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Proceedings of the Standing Senate Committee on
Social Affairs, Science and Technology

Issue No. 40 - Evidence - April 19, 2018


OTTAWA, Thursday, April 19, 2018

The Standing Senate Committee on Social Affairs, Science and Technology, to which was referred Bill C-45, An Act respecting cannabis and to amend the Controlled Drugs and Substances Act, the Criminal Code and other Acts, met this day at 10:31 a.m. to continue the study of the bill.

Senator Art Eggleton (Chair) in the chair.

[Translation]

The Chair: Welcome to the Standing Committee on Social Affairs, Science and Technology.

[English]

I’m Art Eggleton, a senator from Toronto and chair of the committee. I’ll ask my colleagues to introduce themselves.

[Translation]

Senator Petitclerc: Chantal Petitclerc from Quebec.

[English]

Senator Omidvar: Ratna Omidvar from Toronto.

Senator Campbell: Senator Larry Campbell from British Columbia.

Senator Munson: Jim Munson, Ontario.

Senator Bernard: Wanda Thomas Bernard from Nova Scotia.

[Translation]

Senator Mégie: Marie-Françoise Mégie from Quebec.

Senator Poirier: Rose-May Poirier from New Brunswick. Welcome.

Senator Seidman: Judith Seidman from Montreal, Quebec.

[English]

The Chair: Today the committee continues with its examination of Bill C-45, An Act respecting cannabis and to amend the Controlled Drugs and Substances Act, the Criminal Code and other Acts.

Today we will function in two panels. The first panel will go from this point to noon, and then we will get into panel two between 12:00 and 1:00.

We have four entities here for presentation: first of all, the Canadian Public Health Association, Ian Culbert, Executive Director; next, via video conference, a department I’m quite familiar with, Dr. Eileen de Villa, Medical Officer of Health for the City of Toronto, and Sudha Sabanadesan, Policy Development Officer; and bck here in the studio, as they say, we have the College of Family Physicians of Canada, Christine Campbell, Family Medicine Resident.

[Translation]

We also have with us Lucie Granger, Executive Director of the Association pour la santé publique du Québec.

[English]

I would ask for opening remarks from each of the four groups, and I would ask you to keep them within a seven-minute time frame. We’ll start with Ian Culbert from the Canadian Public Health Association.

Ian Culbert, Executive Director, Canadian Public Health Association: Good morning, honourable senators. Thank you for the invitation to present to you today as we discuss a substance that Canadians have been prohibited from using for almost 95 years. According to historians, cannabis was criminalized in Canada long before it was defined as a social problem. There is no record of parliamentary debate, no evidence of public discourse and no paper trail as to why cannabis was criminalized. Much has changed in the past 95 years.

Interestingly, alcohol has been a prohibited substance in every province and territory of this country at some point in the 20th century, but most of those prohibitions ended after only a few years, even though alcohol’s health risk profile, compared to cannabis, is much worse. The worst possible health risk profile, of course, is that of tobacco, a product that has never been prohibited.

On behalf of the Canadian Public Health Association, I am encouraged that the Government of Canada is committed to a public health approach to the legalization and regulation of cannabis, as is demonstrated in Bill C-45. This legislation will provide the governance structure to manage its sale, while the operational considerations will come from the regulations that are currently under development by Health Canada. Today I will restrict my comments to the legislation.

The Canadian Public Health Association believes that Bill C-45 and some of the provincial and territorial responses are steps in the right direction. As this country moves forward with legalizing cannabis, we must keep in mind the lessons learned by other jurisdictions that have travelled this road before us. Regulators must be flexible and ready to adapt to changing conditions in the marketplace. Upfront investments in health promotion are essential. Law enforcement and public health need to work together. And importantly, the interests of the private sector that profit from the manufacture and sale of cannabis are rarely aligned with the interests of public health.

I have had the opportunity to review the transcripts of some of your previous hearings and will use my time today to address some of the public health concerns committee members have raised.

You have heard that the country is not ready for legalization. Unfortunately, we do not have the luxury of time, as Canadians are already consuming cannabis, and the individual and societal harms associated with cannabis are already being felt every day. We need this legislation now to help minimize those harms and protect the well-being of Canadians.

You have heard concerns about the legal age of 18 for the consumption of cannabis. The Canadian Public Health Association supports this provision, given the large number of youth who are already consuming cannabis, and we recommend that provinces and territories establish a legal age for cannabis that matches their alcohol consumption age. This will reduce confusion and help coordinate education efforts.

Concerns have also been raised about the impact cannabis consumption has on the developing brain. While the study often quoted is a piece of the research puzzle, it focuses on young people who are daily and heavy cannabis users. I think we can all agree that if a youth is consuming a large amount of cannabis on a daily basis, there is cause for concern. If a youth is drinking alcohol heavily on a daily basis, there would be a similar cause for concern. From a public health perspective, we need to know why that child is consuming heavily so we can focus our interventions accordingly. In this situation, the problem isn’t cannabis; the problem is a larger emotional, physical or mental health condition.

Some committee members have questioned whether or not this legislation will reduce the number of people using cannabis. Now, I think undoubtedly there will be a short-term spike in consumption immediately following legalization as curious Canadians either try cannabis for the first time or former consumers return to a safer, regulated marketplace. The concern, however, speaks to our understanding of how many Canadians, specifically young Canadians, are currently using cannabis.

You’re all familiar with the statistic that 21 per cent of 15- to 19-year-olds have reported use in the past year. This seems like a large number, even though it does mean that 80 per cent of the same cohort has not used cannabis in the past year. The statistic is a national figure and it is the best one we have.

However, a survey of Ontario students done by the Centre for Addiction and Mental Health found that only 1 per cent of students in Grades 7 to 12 reported using cannabis daily in the past month, only 1 per cent. Now, I’m very concerned about that 1 per cent because they are most likely facing some kind of trauma, the pain of which they are trying to numb with cannabis. This is where our attention should be focused.

The Canadian Public Health Association supports the current legislation because legalizing cannabis will facilitate harm reduction initiatives that prioritize efforts to minimize the harms associated with consuming cannabis. Harm reduction could include providing a product of known potency and quality, providing effective health promotion activities, education about safer consumption methods and promoting the Lower-Risk Cannabis Use Guidelines.

An important element of those Lower-Risk Cannabis Use Guidelines is the recommendation to avoid smoking cannabis and use alternate delivery methods such as vaping or edibles. Of the two, vaping is preferred, as edibles have their own unique risk. It is unfortunate that the current legislation doesn’t deal with either of these alternatives, but the one-year delay in regulations for these products is both reasonable and understandable.

Concerns have been raised about the home cultivation provision in the legislation. The fact is Canadians have the right to grow their own tobacco and produce their own alcohol in their homes. As such, there is precedent that would make the prohibition of home cannabis cultivation susceptible to a court challenge. Furthermore, growing tobacco and producing alcohol at home carry comparable risks to growing cannabis at home, yet we do not have an epidemic of child poisonings or other negative outcomes.

Law enforcement agencies suggest they are not ready for legalization — I should say some law enforcement agencies — particularly with regard to driving under the influence. Given that a large number of Canadians are already consuming cannabis illegally, it is reasonable to assume that some of them, hopefully a small minority, are driving under the influence. If we aren’t seeing a raft of cannabis-related collisions today, we most likely will not see that happen post-legalization either.

If legalization is delayed, then the important health promotion and education work that almost all of your witnesses have recommended is delayed as well. Health and social service practitioners cannot counsel Canadians on lower-risk cannabis consumption techniques if the consumption of cannabis remains illegal.

Yes, we need more research. Yes, we need more health promotion activities. Yes, we will face challenges and need to rethink our approaches, but none of that can happen until Bill C-45 is passed by the Senate and receives Royal Assent. Thank you.

The Chair: Thank you very much.

Now I will go to the video and ask the Medical Officer of Health for the City of Toronto, Dr. Eileen de Villa, to give her opening remarks.

Dr. Eileen de Villa, Medical Officer of Health, City of Toronto Health Unit: Good morning. Thank you to the chair and members of the committee for the opportunity to speak with you today. As stated, my name is Dr. Eileen de Villa and I’m the Medical Officer of Health for the City of Toronto.

My comments today will reflect the position of my organization — Toronto Public Health — and the Toronto Board of Health and are restricted to the proposed legislation for non-medical cannabis.

We support the goal of Bill C-45 to provide Canadians legal access to cannabis, and in doing so, ending the practice of criminalizing people who consume cannabis for non-medical purposes. The consequences of having a criminal record include impacts on access to employment, housing, social stigmatization and economic status.

The science on cannabis is emerging. However, we know that it is not a benign substance. Cannabis is a psychoactive substance with known harms of use. It is therefore imperative that the development of a regulatory framework is guided by public health principles to balance legal access to cannabis with reducing harms of use.

Health evidence shows that smoking cannabis is linked to respiratory disorders, including bronchitis and cancer. Cannabis use impairs memory, attention span and other cognitive functioning. Heavy cannabis use during adolescence has been linked to greater likelihood of developing dependence and impairments in memory and verbal learning. Cannabis use also impairs psychomotor abilities such as motor coordination and divided attention relevant to a key public health concern, impaired driving.

A recent study reveals that many Canadian youth consider cannabis to be less impairing than alcohol. As you may know, motor vehicle accidents are the main contributor to Canada’s burden of disease and injury from cannabis. In addition to strengthening penalties for impaired driving by amending the Criminal Code, as put forward in Bill C-45, preventing cannabis-impaired driving will require targeted public education.

I recommend that the government support municipalities, provinces and territories with local initiatives to discourage people from driving after consuming cannabis. In addition, I recommend the government invest in research for developing evidence-informed standards for drug-impaired driving and undertake research to help establish low-risk consumption limits for cannabis.

The stated key objective of Bill C-45, to prevent young people from accessing cannabis, is central to adopting a public health approach to the legalization of cannabis. We must apply lessons learned from tobacco and alcohol in developing the appropriate policy framework to prevent young people from using cannabis.

Evidence about tobacco advertising shows that it has an impact on youth smoking and that comprehensive advertising bans are most effective in reducing tobacco use and initiation. I welcome the requirements in Bill C-45 that maintain existing promotion and marketing rules in place for tobacco. We would also like to see these restrictions strengthened to include advertising in movies, video games and other media that are accessible to youth.

Furthermore, we know that labelling and packaging are being used for promoting tobacco and tobacco brands. Plain packaging has been identified to be a highly impactful tool for reducing tobacco use. Plain packaging regulations for cannabis should be developed similar to those being considered for tobacco, prohibiting the use of brand elements or other promotional imagery and providing sufficient space for prominent display of health warnings and product information.

