Proceedings of the Special Committee on
Illegal Drugs

Issue 1 - Evidence, October 16, 2000 - afternoon sitting

OTTAWA, Monday, October 16, 2000

The Special Senate Committee on Illegal Drugs met this day at 3:09 p.m. to reassess Canada's anti-drug legislation and policies.

Senator Pierre Claude Nolin (Chairman) in the chair.

[Translation]

The Chairman: Our witness this afternoon is Dr. Zoccolillo, an Associate Professor of Psychiatry and Assistant Professor of Pediatrics at McGill University and Montreal's Children's Hospital. He is also a member of the Research Group on Social Maladaptation in Children, which is directed by Richard Tremblay, Ph.D.

Dr. Zoccolillo is currently the principal investigator on two projects funded by the Canadian Institutes for Health Research. The focus of the first project is the natural history and consequences of alcohol and drug use and dependence from childhood to young adulthood in a community sample. The second project is a study of prenatal maternal smoking and offspring conduct problems in the second year of life, modeling the effects of maternal and paternal conduct problems, maternal responsivity and fetal growth retardation.

Dr. Zoccolillo's main research interests are the development of antisocial behaviour and substance use disorders in children and adolescents. Dr. Zoccolillo received his psychiatry training at Washington University in St. Louis and did a NIMH funded post-doctoral fellowship in child and development psychiatry with Professor Michael Rutter at the Institute of Psychiatry in London. He joined the faculty at McGill University in 1992 and is both a U.S. and Canadian citizen.

[English]

Good afternoon, Dr. Zoccolillo. Thank you for appearing before us this afternoon.

Dr. Mark Zoccolillo, Associate Professor of Psychiatry and Assistant Professor of Pediatrics, McGill University and the Montreal Children's Hospital: I will present an overview of a study we did in Quebec that could possibly have some implications for drug policy.

However, I will start with a study from Ontario just to make a point. This is from the Ontario student drug survey, an annual survey that has been going on for probably 20 years. I want you to notice the comparison between 1993 and 1999. These are representative students from Grade 7 through, I believe, Grade 12, in Ontario. I would like you to notice that the use rate of cannabis, marijuana and hallucinogens has doubled over those six years. It has gone from around 12 per cent to up to 24 or 26 per cent for cannabis, and more than doubled for hallucinogens.

I make this point only as a preface to the study I will present on Quebec, but that will show you that things have changed quite rapidly. In studying drug policy, you must take into account that we are living in fast-changing times, and data from 10 years ago does not necessarily reflect what is going on now.

This is a study conducted by me, Frank Vitaro and Richard Tremblay. It is a study not just of drug use in adolescents, but also of the circumstances of use.

It is a fairly simple, straightforward design. This is a representative sample of adolescents in French language school boards throughout Quebec. Adolescents were interviewed between 1995 and 1997. Table 1 shows their age and grade level. As you can see, most of the adolescents were 15 to 16, and most of them were in secondary 3, secondary 4, which is the equivalent of Grade 9 or Grade 10. I want to make the point that these are ninth and tenth graders, not college students, and not older high school students. I will present the data separately for boys and girls. This is a self-reported questionnaire. We asked them about their alcohol or drug use, as well as the frequency and the circumstances. The emphasis will be, of course, on illegal drug use.

As you can see, most had drunk alcohol by this point. Slightly over half had been drunk, and about 60 per cent had drunk alcohol more than five times.

When we go down the table to illegal drugs, about half the girls and slightly less than half the boys had tried drugs, but about one-third had used drugs more than five times. That was our cut-off question on use, so we asked detailed questions of those who had used illegal drugs more than five times. Of course, the drug that every student had used, if they had used drugs at all, was marijuana. About 20 per cent had tried hallucinogens by this point, and smaller proportions had tried amphetamines, inhalants, cocaine, and other drugs.

We focused on problem use. We tried to key in on the kinds of things that adolescents spend their time doing that could be dangerous or problematic. We were not as concerned with asking about addiction because we were more interested in how adolescents use these drugs. If you look at alcohol problems in table 2, there is driving a motor vehicle while under the influence, drunk at school, getting into fights, playing sports under the influence -- which includes things like bicycling or skateboarding -- police trouble, drank alcohol in the morning, had arguments with friends, had arguments with parents, or sought help to reduce use. The big comparison will be with drug use, but I want to call your attention to the second line, which is "ever drunk while at school." It was close to 10 per cent for boys and 8 per cent for girls. That is for alcohol.

This table shows the proportions of problem drug use in the whole sample. This is not for those who had used drugs; this is simply overall. You can see the striking finding on going "high" to school. One in four adolescents has been high at school by this point. We broke it down according to whether it was once or twice, occasionally, or many times. You can see that about 16 per cent had been to school already high occasionally, or more than occasionally, many times. This is markedly different from what we saw with alcohol. I find that to be a very disturbing figure.

The next question was, if you drank alcohol, what kind of questions did you encounter? The previous numbers were for the whole group, whether or not they drank or used drugs. The comparison will not be with illegal drugs, but how do kids actually use drugs or alcohol. I want you to note here, focusing on illegal drugs, "ever drunk while at school," the third line. Most of the kids who had drunk alcohol more than five times, which was about 60 per cent of the sample, had never been drunk at school. While they may have used alcohol, going to school drunk was not part of that use.

Looking at the bottom of the table, this sums up the number of problems. There was a total of nine. You can see that most kids who drank alcohol reported zero or one, which is about 60 per cent of the boys and more than that for the girls. Most kids who drank, other than playing sports under the influence, largely did not do these other things. If you go down to "having four or more problems," you can see that very few who drank alcohol reported doing many of these things.

The pattern is completely different for drugs. Table 3 shows drug problems in adolescents who used drugs more than five times, but that is a third of the whole sample. This is not a tiny minority.

