Proceedings of the Special Committee on
Illegal Drugs

Issue 4 - Evidence

OTTAWA, Monday, June 11, 2001

The Senate Special Committee On Illegal Drugs is meeting today at 9:06 a.m. to reassess Canada's anti-drug legislation and policies.

Senator Pierre Claude Nolin (Chairman) is in the Chair.


The Chairman: I will now call to order this meeting of the Special Senate Committee On Illegal Drugs. It is a great pleasure for me to welcome you here today. I would like to take this opportunity to welcome all those who travelled to be here in Ottawa for this meeting, as well as those who, through modern technology, are able to listen in either on the radio, on television, or via the Committee's Web site. I would like to inform Internet users listening to our proceedings that they can see us as well. We are doing something new today. Digital cameras will be filming our proceedings. This is a first for a parliamentary committee.

Without further ado, I would like to introduce you to the members of the committee. First, we have the Honourable Colin Kenny from Ontario. Senator Kenny is the vice-chairman of the committee. On his left is the Honourable Eileen Rossiter from Prince Edward Island. On my right is the Honourable Shirley Maheu, from Quebec, and the Honourable Tommy Banks, who represents Alberta. My name is Pierre Claude Nolin, and I am one of the 24 Quebec representatives in the Senate.

The Special Senate Committee On Illegal Drugs was originally established by the Senate during the last Parliament. A little more than a year ago, on April 11, 2000, the Senate voted unanimously to establish the first committee on drugs and I was appointed chair.

After a great deal of preparatory work, we held our first public meeting on October 16, 2000. The 36th Parliament ended last October when the general election was called. This put an end to the committee's work as well. In February 2001, at the beginning of the 37th Parliament, the Senate began consideration of a motion to reestablish the committee and on March 15, 2001, the Senate unanimously accepted the continuation of the committee's proceedings with an amended mandate.


The Special Senate Committee on Illegal Drugs has received a mandate to study and to report on the approach taken by Canada to cannabis, the effectiveness of this approach and the means and controls used to implement it. In addition to its initial mandate, the committee must examine the official policies adopted by other countries.

Canada's international responsibilities with regard to the Convention on Illegal Drugs, to which Canada is a signatory, will also be examined, as will the social and health effects of Canadian drug policies on cannabis and the potential effects of alternative policies.


Finally, the committee is supposed to table its final report at the end of August 2002.

In order to properly fulfil the mandate we've been given, the committee has adopted an action plan that focusses on three major challenges. The first is the information challenge. In order to meet it appropriately, we will be hearing from an impressive range of Canadian and foreign experts including academics, police officers, legal specialists, health-care professionals, social workers and government representatives. Our hearings will be held mainly in Ottawa, but if need be they may also be held elsewhere.

The second challenge, and certainly the most noble one, is sharing the knowledge we have acquired. The committee would like people from all over Canada to seek out information and share in the information we have gathered. It will be up to us to plan and organize a system to make this knowledge accessible and to distribute it. We also want to know what people think about all of this. To that end, in the spring of 2002, we will be holding public hearings in various parts of Canada. If our budget permits, it is very likely that these hearings will begin next fall.

Finally, the committee's third challenge is to examine the basic principles that should underlie Canada's drug policy.


Before I introduce you to our distinguished witnesses for today, I will inform you that the Senate has ordered that all the proceedings of the committee registered during the Thirty-Sixth Parliament be included as an integral part of our proceedings. Also, the committee maintains an up-to-date Web site, which can be accessed at All of the committee's proceed ings are posted there, including all briefs and documentation from our expert witnesses. It also contains more than 150 links to related sites.


I would now like to say a few words about the room in which we are meeting today. It is known as the Aboriginal Peoples' Room and was built in 1996, under the authority of one of our committee members, Senator Kenny, who was chairing the Committee On Internal Economy at the time. This room pays tribute to the First Peoples of North America, who played an active role in the development of Canada, and who continue to do so today. Four of our colleagues in the Senate represent these peoples proudly and well.

Today, we will be talking about drug pharmacology. I would now like to introduce one of our expert witnesses who will be speaking about the contribution of cannabis to medical science. Mr. Ben Amar is a pharmacist who specializes in clinical biology and pharmacology. He graduated from the Université Paul Sabatier in Toulouse, France, and the University of Montreal.

Dr. Ben Amar's studies concentrate on drugs affecting the central nervous system and he also conducts medical laboratory analyses of specimens and examines the interpretation of biochemical tests. He teaches pharmacology and toxicology at the University of Montreal. He has published a number of studies on alcohol and psychotropic substances. He's also been an expert witness in many criminal cases in the Quebec courts. He is currently preparing a book on the pharmacology of psychotropic substances for publication in the fall of 2001. We thank you for accepting our invitation to appear before us and we thank you for your interest in our work.

Mr. Mohamed Ben Amar, Professor of Pharmacology and Toxicology, University of Montreal: I am pleased to be with you today. Cannabis is the most widely used illegal drug in the world. The term cannabis is a synonym for Indian hemp, and it comes from the cannabis sativa plant, which grows in almost all climates. In the case of cannabis, a distinction must be made between marijuana and haschich, which come from different parts of the plant.

Tetrahydrocannabinol is the main active ingredient in cannabis. The THC content usually varies between 1 and 15 per cent in marijuana, and between 3 and 6 per cent in haschich. There are also haschich and marijuana oils. They contain a higher concentration of active ingredients, thus tetrahydrocannabinol, and the concentrations are usually between 30 and 50 per cent.

Cannabis is in the class of psychotropic substances, that is substances that act on an individual's psyche and cause different changes in his or her mental functioning. Cannabis is in the group of psychotropes known as psychodysleptic drugs or halluci nogens.

There are five main categories of psychotrope. The first, the depressants, includes alcohol and substances such as Valium. The second category, the stimulants, include minor stimulants such as coffee and tobacco, and major stimulants such as cocaine and amphetamines. The third class, the psychodysleptic drugs, includes cannabis and more hallucinogenic drugs such as LSD and mescaline. The fourth category includes drugs to treat psychoses and depression, and those used in the treatment of mood problems, such as lithium. Finally, the fifth category is separate and includes the androgens and anabolic steroids.

All of these substances, including cannabis, can, in the long term, result in chronic intoxication leading to tolerance and dependency. Using a drug regularly leads to tolerance, and hence to increased doses, in order to achieve the same effect. After a certain length of time, this can result in intoxication, which can be serious.

There are two types of dependency: psychological dependency, where, when the drug is no longer present, the individual's psychological functioning is disturbed and he or she will have psychological behaviour problems known as "craving."

In the case of physical dependency, when the individual is no longer using the drug, his or her brain will be disturbed and there will be physical symptoms known as the withdrawal syndrome. The importance of this syndrome will vary depending on the type of psychotrope. Thus, all psychotropic substances have what is known as an addictive potential.

The main active ingredient in cannabis can potentially cause an addiction, this phenomenon of variable psychological and physical dependency. At the end of this presentation, I will compare the addictive potential of cannabis to that of other drugs.

There are mainly two ways of ingesting cannabis: by inhalation, or through the lungs and orally. Marijuana and haschisch can be inhaled. Haschisch can also be baked into biscuits or cake. The difference between these two modes of ingestion is observed during the onset of the drug's effects. The influence of this drug is felt more promptly when it is inhaled. When we inhale the smoke, the maximum effect is reached within 30 minutes, and the effect that the consumer is looking for, namely a feeling of well-being, may last from two to four hours. This pleasant feeling, called euphoria, is more intense when cannabis is smoked than when it is taken orally.

As you know, several therapeutical uses of cannabis have been documented all over the world. Let me quote a few. For instance, it can be used against the nausea and vomiting that result from chemotherapy to treat cancer, or it can stimulate appetite for people who are suffering from weight loss, as AIDS patients do. It can also be used to attenuate certain kinds of pain, as a muscle relaxant, in certain cases of epileptic seizures, and even if it is not the best choice, to lessen the internal pressure in the eye that causes glaucoma.

It is interesting to note that already, here in Canada, two products derived from the active ingredient of cannabis, or tetrahydrocannabinol, are being marketed. We have dronabinol, marketed under the name of MARINOL, which is used to treat nausea and vomiting induced by cancer chemotherapy.

We have a synthetic replica of THC, called Nabilone, which is marketed under the name of CESAMET, and this one requires a prescription unlike the previous one which is considered as a narcotic and is more strictly controlled than Nabilone.

Of course, there are provisions, and more specifically in clause 56, that give discretionary power to the Minister of Health to grant exemptions for the therapeutical use of cannabis, which has already been done. This led to the regulations on the exemption of marijuana for medical use, which will become effective on July 15 and which allow physicians to prescribe therapeutic cannabis to their patients.

There is no doubt that cannabis, namely marijuana and haschisch, have adverse effects on the human body. We must make a distinction between what is called acute intoxication, which happens when the substance is used occasionally, and chronic intoxication, which is the result of extended use. The numerous effects that I will enumerate are proportional to dosage and to the frequency of use.

When cannabis is used once in a while, the brain goes through two phases. The first, or euphoric phase, called a "high" in English, engenders the feeling sought by the user, a feeling of well-being and satisfaction, as well as other disturbances in the brain. This phenomenon is followed by a second phase, which is a state of physical and mental lethargy, that sets in gradually a few hours after the drug was first taken. In English, this is called "coming down." Of course, there are also effects on other organs. For instance, the bronchial tubes become dilated, the heart rate increases and blood pressure goes down. We can make a very exhaustive list of effects on the brain and on other parts of the body. When very high doses of cannabis are taken, the most frequent symptoms are the following: sleepiness, confusion, disorientation, altered judgment, hallucinations and paranoia; the latter two symptoms may be interpreted as a psychotic disturb ance.

In cases of acute intoxication, given that cannabis has not caused any documented death even at very high doses, the usual measures consist in calming down and reassuring the patient, defusing the situation and, eventually, giving him a sedative such as Valium. There are no antidotes to cannabis and there is no specific medical treatment. However, one characteristic of cannabis is its very wide safety margin. The difference between a toxic dose and an effective dose is a factor 40 000. This is a very wide margin, so the substance is not life-threatening.

The long-term chronic effects of cannabis essentially cause the following symptoms: memory loss, faulty attention andconcentration, a slow-motivation syndrome of passivity and low initiative, increased risk of respiratory disease, more specifically asthma, bronchitis and emphysema and a higher risk of cancer. It is important to say that there is more tar in cannabis than in cigarette smoke and so it contains more carcinogens. In the long term, there is a greater probability of developing cancer, especially lung cancer. There may be hormone problems causing low fertility in men and women. In men, this can cause the development of breasts which is very unesthetic, and is caused by a transformation of male hormones into female hormones. Finally, in the long-term, it can also cause lower resistance to infectious disease.

Documents show that taking large doses of cannabis during pregnancy can affect the fetus as well as the baby by the following effects: death of the fetus, premature birth, a decrease in weight, malformed organs, heart toxicity, retarded growth, mental retardation and a weakening of the immune system.

Here are two important elements regarding tolerance to cannabis and dependence on it. Little tolerance is developed by casual users. On the other hand, there is high tolerance if the dosage and frequency are high.

Regarding dependency, the psychological dependency ismoderate, physical dependency is weak, withdrawal symptoms have been observed in regular consumers of large amounts, and the main withdrawal symptoms are anxiety, agitation,nervousness, irritability, insomnia, a general malaise, headaches, sweating, loss of appetite, nausea and intestinal cramps.

I handed out the table that sums up the toxic characteristics of cannabis as compared to other legal and illegal drugs. I made a list of six substances: cannabis, nicotine, caffeine, alcohol, cocaine, and heroin. Now this table sums up the toxic powers of these six substances, and this might help you make recommenda tions about the ranking of cannabis with regard to other drugs.

As regards sleep disorders, cannabis can cause sleep disorders throughout the withdrawal phase. As I said, there is the intoxication phase, when a person uses cannabis either in an acute or a chronic way, and the withdrawal phase, namely when the person is deprived of the substance. There can be sleep disorders during the withdrawal phase. Of course, with reference to hard drugs like cocaine and heroin, this can also happen during the intoxication phase as has been observed with alcohol during the intoxication phase.

During intoxication, memory problems can also appear. During withdrawal, there can be mood swings, as well as anxiety and psychosis. This potential for abuse is shared by the six drugs I mentioned.

Tolerance can also vary with different kinds of drugs, but it exists for the six substances I referred to. All six substances have this intoxication potential. Cannabis dependency is considered a moderate dependency as compared to nicotine dependency, which is strong, to caffeine, which is moderate, as is dependency on alcohol. Psychological dependency is very strong for cocaine and relatively strong for heroin. Physical dependency is weak for cannabis, strong for nicotine, weak for caffeine, strong for alcohol, weak for cocaine and very strong for heroin, which is certainly the most dangerous of all illicit drugs.

Thus, all six substances can cause withdrawal. Delirium is not specific to cannabis or to nicotine or caffeine, but it can happen with alcohol during withdrawal and with cocaine and heroin during intoxication. As I said, cannabis has a very wide safety margin. This is what we call the therapeutic index, that is the gap between a toxic dose and an effective dose. This gap is very wide. There is no documented report of death caused by a cannabis overdose.

The adverse effects on babies during pregnancy are deemed to be high for cannabis, very high for nicotine, weak for caffeine and very high for alcohol, cocaine and heroin.

Finally, as regards the potential to cause drug addiction, the potential of cannabis is moderate, that of nicotine is high, that of caffeine is weak, that of alcohol is high and the potential of cocaine is very high.


I would like to conclude by summarizing my personal views, which are shared by the Canadian Medical Association. These were summarized in an editorial by Dr. John Hoey, which appeared in the May 15, 2001 issue of CMAJ, the Canadian Medical Association Journal.

Health Canada's decision to legitimize the medicinal use of marijuana is a step in the right direction. But a bolder step is needed. The possession of small quantities for personal use should be decriminalized. The minimal negative health effects of moderate use would be attested by the estimated 1.5 million Canadians who smoke marijuana for recreational purposes. The real harm is the legal and social fallout. About half of all drug arrests in Canada are for simple possession of small amounts of marijuana: about 31,299 convictions in 1995 alone. Many lead to jail terms or fines and all result in that indelible social tattoo: a criminal record. ... The decriminalization of marijuana possession for personal use does not mean making marijuana "legal" or letting it be sold in every schoolyard. It does mean that possession of small amounts for personal use would become a civil offence, like a traffic violation, not a criminal one.

Senator Kenny: I would like to address my questions to the portion of your testimony that related to the coming medical use of marijuana. I have several questions that perhaps you could enlighten the committee on.

Will it be difficult to prescribe marijuana under the new regulations?

Mr. Ben Amar: I do not think so, because the medical profession has the ability and capacity to prescribe by evaluating each individual's situation. When the new regulation comes into place on July 15, marijuana will be more accessible to patients in need, and the medical profession will be in a position to evaluate whether some patients really need it for therapeutic use and not for abuse. This is my personal point of view.

Senator Kenny: Are there medical protocols in place? Right now, if one goes to a doctor with a certain set of symptoms, the doctor has a sense of what might be prescribed and he or she will go through a big book and decide what to prescribe and in what dose. Are these protocols all in place? Will my family physician know these things? If I had a disease or an illness that marijuana could benefit, would this be common knowledge in the medical fraternity?

Mr. Ben Amar: At the start, some medical practitioners will be more comfortable if they read the relevant literature. As you know, there is not much published about the therapeutic use in randomized clinical trials, which means clinical trials that document clearly the applications and the benefits of use in some patients.

I believe that in the beginning, the knowledge will be documented through literature. Medical practitioners will know that some anecdotal reports exist about the benefits of marijuana in treating some diseases and with the medical record of each patient they will be able to decide whether they can prescribe cannabis. Again, the dosage is not very clear. There is not a clear scientific basis on what dose will be applicable for each disease.

This is the case for any new disease. For instance, when AIDS was first being treated, we did not know what the ideal dosage was for therapeutic benefit. I think it will happen also in the same way when marijuana starts to be prescribed. I am sure that our practitioners in Canada will soon be comfortable prescribing the right dosage for the right people.

Senator Kenny: It is my understanding that when a new drug comes on the market, drug companies send around what they call "detail persons" whose job it is to describe to physicians the benefits of the drug, the side effects, the doses and those sort of things. Do you anticipate that there will be detail people going around describing marijuana to physicians?

Mr. Ben Amar: Health Canada has done excellent work in that area. Before recommending the new procedures for the Minister of Health, there were clinical trials conducted in several Canadian provinces in interesting and qualified centres. Marijuana was studied for AIDS, epilepsy and other diseases. I am sure that Health Canada will have a brochure. The monography for drugs will be available for practitioners and for the public and patients regarding the results of those clinical trials, indicating the right dosage, and the objective and subjective results of those studies.

We should not forget that some effects of cannabis are subjective. The patients might say they feel better with this medication, that they are less tense or anxious or that it relaxes their muscles, but this phenomenon cannot be quantified properly in clinical trials.

You are right in saying that it is not as clear as for other therapeutic applications for drugs where several clinical trials have been done all over the world with a large number of patients, and we know that for these applications we have a certain dosage. In this case, we must be more careful and cautious at the beginning. However, I agree with you that it is not as clear as for other therapeutic applications.

Senator Kenny: What are the illnesses that one would use marijuana for? What illnesses would a doctor have to diagnose before he or she would prescribe marijuana?

Mr. Ben Amar: In terms of prescribing marijuana, the doctor must first do an evaluation of the person, to see if there are contraindications for prescribing marijuana. As well, the doctor would study the possible interactions between marijuana and other drugs that the patient might be taking. As you know, some effects can be potentiated if mixed with other psychotropes, which act on the brain. It is well documented that there are some benefits for problems of nausea and vomiting related to cancer chemotherapy. This is the reason why some drugs containing THC are already on the market.

As well, stimulation of the appetite and anti-convulsive properties are well documented in the literature. There are several other situations for which there is anecdotal evidence of that. For instance, some people will say that they have less pain when they are suffering from certain diseases. Some people will say that it relaxes them for different types of diseases.

Therefore, it is difficult for the medical practitioner to determine exactly the best benefits for each disease because there is a subjective aspect on the part of the patient who will say, "Doctor, I think it will help me." The medical practitioner must ponder the basis for the science that precludes a good therapeutic application of the drug and the interests of the patient who says, "I will function better if I smoke marijuana."

The real benefits for different diseases regarding cannabis are not clear.

Senator Kenny: If it will be available in four weeks through doctors, there must be a menu of diseases for which it will be available. What are those diseases?

Mr. Ben Amar: If you wish, I can give you in detail the diseases for which it will likely be recommended. It may be used for any disease about which a patient says he suffers anxiety. The effect of the drug is a feeling of well-being, of relaxation. It may be used to stimulate the appetite in diseases like cancer and AIDS. As you know, we have what is called the "wasting syndrome" in those diseases. It has been documented in some cases that stimulation of appetite is an objective response.

Also, as I mentioned, it may be used in all diseases where chemotherapy induces nausea and vomiting. It may be used for the attenuation of pain, either intermittent or chronic, when you have headaches, migraines, menstrual cramps, cancer and other chronic diseases. It can be used also as an anti-spasmodic and muscle relaxant. In certain diseases where you feel those sensations in your limbs, for instance, multiple sclerosis or people who have spinal injury, it has been documented that it can have some value. It can have anti-convulsant effects in some cases of epilepsy. It can reduce intraocular pressure in diseases like glaucoma.

It has also been suggested that cannabis can be used in the withdrawal symptoms of intoxication of some psychotropes like alcohol. As you know, the alcoholic person who stops consuming alcohol has a syndrome characteristic of many things, including anxiety. It has been documented that in those situations cannabis will reduce this anxiety.

These are the officially documented applications that could be suggested for the therapeutic use of cannabis. Again - and I want to emphasize this aspect - there is no clear documentation that on all those applications there is substantial benefit. Some aspects are objective, while others are subjective and individual to each patient.

Senator Banks: Putting aside the dread diseases for which cannabis has, I think you could say, an objective value, it sounds as though a doctor who is so disposed could prescribe cannabis, with reason, to anyone who said, "I feel anxious today;" is that so?

Mr. Ben Amar: That is a possibility, which is why I have my reservations. There is an ethical issue for the practitioner in terms of what he should do for his patient. He is there to give the best services to the best of his ability and knowledge. Of course, we cannot exclude this possibility that just for an anxiety problem a patient will say to his doctor, "Yes, I want you to prescribe that for me." I agree with you that this is a possibility that will happen.

Senator Banks: As you have looked at this problem from many different ways, I would like to get your opinion on some unscientific things. We have heard that the epidemiological studies that have been conducted in this country have shown, pretty well irrefutably, that there is not a gateway effect. That is to say that marijuana use does not demonstrably lead to the use of what are usually characterized as harder drugs.

However, there are people who believe that that is not so, for reasons which are not pharmacological or physiological. They subscribe to the notion that one who is a user of an illegal substance comes into contact, by definition, with people who purvey illegal substances. Thus, there is the "try this" syndrome, which is not really a gateway effect, but it is an introduction.

Without attributing anything else than that to it what is your personal opinion of that question?

Mr. Ben Amar: I agree with the fact that it is not a gateway for harder drugs, and I will give some examples. We have the case of the Netherlands, for instance, where it has been tolerated for 25 years. It has not been "legalized." According to general opinion it is wrong to say that it was legalized, it was just tolerated. We have some interesting figures. For instance, there is a study done by the University of Amsterdam that demonstrates that only 10 per cent of cannabis users develop a mild physical dependence. This is the first point.

Most of the time the gateway to harder drugs is related to the fact that to obtain the sensations of euphoria that I mentioned earlier, the person will try harder drugs to get the same effects because of tolerance. This means that at a certain point the drug does not exert any longer the satisfactory effects the consumer is seeking. It is interesting to note that in the Netherlands, smokers of marijuana experience harder drugs only in 8 per cent of cases. In the United States, where the legislation is different, this figure is 41 per cent, which means cannabis smokers will pass on to using harder drugs. In my opinion, it is not a scientific gateway that causes people go to harder drugs; it is more likely that a curiosity or interest in experiencing other effects causes this behaviour. Scientifically, there is not a substantial basis to substantiate the fact that it is a gateway. It is possible in some particular cases that this will be so. However, in general, we can say that it is not a gateway.

