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| Major Studies of Drugs and Drug Policy | ||||
| Canadian Senate Special Committee on Illegal Drugs | ||||
| Volume 3 - Public Policy Options |
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Chapter 21 - Public policy options Recommendation 1
The
Committee recommends that
the position of National Advisor on Psychoactive
Substances and Dependency be
created within the Privy Council Office; that the
Advisor be supported by a
small secretariat and that federal departments and agencies
concerned by
psychoactive substances second, upon request, the necessary staff. National
strategy sustained by
adequate resources and tools
A federal
policy and strategy do not in themselves make a national strategy. Provinces,
territories, municipalities, community organizations and even the private sector
all have a role to play in accordance with their jurisdiction and priorities.
This is necessary and this diversity is worth encouraging. However, some
harmonization and meaningful discussion on practices and pitfalls, on progress
and setbacks, and on knowledge, are to be encouraged. Apart from there
source-starved piecemeal action of the Canadian Centre on Substance Abuse, there are all too few opportunities and schemes to promote exchanges of
this type. The current and future scale
of drug and dependency-related issues warrants the Canadian Government
earmarking
the resources and developing the tools with which to develop fair,
equitable and
well-thought out policies. Like the
majority
of Canadian and foreign observers of the drug situation, we were struck by the
relative lack of tools and measures for determining and following up on the
objectives of public psychoactive substance policy. One might not agree with the
numbers-focused goals set out by the Office of National Drug Control Policy for
the reduction of drug use or for the number of drug treatment programs setup
and evaluated. However, we have to admit that at least these figures serve as
guidelines for all stakeholders and as benchmarks against which to measure
success. Similarly, one
might not feel totally comfortable with the complex Australian goal-definition
process, whereby the whole range of partners from the various levels of
government, organizations and associations meet at a conference every five
years. However, at least those goals agreed upon by the various stakeholders
constitute a clear reference framework and enable better harmonization of action. The European
monitoring system with its focal points in each European Union country under the
European Monitoring Centre for Drugs and Drug Addiction umbrella might seem
cumbersome; and the American system of conducting various annual epidemiological
studies might appear expensive. We might even acknowledge that there are
problems with epidemiological studies, which are far from providing a perfect
picture of the psychoactive substance-use phenomena. However, at least these
tools, referred to and used throughout the Western world, enable the development
of a solid information base, with which to analyse historical trends, identify
new drug-use phenomena and react rapidly. In addition, it allows for an
assessment of the relevance and effectiveness of action taken. No system of this
type exists in Canada, which is the only industrialized Western country not to
have such a knowledge structure. It is for
these reasons that the Committee recommends that the Government of Canada
support various initiatives to develop a genuine national strategy.
Firstly, the Government should call a national conference of the whole range of
partners with a view to setting out goals and priorities for action over a
five-year period. This conference should also identify indicators to be used in
measuring progress at the end of the five-year period. Secondly, the Canadian Centre
on Substance Abuse needs to be renewed. Not only does this body lack resources
but it is also subject to the vagaries of political will of the Minister of
Health. The Centre should have a budget in proportion with the scale of the
psychoactive substance problem and should have the independence required to
address this issue. Lastly, a Canadian Monitoring Agency on Drugs and Dependency
should be created within the Centre. Recommendation 2
The Committee recommends that the Government of Canada mandate
the
National
Advisor on Psychoactive Substances and Dependency to call a high-level
conference of key stakeholders from the provinces, territories,
municipalities
and associations in 2003, to set goals and priorities for action
on psychoactive
substances over a five-year period. Recommendation3 The