You can see vast differences. Most of the students who said they had used drugs more than five times had been high while at school, most had played sports under the influence, and most had used drugs in the morning.

You may recall that most students who reported using alcohol reported, at best, zero problems or one problem. Here that is the minority. Almost half the boys reported four or more of these behaviours. For the girls, about one-third reported four or more of these behaviours. The majority reported at least three or more of these behaviours, so there is a vast difference between how students use drugs and how they use alcohol.

The next issue under discussion was, if they are doing these things, they must be using it fairly frequently. One question asked how often they were using drugs or alcohol. You can see, here again, in the table where we compared drugs and alcohol use, that there were vast differences. In the second column for boys -- and it is not that different for girls -- you can see that 21 per cent of those who drank alcohol more than five times reported using less than once a week, and 50 per cent once a week. Most drinking was confined to once a week or less, even at the time of maximal use. If you look at drugs, it is quite different. The pattern there is that few use once a week or less. If you go down to the last three rows of table 3, you will see that the majority of boys and girls reported that had they had progressed to using drugs three times a week or more.

This is similar to the previous pattern we saw, of going to school high and playing sports while under its influence. We see here that once drug use has begun, there is a fairly rapid progression in its integration into the daily lives of adolescents.

We were not able to break it down and ask each question separately for each drug, but we were able to make some inferences. We asked, of course, about all the different drugs they had ever used, but we also asked them to write down up to three drugs that they were using at the time that they were using drugs the most. We found, first of all, that this group of adolescents all reported using marijuana, but many also reported the use of other drugs. Even those who said they were using other drugs reported that, at the time of maximal use, they were using marijuana. Marijuana is the backdrop to whatever other drug use occurs.

We thought that these adolescents were probably using marijuana when they reported frequent use and going to school stoned. We thought we could look at those adolescents who had just used marijuana and not other drugs. We asked how many drug problems they had if they only used marijuana. The answer is again, as you can see, that the majority of boys and close to a majority of girls reported at least two or more problems if they just used marijuana. Certainly, as you add drugs, the number of problems goes up dramatically.

In the second most common group, who had used just marijuana and hallucinogens, close to the majority reported four or more problems and most reported three or more problems. When you get to those who used multiple drugs, you can see from the data that multiple problem use was the norm for most of them.

My first series of conclusions includes the fact that problem use of alcohol and drugs is relatively common among Quebec adolescents. There is potential for relatively high rates of injury in driving a motor vehicle or participating in sports, such as bicycling, while under the influence of drugs. Attending school while high from drugs is common, with one in four students having done so at any time, and one in six in the previous six months. The pattern of drug use is quite different from that of alcohol use. Alcohol use is more common, but appears limited to weekend use, with most users reporting no problems or only one.

The normal pattern with drugs seems to be the use of drugs several times a week, going to school and playing sports while high, and spending much of the day high. The most commonly used drug is marijuana. It is a myth that most current drug use by teenagers is experimental and limited to occasional marijuana use at parties.

I will go on to more speculative issues in order to try to put this more into the context of your interest in drug policy. You will recall I started my presentation by showing that we have had a doubling of drug use over the last six years. I will return to some findings from that Ontario study, because it also asked about attitudes toward use and availability of drugs in an attempt to make some sense of why we have this increase, and why it has become such a major part of daily life for Quebec adolescents. This compares the same Ontario students between 1991 and 1999, and is titled "first perceptions of harm."

They were asked about the degree of risk in trying marijuana. You can see that the percentage of students reporting great risk declined from 1991 to 1999, as did the percentage reporting great risk in smoking marijuana regularly. Moral disapproval of use also declined from 1991 to 1999, and perceived availability of drugs has increased, going from 29 to 52 per cent.

A second issue I wish to raise briefly is changes in the pattern of marijuana availability, and in particular, growth and type of marijuana. From RCMP reports, and what I read, approximately half of the marijuana currently used in Quebec is grown locally, often indoors. A similar situation exists in other provinces. That is a change from two decades ago, when a large amount of marijuana was imported.

Second, I wish to draw your attention to a recently published book called The Science of Marijuana by Iversen, a person who reviews the literature. He has no particular axe to grind. He notes that the new strain of cannabis that has been bred for intensive indoor cultivation of plants of short stature and high THC content may be changing the picture. It yields herbal cannabis that contains two times more THC, which is the general ingredient, than has generally been available previously. It is also true that such home-grown material is becoming an increasingly important source of supply.

I wish to briefly review two of what I believe are fairly well-established, harmful effects of marijuana, and a number of other areas where there is considerable contention. I will refer again to as good a book as the one by Iversen. The first is the effect of marijuana on memory, detailed in The Scientific Study of Marijuana by Abel. By far the most consistent and clear-cut effect of marijuana is disruption of short-term memory. Short-term memory is usually described as "working" memory. It refers to the system in the brain that is responsible for short-term maintenance of information needed for the performance of complex tasks that demand planning, comprehension and reasoning. The relatively severe impairment of working memory may help to explain why, during the marijuana high, subjects have difficulty maintaining a coherent train of thought or conversation. They simply cannot remember where the train of thought or the conversation began, or the order of components required to make sense of the information. Obviously this is relevant if you are going to school stoned.

This author also deals with marijuana and drug dependence. It is becoming increasingly clear that cannabis is a drug on which regular users become dependent, and that this adversely affects large numbers of people. Cannabis dependence is still largely unrecognized because it is still widely believed that it is not an addictive drug. There is a real need to educate cannabis users in order to convey the message that they do run the risk of allowing the drug to dominate their lives. Again, it is relevant to the pattern we see where it becomes quite rapidly incorporated into the daily life of adolescents.

I wish to point out some conclusions on problem drug use in Quebec adolescents. First, we have the results of an experiment in decriminalization, increased availability, and social acceptance of cannabis. It is important to grasp that, from the perspective of teenagers in Quebec, there has been a de facto decriminalization. This is based on a talk given by a lawyer to a local school board in which he stated that simple possession has become pretty well accepted and arrests unlikely.

