Proceedings of the Standing Senate Committee on
Social Affairs, Science and Technology
Issue No. 44 - Evidence - May 24, 2018
OTTAWA, Thursday, May 24, 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 10:30 a.m. to continue its study of this bill.
Senator Art Eggleton (Chair) in the chair.
[Translation]
The Chair: Welcome to the Standing Senate Committee on Social Affairs, Science and Technology.
[English]
I’m Art Eggleton, a senator from Toronto, chair of the committee. I’ll ask my colleagues on the committee to introduce themselves.
Senator Omidvar: Ratna Omidvar, Ontario.
Senator McCallum: Mary Jane McCallum, Manitoba.
Senator Dean: Tony Dean, Ontario.
Senator Deacon: Marty Deacon, Ontario.
Senator Manning: Fabian Manning, Newfoundland and Labrador.
Senator Neufeld: Richard Neufeld, British Columbia.
[Translation]
Senator Poirier: Rose-May Poirier from New Brunswick. Welcome.
[English]
Senator Seidman: Judith Seidman, Montreal, Quebec, and deputy chair of the committee.
The Chair: We continue today on Bill C-45, An Act respecting cannabis and to amend the Controlled Drugs and Substances Act, the Criminal Code and other Acts. Our particular focus with the two panels we have for this morning is medical cannabis.
On the first panel, I’m pleased to welcome, from the Canadian Pharmacists Association, Phil Emberley, Director; and Jean Thiffault, Member, President, Association québécoise des pharmaciens propriétaires. From the Canadian Association of Medical Cannabis Dispensaries, we have Jeremy Jacob, President. From Tilray, we have Philippe Lucas, Vice-President, Global Patient Research and Access.
Welcome to all of you. I would ask that you give us some opening remarks. I think Mr. Emberley and Mr. Thiffault are going to share their time. The opening remarks are up to seven minutes, and we’ll start with the two of you.
Phil Emberley, Director, Canadian Pharmacists Association: Good morning, and thank you for the opportunity to be here today. I’m a practising pharmacist here in Ottawa and the Director of Practice Advancement and Research at the Canadian Pharmacists Association. I’m joined by Jean Thiffault, pharmacy owner in Laval and President of the Quebec Association of Pharmacy Owners.
We’re here today on behalf of Canada’s pharmacists who are medication experts and who ensure that medications are safe and appropriate for every patient we see. We check for and resolve potential drug-related problems, address side effects and work with patients to ensure their medications are right for them.
First off, I’d like to say that we are generally supportive of Bill C-45. We believe the bill provides the necessary protections and takes a public health approach to the legalization of recreational cannabis. We are here today because of what’s missing from the bill. We’re concerned about the impact of cannabis legalization on patients who are taking medical cannabis for pain, epilepsy, MS and other conditions. If the legislation doesn’t appropriately consider the medical cannabis stream, it will be a huge disservice to our patients.
We’re therefore going to focus our remarks today on the separation of medical and recreational cannabis, and the role for pharmacists in medical cannabis therapy.
On the topic of different streams, there are over 270,000 patients registered to obtain medical cannabis in Canada. These patients have unique needs that differ from those of recreational users. Medical users might need strains and forms to alleviate symptoms and minimize intoxication, like those available through cannabidiol. These patients also need clinical supports, like those they would receive with any other medication therapy.
While the Canadian government has signalled its intent to maintain two distinct streams, until now it has focused almost entirely on regulating the recreational market without much consideration for cannabis patients. The proposed regulatory approach essentially maintains the current status quo for medical cannabis under the Access to Cannabis for Medical Purposes Regulations, or ACMPR. This will make recreational cannabis easier to access than medical cannabis and risks pushing patients into the recreational stream.
Currently, when patients receive a medical document for cannabis, access is strictly available through mail-order licensed distributors or by personal cultivation. There will be little incentive for patients to continue to access cannabis this way once recreational cannabis is widely available in retail stores, especially since the government has indicated that it wants to impose a similar taxation framework for both streams.
If easier access pushes patients to the recreational cannabis stream, they risk losing all medical oversight and increase their chances of complications. We need to ensure that medical cannabis patients are supported and protected through a distinct medical stream and incentivized to continue to use this stream once recreational cannabis is legal.
[Translation]
Jean Thiffault, Member, President, Association québécoise des pharmaciens propriétaires, Canadian Pharmacists Association: Thank you for allowing us to speak on behalf of pharmacists across the country, and particularly those in Quebec, where there is a consensus within the entire industry on the issue of the distribution of medical marijuana in pharmacies. Indeed, both the Ordre des pharmaciens du Québec and the pharmacists we represent share our opinion that medical marijuana should be distributed under the supervision of a health care professional. This position is also supported by Quebec politicians, the various opposition parties and even by Minister Lucie Charlebois, who herself said she supports our approach.
The distribution of medical marijuana in pharmacies is also echoed by the public and by patients. According to a February 2016 survey, 52 per cent of Canadians want medical marijuana to be distributed through pharmacists. According to a survey conducted last December, 75 per cent of the Quebec population would like the sale of medical marijuana to be clearly regulated by structured and credible networks, and only 4 per cent of Quebecers believe that medical marijuana should be distributed by mail, as it currently is.
For us, because of the possible effects and interactions of medical marijuana with other drugs, there is no doubt that only pharmacists are adequately equipped to provide professional supervision and that the current postal distribution must be stopped. We believe that, because medical marijuana is prescribed by a physician, it must be considered in the same way as any other prescription product, which means that it must be dispensed by a pharmacist who will then ensure therapeutic follow-up and integrate it into the user’s patient record. By having access to the patient’s complete pharmacotherapeutic profile, thanks to the pharmacy record, but also to the Health Québec record, not only can pharmacists follow up with patients, but they can also better advise them.
Let’s also remember that marijuana, like any other prescribed product, has different characteristics that only a pharmacist can contend with. Examples include veterans suffering from post-traumatic stress disorder or patients with mental health problems for whom therapeutic cannabis is a third or even fourth line of treatment, but who also take many other medications. There is a real danger associated with drug interactions, contraindications and side effects, and the pharmacist is equipped to deal with these situations.
In addition, it is important to remember that the pharmacy network is a rigorously secured and fully computerized network throughout the supply chain, which allows for security and traceability that are far from being as optimal with the current postal distribution system. In this sense, the narcotic and opiate monitoring surveillance systems already in place in pharmacies are the best tool to protect patients’ confidential data and allow clinical surveillance of diversions, multiple prescriptions from multiple physicians and over-prescriptions.
[English]
Mr. Emberley: Thank you again for the opportunity to represent Canadian pharmacists today.
Pharmacists are committed to ensuring that our patients have access to appropriate medication therapy and that their therapy is safe and effective. As we move forward with the legalization of recreational cannabis, we are asking the government to ensure there is a clear differentiation between the recreational and the medical cannabis streams, along with incentives for patients to remain in the medical cannabis system. We further believe that pharmacists are untapped resources who should be used to strengthen the medical cannabis stream through appropriate dispensing and clinical oversight, as we do for all other medications.
Thank you, and I would be pleased to take your questions.
The Chair: Thank you very much. Next to present will be the Canadian Association of Medical Cannabis Dispensaries.
Jeremy Jacob, President, Canadian Association of Medical Cannabis Dispensaries: Thank you, senators, for the opportunity to address this room.
For full disclosure, in addition to my role with the Canadian Association of Medical Cannabis Dispensaries, I’m also a mechanical engineer with 15 years working in the renewable energy sector. I’m the father of four adult daughters, and I’m also the co-founder of the Village Bloomery, a medical cannabis shop in Vancouver, B.C.
CAMCD was formed in 2011 to provide patients with safe, affordable and consistent access to cannabis, and to transition the businesses that serve them into the regulated market. CAMCD represents morality, ethics and compassion.
CAMCD participated in the creation of Vancouver’s medical marijuana bylaw program. We were invited to sit with the federal task force, and we’ve been engaged at multiple levels of government throughout this process and have submitted numerous papers to government.
CAMCD is self-regulated by publishing the only dispensary operating guidelines in Canada. With this as our guide, CAMCD dispensaries have enacted the highest standards for cannabis retail in Canada.
We applaud the federal government for its pursuit of recreational cannabis legalization and for its inclusion of storefront retailers in the program. However, the absence of regulations for medical cannabis storefronts remains an unfortunate omission in Bill C-45.
We have four key requests to ask of the Senate: to create an excise tax exemption for medical patients and allow the exemption to be exercised at retail storefronts; to improve patient access through medical storefronts and product diversity; to encourage the transition of as many existing industry participants as possible into the regulated market; and to ensure that amnesty and expungements are part of cannabis legalization.
The first point we make is that an access gap has been created due to the lack of regulated medical storefront access and the MMAR, MMPR and ACMPR programs. Canadians living in areas where they have access to community dispensaries have overwhelmingly chosen this avenue as their access to medical cannabis. The face-to-face interaction, the product diversity and the real-time availability of helpful information and access to products are key reasons storefronts were able to close this access gap.
These are essential elements in helping consumers to understand the use of cannabis products and to gain the best wellness outcomes. In the regulated system, with no excise tax relief and no cost coverage through the federal medical program, many Canadians will seek to continue gaining access for medical reasons through regulated recreational storefronts.
Our recommendation to address this access gap would be to provide patients with an excise tax exemption and to allow them to use it at regulated retail storefronts. In addition, an education program is needed for practitioners to increase their knowledge base and to feel more empowered to grant access to patients.
To ensure a successful regulated program, the regulated program has to emulate the unregulated. The industry in B.C. was allowed to evolve over time, based on listening to the needs of people. It’s imperative that consumers can find the complete range of products currently available in the unregulated market within the regulated marketplace or they’ll return to these unregulated market sources.
Regarding high-potency flowers, extracts and other products, we strongly recommend against restrictions on these. We need to trust Canadians to make responsible decisions for themselves as they do with every other product available to them. High-potency products are critical for those dealing with chronic pain and cancer, and they are especially relevant when countering opiate use. Ingested doses of 50 to 100 milligrams are quite commonplace for patients transitioning from opiates to non-toxic, non-lethal cannabis. Lack of availability of higher-potency products runs the risk of leaving patients without the effective tools that are serving them now and will exacerbate the opioid crisis rather than providing viable harm-reduction options.
Five years to review the medical cannabis program is too long for patients to wait, and we ask the Senate to amend Bill C-45 so that the medical program is reviewed in full in not more than a year. We ask you to please ensure that patients have storefront access, product diversity and broadened education for practitioners.
Now on the transition point, B.C. has a mature and robust cannabis industry that is a key economic driver in the province. Regional economies across B.C. depend on cannabis for their economic stability. This industry is larger than forestry, fishing and mining combined in B.C. It’s the single biggest cash crop in the province, and the majority of participants in this industry are otherwise law-abiding citizens. This is according to a Justice Canada report that I know has been brought to the attention of the Senate by other speakers. Many of these industry participants are eagerly awaiting a transition opportunity and a chance to be regulated.
We understand from Health Canada that product diversity is in the plan and that there are small-producer microlicence categories being produced. We ask the Senate to take steps to make sure this transition is as inclusive as possible. Undermining the unregulated market through inclusion is a far nobler way to end prohibition than to prolong and extend the failed war on cannabis. This is consistent with what we have seen in successful U.S. states in transitioning existing industry participants.
Finally,the war on drugs has disproportionately criminalized the poor, Canada’s First Nations and Canadians of colour. This needs to end, and the start would be amnesty for non-violent criminals or cannabis prisoners and an expungement of their records. Minister Ralph Goodale has suggested this may be considered after legalization is proclaimed, but we ask the Senate to ensure that amnesty and expungement are a part of Bill C-45. Amnesty was part of the original Liberal Party resolution on marijuana legalization.
I have many other comments. I invite all of your questions on these or any other topics,and we thank you for this opportunity to present our views and our perspective on Bill C-45.
The Chair: Thank you very much. Next, from Tilray, we have Philippe Lucas, Vice-President, Global Patient Research and Access.
Philippe Lucas,Vice-President, Global Patient Research and Access, Tilray: Thank you very much, Mr. Chair. My name is Philippe Lucas, Vice-President, Global Patient Research and Access at Tilray. I’m also a graduate researcher with the Canadian Institute for Substance Use Research. I’ve been working with medical cannabis patients for over 20 years. I started out as a patient, then a long-time patient advocate, then a patient provider, and for the last 15 years or so, I have been a medical cannabis researcher focusing on patient pattens of use and the use of cannabis as a substitute for alcohol, opioids and other substances.
I first had a chance to testify before the Senate in 2002 when the Senate Special Committee on Illegal Drugs was touring the country. I have to say that I think Chair Nolin would have been very proud of the work the Senate has done on this issue, and I wish he were here to see the progress we have made on this file that was so important to him.
You have a document in front of you, and if you want, you can follow along with a bit of the data I will share with you. I hope to share enlightening data on patient patterns of use. I want to start out by telling you about Tilray’s and Canada’s place in the medical program internationally.
Tilray is a global pioneer, and we’re currently providing cannabis in 10 countries on five continents right now. What a unique opportunity Canada has right now in being a leader in medical cannabis provision in countries around the world, whether in the EU, Germany, Chile, South America or Africa. Medical cannabis produced in Canada is helping patients all around the world, and it’s a unique opportunity created for Canadian medical cannabis producers.
We run a state-of-the-art facility. We were the first GMP certified facility in Nanaimo,B.C., and we recently announced a partnership with Sandoz, which is the first major relationship with a major pharmaceutical company that has happened so far within this medical cannabis industry. We’re pleased to say we’re involved in significant clinical trials to try and shine a light and increase the knowledge about medical cannabis. And we have recently finished a clinical trial with SickKids Hospital looking at pediatric epilepsy, and the results are stunning in how it has helped kids with severe seizure disorder.