I commend the government for not legalizing access to cannabis-based edible products until comprehensive regulations for its production, distribution and sale have been developed. The experience in the United States cautions us of the challenges posed by edible cannabis products, including accidental consumption by children and over-consumption due to the delay in feeling the psychoactive effects of the drug.

I would also like to draw your attention to some of the limitations of existing cannabis research. While there is growing evidence about the health impacts of cannabis, some of the research findings are inconsistent or even contradictory, and causal relationships have not always been established.

Most of the research to date has focused on frequent chronic use, and the results must be interpreted in that context. More evidence is needed about occasional and moderate use as this comprises the majority of cannabis use. I am pleased to see that the government has announced funding for this research, and I urge the government to support strengthening the evidence base on the full range of health impacts of cannabis use, in particular for occasional and moderate consumption.

Bill C-45 gives us an opportunity to promote a culture of moderation and harm reduction for cannabis that may extend to other substance use, especially amongst our young people.

In closing, I would like to reaffirm that Toronto Public Health supports the stated intent of Bill C-45. I do appreciate the complexity of building a regulatory framework. Given that we’re still learning about the impacts of cannabis use, the legal framework for cannabis must allow for strengthening health-promoting policies while curtailing the influence of profit-driven policies.

With that, I will thank you for your attention, and I and my colleague would be very happy to answer any questions that the committee may have.

The Chair: Thank you very much, doctor, for your presentation. We will be getting back to you with some questions, I’m sure.

Next we have the College of Family Physicians of Canada, Christine Campbell, Family Medicine Resident.

Dr. Christine Campbell, Family Medicine Resident, College of Family Physicians of Canada: I would like to thank you first for inviting the College of Family Physicians of Canada to discuss the act from the perspective of family physicians.

The CFPC represents more than 37,000 members. It is a professional organization responsible for the training, certification and lifelong education of family physicians. The CFPC accredits postgraduate family medicine training in Canada’s 17 medical schools.

I am Dr. Christine Campbell. I’m a first-year family medicine resident working through Dalhousie University in Prince Edward Island, and I hope to open my own family medicine practice next year after completing my training.

I should note that the majority of the work that the college has produced addresses the use of dried cannabis for medical and treatment purposes rather than for recreational use. However, many of the findings that I am going to list today remain relevant for considerations of recreational use.

Research shows that dried cannabis is a potent psychoactive substance that can have serious acute and chronic cognitive effects and symptoms including drowsiness, disconnected thoughts, dizziness, altered mood and potential for long-term serious adverse effects, including psychosis.

Cannabis use disorder might be as common as appearing in one fifth of regular users. This is more commonly seen in males, those who start using at a young age and those who use frequently.

Cannabis use causes acute physical effects including high blood pressure, rapid heart rate and release of stress hormones, including adrenaline, catecholamines and other stress hormones. There have been various reports of young people suffering heart attacks shortly after using cannabis.

Chronic use of dried cannabis has been associated with persistent neuropsychological deficits even after periods of abstinence. Heavy cannabis smoking may be an independent risk factor for impaired lung function, chronic obstructive pulmonary disease, bronchitis and cancer.

Substance dependence, although lower for cannabis compared to other substances, is around 9 per cent. This compares to nicotine, which is about 68 per cent, cocaine at 21 per cent and alcohol at 23 per cent.

Problems that affect cognitive and psychomotor functioning and memory can impair the skills needed for driving, which can in turn cause increased motor vehicle accidents. This is an area that requires considerable more study with the pending legalization of cannabis.

Research demonstrates that the health risks of cannabis increase significantly with the intensity of use, frequency of its use and is a strong predictor of cannabis-related harm.

I would like to now discuss cannabis in youth. Cannabis is specifically problematic in users under age 25, where the brain is still developing. This population is at greater risk for the psychosocial harms of cannabis, including suicidal ideation, cannabis use disorder, illicit drug use and mental health issues. It has been shown that the adverse effects of cannabis on the adolescent brain are more severe than the adult brain, especially with persistent use.

Just a story about my residency and experience: I have to rotate through the different specialties in order to maximize training. I am currently doing my emergency rotation, and I have been amazed at how many patients I see on a regular basis coming in with psychosis induced from cannabis or adolescents coming in reporting heavy substance use with cannabis and reporting high amounts of anxiety, depression and seclusion from friends and family.

The CFPC urges the government to involve family physicians in the implementation of any policies related to recreational or medical cannabis given our role as primary care physicians and our first-hand experiences caring for patients who abuse substances. Family physicians require supports to patients who might suffer adverse effects, including cannabis use disorder and harm to mental well-being.

Finally, it is important to distinguish that the advice laid out in this presentation does not cover the impact of proposed legalization on society or the justice system. Such considerations are beyond the scope of the CFPC and I would like my commentary today to not be taken as one position or the other. That is a question for Parliament and for organizations and individuals with expertise in the Criminal Code and regulation for controlled substances.

Thank you very much for your time and consideration of the CFPC’s perspective on this issue. We appreciate the opportunity to provide input and look forward to ongoing collaboration.

The Chair: Thank you very much, Dr. Campbell.

[Translation]

We will now hear from Lucie Granger, Executive Director of the Association pour la santé publique du Québec.

Lucie Granger, Executive Director, Association pour la santé publique du Québec: Honourable senators, I would first like to thank you for the invitation, and I would like to take the opportunity to recognize the harm reduction approach contained in Bill C-45.

Today, the eyes of the world are on Canada. This legislation will have a definite impact. Depending on the preferred approach, it could even be a model for the free sale of cannabis to be followed by all countries that want to favour a harm reduction approach. The ASPQ believes that a responsible policy on drugs must meet the following criteria: protect young people, as they are the largest group of cannabis users in Quebec and Canada; exercise control over the substance and derived products, and limit their access; protect health — the THC level in cannabis on the black market varies between 5 and 15 per cent — because the risks associated with the sale of psychoactive substances are higher when they are under black market control. It involves repressing the acts of violence related to settling scores and the other bodily, moral and social abuses; and finally, to reduce the rate of criminalization, since many Canadians end up with a criminal record because they were arrested for simple possession, which creates some disadvantages for them in terms of employability and mobility.

For these reasons, the association applauds the government’s approach and encourages it to move forward with the cannabis legislation to allow Canada to break out of the prohibition era. However, the ASPQ is concerned about some aspects of the bill and would like it to consider four important recommendations to protect long-term health, what we call “sustainable health care.”

Promoting a product doesn’t just affect its advertising, packaging or sponsorship. It encompasses all the marketing strategies used by the industry to diversify, broaden and develop customer loyalty. The bill defines promotion of a thing or service as follows:

. . . a representation — other than a representation on a package or label — about a thing or service by any means, whether directly or indirectly, that is likely to influence and shape attitudes, beliefs and behaviours about the thing or service.

With respect to the regulation of cannabis for recreational purposes, Canada needs to put in place a set of measures to limit the scope and impact of cannabis promotion strategies. When it comes to promotion, the ASPQ recommends that the government subject authorized producers of medical marijuana to the same restrictions on promotion, which is currently not the case. We have included some documents under the heading “Advertising” that illustrate what I am explaining.

The ASPQ observes that current licensed producers apply different marketing strategies, particularly on social media. Think of Twitter, Facebook and Instagram. The multiplication of sources of promotion is similar to what was found in the tobacco industry at the time when promotion was unregulated.

Currently, some medical marijuana companies are adopting marketing strategies that go well beyond the informational promotion that resembles this one in government documents.

Tweed owns, among others, the brand Leafs by Snoop, which is presented by the famous American rapper Snoop Dogg. The use of a celebrity in an advertising campaign is a well-known marketing strategy, which gives consumers an undeniable appeal. The use of a star to promote a product inspires confidence and adds an emotional dimension that brings the product to life. It gives it charisma, character and style. In short, if we identify with the star, we want to get the product. The ASPQ denounces such a strategy that does not target an audience with health problems, but rather the general public. The assumption that the company is laying the groundwork for the legalization of recreational cannabis remains more than plausible. The ASPQ therefore recommends that the government ban the “star strategy” for both recreational and medical marijuana products.

Diversification and the multitude of products, and the fact that they are sold in an edible form, facilitate the consumption of “ready-to-eat” cannabis and attract an extremely varied clientele. However, they offer a generally safer alternative to inhalants. They are already present on the illicit market. So the question is whether we should offer products that would compete with the black market, or only products that are less harmful to health.

Edible products, when permitted, shall be in a form that is not attractive to children, in packaging that is childproof and accompanied by warnings indicating that the time it takes to take effect is slower, to avoid intoxication.

The question also arises for wax and shatter, which can contain up to 90 per cent of the total THC. This is a difficult choice. Some will say that we have to allow them because they are already on the black market. For the ASPQ, it is clear that wax and shatter must be banned for public health reasons.

The last point concerns traceability. Given the cases of pesticide contamination reported over the past two years by the medical marijuana industry, the ASPQ recommends the establishment of a traceability system for the seed type product for sale to ensure consumer safety.

The history of tobacco shows just how important it is to have a solid foundation for the cannabis bill. We have an opportunity here to enshrine its basic principles within the legislation and preserve the sustainable health of Canadians. Thank you.

The Chair: Thank you very much, Ms. Granger.

[English]

That completes our four initial presentations, so we will now go into questions and answers. Five minutes will be timed for each senator. Please direct the questions, because five people total could take up one question in the whole time period.

Senator Seidman: Thank you all very much for your presentations. I’d like to address my question to you, Mr. Culbert, but I’m sure Ms. Granger would like to respond as well, given her presentation, as well as anyone else.

Mr. Culbert, we’ve heard a great deal of testimony this week about the need for some kind of limit on the THC potency of cannabis given the known association between higher potency products and mental health risks. I noted in your organization’s response to Health Canada’s consultation on the proposed approach to the regulation of cannabis that you said:

The establishment of maximum THC levels for selected products is viewed as one means of assisting individuals in establishing safe consumption habits. As such, CPHA supports these limits. It is noted, however, that no maximum concentration of THC has been established for dried or fresh cannabis. The Association’s view is that limits are necessary as a means of maintaining a consistent product for consumption, thereby helping to reduce the likelihood of over-consumption.

So are you concerned that the government has not provided, as of yet, any indication that it will establish a maximum THC concentration for dried or fresh cannabis? And can you tell us more about how the establishment of maximum THC levels can help people establish safe consumption habits? Thank you.

Mr. Culbert: Thank you, senator, for the question.