Senator Banks: I am asking for a completely subjective personal opinion about a subject that probably does not have a subjective, scientific answer. You mentioned that this does not mean that people will be running around selling cannabis in schoolyards. However, if cannabis is decriminalized, legalized, or any of the possibilities on the scale of reducing its criminality, children aged 11 to 14 will be aware that one day it is illegal and the next it is less illegal. Children see dad having a drink at home and so believe that it cannot be the worst thing in the world. Perhaps dad has a cigarette with his drink, so obviously there is nothing wrong with that.

There is now, in the mindset of a fairly large number of people, a moral compunction that drugs are different from caffeine, tobacco and liquor. That will, in some subtle way, change on the day that the scale of illegality of cannabis changes, as I am sure it did in the Netherlands, Sweden and elsewhere.

In your personal opinion only, do you have any concern about the social, as opposed to scientific, impact of any relaxation of the law with respect to marijuana?

Mr. Ben Amar: Yes, senator, I have many concerns about these aspects. We must not send the wrong message to our children. Moral issues must be considered strongly. We should not give youngsters the perception that cannabis is harmless. Cannabis is not harmless. We should not allow young children the opportunity to have easy access to drugs. In the government`s decision on this, we must balance the moral and social aspect with the scientific aspects.

Senator Banks: If we were to lessen the legal implications of possession of cannabis, are you concerned that North America would attract many people to buy, sell and possess cannabis, if it were easier to do here than elsewhere?

Mr. Ben Amar: That is another concern that we must seriously consider. As you know, in the United States, regulations are different. There, official and scientific positions are more moderate. We should not open the gates for people from other countries to come here because they think that cannabis is more accessible here. I share that concern with you.


The Chairman: I read the documents you sent us with great interest. I am not a scientist, but I require very that high standards be adhered to for this committee. I think that cannabis is required to have, and you have commented on this in your documents, a level of innocuousness that is not required of other substances. Do you have any comments regarding this? There is perhaps a tension that creates some intolerance of a substance that has been demonized.

Mr. Ben Amar: I agree with your comments. There are myths, reality, and opinions. We must always remain objective regarding cannabis. The Le Dain Commission Report provides a foundation for your work.

In 1972, the Le Dain commission stated its opinion on decriminalizing cannabis. The Le Dain commission report concluded that there was no real relation between cannabis abuse and crime rates. The Le Dain commission thus recommended that it be decriminalized. In my opinion, there are two schools of thought.

The Chairman: I have read it. This is much more of a pharmacological and medical point of view. After reading your texts and other texts from witnesses, I have drawn the following conclusions: are we as demanding when dealing with substances that are natural remedies or with truly natural substances? Much more is required in terms of acceptability or harmlessness from this substance than from any others.

For instance, Sudafed is a drug that causes drowsiness, the side effects are described on the wrapper and it is regulated by Health Canada. Health Canada studied the safety and the consequences of taking this drug, and recommended that the producers issue warnings. How do we compare the drowsiness that you refer to with the rest of the list of side effects? You used terms like high dosage, very high dosage and acute intoxication. That is in itself a ranking, and as you rank consumption, you attribute to this last level consequences that are alarming to say the least. When you refer to the fetus, it seems alarming to me. I am trying to understand this.

Mr. Ben Amar: You are quite right in saying that scientifically, more is required of cannabis than of other substances and that this is not for scientific reasons but rather for moral or social reasons. Certainly, we must be strictly scientific and consider that in some ways, cannabis is not more dangerous than alcohol or tobacco. I said in some ways, because in some ways it is more dangerous, but in other ways it is less dangerous. There is a certain level of social acceptance of some illicit drugs. Public perception of cannabis is different because of past history, and perceptions that are not necessarily reality-based. Scientifically, I can affirm that more is being required of cannabis than of other substances which are more easily accessible.

The Chairman: I will come back to that.


Senator Kenny: With regard to physicians and prescriptions, could you describe what the arrangements are to provide a supply? After July 15, will marijuana be available through drugstores? If so, are there special measures in place to transport and store it?

Mr. Ben Amar: In the past, the main concern for patients was that they would not have access to proper cannabis. After July 15, there will be official distributors of cannabis. This means that every patient will be able to choose his distributor. Of course, these distributors will be controlled by Health Canada. Regular inspections will be conducted to ensure that they respect the law.

Also, in these new regulations, there are specifics as to quantities of possession. The patient will be able to possess only the quantity related to the dosage prescribed by the medical practitioner.

After July 15, the patient will be able to renew the prescription once a year.

Provisions of the new regulations will allow for more accessibility, as well as control over the production and distribution of cannabis to the patient, who has a prescription.

Senator Kenny: Perhaps I should work backwards, then. What size doses will be considered appropriate and how will they be measured? Will it be by the chemical content in the marijuana or by the number of ounces? What is an expected prescription likely to be? Will it all be delivered at once? If you are only able to get a refill once a year, it seems to me that you are giving someone a year's supply, which raises questions in my mind.

Perhaps we could start with the dose. What is the dose? How is it measured? How much could someone reasonably expect to receive when his or her doctor writes a prescription?

Mr. Ben Amar: The two drugs that are already on the market today provide a good basis for comparison. For instance, for Marinol, which is a tetrahydrocannabinol, or the drug dronabinol, the prescribed dosage will vary between 2.5 and 20 milligrams per day, depending on the therapeutic application. As you know, sensitivity to a drug varies from one person to another. Thus, the range is larger than for other drugs. Therefore, depending on the tolerability of the patient and the gravity of his illness, there is a margin for the administration of Marinol. For instance, this margin would cover administration in the use of stimulating appetite in diseases like AIDS and cancer, or to fight nausea and vomiting when people receive chemotherapy.

In the case of nabilone or Cesamet right now, the prescribed dosage is from 2 to 4 milligrams per day. Nabilone is the synthetic analogue of THC. I think the dosage will be based on the data that we have already on those two drugs and will be modified accordingly in response to the patients.

I understand the concern that in renewing the prescription only once a year, perhaps large quantities will be possessed by the patient. Certain modifications may have to be adopted once there is an application. I believe it is possible at any time for Health Canada to change the rules according to the consequences of the application of these regulations.

Senator Kenny: My understanding is that marijuana comes in a variety of strengths. Do you anticipate that the marijuana available in this program will all be of a consistent quality and strength, or will it vary as it does on the market today?

Mr. Ben Amar: I am sure that by selecting the producers and having a strict control on that, we will have a less variable percentage of THC in marijuana. I think the average right now is about 10 per cent THC. The producers will have to follow some standards of quality and I am sure that in its inspections Health Canada will also take samples to monitor the dosage of THC.

Senator Kenny: If this program is rolling out in a month, have these standards not been established?

Mr. Ben Amar: There are many things we do not yet know because they have not been made completely public. We will start to have a broader opinion once the regulations are in application. Because I have worked in the past on the development of a drug, I am sure that Health Canada has taken all the necessary precautions. It is a very serious organization. There are very competent professionals working within the department. I am sure that they have predicted and anticipated those concerns and put the right measures in place.

Senator Kenny: We have both identified what appears to be a potential anomaly with the once-a-year renewal and the large quantities of drugs one would have to have. Could you translate into ounces what a daily amount might be? What is the range in ounces that a patient might receive? We can then multiply that by 365.

Mr. Ben Amar: It is difficult because, as I mentioned to you, that will vary from one patient to another.

Senator Kenny: Can you give us the bottom range and the top range and we will figure it out in between? What would the minimum prescription be? I am not expecting something exact, but give us an estimate of what you think a minimum dose might be and what a maximum dose might be. This should give us a sense of what an individual might be carrying away or the range of what they might be carrying away when they fill their prescription for a year's supply.

Mr. Ben Amar: I am cautious in giving figures because it will vary from one person to another. It will depend upon their sensitivity and the therapeutic application that is addressed. It is fair to say that a dosage of between 1 to 20 milligrams per day will be prescribed.

Senator Kenny: My next question has to do with getting the product from the producer, who I presume is licensed, to the supplier or the wholesaler. You said that it would not be a pharmacy. I got the impression that there will be a new entity for people to go to. How will it get from A to B and who will regulate its transportation? Who will regulate the holding of quantities of the drug in various places? How will that be organized so that it is done in a legal and a safe fashion and so that it will not be a target of criminals?

Mr. Ben Amar: Again, I do not have an exact answer because those policies have not been made public. I presume that Health Canada has determined a list of official producers in the different regions of Canada. Some regulations will apply to both the transportation and the distribution to the patient. I am not immediately aware of those regulations.

Senator Kenny: Will it be by FedEx or Brinks? I am curious. If you were shipping this product around right now you would likely find yourself on the wrong side of the law.

Mr. Ben Amar: I am convinced that there are strict rules in the mode of delivery, which means that the producer will have full responsibility for the quantities that he possesses and he distributes. Undoubtedly all necessary precautions will be taken from the moment of production to the point of distribution to the patient so that potential for error is ruled out. There are probably strict applications for the distribution, but I do not know the terms right now.

Senator Kenny: I would like to inquire about the patient receiving the prescription. It sounds to me that the amount of marijuana that the patient would receive would move him or her from the category of user to distributor, based on the volume - if they full year's worth in his or her possession.

The Chairman: Senator Kenny, perhaps I could help you on the regulation that Mr. Ben Amar has mentioned. We will know the final print of that regulation in July. A specific section deals with the quantity of marijuana that you can have in your possession at the one time. It is not 365 days. According to what I read, you could renew the prescription, but to have the possession of a quantity of marijuana will be less. I think it is three or five days supply.

I understand your question. Mr. Ben Amar is probably not the proper witness to answer the questions. However, Mr. Ben Amar, if you have studied the proposed regulations, you are welcome to provide an answer. However, I do not think it is your field of expertise, not today. Perhaps in a month, when the regulations are published and in place we will have people from the department who will come to address those questions.

Senator Kenny: I would like to go through questions such as what happens to a patient. Does the patient have to carry a document or a card with them for identification? I would like to work through the process from the supplier to the user to see how it worked and what was involved.

The Chairman: The answer to your first question is yes. It was also part of the draft proposal of regulations. I do not have in mind the specific amount. I think that one could have three days, four days or five days of marijuana in possession. It does not mean "on you," it could be at home, but in a secured location.

Senator Kenny: If this is not the correct witness, do you anticipate a witness coming before us who can answer these questions?

The Chairman: The department has not finished the evalu ation of all the proposals. As you know, the proposed regulations have received a significant amount of publicity. They are, according to what we have heard from the department, still dealing with the various recommendations that they received.

We will read the regulations when they are published at the end of July. It will be published in mid-July and be in force at the end of July. In early September, we will have the benefit of all of the details of the proposed dates and enforcement regulation. We will have the department before us to help us understand the mechanism.

The Minister of Health is responsible for providing all the safeguards, processes, procedures and protocols that should be applied by practitioners, users and manufacturers.

Senator Kenny: I will finish with a few brief questions that may be more appropriate for this witness. Do you have a view, sir, on whether it would be more appropriate for this drug to be prescribed in an edible form or inhaled? I am particularly thinking of the complications involved if you are smoking. Is there a preference in terms of how one should receive the drug?

Mr. Ben Amar: The American Medical Association suggested the development of a system giving access to the active ingredient, THC, without the tar, which has the cancerous properties. I anticipate that the more practical way to take cannabis will be through inhalation. Currently, this is the only way it will be easily available. Inhalation would be the proper way in the near future in order to achieve certain therapeutic quantities in blood that would exert the proper effects in the body.

Senator Kenny: One notices, as new drugs come on the market in the United States, that they are being advertised. An advertisement describes what the drug will do for you. Then they go through a long list of side effects. It is quite an intriguing advertisement to watch. Sometimes the side effects sound worse than the drug itself.

If you were creating such a commercial for marijuana, what would the side effects be if you tagged them on at the end of the commercial? You have described which illnesses it benefits and how it might benefit them. Could you now tell us what caution should be attached at the end? If you were doing a commercial, what you would say?

Mr. Ben Amar: There is a long list of side effects and contra-indications. I have summarized some of them. For instance, it is well established that smoking marijuana impairs your ability to drive. These effects can be mitigated with alcohol. An extreme caution should be put on the fact that you should not drive a vehicle or work with a dangerous machine when you are under the effects of marijuana. A warning to not mix it with alcohol or other psychotropics should be given. A list of all the psychotropics is in the documents that were distributed to you.

It is clear, also, that different effects on the brain are attributed to cannabis. For instance, it affects memory, concentration and attention. Therefore, these warnings should be put also. Certain people who have some psychotic diseases, for example, paranoia and schizophrenia, cannabis is not recommended because those symptoms can be exacerbated by cannabis.

I could give you other warnings such as cardiovascular problems. As I mentioned, cannabis in large doses could stimulate your cardiac rhythm, which is called tachycardia. Theenhancement of your cardiac rhythm could be increased by up to 50 per cent, which is contraindicated in some cardiovascular diseases.

Also, as I mentioned, it induces a reduction of vascular pressure. This could be dangerous for elderly people. It is documented that cannabis is more frequently used amongst youngsters, but warnings should be made for people who have cardiovascular disease, especially if they use it for therapeutic application. The figures today say that about 1.5 million Canadians use cannabis for pleasure and about 400,000 people use it for therapeutic application. These figures are far greater than the 40 people were by Health Canada to use it in the past.

This list of side effects should be larger rather than smaller to prevent potential dangers for the people who take it. I believe that Health Canada will also include side effects and contraindications in a brochure. You expressed concern regarding the fact that the prescription will be renewed only once a year. I mentioned that matter only because most of the patients benefiting therapeutically will be in advanced stages of diseases, in some cases terminal. Therefore, the longer renewal period will save them frequent trips to the practitioner.

However, I am sure, as Mr. Chairman mentioned, there is some regulation against the patient possessing more than certain quantities at the same time, because of the potential for abuse. It could be used for trafficking. It could be given to other people. I am sure that certain terms will be included so that, according to the quantity prescribed to an individual, he or she can have enough for one week, five days, three days. I think this is an important issue to be considered.

The Chairman: For the committee's information, the proposed regulation indicates 5 grams per day, maximum 30 days at the same time in one location. That is the proposal. We do not know what the final quantity in the regulation will be.


Mr. Ben Amar, I am sure that our research assistants have questions that they would have liked us to ask but, for all sorts of reasons, we will not ask them. Therefore, we would like to ask all the witnesses whether we could write to them, for more information.

Second, if during our deliberations, you think that it is appropriate to give us some information on a particular subject that seems important to you, please, do not hesitate to do so because we would appreciate any comments you may have.

Earlier we were talking about morality and the effects of morality and political pressure on members of Parliament. Do you think that scientists are immune to these pressures?

Before you answer, I would just like to give you two examples. The American medical institute's research did not lead to any conclusive findings on the impact of cannabis on human fetuses.

However, the documents relating to research done on animals shows that animals are administered huge doses which are quite different from those doses taken by humans. I would even go as far as to include regular and heavy users, if you do not mind my picking up on the terms that you used earlier.

Do you think that scientists are in a position to provide an objective assessment and to provide objective and detailed clarification for poor members of Parliament like us, who are attempting to see the forest and the trees in all this intricate information, which is, more often than not, subjective?

Mr. Ben Amar: I hope so. As is the case in all areas of society, there are always some exceptions to the rule, but I am sure that the scientific community will look at this issue in great detail. However, we are not immune to moral, social and personal pressures.

The problem with cannabis is that no monitored and serious controlled research has been done comparing results using the substance and a placebo, to ascertain whether cannabis improves the muscular symptoms caused by multiple sclerosis by80 per cent or whether it increases the weight of a person with terminal-phase AIDS or cancer by 20 per cent. Currently, no comprehensive and clear research has been done to prove or disprove this theory. The research that has been done has been based on mainly anecdotal evidence and has not been based, for example, on a sample of 5,000 patients, where the effects of cannabis on them were studied. This type of research has not been done because it was not permitted under the law.

In a press release in June 1998, the American Medical Association recommended that the National Institute of Health take the necessary administrative and scientific steps to conduct and monitor major research in the United States on the therapeutic applications of cannabis. However, we are still waiting.

The Canadian Medical Association has adopted a broader stance based on specific data. We are also further ahead, and I'm very proud of the fact that specific research has been done in Canada, but on a smaller sample of patients. This is a problem that we are facing in terms of cannabis, but the scientific community is certainly not immune to social, personal or moral considerations.

The Chairman: Do you believe that research protocols should be improved to ensure that this goal is met?

Mr. Ben Amar: I certainly do. The best research protocols are those which are random and double-blind. For example, imagine that there are 500 people with a specific disease. Two groups of 250 people each would be created on a random basis. This is what we call random selection and one group would be given cannabis and the other would not. There are also ethical considerations in this process. In theory, the best research is double-blind, which means that neither the subject nor the researcher knows exactly what is being given.

The cannabis problem is obviously particularly significant because cannabis has specific effects and this creates a problem in undertaking comparative research with other types of drugs. When comparing medication, a patient can be given a tablet which looks the same as normal medication, but which is in actual fact just sugar and the patient will be none the wiser because he is not aware of the effects of the medication. However, in the case of cannabis, assessment is quite difficult because patients realize that the substance that they are taking does not have the characteristic effects of cannabis. Therefore, in theory, yes, it is feasible, but in practical terms comparison is problematic, for the reasons that I have just set out.

The Chairman: I want to ask you one last question and then I will let you go. However, please feel free to remain if you would like to hear the testimony of your colleagues.

Does the latter part of your answer not apply to all marketed natural substances, which for all sorts of reasons - often because of the very nature of the substance - pose standard protocol implementation problems for both medical and government bodies responsible for public health?

I had in mind Chinese medicine, for instance. However, I am sure that there are other natural substances which are used as medication. However, in the West, we are so used to our traditional pharmacists and to the western pharmacopoeia that we do not pay as much attention to these natural substances as we should.

Do you think that assessment protocols for natural substances should be amended? It seems to me that cannabis would fall into this category.

Mr. Ben Amar: It is certainly true that throughout history medicine has varied from one civilization or society to another and traditionally, vegetable-based substances have not been the focus of research in Canada. Indeed, I think that we could amend medical assessment protocols, so as to look at the properties of so-called "natural" substances. However, we have to maintain current standards governing controlled research.

The assessment side of things could be broadened somewhat, but we have to have statistical research which demonstrates that natural substances work significantly better than a regular or non-harmful substance. However, it goes without saying that specific criteria must be applied to vegetable-based substances.

The Chairman: Professor Ben Amar, thank you for having come here today. I think it was a very pleasant and instructive experience for everyone. Please do not hesitate to write to us if you have any further comments you would like to make, especially once you have read the regulation on the distribution of cannabis for medical purposes, which will be published in late July.


Mr. Ben Amar: It was a pleasure to be here.

The Chairman: Our next witness is Dr. John Morgan. He is from the City University of New York Medical School. He is a professor of pharmacology. I wish to remind you that there are people reading our proceedings through the parliamentary Web site. It is a first in the history of our Parliament. We are very proud of that.

Dr. Morgan might be shy about reading his biographical notes, but I am not. It is important for committee members to understand the magnitude of your expertise and how valuable your testimony will be.

John P. Morgan graduated from the University of Cincinnati College of Arts and Science in 1962 and the U.C. College of Medicines in 1965. Following training and board certification in internal medicine, he was in the medical services of the United Air Force and took two years' training in clinical pharmacology. He began an academic career in pharmacology, teaching and drug investigation at the University of Rochester College of Medicine in 1971.

At the University of Rochester, he lectured in musicology. He reviewed performances of popular music for the Rochester Times Union.

In 1974, he received a career teacher award from the National Institute on Drug Abuse. Subsequently, he has focused on the clinical pharmacology of alcohol and misuse of psychoactive drugs. He has retained an interest in clinical pharmacology, foreign medicine, physician prescribing patterns and popular music in society.

In 1976, Dr. Morgan moved to an experimental integrated BS-MD program established at the City University of New York. He organized and taught the first pharmacology course there and served as the program director and acting chairman ofpharmacology until 1992.

Dr. Morgan currently is medical professor in the pharmacology Department of the School of Biomedical Education at City University of New York Medical School. He is also a joint professor of pharmacology in medicine at the Mount Sinai School of Medicine.

He teaches pharmacology to medical students and physician assistant students and drug policy to graduate students in sociology. He frequently lectures on medical use of marijuana, urine testing, the clinical toxicology of MDMA, poisoning during alcohol prohibition, and reflections on marijuana in popular music and jazz.

He has published more than 100 articles and books on clinical pharmacology, psychopharmacology drugs and alcohol misuse and drug policy. He has served as a consultant to the pharmaceutical industry, the Food and Drug Administration, the Drug Enforcement Administration, state medical boards and federal and state public defenders.

Since 1985, he has frequently consulted with unions on the issues of workplace urine testing for drugs and has been part of analysing a variety of medical-legal cases. He has often testified for individuals who claim that their use of marijuana was based on medical need.

In 1997, with sociologist Lynn Zimmer, he co-authored Marijuana Myths, Marijuana Facts: A Review of the Scientific Evidence. In the 1996, he received the Justice Gerald Le Dain Award for Achievement in the Field of Law from the Drug Policy Foundation. In 2000, he received an award for achievement in the area of marijuana law reform from the National Organization for the Reform of Marijuana Laws.

Dr. Morgan, the floor is yours.

Dr. John P. Morgan, Professor of Pharmacology, City University of New York Medical School: Honourable senators, I hope my brief prepared remarks will address the ideas and issues that are important to you.