Adolescents tell us that they know they will be in greater trouble if they have an open can of beer than if they have a marijuana cigarette. They are quite aware that enforcement is low for simple possession or even public use.

Second, as I noted, we have a significant amount of locally grown indoor cannabis that is cheaply priced, and my guess is that it is probably potent.

Third, there has been positive publicity for marijuana. Children have access to literature promoting its use. It is legitimate for people to promote their own viewpoint, but what is absent is the other side of the story.

Finally, we have an interesting situation whereby we have no social controls on cannabis. Contrast this with alcohol. Students grow up with family members who usually drink wine in a responsible way. There is training in or social control over the appropriate use of alcohol. We do not have that with cannabis in Canada. Cannabis inhabits a netherworld between what is legal and what is illegal.

The next question to ask is, does this represent a pattern of dependence? We see a rapid escalation to daily and pervasive use similar to tobacco smoking. Second, smoking is a powerful method of rapid and frequent drug delivery. It is one of the best ways to get a drug into the system quickly without its being metabolized by the liver.

Finally, other studies in the U.S.A. and Ontario, although not ours, addressed marijuana use in adolescents with specific regard to dependence questions. They confirm high rates of dependency symptoms in those who use marijuana frequently. What we are seeing makes me worry about the possibility of dependence.

Given the known negative effects of marijuana on working memory, going to school high will increase dropout rates and decrease grades. We do not know the full ramifications because there have not been any studies addressing this particular question in a population sample.

What about the performance of an individual when riding a bicycle, skating, snow boarding, or engaging in sports in general? Is there an increase in injury? Again, little data has been collected on this subject.

What are the effects on brain development of frequent use by a large segment of the population? We have no studies of long-term consequent use in adolescents at this frequency. There are older studies, largely from other countries, of people who use marijuana, but generally later in life. We do not have much information on adolescents at the ages of 14, 15, or 16.

In the exposure of large numbers of people to this substance, maybe only subgroups will have problems. Certainly not everyone develops problems with tobacco. Similarly, many people drink responsibly, but others simply cannot handle alcohol. With such wide exposure, will we see specific subgroups who cannot tolerate cannabis?

When we first looked at marijuana use, we were unable to find regional differences. We were able to compare Montreal with Val d'Or because of the way the study was set up, and found no differences. We looked at income, and found no differences between users and non-users. We also saw no gender effects.

As our information went back to kindergarten level, one major focus of this study was to determine whether these children were deviant or had long histories of problem behaviour, and the answer is largely no. That is quite worrisome.

We also looked at adolescents who used both alcohol and marijuana to determine whether they handle both drugs in the same way. If adolescents are using both drugs, the answer is no. If they use both alcohol and marijuana, they will say they do not go to school drunk, but they do go to school high.

Special consideration needs to be given to minors when developing drug policy. A policy created only with adults in mind may have strong, unintended negative consequences for adolescents. We have a parental obligation to adolescents. They are not adults. We are often not able to treat adults and adolescents in the same way. This is enshrined in the law in many areas. Alcohol is available and sold by the government, but we have strong strictures on use in adolescents and children. Similarly for tobacco. Honourable senators need to think differently about policies for adolescents and for adults.

Adolescence is the critical time for first drug use. If you use drugs, you will start in adolescence. It is rare for someone to begin drug use in adulthood. We need to think of adolescence as a critical time.

Again, I mention alcohol as a good example of how we have distinct policies for adults and adolescents. I will also mention Lotto Quebec to outline another good example of the addictive phenomenon of gambling. Until recently, children could buy lottery tickets in Quebec. A colleague of mine at McGill discovered a high rate of gambling problems in children and adolescents and went to a local MNA to agitate for some changes. In February, it was made illegal for children and adolescents to buy lottery tickets. Within weeks, Lotto Quebec came out with a video game, ostensibly for adults, that encourages gambling. I mention this as an example of how careful you must be to think separately about adolescents.

In light of a rapidly changing pattern of drug use, you must be careful about drawing conclusions from data from a different era. An example is the potency of marijuana. Marijuana grown in fields has probably not increased in potency; however, indoor-grown marijuana is quite different. This subtle distinction is important in an accurate determination of the current situation.

Marijuana can be harmful. I have mentioned the effects on working memory and the issue of dependence. It is clearly the third most prevalent cause of drug dependency after tobacco and alcohol because it is used so commonly. There is excellent data on that subject in various publications.

I also wish to discuss specific patterns of harm. There is little point in comparing the levels of harm from cocaine, marijuana and alcohol. Each drug has specific kinds of harm. If you were to compare the effects of tobacco and cocaine in young people, you would conclude that cocaine is terrible but tobacco is not worth worrying about, because the harm from tobacco takes 30 years to appear. The point is that there are different patterns of harm and making comparisons among them is not a useful exercise.

You must also take the effects of dose setting and the individual into account. Going to school stoned begs the question of whether you are learning anything in high school. That is one potential for harm. Brain damage is a different issue and we must not confuse the two.

Smoking marijuana frequently carries all the risks of smoking tobacco.

Decriminalization has its own unique set of problems. I will not address criminalization, because you will be hearing from experts on the problems of criminalization and severe sentencing.

As for legalization, you need to think about those who will sell cannabis. Will the provincial governments sell cannabis, as they do liquor? Will the tobacco companies sell cannabis? What consequences will that have?

I want to mention briefly that decriminalization has its own problems. First, there are limited or no social controls. Since it is neither illegal nor legal, it is not talked about. You do not have social controls, as you do with alcohol and tobacco. Second, none of the vast quantities of money involved return to the government for preventing problems from use, unlike with alcohol and tobacco, where the taxation and so forth pays for treating some of the damage.

