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37th PARLIAMENT, 1st SESSION
Special Committee on Non-Medical Use of Drugs
EVIDENCE
CONTENTS
Wednesday, March 13, 2002
º | 1615 |
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Mr. White (Langley--Abbotsford) |
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Ms. Cynthia Callard (Executive Director, Physicians for a Smoke-Free Canada) |
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Dr. James (Jim) Walker (Secretary-Treasurer, Physicians for a Smoke-Free Canada) |
º | 1620 |
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The Chair (Ms. Paddy Torsney (Burlington, Lib.)) |
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Ms. Christy Ferguson (Researcher, Physicians for a Smoke-Free Canada) |
º | 1625 |
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The Chair |
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Ms. Christy Ferguson |
º | 1630 |
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The Chair |
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Mr. Randy White |
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Ms. Cynthia Callard |
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Mr. Randy White |
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Ms. Cynthia Callard |
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Mr. Randy White |
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Ms. Cynthia Callard |
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Mr. Randy White |
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Ms. Cynthia Callard |
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Mr. Randy White |
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Ms. Christy Ferguson |
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Mr. Randy White |
º | 1635 |
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Dr. Jim Walker |
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Mr. Randy White |
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Dr. Jim Walker |
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Mr. Randy White |
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Ms. Cynthia Callard |
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Mr. Randy White |
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A voice |
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Mr. Randy White |
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Ms. Cynthia Callard |
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Ms. Christy Ferguson |
º | 1640 |
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Mr. Randy White |
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The Chair |
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Dr. Jim Walker |
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The Chair |
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Mr. Réal Ménard (Hochelaga--Maisonneuve, BQ) |
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Ms. Cynthia Callard |
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Mr. Réal Ménard |
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Ms. Cynthia Callard |
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Mr. Ménard |
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Ms. Cynthia Callard |
º | 1645 |
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Mr. Réal Ménard |
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Ms. Cynthia Callard |
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Mr. Réal Ménard |
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Ms. Christy Ferguson |
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Mr. Réal Ménard |
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Ms. Cynthia Callard |
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Mr. Réal Ménard |
º | 1650 |
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Mr. Randy White |
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The Chair |
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Mr. Réal Ménard |
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The Chair |
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Ms. Cynthia Callard |
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Ms. Christy Ferguson |
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Some hon. members |
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The Chair |
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Ms. Christy Ferguson |
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The Chair |
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Ms. Hedy Fry (Vancouver Centre, Lib.) |
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The Chair |
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Ms. Fry |
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Dr. Jim Walker |
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Ms. Hedy Fry |
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Ms. Christy Ferguson |
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Ms. Hedy Fry |
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Dr. Jim Walker |
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Ms. Fry |
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Dr. Jim Walker |
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Ms. Hedy Fry |
º | 1655 |
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The Chair |
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Ms. Hedy Fry |
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The Chair |
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Ms. Christy Ferguson |
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Dr. Jim Walker |
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Ms. Hedy Fry |
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The Chair |
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Ms. Carole-Marie Allard (Laval East, Lib.) |
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Ms. Cynthia Callard |
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Ms. Carole-Marie Allard |
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Ms. Cynthia Callard |
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Ms. Carole-Marie Allard |
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Dr. Jim Walker |
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Ms. Carole-Marie Allard |
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Ms. Cynthia Callard |
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Ms. Carole-Marie Allard |
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Ms. Cynthia Callard |
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Ms. Carole-Marie Allard |
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The Chair |
» | 1700 |
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Ms. Christy Ferguson |
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Dr. Jim Walker |
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The Chair |
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Dr. Jim Walker |
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The Chair |
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Dr. Jim Walker |
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The Chair |
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Dr. Jim Walker |
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The Chair |
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Dr. Jim Walker |
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The Chair |
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Dr. Jim Walker |
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The Chair |
» | 1705 |
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Dr. Jim Walker |
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The Chair |
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Ms. Cynthia Callard |
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The Chair |
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Mr. Randy White |
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Dr. Jim Walker |
