Proceedings of the Special Committee on
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
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
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
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
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 www.parl.gc.ca. 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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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 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
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
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
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 -
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
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
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
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
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
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
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
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
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
Senator Kenny: Given your views, what would your advice be for Canadian
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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 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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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: Haveyou 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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
The Chairman: The list of problems, cancer being one, driving another.
Does it rationally convince us that prohibition is the proper way to control
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
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: www.parl.gc.ca 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.