That is our position. We would have liked to have seen maximum THC concentrations in the regulation. It’s a difficult position for us to be in. Our advocacy is evidence-based. Unfortunately, there’s no evidence to indicate what that upper limit should be, and that’s an area where, under legalization, more research will be allowed, and we should be able to set that in the future. It’s one of those situations that we’re finding ourselves in where the cart is slightly ahead of the horse, but unless you legalize, you can’t do the research. So we appreciate that.

As is outlined in the Lower-Risk Cannabis Use Guidelines, the goal is to have people start at the lowest possible THC concentration so that they can adapt their usage. It’s not like the first time a young person has a drink, they go to scotch, necessarily; you ease someone into it so that their bodies can adapt.

Senator Seidman: I’m sorry, I don’t mean to be rude, but if I could just interrupt you, because I’d like to quote something you just said to us in your presentation.

Mr. Culbert: Sure.

Senator Seidman: You said the interests of the private sector that profits from the manufacture and sale of cannabis are rarely aligned with the interests of public health.

Mr. Culbert: Correct.

Senator Seidman: And that’s absolutely right. I think we would all agree with that.

Mr. Culbert: Correct.

Senator Seidman: I appreciate that there isn’t scientific evidence for the maximum limit, but we’ve heard repeatedly from psychiatric experts and medical researchers that 30 per cent, for example, is an extremely dangerous level of THC. Even though we don’t have controlled trials as a gold standard, would you not assume, if we’re really going to have a public health approach here, that we should have some regulations that are very clear on a maximum level of THC?

Mr. Culbert: Absolutely. Our original paper on the topic called for a maximum limit of 15 per cent, with exceptions for medical purposes, if there were extenuating circumstances. I was simply stating I understand why the government hasn’t. They’ve tried to take an evidence-based approach, and there’s no evidence to support that limit.

Senator Seidman: But there’s evidence to support 30 per cent as a —

Mr. Culbert: Certainly we know those higher concentrations are dangerous.

The Chair: Any other comments? You only have half a minute left.

Senator Seidman: Maybe Ms. Granger has something to add.

[Translation]

Ms. Granger: I would just add the element of taxation that should accompany the concern you’re raising. As we can see, beer has an alcohol content of between 5 and 7 per cent. There are products with 0 per cent. After that, there is wine. It will be a whole rigmarole to find the percentage. As I mentioned, products with 90 per cent should clearly not be authorized.

The other very important aspect in the consistency is support with regard to taxation. Products that introduce consumption must be products with a low level of danger.

Senator Petitclerc: Thank you to each of you for being here, and thank you for your very informative and helpful presentations.

[English]

My first question is for you, Mr. Culbert. At the end of your presentation, you said we need more research, so I want to hear from you about that. It seems that from what we hear that there is a lack of data at many levels but, on the other hand, if I may say, a positive side effect of legalization is we will be in a better place to collect that data and information. Am I correct to say that this will give you the opportunity to have baseline and future data in order to do research? How would that look? In terms of funding and organization, do you feel that the $10 million, for example, that has been announced will be enough? What kind of research do we need?

Mr. Culbert: Yes, a legal framework allows you to much more easily do the research that’s required. A lot of the research that we have is out of the States. It’s using poor-quality cannabis and it’s under strictly controlled circumstances, so it’s not the quality that we would like. Legalization in Canada will allow for an explosion of research. We need research all the way from bench research around the actual chemical makeup of cannabis, to the psychoactive effects on the human body, to more the social study side of research about human interaction, the whole range.

The $10 million that CIHR has earmarked is a good starting point. Throwing more money at that from the very beginning probably isn’t going to be helpful because you need a rolling amount of research dollars so that you can build on that preliminary research. If you have too many people going off in too many directions, it’s not necessarily helpful. The funding that has been set aside for the Canadian Centre on Substance Use and Addiction and the Canadian Mental Health Commission is also very helpful because it’s a different train of research. It is all required. It’s a good start. There’s always room for more, but the ongoing commitment to funding that research is going to be crucial.

The Chair: Do you want anyone else to respond?

Senator Petitclerc: Yes, of course.

The Chair: Toronto Public Health wants to respond, I think.

Dr. de Villa: If I may, Mr. Chair, I wanted to add that over and above research, I think what’s important as well are the evaluation campaigns of the efforts that are under way, whether we’re talking about the public education campaigns, messaging campaigns, understanding around drug-impaired driving and some of the comments I made in my remarks. I think there are important opportunities for evaluation efforts as well, over and above the types of research that Mr. Culbert described.

The Chair: Anybody else?

[Translation]

Ms. Granger: I think it’s very important to have zero time data to get a true assessment of the impact on the health and safety of Canadians. It’s key. The pages of history are being written right now, and it is time to define the data that will enable us to evaluate what legalization will generate and the legislator’s responsibility in the choice of public policies that will be more or less severe. Opportunities for legislative review can also be used to make adjustments. Zero time data for an assessment of health impacts is a key factor.

Senator Petitclerc: I will continue on this point. Concerning zero time data, you mean now. To your knowledge, is this being done?

Ms. Granger: I think work is being done. There are people who are thinking. Is there a concerted position across Canada in this regard? Because the provinces are also developing their legislation. So it is necessary to have a common language, to have a common understanding and to share information about it.

[English]

Mr. Culbert: The Canadian Public Health Association is funded by Health Canada. We’re doing consultations. We just wrapped up 23 consultations from Rankin Inlet to St. John’s to Vancouver, talking to health and social services and medical providers about their knowledge, attitudes and awareness of treatment facilities. That kind of baseline data is being done.

In terms of the surveillance that we’ve talked about, a number of different tools are out there. The granularity of data is always the challenge of national surveys, so it is always public health’s cry that we need to do surveillance better, and we need to be doing that now.

Senator Omidvar: Thank you all for being here. My question is for Dr. Campbell.

Dr. Campbell, you have recommended that the age of access for legal cannabis use be lifted from the currently proposed 18 to 25 years old, yet we know that it is the age cohort of 18 to 25 who are the most significant users. I’d like you to comment on the health and social harms related to the ongoing and, I would imagine, continued access to the illicit market by people in this age cohort. On the one hand, if age is set at 18 or 19 or whatever, they would have access to regulated products that are labelled for content and that describes the risks, et cetera, associated with the product, as opposed to going to the illicit market. You’re a family physician, so please comment on the health and social harms of ongoing access to the illicit market by this age cohort.

Dr. Campbell: Absolutely, and that’s a great point. Research shows that, in Canada, the average use of initiation is 17 years old. In 15 per cent of people who we see with schizophrenia and psychosis, it is cannabis-induced, and most of this is from cannabis induced in adolescence. You are at higher risk of this happening before age 25, and specifically before age 21.

There have been documented white matter changes in the brain, vascular changes in the brain, and imaging on MRIs that show irreversible damage that comes from repeated cannabis use. People who are young are vulnerable, impressionable and more likely to develop habits such as cannabis use disorder, which can affect them lifelong. Once you develop certain illnesses, sometimes you can go back to the premorbid brain, but oftentimes you can’t, and for these people it’s very tragic.

Senator Omidvar: Thank you, doctor. Would you comment on the social harms of criminalization of people who are not able to legally access cannabis as per your recommendation of age 25?

Dr. Campbell: Yes. Regarding criminalization, I believe that decriminalization is important. From my understanding, the way the bill is now, the punishments for criminalization are a bit out of proportion. I don’t think that anyone should be criminalized for having small amounts of marijuana on them, but I think there should be this public image where every young person is aware of the harms — like tobacco has done in Canada — and is educated. Especially when it comes to driving, research in Colorado shows that traffic-related marijuana deaths increased 34 per cent from 2013 to 2014. So that’s another thing too.

Senator Omidvar: Thank you.

I want to ask my neighbours from Toronto to weigh in on the social harms of the ongoing use of the illicit black market, especially when it comes to racialized youth. I live in a city and you live in a city where young Black people are incarcerated at three times the rate of other users who also use cannabis. Can you describe the social harms that they are currently experiencing?

Sudha Sabanadesan, Policy Development Officer, City of Toronto Health Unit: Absolutely. As mentioned, there’s a disproportionate number of racialized people who have been burdened with criminal records because of simple possession of cannabis. One of the important things in providing youth with legal access is that also they would be more open to accessing treatment. We could provide services and also have that education and conversation and engage youth in terms of harm reduction or prevention services that we provide. Moreover, at the local level, we are engaged with youth already to have a much more open conversation and for them to speak freely of their use. Legalization starting from age 18 or 19 provides that opportunity.

Also, one of the things about moving forward in talking to youth about cannabis is that we’re able to bring their attention to other substances as well. It’s not just cannabis; tobacco, alcohol and other drugs need to be addressed in concert with cannabis. I know there has been research that cannabis is found in people who have been found impaired driving, but much of that research also shows there have been other substances along with cannabis.

Again, there needs to be more research in that area in terms of what are the co-effects of multiple substances, and also engaging this group, the more risk-taking group between the ages of 18 and 25. Including them is probably one of the most important things to do at this time.

Senator Campbell: Thank you for coming today.

To Dr. Campbell: Can you give me the source of the heart attacks from marijuana? In 40 years, I’ve never heard that one. In 40 years of being involved in this, I’ve never, ever heard that. Where does that come from?

Dr. Campbell: This was put in a document by the CFPC, and they did a literature review of all the research for medical purposes for marijuana and its consequences, so I got it from that review, with me and it was amongst other CFPC members who produced this information. I’m happy to tell you more about the research behind the medical and treatment uses for cannabis also.

Senator Campbell: One of the problems I keep hearing here are the statistics being thrown out, including the one you used, that traffic-related deaths are higher. I should tell you there has been a study just published by the American Journal of Public Health, which is a very prestigious journal, which found no increase in vehicle crash fatalities in Colorado and Washington relative to similar states after legalization. I really worry about all of this conflicting data that keeps coming at us, especially when it comes to youth.

I believe 1 per cent was the figure that we’re talking about that find themselves in trouble. From my experience, that hasn’t changed over the years. There’s 1 per cent in the schools that we should be dealing with, not the 99 per cent. The people we see at this 1 per cent that are at risk, in my experience — and I’d like your comments — in many cases they’re self-medicating for other reasons, whatever it is we go through as teenagers. We’ve all been there; we all know the stresses. So I think we should be careful of that.

The second thing is we keep talking about dosage and levels of THC. We talk about dried or fresh plant. I can tell you there is no such thing as fresh marijuana. You would not smoke fresh marijuana, so it really is all dried. Would you agree with me that one of the difficulties we have is there is no uniformity in a marijuana crop? I don’t care whether you control it as tightly as you can. We’re assuming that marijuana is a chemical and, like alcohol, we can break it down to one tenths. Can I have your comment on that? Is there going to be research that’s going to tell us that finally this is not alcohol? This is a plant-like material. Will research eventually tell us how we measure that? How do I measure a 4,000 square foot grow op? We know the THC is going to be substantially different depending on all kinds of factors. I’m directing the question to Mr. Culbert.