I’m now going to share the results of the Tilray Observational Patient Study, which is the largest national longitudinal tracking of medical cannabis patients to date. This study is taking place right now at 19 medical centres in five different provinces. We are tracking the impact of medical cannabis on quality of life and on prescription drug use. Right now there are over 1,450 participants in the study, and we’re still recruiting for the study. Today I’m going to share the preliminary results from 573 of the patients who have completed at least one follow-up study. This data analysis was done in cooperation with the University of British Columbia, a centre called CHÉOS.
On the findings page, you’ll see that the sample is 55 per cent female with an average age of 49 years old, which may fly in the face of some of the public perception of who is using medical cannabis in Canada. It’s really not just 18-year-old men in a basement hitting a bong,waiting for a doctor to write a prescription to legalize the recreational use. In my 20 years of working with patients, what I typically see are middle-aged individuals who have had treatment failures or unsatisfactory results for traditional pharmaceuticals who are looking for alternatives. And, in fact, seniors and women are the fastest-rising group in the medical cannabis program right now in Canada.
The top three symptoms reported by patients were chronic pain, insomnia and anxiety. And, in fact, we see that about 80 per cent of Canadian patients use cannabis in the treatment of pain and mental health, and those of you with a health background will know that those are often co-morbidities. You often see pain and mental health as co-morbidities. Patients with long-term pain conditions often develop mental health conditions and vice versa.
The average cannabis use was 8.9 grams per week, and the most common method of use was oral ingestion. We’re no longer seeing patients in Canada typically smoking medical cannabis. We’re seeing extracts as being more and more important in the course of care along with vapourization.
Interestingly enough, the preferred type of cannabis in this study was high-CBD cannabis, which caused a lot of great enthusiasm amongst the medical community because it’s non-impairing and has become more and more important in terms of patient care, although I want to point out that a great number of patients still depend on THC and high-THC products for their care.
The high number of women participants as well as preference for high-CBD extracts marks a significant shift in patient patterns of use compared to what we’ve seen historically.
On the next slide, you’ll see that the percentage of patients using opioid and non-opioid pain medications, antidepressants, anti-seizure medications, benzodiazepines, sleep meds and muscle relaxants all declined significantly from baseline to six months. So we can’t look at medical cannabis in isolation when looking at the impact it has on people’s lives and their health. You have to look at the impact it has on reducing the use of other substances.
Here, I’ve shared data on the impact on prescription drugs, but past surveys and studies I’ve done, as well as those others have done, have shown reductions not only in prescription drug use but also in alcohol and tobacco use and also reductions in the use of illicit substances simply by introducing medical cannabis in the course of patient care.
On the next slide, you’ll see data specific to opioid use. I’m sure I don’t need to share with this committee the opioid crisis we’re seeing in Canada. I honestly think the data support the fact that cannabis can play a role in interrupting the opioid overdose crisis, which is having such an impact in my home province of British Columbia, but also all over Canada and North America right now.
With this patient population, we see baseline opioid use was reported by 32 per cent of patients initially, and in six months that dropped to 13 per cent of patients in the study, so a significant reduction in the percentage of patients who are using opioids as a result of introducing cannabis in their course of care.
The next slide is even more dramatic. It shows that mean opioid use went from 187 milligrams per day and was reduced to 48 milligrams per day at six months, a 74 per cent reduction. In fact, about 50 per cent of the initial opioid users had quit using opioids by six months. We’re seeing a significant reduction in the dependence on opioids, and I think that medical cannabis clearly adds a tool to the tool belt of physicians and patients who want to deal with chronic pain.
On top of that, you also see significant improvements in quality of life, and the greatest changes were in physical health, with a 31 per cent increase from baseline at six months, and psychological health, which saw a 17 per cent increase in the quality of life in patients. So you reduce the use and dependence on prescription drugs and increase the overall quality of life of patients as well.
I want to say the government’s stated goals with regard to medical cannabis have been normalization and harm reduction, and I’m concerned that some of the policies in Bill C-45 are inconsistent with these important goals. The first point I want to bring up echoes something that my colleague and friend Jeremy has said, which is the taxation issue. Cost is an ongoing obstacle to access for critically and chronically ill Canadians who are using medical cannabis in their course of care. Over the last 20 years that’s been one of the battles I’ve been finding to try to reduce the cost to patients. At Tilray, we reduce the cost by giving discounts to low-income patients, and we give a 10 per cent discount to seniors as well.
I’m really concerned about the ongoing taxation of medical cannabis. Medical cannabis should be treated like all other prescription drugs in Canada. It shouldn’t be taxed at all, let alone subject to an excise or sin tax. It simply doesn’t make sense, and it’s not in keeping with the goals of the government to normalize medical cannabis use.
It’s a bit stunning. I was an elected official for a while, and I don’t understand the politics of this. There’s no political support for ongoing taxation of medical cannabis. I’ve never met a politician, elected official or senator who says, “I really strongly support continuing to tax critically and chronically ill Canadians this way.” And there’s no opposition for removing the tax, so I really urge this Senate as the house of sober second thought to take a leadership role in this and make sure medical cannabis is no longer taxed for those critically and chronically ill Canadians who can benefit from its use.
The second part I want to address is about smart, effective branding and the impact it can have in reducing harms and improving public health. Patients need clarity, and consumers need guidance. They have told us this, and they have told Senate committees over and over again about their need for clarity and guidance when it comes to both the medical and the recreational use of cannabis. Medical cannabis ultimately is safer than many prescription drugs that are available out there, and yet the branding restrictions under Bill C-45 will mean that medical cannabis is not able to brand the same way as other prescription drugs, even when it ends up in the pharmacy system.
That simply doesn’t make sense in that consideration. Medical cannabis branding restrictions should be the same as all other prescription drugs and not subject to the branding restrictions of Bill C-45.
Additionally, plain packaging clearly leads to increased risk of medication errors. There’s a large body of scientific literature to support this, and we’ve heard stories in the U.S. where patients have meant to use a CBD product and accidentally used a THC product. While it’s not a fatal situation, it does cause a lot of discomfort. So we absolutely need differentiation of look-alike products via colour cues and other visual differentiators to improve public health and safety. The regulation should encourage differentiation rather than homogenization of these products, particularly if they’re going to end up in the pharmacy system and as we see increasing use by patients in Canada.
In talking more towards the recreational use, branding allows consumers to differentiate between high- and low-quality products and safer and more dangerous products. In order to dissuade smoking and encourage the safe use of cannabis, regulations should consider different branding standards between smoked and non-smoked products.
Bill C-45 presents a unique, singular opportunity to move cannabis users away from smoked ingestion, and we should not squander this chance to improve public health. If we allow a broader opportunity to brand in a market products that are non-smoked products, we can actually shift the population away from smoked to non-smoked products. I think that’s an opportunity we shouldn’t squander from a public health point of view.
Thank you all very much, and I look forward to your questions.
The Chair: Thank you to all of you for your opening comments. Before I throw it to my colleagues for questions, let me throw one out for you at the beginning.
You’ve all said that the excise tax should not be applied in the medical cannabis case and that there should be an exemption for it. The Pharmacists Association started out by saying there needs to be incentivizing to continue to use this stream once recreational cannabis is legal.
Now, do all of you think that the tax exemption is the only thing that is needed to do that? Or are you suggesting that other things are needed to incentivize people to use that stream rather than going to the new commercial kind of stream for recreational use? I’ll start with the Pharmacists Association.
Mr. Emberley: We’ve made the position that medical marijuana should be exempted for tax purposes and zero-rated as other prescription drugs are. We’ve not come out with a position as to how to further incentivize beyond that.
The Chair: Do you think that would work? In the Quebec case, as you’re telling us, most people will want to go to the stores, the shops or the pharmacy to do that .
Mr. Thiffault: It’s not only an economic topic. It’s a clinical topic. We’re talking about medication here, and we never talk about how patients are taken care of and supervised by a professional.
Cannabis should not be taxed like a prescription drug, but there’s more than that. There’s the professional requirement needed for the product. Tax is good, but a lot more needs to be done.
The Chair: Yes, except you don’t have that involvement now in the system.
Mr. Lucas: I completely agree. I can’t overstate how important it is to have that patient-physician relationship when it comes to the medical use of cannabis, particularly with the more naive users coming into the program, particularly children and seniors who may have little experience with the use of medical cannabis in the past. I’m very concerned that if there’s no differential pricing via taxation or other coverage, we’re just going to get people self-medicating through the recreational system — to the great deficit, I think, of those patients and those outcomes.
Doctors are getting more and more familiar with the difference of THC and CBD and the appropriate use of one or the other. They’re also getting more familiar with the use of smoked or inhaled products versus orally ingested products.
The Chair: I understand what you’re saying about the tax exemption. You’re all saying the same thing. Is that going to be enough?
Mr. Lucas: Yesterday, I had the opportunity to present to a private payer conference, and I did that last week as well. One of the things we’re working on is getting increased private payer coverage for medical cannabis as well, as a precursor ultimately to provincial coverage for medical cannabis. That is happening now with Sun Life starting coverage, Green Shield offering coverage and, of course, Veterans Affairs Canada offering coverage for patients as well. I think that will incentivize people to stay in that medical system.
Mr. Jacob: That’s a great question. I think Philippe hit it. We need to see our medical programs covering these costs, especially for the critically ill patients. The cost of cannabis medication can be quite expensive, and for many of these people who are chronically ill, suffering from seizure disorders, cancer, fibromyalgia can be debilitating. They are not able to work and they are often not able to afford their cannabis regime which they have chosen for their health and wellness.
Having that included in some way would be a benefit to many Canadians.
The Chair: That would be a long haul. You would have to get them on the formularies, and you have all sorts of campaigning to do with the private sector plans.
I’ll turn it over to my colleagues.
Senator Seidman: Thank you all very much for your presentations. They have provided us with an awful lot of important information, so thank you.
I’d like to pursue the point that the chair began with. I’d like to ask you, Mr. Thiffault, about what you referred to as the clinical role as opposed to the economics of it.
So it’s clear from the poll that you cited, the survey that you cited, that more than half of Canadians want to see medical cannabis distributed through a pharmacy. And that Quebecers are particularly concerned about mail distribution.
I would really appreciate it if you would tell us more about what the problems are with mail distribution in Quebec, why people are unhappy with that. Clearly, the pharmacist’s role — I understand as a Quebecer that the pharmacist’s role is patient-centred, and in fact this committee did a study on pharmaceuticals in Canada, a three-year study, and we looked at unintended consequences and the problems around polypharmacy and the role of overprescribing. We did talk with pharmacists who really have an information system, collect the data, are very patient-centred and very often are the only one who knows the number of medications that a patient takes.
So could you give me some information about the Quebec situation and how you see the role of pharmacists here? Specifically, could you tell us a bit about the importance of the supply chain in the pharmacy and how that would provide a secure supply chain for cannabis, which by the way we’ve heard about here as a very important issue. I know that’s a lot.
Mr. Thiffault: If you allow me, I’ll go on in French.
[Translation]
There is much talk of access to marijuana, but little talk of management. It’s important to make sure the patient receives the right product and that the doses are controlled. We are only talking about the economic problem of access to the product. It seems to me that the current system poses an apparent conflict of interest problem, because the producer sells directly to the patient. It wouldn’t be acceptable for a pharmaceutical company to sell a prescribed product directly to the patient.
There should be a neutral intermediary, supervised by a professional body, who ensures that the right product is used at the right doses to control prescriptions that might be “complacent” for patients who do not necessarily have a clinical need. We are talking about a product prescribed by a doctor. I think that’s the pharmacist’s role. There are clinics funded by cannabis producers for patients to get prescriptions. This raises questions in Quebec. People are sensitive to this perceived conflict of interest.
Some costs are skyrocketing. Consumption and patient numbers are increasing. We saw it with veterans; the budget exploded. Do all these patients need marijuana? I couldn’t say. However, they all need clinical supervision, whether for opiates or other painkillers.
You talked about the supply chain. Yes, that’s one thing I think the pharmacy system can allow. In Quebec, the Société des alcools du Québec will set up a closed organization for recreational use. If the exclusive sale of medical marijuana in pharmacies is allowed in Quebec, these will be the only two networks that will be able to sell recreational marijuana online.
These two networks are excessively watertight and closed. We receive narcotics, methadone and other controlled drugs in pharmacies with a completely sealed supply chain from the producer to the pharmacy. As for the quality of supply, many doors have just been closed. We put transparency into the system. We establish a professional order that ensures that scientific practices are respected and that science is advanced. We suggest that all patients receiving medical marijuana be enrolled in a research project to develop consensus prescribing. This would make doctors better equipped to prescribe marijuana.
Finally, I agree with Mr. Lucas that marijuana can help reduce the use of opiates and other medications. However, these are not drugs that are being cut without professional supervision. Stopping antidepressants can cause withdrawal problems or relapse. Medical supervision is needed to make the most of marijuana and perhaps reduce the use of opiates and other drugs.
That is Quebec’s position.
[English]
The Chair: I remind everybody that each senator has five minutes, and that includes the answer. With short questions and short answers, you can get in more questions and more answers.
The next five-minute period belongs to Senator Manning.
Senator Manning: Thank you to our witnesses. To Mr. Thiffault, in your remarks you mentioned the fact of the effort in mail order distribution. I am wondering what you say to people in remote parts of the country that don’t have access to a pharmacy, that don’t have them in their communities, and to be able to avail themselves of the medicine that the doctor has prescribed for them. How would you suggest we address that?