Much of the money derived from the sale of illegal drugs flows into organized crime and from there into more serious criminal activities.

It may be that legal, more socially responsible businesses may be prevented from entering the market. I have a question mark there, because we have the experience of the tobacco companies, but nonetheless it is a possibility.

Finally, the prevention of problems related to drug use is not the exclusive jurisdiction of any one area, and government policy should take this into account. It is obviously not just a law-enforcement problem, and I do not think I need to reinforce that here. I want to emphasize also that it is not just the medical problem of addiction. You need only think about tobacco control. If you decided to worry only about addiction and its medical consequences, in extending that to tobacco use, you would say that we will not worry any more about preventing use in adolescents, we will only fund the treatment of addiction, lung cancer, and other issues. As you can see, that does not make a lot of sense. You must think about the whole range of issues, including how to reduce use or prevent it in the first place.

It is not just an educational issue. The premise that if you educate people properly they will not use drugs is clearly wrong. There are school-based programs that have been effective in reducing drug use, but it is far more than "education."

Finally, it is clearly also a moral problem. We have all kinds of rules about the circumstances in which we allow drug and alcohol use. We do not allow public drunkenness, and we very much restrict how and where we use alcohol because it is intolerable for other members of society to be around intoxicated people under certain circumstances. It is a problem for all of society if teachers have to teach students who are stoned. That has an effect on whether anyone will even want to be a teacher. These are all components of drug policy and there is no point in avoiding them.

Finally, although this may sound self-serving, I would really like you to consider creating a permanent agency with the mission of reducing the problems of drug use. Drug use and problem drug use fluctuate over time and you need a flexible response. It changes too quickly for legislation to keep up. We need to track drug use over time and publicize the statistics. This doubling of drug use is not very well known and not well publicized.

The agency I propose would obviously promote research into drug problems, but it would not be primarily a research agency. It would develop and support the implementation of drug use prevention programs. Finally, it would obviously not be a law enforcement agency.

I am prepared to accept questions and comments.

Senator Kenny: Dr. Zoccolillo, could you tell the committee a little about the methodology you used in your survey and what precautions you took to ensure that the information you received was accurate? I am thinking that if I asked my children some of the questions you asked, I would not get very good answers. Likewise, I suspect that what some of my boys might tell other boys in a locker room might not be terribly accurate either.

How do you get the truth from kids on a subject like this?

Dr. Zoccolillo: First, although they filled out this questionnaire at home, they were in a separate room from their parents. They filled it out on their own.

Second, there is great internal consistency in the questions. For example, if some wanted to pull a trick on us and said that they were heroin addicts even though they had never tried drugs, you would see responses that do not square with what we know about drugs, and we did not find that. Ample studies have shown that virtually everyone who uses cocaine has also used marijuana. The progression has become, marijuana, hallucinogens, and other drugs. We found exactly that. These students would have to know a great deal about the epidemiology of drug use to respond to the questions with answers that were consistent with other studies.

Also, the questions on frequency of use were separate from those on method of use. We compared alcohol to drugs and found quite different patterns.

Therefore, I think the data is relatively valid. It may well be an underestimate, but I do not think it is an overestimate of the problems.

Senator Kenny: You talked about marijuana becoming rapidly integrated into daily life and about negative consequences. Was that borne out by the statistics on car accidents caused by driving under the influence, or on poor grades? You infer that there is a problem if kids are stoned in class, and it is an easy inference to make, but did you go the extra step and find out whether their grades were deteriorating?

Dr. Zoccolillo: We are studying that now. We are following up, and in the next two or three years we will be re-interviewing. We are specifically looking at that. While we do have data on grades and so forth, it is very difficult to disentangle the effects of drugs from the reasons that you took the drugs in the first place.

If you wanted to show that at 15 years of age, kids who took drugs had somewhat worse grades than kids who did not, you would have to control for a number of things. We are following up with these adolescents and are asking them intricate and detailed questions about their drug use over a period of years. We are trying to model that statistically to get a sense of whether it interferes with their grades. Technically speaking, that is not easy to do because there are many variables. Perhaps a student who decided to smoke pot also decided that he or she did not care about school any more, with the two decisions not being directly related. There may be previous risk factors that made you decide to smoke pot, that also made you do poorly in school. These factors make it difficult to study that directly. We have funding from CIHR, the Canadian Institutes of Health Research, to do that and we hope to have some ideas about that in the next three or four years.

I showed the data on working memory because other studies have shown that and it seems fairly clear that it does have that effect.

You could argue that people smoke cigarettes and drink coffee before they go to school. Not all psychoactive substances impair your ability to think. However, there are enough studies on marijuana to suggest that that is probably the case.

Again, hard data on this issue is limited, in part because previous studies never asked about it. The big epidemiological surveys only asked about use and frequency.

Senator Kenny: You talked about problems. In the data that you provided us with, there was no comparison on how often kids who were not using it have problems with their parents or other difficulties in life. How does the committee tell the difference between drug users having problems and adolescents who are not drug users having problems?

Dr. Zoccolillo: The questions I asked were all keyed to drugs. We asked whether they had problems with their parents because of drugs.

Senator Kenny: You could have asked the kids who were not using drugs whether they had problems with their parents and the answer might have been yes.

Dr. Zoccolillo: We can only ask very specifically whether they had problems because of drugs. We specifically asked that question. We cannot control whether the student inferred from that that we were inquiring about any problems, whether or not caused by drugs. I think the question was specifically about having arguments with parents over drug use.

The question, "Have you gone to school while high?" is fairly self-explanatory. I used the term "problem use" because there is some difficulty in knowing what vocabulary to use to describe this. If a student is going to school stoned, is that dependence? We do not know, but on the other hand, it is clearly not the same as getting high at a party on Saturday night. It is shorthand for "problematic ways of using drugs."

