Speech: Bill C-45, the Cannabis Act – Senator Françoise Mégie
Hon. Marie-Françoise Mégie: Honourable senators, I rise today to join my voice to that of many of my colleagues in this chamber. I want to start by thanking Senator Dean for his tireless efforts to provide important data for our consideration.
Statistics from a range of reliable sources show that Canada is one of the countries where there is a very high prevalence of cannabis consumption by youth under 20. I will go over some of the health concerns associated with this problematic situation.
The human body produces its own cannabinoids, which are known as endocannabinoids or endogenous cannabinoids since they are produced within the organism. These substances act as natural messengers. They transmit information about the state of the organism to both the brain and other organs. The main purpose of the endocannabinoid system is to regulate and maintain a stable environment within the human body. It is responsible for regulating appetite, motor coordination, sensory perception and pain perception.
The key active ingredients produced by the marijuana plant are also cannabinoids. They are exogenous cannabinoids, with THC being the most significant. THC is responsible for the psychotropic effects that make it enticing to use cannabis for recreational purposes.
Cannabidiol, or CBD, is one of the hundred or so cannabinoids that can be extracted from this plant. It is often used for medicinal purposes since it does not have a psychoactive effect. Scientists are very interested in CBD for its usefulness in managing epilepsy, including in children. There are currently a number of interesting studies looking into this.
Both exogenous and endogenous cannabinoids use the same brain pathways. Their modes of action are different and poorly understood. THC can take their place and linger for several hours causing an imbalance in the endocannabinoid system.
There is a growing interest in the therapeutic value of cannabis, which has been recognized by chronic pain and palliative care experts. The anti-inflammatory and analgesic properties of cannabis can help manage chronic pain, neuropathic pain and painful muscle spasms, which are often symptoms of multiple sclerosis.
Cannabis is also used to control the nausea and vomiting caused by chemotherapy. It can also help stimulate appetite, especially among AIDS patients. Products used for this therapeutic purpose are also cannabinoids. One of them is sold as an oral spray, while two others are synthetic cannabinoids known as Nabilone and Dronabinol. They are sold in capsules with very specific dosages. These products received a notice of compliance from Health Canada based on evidence of clinical effectiveness and can be prescribed by doctors.
A study published in the June 2016 issue of The Journal of Pain showed that the use of cannabis to control chronic pain resulted in a 64 per cent reduction in opioid use.
My colleagues who work in the area of chronic pain management pointed out to me that patients whose pain is not adequately controlled by opioids prefer to add small doses of cannabis and at the same time reduce their doses of opioids. This helps avert the need to increase opioid doses, preventing the associated side effects.
Some people prefer to smoke or consume cannabis oil, but only a small group of medical specialists are authorized to prescribe cannabis in this form. Furthermore, patients who prefer this form of cannabis must obtain an exemption form.
A 2014 study published in JAMA Internal Medicine indicated that the number of opioid-related deaths dropped by 33 per cent in the 13 states where cannabis is legal. That information was gathered over the six years following the legalization of cannabis.
Let’s now talk about the harmful effects of cannabis on young people. An increasing number of scientific studies are finding that marijuana use may not be as safe as people tend to believe. Since young people’s neurons do not stop developing until about the age of 25, this drug may have a negative impact on adolescent brain development.
Marijuana can cause psychosis, hallucinations, paranoid delusions, altered cognition and addiction. It may also facilitate the onset of schizophrenia. Dr. Romina Mizrahi, Director of the Focus on Youth Psychosis Prevention Clinic in Toronto, said that the use of marijuana doubles the risk of psychosis for young people who are prone to mental health issues. That is particularly true for those who have a personal or family history of psychosis. However, cannabis can cause acute transient psychosis among adolescents even if they have no history of mental illness.
In the interest of clarity, I would like to explain the difference between a psychotic episode and schizophrenia. Psychosis is a temporary loss of contact with reality. It may be drug or alcohol induced or it may be an indicator of an underlying mental disorder such as schizophrenia, bipolar disorder or depression. However, psychosis is not a permanent condition. It is treatable, and most people who experience it are able to live productive lives.
Schizophrenia is a brain disorder that affects a person’s thoughts, feelings, emotions, perceptions and behaviour. However, not all of these functions are affected at the same time or to the same extent. Many people with schizophrenia can exhibit perfectly normal behaviour for long periods of time. The illness manifests itself through acute psychotic episodes, followed by various chronic symptoms. Generally speaking, it first manifests itself in late adolescence or early adulthood, usually between the ages of 15 and 30. Unfortunately, that coincides with the age at which young people are introduced to drugs.