Mr. Thiffault: I don’t know the situation elsewhere in Canada. In Quebec, there are not so many places where you cannot access a pharmacy within 20 or 30 kilometres. We have deliveries. People need regular prescription drugs, so they can get cannabis access through the actual system. So there’s a way to bring medication to far away regions. I’m sure there’s a way to bring cannabis also with the regular actual system.
With the mail order, we know who is signing for the receipt of the product, but who is using it? Do we know if it’s an underage patient? We don’t know who is using the product once it’s sent out. In pharmacy we do; each time we do check with the patient about whether the condition has changed and so on.
Mr. Lucas: I wanted to respond to say that the industry in general is supportive of pharmacy-based access. We feel that pharmacists play an important front-line role in health care provision and that having cannabis in pharmacies offers an opportunity for pharmaco vigilance to be able to track how patients use medical cannabis, as well as the impact on prescription drugs — the kind of research that I do.
I am a bit concerned about the suggestion that any patient in Quebec needs to be part of a research project, against their will in a lot of cases, in order to access medical cannabis. As a long-term advocate I think that flies in the face of some of the constitutional rights that patients have to access medical cannabis in Canada, but that’s the situation we find ourselves in right now in Quebec.
I also suggest that while I support pharmacy access, I don’t think we should be shutting down mail order for the same reasons that Senator Manning just mentioned. I’m concerned that patients who are housebound and who may be living in remote communities may not be able to access pharmacies quite as easily as suggested. So I think that anything that increases options for patients, from my point of view, has got to be beneficial, including pharmacy-based access, but I don’t think we should make that the exclusive means of access for patients.
Senator Manning: Thank you. I’m wondering about the concern that’s been raised here this morning and has been raised here in the past that people who either don’t have access to or cannot afford medical cannabis will go to the recreational side of things, the black market or whatever the case may be. From a cost perspective — and I’m not sure how it’s prescribed — for a gram of medical cannabis versus a gram of recreational cannabis, what’s the consumer cost?
Mr. Jacob: In the existing market, the variance is wide — anywhere from $5 or $6 to $15, depending on the grade, the quality of the product and the type of cannabis. That should be replicated in the recreational market.
The full range of different qualities and types of cannabis is what consumers are looking for.
As it pertains to medical, there are so many various strains, so many unique effects from those strains and so many different interactions from individuals. It’s a process of elimination to find what works for you.
That applies to both inhaled products and tincture-based products. Each plant has a unique chemical profile of cannabinoids and terpenes. Finding the right fit is a process that can become expensive if there are limits to your purchasing. For example, if you’re on a mail-order system, I believe there are minimum orders. If you’re finding that this minimum order is not working, you suddenly have an expensive batch of product you can’t use.
The solution to that is storefront access and the ability to purchase in small quantities, find your way, find what works and then settle on your suitable products.
Mr. Lucas: I agree with the statements of Mr. Jacob. I would suggest, however, that the cost difference between the illicit market product and medical cannabis is about the same. As Mr. Jacob said, the price is from about $5 to $15, and that’s the same whether you’re buying from a licensed producer or from a dispensary.
However, I am worried that the taxation of medical cannabis as it stands right now discourages patients from being able to access as much as they might need. It sometimes forces patients to choose between putting food in the fridge or paying the rent and getting as much medical cannabis as they need to take care of their symptoms. That’s a concern, along with the lack of options that patients have within the current system in terms of accessing edibles, vaporizer cartridges and vape pens that are increasingly popular among medical cannabis patients in Canada and internationally.
The cost is about the same, but there is a disparity in terms of the products that one can access through the legal system versus the currently unregulated system.
Senator Dean: Thanks for the very helpful presentations. It’s notable that you all appear to be of one mind on the benefits of medical cannabis, including our pharmacist colleagues. I am particularly interested to hear and see evidence of the benefits of cannabis in relation to opioid issues. We’ve heard evidence here to the contrary, of course, that there’s a one-way gateway from cannabis to inappropriate use of opioids. This is the second hearing in a row where we’ve heard evidence on exactly the reverse.
I’d appreciate any further comments you have on opioids. We’ve heard from a couple of you about reduction and treatment.
As a second question, we’ve talked about the possible migration of medical users to recreational. Is there any possibility, as a result of anything that we’re doing here or might do as a result of your recommendations on taxes, that we might see a reverse migration of recreational users to an already rapidly growing medical market? Those are my two questions.
Mr. Emberley: I will comment on the first question you posed.
I work in an addiction clinic pharmacy here in Ottawa. We see patients systematically taken off opioids using medications such as methadone and suboxone, and soon we’ll likely be adding heroin to that mix.
We’re dealing with a receptor when it comes to opiates. It’s different than the receptor that cannabis attaches to, so the substitution is not a perfect one. While we are intrigued by the evidence to suggest that this could be a way of weaning people off opioids, we know that transition is fairly complex.
That’s part of the reason we feel that pharmacists have an intrinsic role to play in this. As I say, it’s not a perfect substitution. As our patients are taken off opioids through other means, it requires a very systemic approach of tapering. How that is done is a very — it’s almost an art to make sure a person doesn’t relapse. We’ve noticed in many cases that relapse can be even worse in terms of outcomes.
Again, the evidence is intriguing and interesting, but it’s not a perfect substitution. We think more evidence is required to get there.
We do feel there’s a potential for patients to move from the recreational to the medical side, in answer to your second question. Right now, there is a limited number of indications for which cannabis has been shown to show evidence, but we know there’s more evidence coming. As the evidence grows, we could potentially see that happening. We don’t see that necessarily as a bad thing, because we know that one out of nine hospital admissions is due to the adverse effects of medication. Part of the reason pharmacists are there is to try and mitigate that.
If more patients are seeking clinical oversight by pharmacists to ensure that cannabis medication fits with the other medications they’re taking and that it’s not going to result in them being admitted to the hospital, that’s important to us. There could actually be positive outcomes there for sure.
Mr. Lucas: There is a growing amount of evidence that cannabis, rather than being a gateway drug, is actually an exit drug to addiction. In 2014, a study was published in the Journal of the American Medical Association showing that U.S. medical cannabis states had a 25 per cent reduction in opioid overdose deaths compared to those neighbouring states that didn’t have medical cannabis programs in place. The longer the program was in place in the states, the greater the effects were.
This is very convincing. Recent data out of Colorado suggest the exact same thing, namely, that by legalizing the recreational and medical use of cannabis, we have seen a significant decline in opioid overdose deaths and mortality.
We’ve just started a study called the Substitution of Opioid Study here in Ottawa at Recovery Ottawa, the biggest methadone and suboxone clinic here in Ottawa, looking at the impact of medical cannabis on treatment adherence for suboxone and methadone. Preliminary data suggest that patients who are looking to get off opioids are very vulnerable when they start methadone and suboxone treatment, and if they feel that, they are at the biggest risk of overdose. If cannabis can help keep those patients on those treatments, by reducing some of the withdrawal and the cravings associated with that, that could actually save lives.
We’re looking forward to sharing that data with you once that comes on board.
I agree with the pharmaceutical association that this substitution for opioids needs to be done in a very deliberate and systemic manner. In many ways, it’s being done in an ad hoc manner. We can improve public health by making this a public health strategy. Right now, medical cannabis is a third line of treatment for chronic pain. Opioids are a second line of treatment. If we follow those treatment guidelines, you have to fail out of opioid treatment before you consider cannabis treatment. We need to modernize those guidelines to make cannabis on par, at least, as a second-line treatment option.
In regard to the transferring of patients from recreational to medical, we have a high standard right now. It’s a high bar for patients to get into our medical cannabis program. We have 300,000 Canadians currently registered in our federal program, but according to surveys, about a million Canadians claim to be using cannabis for medical purposes. That means two thirds of those patients are not part of our program right now. I don’t think we’re going to see a mass migration into the medical program from the recreational just for a minor cost savings when it’s going to be so much easier to access recreational cannabis in Canada.
The Chair: Thank you.
Senator Poirier: Thank you all for being here. I have so many questions that I think I’m just going to try to give bullet questions to see if can I get bullet answers and get as many as I can in.
Following Senator Manning’s questions, why is there such a difference in the cost of recreational marijuana and medical marijuana?
Mr. Jacob: As Philippe was saying, the costs do line up. But perhaps your question is why is there such a difference from top to low end. Is that more to the point?
Senator Poirier: Yes.
Mr. Jacob: It’s production style: larger-scale production, economies of scale, lower costs. Smaller, crafty, small-batch production that is more intensive and involves more hands-on treatment of plants means higher costs.
Senator Poirier: Someone who’s buying medical marijuana compared to recreational marijuana, they’re getting two different products, are they?
Mr. Jacob: No, both types of products exist in both worlds. It’s really the same products for both worlds.
Senator Poirier: If they can get it so much cheaper at the recreational side, why would they go to the medical place to get it, other than wanting the confidentiality and health monitoring by a doctor and pharmacists who know how to guide them through their medical process of needing the marijuana? Would that be the only advantage?
Mr. Jacob: This allows me to speak to your question, as well. A lot of consumers who come to cannabis through the recreational avenues that we have today are coming for medical reasons because of the difficulty of access.
We had an example of a person who came in with a shoulder injury and didn’t want to get on the opiates that were prescribed. She began taking a cannabis tincture that was a ratio between THC and CBD and realized that she was no longer taking her OCD medication. Her kids would always remind her when it was out because she started to be OCD. So she was on cannabis medication for pain and realized that her mental health issues were resolving themselves.
This is a patient now who, potentially, would realize that these benefits exist for them and will again seek access to the medical program through their physician.
Mr. Lucas: For clarity, maybe Jeremy and I weren’t clear. The range in cost for a gram of cannabis within the medical and the recreational systems is about the same. It’s $5 to about $15 a gram.
But that’s not a difference between medical and recreational. The $5 gram in the medical system would be the same cost in the recreational system. It’s just that that is typically the range in prices. That could be reflective of THC levels in a lot of cases where higher THC products can fetch a higher value, whether it be for medical or for recreational use. More and more CBD products are a little bit more expensive because you need more of those plants to produce a CBD extract than you do a higher THC extract. That can be more cost prohibitive to Canadians.
To be clear, there is no financial difference between the recreational cannabis and medical cannabis. We wouldn’t expect there to be some, but we do hope the taxation is removed on the medical so that it’s zero-rated.
Senator Poirier: I want to share that from what I’m hearing up in my end of the province, the people that need medical marijuana would prefer, because of confidentiality, to be able to go into a drugstore and get it rather than going to a storefront or have someone deliver it by mail. I’m hearing that that’s what the people would like to see.
I also understand, Mr. Lucas, that recently your company signed up with Shoppers Drug Mart to supply their brand of medical cannabis, conditional on approval of the pharmacy distribution being able to distribute the medical marijuana.
What is the key factor holding up the pharmaceutical distribution of the medical marijuana at this point? If you do have it, will you be able to offer it through a pharmacy at the same cost that a person would be getting it at now through another system?
Mr. Lucas: What a terrific set of questions, thank you.
Right now, the biggest obstacle is that there’s no explicit provision in Bill C-45 or in the current regulations to allow pharmacy-based access. We are extremely concerned by the suggestions of the government that they’re going to look at that as a next stage of changes in these regulations, maybe going as far out as 2020.
As we know, when Health Canada initiated the MMPR four or five years ago, they initially anticipated pharmacy-based distribution. The pharmacy system at the time wasn’t comfortable with that or with the level of consultation they had had, and they asked to be excluded from that option. Obviously there’s been a big turnaround, and now pharmacists feel that they want to be able to do this. Of course, they are well positioned to catch contraindications and interactions with other medications.
Shoppers Drug Mart is taking a unique path. They’re asking to be a licensed producer on par with Tilray or the other 100 licensed producers in Canada so that they can purchase from other licensed producers and distribute through their system.
What Shoppers Drug Mart will be able to do in the next few months is not going to be what other pharmacies are going to be able to do, because they’re going around the current regulations by making themselves a licensed producer. We think it’s great that cannabis will be available through Shoppers Drug Mart, but we would like to see all pharmacies in Canada being able to supply medical cannabis to patients.
I’ve been working on this for 20 years. Nothing is going to do more to help the normalization of medical cannabis than having it available through pharmacies. No matter what we do to educate patients — and we have a 24-7 helpline, et cetera — it still feels different than every other medication when patients have it delivered to their door.
Senator Poirier: Why can’t other pharmacies do the same as Shoppers Drug Mart?
Mr. Lucas: They could do the same, but it’s a time-consuming process to become a licensed producer.
[Translation]
Senator Mégie: I am addressing both pharmacists, Mr. Thiffault and Mr. Emberley. In your documents, you raised the problem of dispensaries, which are points of sale that have been multiplying rapidly in recent months. Is the term “dispensary” an established term? Is there a place where we could put it in the recommendations or amendments? If we let all this grow, they will all be dispensaries, but we know that they are points of sale and not places where someone could get sound advice. How could we, as legislators, prevent that?
[English]
Mr. Emberley: We’ve seen the proliferation of dispensaries over the last few years, and it deeply concerns us. The term “dispensary” is interesting. There are protected terms within the pharmacy profession; the words “pharmacy” and “apothecary” are protected terms that no other retail outlet is to use.
I actually did some research, and while “dispensary” is not a protected term under most of the acts across the country, it is a very specific term within our profession. It is the professional area within a pharmacy where prescriptions are filled. That department is led by a licensed pharmacist who is held to very high standards of practice and is bound by an ethical framework that is very specific to the role of the pharmacist.
The word “dispensary” is very near and dear to us, and in our mind using it outside of the terms of pharmacy provides a legitimacy to those who are running so-called “dispensaries” that may give Canadians the wrong impression about what is actually going on and the level of knowledge that that person has. It may give the impression that that person is a licensed health care professional when, in fact, they’re not.