Pharmacologists, like physicists, are committed to the study of material, structural and organic entities that they cannot see. Their thinking, ideas and constructs are based upon these tiny entities, whose presence and effects can only be assessed indirectly. The physicist believes fervently in electrons and photons, while the pharmacologist applies his or her trade around the examination of a subcellular structure called the receptor.

Humans co-evolved with the cannabis plant or rather the cannabis plant made humans plant it for approximately10,000 years before the essential character in terms of active chemicals - and the particular chemicals that bind toreceptors - emerged.

In the 1960s, Rafael Mechoulam isolated and identified the cannabinoids and the chief cannabinoid chemical in the marijuana plant: delta-9-THC. Approximately 20 years later, in the late 1980s, Allyn Howlett, a scientist in St. Louis, identified a receptor for THC that is a component of the cell surface of brain cells to which THC bound.

Essentially all chemicals that affect or alter human biology and function bind to receptors and that binding alters cell function, provoking a measurable effect. The character of the effect and the chemical cause us to label the chemical in various ways. In simple terms, some chemicals that humans use to change cellular functions are best classified as food; others are medications, poisons and drugs, subsequent to misuse.

Many chemicals that we are concerned with have been manufactured or synthesized by plants. The history of western pharmacology has been the history of the study of plant chemicals often with an eye toward identifying, isolating, purifying, modifying and finding a dose formulation for that particular chemical, which originated in the plant for a variety of reasons that we seldom understand.

Human culture finds, values, and fears the opium poppy, the foxglove plant, a particular fungus on rye, ephedrine and cocoa. In recent years, the study of most of these plants yields up a particular chemical, which is then exploited for better or worse.

Sometimes human users continue to ingest the crude plant in some form, without refinement. There may be significant conflict between those committed to extraction and synthetic manufacture of the chief chemical and the natural chemical brew of the plant itself.

The interaction of the chemical and the receptor and the organism, we now understand, has often a particular character. Chemicals, particular psychoactive chemicals, work on a prepared system, substrate or playing field, if you will.

The drug works by inserting itself into a pre-existing structural and functional system. Thirty years after the identification of THC, by Dr. Mechoulam, a scientist working with him, William Devane, identified a brain chemical - a chemical we make - which binds to the cannabinoid receptor and causes changes which are qualitatively similar to those provoked by THC. In a spirit of whimsy, Dr. Mechoulam and Dr. Devane identified that chemical and named it Anandamide, from the Hindu word for "bliss."

These studies, the identification of the particular cannabinoid chemical and the identification and characterization of the receptor that binds that chemical, have led to a beginning understanding of the cannabinoid system in the mammalian brain. Cannabinoid receptors are widely distributed in the brain and their activation provokes a number of effects.

In truth, the activation of system is best described as gentle. It might better be classified as a modulating system rather than an effector system. In some cells, in the central nervous system, binding to the cannabinoid receptor modifies a pre-existing energy transmitting system in the cell so that the cell operates in a diminished or reduced response to the usual activation provoked by other neurotransmitters such as norepinephrine andacetylcholine. In other words, the cannabinoid system may quite often turn down cells. It is a down modulator, a modifier of cellular response, which often diminishes the response that cell has normally to other chemicals.

The cannabinoid system may modulate a large number of human physiological processes that may relate to formulation of memory; response to pain and other strong stimuli; modification of movement, particularly relative to its modification of muscular tone; and regulation of appetite. Again, recall that the impact is chiefly modulatory and often gentle. Michael Pollan, who recently wrote The Botany of Desire, said that cannabis inflects the prose of human life without rewriting it.

I believe - as you can tell from my introduction and what you know of me - that THC is properly classified as a therapeutic agent in many conditions. I believe there is adequate evidence, sometimes of an anecdotal nature, sometimes of a scientifically controlled nature, to identify cannabis as a therapeutic agent in some of the following. Cannabis clearly works as an anti-nauseant; in particular it modifies nausea occurring secondary to chemotherapeutic agents in cancer and AIDS. Cannabis modifies appetite; in a particular sense, it modifies the anorexia or dysrexia of illness and provokes appetite. It has been life saving in some individuals with AIDS related wasting.

In animal studies, the blocking of the cannabinoid receptor in young animals interferes with their ability to learn to eat properly. It is entirely possible that the cannabinoid system has critical functions in youthful mammals in terms of establishing eating patterns and helping point the animal toward proper nutrition.

I now believe that cannabis is an effective analgesic. It relieves pain in a variety of situations. Early studies of the analgesic effect, while usually positive, were not particularly profound. However, later studies have indicated its greater potential. Again, to return to the prepared system that exists, when the cannabinoid receptor is blocked chemically, we now have blocking chemicals that bind to the receptor without causing an effect but which prevent its binding by Anandamide. Experimental animals displayexaggerated responses to painful stimuli. In other words, if you take a rodent and use a common model for pain response, and place the rodent on a grid that one can then heat up, the animal will, at a certain heat, jump off the grid because we believe he is perceiving something like pain. If you block his cannabinoid receptors, he will jump off the grid sooner. In other words, the cannabinoid system may operate as a pain modulator in mammalian and human life as a matter of daily occurrence.

It modifies and again diminishes abnormalities and muscle tone in a variety of human diseases associated with increased muscle tone, particularly multiple sclerosis, cerebral palsy and spinal cord injury. In fact, it is important to state that the chief political entity - if I may describe it as such - moving ahead studies of therapeutic cannabis in Great Britan, have been the multiple sclerosis societies. These societies have been active in lobbying and calling for further investigation of cannabinoid because of their ability to diminish muscle tone and diminish pain and spasm secondary to multiple sclerosis.

In the 1970s, there were strong indications that we could move forward in therapeutic cannabis studies - although those were virtually halted by political forces in the United States. In the late 1980s and early 1990s, the major entity lobbying for therapeutic use of cannabis was people with AIDS.

In some humans cannabis diminishes seizure activity and may be an effective antiepileptic. I do not know how many people with epilepsy may respond to cannabis use. Interestingly enough, cannabis lowers inter-ocular pressure and may be therapeutic with glaucoma. I will digress a moment to say something about that.

I was reminded during your questioning of the last witness that there are still eight people in the United States who received cannabis legally from a distribution system that was forced by a court decision in the United States. In 1976, a young man named Robert Randall, who died last week, sued in a Federal Court because he had been convicted of growing marijuana in the backyard of his house in Washington D.C. He brought forward his ophthalmologist who said that the only thing that effectively lowered his inter-ocular pressure, and was likely to preserve his sight, was the smoking of cannabis. This was particularly compelling testimony because his ophthalmologist, a very prominent American ophthalmologist, has remained opposed to the general use of cannabis in ophthalmology and for the treatment of glaucoma. However, he honestly testified in the trial that for Mr. Randall, the only agent that effectively lowered his inter-ocular pressure was cannabis.

Because of that decision, the United States government was forced to supply cannabis to what ultimately became a group of nearly 20 people. However, that program was stopped in 1990. There remain seven people in the United States who are supplied cannabis regularly by the federal government.

I have digressed to let you know that this material is grown on a plot at the University of Mississippi College of Pharmacy. That college has seven acres set aside to grow cannabis to occasionally extract THC for experimental studies and to provide these seven patients with material.

Dr. El Sohly has frequently remarked that he made the decision when this contract was given to him to supply 3 per cent THC marijuana to these now seven people. Indeed, although the dose varies, most of them are sent 300 cigarettes per month. The equivalent of 10 cigarettes per day is sent to a pharmacy and the users pick it up and generally administer it themselves. It is interesting how little supervision the United States government has supplied to these seven people.

The glaucoma patients, formerly Mr. Randall and one other woman, tend to smoke eight to 10 joints per day. The impact of cannabis on glaucoma is short-lived. Therefore, they must take a much larger dose than most of other patients for whatever ailment. There is one multiple sclerosis patient. There are several people with unusual neurological disorders. At the moment, I cannot remember what the ailments of the other patients, but they are sent standard 3 per cent marijuana cigarettes. Marijuana cigarettes could have been produced at 5 per cent or 10 per cent THC.

This digression also enables me to say that in the midst of this furore over the remarkable increases in marijuana potency, it is interesting that the potency of the commercial crop sold in the United States has not varied enormously over the 30 years that potency has been assessed by the analysis of THC content in criminally seized marijuana. In fact, I recently looked at the report, which also comes from Mississippi, that the mean THC content of some 40,000 seizures since 1974 is about 3.5 per cent. It has gone up in last 10 years. In fact, in the last 10 years I believe the arithmetic mean is more than 4 per cent while in the 10 years before that it was about 3.5 per cent.

There have been very high potency products - at least in the United States - since 1975. There were samples with more than 15 per cent potency reported in 1975 in the United States. Although I agree that probably the potency of the commercial crop has gone up, it has not gone up as dramatically as cannabis critics would have you believe.

In 1986, an oral preparation of THC was introduced by an American pharmaceutical entity. This product is called Marinol, as you already know. It is actually pure THC synthetically produced - not extracted from the plant, for a variety of political reasons. It is dissolved in sesame oil and sold in the United States in capsules of three different strengths - a 2.5 milligrams, a5 milligrams and 10 milligrams.

It is in some cases a useful therapeutic agent. However, swallowing THC - even pure THC - is not always effective. The swallowed chemical on absorption is largely degraded by the liver in its first pass through, after it is absorbed by the intestinal mucosa.

Serum levels of THC, after Marinol, are approximately one-fifth to one-tenth that achieved by puffing on a marijuana cigarette or a pipe bowl containing a little marijuana. Further, the peak levels in smokers are achieved in human bloodapproximately 12 to 15 minutes after smoking while the peak level achieved after oral administration of Marinol may require up to a hour and a half. A cancer therapeutic patient may achieve relief of nausea within minutes of taking a few puffs of a marijuana cigarette.

Marinol is extremely expensive. My wife takes Marinol for relief of muscle spasm and pain secondary to her multiple sclerosis. She has been taking it for more than five years now. Recently due to an insurance mix-up, I needed to pay out of pocket for a one-month supply of Marinol for the treatment of her muscle spasticity. The cost was $660 American for a one-month supply of Marinol.

Therapeutic doses of Marinol may cost an American patient who has no insurance somewhere between $6,000 and $7,000 per year. Smoking marijuana is the most effective, most efficient and cheapest way to deliver THC to the receptors in the brain.

It is true that future cannabinoid therapeutics, following the western pharmacological model, probably will reply upon delivery of THC in some fashion other than the smoking of crude marijuana. There is currently experimentation with pure THC inhalers.

There has been some intriguing experimentation recently in California with a THC vapour generator. One puts a sample of marijuana in a glass bowl, and then a heat generator - some times in the form of a specially designed generator - caps on to the bowl. Sometimes one may use a glue gun and cap it on to the bowl, depending upon its size. The application of large amounts of heat will cause some THC to evaporate and come up in a vapour form with minimal accompaniment of other components of the vegetable material. That is, minimal accompaniment of irritants, carcinogens, hydrocarbons and various other material that we inhale when we smoke combusted vegetable material.

The future may hold other formulations. I have mentioned pure THC inhalers. There may be sublingual preparations. I always hasten to inform audiences that there are two patents filed in the United States for THC preparations to be delivered by enema. It works well. One gets pretty good blood levels after the administration of THC in this particular form.

Until such pharmaceutical preparations are a reality, patients using the material therapeutically should be free of criminal justice constraints regarding their possession and use of crude marijuana. In fact, the actions of western governments to suppress the use of marijuana while encouraging consumption of pure THC most resemble the encouragement of the use of syntheticvitamin C by outlawing the consumption of orange juice. As was said by the Schaeffer commission in 1972 - and it is still true today - the greatest hazard faced by the user of marijuana is arrest, prosecution and potential jail time.

I have come to the end of my prepared remarks. I had thought I would make some specific comments on toxicity, in particular the lung toxicity of inhaled material in general, the issue of cognitive dysfunction and the two- to three-hour period of slight stupidity that follows the smoking of marijuana and, perhaps, some other issues. However I think I will invite questions about my presentation.

The Chairman: Thank you, Dr. Morgan. As I have said to all the other witnesses, there may be questions arising from our research. I will write to you with those questions. Hopefully, you will be able to answer those questions that we will not be able to ask you directly this morning.

As well, if you are following the work of the committee and you feel that you could provide more information, please contact us by e-mail or letter. We will be very pleased if you do so.

Senator Banks: I would like to pursue something you have just mentioned, which is toxicity. In respect of another committee on which I have the honour to serve, we have largely irrefutable evidence that smoking cigarettes is in some cases intensely harmful to the foetus. The Government of Canada has established that more or less as a fact of life. We find that when we buy cigarettes in Canada there are often gruesome pictures on cigarette packages that signal a warning that smoking will harm your foetus. I notice in your myth number 13 you say that marijuana does not. The flip question would be: Did you conduct a study to determine that by the eating of cookies? I am assuming not.

The tar content in marijuana cigarettes is greater than that found in most tobacco cigarettes. In light of that fact, I am wondering how it was possible to separate the carcinogenic smoke from the fact that smoking harmed this foetus, but that it was not the marijuana that did it.

Dr. Morgan: I will start in a general fashion and then specifically focus on the foetal harm issue. The inhalation of combusted vegetable material is hazardous to the human lungs. Humans are the only mammals that smoke anything, so we can limit our remarks there.

The makeup of marijuana smoke and tobacco smoke is very similar. There were some earlier studies that showed that humans who inhaled deeply and held their breath for a period of time may have deposited a little more crap and crud in their lungs than humans inhaling tobacco cigarettes. There is a possibility that the filter makes some difference. The reality, however, is that the components, that is, the amount of carcinogens, irritants and particulate material is about the same in tobacco smoke and marijuana smoke. The critical difference is that tobacco smoke contains nicotine and marijuana smoke contains cannabinoids.

In terms of human harm from tobacco smoking, the list is very impressive. I believe there are some reasonable studies showing diminished head circumference and weight, as well as some other problems, in the newborns of mothers who were regular tobacco smokers during pregnancy.

Before I go back to talk about why we doubted that is the case with cannabis, let me state that heavy smokers of marijuana, that is, those who smoke four to six cigarettes a day, which constitutes heavy use in the American classification, have some evidence of pulmonary damage. The evidence is mild. That is, they have increased cough, increased phlegm production and, perhaps, more episodes of acute bronchitis. Thus, there is some evidence that heavy smoking of cannabis is harmful. However, there are reasons to believe that the heavy smoker of cannabis will not succumb to the most severe crippling lung disorder, which is emphysema or chronic obstructive pulmonary disease. Donald Tashkin, who has followed a group of heavy smokers comparing them with tobacco smokers and non-smokers, has found no evidence of diminished lung function of the emphysematous type, except in tobacco smoking. It does not appear to occur in marijuana smokers.

The other issue is the generation of cancer. We are nearly 40 years into the so-called epidemic of marijuana smoking in youth in the western world and there is still no convincing study, links or case reports that show the occurrence of pulmonary cancer in marijuana-only smokers.

To me there is a relatively simple explanation for that. We, of course, emphasized it in our book. It is the dose that makes the poison. The cannabis smoker inhales much less of the toxic substance, which is the smoke. Of course, even a heavy cannabis smoker, by definition, smokes three to five joints per day, while the heavy tobacco smoker may smoke 40 joints per day. For a number of years, my father smoked 60 joints per day. Thus, the dose of smoke is much less in the cannabis smoker. I believe, although I could still be proven wrong, that that low dose of smoke is relatively protective.

I will now turn quickly to the issue of foetal harm. Of course, I would be asked about foetal harm here in Ottawa, since all the studies claiming to show foetal harm have come from Dr. Fried, who is a member of the faculty here in Ottawa. On pages 103 and 104 of our book, we have tried to review the studies of Dr. Fried and the Ottawa Prenatal Prospective Study. It is our belief that over the years, and about 14 or 15 different papers, Dr. Fried has not shown convincingly that the marijuana smokers had foetuses that were harmed.

The study states, in part, that out of all the OPPS studies and all the tests given, the Canadian researchers have found very few differences between marijuana-exposed and non-exposed children. At age one researchers found that marijuana-exposed infants actually scored higher on one set of cognitive tests. At age three the children of moderate marijuana users had higher scores on one test of psychomotor ability. At age four the women of children who smoked marijuana heavily during pregnancy - 19 joints per week - scored lower on one subscale of a cognitive test. However, at ages five and six the difference was no longer present.

This kind of language goes on for two more pages as Dr. Fried has continued to publish studies on the same group of children who were offspring of mothers who smoked tobacco, marijuana or both. It is our belief that there has come to be an overwhelming similarity in the children of marijuana users and non-users, although Dr. Fried has emphasized in his published reports the few differences that he has found.

Recently, Dr. Fried predicted that a new set of executive function would reveal marijuana-related deficits in pre-teen users. A short time later, he published a study indicating that the executive function, a new scale of cognitive interventive values particularly important in business practitioners, was somewhat diminished in this small group of marijuana-exposed children he was still following.

I have come to believe that Dr. Fried - who is the only person who has published repeated reports that the foetuses of marijuana smokers are damaged - has convinced neither me nor some other members of the scientific community that he has credible data. I am happy to recommend that pregnant women not smoke anything. I think that is what they should do, not smoke anything. There is, I think, not convincing evidence that the foetus is harmed by marijuana smoking of the mother. That is not in any way to be construed as a recommendation that pregnant women smoke.

Senator Banks: Before you began to talk about foetuses in particular, you were talking about the lower amount of smoke that a heavy marijuana user smokes in comparison with a cigarette smoker. You said that you thought it has a "protective" effect. Would you please explain that remark?

Dr. Morgan: They inhale less smoke. If you take any group of people and are curious about whether a chemical is poisoning them, the critical issue is the dose of chemical. I do not think marijuana is protective. Because THC is a bronchodilator, there have been some speculation that marijuana smoke has an effect which tobacco smoke does not. However, I do not know of any convincing evidence that that is important. I tend to think that the critical issue is the amount of smoke inhaled and that most marijuana smokers have relatively little evidence of pulmonary damage from that smoke.

Senator Banks: You were talking earlier about finding ways for people to ingest THC for its beneficial effects and, I suppose, for its recreational effects without going through the smoking rigour and the problems that come with it. Would you tell us just a little more about the relative efficacy of eating hash-laced cookies? We heard from the previous witness that it would be difficult to conduct an A-B comparative study with smoking because everyone knows what marijuana smells like and everyone knows what its immediate effects are. Thus, a placebo would not be possible. However, it would be possible in the case of chocolate chip cookies, would it not?

Dr. Morgan: There have been a number of studies since the 1970s of orally ingested cannabis preparations. I am aware of some patients who find oral ingestion of hashish or cannabis-pre pared material, or Amsterdam space cakes, as a perfectly useful therapeutic agent. This would particularly apply to patients who have, in essence, chronic complaints. Patients with multiple sclerosis and chronic pain conditions may find oral ingestion useful. However, it is problematic because the serum levels following oral ingestion are quite low. That is because the liver has the ability to chew up the THC, to degrade it and to destroy it the first time it sees it.

This is characteristic of many medications. We still have medications that we cannot give orally very well, such as the nitroglycerine that angina patients take. Ultimately, I believe that we will end up with some form of inhaled preparation. It is possible, though, that some patients may find the oral ingestion of some material useful even though much of it will be degraded. There are other products that humans take orally, most of which are degraded but enough gets in to exert a therapeutic effect.

Senator Banks: If my last question sounds flip it is not intended that way at all. I am curious as to the pain reduction effects of marijuana. Is the pain actually reduced physiologically or is it - and I do not mean this to sound flip - that it is still there but the patient does not care as much?

Dr. Morgan: That may well be true. In fact, that would provoke no argument from me. I think the same is actually true of the so-called pain relief of opiates. If you question patients who have taken morphine, heroin or oxycodone, quite often patients will say, "Yes, I guess the pain is still there, but it does not seem to matter, or it does not seem to be as severe." What we are talking about is modification of human perception. It may well be true that the drug has no peripheral effect on the pain. It may simply be something the drug does to the system to filter the pain, to modify our perception of the pain, et cetera.

Senator Banks: But who cares?

Dr. Morgan: But who cares; I think that is true.

Senator Kenny: You have given us an interesting presentation. I would like to go back to your book, Marijuana Myths, Marijuana Facts, if I could. You say that studies have not indicated that smoking cannabis, even in the long term, is harmful to the health.

Dr. Morgan: That was actually a quote copped from the Lancet.

Senator Kenny: But you agree with that and that is your position?

Dr. Morgan: I very closely agree with it. I did mention that very heavy smokers do have some manifestations of lung disease. I can put this in a reasonable form for you. Dr. Tashkin reported that heavy smokers have more episodes of acute bronchitis, more coughs, more colds, et cetera. For one year, the Kaiser Permanent prepaid health plan had a registry of smoking. They looked at the outpatient visits to the emergency room with respiratorycomplaints regarding cannabis smokers, tobacco smokers and non-smokers. Tobacco smokers had the highest rates of reporting for acute respiratory illnesses. Cannabis smokers had a statistical ly significant increase of reporting for complaints over non- smokers. The practical issue is that 36 per cent of cannabis smokers reported with respiratory complaints over the year, while33 per cent of non-smokers reported with respiratory complaints over the year.

Thus, respiratory complaints are so common in the human condition that cannabis may, indeed, increase it statistically, but what that means practically is not obviously terrifically important. That is why we fastened it on to the Lancet quote. It said even the chronic smoking of marijuana does not harm human health - and I believe that to be true - but in higher doses some of those statements have to be modified.

Senator Kenny: Is your case solely for the medical use of marijuana or is it for general decriminalization and use?

Dr. Morgan: I am fond of saying that I am one of the few people in the drug reform movement in the United States who came to the movement because of an interest in the medicinal use of marijuana. I first became interested in the 1970s. I do not believe that people should ever go to jail for the possession or use of a psychoactive substance, marijuana being the most important one by far.

I am a strong proponent of decriminalization, legalization and marijuana policy reform for any use in the United States. I do not regard the medical use as necessarily part of that. There could be reform of medical use while the drug remains illegal for recreational users. In fact, people are prone to go in that direction. I can live with that, but I believe reform should be universal. People should not go to jail for possession, use, or transfer of small amounts of marijuana.