Mr. Culbert: We’re talking about, to a certain extent, an agricultural product. Variations in water, minerals and sunlight will change the composition of that plant. I think a lot of really smart people are being paid quite a bit of money by industry to continue to fine-tune these plants.

You’ll never be able to say that plant will always be 12 per cent THC. I think you may have crops where you’ll be able to say this range is between 9 and 14, so you have a general understanding.

Also, the different strains give you different qualities as far as the psychoactive effect or lack of psychoactive effect. Cannabis connoisseurs know a lot about this. The general public certainly doesn’t. I think the research will catch up over time.

You’re absolutely right about the statistics. There’s lots that we can learn from Colorado and Washington State. I was able to do study tours out of there, but one of the things we’ve learned is that the stats coming out in the first five years are going to be meaningless. We saw spikes in hospitalizations, but dig it a little deeper and those were out-of-state people who had no access to the education and health promotion campaigns going on. So it’s the nuances of the statistics that are really important. You’re absolutely right; we have to be very careful, and that’s what I try to be.

Senator Munson: I think I need something for medicinal purposes today.

Sometimes in your discussions here, you think we’re coming to the end of the world as we know it with the legalization of marijuana and regulation of cannabis. Yet, Mr. Culbert, you talked about being encouraged about the government’s public health approach. We seem to lose the fact that tobacco has always been legalized, alcohol is legalized and we never really had a public health approach to any of those. We would have been as a nation much better off if perhaps we had done that and not gone after the tobacco industry and so on, and of course alcohol is what it is.

We do have the opportunity here as a Senate committee — and we will do it — to put amendments forward to make this legislation better, because there are some concerns. To all of you, if you have an opinion, I’d like to know from you what amendments would make this legislation better. Because it’s coming. It’s not going away. It will happen. It just depends on when it will take place and how we protect, as you’ve said, the health and well-being of Canadians. If anybody that has a point of view on that, I’d appreciate it.

The Chair: Let’s start with Dr. Campbell. I’ll go to the screen and then the two on the floor.

Dr. Campbell: For me personally, I think age of use is very important just to kind of, again, protect the young developing brain. There’s different research that shows different ages are appropriate. Definitely 25 is what I think personally, but if that is considered too high, then maybe raising it to 24, 23, 21. I think the older the better, truthfully.

[Translation]

Ms. Granger: Thank you again for giving me the opportunity to remind you that medical marijuana promotion should be subject to the same strict neutral packaging guidelines as recreational products, otherwise the industry will boost sales. The examples in the document I gave you talk about it. It is very important to provide the star system in the legislation so that it is prohibited. It’s the same for edible products. It was mentioned that there should be very strict criteria to protect our young people. Clear information needs to be given on the time required to take effect, which is quite different. Wax and shatter at 90 per cent should not be allowed. The traceability system of seed products for sale should be part of the recommendations. I would also say that the age of 18 shouldn’t be changed because I think the other substances — alcohol and tobacco — would be trivialized, and it’s certainly not something consistent with the reality of health risks. There really is a blind spot, if you change the age. So I recommend keeping the age at 18 years old. Thank you.

[English]

Dr. de Villa: Just to be efficient with time, we would recommend that restrictions on marketing and promotion be strengthened to include restrictions on advertising in those formats that are most accessible and of interest to youth, such as movies, video games, media and online marketing. That kind of thing, I think, could be an important strengthening of the existing legislation.

Mr. Culbert: I echo that. The language around advertising and promotion is open to interpretation, and we’ve seen problems with that when it comes to tobacco, so strengthening that would be positive. All of my other recommendations refer to issues that would be dealt with in regulation.

The Chair: Thank you very much.

[Translation]

Senator Poirier: My first question is for Ms. Granger. Quebec and Manitoba have decided to ban growing cannabis at home. We have heard other provinces express concern about this. Do you think growing at home should be banned across Canada? What is your position on this?

Ms. Granger: In its presentation, the association’s stand was not to ban it. It is difficult for us to intervene on this. Canada has positioned itself and the provinces are positioning themselves right now. Then, everyone will have to evaluate the impact of these regulations. That’s my point of view for the moment.

[English]

Senator Poirier: My second question is for Mr. Culbert. In your presentation, Mr. Culbert, on the last page, page 4, in the first full paragraph, you mention in there, when we were talking about the cultivation: “. . . as such there is a precedent that could make the prohibition of the cannabis cultivation susceptible to court challenges. ”

Yet, in the law, we gave permission to the provinces to be able to regulate the age. Here we have two provinces in Canada — Manitoba and Quebec — who have put in provincial legislation prohibiting the growing of the plants at the homes. But yet here you talk about court challenges.

I would like to hear more on your comments here and how you feel where the court challenges would be on that.

Mr. Culbert: I think in Quebec and Manitoba, they’re likely susceptible to court challenges, but the federal law won’t be. We have a precedent set that you can grow a psychoactive substance. Tobacco is a psychoactive substance. You can brew alcohol, a psychoactive substance, in your own home. Under the medical regime, the B.C. superior court has been very clear that there should be no prohibition on home grow for medical purposes. The legal logic is that if it then becomes legal to use it for non-medicinal purposes, the ability to have a home grow.

Once again, I would prefer Canadians couldn’t brew alcohol or grow cannabis in their homes. Don’t get me wrong. But let’s be practical about it. I wish they also didn’t consume these products for their own health, but we need to be practical. That’s where we stand on that.

Senator Poirier: This question is for Dr. de Villa in Toronto. Again, it’s on the home growing issue. I know from my community and from the communities in New Brunswick — and we also heard it from other communities across Canada when we had the municipalities here — some of the challenges they seem to be facing or fearing with the homegrown cannabis. I’m just wondering, in a city as big as Toronto, do you have views on the cultivation as a safe approach to public health? What are you hearing out there? What can you share with us on that?

Dr. de Villa: Thank you very much for the question. I can certainly tell you that our partners within our municipality, other city divisions, particularly those who are responsible for enforcement of local bylaws and standards, have some concerns, absolutely, about that. As you can well imagine, within the context of a large city, enforcement and monitoring become part of the concern. I don’t know that all the answers have made their way forward. I think there’s still lots of conversation and consideration.

I’m going to turn it to my colleague. She’s been a little bit closer to some of those discussions with our partners in the municipality.

Ms. Sabanadesan: Thank you. I know it is within the provincial jurisdiction. We’ve been asking the province to consult with us in any forthcoming regulations so that there are standards for safety and other means to ensure that home growing doesn’t become something that we have seen in the past in terms of grow operations, cannabis. That has been the experience, but you cannot extrapolate the issues that came up with that with home growing of four plants, if that’s going to be the limit in Ontario. We’re still not sure. We are open to discussions to see how it can be done safely.

Senator Martin: Thank you very much for your presentations today.

I’ve been listening carefully to questions that have been posed by my colleagues. I’m not a scientist and I’m not a medical professional, but we did hear that there’s been about 30 years of data collected regarding cannabis use. It’s not the kind of fulsome data that you’re referring to that we will get once legalization occurs. As a 21-year educator, I have anecdotal examples of what the effects of cannabis can be on youth.

Mr. Culbert, you said we have to be careful. I absolutely agree with you.

Dr. Granger, you were talking about Canada being a model for the world and that the last five years of evidence of legalization in other jurisdictions is “meaningless” in terms of there’s going to be trial and error and we’re still trying to understand this. If we are to be a model to the world, based on what we even heard today, knowing what we know about the effects of cannabis is on youth aged 18 to 25, the effects on impaired driving — that’s another bill, Bill C-46 — I know we’re not ready as a country.

I’m just wondering: We know this is needed for various reasons, but are we ready now? Is this the time? Should we be taking a little bit of time to ensure that the impaired driving law and implementation is going to be ready, combined with Bill C-45? Knowing what we already do, do we need to just be more prepared so that whether it’s this summer or this fall is too soon for this law? I’m curious to hear the panel’s response to that. It’s just based on everything I’m hearing. I’m just so torn and really worried about using our youth and young adults as test subjects to collect this data that we need. I just don’t think we’re ready yet, but I’d love to hear your response.

The Chair: We’ll get a response from everybody. We’ve invited them. We’ll start with Mr. Culbert.

Mr. Culbert: I could spend an hour on this, but I won’t.

Cannabis is ubiquitous in our society already. In the 1980s, if you were a young person in the 1980s, you probably smoked cannabis. We have a lot of experience with this already. To delay legalization is really just a stopgap of allowing us to do the more positive work.

As far as things like impaired driving, 13 years ago the Canadian Public Health Association launched a driving campaign focused on developing resources for adults to have conversations with youth. We just relaunched it two weeks ago, updated the data.

A lot of things are going on. As D-Day comes closer, provinces and territories have to do their education campaigns to the public, education meaning what’s the law in our province and territory. That’s going to require high saturation — television, radio, social media, you name it. They’re all over it. The health promotion campaigns, which empower people to make healthy choices, are ongoing, and they will continue to ramp up. We’re developing all of those resources now.

I believe we are ready and that to delay simply delays the positive work that we can do that is required under a legalized framework.

Senator Martin: I’ll do one supplementary and then I would like to hear from perhaps Dr. Campbell.

We’re hearing from the RCMP they are not quite ready, especially when it comes to impaired driving. There needs to be more trained individuals to do that.

In terms of health education, we’re talking about still developing versus the education that should have started last year. We’re hearing different facts from various stakeholders and municipalities who haven’t yet been fully consulted.

So I guess that’s a comment to you, Mr. Culbert, but I would like to hear from Dr. Campbell, actually, on this question.

Dr. Campbell: I would like to point out that of interest is the latest research for medical uses and the guidelines for its use. As a family physician, if someone comes in with refractory nausea or vomiting from chemotherapy, spasticity from multiple sclerosis or last-line for neuropathic or nerve pain, which is a very specific type of pain, there is strong evidence for it. Otherwise, in a lot of cases, there’s actually evidence against it, as there’s shown to be a strong and consistent association with mood and anxiety disorders. My whole career is based around the best evidence and best care for the patients, and knowing what I know as a family doctor, I would use medical marijuana for those three purposes, and for other areas in pain I would use other medicines that we have available, or non-medicines.

Senator Bernard: I thank all of you for your testimony today.