We’re deeply concerned about that. We think that within the act potentially we should look at it as being a protected term. It has a very specific meaning within the pharmacy profession, and it does denote a certain clinical expertise that a person may have in talking about cannabis with regard to other medications. That’s what pharmacists do: They talk about the therapeutic role of one medication in light of many other medications that a person may be taking.
[Translation]
Mr. Thiffault: I agree with the use of the term “dispensary.” Care should be taken to ensure that a minimum amount of training is given to people who will be working in dispensaries or points of sale. If a product is proposed for treating insomnia, the patient must first be asked if he or she is taking any medication. If so, then a medical or pharmaceutical opinion should be sought as to whether marijuana is good for the patient. The patient should know that red flags can be raised if there is a problem. It is also possible to offer or refuse a product to a patient. The patient must be aware of the services available so that there is at least a safety net.
Senator Mégie: Mr. Lucas, do I understand correctly that you don’t quite agree with neutral packaging?
Mr. Lucas: Yes.
Senator Mégie: However, neutral packaging should not be a problem if the number of grams and the percentage of THC are indicated so that consumers know what they are buying. Would that be enough?
Mr. Lucas: Research has shown that this is not enough. Drugs have similar names. THC stands for tetrahydrocannabinol and CBD stands for cannabidiol. There’s no big difference. The general public doesn’t know what the three letters THC and CBD mean. During the day, some patients will use a product with a high CBD content, because it’s non-intoxicating. In the evening, some will use a product with a high THC content to help them sleep better. Mixing these two drugs can be dangerous, especially if the person is at work, driving a vehicle, and so on. Some people accidentally consume products with a high THC content.
At the moment, Tilray uses different colours and different packaging to ensure that there is no mixing. My concern is that with Bill C-45, people won’t be able to differentiate products and, in my opinion, this is ridiculous and involves risks for patients.
Another concern I have is that Tilray, like other companies in Canada, has been differentiating its products for about five years without any problems. So why change the regulations with respect to medical marijuana? It’s different for recreational use, but I don’t see why Bill C-45 seeks to regulate medical marijuana if everything has worked well so far.
Senator Mégie: That’s because it’s the same product, and everyone uses it in their own way. If one type of use is regulated, the other type will automatically suffer the consequences.
Mr. Lucas: But recreational products are very different from medical products. I don’t think we’re going to see high CBD products in the recreational system. Finally, people will be a little higher and THC will be dominant in the recreational system, but in the medical system, we are seeing more and more CBD-based products. THC and CBD can be confusing. I often make presentations on this subject, and the public doesn’t quite understand the difference between the two substances.
Senator Mégie: Thank you.
[English]
The Chair: Can I clarify one thing before we move on? The packaging regime now is a different regime from what is being proposed in Bill C-45. You’re saying you’d like the current packaging regime to be maintained for medical cannabis.
Mr. Lucas: That’s absolutely all we’re saying. We feel the current system is not causing any problems. There are no reported problems with the current system. We’re not allowed heavy branding, but we are allowed product differentiation using colour metric agents and others that aren’t going to be allowed under Bill C-45. We feel that as medical cannabis becomes more like any other traditional pharmaceutical drug, we should be held to those standards, which we completely agree with, but not the same public health concerns that are addressed in Bill C-45.
Senator Omidvar: Thank you to all of you for being here. I’ll try to get three quick questions in with three quick answers.
I think I heard from Mr. Lucas some background to the question, but I want a response from the pharmacists around the policy rationale when the medical marijuana regime was brought into law. What was the policy rationale for bypassing pharmacists? And if Mr. Lucas is correct and they didn’t want to do it then but they are ready now, how have you come on this journey?
Mr. Emberley: Thank you for the question. We get asked that question. Years ago, we did come out with a statement, as you say, but the landscape has really changed. More Canadians desire access to this medication than ever before, and I think that as a profession we need to acknowledge that. We feel that if access is going to be enhanced and there’s more evidence to support the use of cannabis for legitimate health conditions, then pharmacists have to be involved because of the unique knowledge and expertise that they have to offer.
That’s why we came out with this statement. Our position has really been focused solely on the medical cannabis side. We believe that it is a medication and should be treated as a medication, and, as such, it should have the clinical oversight of pharmacists.
Mr. Thiffault: Technically, cannabis doesn’t have a DIN, a drug identification number. So for technical reasons, we’re not allowed to sell the product. Maybe if that had been taken care of earlier, we would have gotten to the situation earlier.
The population has evolved. We learn about cannabis. We learn how many people are using cannabis, and naturally the role of pharmacists in cannabis distribution came, and it’s very natural for pharmacists now. There’s a strong consensus, which was not there two years ago.
Senator Omidvar: My next question is for Mr. Lucas. We’ve heard very conflicting witness testimony here around the science of cannabis, and this particular question about cannabis as a gateway drug. The medical head of CAMH suggested to us that there is no direct evidence concerning cannabis as a gateway drug. We’ve also heard witness testimony about a report from Smart Approaches to Marijuana. I believe this came from the U.S. They say marijuana doubles opioid use.
Mr. Lucas: I’m currently the author of a systematic review looking at cannabis as a substitute for alcohol and opioids, and I can tell you the literature is certainly in favour of supporting the data I shared with you today, that cannabis can play an active role in being a substitute not just for opioids but also for alcohol and other drugs.
More importantly, I think the U.S. experience gives us a crystal ball to look into what we might expect in terms of the public health impacts. In Colorado, they have seen reductions in alcohol-related automobile fatalities tied to their legalization of cannabis by shifting the percentage of the population, on any given day, to using cannabis instead of using alcohol. They have also seen reductions in alcohol-related impacts such as homicides, suicides and violent crimes.
In fact, Colorado is one of the only jurisdictions in the U.S. that has seen a decline in alcohol use overall, and they’re making more money on the taxation of cannabis than they are on alcohol now. And that’s quite significant in terms of the positive public health impacts they’ve seen as a result of this.
I think the evidence I’m sharing with you is really uncontroversial. It’s also significant to note that in Colorado, after legalization, they’re now seeing a reduced use of cannabis by youth. And, in fact, they haven’t seen rates this low since 1982, the same year that Nancy Reagan told us to say no to drug use. The population level evidence and the evidence I shared with you today is supportive of the fact that when adults are given an option between cannabis and alcohol, some will choose cannabis, and ultimately that leads to positive public health outcomes. That’s what I think we can expect here in Canada.
Senator Omidvar: For my last question, any one of you can answer, and I think it can be only one. What is your position on the provisions in the bill for home growing four plants per individual?
Mr. Jacob: I think that home growing should be a right of Canadians. It’s a non-toxic plant that has been in our tool box as human beings for 7,000 years of recorded history. This 95-year blip of prohibition shouldn’t result in these freedoms not being restored to Canadians.
I know there are many people who would like to grow not simply cannabis but complementary herbs that are anti-inflammatory. There’s a resurgence in plant medicine, and cannabis is a key part of that.
The Chair: There might be a different view over there, but we’ve run out of time. We’ll put you down for the second round.
Senator McCallum: Thank you for your presentations. My comment and question will be going to the pharmacists.
I had not really looked at the phrase “medical marijuana,” and it didn’t hit me that if it is used for medical purposes, there should be an oversight body for this. As a dentist, I’ve always worked with the pharmacists. I’ll call and ask for advice. Sometimes patients don’t tell you all the meds they’re taking, and when I give a prescription, they’ll call me and say, “Did you know this person is also on these medications?” Then we change what I’m prescribing.
So I’m a bit concerned. If they’re going to use the term “medical marijuana,” then there need to be standards and oversight because there are also risks, and I think malpractice could come up. When you’re looking at getting the drug and a medical doctor has prescribed it, you go to the pharmacy to pick up the drug. And it’s usually the pharmacist that tells the patient about the drug they’re going to take or any interactions. It’s usually not the medical doctor or the dentist.
I’m concerned when you have patients who are going to find their own fit, and there’s no professional involved. Could you talk a little bit more about that, about how that could be corrected?
Mr. Emberley: Thank you for your question, senator. I think it’s a really important one.
When you prescribe, say, an opioid for tooth extraction, I think it’s really important that you would know that that patient also happens to be taking medical marijuana. I think one thing that pharmacists maintain is a record of all of the medications that a person is taking, and if we fragment health care so that we don’t capture all of that information, there is a potential for people to experience drug interactions. I think that could be a good example where a physician or a dentist could prescribe an opioid not knowing the patient is using medical cannabis, and that could result in them having a car accident, or we don’t know what.
So I think we need to make sure that we create a system that is fairly fail-safe that protects Canadians from those unintended consequences that could really harm them. I think that we are strengthening our medical records. Hopefully, we’re going to get to nationwide e-prescribing so that we’ll be able to have that information at our fingertips. But, if we fragment, if we don’t have access to the medications that people are using, that will slip through the cracks. People will still end up with unfortunate circumstances as a result.
Senator McCallum: Thank you.
Senator Deacon: Thank you very much. Great speakers. Lots of information. We’re going as fast as we can to get as much information as we can.
I’m listening to a variety of perspectives and experts. We’re looking at the recommendation of possibly having that single regime for medical and non-medical marijuana. We also learned, as recently as yesterday, here and at the National Finance Committee meeting, just how regulated and how enforced and how restricted medical marijuana is, certainly, in many aspects, in a very positive and admirable way.
How would bringing cannabis regulations under a single regime, a single umbrella, impact the work that has been done and the work that needs to be done as we move forward? I know it’s been a bit of a controversial topic, but I’m interested in hearing your perspectives today, and I would welcome anybody to respond to that.
Mr. Lucas: Just to clarify, are you talking about the suggestion by the CMA and others to basically eliminate medical cannabis once we have recreational cannabis available, that basically that would replace the medical cannabis program?
Senator Deacon: My understanding is not necessarily eliminating but working together and having it under one umbrella, with the language of this being better for Health Canada.
Mr. Jacob: I think that if you’re talking about having a retail system where, like in the U.S. states, certain retailers can apply for a medical endorsement where they’ll now ensure that they have staff on site who can provide appropriate information and support for people who come in with medical challenges, this is appropriate, I think, for patient access. Like Philippe was saying, the more access points we have for cannabis for patients, the more this will become normalized and the more we will have the stigmas that are perhaps wrongfully existing in our society being ameliorated.
So I think that, while there need to be distinct provisions made for medical, having a common supply chain and common access points is a very good strategy.
Senator Deacon: How would it help the work that you’re doing now? I guess that’s what I’m really trying to figure out. How do we learn from the work that’s being done, and how does it help to enhance the work that is being done in medical marijuana?
Mr. Jacob: As more companies like Tilray are undergoing clinical studies, there will be more opportunities, with storefront access, for that word to get out, to get more participants on board and to further the knowledge base of how cannabis benefits Canadians.
Mr. Lucas: I think the challenge with the current program is that there’s no community-based access. Obviously, pharmacies would offer that, but that doesn’t negate the fact that maybe other specialized clinics might be able to offer community-based access.
We actually have a two-tiered system already in place when it comes to methadone access in Canada. You can access methadone through pharmacies or through methadone clinics that are community-based and staffed by folks who specialize in the population that they’re working with, people with opioid dependence and otherwise. So a similar system for medical cannabis could be effective as well.
But I do think that, ultimately, the idea of community-based access for patients to be able to access and talk to someone with a health care background to identify drug interactions and contraindications is incredibly important. I really worry about any suggestion that patients can just get access to the cannabis they need through the recreational system. I think the goals of those recreational outlets, whether the LCBO in Ontario or otherwise, are going to be potentially public-health centred — and I honestly believe that — but they’re not medicinal, therapeutic. I think that that’s a really significant difference.
[Translation]
Mr. Thiffault: We talk about improving access, but we never talk about supervising and coaching the patient. Like any other treatment, what we want is the right product, at the right dose and with the right indication, to obtain quick and safe effects for the patient, at a reasonable cost. This isn’t what we’re talking about at all here. We’re only talking about access, but unmarked access causes excesses, and that is what we are seeing at the moment. I believe that if there is no clarification now as to what should be medical and what should be recreational, we will create more confusion.
We must not only look at the economic side, but also at the clinical side and the effectiveness. Clinical research will demonstrate evidence of effectiveness in a variety of situations. However, it would be a mistake to trivialize the medical side at this time. There is a need to strengthen the medical side to ensure that there is optimal therapeutic monitoring and follow-up of patients.
[English]
Senator Seidman: I have actually two very to-the-point questions, so I hope to get to-the-point answers. One has to do just with continuing this line of discussion about maintaining two different streams, medical marijuana and recreational marijuana. I want to be clear on the answer to that because it has become a question. It has become an issue. There are a lot of complaints about waiting more than a year, as expressed by Mr. Lucas, to re-evaluate the medical marijuana system.
I want to know this clearly: Do you think a medical marijuana system should be maintained as a separate system from the recreational system?
Mr. Lucas: I strongly support that, yes.
Mr. Emberley: We’ve always strongly supported that.
Mr. Thiffault: Yes.
Senator Seidman: Perfect. I just want to be clear, for the record, on that.
Mr. Jacob: I believe that while there should be special provisions for medical patients, common access points, as we see in other jurisdictions, are going to be a benefit for those patients — community access.
Senator Seidman: Okay. Thanks. That’s access. That’s different, as Mr. Thiffault referred to.
Mr. Jacob: Yes.
Senator Seidman: Great. Understood. The other question has to do with the Health Canada drug identification number. It was referred to in discussion here. I would like to hear something about what is actually happening around that because there was a plan, with Health Canada, to secure a DIN number for medical cannabis. Could someone please tell me about that?