Senator Kenny: Given your views, what would your advice be for Canadian parents?

Dr. Morgan: I will interpret what I think you mean by that and you can tell me if I am right. The use of psychoactive substances by children, for instance, has never been supported by the National Organization for the Reform of Marijuana Laws in the United States. Psychoactive pursuits should probably be an adult pursuit. I would not recommend that children use marijuana. I would not recommend that parents encourage or use marijuana around their children.

On the other hand, that happens all the time. I suspect it will continue to happen. I think our approach to children should be one of harm reduction education and informing them as completely as possible that marijuana smoking is hazardous for them,particularly in terms of the brief high and the brief period of time after they smoke in which they are dysfunctional. They should not drive. They should not baby-sit. They should not mow the lawn. They should not enter into marital contracts. There are a variety of things they should not do while high, and that needs to be emphasized for them. The lie of saying to them, "Never, never use this because your body will fall apart and your immune system will die and you will become a heroin injector," should stop. However, adequate information should be available to parents and their children.

My two children are pretty much abstemious. My son was even a rock and roll musician in New York and used relatively little cannabis, although I was pleased that he could talk to me about it and I could advise him. I was pleased they were both very minimal users of psychoactive drugs.

Senator Kenny: Suggesting that marijuana is an appropriate adult pleasure seems that it will have exactly the same impact on adolescents as telling them to never use it. You will make it just as attractive to an adolescent by saying that they have to wait until they're a little older and wiser. That is reminiscent of what we are hearing from the tobacco companies these days where they refer to tobacco as being a risky adult pleasure - a phrase that seems to be designed to appeal to 15 and 16-year-olds.

Dr. Morgan: Perhaps it does. One of the things that we do by deciding that certain things are absolutely illegal for children is to increase their interest in them. We have done that for years without re-examining that position very well.

I do not know that I have a particularly intelligent comment to make for you. The idea that saying that it is not the proper role of the state to investigate, prosecute and imprison individuals for psychoactive drugs use is what I believe to be true. Our refusal to live by that value system has harmed us in the United States enormously.

In the U.S., there are 700,000 arrests per year - more than 80 per cent of them are for marijuana possession. Our jails are filled. We now imprison more people in the United States than any other country on earth, with perhaps, the exception of Russia. I am not quite sure where the data are now. Prohibition has been a drastic policy for us. Although I, like you, worry about changing that system; I do not worry about moving it away from prohibition and the foolishness of prohibition, because prohibition has not helped us.

In Holland, the use of marijuana by adolescents, aged 12 to 18, is less than the use of marijuana in the United States. In Holland, where individuals can enter places at age 16 where marijuana is sold, and they purchase marijuana at age 18, the prevalence of use by 12- to 18-year-olds is lower than it is in the United States. Therefore, it is time to re-examine a prohibition system that says they cannot use it.

Senator Kenny: In your book, you say that you believe that marijuana is not a gateway drug. You talk about a casual statistical association. You suggest that many people use marijuana and that it is almost like a pyramid, at the base where many people are using it and then a smaller percentage are using other drugs as you go up the pyramid. You do not seem to infer any relationship there.

It seems that marijuana use is probably an indicator of some sort to people that there is a potential for people moving to harder drugs. For example, how many people would use a harder drug and not use marijuana?

Dr. Morgan: Very few. That is the reason we fell into the intellectual mistake of the gateway theory. If we examine people who have used drugs of low prevalence, such as cocaine and heroin, you find that they have almost all used marijuana before that time. At the same time, individuals who have used these drugs of low prevalence have used all drugs of high prevalence, including marijuana, alcohol, tobacco, pills, and fake ampheta mine, a street drug containing mostly caffeine. We make a mistake by looking at users of low prevalence drugs and saying that marijuana contributed or led them.

However, if we start at the other end, depending on the age group and the time of questioning, some two-thirds of users of marijuana in the United States have never used another illegal drug. We could say, that way, that marijuana is not a gateway drug, it is a terminus drug, that people are satisfied with marijuana and do not go on in two-thirds of instances to use other drugs.

I must refer to Professor Zimmer who said that most riders of motorcycles have ridden bicycles. It would be unusual to find a motorcyclist who had not ridden a bicycle before. Yet, not only do we not believe that bicycling leads motorcycling, but we would not try to alter motorcycling by punishing bicycling. There is no feasible gateway theory.

It is true that individuals who are curious about drugs are curious about drugs, and an individual who never uses marijuana, never uses tobacco cigarettes and never drinks alcohol is very unlikely to ever snort cocaine. On the other hand, there is no proof that marijuana usage, and identifying it as some sort of metatoxic agent, will lead one to more dangerous pursuits.

Senator Kenny: I suppose you could say that most bicyclists have walked first, too.

Dr. Morgan: We had a number of analogies and fractured metaphors we were using, but we stopped with the bicycle-motorcycling one.

Senator Kenny: Is it not a sign or a signal of a type of rebellious behaviour, or some type of behaviour, that gives parents an indication that there is a potential for other things to come - though not necessarily guaranteed to come? If you see a child smoking, there is an indication that that child will be moving into a group that will manifest a certain type of behaviour that will not necessarily be helpful.

Dr. Morgan: As a teenager in the 1950s in the United States, my high school teachers and coaches were all convinced that smoking cigarettes was really just the first step in a life of perdition. The same sort of strictures and talk about where cigarettes would lead one was common. This is a way we approach things. We look at things that are associated with dangers and morality and decide that they are both dangerous and immoral.

Many critics in the United States have decided that marijuana incites some biochemical change in the brain that leads a person to become a tramp on the street looking for cocaine or heroin. It is important to say that I do not believe such a thing exists. The coexistence of drugs in the culture as a determinative of what one will do is rarely pharmacological, or rarely does one drug lead to another.

The prevalence of cocaine use among adolescents inAmsterdam is also lower than it is in the United States. In Amsterdam, where marijuana is readily available, there is less cocaine use in 12- to 18-year-olds than in the United States. The availability of marijuana cannot be claimed to increase the use of other drugs.

The Chairman: In regard to the Netherlands experience, do you think that is sufficient evidence?

Dr. Morgan: That is about all we have. I am quite persuaded by the Dutch experience. I am biased in that direction, of course, but I also have a number of friends and acquaintances who have worked in the Dutch system as police, scientists and therapists. I can find almost no one who thinks that the Dutch experiment has been unsuccessful. There are people in Holland who do not think the program has been successful, but they are few.

The Dutch are not interested in changing their policy, even under significant pressures from the United States Government and the European Community. They think the policy makes sense. I agree. I am willing to cite those statistics to you about adolescent use of cannabis and cocaine actually being lower in Dutch adolescents than those in the United States.

Senator Maheu: I am interested in going back to your myth on the damage to a foetus. I find it interesting that twopharmacologists have opposing views on a myth as important at least to us in Canada right now. Every cigarette package has some warning on it. You spoke about Doctor Fried's Ottawa long-term study. He is still following exposed children. How many other studies are you aware of where long-term following of the same exposed children was as significant issue?

Dr. Morgan: Almost none, there are almost no comparable studies.

Senator Maheu: However, you criticize that study.

Dr. Morgan: I criticize the study on the basis of the probity of its scientific findings. There should have been many such studies mounted in the 1970s when we became worried about the marijuana experience. We should have mounted many compar able long-term studies, but we did not do so. I am sorry that I have come to disagree with Doctor Fried because it is one of the few such studies, as you well stated.

The number of people remaining in the studies and additional reports of harm based on the OPPS sample, which now includes fewer than 30 marijuana-exposed children, may be further forthcoming. However, Doctor Fried himself states that with further distance from the exposure, there is less evidence of harm than in most previous studies.

I do not know Doctor Fried personally, although I have heard him speak a number of times. I would like to sound a polite scientific note of warning. Perhaps the warning is not even scientific. Doctor Fried has continued to receive large amounts of funding, which does not come from the Canadian government. The National Institute on Drug Abuse in the United States funds his studies. It is enormously tempting for a funded scientist to continue to look carefully in his data to try identifying things that will, among other things, provoke more funding.

If Doctor Fried had early on emphasized the small number of changes that he initially found and the evenness and character of those changes, I believe that they would have stopped funding his study. However, it is his public emphasis of the differences between the marijuana-exposed and non-exposed children that has led to his continued funding from the United States. Please, I am not insulting Doctor Fried or calling him a crook. However, I worry enormously about that, and I want you to worry about it too.

The Chairman: Following the question about Doctor Fried's experience and report, I am sure you are familiar with the Institute of Medicine and the review they did of the scientific study, specifically on the work of Doctor Fried. They too do not seem to be convinced by that.

Dr. Morgan: Yes, the Institute of Medicine held three public hearings, and I was invited to testify at one of them. Although I spent most of my time talking about the arguments about dependence and addiction, I was asked about Doctor Fried's studies. I do not think that I had an inordinate impact. They examined the studies the same way that we did on page 103 and page 104. They found out that perhaps the emphasis on the negative findings could have been stated another way. There is not much difference at all. The negative findings tend to go away and come back and go away and come back. I am glad that the Institute of Medicine was also somewhat critical.

Senator Kenny: In a neutral situation, if a parent were dealing with a child why would they encourage them to smoke or why would they say, it is okay? Why would not they say, "Look, this is a product that has risks associated with it. There are potential problems that you should consider." Why not treat this the same as you would alcohol or cigarettes? Why would you not talk about the side effects that relate to the product? At the end of the day, the child will make up his or her own mind. However, you sound very permissive about it almost as though one should encourage the use.

Dr. Morgan: I will state again that I did not regard my role regarding my children as "permissive," but realistic. When it came time to talk with them - as I have often said in public - I was glad that I had had a marijuana experience as a young person so I could talk with them about it.

One of the great advantages of raising children in New York City is that they rarely drive. What a wonderful advantage! My children came home on the subway. Whatever you have heard about the subways, they are nowhere near as dangerous as motor cars. I had that advantage.

I knew that my son occasionally smoked. I had the opportunity to warn him about it. I do not know that it would have done well for me to say, "No, no, here are these problems." Most parents do not encourage use. I did want you to know that there are some parents who have encouraged use. There are some parents whose marijuana experiences were so positive that they saw no reason not to smoke with their adolescent children. I know many people who have done so. I do not approve, but the idea that marijuana is not only not harmful but did some good is a prevalent idea among marijuana users who have reached the age of 50 years in the United States.

I know many people who have smoked with their adolescent children because they feel that the product can be used relatively safely and should not be demonized. I did not take that position. I was not permissive in the sense that I exposed or made available marijuana to my children. I was quite pleased when they were relatively abstemious, relatively low-level users.

The Chairman: Doctor Morgan, two weeks ago the committee heard from the Canadian Police Association. They referred to a study made on air pilots. Are you familiar with such a study?

Dr. Morgan: Yes.

The Chairman: Could you comment on that?

Dr. Morgan: A California-based scientist named Jerome Yesavage wrote the study. It was done in the early 1980s, I think, and it attracted enormous attention. They asked for volunteer pilots, men who flew non-commercial planes and had them do an airplane simulator test. These men did not fly airplanes, but they did simulator tests. Doctor Yesavage's first report said that these men were impaired in terms of their function on simulators, particularly during landing and other highly technical events in the plane. He said, furthermore, that they were impaired for up to24 hours. This study provoked enormous comment in the United States. It was frequently cited by the government as a reason for going ahead with urine testing programs imposed on federal workers in the United States.

I was an early critic of Doctor Yesavage's study because it was completely uncontrolled. That is, people said, "Okay, we are going to give you a marijuana cigarette. You smoke it. We will test you now and test you in four hours and eight hours and24 hours."

As you all have heard, it is difficult to control for marijuana use. When Doctor Yesavage was funded by the federalgovernment to repeat the study with the simple controls that others and I had suggested, they were unable to show any impact of marijuana use after four hours in a similar group of people. Therefore, I believe that the truth is that marijuana use will impact airplane and driving simulators and to some degree driving performance for three hours to four hours after use; however there is no sustained impact. Any impact is relatively minor.

A Dutch scientist who has for years worked on driving experiments found that marijuana using drivers have a little difficulty staying right in the middle of the road. That is most sensitive test. If you smoke marijuana, you tend to weave a little bit more than completely sober people do. That is important, although there have been no studies to show that that amount of weaving had a gross impact on driving ability.

The Dutch scientist included in his report that the amount of weaving was approximately the same in individuals consuming very small amounts of alcohol, very small doses ofbensodiazopenes and very small doses of antihistamines. All of the psychoactive chemicals that we take may have some small impact on our ability to hold an automobile right in the middle of the road. We have focussed on alcohol because at higher doses it is much worse and cannabis because we are so concerned about it.

There is an impact on human function for three to four hours after the use of marijuana. As far as I know, it shall always be true and we have to worry about it. However, one should not exaggerate it, as I think the airplane simulator study did.

The Chairman: In regard to marijuana and cannabis research, do you think the threshold of effect is bad, good, not enough, high enough, too low or average?

Dr. Morgan: Judge Young, in a federal lawsuit in 1987, said that among the psychoactive chemicals that humans are likely to consume, marijuana is perhaps the safest. Many people find that an offensive opinion, but I believe it to be true. I believe the margin of safety, in terms of human dysfunction and other issues of human toxicity is really quite large and makes this a compound that certainly should be approved for medicinal use and should be decriminalized.

The Chairman: This committee is trying to rigorously approach this issue. We are trying to hear objective information and testimony. Do you think it is possible to have objective research in this area?

Dr. Morgan: It is possible to have objective research. I listened this morning as the discussion ensued about scientists who have not shown themselves to be entirely objective. It is a difficult proposition to be entirely objective.

When people criticize me for my long-time commitment to marijuana policy reform, I say that if tomorrow Dr. Kalant orDr. Fried comes to me and says, "Look, you have made a mistake. I have convincing evidence that marijuana is more dangerous than you have believed." I will look at that evidence and let us say I am convinced. I will say as loudly as I can, "I made a mistake and perhaps my subjectivity influenced me to make that mistake and now I wish to apologize for it and wish to state my scientific belief."

At that time, you will then ask me what I feel about societal control of marijuana. I believe I will feel exactly the same way. This argument about danger consumes enormous amounts of time and yet - and I believe it is appropriate - however, the decision to handle dangerous substances or dangerous activities by outlawing them is a failure. We do not outlaw drugs because they are dangerous, but once we have outlawed them, they become more dangerous.

We have more trouble because of prohibition than if we relaxed our attitude. Should we outlaw high school football? Should we outlaw hockey for Grade 8 students? There are significant dangers and hazards in those activities, yet they are approved human activities, so we do not focus on them. There are more spinal cord injuries in secondary to high school football in the United States that leads to severe paralysis and even death than there is due to the toxicity of marijuana. There are more deaths due to high school football in the United States than there are due to marijuana, I believe. I do not want to outlaw high school football. I do not want to outlaw marijuana use, even though they both have dangers and hazards.

The Chairman: Do you agree that science should be the ultimate guiding body of research that should influence public policy on cannabis?

Dr. Morgan: I do. However, as Professor Zimmer and I say in the book, science has become a propaganda weapon in the war on drugs. There was a banner at a NIDA meeting that read: "Science in service to the war on drugs." I believe that is absolutely impossible. There is no such thing as "scientific service" to the war on drugs. There is science to elucidate the truth as best we can do it and we need to state that.

In my case, since my bias is in diminishing control, I need to look very carefully at claims that drug is more dangerous than I think. I promise you that I do that, and will try continue to do that.

Science is a valuable agency for us in understanding the real world and the material characteristics of it. I am afraid what we do once we know is influenced by a great variety of other things which are not as objective as science.

The Chairman: Is that the reason why we do not prohibit the use of alcohol and cigarettes?

Dr. Morgan: We are not prohibiting the use of alcohol because we tried that and we know what happens when we do so. At least I believe that is one of the reasons. Countries that did not, in the 1920s, follow the United States pattern of prohibition saw further decreases in alcohol consumption because alcohol consumption had been dropping in the western world since 1900. Prohibition reversed that and alcohol consumption began to increase in the United States during the time of prohibition. In Canada, Australia and England, alcohol consumption dropped further.

Prohibition was enormously bad for the western world's health. Even though I know that increased alcohol consumption is associated with increased harms, I do not see the way for prohibition to help us in that problem. The same is true of cigarettes.

When William Bennett was drug czar in the United States, it was pointed out that he was a cigarette smoker. He finally stopped during his time as drugs czardom, but he said, "Well, I smoke cigarettes, but there are no drive-by shootings regarding cigarette distribution. There will be when we prohibit it." There will be drive-by shootings regarding tobacco cigarettes if we move to full prohibition, because we will generate a criminal enterprise, and enormous profits for that enterprise.

I am an opponent of prohibition, by and large. I think my scientific view informs that and inflects that. It is hard for me to be objective as it for all people, but my scientific view is formed in traditional scientific reasons and fashions.

Senator Banks: Pursuing that line, in our attempt at rigour, we are hearing from witnesses on all sides of the question. We see the same studies, like the NIDA one and the one for the Office on National Drug Control Policy, and others. We hear different views and different interpretations of them. We are all looking at the same event and see it in different ways.

You said that what should really inform the end decision of any state with respect to prohibition of anything - drugs in particular - should be the scientific evidence. There is the science of pharmacology and the sciences of medicine and oncology and so forth. There is also the science of psychology and the socially oriented sciences.

As the chair said, the police who are dealing with this problem every day have a different view than those of us who do not. It is hard not give credence to that view, because they are faced with it every day and we are not.

You have obviously considered this subject. Assuming that your interpretation of the facts is the right one, what is it that causes the police, and in the United States, the national administration, to be so convinced that prohibition is the answer. In Canada, there are people who believe that trying to stamp it out is the right answer and that, notwithstanding the scientific evidence, that it is wrong. What is the element in our society that is so convinced that the medically oriented science is wrong and that the other science is right?

Dr. Morgan: I will hazard an answer. A good friend of mine who is a sociologist once said to me that there is no social science, there are only social values. I believe what she was saying was that when we begin to examine human behaviour we are foolish if we put aside values, morality, religion and religiosity because they have enormous impacts.

The drug war is a crusade. It has chiefly moral dimensions. Like all crusades, it is not important to win; it is only important to fight. The drug war feeds as well on failure as it does on success. I often ask my students to imagine themselves in the 13th century listening to someone saying, "We have to stop sending young men to try to get the Holy Land back from the Sarazins. We have lost enormous numbers of lives; we are spending enormous amounts of money; it looks as though we will never get the Holy Land back from the Sarazins. We must stop these crusades." Then I always imagine a commander sitting on his horse saying, "Ah, we could stop, but it would send the wrong message."

Let us go on with the crusade. Let us sacrifice more money and more young people because if we do not condemn immorality, we are immoral ourselves.

Senator Banks: Is that not true?

Dr. Morgan: I do not believe it is true. I might make a choice, as an American citizen that something said politically is immoral and improper. Yet, I believe in a value system that says that foolish individual has the right to say that and I cannot act to prevent him from saying it.

I do not regard drug use as necessarily moral or immoral. It is drug use. The effect on the brain of ecstasy is very much like the effect on the brain of Prozac. From one point of view we think that is grand and from the other we think it is horrible and illegal.

I can understand both points of view and I can talk about the science of Serotonin regarding uptake inhibition in the brain. Yet, I know in reality that I have to talk about social values and moral values and criticize the inappropriateness of a crusade and say that it is time to stop this crusade because it is harming us. I know that you want to be moral, religious and to condemn drug use. Please go ahead, but you may no longer use the offices of government and the criminal justice approach to effect your moral wishes. That is what I am looking for.

Senator Banks: But you do understand that all it takes for evil to triumph is that good men do nothing.

Dr. Morgan: That is why I am trying to stop the war on drugs.

Senator Banks: I get it. Thank you very much.

Dr. Morgan: There is another important issue to which I have not referred heretofore, which your remarks make it necessary for me to reference. One of the reasons we in drug policy reform - be it the medical marijuana movement, the movement to provide injection works to drug addicts or the movement to make Naloxone or Narcan readily available to the heroin using community - have found trouble is because there exists, certainly in the United States, and I think to some degree in Canada also, a drug abuse industrial complex. The bill for urine testing in the United States now exceeds $2 billion. Laboratories that used to do three forensic tests a week are now doing 30,000 a day. The opponents of the California marijuana initiative include the California Narcotics Officers Association and the prison guard union. It seems to me that every fourth person I meet makes his money, reputation and life justification on drug abuse teaching, drug abuse prevention, drug abuse urine testing, drug abuse policing or drug abuse imprisonment.

Now, in addition to having to fight against the crusaders, we have to fight with people whose lives and incomes depend upon an enormous drug abuse establishment. For us to get people to stop some of the things that are done in the name of saving our children from drugs is like trying to stop the missile defence system. There are too many contractors making money for us to talk carefully and appropriately about it.

Senator Banks: You think that the war on drugs is quixotic because it cannot succeed?

Dr. Morgan: It is surely quixotic.

Senator Banks: How about your war on the war on drugs?

Dr. Morgan: I am much more optimistic about that because I believe that data and truth are on my side. Of course, most everyone in a fight feels that way.

The Chairman: Thank you very much, Dr. Morgan. Perhaps at the end of Dr. Kalant's testimony we can ask you to join us for an exchange.

Thank you very much for your contribution.

The Chairman: This afternoon we have as our witness Mary Lynch. She is an associate professor in the Departments of Psychiatry, Anaesthesia and Pharmacology at DalhousieUniversity. She is the Director of Research of the Pain Management Unit at the Queen Elizabeth Health Science Centre in Halifax. Dr. Lynch is a Dalhousie Clinical Research Scholar and Director of the CIHR-funded Canadian Consortium for the Investigation of Cannabinoids in Human Therapeutics.

