to think differently about the therapeutic use of marijuana. If the aim is to make it a approved therapeutic product, the reservations of the medical profession, or at least of some representatives of the profession, are understandable: they cannot endorse the approach until the proper controlled studies are carried out so that physicians can prescribe marijuana as confidently as they prescribe other approved therapeutic products. If marijuana is recognized as having therapeutic uses in some cases – at least as proven as any other plant used in homeopathy or herbal therapy – the aim is instead to give it the same status as other natural health products.

 

 

Conclusions

 

The Committee is of the opinion that the potential therapeutic uses of marijuana have been sufficiently documented to permit its use for therapeutic purposes. It should be acknowledged that smoking marijuana can have harmful side effects, particularly for the respiratory system, and users should be informed accordingly. It should also be acknowledged that research is needed to further clarify the specific field of marijuana use and the long-term effects of marijuana.

 

 

 

 

Conclusions of Chapter 9

Therapeutic applications

 

 

 

 

 

 

 

 

 

Marijuana as a drug

 

 

 

 

 

Marijuana and synthetic compounds

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Therapeutic practices

 

 

 

 

 

 

 

 

Research

Ø      There are clear, though non-definitive indications of the therapeutic benefits of marijuana in the following conditions: analgesic for chronic pain, antispasm for multiple sclerosis, anticonvulsive for epilepsy, antiemetic for chemotherapy and appetite stimulant for cachexia.

Ø      There are less clear indications regarding the effect of marijuana on glaucoma and other medical conditions.

 

Ø      Marijuana has not been established as a drug through rigorous, controlled studies.

Ø      The quality and effectiveness of marijuana, primarily smoked marijuana, have not been determined in clinical studies.

 

Ø      There have been some studies of synthetic compounds, but the knowledge base is still too small to determine effectiveness and safety.

Ø      Generally, the effects of smoked marijuana are more specific and occur faster than the effects of synthetic compounds.

Ø      The absence of certain cannabinoids in synthetic compounds can lead to harmful side effects, such as panic attacks and cannabinoid psychoses.

Ø      Smoked marijuana is potentially harmful to the respiratory system.

Ø      People who smoke marijuana for therapeutic purposes self-regulate their use depending on their physical condition and do not really seek the psychoactive effect 

Ø      People who smoke marijuana for therapeutic purposes prefer to have a choice as to methods of use.

 

Ø      Measures should be taken to support and encourage the development of alternative practices, such as the establishment of compassion clubs.

Ø      The practices of these organizations are in line with the therapeutic indications arising from clinical studies and meet the strict rules on quality and safety

 

 

Ø      The studies that have already been approved by Health Canada must be conducted as quickly as possible.

Ø      The qualities of the marijuana used in those studies must meet the standards of current practice in compassion clubs, not NIDA standards.

Ø      The studies should focus on applications and the specific doses for various medical conditions.

Ø      Health Canada should, at the earliest possible opportunity, undertake a clinical study in cooperation with Canadian compassion clubs.

 


 



[1]  International Conference on Medicinal Cannabis, November 22-23, 2001, The Hague, Netherlands.

[2] Joy, J.E., S.J. Watson and J.A. Benson (1999) (eds.), Marijuana and Medicine: Assessing the Science Base. Washington, D.C.: National Academy Press.

[3]  DuPont, R.L. (1999), “Examining the Debate on the Use of Medical Marijuana”, Proceedings of the Association of American Physicians, Volume 111, No. 2, page 169.

[4]  Rosenthal, M.S., and H.D. Kleber (1999), “Making Sense of Medical Marijuana”, Proceedings of the Association of American Physicians, Volume 111, No. 2, page 159.

[5]  Dr. Mark Ware, Assistant Professor of Family Medicine and Anesthesia, McGill University, testimony before the Special Senate Committee on Illegal Drugs, Senate of Canada, May 31, 2002.

[6]  See in particular the study by W.B. McAllistair, Drug Diplomacy in the 20th Century. This point will be discussed later in chapter 19.

[7]  Dr. Harold Kalant, Professor Emeritus at the University of Toronto, testimony before the Special Senate Committee on Illegal Drugs, Senate of Canada, first session of the thirty-seventh Parliament, June 11, 2001, Issue 4, pages 70-71.

[8]  Dr. Mark Ware, op.cit.

[9]  Dr. Henry Haddad, President, Canadian Medical Association, testimony before the Special Senate Committee on Illegal Drugs, Senate of Canada, first session of the thirty-seventh Parliament, March 11, 2002, Issue 14, pages 52-53 and 54-55.

[10]  Russo, E.B. (2002), “The role of cannabis and cannabinoids in pain management”, in Weiner, R.S. (ed.), Pain Management. A Practical Guide for Clinicians, Boca Raton, London, New York, Washington: CRC Press.

[11]  Quoted in Russo, op. cit., page 359.

[12]  Ibid., page 360.

[13]  Ibid., page 361.

[14]  Dr. Mary Lynch, Director, Canadian Consortium for the Investigation of Cannabinoids, Professor, Dalhousie University, testimony before the Special Senate Committee on Illegal Drugs, Senate of Canada, first session of the thirty-seventh Parliament, June 11, 2001, Issue 4, page 49.

[15]  The following information is taken primarily from Russo, op. cit., Hartel, C.R., “Therapeutic Uses of Cannabis and Cannabinoids”, in Kalant, H. (ed.), The Health Effects of Cannabis, Toronto: Addiction Research Foundation, and INSERM (2001), op. cit.