Mr. Lucas: I’m happy to tackle that, and I’ll be as brief as possible. Health Canada has announced what they have called an “accelerated program” to create DINs for cannabis. I want to be clear that there will likely never be a blanket DIN for cannabis, which is thousands of different plants with different cannabinoid ratios, but we’re eager to find out more about that. We still haven’t. I’ve got a meeting with Health Canada, as part of our industry association meeting, on Monday and hope to hear more about that.
What I can tell you is that there is a pathway to a DIN, which is through the traditional clinical trial system. Tilray is engaged in four Phase II clinical trials now, and, once they get to Phase III, which is expensive and time consuming, theoretically a DIN could be issued for specific preparations for specific indications. It’s daunting for many companies to take this on, and it’s not addressing the patient need right now.
The last thing I want to say on the matter is that DIN should not be a reason for cannabis to not make its way into pharmacies. Pharmacists regularly dispense products that don’t have a DIN. Compounding pharmacies create DINs as they compound products as well, and at Tilray we’ve created pseudo-DINs to help pharmacies and insurance providers track what specific products patients are using. We’re doing our best to try to address the DIN issue.
Senator Seidman: Do the pharmacists have something to say about that as well?
Mr. Thiffault: A DIN would allow the product to be put in the provincial patient file so any practitioner would see the patient is receiving cannabis. Security-wise, it would be better.
Mr. Emberley: Some insurance companies have a policy of only covering medications with DINs, so that’s another point that’s important to raise.
Senator Seidman: Yes, for the insurance coverage. Thank you.
Senator Omidvar: My question is to Mr. Thiffault. What’s your point of view on the four plants for private, homegrown use?
Mr. Thiffault: My concern is if we allow that for medicinal reasons, we don’t know what the person is growing. How can we treat a disease with a plant whose THC or CBD we don’t know? That’s the clinical part.
The other part is what is allowed. Four plants per person is more than an individual needs for cannabis. What happens to the rest of the plant that is produced? Would it be sold to friends?
There’s an alternate market for homegrown which is not used by the patient. That’s the second concern we have. We support Quebec’s position on that.
The Chair: To clarify here, it’s four per household.
Mr. Lucas: I think when it comes to medical use, it has been established through the Constitution that patients have the right to produce their own, so I don’t see us relitigating that issue.
Medical use patients have an application process through Health Canada that they can go through. It’s certainly stricter than what we anticipate seeing under the recreational system, and I don’t see Health Canada successfully removing that right through the courts as it stands.
When it comes to recreational use, I produce my own tomatoes and I’m an avid organic gardener. If recreational users want to produce their own cannabis, I’m convinced they can do so safely without increasing the risk to communities, neighbours or others. I don’t have any real concern with regard to that. Most people simply will not choose to do so. All Canadian patients have a right to do so. Very few choose to do so. When it comes to recreational use, all Canadians can produce their own beer and wine but most choose not to, so I don’t anticipate it’s going to be a major issue.
Mr. Emberley: We don’t have a position on there, but we are concerned about children, and if homegrown increases the chance that a child may accidentally ingest this, it is a concern of ours, and we have expressed that.
Senator Omidvar: But you have to smoke it. It has no effect if you just eat it. I wonder if that concern is a little overblown.
Mr. Lucas: I have difficulty getting my nine-year-old to eat vegetables, so she would certainly not be tempted to eat the plants around our house. She nibbles around our garden because she knows the difference between what’s edible and what’s not. I don’t share those concerns. I don’t want to ask for a show of hands, but we all have liquor cabinets at home, and there are no safety provisions on a bottle of vodka. I’m far more concerned about my nine-year-old, as she grows older, getting access to that than plants growing in the backyard.
The Chair: And the bottle of vodka does not have a plain label.
Senator Deacon: A question for you, Mr. Lucas. Great thanks to you for talking in your report about this compassionate society on Vancouver Island with 2,000 or 3,000 members; it’s been around for a long time.
I’m trying to understand, first of all, that and what the makeup and profile of that group are, if you could generalize, and if there are others that you know of across the country of that kind of size.
As we look at legalizing cannabis, how would they be impacted?
Mr. Lucas: In my 20 years of working with patients, I have had a lot of different viewpoints from that point of view. In 1999, I opened up the Vancouver Island Compassion Society, one of Canada’s first non-profit medical cannabis dispensaries. I think it’s going to celebrate its nineteenth anniversary this year. It’s been a number of years. I was executive director there for 10 years, and I’m no longer involved in any of the day-to-day operations of the Vancouver Island Compassion Society.
I would suggest that, like licensed producers, liquor stores and convenience stores, there are some dispensaries out there who are well-intentioned, professional and do a good job of taking care of their clients, patients and otherwise. There are others who are more profit-centred and focused on other aspects of this.
I think that ultimately a lot of these dispensaries right now are looking to make their way into the legal system. If allowed to do so, if the hurdles aren’t too high, in places like B.C. where we have a combination of private and public, I expect a number of them to be leaders in the distribution of recreational cannabis going into the future. I would like to defer to Mr. Jacob, who is head of the Canadian Association of Medical Cannabis Dispensaries, who might be able to speak to that too.
Mr. Jacob: One of the biggest concerns faced by many operators of compassion clubs or non-profit retail shops is what we do with our patients. They choose to access cannabis at dispensaries. They’ve found solutions that are serving them well. We’re going to be losing significant amounts of our product diversity at the onset of regulation, and we have no idea how we’re going to support these patients through this transition. It’s onerous for them. It’s causing tremendous amounts of stress. People who are ill do not need that type of stress.
Something important to realize for the Senate is that in B.C., where we’ve had 20 years of evolution of a storefront retail model, this is a successful experiment. This is a normalized economy and environment for cannabis. People can walk past a shop with a mother and her stroller and it’s not onerous and not the same as what has been experienced here in Eastern Canada.
I think this is probably the biggest change and the biggest impact. How do we support and protect the rights of these patients to access this medicine that’s working for them when the product diversity is going to be scaled right back and released over time?
Mr. Lucas: I would add one more quick point. The removal of product diversity only benefits the black market. If patients can’t access vape cartridges, the edibles they’ve gotten used to or high-potency cannabis, the only winners in that are the black market, which will continue to supply these products.
The decisions being made here or by Health Canada aren’t what Canadian patients or recreational users are going to use. The decisions being made here are deciding what’s going to be regulated by the government and what’s going to be controlled by the black market. These are the decisions being made at this table.
The Chair: We have run out of time, I’m sorry to say. We do have another panel waiting. By the way, the B.C. Compassion Club Society is in the next panel, so there may be more questions to them on the subject.
Thank you to all four of you. You’ve been quite helpful to us. You’ve explained your positions very well, and we will take all of that into consideration.
On our next panel, we welcome James O’Hara, President and CEO of Canadians for Fair Access to Medical Marijuana; and Hilary Black, Founder of the B.C. Compassion Club Society. We also have an individual whose name we’ve heard before, because we had one of his colleagues here, Mr. Conroy: Kirk Tousaw, Barrister, Tousaw Law Corporation.
Welcome to all three of you.
We’ve got until 1:15 for this panel. I will ask each of you to give opening comments of up to seven minutes, and then we’ll have questions from my colleagues and me.
I’ll start in the order on the list.
James O’Hara, President and CEO, Canadians for Fair Access to Medical Marijuana: Thank you, senators, for the invitation to speak to you today.
Before I begin my remarks, I would like to say this is very special day for me. On this very day in 1974, Victoria Day, May 24, I first arrived in Canada from Scotland as a wee lad. I want to take this opportunity to recognize and sincerely thank Canada and the Government of Canada for welcoming me to this country, as of this day, my home now for 44 years. It is with humble gratitude that I sit before you today. I appreciate the opportunity to talk to you about how we can make this wonderful country even better.
CFAMM is a national non-profit organization that has successfully represented medical cannabis patients since 2014. With a membership of over 20,000 Canadians, the organization has emerged as the thoughtful, legitimate, grassroots voice for medical cannabis in the non-profit advocacy space.
I’m a former bank vice-president, and for many years now I’ve also been a medical cannabis patient. I have a number of conditions that I successfully treat using medical cannabis, including focal seizures, osteoarthritis and chronic asthma. The use of medical cannabis in my life has been utterly life-changing, and I do mean life-changing. I’ve been able to reduce the number of seizures I have by about 80 to 90 per cent, and my overall quality of life has increased dramatically.
I am far from alone in my experience.
It’s with this thought in mind around the legalization of recreational cannabis in Bill C-45 that it’s important for us not to lose sight of the needs of patients. We have had a system of legalized medical cannabis in Canada for a number of years now, supporting patients with legitimate medical needs who are treating their conditions and symptoms with the support of competent health care professionals.
Let me touch on some of the challenges. There are indeed challenges with the medical cannabis system, and a significant one is that many patients can’t afford to get the medicine they need. As advocates for patients across the country, we want to make sure the government’s move to legalize recreational cannabis doesn’t compound or worsen the challenges medical cannabis patients already have and are struggling with today.
Today, over a quarter of a million Canadian medical cannabis patients get relief for symptoms from various conditions and illnesses including pain, headaches, anxiety, sleep disorders, MS, Crohn’s disease and epilepsy, just to name a few. That’s why it’s of critical importance that the ACMPR medical cannabis system be supported and continued.
In crafting Bill C-45, we want to commend the government for recognizing the need to maintain a separate and distinct regulatory approach for medical cannabis, and we want to ensure that it is maintained.
Beyond the government’s constitutional requirements to provide reasonable access to cannabis for medical purposes, patients have unique considerations that can best be met in a distinct regulatory regime.
Moving forward, beyond Bill C-45, it is important that the government prioritize and adequately support the needs of patients by addressing their unique requirements. Among these requirements is the need for integrated end-to-end health care where a patient can have a conversation with their doctor all the way through to their pharmacist. Patients must be as free to discuss medical cannabis as a treatment option with their primary care physician as they are with any other condition today, while understanding any potential medication interactions they may face.
In addition to the continuation of mail order today, we believe pharmacies should have the authority to retail medical cannabis. Further product forms should also be made available. Sales and consultation through pharmacies will help to ensure that patients across Canada can access their medicine easily and that they can receive reliable education on the safe and effective use of medical cannabis from a trained health care professional with regulatory oversight.
This is not only of significant importance today, but it will be especially in the future as the age demographics of our population dramatically change. Very soon, we will have more older Canadians than young, and this brings with it a seismic shift in health care needs for this country.
You already heard about the following this morning, but let me underscore from a patient’s perspective that affordability of medical cannabis remains an urgent crisis for the majority of patients as fully 60 per cent of these patients cannot afford their full dose. Insurers rarely cover the cost of medical cannabis, and the majority of patients’ expenses are out-of-pocket. Again, this will become a critical demographic issue as more and more Canadians will be on fixed incomes.
Also keep in mind that this is a medicine whose cost is already significantly burdened by HST, and it shouldn’t be. Other medicines in Canada are zero-rated and not subject to any tax. To compound this situation, just this week the government passed yet another tax for medical cannabis patients — an excise tax or what is commonly described as a sin tax. To disincentivize the responsible management of someone’s medical needs makes absolutely no sense, and applying a sin tax to medicine is completely out of line with our collective moral beliefs and principles as Canadians.
It’s important to recognize where cannabis tax revenue has been coming from up to this point, and that is medical cannabis patients. Essentially, the government is telling patients it wants them to pay excise and consumption taxes to help pay for education and enforcement for legalization of recreational cannabis. This is an unprecedented approach and is wholly inappropriate for patients. Think this through. The government is funding education and enforcement to fight the opioid crisis, but they’re not asking legitimate patients who use opioids to pay for those efforts, so why are they asking this of cannabis patients?
Finally, on a related topic, affordability is one of the reasons why we also support personal production. That is to give patients who struggle financially the option of producing their own medicine.
I have three main asks today. One is that CFAMM supports cannabis research and education initiatives, but that should not be paid for on the backs of patients who are already carrying significant burdens today. Two, the government should do all it can to facilitate insurance coverage for medical cannabis. This is a big issue, and it confronts many, many patients today. Finally, remove all taxes for medical cannabis.
Thank you, and I’m happy to take your questions.
The Chair: Thank you. Next we have Hilary Black from the B.C. Compassion Club Society.
Hilary Black, Founder, B.C. Compassion Club Society: Thank you for the opportunity to speak with you today. I am the founder of the first medical cannabis organization in the country, the B.C. Compassion Club Society, which was founded in 1997.
In the interest of disclosure, I am also employed by Canopy Growth, but I am here today in my role as the founder of the Compassion Club Society.
My remarks will focus on prioritizing and protecting critically and chronically ill Canadians through three recommendations. We will ask you to protect Canada’s historical medical cannabis institution, the Compassion Club; to bring cannabis in all of its forms and potencies into the regulated market; and to remove the unjust taxes on medical cannabis.
I have been publicly, safely and responsibly retailing cannabis out of a storefront for over 20 years. The Compassion Club is a non-profit society, and our model is unique. In addition to cannabis therapies, we have a subsidized wellness centre. Last year we provided 3,400 non-cannabis-related holistic health care appointments, such as counselling and acupuncture and clinical herbalism, to some of Vancouver’s most marginalized people with little or no cost to our 11,000 members.
Our clients often have multiple diagnoses, mental health issues and substance abuse issues. They are falling through the cracks of the health care system until we catch them.
We have developed the gold standard for medical cannabis education. We know how to maximize benefits, minimize risks and avoid adverse effects — knowledge that is transferable to the recreational cannabis market.
In 2002, I had the honour of testifying before the Senate Special Committee on Illegal Drugs and hosting that committee for a tour at the Compassion Club Society. Their report recommended that the Compassion Club should be the standard for medical access and patient care across the country. Our model was enshrined into municipal bylaws by the City of Vancouver to encourage the replication of that model.