Her research focusses on the development of novel agents in the treatment of neuropathic pain. In collaboration with Dr. Jana Sawynok, she does translational research, bringing findings from the lab into clinical trials at the Pain Management Unit. This research has attracted funding from the CHIR, provincial partnership funding and significant industrial support. Dr. Lynch has established collaborations with colleagues in rehabilitation medicine in the area of spinal cord injury, neurosurgery in the area of spinal cord stimulation, and chronobiology in the area of the interaction between chronic pain and sleep.

She is also developing collaborations in emergency room treatment of pain and is spearheading the development of a national clinical trials network in her role as director of the Canadian Consortium for the Investigation of Cannabinoids.

Dr. Lynch, the floor is yours.

Dr. Mary Lynch, Director, Canadian Consortium for the Investigation of Cannabinoids, Dalhousie University: First, let me thank you for inviting the Canadian Consortium for the Investigation of Cannabinoids in Human Therapeutics to make a presentation to your committee. It is my privilege to represent that national group of researchers this afternoon in this presentation.

May I draw your attention to the screen, please? I am making a power point presentation. You may be interested in some of the illustrations that accompany the presentation.

The Canadian Consortium for the Investigation ofCannabinoids is a national interdisciplinary group of researchers. We are represented from coast to coast. The consortium is represented by basic scientists who work in the lab, as well as clinicians who work every day with individuals who are suffering with various conditions. My setting is primarily that of a tertiary care pain management unit, where we are faced with people suffering from severe intractable pain that we are unable to treat adequately in many cases even with all the tools and drugs we have available to us. Our interest in this group of chemicals and substances is that they are looking like they will be very good additional options to our pain-fighting armamentarium.

We are a group of people who originally came together last spring with seed funding from the Canadian Institutes for Health Research. Our mission is to bring together key Canadian researchers who will pursue excellence in basic science and clinical research on the cannabinoids system.

We have identified that as a part of our mandate we will liase with members of Health Canada, the CIHR and other bodies, which is why I am here today, in an effort to facilitate cannabinoid research across the country.

What you see before you is my setting in the pain management unit. Our aims and objectives are to enhance the health of Canadians by using Canada's strong research community to assess the role of cannabinoids in the treatment of a variety of health conditions. I will speak about the ones that we are most hopeful about with regard to this group in a moment.

I will break my presentation down into four parts. I will limit it to 20 to 30 minutes so that there is sufficient time for questions. I will focus on why we think further research into this group of substances, cannabinoids, is important. I would then like to present an international perspective because there have been a number of excellent reviews - both national and international - that have been done. I will summarize those. I will briefly talk about the challenge of pursuing cannabinoid research in the current socio-political climate. I will end by making a number of recommendations.

Cannabinoids are compounds that act like delta-9-tetrahydro cannabinol, about which I know the committee has learned a tremendous amount. This is the main psychoactive ingredient in marijuana. Herbal cannabis has been used for centuries, but it has only been in the last 40 years that scientists have been able to identify how these substances work and how wide the applica tions may be for therapeutic purposes.

This slide is included in the documents that you have before you. I am not going to go through all the details. I want to emphasize that in the last 40 years, since 1964 when delta-9-THC was originally synthesized and its structure identified, there have been a number of excellent discoveries and steps made in cannabinoid pharmacology. These discoveries have allowed scientists to learn much more about these drugs, why they work and how they might be applied to human suffering.

Specifically, I would like to draw your attention to the fact that there are now a number of synthetic cannabinoids available and more are being developed. Some are very interesting because the psychoactive effect is divorced from the therapeutic effect in some of them.

In addition, the cannabinoid receptors - the CB1 receptor, which has been found to exist in the central and peripheral nervous systems of animals and humans, and the CB2 receptor, which has been found in many of the cells of the immune system - have been identified and mapped in the human systems.

Dr. Morgan spoke this morning about what a receptor is and specifically what a cannabinoid receptor is. I am showing you a picture of what these look like. A receptor is a protein that is embedded in the cell membrane. In this case, the cell membrane is of our neurons in our brain, spinal cord and central nervous system, and in our immune system. I have shown you a picture of a CB1 and the CB2 receptors here.

You will notice that the receptor - although it sits in the medical brain, which is pictured as the yellow bar across the middle of the slide - also has extracellular and intracellular components. The cannabinoid binds to the extracellular part of that receptor. Once it binds, a number of chemical reactions and responses will occur within the cell. We refer to that as the mechanism of action.

These cannabinoid receptors have not only been discovered, they have been very well mapped using a number of different scientific approaches. I will briefly review the areas where they have been found.

In the central nervous system, cannabinoid receptors have been found in areas important in memory and coordination; areas important for higher cognitive functioning, such as thought, higher processes, the reward centre, in centres very important for pain modulation, centres for endocrine regulation and centres involved in nausea and vomiting. The CB2, or peripheral cannabinoid receptors, have been found throughout various cells in the immune system.

Senator Banks: What is this reward centre?

Ms Lynch: The centre in the upper part of the brain stem. That is the reward centre.

Senator Banks: Whom does it reward for what and when?

Ms Lynch: It is the centre thought to be involved in response to thing that is give us pleasure, such as various drugs and other types of activities.

Senator Banks: Thank you.

Ms Lynch: Once you have identified that cannabinoid receptors are present if the body, the next question is, why do we have those receptors? The existence of a receptor in the body suggests there is an endogenous chemical that can bind to that receptor. In this case, a marijuana-like chemical that is naturally produced and acts at that receptor.

As Doctor Morgan mentioned this morning, there have been endogenous cannabinoid receptors discovered. We know that the body is able to produce marijuana-like chemicals that are able to act in a system of receptors that extend throughout the nervous and immune systems.

There has also been a tremendous amount of research looking at how these chemicals work. There is a large body of research. I will briefly review it by saying that as Dr. Morgan said this morning, 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 firingand 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.

I have noticed the fact that this mechanism of action is very much like the mechanism of action we see with the opioid, or morphine, group of medication. With regard to morphine, in the world of chronic intractable pain, we now know that the morphine drugs, when used for pain, are not addictive. Patients can be on these drugs for long periods, by prescription, in appropriate doses without problems of behavioural maladaptation associated with addiction. These drugs can be effective over long periods of time and can be used in combination with other agents.

I return to the cannabinoid system. Cannabinoids exhibit a mechanism of action much like the morphine group of drugs, but they are able to act independently; morphine need not be present in order for the cannabinoids to work. The cannabinoid system is larger. In fact, there are 10 times more CB1 receptors than there are mu-opioid receptors in the brain. The mu-opioid receptors are most important in pain control in the morphine group. The cannabinoid system occupies more areas, with the implication that the cannibinoid system may have wider therapeutic applications.

I would like to discuss three main areas where cannabinoids are known to have potential significant therapeutic application. They are pain, nausea, vomiting and wasting, and spasticity. For pain, there is a direct analgesic action and also an anti-inflammatory action.

There are many ways to study pain. I will mention several different ways. In pre-clinical work in awake, behaving animals, studies have demonstrated that the cannabinoids block pain responses in virtually every acute pain model tested. They are effective against thermal, mechanical and chemically induced pain. They have been found to be comparable with opioids in their potency and efficacy.

In models of chronic pain, cannabinoids have been found to exhibit even greater levels of potency and efficacy. In situations of inflammatory or neuropathic pain - which is pain due to nerve damage, which is a terrible clinical problem and very difficult to treat.

There are also electro-physiological studies where scientists can record the electrical activity coming from a single neuron, wherever they chose to study it in the system. These extracellular single neuron recordings have found that cannabinoids can produce profound suppression of cellular pain-related responses with no suppression of neurons that respond to other things such as touch.

It is been identified that cannabinoids exhibit analgesic efficacy in animal models of acute and chronic pain. They exist as characteristics of good painkillers in animal studies.

The cannabinoids are also known to act at multiple levels when it comes to pain modulation. Studies using direct injection cannabinoids into certain brain centres, direct spinal application and peripheral administration have all found that the cannabinoids can lead to analgesia. I will summarize this slide and we can come back to it later if people have specific questions about the research that brought us to this conclusion.

It is also known that there is a significant role for cannabinoids in our pain defence network. Probably everyone has heard about endogenous opioids or the body's ability to produce it is own morphine-like chemicals in helping us to defend ourselves against pain. Our bodies' pain-defence mechanisms work well. We have all heard of a situation where someone has been injured during a sports event or in the heat of battle - sometimes with very significant injuries or even traumatic amputations - and they do not become aware of the pain caused by that injury until later. That is evidence that we have an underlying, very efficient pain-defence network in our bodies.

We have known for quite a few years that our bodies can produce morphine-like chemicals and these endogenous opioids, as we call them, are very much involved in our body's pain defence network. However, it is much more complicated than that. There are many different substances involved in that pain defence network. It has only been in the last couple of years that scientists have understood that cannabinoids have a big role to play in that pain-defence network in our bodies. There is some good research to support this now. I have summarized this in the documents that have been distributed to you.

The evidence supports that cannabinoids are analgesic. It looks like the fellow on this slide is going to need some endogenous cannabinoids working in his system in just a minute. There is an extensive endogenous cannabinoid system that is part of our natural pain defence network.

There is a lot of compelling data showing us that cannabinoids are very good pain drugs. However, it is surprising how few human studies have been done on these agents as good painkillers. There are only six published control trials in the world literature, and only three of them are on chronic pain. The three are on acute pain have been mixed. Unfortunately, they are all old and small.

To briefly review them, one study showed that smoking cannabis led to an increased sensitivity to electrically induced pain in 26 men. That is very different from the reality of pain in a real-life situation.

Another study showed that IV THC was inferior to diazepam and placebo in a post-extraction dental pain study of only10 patients. Unfortunately, the study only looked at extremes of pain tolerance rather than pain intensity. Again, it was very difficult to interpret. Another study looked at IV THC, finding that it was effective in reducing surgical pain, but we need more research on the cannabinoid group for treating the human pain.

There are three studies looking at cannabinoids in treating human chronic pain. Specifically, delta-9-THC was found to exhibit an analgesic effect roughly equivalent to codeine in two studies of cancer pain in the mid-1970s. Another recent publication exhibited that oral THC reduced the pain of familial Mediterranean fever in an individual with severe abdominal pain related to that disorder.

Not only are cannabinoids looking like they have a good direct analgesic effect, - especially in animal studies, although we need more human studies - but they are also anti-inflammatory with an implication for treatment of arthritic conditions. Cannabinoids have been found to act on CB2 receptors - those being the peripheral receptors in the immune system - located on mast cells, which are very important cells when it comes to the inflammatory or immune response. Cannabinoids also lead to a decrease in the inflammatory mediators: histamine and serotonin.

Palmitoylethanolamide, or PEA, which is a CB2 agonist, actually down-modulates mast cell formation after injury, leading to decreased swelling and pain. Administration of some of the newer, non-psychoactive cannabinoids has also been found to suppress inflammation. Therefore, they are looking like good pain drugs and potentially good anti-inflammatories.

In the treatment of nausea, vomiting and wasting there has been much more research, particularly in the area of chemotherapy-induced nausea and vomiting, and research on AIDS-related anorexia with weight loss. These are the only currently approved indications for the use of the oral cannabinoids available here in Canada. I know that you already know that the oral cannabinoids include delta-9 THC or dronabinol/Marinol and nabilone or Cesamet.

To summarize the current research in the area of nausea and vomiting, cannabinoids are thought to be modest antiemetics. There are more effective antiemetic agents available. However, because antiemetics work through a number of differentmechanisms 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.

Dr. Morgan has already talked about wasting in HIV-infected patients. Not many control trials have been published, but the studies that have been done do show us that there is some role for cannabinoids in this problem. Short- and long-term administration is associated with increasing the appetite and stabilizing the weight in individuals with this terrible problem of wasting in end-of-life care. There are potential implications for terminal cancer as well.

In summary, they may provide an additional treatment in the management of nausea, vomiting and wasting in people with chemotherapy-induced nausea and vomiting and in HIV infected individuals, but we need more research. We need to identify the best and most specific agents and we need alternate delivery systems.

That brings me to spasticity, the other big area that I want to briefly mention. It is a terrible problem for people with MS, spinal cord injury and other neurological disorders. Marijuana and THC have been reported to have an antispasticity effect in patients with MS or spinal cord injury by anonymous questionnaire and case reports. There are also several controlled trials using objective measures of spasticity that have shown improvement after oral and rectal administration of THC or nabilone. However, there are no controlled trials comparing smoked marijuana with oral THC or with other antispasticity agents. We do have some good antispasticity agents available, but even using the best that we have there are still many people with severe, uncontrollable spasticity.

Where does smoked marijuana fit in? The debate boils down to whether we should permit smoking of medications and whether the crude plant material has effects that differ from the currently available oral synthetic agents. Why do we not just use the oral cannabinoids that are currently available on the market? Would that not easily solve the problem?

In some cases, this may be reasonable, but in many cases the utility is hindered by slow and sometimes unpredictableabsorption and the side effects, especially dysphoria, in higher doses can be limiting. The oral cannabinoids on the market are helpful in some situations but are not meeting the need that they think these drugs, if they are allowed to be developed, would be able to meet in more specific molecule forms and in better delivery systems.

Senator Banks: What is dysphoria?

Ms Lynch: Dysphoria is sadness. It is the opposite of euphoria.

Labs around the world are working on the identification of compounds that retain the therapeutic effects without the side effects and agents that are better absorbed following oral administration or that can be administered via alternative methods of delivery such as other non-toxic inhalational approaches mentioned by speakers this morning.

The CCIC feels that further research into cannabinoids is extremely important because there is so much compelling literature suggesting significant therapeutic application, but we need to bring this into better and bigger human trials.

In summary, the current literature supports that there is a complete cannabinoid system in the body that regulates various physiological processes in the brain and peripheral tissues, and that there is significant potential to manipulate this system in treating human suffering and disease.

I would like to mention briefly the international perspective. In the past seven years, numerous national medical and scientific groups and an expert review panel of the WHO have reviewed the issue of the therapeutic use of cannabis in depth. These reviews have led to reports are reviewed in the documents that you have before you. I would like to summarize those.

There is virtually unanimous agreement that the purecannabinoids - both THC and synthetic THC - will prove to be useful in the treatment of pain, spasticity, nausea and vomiting, and wasting syndrome in cancer and AIDS. There is some disagreement regarding the potential value in glaucoma, asthma and epilepsy. All agree that more research is needed in the new agents and in alternate delivery systems.

What do they have to say about smoked marijuana? Most of these reports agree that smoking is not a recommended route for medical administration due to the toxic particulates that are in the smoke, with irritation of airways and some evidence of a risk factor for upper airways carcinoma. However, because it is possible, in theory, to limit the inhaled amount - and it is looking like the doses only need to be two or three puffs according to some recently presented data coming out of Montreal - most reports have recommended that short-term use of smoked cannabis might be tried for some limited illnesses or when there is a shortened life expectancy.

We need more research in the area of smoked marijuana. We need scientific comparison of the effectiveness, tolerability, appropriate dosage and hazards of smoked cannabis versus the pure cannabinoids by mouth and by other routes of administra tion.

To do this research, researchers face numerous challenges. Because crude cannabis is classified as an illegal substance, research regarding all cannabinoids is often delayed or obstructed. The acquisition of research materials is a problem. There are additional licensing requirements for importation, acquisition and distribution of study materials. We have to be concerned about the protection of our study subjects from prosecution under the Criminal Code. Our research institutions are very uncomfortable with the whole area of cannabinoids, which leads to delays in the ethics review processes required for us to conduct our research.

We would like to make some recommendations. Werecommend that the government proceed with establishing policies or legislation that will facilitate cannabinoid research. This policy change or support of legislation must accomplish protection of our research subjects from prosecution under the Criminal Code while preserving their confidentiality andminimizing further documents, if possible.

We recommend that directives to facilitate the research review process be given to institutions and hospitals where the research takes place so that our ethics review committees might be less frightened about this research in the current climate. We recommend that the acquisition of THC cannabis and synthetic cannabinoids be facilitated so that we can do our research here in Canada. We request support for epidemiological studies regarding the use of cannabis for therapeutic purposes in Canada.

We recommend support for Health Canada's initiative to study therapeutic cannabis use. We also recommend the clinical appraisal of the safety and efficacy of cannabis for therapeutic purposes and the determination of short- and long-term health effects on therapeutic users following existing drug development guidelines. Finally, we recommend that there be support of research into alternative delivery systems of cannabis preparations and cannabinoids.

We have some excellent researchers here in Canada who are trying to do this research. However, the research has been delayed because of the current socio-political climate. Anything the committee can do to assist us in doing more research would be very valuable.

Senator Banks: You said near the end of your remarks that two of three puffs are all that is necessary. Is that not like asking someone to eat but one peanut?

Dr. Lynch: I have many patients who use marijuana. They are very good at identifying the least effective dose that will work for them. They just want the pain or the spasticity control. I have a number of patients with MS, as well as spinal cord injury. They will literally only use two or three puffs. One of the physicians at McGill has done some initial questionnaire studies on folks with HIV who smoke marijuana to control their pain. They are asked what dose they are using to control their pain, and they are saying two or three puffs. That is actual data and clinical experience.

Senator Banks: I was surprised to hear you say that there are now studies that show that there is no long-term addictive problem associated with the proper dosage of morphine in pain control.

Dr. Lynch: That is correct.

Senator Banks: That goes against what until now has been conventional wisdom, does it not?

Dr. Lynch: That is correct. That is why I felt it important for me to mention it here. This is now well-established literature. The Canadian Pain Society has established guidelines for the use of opioids for chronic non-cancer pain. That is the area in which it is controversial. In cancer pain, most people do not have a problem with using opioids. They do not worry about addiction. It is in the non-cancer intractable pain situation that used to worry people, and still does if they are not aware of the literature. The guidelines established by the Canadian Pain Society have been adopted be many provinces and we use them.

Senator Banks: You no doubt have seen the Senate study on palliative care, have you?

Dr. Lynch: I am aware of it. I have not read it.

Senator Banks: I hope you will read it.

Dr. Lynch: Yes, I will.

Senator Banks: In the research and in the contemplation that you make, I am assuming that all of the cannabinoids, or the real thing, have to be ingested in some way. There is no topical application of this; is that correct?

Dr. Lynch: At present, there is certainly no clinically available topical preparation, but it is interesting that you should mention it.

Senator Banks: Is it theoretically possible?

Dr. Lynch: Yes it is theoretically possible. It is very attractive because we are learning from topical use of other drugs - putting them on to the skin in a cream form, is very successful in neuropathic pain conditions that previously we have had great difficulty controlling. Because cannabinoid CB-1 receptors have been found at the peripheral nerve level, there is good theoretical reason to try this topically.

Senator Banks: I am assuming that in the laboratory test animals cannabinoids were ingested by injection because you cannot get rats to smoke very well.

Dr. Lynch: That is right.

Senator Banks: In the battle situation, or the sports situation to which you referred, in which you said that the body manufactures cannabinoid-like substances as a defence mechanism, is there anything other than anecdotal evidence to support that? Could it not simply be that the cause, whatever it is, freedom or winning the cup, simply allows us to use mind over matter and to submerge the pain? Maybe it is one and the same thing. However, are we sure that it is a pharmacological reaction as opposed to simply mind over matter?

Dr. Lynch: Yes. It is an excellent question. The slide I skipped over reviews just that. It is also reviewed in the documents that you have sitting before you. Dr. Morgan talked about some of the literature this morning. Pharmacologists can do all kinds of really neat things. Once have the tools they need - such as the agonists, which are the drugs that connect with the receptors to make things happen, like the endogenous agonists, or the antagonists, which connect to the receptor and block things from happening - then they can manipulate the system. Now they have mice called "knockout mice," which that do and do not have the receptors, and they can do things to them to see what happens and learn all kinds of things about these systems.

Dr. Morgan mentioned that cannabinoid antagonists, orblocking agents, have been administered to animals and these animals exhibit an increased response to painful stimuli. The administration of cannabinoids can block the analgesia that would normally be elicited by electrostimulating the periaqueductal gray.

We have known for 20 years that if you stimulate the periaqueductal part of the brain, which is a part of the brain stem, you can block pain. That was an interesting finding because it ended up leading to deep-brain stimulation and spinal cord stimulation approaches to treating chronic severe intractable pain that is incurable by any other means. You can stimulate certain areas of the brain and block pain.

We have known that opioids are very much involved in that electrostimulation pain blocking effect. Cannabinoids are very much involved in that electrostimulation of the periaqueductal gray pain blocking effect. Pharmacologists have cannabinoid blockers, which they can administer at the same time they are stimulating certain areas, and they can block the pain-blocking effect of the electrostimulation.

Senator Banks: You can stop it from stopping it.

Dr. Lynch: We have the cannabinoid antagonists which, when administered while you are trying to get the pain blocking effect, block it.

Let me tell you another interesting thing. This work comes from Brown University, the Michael Walker group. Michael Walker is one of the international consultants to the Canadian Consortium for the Investigation of Cannabinoids. He has been helpful to our group, along with Dr. Kalant, who is going to be speaking later.

His lab has done some interesting things. For example, using some lovely technology that allows them to literally collect neurotransmitters that are being released from the neurons in the periaqueductal gray. They can analyze these neurotransmitters, and they found, using microdialysis and fancy assay techniques, that when the periaqueductal gray is stimulated, anandomide is released.

They have shown - and this is from research done years ago - if you do something painful to an animal it releases endorphins, so that pain can evoke the release of endorphins, which is associated with behavioural analgesia in the animal models.

We have now evidence from Michael Walker's lab that in association with doing something painful to the animal, in this case, injecting formalin into their hind paws - that is a model for prolonged pain in animals - that the periaqueductal gray in the lateral and dorsal areas releases anandomide. We have a great deal of information coming together to show us that it is anandomide being released from the pain modulatory centres in the brain stem. It is a direct analgesic effect.

Senator Banks: I would like to ensure that this record shows that the witness said "fancy assay" when she was talking about the process that Dr. Walker was engaged in.

Among your recommendations was the minimizing of further documents. I do not understand that.