The literature speaks of an individual predisposition, a genetic predisposition, a cerebral metabolism imbalance involving the neurotransmitters dopamine and glutamate, and triggering factors like major life events, cannabis, and so on. This shows that the connection between cannabis and psychosis is not a simple cause-and-effect relationship. However, strong evidence remains that a pre-existing vulnerability to psychosis is a key factor modulating the relationship between cannabis consumption and psychosis. Other factors that come into play include the amount taken, the concentration of the substance, the frequency of use, and the setting in which it’s taken.
Recently, one of my colleagues, a family doctor who works in a substance abuse clinic, told me that a serious investigation is needed to determine the reasons why young people take cannabis. Besides a desire to fit in, some young people say they take it to improve their focus or to overcome feelings of shyness. Doctors must be sure to check for comorbid conditions such as attention deficit disorder, attention deficit hyperactive disorder, depression, or a predisposition to schizophrenia. These are all vulnerability factors that put young people at risk of experiencing harmful effects from cannabis consumption. In order for a course of treatment to succeed, it must address comorbidities while managing drug consumption.
Alongside the youth vulnerability theory, Reiman and Burnett, from the Drug Policy Alliance, also raise the self-medication theory. This theory holds that individuals who present with psychotic symptoms use cannabis to self-medicate before they are formally diagnosed with psychosis. The authors clearly state that individuals who have shown symptoms of psychosis are more likely to smoke cannabis. This makes it hard to determine which came first, the psychosis or the cannabis use.
Other acute effects include withdrawal symptoms. People who quit after heavy use can experience irritability, anxiety and sleep problems. Heavy use refers to daily or almost daily consumption for at least a few months. Withdrawal symptoms appear from 24 hours to 72 hours after the last consumption and can last from one to two weeks. Sleep problems can last up to one month. In addition to the acute effects just mentioned, there is also functional impairment, which includes diminished performance or absenteeism at school, decreased participation in activities, withdrawal from friendships and family conflicts.
However, those harmful effects on cognition and attention and the psychotic episodes are also manifestations of excessive alcohol consumption. Alcohol abuse has serious consequences and can result in alcoholic coma and death. A paramedic told me that he deals with alcohol-related psychoses far more often than cannabis-related ones. In 1971, the World Health Organization classified psychotropic substances according to their risks. Alcohol ranks first, cocaine ranks second and cannabis ranks ninth, in last place. Although alcohol is harmful, it is still a legal drug. This was a comment I heard from the young people who participated in my focus group last week.
Honourable senators, regardless of our position on the legalization of marijuana, we must recognize these alarming facts, as mentioned earlier on. How do we reconcile what I just mentioned with the fact that youth aged 12 to 17 will soon be able to possess up to five grams of cannabis? Why do you think young people choose to have cannabis in their possession? They are either going to use it or sell it. I, for one, thought that the legalization of cannabis was meant to stifle the black market, not enable it.
Add to that the possibility of growing marijuana at home. How will parents ever notice that one or two marijuana buds are missing from one of their four plants? What will they say when their 12-year-old suggests growing cannabis? It will be legal, after all. It is not a harmless substance; its negative effects on our young people will affect society as a whole. Therefore, we have a duty to regulate and restrict access to cannabis.
In order to justify home marijuana cultivation, many have compared it to making wine at home, which is legal. This argument is rather simplistic. Making wine is far more labour-intensive than growing a plant. Indeed, winemaking requires a certain amount of knowledge, without which it is difficult to make wine for personal consumption.
Given the dangers of cannabis use, we must adopt a public health approach. In particular, we must at all costs delay the age at which people begin using cannabis. We must work to decrease the frequency of consumption in order to reduce addiction problems. Moreover, we must ensure that non-consumers do not begin consuming cannabis simply because it is legal.
To achieve these goals, we must make a collective effort to introduce adequate and supported awareness and prevention campaigns. To ensure public safety, these measures must work in synergy with the communications strategies that are adopted. In addition to the usual media, digital networks should also be considered.
Furthermore, effective implementation entails taking the necessary time to ensure that legalization goes smoothly. After nearly a century of prohibition, people have the right to expect a smooth transition. Members of our communities should have the opportunity to prepare for the new challenges they will face.
Let’s focus our energies on educating young people, parents and families, and on training resources. These individuals will have a presence in schools and in our communities. Canadians must be made aware of the dangers of addiction, impaired driving and consumption.
We will also need a federal management framework to regulate the production, points of sale, quality and safety of the products available on the market.
We absolutely must invest in research. With legalization, it will be easier to report use to researchers and physicians, and the data collected will be more reliable. This will also foster a better understanding of the effects of cannabis, so that it can be used safely and so that potential health problems can be avoided.
Honourable senators, legalization may be inevitable, but not at any price. Let’s take advantage of this momentum to engage in deep and meaningful discussions in the various senate committees. Thank you.
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