Members of the task force, including the chair, Anne McLellan, visited the Compassion Club, and we are referenced as a model in that report.
We worked with patient groups like CFAMM to host a special meeting of patients for the task force, and partially as a result of the task force hearing directly from patients, the task force recommended the preservation of the medical system, which is absolutely the right thing to do, to encourage patients to use cannabis with the support of their health care professional.
I was selected by Senator Nolin, may he rest in peace, to receive the Queen’s Diamond Jubilee Medal acknowledging the work of the Compassion Club for its significant contribution to Canada.
Today, the Compassion Club is facing extinction as we do not fit into the regularity framework of the ACMPR or this legalization bill. We have a massive responsibility to ensure that the health care of our 11,000 members is not interrupted, and we respectfully suggest you share that responsibility with us.
Washington and Colorado have prioritized transitioning long-standing medical cannabis institutions into the regulatory framework, and we should be doing the same.
The Compassion Club is a national treasure, and we ask that you recommend that the Compassion Club be given special consideration and protection, and we will work it out with the government and find a way to survive.
We have risked arrest for decades and have been dedicated to patients and inspired by people like Greg Cooper. When I met Greg, he was 22, had severe multiple sclerosis and could not put on his pants or feed himself until his tremors, muscle spasms and pain were relieved through both inhaling and ingesting cannabis and potent cannabis products.
Dan Hill, who is no longer with us, was diagnosed with HIV, hepatitis C, mental health issues and substance use issues. He used potent cannabis products as a gateway out of his addictions to heroin, crack cocaine and alcohol. He moved off the street into his own apartment, fell in love and died a happy man.
My grandmother Jean Black, who is 102 in June, uses a few drops of cannabis extract in her tea instead of codeine and to manage her arthritic pain and it helped her with the side effects of the intensive radiation she had to heal the tumour in her throat.
These are just a few stories of Canadians whose lives have been transformed by cannabis, and I have witness thousands of them. They have asked me today to talk with you about potency and about tax.
There is one really important thing to understand when we’re talking about potent cannabis products. Did you know that we have very few cannabinoid receptors in our brain stem? The brain stem controls cardiac function and respiratory function. What this means is that cannabis cannot cause death. When we talk about overdosing on cannabis, it’s actually very misleading because the word “overdose” implies that death is possible. When someone uses too much cannabis, the effects can be very uncomfortable. They can include nausea, vomiting and anxiety, but never death.
Potent cannabis products allow patients to consume less plant matter to achieve the required effect and can be more cost effective. For a recreational consumer, extracts can mean taking one inhalation of an elegant vape pen rather than smoking an entire joint.
Potent concentrates, finished edible products, tinctures, topicals, resins and suppositories must be brought into the legal market as soon as possible. Consumers will continue to access and use these products in an unregulated market. Your concerns will best be addressed by the production, distribution and education occurring in a regulated market. Potency limits will not achieve the results you are looking for.
So potent cannabis extracts have not been responsible for a single death. Conversely, last year in B.C. more people died from opioid overdoses than traffic accidents. One of them was my best friend’s 18-year-old daughter.
The Compassion Club has acquired tremendous experience with people struggling with substance use issues using cannabis as a harm-reduction tool. We have witnessed cannabis being substituted for recreational and prescription opiates, cocaine, alcohol and even fentanyl.
As you know, the opioid crisis is a great public health emergency of our time. This country needs solutions now. As you have heard, cannabis has great potential.
So we implore you to vote yes to Bill C-45, to accelerate the legalization of cannabis in all of its forms and potencies and to invest in research into the potential role of cannabis as part of the solution to this crisis.
I was raised to believe that as Canadians we use our power and privilege to protect those who are unable to defend themselves. We stand up for the rights of those who are being mistreated. I’m so disappointed this week that the House of Commons committee decided to maintain the excise tax on medical cannabis.
The truth is that I am ashamed of my country that we’re forcing patients to pay not only a sales tax but also a sin tax on their physician-authorized medicine. Some families are paying hundreds of dollars a month alone. We do not tax medical necessities in this country.
So I ask you to please make us proud of our government’s compassion and wisdom and remove the tax on physician-authorized medical cannabis.
The world is watching us. Together we have an immense responsibility to get this right. We know the harms of prohibition are far greater than the risks of cannabis use. Prohibition laws have disproportionately affected Indigenous people, people of colour and other minority groups. Around the world families are being torn apart, lives ruined, people jailed and futures of young people destroyed.
You are a part of righting this great wrong, and I thank you for your diligent work.
You can trust the Senate committee report of 2002. You can trust the legalization task force process and report and trust your amazing team at Health Canada working its way through these complex issues.
I ask you for three things: Protect Canada’s historical medical cannabis institution. Bring cannabis in all of its forms and potencies into the regulated market as soon as possible. And remove the cruel tax on medical cannabis patients.
Thank you for your time.
The Chair: Thank you very much. And finally we have Kirk Tousaw.
Kirk Tousaw, Barrister, Tousaw Law Corporation, as an individual: Thank you, honourable senators. I’m here as an individual. I’m here as a medical cannabis consumer myself. I use cannabis on a daily basis for chronic pain and have since I was 30 years of age. I’m also here, I’d like to think, as a voice for the hundreds of people I have represented in the criminal and civil courts over the years of working in this field, victims of prohibition that did not deserve to be criminalized for their conduct.
With that said, a brief history lesson. Sixteen years ago, the late Progressive Conservative Senator Pierre Claude Nolin chaired the Senate Special Committee on Illegal Drugs, which issued a comprehensive 600-page report on the issue that currently occupies this body’s deliberations: How should the Government of Canada deal with the issue of cannabis? I had the privilege of speaking with Senator Nolin many times about this, and he regularly reminded me that he’d come to the issue a staunch opponent of legalization. As a father, he said to me, he was mainly concerned about the impact on his children. Senator Nolin, however, allowed and, indeed, demanded that the committee use a rigorous review of the evidence to drive its conclusions, and there was much evidence.
This Senate study remains one of the most comprehensive analyses of cannabis and cannabis policy ever conducted anywhere in the world. The report began by acknowledging that, at its most basic, the discussion is really not about people consuming cannabis. Under prohibition, Canadians consume plenty of cannabis. We grow it. We sell it, and we consume it in vast quantities. As the committee pointed out, the issue is really about whether criminalizing millions of Canadians for those personal choices is good public policy.
The committee grounded its analysis in principles that should serve as guides to this body. Good public policy should promote freedom for individuals and society as a whole. The proper role of the state is based on respect for autonomy and individual and societal responsibility.
Ultimately, Senator Nolin and the rest of the nine-member committee determined, in 2002, that criminalization was bad public policy. They concluded:
. . . the state of knowledge supports the belief that, for the vast majority of recreational users, cannabis use presents no harmful consequences for physical, psychological or social well-being in either the short or the long term.
The committee also concluded that it was prohibition that actually caused the most harm to society. The main social costs of cannabis are as a result of public policy choices, primarily cannabis’s continued criminalization, while the consequences of its use represent a small fraction of the social costs attributable to the use of illegal drugs.
Concluding that cannabis prohibition is harmful public policy, the committee recommended legalizing cannabis for Canadians over age 16 and granting amnesty to anyone previously convicted of simple possession. The committee’s specific policy suggestion may seem familiar:
The Committee recommends that the Government of Canada amend the Controlled Drugs and Substances Act to create a criminal exemption scheme. This legislation should stipulate the conditions for obtaining licences as well as for producing and selling cannabis; the criminal penalties for illegal trafficking and export; and the preservation of criminal penalties for all activities falling outside the scope of the exemption scheme.
Honourable senators, this appears to be precisely what Bill C-45 proposes to do, and the Government of Canada should be commended for now moving forward with reforming our cannabis laws.
That said, I disagreed then, and I disagree now, that a criminal-law-based approach is appropriate. At most, cannabis should be treated in the same general way we treat alcohol, a much more dangerous substance — a regulatory approach with extremely limited offence provisions.
I dare say that the Senate committee believed that any vestige of a criminal-law-based regime should be extremely limited because one of the report’s guiding principles is that “. . . only offences involving a significant direct danger to others should be matters of criminal law.”
In the intervening 16 years, we’ve learned much more about both the harms of prohibition and the impacts of legalization. We’ve seen experiments in legalization, both tacit and explicit, at home and abroad. We’ve had a system of legal access, including legal home production of medical cannabis since 2001 in this country. We’ve had a system of commercial production and sale for medical purposes since 2014, which now has 300,000 participants. We’ve had a system of relatively open and widespread dispensary access in many major cities in Canada since 2014 and more limited dispensary access for more than 20 years.
You can’t walk 10 blocks in the city of Vancouver or downtown Toronto or, for that matter, Hamilton or Victoria or Seattle or Denver or Los Angeles without passing a storefront selling cannabis. These stores are selling, at least in Canada, so-called illicit cannabis openly and safely right now, in almost every city and town in British Columbia and in most major population centres in every province in this country.
This scares some people, and I understand that. Change is scary, particularly when you aren’t familiar with the things that are changing. But I also understand that the evidence is clear that we have not seen and will not see the types of harms that so many seem to fear.
Chaos does not reign in Vancouver. Every day, you see people walking past dispensaries and some going in to shop, just like they do in every other store. One year after this change is implemented, I suspect we will mostly be wondering what all the fuss was about.
I do have four specific recommendations.
First, I want to reiterate my objection to a criminal law approach because such an approach will continue to have significant negative external consequences, such as the continued disparate enforcement against visible minorities and those with fewer economic means. I hope that we move beyond this approach swiftly. But, at the very least, we must expunge criminal records for simple possession so that our previous bad laws are not anchors weighing down our fellow citizens’ life prospects. We should also remove all criminal penalties in Bill C-45 associated with simple personal possession and production of cannabis.
On that point, second, I want to emphasize that lawful personal gardens are critical aspects of this reform. Allowing commercial production and sale but criminalizing people, Canadians, with penalties of up to 14 years in prison who want to grow the exact same plant for themselves at home turns the point of legalization on its head. Legalization should and must be about not criminalizing individual Canadians for cannabis. The development of a vibrant industry will, of necessity, follow.
Third — and as a parent of four children under 18, this comes from my heart — we must not criminalize young people in our pursuit of our laudable goals of trying our best to keep them safe and give them the tools they need to make responsible choices. We’ve tried the criminal approach. It isn’t working now, and, as the Senate committee determined, it is actually the single most significant source of harm from cannabis. A criminal penalty of up to 14 years in prison for a 19-year-old that shares a joint with her 17-year-old cousin is abhorrent and morally insupportable.
Fourth, as we implement these changes, we must be looking for ways to transition the existing underground cannabis economy out of the shadows and into the light. This change is scary for them too. Most, 95 per cent of the domestic industry, are not involved with criminal gangs or violence in any way. I’ve represented hundreds of these folks over the years. They are small farmers, small shopkeepers and people who love this plant. They are also a rich source of knowledge and experience, and let’s be very blunt: If we don’t bring them into the fold, many will likely continue to operate outside of it. That is not good public policy.
Finally, I want to thank the committee for the opportunity to address this critical issue. I also want to thank Canada for taking this step and bringing in legalization 1.0. It is not perfect, but it is an important first step. I look forward to your questions.
The Chair: Thank you very much. That completes our three panellists’ opening remarks. Now I’ll go to my colleagues. Again, five minutes, questions and answers. If the questions can be short and the answers short, you get more in.
Senator Seidman: Thank you all very much for sharing your stories with us. Clearly personal but, as well, your expertise, and it’s been helpful. Thank you.
Ms. Black, if I might ask you, you did say that you are representing the B.C. Compassion Club Society, but then, in full disclosure, you told us that you’re also working for Canopy Growth.
Ms. Black: This is correct.
Senator Seidman: I thought that was particularly interesting. I’d just like to know, when did you accept a position with Canopy Growth?
Ms. Black: I have been working with Canopy Growth for over three years. My position there is director of patient education and advocacy. At the same time, I continue as the founder/mother of the Compassion Club, and I will always have a commitment to ensuring the continued care of the clients that I’m responsible to at the Compassion Club.
Senator Seidman: Great. It’s interesting. Is it becoming, then, more common for patient advocates to take paid positions with cannabis producers?
Ms. Black: I would say that many of the licensed producers are looking for people who have experience in educating and working with patients. When I was just listening to the pharmacist speak about the importance of having a pharmacist or health care professional be the person dispensing cannabis, I would suggest that there is a very important role for health care professionals but that, more importantly, what patients need is access to somebody who has an expertise in cannabis itself.
So, for people who have been distributing cannabis in civil disobedience, breaking these unjust laws until the country decided to start transforming them, there are employment roles for us, either with licensed producers or with specialized cannabis clinics. In fact, there aren’t enough of us. Much of the experience and education that I have I’m working on transforming into education platforms through Canopy Growth so that that knowledge will be available on a much broader scale, even to the pharmacists, who, I may suggest, probably have a tremendous amount of learning to do about cannabis.
Senator Seidman: Thank you. If I might, my time is short. I don’t mean to cut you off or interrupt, but I did want to get to the excise tax issue because it is clearly an important one.
We’re pre-studying portions of Bill C-24 in the Senate, and the amendment was not passed in the House of Commons that would have exempted medical cannabis from the excise tax. What advice would you have for us here in the Senate now that we deal with a provision in the bill when it arrives?
Ms. Black: My suggestion would be that I believe the people in Health Canada and at Canada Revenue Agency are very intelligent and will find a way to make a system work where either patients can get a refund in their taxes for the taxes they pay, or there is a system where they are exempt from paying them in the first place.