I have one question for you, Mr. Culbert. In that 1 per cent that you talked about in your statement, you’re concerned because many of them are experiencing some type of trauma and that may be why they’re overly using cannabis. Can you speak more about how legalizing marijuana can help with addressing that 1 per cent and the issues that the 1 per cent may be dealing with?

Mr. Culbert: To be completely honest, I don’t think it does address it and I don’t think it can address it. It creates an environment where talking about cannabis use is okay for parents, for teachers, for social workers and so on. It’s not just the attitude of just say no, it’s illegal and you can’t do that.

What’s more important, and what I’m slowly seeing and trying to reinforce every time I speak publicly, is that when we’re looking at problematic use of a substance — and there’s a whole paradigm of use from non-problematic to problematic — it is just a symptom. We look at that and want to dive deeper instead of demonizing the substance. You can use other drugs, like alcohol and cannabis without danger unless it’s an inappropriate use of that when you’re trying to numb some kind of a pain.

Let’s change that dialogue so that it becomes a mental health conversation and a social conversation about how we use that. Absolutely crucial in all this is the role of parental modelling. Of course, this bill can do nothing about that, but parental modelling plays a huge role.

[Translation]

Ms. Granger: With regard to the uneasiness that exists — because your question brings us to that — I think we need to take action through prevention. We know that there are mental health issues within the context of this bill. But anecdotally, in the consultations that took place in Quebec, a street worker explained that if cannabis was legalized, we could finally discuss it openly with young people and look at those who have a problem. That is acting preventively. We must jump on every opportunity to do so, and we must also be on the look out for what can be done in this area. Thank you.

[English]

Senator Bernard: This picks up on the question that Senator Omidvar raised about the over-incarceration of people of African descent. We’ve heard a fair amount about that. What we haven’t heard about is the impact on the health of African-Canadian communities. I’m wondering if either of your organizations has looked at that. If you have evidence around that, it would be useful for us to get that from you.

Dr. de Villa: Thank you very much for the question. I have a couple of points. As I tried to make clear in my remarks, we talked about how criminalization has negative impacts at the individual level, whether we’re talking about stigmatization, negative impacts on employment opportunities and therefore economic status, et cetera.

While I did talk about those impacts at the individual level, you can well imagine when those impacts are applied and actually felt by a large number of individuals, particularly those who are associated or are a part of racialized communities, that it goes from an individual level to a community level. That too has negative impacts. Again, you would experience social stigmatization, negative impacts on income and employment, et cetera, both at the individual and social levels. I think you’re quite right that there are implications at the community level as well, and they mimic those that would be felt at the individual level.

[Translation]

Senator Mégie: My question is for Dr. Campbell. People are currently buying the product on the black market. When young people end up in ER in a psychotic state, do we have an idea of the amount of pollutant in what they have consumed or that could have induced the psychosis, even if the THC, as we know, induces it too? Was the amount smoked taken into account? Are all these factors considered in the emergency room?

[English]

Dr. Campbell: Thank you for your comment. I think that’s a very important thing to bring up.

There is a large amount of cannabis being used among young people today, even without legalization, and I think that is fact and well known.

My fear is that with the pending legalization, the attitude, thoughts and perception towards the substance will change and people will be more open to starting at a younger age without realizing the consequences. This is a bit out of my expertise, but I do think there will always be a bit of a black market regardless, and people will find cheaper ways of getting the cannabis.

When people come into the emergency department, we always document the amount they smoke, but it’s really on an individual basis. Every person is affected by different quantities of marijuana; one person could have a higher tolerance than another, and that’s variable. There are often lots of other substances involved, if cannabis isn’t the only one.

I agree that things aren’t perfect the way they are now, so I’m echoing what everyone else has said. Education is so important, as is limiting advertising and that kind of stuff.

[Translation]

Senator Mégie: Exactly, if it becomes legal, could the young person possibly know what he is taking? Because he takes what he is given. Say he took a 10 per cent concentration and had a bad trip. Next time, the kid could say he’ll take 5 per cent or something like that. Do you think that could have a positive impact in this sense?

[English]

Dr. Campbell: Absolutely. I think that is a good point. I think there are positives about the legalization, but just from what I know and what I’ve seen, there are some serious dangers with this substance used recreationally or medicinally. I don’t think anyone under the age of 25 should be using it. I think that it can ruin lives permanently, never get it back. I think our focus should be more on decriminalization, minimizing health risks, health promotion, just from the medical facts that I know. But I do think that that is one of the positive things that people do, that they are able to know exactly what they’re taking if they choose to take that substance anyway.

The Chair: That brings me to the end of round one. Before I go to what will be a brief round two, I’m going to insert a question here myself.

I want to pick up on those last comments from Dr. Campbell, because I’m concerned with this age factor. The legislation says 18. It can be adjusted to 19 to coincide with alcohol. Alcohol, taken in excess, is very dangerous as well, and I’m sure that back in the 1920s and 1930s, when they talked about lifting that prohibition, they probably said a lot of the same things you’re hearing in this debate today. Yet, we somehow came to grips with it, and the world didn’t come to an end.

But you talk about 25. First of all, we consider a person an adult at 18 or 19. Are we saying to somebody 23, 24, 25, “No, you don’t have the right? The government will make that decision for you, as opposed to you being mature enough to be able to make that decision yourself?” Yes, it could be bad for you, particularly taken in excess, but isn’t it right that the person who is considered an adult should have the right to make that kind of decision, hopefully fully informed and doing what is best for their own health?

Yesterday, the Canadian Medical Association and the Canadian Psychiatric Association said it should be 21. Well, that is not quite as much of an infringement upon adulthood as 25 would be, but, nevertheless, it is over what is considered to be the legal limit for voting, for just about anything else, making decisions as an adult, in this country.

I’m concerned because the cohort between 18 and 25 is the biggest single cohort in the use of cannabis. If we followed that guideline of 21, we would be talking about exposing people at 18, 19, 20, up to 21, to a situation where it is still criminalized. We’re trying to cut down on the criminalization of this, to stop sending our young people into prisons or stop giving them criminal records, ruining their lives because they get caught in possession of marijuana. Yet, we would be continuing to expose those people.

Not only would we expose them to criminalization, but we’re exposing them to the black market still because that’s where they’re going to get it. If this is the biggest cohort that uses it, they’re going to continue to get it from the black market. I just read the other day that three people were killed in Illinois from consuming cannabis that was laced with rat poison. Even if you decriminalize it, you still have to get it from the black market, and the black market is producing stuff that is very dangerous to people’s health and can kill them. We’ve seen that in the opioid crisis, where this stuff is laced beyond anything that can possibly be considered safe for people. So, if you don’t allow for the regulation of it, which is what the government is proposing, then you continue to expose them to that danger of contaminants and the danger of THC levels that would be beyond what is reasonable.

I’d like your comment about the age thing a little bit further. I’ll start with my friends in Toronto. Who knows? They may contradict me anyway, but I’ll start with them anyway and then come across the table. I don’t have much more left in my five minutes after I pontificated on it.

Dr. de Villa: So then we’ll be quick and say that, no, in fact, we’re not going to contradict you here in Toronto. We agree with you. We know that the use is most pronounced amongst young people. I don’t think there’s any question. The scientific evidence suggests that. Of course, if you can avoid use when the brain is developing, then that’s the best course of action. We know that the brain develops until age 25. But I think what we’re talking about is balancing out the risks and actually allowing for a more public-health approach rather than an enforcement-driven approach. I think, actually, just picking up on your points, senator, we would wholeheartedly agree with your perspective as you’ve described in your comments. I won’t call it pontificating.

Mr. Culbert: I agree with my colleagues and will pass along the time.

[Translation]

Ms. Granger: I think you are absolutely right, and I stress the blind spot that it would send as a message, that alcohol and tobacco are less dangerous products than cannabis, which is not the case.

[English]

Dr. Campbell: I would just like to agree that alcohol and nicotine have big psychosocial harms and physical effects. But I think that we should just remember that every substance is different, and we don’t need to compare them.

The Chair: Okay, thank you very much. My time is up.

On round two I have three people but two minutes, so maybe just a quick question from each one of you and we’ll take the answers all at once. So no answers until I get the three questions on the floor.

[Translation]

Senator Petitclerc: I would like some clarification from Ms. Granger about neutral packaging. Do you think the appearance of neutral packaging is just as important as the names that would be chosen?

[English]

Senator Seidman: I’d like to know, especially directed to Mr. Culbert, would you support a tightening of restrictions on advertising and promotion that’s in line with tobacco? Your statements from your organization have said as much, but I’d just like to hear it, if I might, on the record.

Senator Campbell: Mine is just a clarification in the interests of the real world. The marijuana you were talking about that was laced with rat poison was synthetic marijuana. It was made in China, and it has no semblance to marijuana. I just wanted to get that out for clarity.

The Chair: Thank you. I’ll ask Ms. Granger, first of all, and then Mr. Culbert to respond to the two questions from the two senators.

[Translation]

Ms. Granger: To give you a very short answer, Senator Petitclerc, definitely, yes.

[English]

Mr. Culbert: Yes, we would agree with a tightening of regulation.

Senator Seidman: In accordance with tobacco.

Mr. Culbert: Yes.

The Chair: We’re right on time. Thank you very much, to all five of you, for your contribution to this discussion.

We are now on to panel two on Bill C-45. We have one hour on this panel and we have three groups. First of all, from Rideauwood Addiction and Family Services, Marion Wright is the Executive Director and Andrew Mendes is Director of Operations; from the Pan-Canadian Joint Consortium for School Health, we have Katherine Eberl Kelly, Executive Director; and from the Canadian School Boards Association, Josh Watt, Representative, and Executive Director, Manitoba School Boards Association.

Welcome to you all. You have seven minutes for opening remarks. I take it Marion Wright will do it for the Rideauwood organization, so please get us off and under way.

Marion Wright, Executive Director, Rideauwood Addiction and Family Services: Thank you very much. Honourable senators, members of the Senate committee, on behalf of Rideauwood Addiction and Family Services Ottawa, we would like to thank you for the opportunity to speak with you today.

My name, again, is Marion Wright and I’m currently the Executive Director of Rideauwood Addiction and Family Services. With me today is Andrew Mendes, the Director of Operations at our agency.

From our perspective, with approximately 50 years, I’m sad to say, of experience in Ontario in leadership roles for addiction and mental health services and as a senior surveyor for Accreditation Canada specializing in addiction and mental health, I welcome an opportunity to speak about the pertinent issues related to Bill C-45 and how it may interact with individuals accessing Rideauwood services. I will also offer my main recommendations regarding the bill in question.

Today we will cover three topics: a brief description of what it is that Rideauwood Addiction and Family Services as a direct service provider in the community does; a report outlining the substances used by both youth and adults accessing Rideauwood services; and finally our conclusions and recommendations.