Dr. Lynch: We would like to be able to have our subjects protected from criminal prosecution. One of the things we have struggled with around the table - and Health Canada has been helpful in coming to our meetings and assisting us - is what if one of our patients or subjects in a research trial is picked up with a study joint on their person? What can we do to protect them, and how can we protect them in way that protects their confidentiality without having to have all these documents on their person? When you have additional documents, there is the concern that they can always be created fraudulently, and then will we need to be concerned about putting the fancy holograms on the documents? You can see what we have struggled with. These are the types of issues with which researchers have had to struggle.

Senator Banks: Perhaps we can put the royal warrant on the joint.

The Chairman: Have you read the regulations that Minister Rock published a few weeks ago on the medical use of marijuana?

Dr. Lynch: I have read bits and pieces of it. I have not yet had the opportunity to read the entire thing.

The Chairman: Your patients are already using marijuana.

Dr. Lynch: Yes.

The Chairman: I am sure they all have an exemption from the ministry.

Dr. Lynch: The section 56 exemptees.

The Chairman: You are able to prescribe them specific amounts, and, therefore, you should read that document. If you want, we can have a copy sent to you if you want to comment. The minister will finalize the drafting of that regulation by the end of July.

Senator Kenny: Over the long term, do drug doses have to increase over time to have the same effectiveness?

Dr. Lynch: You are talking about the issue of tolerance. Are you asking with regards to cannabinoids, specifically, or in general?

Senator Kenny: In general and then specifically.

Dr. Lynch: Yes, in some cases the issue of tolerance does occur where one has to increase dosage levels in order to get the same effect. We used to think that in all cases with regard to opioids you would find tolerance becoming a problem.

What we have learned with the long-term studies and in our clinical experience with patients using opioids over the long-term in a consistent dose is that there is a large population of people who do not appear to be having difficulties with tolerance. Using the dose in the same amount over time continues to give them the same analgesic effect.

Other individuals experience some difficulties with tolerance, and now there is a clinical practice where it appears - and we need more research in this - that switching from one opioid to another will sometimes get around the problem of tolerance if it has developed in a certain individual. However, in many cases, we are not running into problems with clinical tolerance.

Senator Kenny: You talked about the scarcity of studies relating to cannabis. What about other controlled drugs? Are there many studies available on heroin or other drugs?

Dr. Lynch: There are certainly many studies available on the use of opioids. The tricyclic anti-depressants that were originally discovered and used as anti-depressants have also been found to be good analgesics. There are now close to 60 well-controlled trials using the anti-depressant analgesics in pain.

There are a number of trials looking at anti-convulsants in the treatment of pain and other agents that are known to be generally inhibitory in nature that have been examined in analgesic trials.

Senator Kenny: These are all controlled drugs that would not be available without a prescription.

Dr. Lynch: Yes, they all are.

Senator Kenny: Given the widespread use of cannabis over the past 40 years, why is there a lack of research in this area, whereas other drugs that are controlled have had research?

Dr. Lynch: That is an excellent question, and my thoughts are there is a fear because of the illegal nature of marijuana. The connection that cannabinoids in general - even the synthetic ones - have with marijuana has led to great difficulties in pursuing research in this area because they are illegal, very controlled substances.

Senator Kenny: The other substances are also illegal and will be controlled. Heroin is controlled.

Dr. Lynch: Yes, and opioids are controlled. That is a good question. Perhaps it is the stigma that marijuana has associated with this whole group of chemicals.

Senator Kenny: Could you walk us through the difficulties that a researcher has in trying to conduct research in this area with the law as it stands today?

Dr. Lynch: I have already mentioned the struggle we have in ensuring that our research subjects are protected. However, even before that, it is difficult to get research materials.

Senator Kenny: Specifically, what do you mean by "research materials"?

Dr. Lynch: I refer specifically to, first, smoked marijuana. We have only recently been told that we will be able to use the NIDA joints and that Health Canada will import the NIDA joints and may obtain the licences necessary for their importation so that the researchers will not have to do so. That has only recently become clear. We have been discussing that over the last year.

Senator Kenny: Can you contrast that to the problem that a researcher would have with an opiate, for example?

Dr. Lynch: Often opioid research is industrially funded so the drug company doing the work will supply the study materials. If we were interested in pursuing research into a new opioid preparation, we would just obtain it.

As another example, we are looking at a new topical preparation of an anti-depressant analgesic. We just use one of the anti-depressant analgesics currently available on the market and ask compounding pharmacists to prepare this in a topical preparation for us. We then make it available to our study subjects. Because it is an off-label use of a currently approved drug in Canada, we are able to do that under investigation of new drug status because we are not the manufacturer of the drug - we are just researchers looking at whether these drugs will have human application. It is very easy in that situation. We just take a currently available drug, develop it in a cream, and use it in our study.

Senator Banks: You just said that you think you are going to be able to import NIDA joints.

Dr. Lynch: Yes.

Senator Banks: Why would we do that? We export 80 per cent of our marijuana crop to the United States. Legislation is now in place that permits the legal growing of marijuana, which is taking place as we speak. I am sure the crop is ready by now. Why would we have to import it?

Dr. Lynch: That is an excellent question. This past year has been a learning process for us all in the CCIC. The problem is that although Canada now has an approved grower that is growing the first crop, the crop has to grow, be harvested, and be analyzed. The appropriate analysis on the toxicology of that product has to be performed and the appropriate master file has to be created. Health Canada has to have access to that master file which contains all the chemical information on the drug. When researchers put in our protocol investigation of new drugs applications, which we must do to be allowed to do research on this particular substance in our health care institutions,Health Canada can cross-access the master file created by the manufacturer with our research protocol. You can see that the paperwork involved in this is quite complex.

Senator Banks: Is it mechanical and merely a matter of time before this will be fixed?

Dr. Lynch: It is mechanical and it is a matter of time.

Senator Kenny: Please carry on with describing the practical problems involved.

Dr. Lynch: Yes, with regard to the practical problems involved in obtaining the study materials, I spoke briefly about marijuana. There are also the synthetic cannabinoids. A number of cannabinoids have been developed around the world. There are trials going on in Europe using some of the newer synthetic chemicals in humans.

There are also preparations of herbal cannabis, the crude cannabis, that are available via alternate delivery systems such as, potentially, sublingual. We would really like this research to be done in Canada, but there have been delays with regard to getting the materials into the country in order to research them.

For example, one researcher at Dalhousie has a wonderful new delivery system. He has been able to obtain some delta-9-THC of the type he needs to put into this new delivery system and test it in animals. However, there have been significant delays in getting this into human trials. He is caught in a catch-22 situation. The next step would be to get some healthy human volunteers to try some of this stuff. There have been significant delays in his research.

Senator Kenny: You refer to minimizing the need for additional documents. From that, one concludes there is a problem here. Would you describe it to the committee?

Dr. Lynch: We are trying to figure out a way to protect the confidentiality of our research subjects. We do not want to have to call the local RCMP office, tell them who our study subjects are and ask them not to bust them if they are found in possession of marijuana.

We thought that as an alternative to that perhaps they could carry a document. We were trying to identify exactly what that document would have to include and how to design it, et cetera. We were hoping to minimize documentation as much as possible in protecting our research subjects.

Senator Kenny: Is there any documentation now?

Dr. Lynch: It is my understanding that, because marijuana is an illegal substance, if our study subjects were found possessing it, they would be at risk of arrest. Our concern is to protect them without informing the local RCMP detachment.

Senator Kenny: Would something like a driver's licence be unreasonable?

Dr. Lynch: There are various ways to solve the problem, but we as researchers do not want to have to figure it out. We are looking to this committee and other individuals involved with the system to help us to protect the confidentiality of our subjects.

A document like a driver's licence might work, although it may lead to additional procedures and costs. Hopefully the researchers would not have to bear those costs, or at least would know about them up front so that we could budget for them in our research grant requests.

Senator Kenny: You talked about more research into preferred delivery systems. Given what you know now, what are the preferred ways of delivering the drugs?

Dr. Lynch: Inhalational certainly is very attractive and so is sublingual. However, sublingual would potentially be through an oral route that has variable absorption. Inhalation and topical are the ones that look good from where I sit. Topical application would target the peripheral nerves, and inhalational application to try and get it into the alveoli in the lungs, where there is a huge surface area across which the medication could get into the blood.

Senator Kenny: You talked about delays in ethical review procedures.

Dr. Lynch: Yes.

Senator Kenny: Can you tell us what ethical review procedures are, and then tell us about the delays?

Dr. Lynch: Whenever research is conducted on humans or animals, the research protocols have to go before ethical review boards that are in the institutions where the research will be conducted. If I as a researcher at the QE II Health Science Centre want to study a new analgesic we think is going to work for pain, I have to take my protocol along with a covering letter and a copy of the consent form -

Senator Kenny: Protocol would be what?

Dr. Lynch: Protocol is the paperwork that describes the research to be conducted. It describes the research questions that we are asking, the medications that we want to be using, and the design. Preferably, as the presenters mentioned this morning, the ideal design is a randomized double blind clinical trial where you are comparing the drug in question with a placebo in an ethical fashion, then asking the question under double blind conditions so that the investigators do not know whether they are giving the active drug or the placebo, and the subjects do not know if they are receiving the active drug or placebo.

Senator Kenny: Does the phrase "ethical fashion" mean something different to a physician than it does to the public?

Dr. Lynch: I do not know the answer to that. "Ethical" is a multi-faceted concept. Because it is so multi-faceted and important, our hospital ethical review boards are usually made up of quite a few people - approximately 15 in our hospital - a number of physicians, lay public, lawyers, and now bioethicists who sit on these committees and review the protocols in detail and ask questions as to whether or not this is ethical research to conduct on human subjects, or, in the animal committees, animal subjects. There are very strict standards by which we must conduct ourselves in order to undertake the research in our institution. These are good standards.

Senator Kenny: Can you give us an example of a few?

Dr. Lynch: Let us talk about pain work and the issue of placebo. If you have someone in moderate to severe pain, the committee and the investigator are going to be concerned about not causing individuals additional suffering because they are taking part in a research trial.

There are a number of ways to get around that. Usually what we do, because we are looking at a population of individuals who suffer from moderate to severe pain in spite of all the agents we have available to treat them, we will say you can stay on all your current drugs. We are going to use this study drug as an add-in drug to see if we can get you more pain control than the drugs the you are already on. That is one ethical way of trying to learn something new about a new analgesic. There are other ways to do it as well.

These are the types of questions that ethics review boards struggle with. We do not want to expose people to more suffering or unacceptable risks or adverse events or reactions if possible. If there are adverse reactions or events that are associated with this new agent, the individual has to be fully informed about them right up front, so that there is a process of full, informed consent. The consent forms are very detailed and involve a process of telling the subjects exactly what they are going to be exposed to in the research trial and exactly what the risks, potential adverse reactions and potential benefits might be.

There is also the issue of telling them that if they decide not to take part in the research trial that their medical care will not be affected, and they can withdraw from the trial at any time.

Senator Kenny: Is the work of ethical review boards open to the public? Is it a majority vote? Is unanimity required?

Dr. Lynch: These are excellent questions. As of now, I do not think there is a document standardizing the actual answer to your questions across the country. I know from recent discussions that a document is being developed. I am not sure where it is right now. Across the country there is fairly even balance with regard to assuring good representation from medicine, lay public,bioethicists, lawyers and, potentially, members of the spiritual community to create a balanced look at every detail of the protocols that are going before the institutions to assure that the research is conducted in an ethical manner.

You can imagine in a mixed group of individuals examining each protocol in great detail that if anybody has a fear of cannabinoids, whether it is based in fact or fantasy, it will lead to prolonged discussions and delays, and more paperwork going back and forth.

Senator Kenny: Is unanimity normally required?

Dr. Lynch: I do not know the answer to that question.

Senator Banks: On your committee?

Dr. Lynch: Unanimity, as far as how many have to vote, I do not know the answer to that. I do not sit on the ethics review board.

Senator Kenny: Are the discussions public? Are they on the record?

Dr. Lynch: They are certainly on the record. Minutes are kept. I do not know the answer as to whether those minutes are accessible to the public, but I would think they would be.

The Chairman: Can you find out and write us the answers?

Dr. Lynch: Yes.

Senator Rossiter: Dr. Lynch, Marinol and dronabinol are synthetic cannabinoids with the exact same elements as the natural. Is that right?

Dr. Lynch: One of them is delta-9-THC and one is nabilone. Delta-9-THC is the same chemical that is in the marijuana, and the nabilone is a slightly different synthetic cannabinoid that is more potent than delta-9-THC.

Senator Rossiter: These are controlled drugs inasmuch as they have to be prescribed for a specific reason by designated persons and held under lock and key by the pharmacists?

Dr. Lynch: In Nova Scotia, they can be prescribed, and they are treated very much as the opioids are. We have to use our triplicate prescriptions for opioids and for the cannabinoids that are available. One form goes to the patient, one stays with the prescriber and one goes into a central drug-monitoring program.

Senator Rossiter: Are they used much?

Dr. Lynch: No.

Senator Rossiter: Just for scientific purposes.

Dr. Lynch: They are used clinically. The only excepted indications are for the use of chemotherapy-induced nausea and vomiting and wasting in HIV. Those are the only accepted uses.

Senator Rossiter: Are they the same as grown marijuana?

Dr. Lynch: The delta-9-THC is the same as the delta-9-THC in marijuana.

Senator Rossiter: They are controlled, but not illegal; is that correct?

Dr. Lynch: That is correct.

Senator Rossiter: It is a strange situation.

Dr. Lynch: Yes.

Senator Rossiter: One is illegal and more or less uncontrolled, and yet they are the same.

Dr. Lynch: Yes, that is correct.

Senator Banks: It is the natural one that is illegal.

Senator Rossiter: In one way you would think that the natural one would be the legal one.

Dr. Lynch: The covering letters would probably discuss these types of issues. Unfortunately, one of our investigators who is looking at this alternate delivery system has run into significant slowdowns.

Senator Rossiter: It is almost conceivable, if you took the item far enough, to say that if there was enough synthetic, there would not be any traffic in the natural.

Dr. Lynch: That is the question. That is why we need more research trials comparing the synthetic, single cannabinoids with the natural herbal mixture. There are some groups that would say that the natural, herbal mixture creates a nice mix of cannabinoids that is potentially more therapeutic. We need to test that in control trials.

The Chairman: What is the role of the pharmaceutical in the research and development of cannabinoids for medical purposes?

Dr. Lynch: The role of the pharmaceutical industry is significant, but I do not think the industry will do all of the research that needs to be done. The pharmaceutical industry will be interested in furthering their products only. We know, for example, that there is potentially a sublingual preparation that might be coming out of Great Britain that would be very interesting to look at. We are also interested in other preparations that are not currently being developed by any of thepharmaceutical companies.

Often, the pharmaceutical companies are not interested in looking at certain questions. This is the type of work that interests CIHR - the work on chemicals that a pharmaceutical company is not interested in funding.

The Chairman: In the list of illnesses that you mentioned, you mentioned epilepsy as not a conclusive one. The courts have decided that it was conclusive. Have you read or heard the evidence that was presented before the courts in Ontario on Mr. Parker's case?

Dr. Lynch: There is some support for an anti-epileptic effect. However, there is not enough research. More research needs to be done in this area. There were primarily the results of the international committees and the results of their reports where they were virtually unanimous in agreement and where there were some conflicts. Epilepsy was one area where there was some support but it was not unanimous.

The Chairman: The court seems to have a lower threshold for being convinced by evidence than the researchers. They said, unanimously, that they were convinced that Mr. Parker should smoke marijuana.

The regulations that we will have by the end of July, come directly from the decision in the Parker case. That is my question, the courts are saying they are convinced, the research body is saying they need more.

Dr. Lynch: There needs to be more research on cannabinoids and their role in epilepsy. We do not have good, large, randomized control trials looking at the different cannabinoids and what role they might play in epilepsy.

We are not disagreeing with the courts. We are saying that we do need more research looking at these agents. Our emphasis in the CCIC right now is to look at cannabinoids in regard to pain, spasticity, nausea, and vomiting and end-of-life care. That does not mean that we are not interested in research into potential applications in epilepsy. That is not one of our first areas of priority. As a group we decided on certain areas of priority. Epilepsy did not happen to be one of them.

The Chairman: I am not qualifying your decision to do research on one area and not another. I am saying that the courts in Ontario have decided that they we are convinced that Mr. Parker needs to smoke marijuana to treat his epilepsy. Two levels of courts are convinced of that. The federal government has decided not to appeal that. That is the law of land now. If you have epilepsy, you can smoke marijuana. Epilepsy will be on the list of illnesses that will trigger the use of medical marijuana in a month.

That is why I am saying we have the courts, which are known to have a rigorous approach towards evidence. You cannot say whatever you want. You cannot table whatever you want. You must follow a procedure. That has been done. In the research field, we need more. What is the problem?

This morning you heard my question about morals and sociological problems. If cannabis were considered the same as a natural product, would the research or the threshold be the same? If there were a label that said it was safe.

Dr. Lynch: If you are asking if we could buy cannabis in a health food store, how would our research change, our research would change significantly. The only equivalent I can think of right knew that we are researching are the tricyclic antidepressant analgesics, which are easy to research in the current climate. Those are prescription drugs, not natural products that we can buy in a health food store.

If this were something that could be obtained in a health food store, it would take away much of the stigma that is slowing our research protocols in ethics review, for example. The acquisition of our research materials would be easier as well.

Senator Banks: I do not know who would end up selling packaged legalized or non-criminalized marijuana, if that were ever to happen. I suppose it would either be the Ontario Tobacco Company or Glasgow Welcome, or whatever they are this week.

Senator Kenny: Or the Government of Ontario.

Senator Banks: Is there an element in a joint that will be patentable?

Dr. Lynch: There are already a number of patents on the synthetic cannabinoids.

Senator Banks: I am talking about the real stuff.

Dr. Lynch: I am not completely clear on that. I am not sure if delta-8-THC, which is similar to delta-9, is quite as psychoactive. Delta-8-THC, I believe, is in the public domain. Dr. Mechoulam told us that there is no prohibition on obtaining and even creating delta-8-THC. Delta-9-THC is already patented - and I may be incorrect on that - but there are several of the newer, synthetic and more specific cannabinoids that have been patented. Delivery systems have also been patented.

Senator Banks: We have heard a significant amount of criticism that in the pharmaceutical industry, for example, among other places, that ethics is more or less defined as something in which the benefits outweigh the harm. If the benefits outweigh the harm, then it is ethical.

Of course, there are many instances where that would not apply. There are some things that we would be able to look at and say, "Well, the benefits of this outweigh the harm, but they are simply wrong and we are not going to do them." You could kill me and harvest my organs, if they are still working at all, and save the lives of five or six people, but we do not do that, notwithstanding that the benefits outweigh the harm.

Are you satisfied that enough of the other kinds ofconsiderations are being taken into account in the ethical questions that are being addressed by the people who govern what you do, beyond the simple "add up this column, subtract this from this, and if it weights on this side, we will do it, otherwise we will not." Are you comfortable ethically with what you are permitted or likely to be permitted to do?

Dr. Lynch: Absolutely. There are many checks and balances in the system already. There are documents being created that will standardize ethics review boards across the country.

First, there are the checks and balances within the researchers themselves, and anybody who is coming at clinical research, from a clinician's perspective, always puts the interests of the patient first, well before the research.

Then the ethics review boards are large and go through things in such detail that they really do make excellent decisions, at least in my experience.

Senator Banks: Do they always make them, even if there is a $5-million research grant at stake?

Dr. Lynch: I do not know the answer to that.

Senator Banks: Neither do I, thank you.

The Chairman: Dr. Lynch, thank you very much.

Honourable senators, our last witness today is Dr. Kalant. Dr. Kalant obtained his MD and Ph.D. degrees from the University of Toronto and did post-doctoral degree work at the Cambridge University in the U.K.

Since 1959, Dr. Kalant has been engaged continuously in biomedical and behavioural research on alcohol, cannabis, benzodiazepam and other drugs. He is currently professor emeritus in pharmacology at the University of Toronto and researcher emeritus for the Centre of Addiction and Mental Health. He has written or edited 23 books and more than360 research papers. He has won numerous honours for his research. He is a fellow of the Royal Society of Canada and a first honorary fellow of the British Society for the Study of Addiction.

Dr. Kalant has acted as a consultant to numerous national and international bodies including Health Canada, Justice Canada, NIDA, the World Health Organization and the Australian drug strategy.

He chaired the committee that conducted the most recent WHO review of cannabis and is the senior editor of the published volume, The Health Effects of Cannabis.

Dr. Kalant, the floor is yours.

Dr. Harold Kalant, Professor Emeritus, University of Toronto: Honourable senators, I am grateful for the invitation to meet with you today. The topic is clearly one of great importance, both for medicine and for society in general.

I would like to talk briefly about two topics in my formal presentation today. I will not touch the basic mechanisms of action, or the medical uses of cannabis, because both Dr. Morgan and Dr. Lynch have spoken about those. In terms of the actions of cannabis, I will speak only about the adverse effects that have received relatively little attention today, as far as I can tell.

The other topic is the question of what goes into the formulation of control policies for medical and non-medical use and how do they relate to cannabis.

The first point to make is that every society uses psychoactive drugs - that is, drugs that change how you feel, how you react to the world around you, how you perceive the world, your mental and emotional processes and so on. These drugs are used because they do something that people value. In all societies, psychoactive drugs have been incorporated into a variety of religious and other rituals, social gatherings and individual pleasure. They differ in terms of the type and degree of risk, but it is important to remember that every drug carries some risk. By definition, there is no such thing as a totally safe drug, there cannot be.

The risk that any drug carries is related not only to the basic mechanism of action - what the drug does as a drug - but also the dose. As Dr. Morgan has already pointed out, the frequency of use, the characteristics of the user, the circumstances in which the drug is used, et cetera, are all things that contribute to determining the degree of risk. The total harm produced to a society varies with the total extent of use of the drug in the population.