I would suggest to you that from a moral, ethical and compassionate place, this is one of the most important things that you can address — the tax on patients. The sales tax in itself is unethical and unacceptable, and it doesn’t comply with the essence of our tax laws.
Senator Seidman: I don’t mean to interrupt, but I would like somebody else’s viewpoint on that. Mr. O’Hara, perhaps.
Mr. O’Hara: Let me add one important thing. Understand the term “medical cannabis.” In the Finance Committee the other day, I heard MP O’Connell state that medical cannabis was already exempt from excise tax. Therefore, the amendment that the NDP had tabled was redundant.
What’s important to note is they’re playing kind of fast and loose with the term “medical cannabis.” What a number of conversations I’ve had and a number of MPs have had is that they’re talking about medical cannabis in the context of Sativex, which is a prescribed medical cannabis derivative, but it’s not medical cannabis per se. I would urge everybody to understand that and not be confused if that comes up and in essence be prepared for those conversations that will take place.
Senator Seidman: So how should we deal with this provision in the bill?
Mr. O’Hara: It’s very simple. Medical cannabis, as authorized today, should be fully exempt from all taxes, especially excise tax. We need to recognize that excise tax is essentially a compound tax. It’s tax upon tax. It’s inherently evil and just shouldn’t exist.
The Chair: Thank you very much.
Senator Dean: Thank you. Mr. Tousaw, I’m thinking about your point about social sharing and the impact in terms of closeness of age, an individual sharing with a peer or relative. What would your advice be if we were to try to tackle that? What would be a straightforward means of just opening the door a little bit to social sharing?
Mr. Tousaw: Let’s be clear. I think Bill C-45 takes steps in the right direction by not criminalizing young Canadians for possession under 5 grams of cannabis. You’re precisely right to say this close-in-age issue is a very serious issue. My eldest daughter is 17. Her peer group includes people down to 14 years of age and up to 18, 19, 20 years of age. It is perfectly normal behaviour for young Canadians who are 19 to potentially use cannabis and share cannabis with their peers who might be under the legal age under Bill C-45.
We have a close-in-age exemption to sexual conduct laws, for example, in the Criminal Code. That type of close-in-age provision, if you were within two or three years of the person you’re engaged in the activity with, could easily be imported into this. But I think that doesn’t necessarily go far enough.
One of the things this bill also does is criminalize a parent who would want to have their teenager, for example, use cannabis in the home as opposed to out with their friends or out at a party or something like that. With alcohol right now, you can allow your children to use alcohol in your home without fear of criminal penalty, and that makes sense. That’s how you teach young people appropriate behaviour. This sort of forbidden fruit idea actually drives people towards unsafe use of substances. We see it with alcohol and other substances.
I think it’s important to recognize that parents need to have an active and participatory role in their children’s development. I would much rather my children are introduced to cannabis on my back deck by me than by a shopkeeper or by a peer driving around or at a party with other 16-, 17- or 18-year-olds. We know they’re doing it. Let’s not pretend here. We have some of the highest youth rates of cannabis use in the Western world, and our kids are pretty good. They’re doing pretty well. We have good outcomes in this country for a lot of children. It’s obviously socio-economic dependent, as all things are, but we need to be sensitive to these issues and not be looking at people and say you can go to prison for 14 years if you pass a joint to someone in your peer group. That seems to me to be completely wrong-headed.
Senator Dean: For Ms. Black, you mentioned concerns about placing potency limits and restrictions on high-potency cannabis products. At the outset of legalization in Canada, we would see only two limited products, dried cannabis and oil, both at the low end of the potency spectrum, I think it’s fair to say. There have been some suggestions in discussions here that even those low-potency limited initial product offerings should have potency limits imposed on them, possibly on an age basis. What’s your reaction to that?
Ms. Black: Well, people will just consume more of the plant matter to achieve the desired effect. So you may end up inhaling 2 grams of cannabis in one sitting to try to obtain the desired effect, which is not in the interest of public health. When people are using potent flowers or extracts that have been made, they’re able to inhale or ingest a much smaller amount of plant material to reach the desired effect. So in that way, potency limits are not going to achieve the goals of limiting the amount of THC or CBD that people are taking in.
On the other side, you would just be forcing people to continue to access the products that they want in an unregulated market. So the goal, really, is to bring all of the products in all of their forms and all ranges of potency out of the unregulated market and into the regulated market.
When we’re distributing cannabis in a regulated way, we have the opportunity to provide proper education. At the Compassion Club, every patient gets an hour-and-a-half intake session. I’m not saying that is necessarily replicable in a retail environment, but that kind of knowledge we have of how to teach people, either patients or recreational consumers, the safe place to start and how to slowly increase their dose until they reach the desired effect without any adverse effects, we can provide that education in a regulated environment, and that’s your best tool to avoid the adverse effects I believe you’re trying to avoid through potential potency limits.
Senator Dean: Thank you. You’ve given us good advice.
Mr. O’Hara: We hear from patients constantly, especially patients suffering from MS or chemotherapy-induced nausea. They need high THC. The second aspect of that is the cost part of it. We’re completely against that. We don’t support THC limits.
Senator Poirier: Thank you all for your presentations. Greatly appreciated.
My first question is for Mr. Tousaw. We heard a lot of talk in committee about the risk associated with cannabis but not so much on not nearly enough education on the consequence of the law. When it comes to possession or home growth or age limit, in your opinion, are Canadians, young and old, well informed and aware enough about the consequences of Bill C-45? If they’re not fully aware of the consequences of Bill C-45, what could be the impact, in your opinion, on the juridical system?
Mr. Tousaw: That’s a very insightful question, and I would broaden it further. Not only are Canadians not aware of the impact of Bill C-45, but Canadians aren’t very well aware of the current laws surrounding cannabis. I cannot tell you how many people I talk to who think cannabis is legal right now. It’s absolutely stunning. I talk to people in the regulated industry who don’t know how the rule set works. The lack of knowledge.
Look, it’s complicated. You read legislation. You folks have all done it. It’s not easy to do. You have to slog through it. It’s referential. You have to think about it in a deep way. But there’s a tremendous amount of confusion out there. And the problem with that is that the legislation has so many sort of arbitrary limits that people are going to just, of necessity, run afoul of it.
For example, you’re going to be allowed to possess 30 grams of dried cannabis, and then there’s this equivalency ratio that applies to other cannabis products. So you’re going to have to do this math in your head when you leave the house, “I can bring two cookies with me and not four because four means I’m breaking the law and two doesn’t.” Or, “I have this jar of cannabis here. Do I have to weigh it before I leave the house?” It doesn’t make a lot of sense, and it’s completely arbitrary.
When you go to the alcohol store, you can go into the alcohol store and buy enough alcohol to kill a small town, put it in the trunk of your car and drive away. What we depend upon is Canadians exercising individual responsibility. We don’t depend on the government to say you can only buy six beers at a time each day, or you can buy six beers now, go home and drop it off, go back to the store, buy another six beers, go home and drop it off.
That’s the system we’re going to have for cannabis, and it doesn’t make a lot of sense. That’s why one of my recommendations to this committee is that all criminal penalties associated with personal — not commercial, personal — possession and production of cannabis should be eliminated from Bill C-45. Canadians deserve to stop being criminalized for their personal individual choices. They deserve that from this committee and this government. That’s the point of legalization.
There also has to be education. I think Health Canada is doing a very good job so far of educating people on each step along the way about what the changes look like and what the ramifications might be.
The best thing we can do for Canadians is make it simple. You’re allowed to possess cannabis. You’re not allowed to unlawfully sell it. You’re allowed to possess it. You’re allowed to grow cannabis. Just like you can’t make beer and sell it out of your garage, you’re not allowed to grow it and sell it out of your garage. But you shouldn’t risk going to jail for 14 years because you have five cannabis plants in your garden instead of four. That just doesn’t make much sense at all.
Senator Poirier: My next question is for Mr. O’Hara. I was wondering if you can do a comparison for us when it comes to access to medical marijuana for Canadians in need. What will the impact of C-45 be on access to medical marijuana? Will access be prevented? In your opinion, would it put medical patients in need of medical cannabis in harm’s way by turning to a different, less effective medication?
Mr. O’Hara: There’s a short answer to that, and that is that Bill C-45 doesn’t affect medical cannabis directly. This is more about the recreational side. Medical cannabis patients will still be able to access cannabis through the ACMPR system, which to this point remains unchanged. That’s one of the points we’re advocating strongly, that that continue on. There’s nothing in Bill C-45 for medical per se.
Senator Poirier: Mr. O’Hara, I understand that your organization has been working to get insurance companies to cover medical cannabis. Can you give us an update or an overview of the status of this project? How many companies provide some coverage today? Are you optimistic that others will be following suit?
Mr. O’Hara: That’s a great question. Really there are only a handful of companies that provide coverage today, and it’s important to note that they’re providing coverage that is optional for that policy to be taken up. Just because they’re enabling coverage doesn’t mean to say that it’s widely adopted. But there are some companies who have done that today. Sun Life is one, and there are a few others.
I fully expect that to continue. There’s a lot of interest and a lot of discussion around the topic within the industry.
Senator Poirier: Thank you.
The Chair: Can I just follow up on that? Are any other provinces putting it onto their drug formulary in terms of coverage?
Mr. O’Hara: Good question. Not that I’ve heard.
Senator Manning: Thank you to our witnesses.
Just quickly, Mr. Tousaw, following up on your comment regarding the confusion that is out there, I believe many people are confused thinking we’re talking about decriminalization here instead of legalization, from people I talk to, whether we’re talking medical use or otherwise.
The C.D. Howe Institute has recommended that the government consider pardoning people previously convicted of cannabis possession and dropping any outstanding charges to free up much-needed resources for cannabis legalization. The government has said they don’t intend to pursue pardons at this time.
I understand you have previously expressed your disappointment with this decision. Is there any reason why the government couldn’t go ahead with some form of amnesty with legalization?
Mr. Tousaw: Great question, senator. No reason whatsoever. There are literally thousands of pending civil possession cases in the criminal courts in this country today. People have been arrested to the tune of 25,000 for simple possession per year while the Government of Canada is debating this legalization process and bringing it in. That is unjust.
The justice minister can direct the Public Prosecution Service of Canada to discontinue all prosecutions for simple possession or any cannabis offences at any time that the minister chooses to do so. I urge the minister to do that. We just had a Supreme Court of Canada decision in Jordan about excessive delay. We see an already overburdened court system creaking its way, day by day, into further decline. We don’t have enough judges. Why are we spending scarce resources prosecuting people for simple possession of cannabis?
We also know, by the way, that simple possession is enforced in a discriminatory manner against visible minorities and persons of lower socio-economic status. This is an absolutely unethical, immoral process. We should stop, and we should have stopped a long time ago, prosecuting simple possession. Senator Nolin’s report came out in 2002. I think it’s an important step, but there’s so much more we can do. We can do it without legislative change; we can do it by policy.
Senator Manning: Just yesterday I believe people were charged with possession in my home province of Newfoundland and Labrador, and here we are debating this issue.
The government has spoken at length about how the cannabis act will crack down on organized crime. We’ve heard conflicting evidence on whether or not this will actually be effective. We’ve heard, from many sides, many different stories.
One of the ones they keep using here over the past is what’s happened in Colorado. Last night on CBC National News Briar Stewart did a report on what’s happening in Colorado and the fact that the organized crime black market seems to have gone through the roof there’s so much of it down there.
I’m just wondering, maybe you could help us understand the different perspectives on the presence of organized crime in the illicit market. Who’s currently supplying Canadians with illegal cannabis? Is this criminal gang activity on a large scale, as the government suggests? Is that something we need to be looking at here?
Mr. Tousaw: A huge misapprehension is that people involved in the illicit cannabis economy domestically in this country are connected to organized crime. It was referenced in the earlier panel, and I referenced it in my comments; about 95 per cent of the domestic cannabis industry is not what we normally think of as organized crime, criminal gangs and people that are engaged in the use of violence.
I have represented hundreds if not over a thousand people charged with cannabis offences over the last 15 years. I can tell you that with very, very few exceptions, I would invite them home — and have invited many home — to meet my family and sit at my kitchen table. They’re good people. They’re people that are otherwise law-abiding.
I think using terms like “crack down” is part of the problem. Bill C-45 is not going to crack down on organized crime. The only way — and I think the entire experience of prohibition is evidence of this — that you eliminate an underground economy on a product is that you make it lawful and you make it easy for people to transition out of the very vibrant, very well-entrenched illegal economy that exists today, out of the shadows and into the light.
Health Canada has taken several steps in the right direction with the promulgation of microproducer rules, microprocessing rules, and its policy decision not to automatically bar people with prior involvement from participating in the licit industry.
The individual provinces have taken varying approaches to that. British Columbia, I think, has said very explicitly, “We’re not having an automatic bar.” On the other hand, Alberta has gone in the other direction. So Alberta, with an otherwise very robust private retail system, has said, “If you have any experience selling cannabis, you can’t participate.” That seems to me to be amiss.
Prohibition, criminal law penalties, including mandatory minimum penalties brought in in 2012 by the former government of this country, have not made any impact in supply, consumption or demand for cannabis in this country. They don’t reduce it.
So we can’t criminal law our way out of this issue. We have to use common-sense economic strategies. The illicit economy will go away when the licit economy is easy to participate in, carries the same range of products that the illicit economy does and sells them with good customer service at good or better prices. That’s how you get rid of the illicit economy. The idea that we’re going to do it with a criminal law approach I think has proven to be a spectacular failure.
The Chair: I have to move on.