Senator Kenny: Was there any correlation with tobacco use?

Dr. Zoccolillo: Sure. Kids who use tobacco are more likely to use other drugs. Alcohol, tobacco and other drugs are all associated, but there were kids who smoked marijuana but not cigarettes, and there were kids who smoked tobacco but not marijuana.

Senator Kenny: Perhaps the use of alcohol on weekends and marijuana during the week is because it is easier to hide from parents or other authority figures on the weekends. What conclusions do you draw from that?

Dr. Zoccolillo: My conclusion is that it is not so much on weekends. We asked "How often did you use alcohol?" and the most common responses were less than once a week or once a week. Then we asked a separate question: "Where did you use alcohol or drugs most frequently?" Even for marijuana, they would say the weekends.

Alcohol use is largely restricted to weekend partying, whereas with marijuana, they get up, get stoned, go to school, maybe get stoned after school or during recess, and then they get stoned on the weekends too. So the use is several times a week as part of the daily routine.

The Chairman: Is it possible to have the questionnaire from your study?

Dr. Zoccolillo: Sure. I do not have it with me, but I can send it to you.

Senator Carstairs: I find your study interesting, but I must say that I also find it somewhat problematic. I spent 20 years of my life teaching adolescents. I know that a considerable amount of bravado might well find its way into the answers on such a questionnaire. If you ask a typical teenager, "Have you every smoked marijuana?" they will say yes with glee, even though they may not have ever done so. How did you filter out that response from your study?

Dr. Zoccolillo: Well, we cannot. It is hard to filter out, except by using multiple questions and looking at internal consistency. Again, it is just difficult to believe that adolescents are so good at answering these questions that they know enough to realize, "Well, if I say I use cocaine, I had better say I use marijuana, because most studies have shown that it is unlikely you will use just cocaine and not also use marijuana at some point."

They answered questions about alcohol quite differently. It is hard to explain why they would answer alcohol questions one way and drug questions another way.

Again, I do not think the internal consistency of the study reflects bravado on their part.

It is not hard data, but more in the nature of collateral data. I have run a day treatment program for the last eight years. It is not just for adolescents with drug problems, but those who have problems in general. Eight years ago, drug use was not a big issue. Now it has become routine to ask, "Have you smoked pot? If so, how often?" We get the same response from these kids: "I started in seventh grade." "I started in eighth grade." "How often?" "Well, I started, but next thing it was three or four times a week." "Did you go to school high?" "Well, yeah, I went to school high." It is quite consistent with other data that we have.

It is consistent too with other data from the Ontario survey, where they asked dependency questions such as, "Do you have trouble stopping?" "Have you had problems with use and then could not stop?" The rate is quite high in adolescents. A recent study in the United States, again from a household survey, found that, particularly among adolescents who reported using once a month or more, there was near daily use, which is similar to our data; again, quite high rates of diagnostic-criteria-based dependency. It seems to be consistent.

Senator Carstairs: What was your definition of "being stoned?"

Dr. Zoccolillo: We left it up to the adolescents. We said, "Have you gone to school while high on marijuana?" I would have to look back at the questionnaire to be sure. We tried hard to make sure that we had clearly reflected that they had been smoking marijuana and had then gone to school or played sports and so forth.

Senator Carstairs: There is a considerable difference between a bunch of kids on a school bus who all pass one cigarette around and say they are stoned, and a clear definition of someone who is genuinely stoned. How did you differentiate that?

Dr. Zoccolillo: You cannot get that fine-grained in such a large survey. I can tell you that that is why we asked about the frequency of being stoned and why we asked multiple questions. We found that the student who said, "I have been stoned at school" is also the student who said, "Yes, I smoke in the morning, and yes, I play sports while stoned." That is more than just being stoned on a school bus. They also reported that they progressed to using it three or four times a week.

Senator Carstairs: I have had experience with students who were stoned and also with some who were drunk. Was there any study of the teachers to see if they could identify how many of these children were stoned or drunk, and was any correlation done between that and the data?

Dr. Zoccolillo: It would not have been possible in our survey because these students were spread out all over the place. It would be interesting to see such data. One partially related question asked students, "Do you think your parents are aware you use drugs?" Most of them said yes. That is not the same as saying their parents are aware they go to school stoned, but they certainly thought their parents were aware of their use.

Senator Carstairs: One interesting thing about cannabis use, and I do not know whether your group has analyzed it, is that compared to the period 1993 to 1999, the earlier period around 1978 also saw very intensive use of cannabis, and now you have a 26 per cent growth rate when the time lag between the groups is about 21 years.

Are some of the judgments coming through here? How many of these kids' parents were cannabis users?

Dr. Zoccolillo: We have that data on these parents, as we asked them about their own use. It is much lower than what we see in the students. I am not sure what to make of that. We asked the parents virtually the same question about using drugs five times or more, and the use was considerably lower than in the adolescents.

Regarding cyclical changes, you are right that most drug survey studies started in the late 1970s, and there was a peak. Drug use came down to a low about 1989 -- this is in Canada and the United States -- and now it has gone right back up.

The Chairman: When you talk about parents' use of marijuana, are you talking about in school?

Dr. Zoccolillo: I am talking about their use in general.

Senator Carstairs: Is that now, or when the adults were the same age as the children?

Dr. Zoccolillo: We just asked them, "Have you ever used marijuana five times or more?"

The Chairman: That is why it is important that we get the questionnaire and the answers, your raw material.

Dr. Zoccolillo: Sure.

Senator Rossiter: Was there any information on where the children got the marijuana?

Dr. Zoccolillo: We did not get that information from the survey. We ask the kids in our various treatment programs. Generally, I can tell you that there is an explosive increase when they hit high school. You do not see it in sixth grade. These kids start, on average, around 14, but with fairly high use also at 13. It seems to me there is something particular about entering high school.