The first graph here displays, on the vertical axis, the death rate from alcoholic cirrhosis of the liver. Along the horizontal axis is the average per capita consumption of alcohol in the particular year. These are data from the Province of Ontario. As theper capita consumption increases to the right, along the bottom axis, the death rate from cirrhosis rises, as shown on the vertical axis. What that means is that the more the entire population uses, the more are there heavy users who use enough to develop cirrhosis of the liver.

Therefore, every society exercises some kind of control over the degree of use of drugs that are capable of producing both desired and undesired effects. There are many types of controls, it is not just a question of legal controls and it is not just a dichotomy between prohibition and legalization.

There are a variety of different types of control that are available that differ for medical versus non-medical uses of drugs. For example, for over-the-counter drugs, there are regulations that govern the purity, the safety, and the claims that the manufacturers make for what the drug can be used for. For prescription drugs, there are required tests of efficacy and of safety before the drug is licensed for manufacture and sale. A licensed practitioner must write the prescription. Only a licensed pharmacist may dispense the drug. There are regulations which govern how it is stored - whether it is under lock and key, what records must be kept of amounts received, dispensed and so forth. There must be a monitoring of adverse effects after the drug goes into general use. If unexpected serious side effects occur, the drug can be withdrawn from sale.

This type of regulation and legal control is based on expert knowledge and research. In other words, it is based largely on factual knowledge of the drug's effects - both beneficial and adverse - on statistics and on careful record keeping. The public is generally willing to leave the choice of control methods to the interaction between health care experts and government agencies because they recognize that the drug is being used essentially for their well-being and they rely on expert knowledge to decide the best way to protect that.

With regard to non-medical use, there is quite a range of control methods that enter the picture. These methods are different in many ways for legal versus illegal drugs, even though both are being used for non-medical purposes.

Legal drugs - for example, alcohol, tobacco, others of a similar kind - are controlled by regulations governing places and hours of sale, price policy, taxation, minimum legal ages for use, and the places and circumstances in the drug may or may not be used. The traditions and the fashions of society dictate, in large part, what is acceptable and not acceptable. There are social norms of behaviour. Education and publicity are used in efforts to control the extent of use.

Illegal drugs, rely much more strictly on legal controls: law enforcement; the courts; a range of different penalties ranging from conditional discharges or fines up to severe prison terms; police action; the seizure of materials affecting the availability on the price at least temporarily in certain areas. Drug testing has increasingly entered the picture, often quite unjustifiably; never theless, it is a reality that affects employment possibilities. A number of things can be affected by a positive drug test, which is presumed to have some deterrent action on use. At least that is the intention, supposedly. Social disapproval is another factor. Social consensus about whether a drug is or is not something that the majority of society wants to see in use affects rates of use. Education and publicity are also used, though there is a good deal of question about how much effect they have.

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. Heroin was widely used many years ago. It was available as a prescription cough syrup, which could be dispensed by drug stores. It was used extensively in obstetrics and gynaecology for its intense but short-lasting effect so that a foetus would be born without a drug effect, which is harder to achieve with morphine. Cocaine is still used as a local anaesthetic in nose and throat surgery. Heroin became illegal, as you know, but there was a campaign some years ago and its use was again permitted for treatment of pain in terminal cancer patients.

Yet, nobody argues that, because these drugs have some limited medical use, that they should therefore be legalized for non-medical use. In other words, the public recognizes that governing the use for medical purposes is one matter; governing it for non-medical uses is quite another.

Hallucinogens have no recognized medical use and they are illegal, but, some years ago, work was being done to study their possible beneficial effects in psychotherapy and the drugs were legally available to researchers for those purposes.

Cannabis is perhaps the one exception in which possible medical uses are often claimed by some proponents of legaliz ation 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.

Do the control measures actually work? It is important to point out that no control measure is 100 per cent effective. The law against murder does not prevent all murders. The law against speeding does not stop all speeding. We recognize that, as an expression of social norms, the legal or illegal status does tend to demonstrate to the public a certain view of what is appropriate or inappropriate and that governs how many people act.

I am showing a graph on which the upper line shows the death rate from all causes in the United States from well before prohibition, through prohibition, and after. You can see that the death rate declined gradually as medical care, public health measures, hygiene, and nutrition improved. The lower line shows the death rate from cirrhosis of the liver. I would emphasize that these measures are on two different scales; do not surmise that most deaths were due to cirrhosis.

The death rate from cirrhosis was fairly stable up to the beginning of prohibition. De facto prohibition began in the United States in 1916 when it became clear that the country was moving gradually towards entry into the First World War. A variety of measures, the net effect of which was prohibition, came into effect before the constitutional amendment was passed, and there was an abrupt drop in the death rate from cirrhosis. It remained low all through the period of prohibition and then, after repeal, it started to rise again, up to and eventually past the previous level.

The next graph shows how price policy affected cigarette consumption in the United Kingdom. The dotted line is the price in constant pounds Sterling. There was an early peak after the Second World War. Taxation policy raised the price of cigarettes and there was a sharp drop in the annual per capita consumption in cigarettes - indicated by the solid line. There is a sharp fall near the left side of the graph. There was a change in government policy, taxation was lowered, price came down and use went up in a mirror image. There is a similar crossover as policy changed later on. Identical graphs are available in Canada for the effective price of alcohol versus death rate from alcoholic cirrhosis.

In another example, when the legal drinking age in Ontario and most other provinces and in some states in the United States was reduced from 21 to 19, there was a steep rise in the percentage of drinking-driving accidents contributed by 16- to 18-year-olds. That meant that, when the law said you cannot drink below the age of 21, 16- to 18-year-olds did not drink very much. When the law said you could drink at 19, 16- to 18 year-olds drank a lot more and drove when they were drunk.

Control measures, while by no means perfect, do, in fact, have an effect. There is not much evidence that education works because there has been intensive education and yet the level of use of cannabis in Canada, as in the United States, has fluctuated up and down over years without any consistent relationship to education campaigns. That is probably much more of a reflection on teenage fads and fashions. However, social consensus is a much more powerful factor than formal education campaigns and the effect on smoking currently in this country is a good example of the effect on social consensus.

The problem is that all control measures have costs as well as benefits. Therefore, when you are setting a policy, particularly in relation to non-medical drug use, you need to consider the costs and the benefits both of drug use and of the measures taken to control drug use. Both have costs and both have benefits. Assessing the cost benefit balance depends on having accurate and factual information of many different kinds. What is the level of use? What do we know about different consequences and the relationship to level of consumption? How valid is the picture that we have available of the extent of harm or the extent of benefit?

We must also for the values, traditions and beliefs of society at large. When you judge costs and benefits, value systems influence our definition of these terms. What one person calls a cost another may call a benefit, and vice versa.

The next slide illustrates what I mean by the range of things you must look at. Those considered costs are in the two left-hand boxes and those considered benefits are in the two right-hand boxes. The upper line is the costs and benefits of drug use, and the bottom two lines are the costs and benefits of the control measures of drug use.

You can see that there are many kinds of costs and benefits. There are financial costs and financial benefits. The manufacture of drugs is big business. It generates jobs, income, taxation and so on. Alcohol and tobacco provide a great deal of revenue. One could argue that legalization of cannabis would provide another source of revenue to the government.

At the same time, the increase in use that accompanies easier access, lower price and legal sanctioning means an increase in the total harm produced. You must then consider the financial costs of the extra health care burden. You must consider the philosophical costs and benefits. For those who favour legalization, the benefit is greater freedom - that is, less interference by government regulation of what they feel should be personal choice. Those who oppose legalization say that the cost in philosophical terms is disunity in society - a type of society that permits freedom to do things that the majority of people may not agree are good things to do. Then you must determine whether freedom is of such importance that it overrides the attitudes, beliefs and wishes of the majority, or is it subject to the control of the attitudes, values and wishes of the majority of citizens?

The same applies to control measures. There are monetary costs and costs in terms of harm to people convicted of possessing marijuana or other drugs; there is harm imposed by jail sentences and the restriction of subsequent employability and international travel opportunities, et cetera. All of these things involve value judgments. Therefore, it is not an area for expert decision. In a democracy, it is an area for decision by consensus of the whole population.

Therefore, the role of the expert is limited to providing accurate facts. The judgment as to whether things are good or bad, how good and how bad they are, and what is the best balance between them is a political philosophy decision that belongs to the whole population and their elected and appointed representatives. It is necessary to estimate as objectively as possible all the results of potential changes of policy. In other words, we must look at cost benefit balance under present controls and under any proposed future set of changes to those controls.

I would like to discuss the adverse health effects of cannabis use regardless of the issue of legalization, controls or whatever, simply as a purely medical subject. Cannabis has a long history, as both Dr. Morgan and Dr. Lynch have described, of traditional use as a medication in various parts of the world. Used for this purpose, it has always been taken by mouth rather than smoked.

Cannabis was brought to England in the 1840s. An extract of cannabis was prepared by a pharmaceutical firm and was used as a sedative, as a tonic, for relief of muscle spasms, seizures and diarrhoea. It was adopted into the British pharmacopoeia and then into the U.S. pharmacopoeia and included in a variety of over-the-counter medicines. It was used for all of these purposes by mouth, not smoked.

After 1900, the use of cannabis declined steadily and fairly rapidly for several reasons. Its composition and potency were too variable. The chemical knowledge was not available at that time to assay it accurately and determine how long that assay remained applicable. In other words, the shelf life was too short. Cannabis was replaced by newer, pure synthetic compounds of exact composition and exact dosage that were more potent, in general, and more reliable in terms of the therapeutic effect that could be expected when a doctor prescribed them.

By the time the over-the-counter medications in Canada were banned in 1923, the use of cannabis had almost disappeared because medicine found these other newer drugs to be generally better, more reliable and more easily controlled in treatment. Therefore, when the over-the-counter drugs were banned there was essentially no protest from the medical profession.

Prescribed cannabis continued to be available until the mid- or late-1950s, but there was so little use that by the time it disappeared, no one cared very much because other drugs had virtually completely replaced it.

The interest in cannabis as a medication reappeared when pure THC and other synthetic compounds became available so that exact dose response curves could be established. Receptors were discovered and it became possible to tailor drugs by modifying their structure to make them fit one rather than another type of receptor, and to concentrate on producing the effect desired for therapeutic purposes with a minimum of undesired side effects.

What are these side effects? I would like to first focus on the acute effects and then on the chronic effects. "Acute effects" are those effects that you experience during the course of action of a single dose. In the nervous system that includes a period of several hours in which, as Mr. Morgan said, you become "chemically stupid." Side effects include decreased arousal and drowsiness, which acts together with the drowsiness produced by alcohol and other central nervous system depressants. Other side effects are impaired short-term memory, slowed reactions, less accuracy in test performance and less selectivity of attention. For these reasons, you would expect driving ability to be diminished.

Low doses generally produce the effects that cause people to like smoking pot. They include mild euphoria, relaxation, increased sociability and a non-specific decrease in anxiety. However, high doses produce a bad mood, anxiety and depression. There can be increased anxiety to the point of panic or even an acute toxic psychosis which, fortunately, is of very short duration and goes away when the drug effect wears off. High doses cause impaired motor coordination, unsteadiness of control and decreased muscle tone, which is therapeutically useful.

However, the same action, if not for medical purposes, becomes a drawback. With low doses, perception is enhanced. That is part of the pleasure. In high doses, the same action produces sensory distortion, hallucinations and the acute toxic psychosis to which I have already referred. This tends to happen only with very high doses with naive users. It is not something you will likely see very often, but emergency rooms do see it from time to time.

I will not take the time now to list other effects on the nervous system because they mainly deal with the therapeutic advantage, things for which the drug may be beneficial.

It does not seriously affect the cardiovascular system. There is an increase in heart rate and an increase in the output of blood by the heart per minute and, therefore, more work for the heart muscle. If the user, who is being given the drug for medical purposes, is a middle aged or elderly person with some cardiovascular disease, you would be worried that there might be a possibility of adverse effect on the heart.

The main thing that I would mention is the respiratory system. As Dr. Morgan mentioned, there is some dilatation of the airways produced by THC when you first start using it, suggests the drug might be beneficial for asthma. The problem is that the smoke irritates the lining of the airways and offsets the advantage of the THC. Therefore, it has not proven to be useful in the treatment of asthma to smoke cannabis, though THC by other routes might possibly have some benefits.

Finally, I would like to touch briefly on the acute effects and driving. Dr. Morgan referred to some experimental studies this morning. A number of studies, reviewed by Dr. Smiley in the report of the World Health Organization Committee on Health Effects of Cannabis, indicate a fair measure of agreement on what the predominant effects on driving are. The lane control, as Dr. Morgan mentioned, is impaired. The person does not steer as accurately. In addition, there was slower starting time and slower braking time. There was decreased visual search. In other words, when you drive, you must monitor for sources of danger to both sides and not just ahead of you. There was decreased monitoring, decreased recognition of danger signals. The effects were synergistic with those of alcohol. The one favourable thing about cannabis compared with alcohol was that there was less aggressiveness in the cannabis smokers than in the drinkers, so they were less likely to pass dangerously or to speed. Neverthe less, driving ability was impaired not just by weaker, poorer steering control, but also by less alertness to unexpected things that might happen and pose a hazard.

I will not go into the statistics of actual field studies of the involvement of cannabis in driving accidents. However, I would like to say that a number of studies have shown that there has been evidence of cannabis presence in the blood or the urine of people who have been stopped for impaired driving who did not have alcohol present. There are more that do have alcohol present together with the cannabis. In the past, this was interpreted to mean that cannabis was not doing anything. If there was alcohol there, the problem was due to alcohol. This, I would submit, is a nonsensical interpretation. If there are two drugs present that are both capable of affecting driving ability, both are contributing to the impairment that you actually see.

As to chronic effects, in the central nervous system there is impaired memory, vagueness of thought, decreased verbal fluency, and learning deficits in chronic, heavy users. I emphasize "heavy" because the social user does not, by and large, show any significant health effects. Neither does the social user of alcohol. The people who show adverse effects to any drug, by definition, are the heavy users. Therefore, the fact that the majority does not show adverse effects with occasional light use is no surprise. If there are to be serious adverse effects, you must look at the heavy users, and cannabis is capable of producing adverse effects on health with heavy use, just as alcohol or cocaine or heroin or any other drug can.

These effects on cognitive functions fortunately tend to go away if the heavy user stops, for whatever reason. As long as use continues, there is a chronic intoxication, apathy, confusion, muddled thinking, depression, and sometimes paranoia.

Dependence is a point on which I disagree with Dr. Morgan. Cannabis dependence, as defined in the conventional diagnostic criteria for dependence as set out in the latest edition of the American Psychiatric Association, or the equivalent publication of the World Health Organization, has been well documented in regular, heavy users. Numerous studies now show that a significant percentage of regular users are dependent. In some studies in Australia of long-term heavy users, mainly daily users for periods of 15, 17, 20 years, 60 per cent or more of them met the diagnostic criteria as set out in these standard reference works for dependence.

Tolerance has been shown. By and large, it is not a terribly serious effect, and the physical withdrawal syndrome is not severe. Nevertheless, it is there, which indicates that physical dependence, in addition to psychological dependence, occurs as well. You can precipitate the withdrawal syndrome by giving a receptor blocker that displaces the cannabinoids from their receptors and, therefore, produces a sudden abstinence in the same way that you can produce an acute morphine withdrawal syndrome by giving naloxone, which blocks the effect of the morphine and produces a sudden withdrawal.

There is also evidence - not proof - that schizophrenic patients who have been treated and have been able to readapt and get back into functioning in society, if they resume or begin cannabis use, have a greater liability of relapse than if they do not.

With regard to the effects on the children of mothers who smoked cannabis during pregnancy, this is a point of disagreement between Dr. Morgan and myself. It is a question of how convincing one does or does not find the evidence. Personally, I find the evidence that Dr. Fried has accumulated over the years to be convincing, but indicative of very mild effects. I do not think the effects are marked. They are certainly not serious. The concern is that perhaps they will, in some ways, in some children, impair their school performance and, therefore, ultimately affect their career possibilities. I do not know whether that is true or not. There is enough evidence to make it worth continuing the study to see what happens to these people as adults. I agree fully with Dr. Morgan that there is a need for larger and separate replications of this type of study in other centres with other populations to see if it is attributable or not.

The last thing I would like to talk about is the effect of long-term heavy smoking and cancer risk, which is again a point of disagreement between Dr. Morgan and myself. He has already referred to the study from the Kaiser Permanente Foundation, published by Sidney, et al. in 1997. The Kaiser Permanente Health Care System is one of the contractual health care systems in the States in which employers can pay the premiums for their employees to give them full health care coverage. Therefore, there are thousands of people available in their health registers upon whom they can do epidemiological studies. They reported that there was no link between marijuana use and lung cancer or total cancer. The problem is that their definition of a marijuana user was, in my point of view, absurd. They defined a current user as anyone who had smoked cannabis more than six times in his life, which to me is an utterly meaningless definition of a current user. Even at that level, only 22 per cent of the sample qualified as "current users." The great majority of those were families, employed, the dependents of the families, many of them small children. Clearly the sample of true, chronic heavy users was nowhere near large enough to see whether there was any link to cancer of any kind.

The puzzling thing is that in spite of that, they found a small but significant statistical link between cannabis use and cancer of the prostate in men or of the cervix in women. No rationale for that was ever provided. To me, that is more evidence that the study was of no particular value because of the failure to define adequately what is meant by a chronic user.

The other study, published by Zhang et al. at the end of 1999, was a case control study in which 173 cases of proven head and neck cancer at the Memorial Sloan-Kettering Cancer Center in New York, were compared with 176 matched controls who had no cancer but were of the same age, sex, general socio-economic status, et cetera. They were controlled for their use of tobacco, alcohol and other known risk factors. The overall risk in cannabis smokers was 2.5 times greater than in the non-cannabis users. That is for all marijuana users. It was three times greater for the younger ones. However, if you took the combined cannabis and tobacco smokers, corrected for the contribution of the tobacco - to see the potential combined effect when you put cannabis and tobacco together - the risk was 36 times greater than in the non-cannabis users. The risk with cannabis use was proportional to the frequency and the duration of marijuana use.

They considered a number of possible confounding factors that might give rise to a false conclusion in their study. They corrected for as many of them as they could by statistical means to show that their selection of the control subjects was not biased in any way, that they were, in fact, representative of the general population of non-cannabis users.

They wisely do not conclude that their study is proof that cannabis causes cancer, but the risk factor that they have found is so strikingly high in the combined users that it means one cannot write this off. It is necessary to do the same kind of study again with larger numbers, in other centres with other populations, to establish whether there is or is not a close enough link that you can satisfactorily conclude a causal role.

In conclusion, Mr. Chairman, I hope I have been able to leave for your consideration two points. First, in the case of all drugs, people would not use them if they did not do something that people value. At the same time, they all carry risks. All societies control drug use because of the risks. The control measures themselves have benefits, risks and costs.

Therefore, in formulating social policy on non-medical use, you must consider not only at the harm done by the law or at the harm done by the drug, but as far as possible a full cost/benefit analysis of drug use and the control measures, and any change in control measures that you may contemplate. This is a matter for all of society to decide - not for experts to decide as a matter of scientific knowledge.

Second, I would not argue by any means that cannabis is in any sense the most dangerous drug. I do not believe it is. However, there are enough risks that one must take them seriously. One cannot say that this is something that should be made freely available because it is a safe drug. There is no such thing.

The Chairman: I would invite Dr. Morgan to sit at the table now. It is rare that we have the benefit of having two experts in front of us. Particularly, because the two of you do not agree on some of the evidence and you are both coming up with strong support for both sides of the coin. That is why we are doing this.

Dr. Kalant: I would not consider myself a strong supporter of the opposite of legalization. I am not. I am a supporter of an objective, scientific evaluation, and a democratic social decision.

The Chairman: That is exactly what we want - a rigorous approach towards that. At the end of the day, the will weigh the scientific evidence, as well as all the other evidence.

Dr. Morgan, did you want to add anything in response to Dr. Kalant's presentation?

Dr. Morgan: I should like to take a few moments to talk about the areas of disagreement. I will start by saying that everyone should have as an opponent someone who makes his case so clearly as Dr. Kalant. In situations of debate with some other opponents, it takes half an hour to clean up the mess they have left. That is not true here, so it is always a pleasure to argue with Dr. Kalant and to agree with him, because we do indeed agree on many things.

I agree fully with him that increased alcohol use is associated with increased death rates in the population - mostly due to cirrhosis of the liver and some other causes. Where we disagree is with the exact relation of alcohol consumption to prohibition, at least in the United States. I will be happy to supply the committee with my paper on alcohol consumption levels followingprohibition and what really happened. I will also provide copies of the papers of Jeffrey Miron, who is an economist at Boston University.

We believe that alcohol consumption in the United States began to drop well before the unofficial prohibition of 1916, and it was coming down actually from about the turn of the century. You did notice Dr. Kalant's data, which showed cirrhosis levels during prohibition actually went up slightly. I believe, by and large, that is what the data shows in the United States. It is difficult to say that prohibition worked, yet cirrhosis levels went up during prohibition. There is quite a good explanation for that.

Prohibition was effective in the United States against beer. It was not effective against higher potency forms of alcohol such as whiskey. Of course, what Canadians smuggled into the United States, which was one of the sources of illicit alcohol during prohibition, was distilled spirits. Canadians did not smuggle in any beer. The people making drinks in the United States did not promote beer. I believe that in truth, and Miron agrees with me, that alcohol consumption probably went up during federal prohibition in the United States. Indeed, this reflects the dangers with an increased cirrhosis rate.

I also would like to point out that Miron's paper says that from the ending of prohibition in 1930, to 1942, there was no increased evidence of consumption in the United States. Consumption went up again in the United States with the onset of World War II. The stopping of prohibition, therefore, had minimal impact on consumption. That is because, of course, consumers had already consumed during prohibition.

There are arguments that we have about how these numbers move and what they move with. There is an essential agreement here that alcohol is dangerous in high doses, even dangerous in doses that many of us may not consider high.