» | 1710 |
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The Chair |
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Mr. Randy White |
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The Chair |
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Some hon. members |
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Mr. Randy White |
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Ms. Christy Ferguson |
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Ms. Cynthia Callard |
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The Chair |
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Ms. Hedy Fry |
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The Chair |
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Ms. Carole-Marie Allard |
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Ms. Cynthia Callard |
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Ms. Carole-Marie Allard |
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Ms. Cynthia Callard |
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Ms. Carole-Marie Allard |
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Ms. Cynthia Callard |
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Ms. Carole-Marie Allard |
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Ms. Cynthia Callard |
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Ms. Carole-Marie Allard |
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Dr. Jim Walker |
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Ms. Hedy Fry |
» | 1715 |
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Ms. Cynthia Callard |
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Ms. Hedy Fry |
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Ms. Cynthia Callard |
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Ms. Hedy Fry |
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Dr. Jim Walker |
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Ms. Hedy Fry |
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Ms. Cynthia Callard |
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Ms. Fry |
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Ms. Cynthia Callard |
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The Chair |
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Voices |
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The Chair |
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Voices |
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The Chair |
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Dr. Jim Walker |
» | 1720 |
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The Chair |
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Dr. Jim Walker |
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Ms. Cynthia Callard |
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The Chair |
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Dr. Jim Walker |
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The Chair |
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Mr. Randy White |
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Dr. Jim Walker |
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Mr. Randy White |
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The Chair |
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Dr. Jim Walker |
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The Chair |
CANADA
Special Committee on Non-Medical Use of Drugs |
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EVIDENCE
Wednesday, March 13, 2002
[Recorded by Electronic Apparatus]
º (1615)
[English]
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The Vice-Chair (Mr. Randy White (Langley--Abbotsford, Canadian Alliance)): I call this meeting to order, and I welcome everybody. Pursuant to the Order of Reference adopted by the House of Commons on Thursday, May 17, 2001, we are the committee that is looking at the non-medical use of drugs and the factors underlying or relating to all of those issues.
Today, I'd like to welcome three individuals. Dr. Jim Walker is secretary-treasurer for Physicians for a Smoke-Free Canada, Cynthia Callard is the executive director, and Christy Ferguson is a researcher with that organization.
We welcome all of you. Although some of our members are not here, this is being telecast live and you are on record, so we'll go from there.
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Ms. Cynthia Callard (Executive Director, Physicians for a Smoke-Free Canada): I want to thank you very much and say to the committee
[Translation]
that I thank you very much for your attention today.
[English]
We are coming here with some information about the medical use of marijuana. That seems a bit ironic for a committee that's looking at the non-medical use, but I hope you'll agree that what we've found as we've looked at the current situation has lessons for this committee. Also, tobacco and what has happened with tobacco has lessons for this committee as it looks for a coherent policy on drug use.
I just want to remind you that part of my daily job is to remind people that tobacco remains the leading preventable cause of death. It's responsible for one in five Canadian deaths currently, or 45,000 Canadian deaths a year. One in two smokers dies as a result of smoking tobacco.
It took us a long time to develop the epidemioliogy that makes this case. Currently, 23% of Canadians smoke cigarettes, but 7% of Canadians smoke marijuana. What about the health impacts of smoking marijuana? This is the kind of question that led us to look at the current marijuana policies.
But there's another real lesson about tobacco, that being what happens when a substance becomes legal and what happens when it becomes commercial. How do you constrain the activities of commercial firms that have rights under our Constitution and are not shy to exercise those rights?
In 1997, the Parliament of Canada passed the Tobacco Act, which is supposed to ban all tobacco advertising. If you go into most retail stores, you continue to see tobacco advertising. Tobacco companies are in court fighting that ban right now. They won the last time, and they might win this time. They're also fighting current government proposals such as the proposal to take “light” and “mild” off their packages, which are deceptive to consumers. So you have to look at what happens when you create a business. We have a tobacco business. As we look at drug businesses, how do we manage them?
But our overall preoccupation in this debate at the moment is the public health dimension of drug use, and specifically the public heath dimension of smoking and inhaling, by smoke, burned marijuana.
Dr. Jim Walker has been the secretary-treasurer of Physicians for a Smoke-Free Canada for about fourteen years, since the beginning. Before he gives his comments, though, I'll just remind you that Physicians for Smoke-Free Canada was formed in 1985. It's an organization whose members and directors are entirely physicians. We have two permanent staff people—I'm one of them—but none of the staff are physicians. We are a relatively small, non-governmental organization with a very concrete mandate. Our funding comes from government, from our members, and from some foundations. Generally speaking, we operate with a budget of around $250,000.
Jim Walker will give you the substance of our concerns.
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Dr. James (Jim) Walker (Secretary-Treasurer, Physicians for a Smoke-Free Canada): As Cynthia indicated, for the past seventeen years, Physicians for a Smoke-Free Canada has mainly dealt with the primary epidemic in Canada, that being the tobacco epidemic. We now find ourselves in a position in which we fear there may be a second epidemic potentially brewing, one that could mirror the first epidemic. The similarities are too great for us to stay away from the forum and the opportunity to present our point of view.