As for the kids that we have asked, there often seems to be an older adolescent in the group, perhaps an older sibling. It is just someone at school. Quite often they report they smoke with other kids. It is almost always smoking with other kids, and they may or may not have to pay for the drugs initially.

Senator Rossiter: Would this likely be a new school, a change of school?

Dr. Zoccolillo:Yes, it seems to be quite coincident with the entry into seventh grade, or high school, where my guess is that older kids are smoking it and it gets filtered down to the younger ones. It is not uncommon at different high schools in Montreal for kids to accumulate and smoke pot before and after school.

Senator Rossiter: Would the alcohol be taken from their parents?

Dr. Zoccolillo: I am not sure where they get the alcohol, whether it is from parents or whether they get an older person to buy it from a corner store or whatever.

Senator Wilson: You said in your conclusions that you believe it is not only a law enforcement, medical, or educational problem. I know that you are only data-gathering, but do you know of any other instances where those three sectors have been brought together and perhaps extended to include students and parents? Do you see that as a viable way for us to proceed, or did you just put that up as an idea?

Dr. Zoccolillo: I put that up to emphasize that no single action will address this.

Senator Wilson: To your knowledge, has there been any serious attempt to bring those sectors together to look at the problem?

Dr. Zoccolillo: I am sure there are programs and places where people have done that. Some schools in Montreal have decided they will not tolerate drug use any more and have policies that are clearly enforced. They have the co-operation of the local police. They have talked with parents and students, and they have made it a very clear policy. That is an example of a co-operative arrangement at a local level.

Senator Wilson: You have not been involved in any of that?

Dr. Zoccolillo: Not particularly, no.

[Translation]

Senator Pépin: I am somewhat surprised to learn that among young adolescent women, the rate of use of certain types of drugs is higher than among young adolescent males. You commented on the difference between marijuana grown indoors and marijuana cultivated outdoors.

Dr. Zoccolillo: Yes, I read about this in Iversen's book. It is a very comprehensive work on the subject. I am not really an expert in marijuana growing, but he did present some very sound evidence to show that marijuana cultivated in greenhouses is much stronger.

Senator Pépin: You also stated that adolescents begin experimenting with drugs around the ages of 15 or 16 and quickly move on to other substances. Do they tend to move on to harder drugs like cocaine and heroine, or does usage decline with age, or according to the type of drug used?

Dr. Zoccolillo: I cannot say if drug use decreases. Rather they begin to experiment at 13, 14 or 15 years of age. The adolescent cocaine user is often different from his peers. However, there is a link between hallucinogenics and marijuana. Hallucinogenics are the most popular drugs after marijuana and drugs like PCP or Ecstasy are more dangerous than cocaine. They lead to a host of problems and their use is more closely associated with marijuana smoking than with cocaine use.

The Chairman: On what do you base your contention that there is some link between the two?

Dr. Zoccolillo: On the fact that the use of marijuana and hallucinogenics has increased in both Ontario and Quebec. Furthermore, a study conducted in Holland found a link between cannabis and hallucinogenics.

The Chairman: Are you saying that adolescents who use marijuana also take hallucinogenics at the same time? Is that the link?

Dr. Zoccolillo: It is one link. It is also a fact that adolescents who use marijuana are also more likely to use hallucinogenics. Judging from not only our findings, but from our conversations with adolescents in our treatment program, it appears that the use of hallucinogenic substances is quite common. There is a difference between cocaine, heroin, hallucinogenics and marijuana. Adolescents often take hallucinogenics.

The Chairman: You see a link, but is this because of your research findings, or because of what you have discovered personally though readings done in conjunction with your research? What you are telling us does not jibe with the written material and research already before the committee. That is why your testimony is important. Above all, it is important that you share with us all of the data on which you have based your testimony. That is why we have questions for you.

[English]

If we may, we will also send you written questions to answer, because you are offering us a lot of food for thought, and of course the hearing this afternoon is not the end of it. We will have more questions. Perhaps we will ask you to come back and suffer through another question period.

Dr. Zoccolillo: With regard to hallucinogens, I can only say that there was a reference in this book that I mentioned on marijuana that looked specifically at the experience in Holland. One reason why they decriminalized cannabis was to break the link to hard drugs, and the author questions whether that occurred. He cites a study which shows that marijuana may have increased the use of hallucinogens, but I have not read that particular article. We see from the Ontario drug study that use of marijuana and hallucinogens have increased together, whereas use of other drugs has not increased. It is the second most common drug that we see in Quebec after cannabis. The adolescents we talk to smoke cannabis, and if they have tried another drug, it is a hallucinogen. Finally, the other big difference between cocaine and heroin versus the hallucinogens and cannabis is that the latter are home-grown. They are produced in Quebec by bikers and so forth. It is locally available.

You are correct that more studies need to be done, and again there is a changing pattern. You have to distinguish between whether cannabis leads to hard drugs, meaning cocaine, which I would agree is probably not the case, and whether cannabis leads to hallucinogens. Within hallucinogens, there are drugs like LSD that are probably not terribly dangerous overall, and there are others like phencyclidine that are unquestionably dangerous. They are dangerous in the short term: you take it and you might die or become psychotic. All I can say is that hallucinogens also seem to be quite commonly used by adolescents.

[Translation]

Senator Pépin: You stated that when interviewing adolescents, you routinely asked them whether they used drugs, because this was now a reality of daily life.

Dr. Zoccolillo: That is correct.

Senator Pépin: Today in Quebec, while it may not be normal, it has become fairly common for adolescents to use drugs at school.

Dr. Zoccolillo: Common in that one in four adolescents uses drugs. I do not know if this number will increase. I spoke with a CEGEP teacher who told me that he smoked marijuana a great deal while in CEGEP. I do not know if usage is greater at 17 or 18 years of age.