First of all, Rideauwood Addiction and Family Services opened in 1976 to support the Ottawa community affected by substance use issues. Early on, Rideauwood recognized that support was essential not only for people consuming substances but also for their families.

With those principles in mind, Rideauwood continues to align treatment programs adhering to best practices, including constantly reviewed evidence-based therapeutic models and ongoing development of partnerships and collaborations to improve client access and increase supports that are available to clients.

Rideauwood began offering services with a three-year pilot start-up grant from Health Canada and, over the past four decades, has established funding agreements to enable the organization to continue to support the community with specialized substance use services. Current funding is provided by the Champlain Local Health Integration Network, the Ottawa Catholic School Board, the Ottawa Carleton District School Board, the Ministry of Child and Youth Services, Ministry of the Attorney General, the City of Ottawa, Algonquin College and the Children’s Aid Society of Ottawa.

Our objective as an agency, a direct service provider, is to provide services to adults, youth, young adults, parents and family members affected by substance use and by problem gambling. Clients receive both individual and group counselling in addition to screening, assessments and referrals.

Additionally, in the interests of prevention and increased public education, Rideauwood offers regular education and information sessions to clients, family members, students, partner agencies and the community. All services are provided on an outpatient basis at various sites in the Ottawa region and, on the average, we serve approximately 1800 clients per year.

The organization’s programs are structured into three main departments: our adult programs, our parent and family programs and our youth and young adult programs. Evaluation and quality improvement initiatives have been recognized as being essential to supporting our clients and capture the valuable work accomplished by the dedicated staff at Rideauwood.

Rideauwood’s data demonstrates that 75 per cent of adult clients are accessing our services for problematic alcohol use — that’s adults — while 33 per cent of adult clients are accessing our services for problematic cannabis use. In terms of the youth demographic, 54 per cent of the youth are accessing our services for problematic alcohol use and about 65 per cent are accessing services for problematic cannabis use. Other substances are reported at lower rates, and of course some access services for using both alcohol and cannabis.

Adult and youth clients show some consistent differences in reported problematic use. Adult clients are most likely to only report alcohol use and youth are more likely to report cannabis use only or combined problematic use of cannabis and alcohol and other substances. Please note that in the graphs that you have in front of you, the illicit substances include non-prescription use of pharmaceutical drugs.

Over the past seven years, cannabis, alcohol and nicotine have been the substances of use most frequently reported by youth clients who are accessing Rideauwood services.

In short, substance use disorders are strongly affected by multiple factors, such as social, biological, psychological and emotional, and rarely are they in isolation. The disorder is complex and is diagnosed in DSM-5, the Diagnostic and Statistical Manual, in three main categories of mild, moderate and severe. The cannabis legislation is relevant for each domain, in particular for society and health.

Legislation changes have been taking place across multiple states in the United States, including Colorado, providing opportunity for academic and policy study. Hopfer 2014 from the University of Colorado has conducted an extensive review that confirms the unknown long-term health effects correlated to the change in legislation. One can expect an overall increase in the use of a newly legalized substance and, despite regulation, the available strains, potencies and consumption forms will require further study to truly understand the long-term health implications. Hopfer also concluded that public health, medical and scientific resources dedicated to understanding and reducing negative consequences of youth cannabis consumption need to be substantially increased to levels commensurate with those efforts for tobacco and alcohol.

At Rideauwood, adults and youth accessing services present for a multitude of reasons, but one that is more common is that they have become marginalized by their use and therefore experience barriers that limit and delay their recovery. Overcoming legal issues in addition to biological and psychological substance use is more arduous and demanding on the individual and the services available to assist them.

At Rideauwood, youth more often access services to receive support due to cannabis than for alcohol use. Nonetheless, the overall rates for use of alcohol are higher, as reflected in the recently published Ontario Student Drug Use and Health Survey of 2017. Youth attending our programs report an array of impacts caused by the use of cannabis, such as increased anxiety, decreased motivation and insomnia.

One should note the majority of youth using cannabis are not engaged in services. We’re talking about those who are engaged with us, and the general view of cannabis is that the substance is natural, safe and not addictive, and indeed, research has noted that youth who do not think cannabis presents risks are more likely reporting to have used the substances.

Furthermore —

The Chair: Sorry to interrupt, but if you could wrap up, please. We are well over seven minutes.

Ms. Wright: Okay. Number one, increased prevention and education is suggested as an effective measure to prevent and reduce problematic substance use. Approaches such as resistance skills training to teach students about social influences and the specific skills for resisting these pressures, alone or in combination with broader-based life skills, appear to effectively reduce substance use.

Increased treatment: Based on the possible health impacts and increased use of cannabis expected in the first years of legalization, we strongly advise that education, prevention and treatment are all increased and made more widely accessible.

Finally, our position is that we are certainly in support of Bill C-45. We talk in our brief about the WHO, which has called on countries to develop policies and laws that decriminalize drug use.

Finally, the evidence presented here to you today is grounded in both current literature and the experience Rideauwood has as a direct service provider over the last 40 years. Thank you.

The Chair: Thank you very much. We do have a written copy so we can pick up things you weren’t able to get to. We will also do that in questions.

Katherine Eberl Kelly, Executive Director, Pan-Canadian Joint Consortium for School Health: Thank you very much for the opportunity to be here today, honourable senators.

The Pan-Canadian Joint Consortium for School Health was established in 2005 as a partnership or a consortium of provincial and territorial ministries of health and education from across the country, working together to promote the health, wellness and achievement of children and youth in the school setting. All ministries of health and all ministries of education from 12 provinces and territories are members of the joint consortium, and we have support from the Public Health Agency of Canada. Quebec is not a member at the present time, but we do work collaboratively with them.

The Pan-Canadian Joint Consortium for School Health espouses a comprehensive school health approach, and the four components of this framework are helping to frame the dialogue and discussion that our member ministries of health and education are having around the legalization of cannabis.

All jurisdictions are feeling the time pressure regarding being adequately prepared to address and navigate the ramifications of cannabis legislation, and we’re waiting patiently for the promised materials from Health Canada that can then be used to develop provincial and territorial-specific materials.

Just as an aside, based on current data from the health behaviours in school-aged children study — of course, you’ve already discussed this earlier — Canada does rank among the highest in the world in regard to self-reported cannabis consumption among youth.

Looking at the issues through the four components of comprehensive school health, the first component is teaching and learning. What are we teaching children and youth in the classroom? We need to ensure that curricula are as current and accurate as possible regarding cannabis. It will still be illegal, of course, for youth to be in possession of cannabis, so we don’t see significant changes needed in the curriculum, but we do know that educators will need professional development to ensure the information they share with students is accurate and current. The approach in the curriculum, as with any substance, is primarily around strong decision-making skills so that they can make healthy and responsible choices.

The second of the components of comprehensive school health is to look at policy. We want to ensure that schools and school boards have the resources they need in a changing environment so that current school policies remain effective at addressing student possession and use.

The social and physical environment is the fourth component of comprehensive school health, and we want to be sure that we’re providing schools and students with accurate information to address and dispel common myths around cannabis use, i.e., that it is a natural product and not harmful. We want to distribute cannabis information to help, as our public health colleagues stated, normalize the conversation, but not consumption. We know that with legalization comes a certain amount of normalization. We have expressed concerns, of course, around the marketing and promotion, as you spoke a lot about in the previous session, because we feel this could be a big influence for youth.

Partnerships and services, so looking beyond the school walls and engaging partners such as parents and the broader community, other external stakeholders. We want to ensure that we do have timely information for parents so that they can have conversations with their children and youth. We want to make sure there are materials for principals, student support staff as well as materials in the curriculum. We want to ensure that there are resources to support the different groups so that it can speak to them most effectively, and we want to explore partnerships with external stakeholders to ensure cannabis information sessions are available.

Thank you.

The Chair: Thank you very much.

Josh Watt, Representative, Executive Director, Manitoba School Boards Association, Canadian School Boards Association: Honourable senators, it is with a sense of profound duty that the Canadian School Boards Association has accepted your invitation to share our views on Bill C-45, the cannabis act.

Our association represents over 300 school boards across Canada, with responsibility for the public education of close to 4 million students.

[Translation]

Among their many mandates, school boards strive to provide youth with the opportunity to develop in a safe and healthy learning environment that supports their academic success. We strive to educate young people to become informed, conscientious and autonomous citizens who will assume their position as active members in the development of Canadian society. Finally, we promote the importance of wellbeing and a healthy lifestyle through nutrition, physical activity and the prevention of substance abuse.

[English]

These mandates speak directly to the kind of outcomes that we hope all students will embrace. As such, many school boards cannot support what is being proposed under Bill C-45 in terms of the decriminalization of cannabis. We do, however, acknowledge that it is the intention of Canada’s current government to see Bill C-45 through to assent.

[Translation]

On November 15, 2017, in anticipation of upcoming events, our association released its Declaration from Canadian School Boards on the Impacts of Cannabis on Schools. We have provided the committee with translated copies of this declaration to help inform your work on Bill C-45.

[English]

In the months that have followed release of the CSBA declaration, school boards and their provincial associations have been consulted as critical new legislation has been introduced. From risk and harm reduction measures to safe and responsible retail sales and strengthened provisions to address impaired driving, many of our stated concerns are currently being addressed nationwide.

In addition, the Canadian School Board Association gratefully acknowledges that under the scope of Bill C-45, a far greater number of criminal offences is proposed, many of which speak directly to the protection of our youth. School boards certainly appreciate such efforts.

[Translation]

Notwithstanding such measures, school boards remain concerned. According to the World Health Organization, Canadian youth rank highest in the developed world in terms of the consumption of cannabis, even as the Canadian Mental Health Commission has recently estimated that up to 25 per cent of youth suffer some form of existing mental health problem or illness. Canada now also faces a considerable opioid epidemic that further endangers and frustrates our efforts to promote substance-free lifestyles for the advantage of our students.

[English]

Within this overall context, Canada’s current proposed legal framework for addressing cannabis, including Bill C-45, fails to address many key issues. As an association, we wish to highlight some of these.

The first concerns the protection of children in private dwellings. Nothing that has been proposed under Bill C-45 would prevent use of cannabis in residences where children may be present. Similarly, no provision will mitigate against secondary exposure to cannabis by children who reside in dwellings such as apartments, condominiums or even provincially funded public housing facilities.

[Translation]

This challenge speaks to the need for balance between government regulation of public versus private spaces and the right of governments to impose legal restrictions upon the private sphere of activity. However, for us, it is paramount that a responsible duty of care be set under Bill C-45, so that the rights and best interests of the child remain public policy objectives.