[16]  Russo, op. cit., page 365.

[17]  Dr. Mary Lynch, op. cit., page 52.

[18]  R.D. Hartel, op. cit., page 465.

[19]  Russo, E.B., et al. (2002), “Chronic cannabis use in the compassionate investigational new drug program: An examination of benefits and adverse effects of legal clinical cannabis”, Journal of Cannabis Therapeutics, Vol. 2, No. 1, page 45.

[20]  Russo, op.cit, discusses these weaknesses in greater detail.

[21]  Gurley, R.J., R. Aronow and M. Katz (1998), “Medicinal marijuana: A comprehensive review”, Journal of Psychoactive Drugs. Vol. 30, No. 2, page 139.

[22]  Scholten, W.K. (2002), “Medicinal cannabis: A quick scan on the therapeutic use of cannabis”, in Pelc, I. (ed.), International Scientific Conference on Cannabis, Brussels.

[23]  Hilary Black, Director, Vancouver Compassion Club, testimony before the Special Senate Committee on Illegal Drugs, Senate of Canada, first session of the thirty-seventh Parliament, November 7, 2001, Issue 10, page 36.

[24]  Ibid., page 39.


Chapter 10

Canadians’ Opinions and Attitudes

One of our main objectives throughout our study was to get Canadians involved. We wanted people to share their opinions, experiences and fears regarding marijuana. We also wanted to provide access to the information we held so as to contribute, within our modest means, to better knowledge of the realities of marijuana, if only to raise the level of public debate. At the start of each public hearing the Committee Chair stated:

 

The second thrust is the sharing of knowledge. This is definitely our most noble objective. The committee wants all Canadians to become informed and share the information we collect. Our challenge will be to plan and organize a system to ensure that the knowledge is available and distributed. We would also like to hear what people think about this knowledge. In order to do this, in the spring of 2002, we will be holding public hearings in various parts of Canada.  

This was indeed a major challenge. It is one thing to passively make available such information as proceedings of our hearings and our commissioned research reports. It is another thing to actively disseminate that information widely, having the means to do so. And it is another thing again to take the pulse of Canadian society.

To convey the information to Canadians, we chose to make full use of our Internet site, posting all of our documents as they were ready. To boost circulation, we used two main tools. The first was a conventional tool: the media. We worked to get as much media coverage as possible in order to promote our work or simply let people know the Committee existed. With the same goal in mind, some members of the Committee took part in conferences, round table discussions and open-line shows. The second tool, one we considered essential in promoting our work, was the discussion paper we released in May 2002. The paper laid out some of our preliminary research findings on eight key issues, put forward a number of public policy options and proposed questions for the public hearings. The main aims of the paper were to convey our knowledge and generate public interest. A third objective was to provide a backdrop for the public hearings we held throughout the country in May and June 2002.

Only time will tell whether and to what extent we were successful in promoting our work and, more importantly, in increasing public knowledge of marijuana. We did not have the financial means to conduct a far-reaching public information campaign or an opinion poll before and after the release of the discussion paper to determine whether we had any impact on Canadians.

It is much harder to gauge the public’s opinions, attitudes and concerns. The traditional method of surveying a representative sample of the population was too expensive. Surveys also have limits, which we will discuss in more detail later. However, we did commission a qualitative study using focus groups, the results of which will be presented in this chapter. We will also report the results of other surveys that came to our attention. As well, many Canadians wrote to us or sent us e-mails, and some came out to our public hearings. We obviously cannot draw any conclusions from this: the only people who wrote to us were probably people to whom the issue is very important, regardless of which way they lean. Some will be cited but we reiterate that nothing is to be drawn from these opinions in terms of representativeness.

No account of Canadians’ opinions on and attitudes toward drugs in general would be complete without an examination of the role of the media in shaping those opinions and attitudes. In recent years, as a result of this Committee’s work and other initiatives, various Canadian newspapers and magazines have run stories or written editorials on the issue. These will be the focus of the first part of the chapter. The next part presents the results of surveys and polls, including the survey we commissioned and surveys conducted in different provinces. The last part covers our understanding of what Canadians told us.

 

The media

At the start of the century, the media played a key role in creating a moral “panic” over illegal drugs. First it was the “Yellow Peril” and the opium crisis in the early 20th century, primarily in Vancouver.[1]   

[…] tolerance for the habit of smoking opium lasted only as long as British Columbia’s tolerance for the Chinese. In the early years of the twentieth century, both a labour surplus and anti-Asian resentment developed […] If you look at the Vancouver Province, virtually any front page in the first five years of the 20th century, there are racist cartoons warning about the yellow peril, about how British Columbia is going to be swallowed up by the Chinese, and about another boatload arriving. [2]

The following appeared in Canadian Magazine in 1900:  

It was quite evident he (the Chinese servant) had had his share and a night of it, for there are Chinese dens in Vancouver where opium is smoked and unspeakable infamies are practised, and no matter how meek and mild your Chinaman may look, no matter how gentle his voice or confiding his manner, Saturday night is almost certain to find him ‘doped’ in his bunk, weaving dreams under the poppy’s subtle spell. [3]

 

Then it was the cocaine plague in Montreal as described by the following article in the Montreal Witness in 1910:

This curse of cocaine […] has existed for a short time in the city. It is a real evil. It is a social plague, and it goes on spreading so fearfully that it is time for society to take marked notice. Alcoholism and morphia are nothing to cocaine. It is the agent for the seduction of our daughters and the demoralization of our young men. […] Those who know what cocaine is and what its evils are, are those who can hurt society most. [4]  

This vision of the decay and degeneration of the working class and, more broadly, Anglo-British and Christian civilization, would subsequently be picked up by temperance movements. A key figure in women’s history in Canada, Emily Murphy, would play a leading role in the 1920s in articulating this apocalyptic vision. Murphy, a writer and journalist, was president of the Canadian Women’s Press Club (1913-1920), the founding president of the Federated Women’s Institute and a member of the National Council of Women of Canada before becoming a judge in Alberta. She also fought to have women’s rights recognized in the Canadian constitution. She was a tireless fighter in the war on drugs. In a series of articles published in MacLean’s magazine in 1920, she attacked the “plague” of drugs.  

[…] whatever form these drugs are taken, they degrade the morals and enfeeble the will. No matter what their status has been, inveterate users of drugs become degraded. All are liars: nearly all become dishonest. Being deprived of the drug, they will go any length to get it, even to thievery and prostitution. While sober they are uncomfortable, and prolonged abstemiousness hurts them like nails driven into the flesh. [5]

 

In 1922, in her book The Black Candle, she also attacked marijuana, which she described as follows:

Persons using this narcotic smoke the dried leaves of the plant, which has the effect of driving them completely insane. The addict loses all sense of moral responsibility. Addicts to this drug, while under its influence, are immune to pain, and could severely injured without having any realization of their condition. While in this condition they become raving maniacs and liable to kill or indulge in any form of violence to other persons, using the most savage methods of cruelty without, as said before, any sense of moral responsibility. When coming under the influence of this narcotic, these victims present the most horrible condition imaginable. They are dispossessed of their natural and normal will power and their mental is that of idiots. If the drug is indulged in any great extent, it ends in the untimely death of the addict. [6]  

Beyond the verbal impact of these articles and racism toward Asians, there is some similarity between the messages being conveyed at that time and some contemporary messages about drugs: drugs attack the moral roots of society, the family in particular. They put young people at risk and cause crime and violence. Dealers are everywhere, especially around schools, ready to do whatever it takes to expand their client base. And drugs, by definition, lead to drug addiction. 

That does not mean, of course, that the newspaper articles were the main reason why drugs were criminalized. Nor does it mean that people ultimately believed what was written. Still, analysts of the evolution of drug laws in Canada agree that the media played an important role in shaping Canadian drug legislation.

Where do Canadian media stand on drugs today? We did not analyse all the press coverage of drugs in Canada, although the exercise would probably have been interesting in sociological terms in identifying key notions and seeing just how public opinion is shaped. All we do here is examine two main types of media article. The first is news related to criminality, the second, feature stories and editorials.

News stories on illegal drugs usually focus on police operations: raids, seizures, dealer arrests and dismantling of organized crime rings. The best-known modern example was surely the 2001 arrest in Quebec of more than 70 Hells Angels members known to be involved in narcotics trafficking and other illegal activities. And then there are seizures, month after month, of kilograms – even hundreds of kilograms – of drugs, more and more often marijuana.

We do not know how this information helps shape public opinion on drugs or what impact it has on the public’s demands concerning drugs. However, these articles probably give people the impression that the “drug problem” is first and foremost an organized crime problem. But while there may have been an impression until the mid 1980s, shall we say, that marijuana was a problem exported into Canada from other countries, the growing number of articles on raids of domestic producers – as opposed to shipments from overseas – is giving more and more people cause to think of marijuana as a home-grown problem.

Other news stories focus on the relationship between drugs and crime, especially prostitution, residential break-ins, and “incivilities” experienced by street youth and the homeless. Some of these activities are at least in part associated with drugs. For prostitution, it is the fact that people, mostly women, are forced to work as street prostitutes in order to support their habit. Residential break-ins are also tied to supporting drug habits, although the perpetrators are different: most break-ins are committed by young men. For street youth, the main problem is intravenous drug use and the risk of spreading AIDS. None of this is directly related to marijuana. Except for schools. Virtually every big city in Canada – and every not-so-big city, too, for that matter – has seen some kind of police operation in schools. School raids usually elicit two types of reaction, both rooted in indignation: people are indignant when they learn that drugs are so much a part of the school environment while others think the police are abusing their authority and failing to respect young people’s rights.

Several years ago, there were a number of feature reports in newspapers and the electronic media. The series written by journalist Dan Gardner of the Ottawa Citizen in 2000, which was picked up by most of the newspapers in the Southam chain, is surely the best-known example. In his 10-article series, Gardner explained why the “war on drugs” is a patent failure. He began his series as follows:

Uncle Sam’s global campaign to end drug abuse has empowered criminals, corrupted governments and eroded liberty, but still there are more drug addicts than ever before. On June 6, 1998, a surprising letter was delivered to Kofi Annan, secretary general of the United Nations. ‘We believe’ the letter declared, ‘that the global war on drugs is now causing more harm than drug abuse itself. The letter was signed by statesmen, politicians, academics and other public figures. Former UN secretary general Javier Perez de Cuellar signed. So did George Shultz, the former American secretary of state, and Joycelyn Elders, the former American Surgeon General. Nobel laureates such as Milton Friedman and Argentina’s Adolfo Perez Esquivel added their names. Four former presidents and seven former cabinet ministers from Latin American countries signed. And several eminent Canadians were among the signatories. The drug policies the world has been following for decades are a destructive failure they said. Trying to stamp out drug abuse by banning drugs has only created an illegal industry worth $400 billion US. ‘or roughly eight per cent of international trade.’ […] This powerful statement landed on Mr. Annan’s desk just as the United Nations was holding a special assembly on global drug problems. Going into that meeting, the governments of the world appeared all but unanimous in the belief that the best way to combat drug abuse was to ban the production, sale or possession of certain drugs. […] Still, the letter to Mr. Annan showed that this view is far from unanimous. In fact, a large and growing number of world leaders and experts think the war on drugs is nothing less than a humanitarian disaster. [7]

In a way, Gardner’s series echoed editorials that ran in the Ottawa Citizen in 1997 calling for the decriminalization of drugs.[8] The following appeared in the second article in the series: “TThe recent history of drug enforcement, in both Canada and the United States, is largely a record of failure. Tax dollars are lavished on enforcement. Police powers are expanded at the expense of civil liberties. Criminal gangs grow richer. And drug use goes on regardless.”

In 1998, the Toronto Globe and Mail expressed a similar view under the headline “What are G8 Leaders Smoking?” The newspaper wrote, “Prohibition does not work and cannot work, and its costs are higher than those of a policy of properly supervised and regulated access to drugs. Given that the elimination of drugs from our society is not an option, the G8 leaders should have been asking themselves how they can minimize the harm that drugs represent. As it is, their policies maximize the damage.” The Globe and Mail did the same thing in a two-part editorial in July 2001, recommending decriminalization of marijuana. The Vancouver Sun followed suit in October 1998, and the National Post also called for an end to the prohibition on marijuana. More recently still, in the wake of the tragic events of September 11, 2001, the Citizen editorial staff responded to those who suggested that money from drug trafficking was being used to finance terrorism. The editorial read:

The latest drug-war scare, from Solicitor General Lawrence MacAulay and others, is that terrorists may be using drug money to finance their evil deeds. If so, you can see why. Terrorism, like any real crime, produces victims rather than satisfied customers, so it's not exactly self-financing. The drug trade, by contrast, turns a regular profit because it involves transactions so mutually satisfactory that buyers and sellers will risk jail to conduct them. […] In short, the drug war not only brings the law into contempt and threatens public safety, it also funnels money to terrorists and helps them move between countries. And people want more of it? I say a virtuous choice must be a choice to be virtuous, so I'd repeal the drug laws on moral grounds. But put aside my distaste for paternalism. If fighting the war on drugs increases the danger of losing the war on terror, surely it's doing far more harm than good. [9]  

These editorials and features are interesting for many different reasons. First, they mark a major shift from the positions that were more tentative or simply favoured prohibition that had held sway since the beginning of the century. They were also part of a constant questioning of the government’s role and the appropriateness of government spending and reflected growing concern for individual freedoms.

We do not know how they affect public opinion. We are not in a position to say if they reflect views held widely among the public or whether they are skewed. Only one thing strikes us as relatively certain: most major media outlets in Canada have distanced themselves quite significantly from prohibitionist policies.

 

surveys

According to one of our witnesses:

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 of a century that so far has been ignored by lawmakers and policy-makers. [10]

One of the biggest limitations of opinion polls is their superficial nature: the questions are often inserted into more general surveys covering a variety of subjects, there is little opportunity to ask multiple questions, and the meaning of the terms is rarely explored. For example, the terms “legalization” and “decriminalization” do not necessarily mean the same thing to all respondents. But general surveys are not able or rarely have the means to bring those differences to light. If the survey asks a single question about marijuana along the lines of “are you in favour of decriminalizing the possession of small quantities of marijuana?”, there is no way of knowing what the respondents think when they hear “decriminalizing” and “small quantities”. For some, decriminalization may mean no penalty; for others, it may mean a fine. And the difference between 5 grams and 30 grams is enormous.

Like the media, and in an equally complex way, surveys help shape public views. And also like the media, it is hard to determine the role they play in changing attitudes and, more importantly, behaviour. With those reservations out of the way, we provide in the following paragraphs a sample of data from a number of different surveys.

In the 1994 national survey on alcohol and drugs, the respondents were asked to give their opinion on marijuana: 27% said that possession of small quantities should be legal; 42% said it should be illegal but should not result in a penalty or should result in a fine only; and 17% said that possession of marijuana should lead to a possible prison sentence for a first offence. Men and younger people are more inclined to favour legalization of marijuana, as are residents of British Columbia, Quebec, Alberta and Ontario.[11]

In 2000, the National Post reported the results of a survey which showed that almost two thirds of Canadians were in favour of decriminalizing marijuana and that the punishment for possession of small quantities for personal use should be a fine.[12]

More recently still, in a May 2001 survey, 47% of Canadians said they favour legalization of marijuana, up from 31% in 1995 and 26% in 1975.[13]

A smaller survey of public perceptions was conducted in Quebec in 2001 using a sample of 2,253 respondents (response rate 70%).[14] The survey focused solely on drugs, drug addiction and HIV and measured knowledge, perception of risk, perception of drug addicts, and possible policies and measures. What makes this type of study interesting is that because the questions were limited to drug addiction and drugs, it provides clearer and more comprehensive information on certain issues.