Senator Pépin: You have not looked at university students. Are there any adolescents who stop using drugs once they reach their twenties? Could it be that drug use is simply part of their passage through adolescence, that they do not become drug dependent and that once they reach adulthood, they simply stop using?

Dr. Zoccolillo: I hope many will stop using drugs. Past studies conducted in the United States have shown this to be true. However, there is one problem with these studies, namely that they fail to consider the effect of cannabis on a 15-year- old attending school. To say that a person will stop using cannabis at 20 is quite a different matter. My study focused on the effects of cannabis use on 15 and 16 year olds.

Senator Pépin: And you do not know what the long-term effects will be at this time?

Dr. Zoccolillo: The long-term and short-term effects are quite different. These findings surprised me because they were not what I was expecting. When we began our study, we were under the impression that adolescents used marijuana at parties and on weekends. We were surprised by the findings. Therefore, in considering either long-term or short-term effects, we cannot overlook the effect of marijuana use in today's schools. That is an entirely different matter than smoking cannabis for a period of 10 years.

The Chairman: As a psychiatrist and observer of adolescent behavior, and based on your clinical experience, what do you think motivates adolescents to use drugs? It is a question that many people have asked themselves.

Dr. Zoccolillo: In our study, we asked adolescents to tell us why they use drugs.

[English]

We gave them five reasons -- for example, to make me feel better, because it is fun, because other kids do it, and so on. The overwhelming reason was because it was fun. Most drug use is done with other kids. It does not fit the model that they are anguished or unhappy. It is because it is there, it is available, and it is fun.

Senator Pépin: They want to be part of the group.

Dr. Zoccolillo: I do not know how much it involves peer pressure. In the clinical sample -- and this is kids who are being treated for problems -- they reported that once they started, it really made them feel good. However, when they tried to stop, they reported that they felt sad, irritable and upset, so they continued to smoke to feel good.

The Chairman: The latter part of your answer refers to those you are seeing in your clinic, or from your sample?

Dr. Zoccolillo: Those are from my clinic.

The Chairman: Those who have a dependency problem?

Dr. Zoccolillo: Not necessarily. The best example is a boy in our program now who is 13. He has a long history of other problems, such as with attention. He could not get along in school. He is in a program that helps kids get back into school. We asked him if he drank, but he said he did not. He tried cigarettes, but he did not like smoking. We then asked him about marijuana. He said, "I started in January. Within two months, I was smoking it three or four times a week. I was going to school stoned. I smoked it at night to go to sleep and I did this for several months. I was using it almost every day, and then I stopped." We asked, "Why did you stop?" He said, "I stopped because it was making me sad. I was doing badly enough at school without also being stoned, which made it worse." If you were to follow him for five years, maybe he would show no effects from the marijuana that he smoked, but in that six-month period it had already caused him problems. He already sounded like someone who was dependent on it because he was smoking it heavily and it made him feel bad. We are not sure if he has really stopped. We think that he may not have. This is the kind of real situation that we see.

The Chairman: Do you have empirical data to support this? That is only one case.

Dr. Zoccolillo: Empirical data supports the belief that adolescents who smoke marijuana on a frequent basis have high rates of dependency. That is from the diagnostic criteria of the American Psychiatric Association -- not from our study, but from other studies.

Senator Pépin: Do you believe that the parents of those adolescents are aware that their children are smoking?

Dr. Zoccolillo: We asked the adolescents in our study, "Do you think your parents know?" Most said, "Yes, we think our parents know that we use drugs."

Senator Pépin: Do you think it would have helped if they had received public education when they were younger -- for example, when they were in primary school -- about drugs and the dangers of using them, or does it happen because they are adolescents and they have to try it?

Dr. Zoccolillo: Some drug prevention programs do not work and some do. Not every drug program works. I do not think pure education about what drugs do is very effective. Also, it is hard to say whether students in schools have been told about drugs. I do not think it is education in the sense of, "These are drugs that cause problems. These are the problems that they cause." Students are bombarded with all kinds of information about marijuana and other drugs by their peers. The programs that have been effective have been more sophisticated than just education.

The Chairman: When you say that educational programs do not work, are you referring to current programs?

Dr. Zoccolillo: Most programs currently in place are not successful. If they are having success, that is great. However, it is worrisome if they are not preventing something even worse from occurring. What strikes me is the lack of significant programs in the schools. First, you must use programs that have shown some success. They must be financed on a long-term basis and require considerable effort. It must be more than two or three hours of lectures in the sixth grade.

Senator Carstairs: You are really saying that you cannot send in the police to scare them to death because it does not work.

Dr. Zoccolillo: I do not think that sending in the police to speak to them will work because they also know that when the police car drove by as they were smoking pot, the policeman either did not stop, or got out and said, "What are you doing? Put it out." They know that there will not be any serious police consequences. We have had RCMP drug officers come to talk to the kids in our drug program. They seem to get a lot out of listening to the officers, but it is at a different level. They are talking about cocaine and so on. That kind of thing, in and of itself, does not work, but if it is part of an overall societal program saying, "It is a bad idea to go to school stoned at 14," that may have more effect. I do not know.

The Chairman: You are talking about social control, or the lack thereof, on marijuana. Your remarks and your study tend to indicate that social control on alcohol works, correct?

Dr. Zoccolillo: I would say, given that students seem to use alcohol more responsibly than marijuana, something must be going on there. I am just guessing that social control is an important part of it.

The Chairman: Does the social control that you are talking about in connection with marijuana also come into play with other substances, illegal drugs? Your numbers show that, if you are making --

[Translation]

The Chairman: You are saying that there is no social control over cannabis. Is that also true of other illegal drugs?

[English]

Dr. Zoccolillo: I think there is, in that -- and I am just speculating -- when we talk to kids they are clearly fearful of cocaine. The same kid who is using marijuana and hallucinogens is afraid of cocaine. Something in society leads kids to believe that marijuana is fine while cocaine is not.