Senator McCallum: Thank you for your presentations. This question is for Mr. Tousaw. I wanted to talk more about the criminalization of youth. I agree with you on that because marijuana is used by a lot of young people. I’m from a reserve. They use marijuana to deal with the social issues they have. I don’t know if you’ve heard of Gordon Crews. He worked with a lot of juveniles in detention systems. He interviewed former residents, and they said to him, “Don’t criminalize the young. Give them alternate programs.” Can you speak a bit about that?
Mr. Tousaw: I think that’s very sensible. Let’s just situate this. The use of cannabis by young people is part of growing up. It’s normal, standard behaviour, not for everyone but for a substantial portion of our young people. They are going to use cannabis. They are going to use alcohol when underage. They’re going to do these things. We can’t stop that.
So what can we do? We cannot make the impacts of that use dramatically worse by also involving them with the criminal justice system. Involvement with the criminal justice system for simple possession of cannabis provides no benefit to the young person. In fact, it’s all negative. You become fearful and resentful of police. You become entangled with the criminal justice system. You might have a lifelong criminal record. You might not be able to cross the border into the United States. Future employers might turn you down. There are a host of negative consequences that arise simply because we’ve chosen to label that normal behaviour as criminal behaviour. We need to take a different approach.
Our young people are the most precious resources we have. I have four children between the ages of 7 and 17. I don’t worry about the fact that they may try cannabis. What I worry about is the fact that they may try it and then get arrested by a police officer and develop a lifelong aversion to going to the police when in need of them. I was this 16-year-old. I was arrested for simple possession of cannabis more than once. I developed a real antipathy to police officers. And it wasn’t until I became a practising lawyer and worked with them on a daily basis — in an adversarial capacity, granted — that that initial feeling went away. I realize that these are human beings, like everyone else, trying to do a very difficult job, and in the area of substance use, they’ve been tasked with an impossible job. It’s impossible. They should not be the front-line response to substance abuse. Parents, educators and social workers should be the first line of response, not the criminal justice system.
Senator McCallum: This question is for Ms. Black. I was very encouraged by your Compassion Club. You said you developed a gold standard for education. Coming from First Nations where there are a lot of addictions, I wonder if you could share a bit of that with us.
Ms. Black: Certainly. First of all, it’s about spending the time. The Compassion Club has the capacity to spend an hour to an hour-and-a-half with every new client who comes in for a one-on-one education session. That’s a choice about making the investment and spending the staff time to do that.
Over the years we’ve developed systems for teaching people how to start using cannabis safely and to avoid the adverse effects. When inhaling cannabis, it’s easier to avoid adverse effects because you feel the effects right away. You have a little inhalation from your vapourizer, you wait a minute or two, you decide if you want to take a little more, you have another puff, and you can feel the effects.
When we ingest cannabis, it takes much longer for the onset of the effects because it has to be digested through our GI tract before it gets into our bloodstream. When people are eating cannabis products is when we have to give them a lot of education. Say they eat a piece of a cannabis edible product and two hours later they don’t feel any effects so they eat more. We call that cumulative dosing, and that’s where they might feel the effects of both doses at once. This is what the kids call greening out, which is where you might get a bit pale, feel nauseous, feel anxious, and you might even vomit if it’s a serious case. So when we’re dealing with seniors or people with very sensitive systems, it’s really important that we avoid that.
In the old days, we didn’t have access to laboratories because we were breaking the law and there weren’t laboratories that would work with us, so we didn’t have precise measurements. We would tell people, if they have a cookie, to take one little bite and then wait until the next day before having more. Wait a whole 24 hours.
Now in the modern cannabis world, we do have access to laboratories. So if I’m dealing with somebody who is brand new to using cannabis, I will tell them if they’re looking for pain control using THC, to take equal amounts THC and CBD and balance them together, and you start at 2.5 milligrams, which is a very small amount. Then I encourage them to wait 24 hours before they increase by another 2.5 milligrams. This system can pretty much guarantee that it’s going to avoid adverse effects, and it’s the same knowledge we can easily translate to the recreational market when it comes to potent products, about how to use them in a very safe way where you start slow and go very slow but in a precise, measured way. People will learn what the amount is they need to achieve the desired effect while avoiding any adverse effects.
Mr. Tousaw: If I could add one quick sentence, that’s not really any different from how we deal with other medicines. Your doctor will prescribe you a painkiller and say take one, and if it works, don’t take two; if it doesn’t work, maybe the next day try taking two up to a maximum. We’re familiar with this.
[Translation]
Senator Mégie: My question is for Ms. Black. Why do you say that your organization B.C. Compassion Club Society is in danger because of the legalization of marijuana? It offers a service to the population. Why do you feel it’s in danger?
[English]
Ms. Black: Thank you for your question. The way that we have created the medical stream currently is through the licensed producers and distribution of cannabis through the website and the mail-order system.
The Compassion Club is a community centre. It’s a storefront. It’s still engaged in civil disobedience 20 years later. We try to be as lawful as we possibly can and to obey bylaws. In Bill C-45 there is no provision for a community centre that takes care of patients, so we could pursue getting a recreational licence from the province, but in that case, we would not be able to supply all of the edibles and extract products that our patients rely on. So we are in a place where we are going to be forced to continue to break the law to ensure that the medication that our patients are depending on is not interrupted until the time the law changes.
There is currently no licensing scheme under either the ACMPR or Bill C-45 that is going to allow us to legally continue to provide, in some cases, the life-saving health care that we’re providing to our clients. So when I ask what can you do to help protect this organization, really what I think you can do is make a recommendation in your report to the government to find a way to give special status and protection to this organization, and we will work with Health Canada and find a way to creatively find licensing so that we can do what we’re doing in a legal environment. And you need to bring edible products and extracts into the regulated market so that we don’t have to continue to risk criminalization to provide the medicines that our patients require.
[Translation]
Senator Mégie: The dispensaries that will soon be everywhere won’t have the same problem and won’t worry about it, since it will be legalized. Then they can sell some.
Couldn’t you go down the same path as them, but go to patient services? Is that possible?
[English]
Ms. Black: It is possible. We could apply for a provincial licence, in which case we would be agreeing to no longer distribute finished edible products or any of the inhaled or ingested extracts because they’re not in the legal market.
Also, the way that British Columbia is proposing to do supply, they’re going to have a central warehouse where the licensed producers supply this central warehouse and the dispensaries will then be able to purchase from that warehouse.
I do not have faith that that system will be able to do appropriate quality control and maintain the quality of this perishable product. I just don’t believe that we’re going to be able to maintain the quality of medicine and definitely not the selection of products that patients are requiring.
The Chair: Let me follow up on that.
You’ve existed for 20 years. Obviously, that’s with some agreement or tolerance from local authorities, who must think you’re doing a good job. Why should you now suddenly feel threatened? You don’t necessarily have to go into the mould. You haven’t been in the mould for 20 years, so why would you think that? Also, how many other compassion-type clubs are there aside from yours? Is it widespread?
Ms. Black: There are other excellent medical cannabis dispensaries that focus on patients, but what makes the Compassion Club very special is that all of the profits go to funding our wellness centre. People are using cannabis therapies in conjunction with a counsellor, a nutritionist, a herbalist and an acupuncturist. These services are being provided to people who are usually living in dire poverty and are often minorities and marginalized.
This is the way that we are catching people who are falling through the cracks of the health care system. To my knowledge, no other organization operates in the same way that the Compassion Club does across the country.
As we are evolving our legislation around cannabis, we have offered our expertise to the parliamentary Health Committee and to the Senate. Every time we have an opportunity to come and help this government shape the progress around the evolution of cannabis laws, we do that. We don’t want to continue breaking the law. We want to be legal. We want to be licensed. But we will be forced to continue to break laws until such time as all of the products that patients are requiring are legally brought into the regulatory framework.
The Chair: That completes round one. I have a question for Mr. Tousaw before I go to round two.
I totally agree with what you’re saying about removing criminal penalties for simple possession, particularly as it relates to our young people.
However, you and others have pointed out this whole question of social sharing — that is, a 19-year-old, a 17-year-old and all those combinations — and you can end up in the youth criminal court with more than 5 grams and yet an adult can have 30 grams. We’ve got all those things about close in age, social sharing, et cetera.
One point of view is — and I know a lawyer would never consider this acceptable — that they would never actually be prosecuted and that those kinds of prosecutions would not take place even though technically they are a violation of the law. Technically, in some cases it could be a fine, but it could eventually lead either in the youth criminal court system or the adult criminal court system to something more than that.
What do you say to that, that there’s nothing to worry about here?
Mr. Tousaw: I have a two-part answer to that. The first part is that it’s a common misconception that simple possession cases are currently not prosecuted in this country: 26,000 people a year end up prosecuted for these offences.
The Chair: A lot of them are minorities.
Mr. Tousaw: That’s the second part of my answer. Is my child — white, privileged, with a lawyer for a father — going to get prosecuted? No. But that’s not good enough. We know that these laws are applied in disproportionate manners against marginalized people, visible minorities and people with different socio-economic status. I don’t think it’s acceptable that some people, like my children and like Mr. Trudeau’s brother, get to escape criminal prosecution because of what they look like or their connections, while others, who don’t have those connections and who don’t look that way, end up in the criminal justice system. That’s what we see today. That’s what we’re going to see in the future, namely, a disparate enforcement of these laws. That is absolutely unacceptable in a free and democratic society.
The Chair: On round two, we have seven minutes.
Senator Seidman: Actually, my question was asked. I believe, Mr. O’Hara, you answered it because it was about the insurance companies. So I’m okay.
All is well now. I just wanted to be clear.
Senator Manning: Once again, I want to thank our witnesses.
I’m a big supporter of decriminalization, not necessarily of legalization. I want to follow up with questions I was asking you before, Mr. Tousaw, in regard to the possibility of different provinces having some different rules. I watched in Colorado, for example, some of the concerns that are in that area — that is, the fact that Colorado has legalization while the next state may not. Quebec, from what we hear, is not going to allow homegrown, whereas New Brunswick is.
You spoke about British Columbia versus the storefronts in Alberta. From a legal point of view, what would your concerns be in relation to the fact that we’re going to have a national law, Bill C-45, but we’re going to have provinces with different jurisdictions? Are we going to have concerns from province to province, interrelated?
Mr. Tousaw: I think we are. I always like to divide this issue into two different things: commercial versus consumer. The business plan, the commercial regulation, I have concerns about, but the Comeau case in the Supreme Court of Canada made clear that provinces are entitled to regulate differently than each other and even to impose certain barriers to interprovincial trade. I don’t think we’re going to see another challenge to that provision for a good long time.
My difficulty is on the individual side, on the consumer side.
On the commercial side, I have preferences. I think private retail is better than public monopolies. I think it makes a lot more sense. We’re going to end up there eventually. We’re going there for alcohol. It just makes more sense.
On the individual side, it’s absolutely inappropriate to legalize personal production of cannabis across this country. The federal government in this country is the sole source of criminal law jurisdictionally. But in Quebec, to step in and say, “This behaviour that is otherwise lawful in the rest of the country we’re going to punish you for and criminalize this conduct as a province,” not only is it wrong-headed because it’s going to lead to the continuation of the problems that prohibition causes, but also I think it’s not fair. Why should someone, one foot across a line, be able to grow four plants perfectly legally and the person on the other side of that line — it may even be neighbours — can’t do that and the police could come in and arrest them for it? That is absolutely inappropriate. It should not be tolerated and, quite frankly, I think ultimately the courts are going to resolve that portion of the issue.
I don’t think it’s constitutional for a province to criminalize otherwise lawful behaviour that’s lawful across the rest of the country. If I spoke French better, maybe I’d take a case like that, but unfortunately I don’t.
Senator McCallum: Do you feel that the excise tax and the criminalization of youth are discriminatory?
Mr. Tousaw: I think it is, particularly the excise tax. I join with everyone you’ve heard today to say applying an excise tax to medical cannabis — and let’s be clear, it’s not currently applied to medical cannabis. So we are adding a tax to sick and suffering citizens’ burden. We should not be doing that. But any of these policies, just because of the way our society is structured and the institutionalized racism that we have and the institutionalized socio-economic discrimination that we have, all of these issues are magnified when applied to people of marginalized groups, visible minorities and people of lower socio-economic status. Taxes hurt those folks more than they hurt people with means.
I can pay the extra dollar a gram. Even for my medical cannabis I can afford it. But a lot of people can’t. We should be concerned more about those people than about people like me who aren’t going to have these kinds of difficulties. And the same is absolutely true of every other aspect of taking a criminal law approach to this issue.
The Chair: Is there anybody else?
We are finished.
Mr. Tousaw: We can just keep going. I have a lot more I could say.
The Chair: The Senate is meeting in another 15 minutes, so we have time to wrap up.
I want to thank the three panellists that we’ve had in this second panel. You’ve been most helpful to us. I appreciate the answers you’ve given to our questions.
Colleagues, before you leave, I would remind you that we are back again tomorrow morning at 8 a.m. We have four hours of dialogue with various officials on the four reports that came from the other committees.
I also want to remind you that any amendments or observations to the bill — because on Monday at three o’clock we — we start at one o’clock on Monday but we have an hour and a half with Mr. Blair and officials from Health Canada. But at three o’clock, after an hour break between the sessions, we go into clause by clause. So amendments and observations, remember the request is they must be in both languages, and they must fit the format of the clause provisions of Bill C-45. You can’t just have a general wording. It has to meet the provision that goes into the bill. That’s why we suggested you consult the Law Clerk with respect to that. Those are due by 4 p.m. tomorrow so that we can get them all sorted out and get them ready for Monday. We will be getting them on the weekend, so there won’t be much of a weekend break. We’ll be ready to go on Monday.
Please remember all of that. We’ll see you at 8 a.m. tomorrow morning.
(The committee adjourned.)