Committee recommends that
the Government of Canada amend the Canadian Centre on
Substance Abuse enabling
legislation to change the Centre’s name to the
Canadian Centre on Psychoactive Substances
and Dependency; make the
Centre reportable to Parliament; provide the Centre
with an annual basic
operating budget of 15 million dollars, to be increased
annually; require the
Centre to table an annual report on actions taken, the key
issues, research and
trends in the federal Parliament and provincial and
territorial assemblies and
legislatures; mandate the Centre to ensure national
co-ordination of research on
psychoactive substances and dependency, and to
conduct studies into specific
issues; and mandate the Centre to undertake an
assessment of the national
strategy on psychoactive substance and dependency
every five years. Recommendation4 The
Committee recommends that
in the legislation creating the Canadian Centre on
Psychoactive Substances and
Dependency, the Government of Canada specifically
include provision for the
setting up of a Monitoring Agency on Psychoactive
Substances and Dependency
within the Centre; provide that the Monitoring Agency
be mandated to conduct
studies every two years, in co-operation with relevant bodies,
on drug-use
trends and dependency problems in the adult population; work with
the provinces
and territories towards increased harmonization of studies of the
student
population and to ensure they are carried out every two years; conduct
ad hoc
studies on specific issues; and table a bi-annual report on drug-use
trends and
emerging problems. A
public
health policy
When cannabis
was listed as a prohibited substance in 1923, no public debate or discussion was
held on the known effects of the drug. In fact, opinions expressed were
disproportionate to the dangers of the substance. Half a century later, the
Le Dain Royal Commission of Inquiry on the Non-Medical Use of Drugs held a
slightly more rational debate on cannabis and took stock of what was known about
the drug. Commissioners were divided not so much over the nature and effects of
the drug but rather over the role to be played by the State and criminal law in
addressing public health-related goals. Thirty years after the Le Dain
Commission report, we are able to categorically state that,
used
in moderation, cannabis in itself poses very little danger to users
and to society as a whole, but specific types of use represent risks for users. In addition
to being ineffective and costly, criminalization leads to a series of harmful
consequences: users are marginalized and exposed in a discriminatorily fashion
to the risk of arrest and to the criminal justice system; society sees organized
crime enhance their power and wealth by benefiting from prohibition; and
governments see their ability to conduct prevention of at-risk use diminished. We would add that,
even if cannabis were to have
serious harmful effects, one would have to question the relevance of using
the criminal law to limit these effects. We have demonstrated that criminal
law is not an appropriate governance tool for matters relating to personal
choice and that prohibition is known to result in harm which often outweighs the
desired positive effects. However, current scientific knowledge on cannabis, its
effects and consequences are such that this issue is not relevant to our
discussion. Indeed
available
data indicate that the scale of the cannabis use phenomenon can no longer be
ignored. Chapter 6 indicated that no fewer than 30% of Canadians (12to 64 years
old) have experimented with cannabis at least once in their lifetime. In all
probability, this is an underestimation. We have seen that approximately 50% of
high school students have used cannabis within the past year. Nevertheless, a
high percentage of them stop using and the vast majority of those who experiment
do not go on to become regular users. Even among regular users, only a small
proportion develop problems related to excessive use, which may include some
level of psychological dependency. Consumption patterns among cannabis users do
not inevitably follow an upward curve but rather a series of peaks and lulls.
Regular users also tend to have a high consumption rate in their early twenties,
which then either drops off or stabilizes, and in the vast majority of cases,
ceases altogether in their thirties. All of this does not in any way mean, however, that cannabis use should be
encouraged or left totally unregulated. Clearly, it is a psychoactive substance
with some effects on cognitive and motor functions. When smoked, cannabis can
have harmful effects on the respiratory airways and is potentially cancerous.