The study showed that the majority (66%) of Quebeckers think that drug use is increasing. It also showed that “[translation] marijuana is in a class of its own” in terms of perception of risk because “[translation] only one in four people felt that marijuana is dangerous the first time it is used, which is less than the opinion reported for tobacco, even though tobacco is legal. Moreover, marijuana is the only substance that a relatively large number of respondents described as never harmful to health. […] People consider it less dangerous than tobacco.”[15] The surveys also show that marijuana is the substance least likely to lead to addiction: approximately 15% of respondents think that marijuana creates a dependency the first time it is tried, whereas more than 40% said it would have to be used every day and 8% said that marijuana never creates dependency.[16]

As to opinions on public policy, the study showed a clear preference for prevention and education over controls and repressive measures. Almost 35% of those asked what measures would be likely to eliminate drug problems said that the controlled sale of marijuana and hashish would help reduce the adverse effects. According to the authors, the public “[translation] is very open to some form of legalization of hashish and marijuana. More than 90% said that people with certain serious illnesses should be allowed to get prescription hashish and marijuana in order to relieve their pain. Far fewer people, although still a majority (60%), would be willing to allow those drugs to be used under certain conditions perhaps like alcohol.”[17] Fewer than 40% thought that current laws help prevent people from using (and approximately 60% disagreed somewhat or completely with that statement).[18]

In Ontario, the school survey also looked at students’ perception of risk and disapproval of marijuana use. The results are shown in the following table.  

 

Perceptions of Ontario high-school students, 1989-2001 [19]

 

1989

1991

1993

1995

1997

1999

2001

Disapprove of experimentation

 

Total

Grade 7

Grade 9

Grade 11

Grade 13

 

40.8%

58.9%

38.0%

33.0%

26.7%

 

43.2%

58.0%

48.3%

32.5%

28.4%

 

37.1%

48.6%

38.8%

30.2%

27.7%

 

28.8%

44.9%

30.1%

16.3%

25.7%

 

23.4%

40.8%

21.6%

13.2%

18.8%

 

26.0%

44.3%

25.7%

18.2%

13.4%

 

28.6%

48.2%

23.7%

19.4%

20.7%

Disapprove of regular use

 

Total

Grade 7

Grade 9

Grade 11

Grade 13

 

61.0%

73.7%

59.8%

54.9%

50.1%

 

60.8%

72.1%

62.5%

52.4%

56.1%

 

55.9%

66.6%

54.3%

50.9%

51.1%

 

47.2%

62.3%

48.6%

33.6%

48.6%

 

45.2%

58.7%

41.1%

30.9%

42.6%

 

43.1%

63.6%

43.6%

31.2%

32.8%

 

41.7%

64.0%

34.3%

29.8%

40.7%

Associate high risk with experimentation

 

Total

Grade 7

Grade 9

Grade 11

Grade 13

 

27.8%

39.2%

29.7%

18.0%

19.2%

 

30.7%

37.0%

35.4%

25.2%

21.2%

 

27.3%

35.3%

29.3%

21.8%

19.7%

 

18.5%

30.7%

18.6%

10.5%

14.2%

 

17.1%

26.2%

14.3%

12.8%

16.4%

 

18.4%

28.4%

16.6%

15.2%

12.5%

 

18.6%

27.0%

18.5%

11.1%

17.7%

Associate high risk with regular use

 

Total

Grade 7

Grade 9

Grade 11

Grade 13

 

75.4%

72.6%

79.1%

74.7%

73.3%

 

73.3%

72.1%

74.0%

73.9%

73.1%

 

69.3%

69.8%

73.7%

66.9%

63.4%

 

58.1%

67.6%

60.8%

50.8%

50.6%

 

56.1%

60.5%

59.3%

49.4%

55.7%

 

52.0%

63.6%

53.1%

44.9%

45.2%

 

48.2%

61.1%

47.8%

36.8%

47.8%

 

These results show that Ontario high-school students’ attitudes on all indicators are either less alarmist or more liberal, depending on one’s point of view. Fewer students disapproved of experimentation (one or two times) with marijuana and regular use in 2001 than in 1989. However, more students still disapproved of regular use than occasional use. The level of disapproval decreases as level of schooling increases. Further, fewer Ontario students associated a high risk with marijuana use in 2001 than in 1989, but still almost three times as many associated a high risk with regular use than with experimentation. It bears noting that students who associate a high risk with regular marijuana use now make up less than half the student population, down from three quarters in 1989.

By and large, these data are in line with the results of the study the Committee commissioned from the firm Léger Marketing.[20] The objective of this qualitative study using focus groups was to determine whether it was possible to identify elements that could serve as the basis of a social consensus on the use of cannabis. More specifically, the study was designed to determine the overall perception of drug use in general and cannabis in particular; the images associated with cannabis; attitudes and social behaviour toward the use of cannabis for recreational purposes; fears and prejudices; knowledge of the legislative framework; and the expectations of citizens with regard to a public policy on the use of cannabis for recreational purposes. Léger held 16 focus groups and conducted 15 in-depth interviews in Montreal, Trois-Rivières, Halifax, Winnipeg, Vancouver, Toronto and London. In all, more than 130 people took part in the study. In each city, there were at least two focus groups, one with adults over the age of 18, and one with youth 14 to 17 years of age.