[English]

Second, we are concerned in respect of the possibility for minors to gain employment related to the production, distribution and transportation of cannabis. Standards, laws and regulations for retail sales also vary from province to province in terms of whether minors can assist with the sale of cannabis, such as they do for tobacco. These dimensions also ought to be addressed under the scope of Bill C-45.

[Translation]

The third challenge resides in the fact that Bill C-45 provides for online retailing of cannabis. While a number of school boards have been assured that age verification will be enforced, no plans have yet been announced in order to prevent minors from accessing cannabis through online merchants.

[English]

Last is the need for investment in youth-targeted public awareness campaigns. School boards nationwide have been working proactively with ministries of education and health to promote enhanced curricula. These efforts aim to ensure that the “just say no” message of yesteryear is rebranded and accentuated for today’s youth.

[Translation]

However, jurisdictions have limited revenues to carry out such projects. In addition, some have already acknowledged that the lion’s share of any taxation revenues that can be expected from the sale of cannabis will require investment in health and justice mandates to mitigate the anticipated outcomes of decriminalization.

[English]

As I mentioned, these are just some of the many key challenges that have been outlined in our brief to the committee. We hope you will take these under advisement.

[Translation]

In 2002, the Senate of Canada released the final report of the Special Committee on Illegal Drugs. The testimony of the many Canadians led to some specific recommendations that are still relevant. Many of those recommendations have not been included under Bill C-45 or under other current plans. It is very important to refer to that study, as a reminder of the preconditions that were established by senators themselves, if decriminalization were to ever take place in Canada.

[English]

To conclude, honourable senators, we would invite you to stand alongside Canada’s school boards as we look to the future in hopes of preparing future generations to inherit an even better Canada. Please recognize that this present generation of students will help usher in the dawn of the 22nd century. What this country looks like between now and then, and the challenges they may face, depends upon the decisions we make today, decisions that we trust will be for the betterment of our youth and that will help promote their personal, physical and cognitive integrity.

In respect of Bill C-45, the Canadian School Boards Association therefore encourages the Senate to dutifully exercise that sober second thought, la réflexion sage, that has always been its guiding standard. We believe that this same standard of sobriety is Canada’s right to expect from all of its citizens. Thank you.

The Chair: Thank you to all three organizations. Senators, we’ll try five minutes. It will be tight here, so I might revise that a bit. We have until 1 o’clock.

Senator Petitclerc: Thank you very much for your presentations.

My question is for all of you. Like many, when we started to study this bill, I was quite disturbed to learn that our youth are among the largest consumers of cannabis in the world. I will not ask you the question to which I did not get an answer, which is “why.” That’s another talk.

One of the things that comes up often — and you’ve all mentioned it — is the importance of awareness and education. We had the minister here, and I was a little concerned that I was not really aware of what was happening in terms of awareness and education. I did not see much of it. I was reassured that it’s because I’m too old. I wanted to ask you, because you do work with the younger crowd, if you feel that we have done enough awareness and education at the moment. Also, how do you feel about the added commitment of funding for awareness and education this government has promised? Do you feel it will be enough? In general, how crucial will education and awareness be?

The Chair: I’ll start with where we started with opening remarks, with Marion Wright. Andrew Mendes, if you want to be part of that answer, that’s fine as well.

Ms. Wright: Thank you. In answer to the last question you asked, senator, no, there are not sufficient resources applied to education, primary prevention and early intervention. One of the things that research has demonstrated quite clearly in our experience is if you can delay the onset of youth using cannabis, that is certainly a very strong strategy to have. We have education starting in Grade 6, and we still think it ought to be even earlier in all the schools, in the Catholic board and the public board. The answer is “no” to your critical question about there being sufficient resources for prevention, education and early intervention. Those are also really important areas.

Ms. Eberl Kelly: I agree that there are not enough resources, and this topic has been raised by all of our member ministries of education as well; namely, that we do need up-to-date resources. I think Health Canada is working on those — I’ve been at some stakeholder engagement sessions — and I know the Canadian Public Health Association has some materials as well. We need to get those so that they speak to youth, and the engagement of youth in the preparation of the materials is really important. That’s key.

With regard to the number of youth, of course, there’s much speculation about this, but we have to remember that it is a self-report. It’s possible that Canadian youth feel more open to reporting or maybe they truly are using more, but it’s always that balance.

Mr. Watt: I would echo what my fellow presenters have said in terms of the lack of resources that are currently proposed. There are substantial efforts being undertaken in order to increase awareness among youth in particular. Going forward, in a post-decriminalization world, it will become very important for resources to be provided, especially in the context of what I had mentioned before: those children who live in residences where parents or caregivers may opt to use the substance in front of them. Modelling behaviours will become very important across society as a whole.

We’re doing our part, just as an example, in Manitoba. We recognize that there are insufficient resources at the provincial level. The Manitoba School Boards Association is working with our parent councils association to develop fact sheets on talking to your kids about cannabis, which is aimed at parents because we realize that, in addition to a youth audience, we also have to speak to parents.

Senator Seidman: Thank you all very much for your presentations.

I’d like to begin by addressing my question to you, Ms. Wright, if I might. I’d like to try to get down to the ground level because I think that’s what your agency does. You have counsellors on the ground in the schools every day, I believe, who help youth. I’d like to try to understand that, because there are a couple of things you mentioned in your presentation that are worrisome, and it’s not something that we haven’t heard before.

First of all, you say that, at Rideauwood, youth more often access services to receive support due to cannabis use than for alcohol use. Then you go on to say that for the majority of youth, their general view of cannabis is that the substance is natural, safe and not addictive, and that the research has noted that youth who do not think cannabis presents risks are more likely to report using the substance.

I’d have to say that this is rather alarming, given the fact that cannabis will be legalized and young people might see that as an additional licence to use cannabis. In fact, there was Statistics Canada data that came out yesterday of the first three months of their ongoing attempt to establish a baseline of use in Canada, and that data showed that 25 per cent of those who currently use cannabis say they will increase their use, that is, use it more frequently, after legalization. That’s in Statistics Canada data in an attempt to establish a baseline before legalization and after legalization. The first three months came out yesterday.

I’d like to ask you, given what you present to us, what are your own concerns in this regard in terms of more frequent use in the schools? What do you see on the ground? What would you suggest to us could be the biggest issues, and how would we deal with those?

Ms. Wright: Thank you very much for your question.

You’ve mentioned the school-based program where we’re present in all the schools every week throughout the school year in the Catholic, public and French boards. I think one of the things we see on the ground is that it’s increasing access by taking the counsellor and the services to where the clients are. They don’t have to engage in any kind of difficult or face-saving kind of behaviour to come and get early intervention or early treatment, if necessary. It’s easier for them to do it when we take our services to where they are as opposed to simply handing out something, expecting them to read it and then make the effort themselves. As you and we say, they may not think that it’s as challenging a problem as many researchers indicate that it is. That’s one thing.

I think the other thing is that when you look at use of substances in a young population, they tend, by and large, to have problematic use when there’s more than one substance that they’re involved with. The other substance tends to be alcohol, and it also sometimes tends to be nicotine as well. Even though we do have an opioid crisis, those data points have not really increased in that population, although the consequences certainly have been very tragic.

I’ll turn it over to my colleague, Andrew, to answer further.

Andrew Mendes, Director of Operations, Rideauwood Addiction and Family Services: Thank you, senator, for the question.

With regard to the general perception of youths regarding the harmful effects of cannabis, keep in mind that the research provided is from the general population, which then affects the perception and the actions that youths may take in order to begin consuming a substance. When youths begin to access services such as ours for prevention and education, that has already shifted. They start recognizing some consequences and some impacts that the substance is creating. But the general population, that larger number of people consuming — and that will consume the substance — are the ones who carry the general view of the harmless effects of the substance. The same happens with alcohol, where the majority of the population sees alcohol as harmless when it’s equally or more harmful in many other ways.

This is where we stress the need to intensely review our education approach towards substance use in general, not just cannabis but overall, and provide youths with factual information that translates into today’s reality.

Senator Omidvar: I have first a comment and a clarification, and then a question to you, Ms. Wright.

I think I heard you say that you expected cannabis use amongst young people to go up post-legalization. The experience from Colorado tells us differently, where the National Survey on Drug Use and Health found that the use of cannabis in Colorado dropped for young people aged 12 to 17 from 11 to 9 per cent.

My question is about the Rideauwood data that you presented, indicating that 75 per cent of adult clients are accessing services for alcohol and 33 per cent for cannabis use, while 54 per cent of youth access services for alcohol and 65 per cent for cannabis. Those are absolute percentages. What’s the size of your data set?

Ms. Wright: The data set is in the thousands over the course of a number of years.

Senator Omidvar: Could you provide us with that information?

Ms. Wright: Yes, we could, in more detail, absolutely, senator.

The other thing I’d like to do is comment, for clarification, on the Colorado data. We see trends going up and down, and I think that it might be an error for us to think that because it went up, it meant that it was going to continue going up. I think it will go down again, as Colorado showed, as well.

In fact, we’ve shown through our Project Step here in Ottawa that cannabis use has decreased when individual students have accessed the services, because they realize from talking to our staff that, my goodness, there are some challenges in using substances. But they also develop the skills to be able to resist using more or to stop using.

Senator Omidvar: Mr. Watt, you raised a very interesting point for me, which is the possibility for minors to gain employment in the market, and you’re recommending that this dimension be addressed under the scope of Bill C-45. However, labour and employment law is provincial jurisdiction. The way the government is proposing to deal with illegal possession and sale is if young people under a certain age are caught with cannabis over 5 grams, they will be criminalized. Do you think that is enough? Would you add something to it to prevent something that I think is an important point, and that is, the potential for employment in an ongoing illicit market?

Mr. Watt: When tabling that particular recommendation, it’s in full recognition of the division of jurisdictional responsibilities and authorities between federal and provincial when it comes to matters of employment. In respect of retail, that is exclusive provincial jurisdiction. The comment was made simply that practices do vary from province to province in respect of having minors who do assist with the retail of tobacco products currently. In some provinces, they are allowed to sell as long as the person who is purchasing the product is the right age of consumption.

When it comes to employment in production facilities, however, we believe that’s an important loophole that has not been addressed to date. It’s true that the criminal offences that are proposed under Bill C-45 would inhibit a young person, if they were to be employed in such a facility, from possession of the good. That said, it was a consideration for us, especially when it came to production facilities themselves.

Senator Poirier: Thank you for being here. I guess my question will be to Mr. Watt at the end of the day, but I’m going to be including Ms. Wright in my comments.