Some vulnerable people should be prevented, as much as possible, from using
cannabis. This is the case for young people under 16 years of age and those
people with particular conditions that might make them vulnerable (for example
those with psychotic predispositions). As with alcohol, adult users should be
encouraged to use cannabis in moderation. Given that, as for any substance,
at-risk use does exist, preventive measures and detection tools should be
established and treatment initiatives must be developed for those who use the
drug excessively. Lastly, it goes without saying that education initiatives and
severe criminal penalties must be used to deter people from operating vehicles
under the influence of cannabis. As for any other substance, there is at-risk use
and excessive use. There is no universally accepted criterion for determining
the line between regular use, at-risk use and excessive use. The context in
which use occurs, the age at which users were introduced to cannabis, substance
quality and quantity are all factors that play a role in the passage from one
type of use to another. Chapters 6 and 7 identified various criteria, which we
have collated in table form below. Proposed Criteria for Differentiating Use Types
Environment Quantity Frequency Period of useand intensity Experimental
/ Occasional
Curiosity
Variable A few times over lifetime None Regular Recreational,social Mainlyin evening Mainlyin a group A few joints Less than one gram per month A few times per month Spread over several years but rarely intensive At-risk Recreational and occupational (to go to school,
to go to work, forsport…) Alone, in the morning Under 16 years of age Between 0.1 and 1 gram per day A few times per week, evenings, especially
weekends Spread over several years with high intensity
periods Excessive Occupational and personal problems No self regulation of use Over one gram per day More than once per day Spread over several years with several months
at a time of high intensity use If cannabis itself poses very little danger to
the user and to society as a whole, some types of use involve risks. It is
time for our public policy to recognize this and to
focus on preventing at-risk use and on providing treatment for excessive
cannabis users. Recommendation 5
The
Committee recommends that
the Government of Canada adopt an integrated
policy on the risks and harmful effects of
psychoactive substances
covering
the whole range of substances (medication,
alcohol, tobacco and illegal drugs).
With respect to cannabis, this policy shall
focus on educating users, detecting
and preventing at-risk use and treating
excessive use. A
regulatory
approach to cannabis
The prohibition of cannabis does not bring about
the desired reduction in cannabis consumption or problem use. However, this
approach does have a whole series of harmful consequences. Users are
marginalized and over 20,000 Canadians are arrested each year for cannabis
possession. Young people in schools no longer enjoy the same constitutional and
civil protection of their rights as others. Organized crime benefits from
prohibition and the criminalization of cannabis enhances their power and wealth.
It is a well-known fact that society will never be able to stamp out drug use –
particularly cannabis use. Some might
believe that an alternative policy signifies abandoning ship and giving upon
promoting well-being for Canadians. Some might maintain that a regulatory
approach would fly in the face of the fundamental values of our
society. We believe, however, that the continued prohibition of cannabis
jeopardizes the health and well-being of Canadians much more than the regulated
marketing of the substance. In addition, we believe that the continued
criminalization of cannabis undermines the fundamental values set out in the Canadian Charter of Rights and Freedoms and
borne out by the history of a country based on diversity and tolerance. We do not
want to see cannabis use increase, especially among young people. Of note, the
data from other countries that we compared in Chapters 6 and 20 indicate that
countries such as the Netherlands, Australia or Switzerland, which have put in
place a more liberal approach, have not seen their long-term levels of cannabis
use rise. The same data also clearly indicate that countries with a very
restrictive approach, such as Sweden and the United States, are poles apart in
terms of cannabis use levels, and that countries with similar liberal approaches
such as the Netherlands and Portugal are also at opposite ends of the spectrum,
falling somewhere between Sweden and the United States. We have concluded that
public policy itself has little effect on cannabis use trends and that other
more complex and poorly-understood factors play a greater role in explaining the
variations. An exemption
regime making cannabis available to those over the age of 16 would probably lead
to an increase in cannabis use for a certain period. Use rates would then level
out as interest wanes and as effective prevention programs are set up. This
would then be followed by a roller-coaster pattern of highs and lows, as has
been the case in most other countries. This approach
is neither one of total abdication nor a sign of giving up but rather a vision
of the role of the State and criminal law as
developing and promoting but not controlling human action
and as stipulating only necessary prohibitions relating
to the fundamental principle of respect for life, others and a harmonious