The participants in the focus groups did not spontaneously mention drugs as everyday concerns; they reported being more concerned about health, education, employment and poverty. When the subject was raised by the interviewers, the participants first named crime related to the sale of drugs and drug smuggling as primary concerns, not drug use by Canadians. In some cities (Montreal, Vancouver), the participants also voiced concern about the impact illegal drugs have on quality of life and safety in some neighbourhoods.

Questioned about marijuana, almost all of the participants spontaneously made a distinction between soft drugs (marijuana, hashish) and hard drugs (cocaine, heroin); some even thought the word “drug” was inappropriate in reference to marijuana. That distinction is based on two major elements: composition and effect. Hard drugs are more closely associated with chemical products that have destructive effects, particularly a greater tendency to develop an addiction. Marijuana and marijuana derivatives are associated with plants or natural products, and the risk of dependency is virtually nil, except among people who are especially predisposed or vulnerable. There were many comparisons with alcohol: alcohol can be used in reasonable quantities without a problem, and only a small proportion of users develop dependency problems. Nor was marijuana associated with crime: “I can’t picture a guy robbing the corner store to buy himself a joint. This is something heroin addicts would do. First, pot is cheap, second it doesn’t make you want it desperately.” The only exception more common in Quebec than elsewhere was the association with organized crime, that is, motorcycle gangs.

In contrast to “hard” drugs, which are considered part of a world of moral and physical distress and social decay, the participants generally associated marijuana with relaxation and pleasure, a drug used primarily in social settings, like alcohol.

In any event, recreational use of marijuana was generally well accepted: “it doesn’t bother me that people do marijuana. As long as they are aware of their decision and what they are doing, I respect it.” In fact, several participants in each group spontaneously mentioned their own past or current experiences with marijuana use: “I sometimes smoke pot and it doesn’t keep me from being a productive guy at work or a good family man.” And like alcohol, the difference lay more in the notions of abuse and responsibility, although the participants were harder on alcohol abuse, which they associate with violence. “I used to go out to bars a lot. Every night there would be a fight. A guy gets drunk and then starts insulting somebody else or feels another is flirting with his girlfriend. At one point punches get thrown around. But you know what? I have never seen a guy stoned on pot go nuts and want to knock somebody out.” While they did not associate marijuana use with violence or crime, the participants did express concern about people’s behaviour when under the influence of marijuana. Finally, the participants did not associate marijuana use with a particular social class: young people use marijuana, but so, too, do professionals, artists, lawyers, government employees and others.

The researchers did not observe any generational differences in recreational use of marijuana. If there were a difference, it would be rooted more in socio-occupational features: people with less education and people in rural areas appear to be more resistant. Further, people who oppose recreational use of marijuana do so more for moral and sometimes even religious reasons. Another difference is that women with school-age children said they were very concerned about how readily available marijuana is in schools. [translation] “I don’t care if they legalize it or not. All I want is for marijuana to be kept away from children. It makes me furious that they sell it in primary school, because that gets them hooked at a very young age.”

As the public opinion surveys discussed earlier showed, the participants generally supported the legalization of marijuana for medical use. However, some of the respondents said they would like to see a clear distribution structure put in place in health care establishments and that dosages should be geared to the intensity of the pain.

Generally, the participants felt that occasional use had no adverse health effect. Spontaneously making a comparison with alcohol and tobacco, they felt that marijuana was not the most dangerous of the three substances. Further, most of the respondents were not afraid of people getting hooked on marijuana, noting that dependency is a function of the person’s maturity and frequency of use. “This is the key question. I don’t think you can get hooked on it really. Not as much as booze or nicotine for sure. But that’s the kind of proof or medical evidence I would like to have if you want me to make up my mind on it.” The participants also did not think that marijuana is a gateway to other drugs or “hard drugs”, because the user’s personality and maturity have more influence than the marijuana itself.

The interview guide asked the participants to react to two research findings: the proportion of Canadians who have used marijuana in the past 12 months is approximately 10%, and about 30,000 charges are laid a year for simple possession of marijuana. In both cases, the participants were incredulous. Regarding the proportion of users, all the participants felt that there were far more: [translation] I’m surprised that only 10% of the population are users. I would have said 50% or 60%.” Regarding the number of charges, the participants unanimously felt that police should focus more on fighting crime rings: “30,000 people charged per year seems like a waste of taxpayers’ money, if it is just for possession. It’s a lot of money to prosecute and they all get thrown out anyway.” [translation] “When you think about other, more serious crimes, when you think how it clogs up the courts, I think it’s ridiculous.” Nevertheless, the participants felt that Canada is a relatively tolerant society when it comes to recreational use of marijuana, at least in comparison with other countries, and spontaneously named the United States and Saudi Arabia as repressive and Switzerland and the Netherlands as tolerant; Canada fell somewhere in between.

The interviews were conducted after the Committee released its discussion paper in which it set out a number of public policy options. The focus group participants were first urged to freely voice their opinions on the public policies they would prefer to see and were then presented with the Committee’s proposals and asked to react.

By and large, the response from the participants fell somewhere between decriminalization and legalization. That position was most prevalent in Montreal, Toronto, Vancouver and Halifax; more participants in Vancouver and Montreal favoured legalization with government controls: “The best option is decriminalization leaning towards government legalization. The worst option would be depenalization: to legalize without getting involved.” According to the participants, those options would make it possible to increase the ability to provide information about risk, user health, public safety, respect for individual rights and freedoms, and the effectiveness of government spending, and would reduce illegal trafficking and the involvement of organized crime. They also said they would anticipate an increase in recreational use of marijuana but did not think that there would necessarily be an increase in use or abuse among young people. On the contrary, several participants felt that decriminalization would lead to a decrease in use among young people because the appeal of the forbidden fruit would be gone.