In the last year or so, I had the opportunity to meet with high school students in my province of New Brunswick, and obviously the question became cannabis and the law coming in. In that discussion, I realized a lot of the students felt the risk of normalization or they were saying that if it’s going to be legal, then it’s okay; there’s nothing wrong with it. Ms. Wright, in your remarks, I saw that you pretty well spelled out exactly what I had witnessed personally at the school when I was there. The students say they feel that there’s no big deal driving or taking it. It will be legal. It’s completely safe.

Being involved with the Canadian School Boards Association, Mr. Watt, in your experience in working with these youth, do you see that the normalization of consuming cannabis by our youth as an unintended consequence of this legislation?

The second part of my question is that I also realize Ms. Wright talked about all that they’re offering in the school system and being there for helping with the families and the addiction, but in rural New Brunswick, where I’m living, and in even the more rural, remote areas of Canada, I’m wondering where they are going to get this service of addiction and family services in a timely fashion as they do in the cities and in urban Canada. Do you have any concerns with that?

Mr. Watt: I’ll go first. It is a grave concern for school boards that the use and consumption of cannabis do become normalized over time. As mentioned in our remarks, in 2002, when the Senate did its study, the Special Committee on Illegal Drugs, the statement was made that at no time should the decriminalization of cannabis lead to such a social normalization in terms of the use of the substance. I think that was an important recommendation.

One of the major recommendations coming out of the study that the Senate realized at that time — it was 16 years ago; it was not that long ago — was that the Government of Canada should adopt an integrated policy on the risks and harmful effects of psychoactive substances covering the whole range of substances, including cannabis, medications, alcohol, tobacco and other illegal drugs, with a focus on educating users, detecting and preventing at-risk use and treating excessive use.

I was a page in the Senate when that report was released, so I was there when the testimony was given. It was very clear that these recommendations were being posited with reference to youth in particular.

It is a concern for Canadian school boards in terms of a social acceptance of cannabis use as a result of decriminalization.

Senator Poirier: On the second part of the question about the accessibility to addiction and family services, does that give you any concern? We know it’s available in urban Canada, but when you get to rural Canada and even very remote rural Canada, the longer you wait for the service, the less service is available there. Do you have concerns with the appropriate time frame to give the service so the families that need it will have it?

Ms. Wright: I’ll turn this over to my colleague, Andrew Mendes, as well.

I think you also heard me say that even though we have this lovely resource here in an urban centre, it is still not adequate or sufficient to be able to effectively deal with substance use of several kinds in the youth population and the young adult population. So even though we may have more than you would in a remote rural area in New Brunswick, it is still not sufficient. That’s why our recommendation is enhanced resources not only for treatment — and that’s really important — but also early intervention, primary prevention. And rurally, it’s really important.

I think the other point that my colleague made is the important role of involving youth in how to engage them in early intervention, primary prevention or education. What we may think is really a great way of doing it may not be adopted at all by youth. We also have to look at what is effective. There is some very good research that comes out of the Ontario Centre of Excellence for Children and Youth Mental Health. It’s all around engagement. They have youth involved everywhere. I think we can learn from each other collaboratively about how to do this critically important piece.

[Translation]

Senator Mégie: My question is for Mr. Watt and Mrs. Wright. We received a witness who said that in their city, they started — not because of cannabis, but well prior to that — to educate young people on drugs in general, such as hard drugs and cannabis. This initiative has helped the city lower its rate of drug use, which is entirely to its credit.

Would it be better for school workers to be nurses rather than social workers for prevention and support? Or should it be the responsibility of other Rideauwood Addiction and Family Services resources?

[English]

Ms. Wright: I think a more collaborative, comprehensive, integrated approach is what we need. We need the social workers, psychologists and nurses that public health has in the schools, but we also need counsellors who are trained in how to engage and how to build the appropriate skills using cognitive behaviour therapy or other types of techniques and can motivate youth to engage in safe behaviours. Just one single approach is not going to be adequate. We do need to have many arms, and certainly the educators and parents are critical because they are still the parents, even if the youth is engaging in things that they would prefer them not to be engaged in.

[Translation]

Mr. Watt: To answer your question, senator, in rural Canada and in Canada’s far north, it’s very difficult to access these resources needed to promote due diligence in preventing and reducing dependence.

For us, it is important that the template be collaborative at all times, while bearing in mind that the school system in Canada cannot be the only support. Resources are currently too few to meet this great need. As I mentioned, up to 25 per cent of young people have mental health issues that have nothing to do with drug and alcohol use. It is very important that we work closely with all health organizations to prevent addiction.

Senator Megie: Could you tell me what you think about the fact that many people say that, once it is legal, all young people will feel that it is normal to use cannabis. If prevention, awareness and support campaigns focused on drugs in general rather than just on cannabis, would this help make young people understand that cannabis is legal, but is just as harmful as the other products that are illegal? In the minds of young people, could this prevent normalizing its use?

[English]

Ms. Wright: I will look at the wonderful work that’s happened with our youth around nicotine and alcohol. Now, it may have taken a decade or so to move from what we used to do to what we’re doing now, but certainly those have been very effective. Both are legal substances, both have health implications, and I think the smoking cessation approach that’s been taken across the country is something that we should try to mirror when we’re looking at cannabis.

The Chair: We’ll head into round two.

Senator Seidman: Ms. Eberl Kelly and others have referred to harm reduction. I think you’ve all talked about it. First of all, we know that other jurisdictions, like Colorado, for example, recommended Canada implement public health education campaigns well in advance of legalizing marijuana. So here’s the concern about public education and these kids and the dangers and harms around marijuana use. You’ve already said that school boards need more resources, and in fact, Mr. Watt, you said school boards shouldn’t be the only resource because you’re already running thin. What other harm reduction strategies would you recommend in the school setting? Perhaps we could start there. I might start with you, Ms. Eberl Kelly.

Ms. Eberl Kelly: The Joint Consortium for School Health is all about a population, a prevention approach. We recognize fully that there will always be needs for clinical interventions, but all of our tools and resources are based on that health promotion, good decision-making, healthy relationships, having a school environment that supports engagement of students, learning of students and making good decisions. I am not an expert in what clinical resources would be most appropriate, but I think supports and a collaborative approach to providing students with information and engaging with them and having that conversation is what our members would support.

Senator Seidman: Thank you.

Mr. Watt, you talked about harm reduction several times in your presentation. What other harm reduction strategies would you recommend in a school setting?

Mr. Watt: I think, for the lack of a better term, and a statement that’s been used too often, it truly does take a village to raise a child. Because of that reality, multiple agencies are going to be needed and required to help us in responding to the perception that legalization will normalize cannabis, but also again situated in this larger context of other drugs and substances.

I think it’s important especially for the health sector to come alongside of school boards in terms of the delivery of supports and services. Country wide, for family service agencies as well, which are at the front line of those instances where children are remanded into the custody of the Crown due to parental substance abuse, it will be very important to buttress the supports and services that are provided by social workers under those auspices.

This is a multi-pronged approach involving many different actors, and again, to cite the example of Manitoba, we’ve seen how important it is for our public insurance for vehicle registration to come alongside of us because they have launched a proactive campaign to raise awareness of the dangers of driving under the influence of drugs. So even agencies like that are important, and truly it will take a multi-pronged approach.

Mr. Mendes: Thank you for the question.

I could add in terms of harm reduction interventions that we need to be thinking from the youth perspective and again reviewing all of the education now that is provided and provide them with education that does match today’s reality and today’s youth behaviours.

Like my friend was saying, we need to focus on programs that go beyond the school and are making links and connections with after-school programs and after-school community-based services of prevention and so on, such as what Rideauwood provides, but, of course, Rideauwood is a really small example here in the capital region.

The other big piece around harm reduction is the legislation itself. That’s quite a big spring for harm reduction. Cannabis, as it’s illegal, and as it marginalizes youth, and as it’s accessed through illegal sources, it’s also putting youth at risk and at the opportunity of using other substances. We see a large number of youth with underage drinking and where they may underage drink and not use other substances, or not report use of other substances, while cannabis use reports in the youth population is strongly also associated with the use of other substances. We strongly believe that this strong association has to do with the sources of access of this substance are all illegal and usually are attached to a whole set of other subcultures of illegal behaviour.

A big piece around harm reduction is the legislation itself and, again, augmenting the existing education programs and reviewing those in addition to after-school programs that give youth outlets to not feel the need to access the substances.

Senator Seidman: You’re emphasizing prevention as well.

Mr. Mendes: Emphasizing prevention, yes.

Senator Seidman: A major piece of work to be done.

Senator Petitclerc: I have a question for all of you that I realize maybe has to do with provinces. While we have you and you are dealing with the schools and the students and our youth, I’m wondering how worried or if you are worried about proximity of distribution of cannabis to the schools. The reason I’m asking is we are aware of one province that will authorize it at 100 metres, which really is a 40-second walk. That kind of resonated with me. Do you have a distance that you feel would be recommended?

Mr. Watt: I can start off with this, because it’s an issue that speaks directly to our interests.

Proximity is a provincial authority and has been delegated increasingly by the provinces to the municipal level of government in terms of zoning bylaws as necessary to establish retail buffer zones. We don’t have advisement on what a safe distance would be from a school, but we are very concerned in terms of retail facilities opening in direct proximity to schools and also to other areas that children frequent such as parks, playgrounds, recreation facilities and child care centres.

Two weeks ago in Ontario, it was reported that one of the first stores in that particular province opened up right next to a school. Premier Kathleen Wynne was shocked that this had managed to occur notwithstanding provincial regulations that provided to the contrary.

Those types of things and developments occurring are of grave concern to school boards. It does pose a special challenge, especially given the fact that when you look at school board jurisdiction and municipal jurisdiction, oftentimes there are multiple jurisdictions that overlap. What has really become the standard as a result is that school boards will have to talk to multiple municipal catchments in order to ensure that proximity remains the same and that students are protected from exposure to cannabis.

Ms. Eberl Kelly: I’m certainly not an expert on this, nor could I speak for all the members of the joint consortium. Surely it points to good control around purchasing and who can purchase.

Ms. Wright: I agree as well with my colleagues, but I would like to say something about proximity that’s a little bit off your question, senator. When we move from criminalizing to decriminalizing cannabis, we are also changing proximity to other illicit drugs, and some of them these days are extremely lethal. When you look at a youth or a young adult as to where they might get their cannabis, they might also get other things there that would have more deleterious effects. It’s not a proximity answer, really, but I wanted to get that in.

The Chair: It’s an important point.

Ms. Wright: Yes.

The Chair: We have reached the end of our time. Thank you to all four of you for being here and providing us with further information that will help us in our deliberations on Bill C-45.

(The committee adjourned.)