community, and as supporting
and assisting
others and not
judging and condemning difference. We might wish for a drug-free world, fewer tobacco smokers or alcoholics or
less prescription
drug dependency, but we all know that we shall never be able to eliminate these
problems. More importantly, we should not opt to criminalize them. The Committee
believes that the same healthy and respectful approach and attitude should be
applied to cannabis. It is for
this reason that the Committee recommends that the Government of Canada amend
the Controlled Drugs and
Substances Act
to
create a criminal exemption scheme for the production and sale of cannabis under
the authority of a licence. Licensing and the production and sale of cannabis
would be subject to specific conditions, that the Committee has endeavoured to
specify. For clarity’s sake, these conditions have been compiled at the end of
this section. It should be noted at the outset that the Committee suggests that
cigarette manufacturers be prohibited from producing and selling cannabis. Recommendation6 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; criminal penalties for illegal
trafficking
and export; and the preservation of criminal penalties for all
activities
falling outside the scope of the exemption scheme. Recommendation
7 The
Committee recommends that
the Government of Canada declare an amnesty for any
person convicted of
possession of cannabis under current or past legislation. A
compassion-based
approach for therapeutic use
In Chapter
9, we noted that cannabis has not been approved as a medicinal drug in the
pharmacological sense of the word. In addition to the inherent difficulties in
conducting studies on the therapeutic applications of cannabis, there are issues
arising from the current legal environment and the undoubtedly high cost to
governments of conducting such clinical studies. Nevertheless,
we
do not doubt that, for some medical conditions and for certain people, cannabis
is indeed effective and useful therapy. Is it more effective than other types of
medication? Perhaps not. Can physicians currently prescribe cannabis at a known
dosage? Undoubtedly not. Should persons suffering from certain physical
conditions diagnosed by qualified practitioners be permitted to use
cannabis if they wish to do so? Of this, we are convinced. Regulations made in 2001 by the Health Canada,
even though they are a step in the right direction, are fundamentally
unsatisfactory. They do not facilitate access to therapeutic cannabis. They do
not consider the experience and expertise available in compassion clubs. These
regulations only govern marijuana and do not include cannabis derivatives such
as hashish and cannabis oils. It is for
these reasons that the Committee recommends that Health Canada amend the Marihuana Medical Access Regulations in
order to allow compassionate access to cannabis and its derivatives. As in the
previous chapter, proposed rules have been compiled at the end of this chapter. Recommendation 8
The
Committee recommends that
the
Marihuana Medical
Access Regulations
be amended to provide new rules regarding eligibility,
production and
distribution of cannabis for therapeutic purposes. In addition,
research on
cannabis for therapeutic purposes is essential. Provisions
for
operating a vehicle under the influence of cannabis
In chapter
8, we discussed the fact that research has not clearly established the effects
of cannabis when taken alone on a person’s ability to operate a vehicle.
Nevertheless, there is enough evidence to suggest that operating a vehicle while
under the influence of cannabis alters motor functions and effects a person’s
ability to remain in his or her lane. We have also established that the combined
effects of cannabis and alcohol impair faculties even more than alcohol taken
alone. Epidemiological studies have shown that a certain number of cannabis
users do drive under the influence of the substance and that a large proportion
of these people, mainly the young, appear to believe that cannabis does not
impair their ability to drive. This chapter
also indicated that no reliable and non-intrusive road-side detection tools
exist. Saliva-based equipment is a promising development but for the time being,
provide random results. We have also established that a visualre cognition
system, which has mainly been developed and assessed in the United States, is a
reliable way of detecting drug-induced impaired driving faculties. Recommendation9 The
Committee recommends that
the Criminal Code be amended to lower permitted
alcohol levels to 40milligrams of alcohol per
100 millilitres of blood, in the presence
of other drugs, especially, but
not exclusively cannabis; and to admit evidence
from expert police officers
trained in detecting persons operating vehicles
under the influence of drugs. research
Research on
psychoactive substances, and particularly on cannabis, has undergone a boom over
the past 20 years. The Committee was able to fully grasp the actual extent of
this increase, since we faced the challenge of summarizing it. Not all research
is of the same quality and the current political and legal climate governing
cannabis hampers thorough and objective studies. Nevertheless, a solid fact base
was available to the Committee, on which to base its foregoing conclusions and
recommendations. However, more
research needs to be done in a certain number of specific areas. In Chapter6,