Current marijuana policy has really been driven by legal engines rather than by health concerns. To us, this clearly is a health concern, and a public health concern, as Cynthia indicated. The present tack that government has taken really flies in the face of the advice from every major medical body. This certainly concerns us, because those bodies are speaking in the interest of public health.
Regulations currently being entertained actually promote the use of smoked marijuana—and I want to make a very big differentiation here. One of our main messages is that smoking is a very dirty delivery system, and a very toxic delivery system. There may well be valuable components within marijuana. That is the way many of our drugs have been developed: in finding a valuable component in various herbal things and other compounds, isolating it, and studying it properly. We don't know that answer for sure, because the proper studies really have not been done. We don't know what the benefits are. There probably are some, but for the most part, they're an uncertainty.
On the other side of the equation, that of the risks, we know that when you're smoking marijuana or any other organic compound that you burn, and burn incompletely, the smoke is toxic. It contains many carcinogens. There are known carcinogens and other toxic compounds within marijuana smoke, but the extent of this risk is really not known.
We really are making a couple of requests today. One is that an alternative to smoking marijuana be encouraged in the studies. In fact, smoked marijuana should probably not be one of the options in the studies. There are alternate drug delivery systems. If you look at the pharmaceutical industry, the most obvious one that compares to smoking is an inhaler, such as would be used for asthma or for different respiratory diseases. Once they're identified, this would deliver the active compounds at the same rate that smoking would.
As our other request, we feel the same standards applied to other compounds and substances should be applied to the investigation of marijuana, particularly in terms of the health protection aspect of investigating a drug properly. The risks and benefits, the indications and contraindications, should be sorted out before this is promoted to the public.
We feel there's also a significant liability issue here for the government. If marijuana is in fact promoted and provided by government, then there's going to be a significant liability down the line, because we know from the studies that have been done to date that marijuana is a dangerous compound when smoked. The actual smoke from marijuana is very toxic. It causes lung damage. As you know from the current proposal, marijuana is not only being promoted for use of terminal illness, but for chronic illness and for many other very soft indications.
If we step back and look at the bigger issue in comparing marijuana to tobacco, one of the major areas of progress that we collectively have made in the past two decades with tobacco is denormalization. As some of you may remember, twenty or thirty years ago, everywhere you went inside, there was a blue cloud of tobacco smoke. That's a very rare thing now. To see smoking in an indoor setting is actually not very normal. On the other hand, if we take the present course with marijuana, we are starting to normalize marijuana and we are going to see another epidemic that will mirror the tobacco epidemic.
As it now stands, tobacco is the only legal commercial product that we're aware of that is lethal when used as intended. If the current regulations continue to proceed the way they are currently proceeding, marijuana will be the second item added to that list.
Thank you.
º (1620)
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The Chair (Ms. Paddy Torsney (Burlington, Lib.)): Thank you very much, Dr. Walker.
Ms. Ferguson.
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Ms. Christy Ferguson (Researcher, Physicians for a Smoke-Free Canada): I'm going to talk about the current state of knowledge on the harms and benefits of smoked marijuana, just to give some context to the debate. Because a lot of the policy recommendations are being driven by medical claims, it would be useful to know where we stand, what we do know, and what we don't know.
The possible benefits that are being advanced are for AIDS wasting syndrome, arthritis, chronic pain, epilepsy, glaucoma, multiple sclerosis, muscle spasticity, asthma, anorexia, intractable hiccups, and nausea and vomiting. These are the main ones, but there are quite a few others as well. Of these, the best potential seems to be for pain relief, for nausea and vomiting, and for epileptic seizures. The evidence for appetite stimulation is mostly in AIDS and cancer patients. It seems to be effective, but there have not been very many studies, there have not been very many double-blind trials, or anything like that.
In pain relief, there is evidence that cannabinoids work via a different mechanism from the pain relievers available now. They seem to work on a different receptor system, so there is potential, but any studies that have been performed have been small and have had a high rate of side effects. Mental clouding, sedation, and anxiety are reported and have been a real problem when smoked marijuana has been used.
It seems to be somewhat useful in the relief of nausea and vomiting in chemotherapy patients. Again, though, a high rate of side effects has been troubling to patients.
In epilepsy, the active ingredient cannabidiol, or CBD, seems to control seizures in animals. There was one human trial, but it was never repeated.
So basically, in terms of benefits, there is some evidence of some benefits, but there haven't been many trials. That's partly because of the ethics of using a smoked substance in a clinical trial because of the harms involved, and partly because pharmaceutical companies have not been interested in putting their money into this. There just hasn't been very much research.