There is still a hard-core minority who think that current laws are not harsh enough and that society should move toward greater criminalization of recreational use of marijuana. That position was voiced most loudly in Winnipeg among persons over 40 and in Trois-Rivières.

Finally, the participants said they would like to be informed and “educated” about marijuana use and in particular would like to be made aware of scientific knowledge of the short- and long-term effects, the real risk of dependency and escalation, ways of protecting children against early use, and the impact of decriminalization on the war on organized crime.

The authors of the study identified the following key factors:

·               the protection of youth and children is central to any discussion of a public policy on marijuana;

·               decriminalization of use is the preferred option, as it would make it possible to recognize the social reality and at the same time focus on the “real” problems;

·               some participants expressed support for legalization but wondered about the nature and control of production and quality standards, methods of distribution and marketing, and the establishment of quotas in order to prevent abuse.

 

Because this was a qualitative survey, we cannot extrapolate the results to the entire Canadian population. Our financial resources did not allow us to conduct a comprehensive study using a representative sample of the population, which would have allowed us to validate these “hunches”. Still, we are able to state the following: 1. these results are similar in many ways to the data from the opinion polls; and 2. the commonalities between the focus groups in most of the cities and between age groups suggest there is some validity to these hunches.

 

 

Attitudes and opinions shared with the committee

 

Hundreds of Canadians from all over the country wrote to us, and dozens appeared at our public hearings in the regions. They came to recount their personal experiences, state their opinions and voice their fears. They represented rights and freedoms advocacy groups, compassion clubs, which distribute medical marijuana, treatment and prevention organizations, and women’s groups. They were mayors, police chiefs, users of medical marijuana, parents, educators, physicians, lawyers and recreational marijuana users, young and old alike. They often spoke from the heart, and we were moved by what they said. Appendix 2 is a list of all the people the Committee heard during its public hearings. We would like to thank all those who took part in our proceedings.

It is impossible to present in this report all the contributions to our discussions and highlight their extraordinary worth. Fortunately, the transcripts of the hearings will remain on our Internet site. The following will summarize the opinions conveyed to us in reaction to our discussion paper.

We should point out first of all that the people who shared their views were for the most part very happy with the diligence of our work and, more specifically, were very appreciative of the opportunity they were given to take part in this social debate.

 

I have followed with great interest the proceedings of the Special Committee on Illegal Drugs and would like to thank the person who decided to publish the brief so completely and honestly. This speaks volumes of transparent government, which is a key element in resolving the debate.

 

I would first of like to commend the Senate for its Special Committee on Illegal Drugs and its impartial and ground-breaking work on marijuana.

 

Thank you for taking the time to review my submission. I would like to commend the Senate Committee on Illegal Drugs for its excellent research on the facts and criticism of the myths surrounding illegal drugs.

 

First of all, I would like to thank the Committee for skilfully separating the facts from the propaganda surrounding this issue. […] Thank you for taking the time to get public input on the issue. I only hope that this will not fall on deaf ears as was the case with the Le Dain Commission before you. Again, I believe the Committee is trying to do its best for the people of Canada.

 

I read your discussion paper on marijuana and the accompanying documentation and found the material to be most interesting. I would like to commend you for your willingness to launch a public debate in this area of policy.

 

Most of the people who took the time to respond to us also said they found the discussion paper to be well done, useful and balanced. Moreover, the respondents said they agreed with the research data we presented in the paper. Where there were reservations, they pertained to:

·               biased interpretation of the data: for some people, marijuana is unquestionably a gateway drug;

·               an overly cautious side: saying that marijuana is a drug and therefore should not be used was perceived as “politically correct”;

·               a lack of compassion and concern for youth and children.

 

Many Canadians from different walks of life shared with us their concerns about the prospect of marijuana being decriminalized and about the message that that kind of decision would send to young people.

 

[Translation] It doesn’t make any sense to use to legalize a drug with all the question marks and solid facts that are seen as consequences of marijuana use. If we had to do it over again, I don’t think with the information we currently have that we would want to legalize nicotine or even alcohol. Once we consider legalizing a drug, we can assume that the drug will become more readily available and that there will therefore be more use and more problems. Remember: marijuana is not harmful because it is illegal; marijuana is still illegal because it is harmful. [21]

 

Informed public debate is healthy and valuable, but it requires exposure to a full range of viewpoints. Regrettably, this is not the case in regard to the non-medical use of drugs. Rather, we have had constant and copious representation of the view that the only way to deal with the drug problem is to accept its inevitability and even its normalcy. (…)

In discussion about drug strategies, the harm of illegal drugs is usually identified , not with the drug’s intrinsic chemical effects on the human body, especially on brain function and behaviour, but rather on extrinsic consequences of the illegality of the drug. Thus, the general havoc wreaked on the lives of addicts and their families is ignored in favour of deploring the harm that a criminal record can do to self-esteem. Further, the property crime and violence carried out by drug users are attributed to the illegality of the drugs rather than to the diminished work habits and lack of earning capacity which result from drug use. [22]

 