You could say that it is also a form of social control that somehow seems to be working. However, this is really more speculation than anything.

[Translation]

The Chairman: Your study has led you to make a number specific recommendations. Perhaps I should have asked you the next question off the top. Would you say that banning illegal drugs has proven successful as an approach?

[English]

Dr. Zoccolillo: That is a difficult question to answer.

[Translation]

The Chairman: That is why I waited until the end of the meeting to ask you.

[English]

Dr. Zoccolillo: You have to be careful and ask if we are really prohibiting marijuana. If it is easily grown, easily accessible, and the law is not really enforced by the police, is it really prohibited? That is the reality. We see the same increase in use in the U.S., where there is supposedly more police enforcement.

It may be one of those things that is simply not enforceable by the police. If it is grown extensively, as it is in Quebec and other places, and if it is highly desirable, then it may be similar to alcohol. If you said, "Well, we have lots of problems with alcohol. We will recommend that it be made illegal and prohibited," that would not work. Maybe marijuana is like that; I really do not know.

There has been increasing use among adolescents, not just in Canada, but in the U.S. and Europe, including the Netherlands. Perhaps it is increasing among adults, too. We did not survey that, so I do not know.

The Chairman: How do you treat dependency on marijuana?

Dr. Zoccolillo: We have limited experience with that. As a result of this study, we decided to start a small drug program at the children's hospital where we never had one before. Our limited experience shows that the first thing you require is some motivation to stop, otherwise you do not show up. We look at what reinforces their desire to smoke. We look at why they have trouble stopping. We give them strategies. If they try to stop and feel irritable, we try to help them cope with that. Again, on a voluntary basis and because they are in a program, we use drug screens to help confirm that they are using, that they have stopped using, or that they are cutting down. It takes some motivation for drug programs to work.

The Chairman: What reasons do those who show up give for starting to smoke?

Dr. Zoccolillo: Do you mean in our clinical program?

The Chairman: I am narrowing it down to those who are using marijuana, are dependent on it, and come to you for help. We are into a smaller group of individuals. Are you trying to understand why?

Dr. Zoccolillo: We are just accumulating some experience with this. Thus, my experience is limited. Some kids that we have treated have a long history of problem behaviours, and this is just one more in which they have engaged. Others started it, felt so good and liked it so much that they continued using it on a frequent basis. Suddenly, they realize that their lives are dominated by it, that they are spending endless hours on it, and now they are being told by a girlfriend, for example, "You are stoned all the time. I do not like you like this." Their parents are finally worried enough to say, "This has to stop. We do not want marijuana around the house. We do not like the way you are acting. School work has fallen apart." The kids then say, "I do not want to live my life like this any more." They are tired of what has happened to them because of cannabis use.

[Translation]

Senator Pépin: We always hear talk of the cause-effect relationship. Given that some adolescents who use marijuana do so because of peer pressure and for enjoyment, does this necessarily mean that children who use cannabis should be considered problem children?

Dr. Zoccolillo: No.

Senator Pépin: Then they use cannabis because they want to and because everyone else is using it?

Dr. Zoccolillo: We have observed that adolescent users do not have many problems. That is a fact. The same thing may be said of adolescent smokers.

Senator Pépin: I see.

Dr. Zoccolillo: Many people smoke and many become addicted. There is no relation between psychopathology and other problems. However, when a person begins smoking, that is when the addiction takes root. I think the same can be said of marijuana.

The Chairman: When you talk about dependence on marijuana, how do you define this phenomenon? Is it the same as being addicted to cigarettes?

Dr. Zoccolillo: The American Psychiatric Association uses three criteria to define dependence.

[English]

There are two types of dependence. One is physical tolerance and withdrawal -- you need more drugs to get the same effect.

The second part of it is loss of control -- you are smoking it and cannot stop, although you want to. You are smoking it, you get stoned, fall down the stairs and hurt yourself. However, you do not learn from that. You keep smoking and you keep getting into trouble because of it. These are the criteria of dependence. They are well recognized and accepted by the medical profession.

The Chairman: From the total numbers in your study, and in percentage terms, how many marijuana users are dependent?

Dr. Zoccolillo: We did not ask specific dependence questions in our study. The Ontario study that I showed you reported that 57 per cent of the adolescents who used marijuana met at least one of the dependence criteria. Studies in the U.S. of people who use at the same frequency as this show that about 80 per cent report at least one of the dependence criteria, and a smaller proportion report all three.

Senator Rossiter: These children were all selected from different schools, from small, medium and large French school boards. I would imagine that most of them would be classified as urban and only a very small percentage as rural?

Dr. Zoccolillo: The sample represents the population of Quebec -- as much as Quebec is urban or rural.

Senator Rossiter: So it was done elsewhere.

Senator Pépin: Val d'Or is not rural.

Dr. Zoccolillo: We were able to compare Val d'Or with Montreal, and we did not find any differences. I have been told that it is no different in rural areas. I could not tell you whether or not it varies by province. You would have to look at various studies from other provinces.

Senator Rossiter: Would it be more readily available in urban areas?

Dr. Zoccolillo: Not necessarily, because it is often grown outdoors. You may find that it is readily available in farming communities.

[Translation]

The Chairman: Thank you very much, Dr. Zoccolillo, for your testimony. As I said earlier, we will likely have more questions once we have reviewed your detailed findings. If so, we will convey them to you in writing and hope to receive an answer from you.

Dr. Zoccolillo: By all means. Thank you.

The Chairman: And since your testimony has been retransmitted on our web site, perhaps some people will be submitting their comments and, if my colleagues have no objections, I will also send you the questions arising from these comments.

[English]

Senator Kenny: Mr. Chairman, I have a small piece of committee business. I want to congratulate whoever prepared the summaries. They were very helpful. I found them useful. I hope the same quality continues.

The committee adjourned.