we established that a lack of practical research on cannabis users has resulted
in only a limited amount of information on contexts of use being available. It
is also currently difficult to establish criteria on the various types of
cannabis use in order to guide those responsible for prevention. The Committee
suggests that cannabis use of over one gram per day constitutes excessive use
and that between 0.1 and one gram per day equates to at-risk use. We also
suggest that any use below 16 years of age is at-risk use. This is of course
enlightened speculation, but speculation nevertheless, which remains to be
explored. In Chapters
16 and 17, we referred to the fact that we know very little about the most
effective prevention practices and treatment. Here also, the current context
hindered. As far as prevention is concerned, the more or less implicit “just say no ” message and the focus
on cannabis use prevention are strategies that have been dictated by the
prohibition-based environment. In terms of treatment for problem users,
abstinence-based models have long been the dominant approach and continue
to sit very poorly with harm-reduction-based models. Thorough assessment studies
are required. The Canadian Centre on Psychoactive Substances
and Dependency must play a key role in co-ordinating and publishing the results
of studies. The Centre does not have to conduct research itself. This can and
indeed must sometimes be carried out by academics. The Health Research
Institutes are also natural players. However, it is important to clearly
identify a single central body to collect research information. This will enable
the information to be distributed as widely possible and, we hope, used. Recommendation10 The Committee recommends that the Government of Canada create a
national
fund for research on psychoactive substances and dependency to fund
research on
key issues - more particularly on various types of use, on the
therapeutic
applications of cannabis, on tools for detecting persons operating
vehicles
under the influence of drugs and on effective prevention and treatment
programs;
that the Government of Canada mandate the Canadian Centre on
Psychoactive
Substances and Dependency to co-ordinate national research and
serve as a
resource centre. Canada’s
international
Position
The Committee
is well aware that were Canada to choose the rational approach to regulating
cannabis that we have recommended, it would be in contravention of the
provisions of the various international conventions and treaties governing
drugs. We are also fully aware of the diplomatic implications of this approach,
in particular in relation to the United States. We are keen to avoid replicating, at the Canada-US border, the problems that
marked relations between the Netherlands, France, Belgium and Germany over the
issue of drugs-tourism between 1985 and 1995. This is one of the reasons that
justifies restricting the distribution of cannabis for recreational purposes to
Canadian residents. We are aware of the fact that a significant proportion of the cannabis produced
in Canada is exported, mainly to the United States. We are also aware that a
considerable proportion of heroin and cocaine comes into Canada via the United
States. We are particularly cognisant of the fact that Canadian cannabis does
not explain the increase in cannabis use in the United States. It is up to each
country to get its own house in order before criticizing its neighbour. Internationally, Canada will either have to
temporarily withdraw from the conventions and treaties or accept that it will be
in temporary contravention until the international community accedes to its
request to amend them. The Committee opts for the second approach, which seems
to us to be more consistent with the tradition and spirit of Canadian foreign
policy. In addition, we have seen that international treaties foster the
imbalanced relationship between the Northern and Southern hemispheres by
prohibiting access to plants, including cannabis, produced in the Southern
hemisphere, while at the same time developing a regulatory system for medication
manufactured by the pharmaceutical industry in the Northern hemisphere. Canada
could use this imbalanced situation to urge the international community to
review existing treaties and conventions on psychoactive substances. Canada can
and indeed should provide leadership on drug policy. Developing a national
information and action infrastructure would undoubtedly be key to this. Canada must also play a leading role in the
Americas. We believe that Canada enjoys a favourable international
reputation and that it can promote the development of fairer and more rational
drug – in particular cannabis - policies. We also contend that Canada should
strive for the creation of a European Observatory-style Drug and Dependency
Observatory for the Americas within the Organization of American States. Recommendation11 The
Committee recommends that
the Government of Canada instruct the Minister of
Foreign Affairs and
International Trade to inform the appropriate United Nations
authorities that
Canada is requesting that conventions and treaties governing
illegal drugs be
amended; and that the development of a Drugs and Dependency
Observatory for theAmericas be supported by the Government of Canada. Proposals
for implementing the regulation of cannabis fortherapeutic and
recreational purposes
Amendments to the
Marihuana Medical Access Regulations
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