Our concerns with the Discussion Paper released by the Committee centre primarily on cannabis policies and the resulting effects on youth and families. (…) We suggest to the Committee that rather than focusing on reforming our drug laws, efforts would be much better spent on examining strategies focused on prevention. (…) Much rhetoric exists around the supposed ‘war on drugs’: have we lost the war, what do we do now and were we really fighting a war to begin with? The challenge presented to this Committee is not an easy task: to recommend workable, feasible policies regarding cannabis use. To this end, we trust that the Committee will be prudent in its decisions, innovative in its policy recommendations and resistant to the urge to simply give sway to ‘hemp mania’. We owe it to our young people. [23]

 

Please, ladies and gentlemen, please do not just rely on research and the experts. There are many well-financed documents and experts that are paid to promote legalization. THC, the active ingredient of cannabis can be taken in pills, we do not have to promote smoking in another form. […] If I could suggest the following: 1. Provide more treatment resources and services; 2. Change our system of incarceration when it comes to drug-induces crime – mandatory treatment; and 3. Have our country adopt a zero tolerance to illegal drugs and provide the ability to our police to enforce the policy and mandate our courts to address the issue. Please do not provide another avenue for our children to escape reality. [24]

 

That said, most of the people who responded to the questionnaire also said they were in favour of decriminalization or controlled legalization of marijuana and marijuana derivatives. For that reason, we have to be very careful still regarding the meaning of the comments we received: most of those who wrote to us are probably interested, for personal reasons, in seeing the current legislation amended to introduce more tolerance. That view probably coloured their assessment of our discussion paper and the quality of our research findings.

 


Conclusions

 

What is the status of public opinion in Canada? We are not able to come up with firm answers to that question. We do think, however, that:

 

 

Conclusions of Chapter 10

Opinions on marijuana

 

 

 

 

 

 

 

 

 

Opinions on public policy options

Ø      Public opinion on marijuana more liberal than it was 10 years ago.

Ø      Tendency to think that marijuana use is more widespread than it used to be.

Ø      Tendency to think that marijuana is more available than it used to be.

Ø      Tendency to think that marijuana is not a dangerous drug.

Ø      Relatively significant concern about organized crime.

Ø      Strong support for medical use of marijuana.

 

Ø            Tendency to favour decriminalization or, to a lesser degree, legalization.

Ø            Critical attitude toward law enforcement for simple possession of marijuana.

Ø            Concern for youth and children.

 

 



[1]  See the analyses by Giffen, P.J., et al. (1991), Panic and Indifference. The Politics of Canada’s Drug Laws, Ottawa: Canadian Centre on Substance Abuse; Boyd, N. (1991), High Society: Illegal and Legal Drugs in Canada, Toronto: Key Porter Books.

[2]  Boyd, N., op. cit., pages 27-29.

[3]  Quoted in Giffen, P.J., op. cit., page 61.

[4]  Quoted by McKenzie King in Hansard, House of Commons, January 26, 1911, pages 2641-2642.

[5]  Murphy, E., (1920), “The underground system”, MacLean’s, March 15, 1920.

[6]  Murphy, E., (1922) The Black Candle. Toronto: Thomas Allans, pages 332-333.

[7]  Gardner, D., “Why the war on drug has failed: Uncle Sam’s war”, Ottawa Citizen, September 5, 2000.

[8]  Editorial, “Decriminalizing Drugs”, Ottawa Citizen, April 12, 1997, April 14, 1997, April 15, 1997, and April 16, 1997.

[9]  John Robson, “How many burbs must the drug war burn, before we call it a bust?, Ottawa Citizen, May 17, 2002.

[10] Dr. Benedikt Fischer, Professor, Department of Public Health Sciences, University of Toronto, testimony before the Special Senate Committee on Illegal Drugs, Senate of Canada, First Session of the thirty-seventh Parliament, September 17, 2001, Issue 6, page 13.

[11]  Canadian Centre on Substance Abuse (1999), Canadian Profile, 1999: Alcohol, tobacco and other drugs, Ottawa: author, pages 214-215.

[12]  National Post, “Two-thirds favour decriminalizing pot”, May 15, 2000.

[13]  Julian Beltrame, “Reefer Madness: The Sequel”, MacLean’s, August 6, 2001, Vol. 114, pages 22-25.

[14]  Hamel, D., et al. (2001), Perceptions de la population québécoise en lien avec les programmes de prévention de la toxicomanie et du VIH, [public perceptions in Quebec regarding substance abuse and HIV prevention programs], Quebec City: Institut national de santé publique du Québec.

[15]  Ibid., page 3.

[16]  Ibid., page 27.

[17]  Ibid., page 4

[18]  Ibid., page 38.

[19]  Adlaf, E.M., and A. Paglia (2001), Drug Use among Ontario Students 1977-2001. Findings from the OSDUS, Toronto: Centre for Addiction and Mental Health.

 

[20]  Léger Marketing (2002), An Exploratory Study Among Canadians About the Use of Cannabis, Montreal: author. Available on line at the Committee’s site.

[21]  Brief from A. Maillet and C. Cloutier-Vautour to the Special Senate Committee on Illegal Drugs, Moncton, June 5, 2002.

[22]  Brief from Real Women, submitted to the Senate Special Committee on Illegal Drugs, June 6, 2002, pages 1-2.

[23]  Brief from Focus on the Family to the Special Senate Committee on Illegal Drugs, Richmond, May 14, 2002.

[24]  Letter from Kathy Bedard, Prince Rupert, British Columbia, May 15, 2002.


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