Cannabis toxicity is much lower than alcohol toxicity. Even if one could show that strong legislation affects consumption of cannabis, and that consumption goes up in Canada and the United States when we lessen the law, I would not worry very much because of the relevant important low toxicity of cannabis.

Dr. Kalant said that there are studies that show chronic heavy users have cognitive problems and impaired mental functions. It is true; there are three or four studies. Most of those studies focus on a relatively small group of chronic heavy users. The dilemma for these studies is that they all use relatively small numbers of subjects, and almost all chronic heavy users of cannabis turn out to be people who have other lifestyle problems that might have contributed to their dilemma. For example, chronic heavy users of cannabis are by and large chronic heavy users of alcohol. By and large, chronic heavy users of cannabis are heavy users of tobacco cigarettes.

It is difficult to separate out the cognitive impairment in these people and the studies showing cognitive impairment in chronic heavy users. I would point out also that in one of the studies most often used, when one removed the women heavy users from the heavy use group, the differences all went away. What that means was that males were contributing most of the problems and that males were the most deviant. They were the heaviest cannabis users and the heaviest smokers.

There is one study that I know Dr. Kalant does not agree with, in which a large group of people underwent mental function testing in terms of another project. This was in the Baltimore area. It turned out a few years later that a subset of these same people was tested for their cognitive abilities. It is a study published by Dr. James Anthony and other people working in epidemiology at Johns Hopkins. They found that there was no decline in cognitive abilities, by this test, in relation to cannabis use. It is a large study. Although it was not designed to test cannabis use, it showed that, at least with this particular mental function test, there was no decline even in relatively heavy users of cannabis.

With regard to the cannabis dependence issue, again,Dr. Kalant is so honest. Your researchers should get you a copy of the DSM-4 - the Diagnostic and Statistical Manual of the American Psychiatric Association - and read the seven criteria which, if you have four, you are accorded as dependent. They are essentially all behavioural phenomena: "I use more than I want to"; "I do not like to stop"; "I should probably stop." These are a variety of behavioural criteria that are scarcely scientific at all.

I signal a warning for you that cannabis dependence is an increasing illness in the United States because the number of physicians practising addiction medicine is an increasing phenom enon in the United States.

A few years ago when I helped to form the Addiction Medicine Society - a mistake I apologize for - there were relatively few specialists practising addiction in the United States. There are now 4,000. Some of these men and women are excellent people, caring for people with severe alcohol and heroin problems. There is now a need to fill those office seats with lots of dependent people. We find new dependent people among users of cannabis.

Of the weekly drug users in the United States - that is, current users of drugs - the government lists about 15 million people. Of those, 13 million are users of cannabis. There would be no drug testing industry in the United States if it were not for cannabis laws. There would be no frequent reports of cannabis dependence, I believe, if it were not for the need for cannabis-dependent people.

Having said that, which is somewhat aggressive, of course people can become dependent on cannabis. Cannabis is a drug that diminishes anxiety and makes people feel good. There are some people for whom the only amount of a drug that is enough is too much. Some of those people will fit almost anyone's criteria for heavy dependent drug use.

We agree on the fact that the withdrawal syndrome, if it exists, is mild. Dr. Kalant mentioned precipitating withdrawal by giving a cannabis receptor blocker. Those are only animal studies; there are no human studies showing the precipitation of withdrawal by giving a cannabis blocker in humans. That may occur, but it has not yet been shown.

I agree that cannabis impairs some of the functions that have to do with driving. I will be with you when you recommend a variety of laws against driving under the influence of cannabis once you have legalized cannabis. That is an excellent idea. The only way that will occur in the culture is if there are some stringent restrictions against driving. I am supportive of those. Although I do not think cannabis is a strong contributor to mayhem and death on the highway. I do not think there are any statistics that support that.

The cancer issue was recently enjoined because of Zhang's studies of head and neck cancer that Dr. Kalant described to you with some thoroughness. It is interesting that there is still no evidence of lung cancer increases in smokers of cannabis. The idea that there is increased head and neck cancer is problematic and could be true. However, interestingly enough, most studies looking at the impact of delta-9-THC on cancer growth show by and large that delta-9-THC is an inhibitor of cancer growth.

There was a recently published study which the United States Government held in its files for a long time that showed that rats regularly treated with cannabis had a lower level of a certain type of cancer which occurs fairly commonly in old rats.

The last thing about Zhang's study is that it certainly does not prove that cannabis smokers get cancer of the head and neck. What it proves is that smokers get cancer of the head and neck. I do not believe that Zhang could adequately separate the issue of tobacco versus cannabis smoking in this group of people. What this study shows is a slight increase in cancer of the head and neck in smokers. It may be true that cannabis made a greater contribution. I do not think the study shows that.

In summation, my friend and colleague, Dr. Kalant and I agree on certain issues; we disagree on others. Cannabis is a drug of relatively low toxicity. Most of the things Dr. Kalant is concerned about do not warrant a level of concern to diminish a commitment to drug policy reform.

High doses of many drugs are dangerous. High doses of alcohol are particularly dangerous. Of course, cannabis is a drug that has some adverse effects; all drugs do. However, the level of adverse effect in cannabis use, even heavy cannabis use, is not so serious that we should proceed as we have heretofore.

Dr. Kalant: Again, I would invite honourable senators to look at the graph. I seriously question that anyone can doubt the level of cirrhosis death rate before the beginning and the abrupt increase in steepness after prohibition. It defies common sense to say that that was part of the same line.

The Chairman: What you are trying to establish is the fact that you are focussing on rate of death specifically caused by intake of alcohol.

Dr. Kalant: That is correct.

The Chairman: I am sure you are not trying to imply that all the death rates, or all the deaths relative to alcohol intake lowered during that period because of prohibition.

Dr. Kalant: No, what I am saying is that the death rate from cirrhosis has been studied extensively as an indicator of the extent of use. Some things did decrease in parallel. The death rate from traffic accidents due to intoxication generally also went down. There is an American study addressing the rates before and after change in the laws, which found similar evidence showing a decrease in death rate from alcohol-related accidents when ease of availability was diminished and hours of sale were reduced.

Various kinds of legal controls do have an effect. They do not prevent all drinking, but they do have a marked effect in reducing it. I have read the manuscript of the study to which Dr. Morgan referred. I am not aware that it has been published, but I saw a pre-publication copy. If you look at the death rate during prohibition, anyone who measures that line and tries to measure a significant difference between the slope of that line and the horizontal obtains a negative result.

There is no difference in the death rate from cirrhosis during that period. Dr. Miron concluded that there was actually an increase by making a number of assumptions about the changing drinking population as a result of young men being sent off to war. Therefore, there was a difference in the demographic make up of the population that was drinking and so on.

If you look simply at the facts, there is no increase in death rate from cirrhosis during that period. There is an increase afterwards. It was not as fast as the fall, because that was the depth of the depression and the price of alcohol comes in as another controlling factor there.

Dr. Morgan referred to the Baltimore study. He is correct; I do disagree with the findings of that study. That was the Baltimore catchment area study that looked at a group of people of varying ages at one point in time and then returned some years later to look at them again. They looked for evidence of cognitive change. They did not find any effect of cannabis in the rate of loss of mental function. The problem there is that they lost most of their young chronic cannabis users - which is not surprising, because the heaviest users tend to be deviant in other ways; many have a low social stability, to drift off elsewhere and not be traceable. Therefore, we really do not know what the effect of cannabis was on cognitive performance in that population.

The Chairman: On a scale of 100 what is the level of chronic users?

Dr. Kalant: What percentage of chronic users? It is hard to get good figures on that. It depends on how a chronic user is defined and how a heavy user is defined.

As a percentage of all users, it is probably not terribly different from the percentage of heavy drinkers among all alcohol users - somewhere in the range of 5 per cent or perhaps a little higher, a little lower. As a fraction of the total population, it is lower because a smaller fraction of the population uses cannabis.

On the third point Dr. Morgan raised, dependence criteria, I agree with him. The criteria for dependence in the DSM-4, or the World Health Organization's ICD-10 are behavioural but that is no surprise because addiction or dependence is a behavioural phenomenon. Tolerance and physical dependence may or may not be present. What really defines dependence is the preoccupation with constant use; the major role that getting it and using it plays in a person's life; the difficulty in stopping; or, if the person stops, the difficulty in staying stopped; and the relapse rate.

Therefore, it is not surprising that the criteria are essentially dependent or behavioural criteria. More than that, they are the same criteria that are used for defining dependence on heroin, alcohol, cocaine or anything else. If you criticize them for their application to cannabis, you must also criticize them for their application to the other drugs. The point is, is it any different when applied to cannabis and when applied to these other drugs?

Precipitated withdrawal, we agree, it is a very mild reaction. That is not the point. The point is that there is some element that you can show by giving an antagonist that produces a mild, withdrawal reaction that goes away again if a person uses more cannabis. If you are talking about definitions and if the definition of physical dependence is the creation of a withdrawal reaction when a person stops, there it is. It is not dramatic. I do not attach much importance to it. All I am saying is that cannabis can produce dependence of both physical and psychological types.

Finally, on THC and cancer, I agree that THC is not the cause of whatever risk of cancer there may be in cannabis. It is the smoking. That is why smoking is not recommended as a form of drug administration for medical purposes. This is particularly so if the treatment applies to a lifelong disease for which long-term smoking will have to be given. The risk would increase in cases of a disease such as glaucoma, which as Dr. Morgan and Dr. Lynch stated, would require a person taking the drug eight or ten times a day to maintain persistently low pressure in the eyeball so not to further damage the eye. We are quite agreed; THC is not a carcinogenic agent, but smoke is.

Senator Banks: In the study you mentioned in which the result showed that there was a 36 times greater risk, I would be grateful if you would send some background to the Clerk of the Committee.

Dr. Kalant: I did not put references in my background paper because they are all in the book.

Senator Banks: If you could I would be grateful.

Dr. Kalant: I would be happy to.

Senator Banks: Those are numbers and attributions that we have not heard before. What was the size of the sample?

Dr. Kalant: There were 173 cases of head and neck cancer and 176 matched controls.

Senator Banks: You also mentioned cervical cancer and prostate cancer?

Dr. Kalant: That was the Kaiser Permanente study with65,000 people.

Senator Banks: The question you raised about medicinal use as being a rational reason for something to be okay, but not licensing it for other purposes, would apply to liquor as well - snake bite, the old gag.

You have correctly stated that questions having socialimplications must not be decided only by experts - whoever they are - but by people, because it affects everyone and no one is, in respect of those it affects, necessarily more expert than anyone else. Do you think that there is something inherently wrong in the seeking of personal pleasure?

Dr. Kalant: No, I do not. Life would be miserable if people did not seek personal pleasure.

Senator Banks: If you can imagine a hypothetical situation in which drugs, for recreational purposes and medicinal purposes, were strictly controlled - maybe even to a greater degree than liquor is in Ontario - would that be acceptable?

Dr. Kalant: I can answer only with a personal opinion, not an expert opinion.

Senator Banks: Only a personal opinion.

Dr. Kalant: Yes, if the control measures can be shown to be applied fairly, honestly and effectively, by all means. I have no inherent bias against the use of cannabis for pleasure.

The point I have made before is if we were starting from scratch and we said that our society needs a good soma from Brave New World - needs a good drug to make people happy - which one would we pick? I would not be surprised if we picked cannabis. It may very well be that the net harm would be less than with alcohol.

The point is, we do not start from scratch. We already have alcohol, tobacco, a range of other drugs, including some licit and some illicit. As Dr. Morgan pointed out, the heaviest users of cannabis are also heavy users of alcohol, tobacco and a variety of other things. Therefore, it is a matter of, do we want to add another one or not? If we do, will we have more harm by adding it and having more drugs in current use, than if we do not?

This is the kind of thing where we really do not yet have adequate statistical epidemiological information about the total harms, partly due, I acknowledge, to the illegal status of cannabis. It is easier to gather data about a legal drug and its consequences and about the extent of use than it is about an illegal one. Therefore, it is a catch-22 in a way: It is illegal, therefore we cannot say effectively what the total harm is; but then we say we should not legalize it because there might be more harm. We do not know.

We must look at it from a broad philosophical point of view rather than a narrow focus on cannabis itself. The best I can say to answer your question is, I would not have any objection if it could be shown that careful control meant only a small increase in use and no change in public attitude about what was tolerable or permissible behaviour.

Senator Banks: I am sure you would agree if there were a change in public attitude that led to the public perception that it was less acceptable, less hip, less advisable, less desirable.

Dr. Kalant: Actually, no public attitude played much of a role in that. That was an instance of one self-styled expert changing the law almost single-handedly, without any great public knowledge or debate of it. Emily Murphy wrote a book that was as false and misguided as the movie Reefer Madness. The drug was not used in Canada non-medically to any significant extent at that time. Nobody knew much about it. People said, "Oh well, if it is bad, I guess it is bad, so, sure, put it on the prohibited list." There was no attempt to look carefully at what the evidence was and what the risks were of leaving it available versus banning it.

I agree with the Le Dain commission, and others, that the decision to make it a criminal offence probably did, in its own way, more harm than having left cannabis at that time to be used by only a handful of people - mainly in the pop music scene. The point is that we cannot undo history. We must look now at what we have now, not what we had 60 years ago.

Senator Banks: If society were to decide to lessen the penalties or the likelihood of incarceration for cannabis, would we really be adding on another level of potential abuse? I am asking you this in the context of the uninhibited access that people have to cannabis. You know how readily available it is, I am sure.

Dr. Kalant: Yes, it is certainly readily available. It is not unlimited. If it became legal and inexpensive, one of the arguments made for legalizing it is that it would drive out the black market. It would only drive out the black market if it was cheaper than black market material. If it is cheaper and legally available and, therefore, by definition, socially accepted, I am convinced that there would be a very significant increase in use. Therefore, there would be a significant increase in adverse effects. If you ask not about legal situation but simply not sending kids to jail for having pot, personally, I am in favour of that. I do not think people should be sent to jail for possession of small amounts for personal use.

There are others who disagree with me and who say you can avoid jail by means other than formal decriminalization. About the program in Toronto, for example, which deviates offenders from the judicial system to treatment, prevention or whatever, it is claimed that that is another way of preventing young people from going on to heavy use without risking legal penalties. I have seen no statistics on how effectively that works. Thus, I can say nothing about it.

Senator Banks: We do not send many people to jail for simple possession.

Dr. Kalant: No.

Senator Banks: However, quite often, we convict them of a criminal charge for simple possession. That lasts their whole life unless it is expunged.

I would like to make a suggestion and ask you to comment on it. You inferred that it would be very difficult to change public opinion one way or another. I will talk about tobacco smoking now, which is at least as insidious and awful an addiction as anything else and it kills more people.

The youth smoking rate in Newfoundland hovers somewhere around 30 per cent, as it was not that many years ago in California. However, in California, a comprehensive undertaking has been made by the government to use marketing, to put it most simply - clever and good marketing, not just advertising but a comprehensive marketing program - to reduce their youth smoking rate to 6.9 per cent. The means by which they have done that is by convincing their target audience - young people - that notwithstanding that this substance is legally available to them in a store, or if not legally, then available, and notwithstand ing that their parents may do it and that it might look hip in the movies, smoking is a really dumb, uncool and unhip idea for all of the following reasons. That is a successful program.

In the event that cannabis were legalized, do you think that we could do that same kind of thing here with cannabis, liquor and with whatever else we think is a bad idea?

Dr. Kalant: I would like that to be the case, yes. I wish that it were so.

Senator Banks: But it is.

Dr. Kalant: I have not seen any report of the California program and what its analysis is based on. Thus, I cannot comment on it. The studies that have been conducted on the effects of education programs among high school students in Canada, for example, or in Australia and the northern territories, have not given much evidence of great effect.

Senator Banks: Agreed. Pardon my interrupting. I am not talking about an educational program. You are right; they do not work. I am talking about a comprehensive program of which education is a part, but only a part. You are quite right, educational programs per se do not work.

The comprehensive program I am talking about worked in California to our satisfaction, and an educational program in Oregon failed utterly to work. You are quite right about that. I am talking about something that is much more broad.

Dr. Kalant: I can tell you that I have had fantasies about a similar program. I wish I had the ability to put it into effect. It would be something that would show a baby wearing a diaper and holding a nursing bottle and beside it a teenager with a bottle of beer, stating, "So you think it's grown up?" I do not know whether that would work or not.

Dr. Morgan: I would like to point out that the United States embarked upon a comprehensive indoctrination program in the mid-1980s. One can characterize it as much more thaneducational. First, it started by getting children in the kindergarten to the sixth grade to do chants. They had anti-drug slogans on their school books, videotapes and candy bars. Everyone in America stood up in front of available cameras and decried the use of drugs, marijuana in particular. I regard that whole intervention as a strange, bizarre and unevaluated social experi ment.

Of course, at the time those things were put in place, drug use was still declining in the United States from its peak in 1979. During the time of the application of those programs, drug use levelled off and is going back up. As far as I can tell, those sorts of comprehensive programs - and I do not know the California data - are strange and experimental events that may have encouraged drug excitement fervour and use in young people. I do not see any reason for us repeating any of those things without very careful evaluation.

The dilemma is no one wants to evaluate them carefully. Why? Because they are part of a crusade: "I get to say these things and I feel wonderful. You tell me that they do not work, but I feel wonderful." When we told all the DARE officers in America that the DARE program was not good, they said they liked it, so they kept doing it.

Senator Banks: We are convinced that the California program did work. The assessment we use is one that was done mainly by the Centers for Disease Control in Atlanta. They examined it and convinced us that it did work. It was far more than education and far more than advertising.

The Chairman: Dr. Kalant, in your written presentation, which I read with much interest, you say at page 5:

- in order to minimize the frequency and severity of the harm, every society imposes various types of control on the level of use.

Your information seems to say that societal controls are rational, based on assessment of harm. Is that your interpretation?

Dr. Kalant: My intention in writing that is that all societies are aware that drugs of various kinds can cause harm and have put measures in place to limit that harm. I would not say that they are rational, well thought through measures. By and large, they tend to be reactions to crises.

I am arguing that to do it sensibly, there must be both a rational assessment of risks and benefits - or costs and benefits - and a value judgmental decision about which balance of costs and benefits or of control measures gives the optimum benefit for the minimum risk.

That is where it stops being rational. Once you get into values, it cannot possibly be decided purely on objective grounds. It must account for the traditions, the values, and the attitudes of any given society at any given time.

The Chairman: If we go back to 1923, such a rational approach, analysing harm, cost and risk was not done.

Dr. Kalant: No. Generally, in the past, it has not been done. There has been a growing interest in doing this.

The Chairman: After the fact.

Dr. Kalant: Health economists of various kinds have looked at measures and tried to assess the consequences of different measures: The costs of drug use, the costs of the control measures, et cetera. It is far from complete and certainly not done to the degree that can convince the population that there is a rational basis for making whatever recommended change in policy is proposed.

The Chairman: Now that we are looking at the policies that we have and listening to the evidence that you and your colleagues have given us, I know I am simplifying, but is the real problem cancer?

Dr. Kalant: No, that is one problem. Although Dr. Morgan and I do not agree on the extent, we both agree that the temporary effect of acute intoxication is a problem that must be assessed. There is a hazard in driving or operating any potentially dangerous machinery when you are intoxicated with anything.

The Chairman: The list of problems, cancer being one, driving another. Does it rationally convince us that prohibition is the proper way to control marijuana?

Dr. Kalant: It would not matter what adverse effects you were looking at. None of them by themselves would or should convince anyone that prohibition is the proper way to do it. What is needed, first, is an assessment of all of the potential adverse effects. How many of them actually happen at present levels of use? What are the costs to society of those things happening? What are the costs to society of prohibition? Then we ask, "Are we getting more benefit than harm by having prohibition or not?" If we are not, is there some other system of control that could avoid the harms of prohibition but still achieve the benefit of controlling the level of use and, therefore, control the risks?

This is where all the other potential control measures must be looked at to see if they will do the same job as prohibition, or do a better job at lower cost. The point is that it requires a cost/benefit evaluation not only for what we now have, but also for what we might have as an alternative.

Dr. Morgan: I am not opposed to regulatory, informal and non-criminal justice control measures. I would listen to early closing hour arguments. I would listen to arguments about increasing the costs. I would listen to arguments about a variety of issues of decreasing accessibility of dangerous substances. However, I am not convinced of the utility of prohibition even regarding proven dangers.

The danger issue is an important issue. The discussion we have had here today about the dangers of cannabis is extremely important. However, if it turns out I have made mistakes and cannabis is more dangerous than I thought, or that cannabis in some crazed way, because of increased concentration of THC begins to approach the dangers of other drugs such as alcohol, I would still doubt if prohibition is ever a reasonable response.

There is an inevitable cost of trying to limit accessibility to drugs. Prohibition always goes too far and exerts a deleterious impact on society. There are informal controls, rules, covenants, regulations and economic pressures that can be applied to dangerous drugs to diminish their availability. I have no objection to those. However, to say to a citizen, "You may not use this substance and I will put you in jail if you do." is wrong.

Senator Banks: Does that rationale apply to all drugs across the board?

Dr. Morgan: For me, it does.

Senator Banks: Would you be in favour of a state that had safe injection sites?

Dr. Morgan: Yes, I would.

The Chairman: Thank you, gentlemen. We appreciate your presentations. Our researchers have questions for you and they will ask me to sign a letter of questions from them. I hope you will respond. Thank you very much for appearing. Hopefully you have enjoyed your day with us.


Before I adjourn the proceedings of this committee, I would just like to point out to all those who are interested in what this committee is studying, that they can get more information on the illicit drugs issue on the following Web site: All the presentations of the witnesses we have heard, as well as their resumes and the supporting documents that they supplied us with are posted on this site. The site also features more than150 hyperlinks on illicit drugs. You can also get in touch with us by e-mail at the same address.

On behalf of the Special Committee On Illigal Drugs, I would like to thank you for your co-operation in our proceedings.

The committee is adjourned.