Possible harms caused by smoking marijuana are chronic bronchitis, cancers of the respiratory system, lung and bronchial infections, and chronic obstructive pulmonary disease. As Jim has already pointed out, the smoke from marijuana produces 50% more tar than tobacco smoke. This has been shown through machine tests, as well as through some biological tests. It contains many of the same carcinogens as tobacco smoke as well, including benzo[a]pyrene, which seems to be present 70% more than in tobacco smoke.
As I say, this has been studied in mechanical tests, in animal tests, and in short-term studies on humans, so it's very disturbing. There are a lot of ingredients in it that are poisonous and toxic. The way in which people inhale marijuana smoke tends to be deeper. They hold it in their lungs longer, which leaves more tar residue in their lungs and potentially leads to more damage.
Health Canada is currently engaged in a research program to find out more about the benefits and harms. I think everyone would agree that we'd like to know more. The problem that we have seen is that the goals of the research program seem to neglect health and the health aspects, basically. The government is looking into smoked marijuana in particular. Its call for proposals explicitly states that although
marijuana's potential as a medicine is undermined if patients must inhale harmful smoke...the investigation of the safety and effectiveness of smoked marijuana is a priority of this program. |
So the government is targeting smoked marijuana as a delivery system, and this is worrisome to us.
They did safeguard themselves by saying the trial should be restricted to short-term, self-limiting conditions, but the trials they are actually funding include a study of chronic neuropathic pain. We're therefore worried about, for one thing, the trial participants. What are they being exposed to? What dangers are they aware of ? What are the ethics? Secondly, where is this going? If they don't think marijuana is safe to be smoked for a long term, why are we studying its use for chronic diseases?
º (1625)
What we really need to find out, what we'd really like to know, is more about the benefits, what conditions it's good for, what dosages would be useful, and what delivery systems could be used. We'd also like to know what the risks are in the short term and the long term for both the users themselves and for those around them, if second-hand smoke is an issue; how it's to be used in the long term and short term recreationally and medically; and how people interpret government policies.
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The Chair: Can I just interrupt for two seconds?
Leaving our room at this point are some wonderful young Canadians from across Canada who have been chosen to participate in the Forum for Young Canadians. Before they leave, I would like to say that I hope they will check out this committee's testimony in the Hansard for this committee, and that they will give us the benefit of their ideas on the subject of drugs.
The committee is not just studying marijuana, it's studying all drugs, and I hope you will participate in the process. I also hope you have a great week and that some of you come back as pages for members of Parliament and their staffs.
And now that I've already interrupted you, and in case they leave too, we also have the Kingston city council members here, and we welcome them as well.
I apologize for that, and I would ask you to continue.
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Ms. Christy Ferguson: That's fine.
I'll just conclude by saying what should happen. If medical indications are going to be pursued, we need to identify and isolate the pharmacologically active compounds within the drug, within marijuana, and we need to develop delivery systems that don't involve inhaling smoke. That's where research should go, and that's where the government's research money should go.
If we want to know about the health effects of smoked marijuana among recreational and other users, we need long-term epidemiological evidence. This isn't yet available. It has been complicated in part by the patterns of marijuana use and by the high rate of coincidence between tobacco and marijuana use. But one message that we want to leave is that we don't want to wait for the epidemiological evidence. Basically, based on the make-up of marijuana and the way it's used, we have a lot of reasons to believe it is severely damaging to health. We don't want to wait twenty or thirty years and then see the cancer rates that are correlated with that.
º (1630)
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The Chair: Thank you.
Is there anybody else? No? Then we have some opportunity for questions from my colleagues.
Mr. White, do you have some questions?
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Mr. Randy White: Thank you.
As a past smoker who can no longer tolerate being in the same room as a smoker, I'm glad to see you here.
Could you tell me how many people smoke cigarettes in Canada today? Do you have an estimate of that?
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Ms. Cynthia Callard: It's about 23% of the population, so it's about five million people. About 7% of people report that they smoke marijuana regularly, and 2% of people report that they smoke marijuana regularly for medical reasons.
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Mr. Randy White: So you would say 350,000 would smoke marijuana. I suggest that's light, but is that what you're saying?
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Ms. Cynthia Callard: No, it's 7% of 30 million, so that would be about 1.5 million, while about 850,000 smoke marijuana regularly, so the total is about 2.5 million. About 700,000 smoke it for medical reasons.
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Mr. Randy White: Okay, so 2.5 million have smoked it.
I'll just pursue this. I don't want to get hung up on the numbers, but do you think there's a correlation between people who smoke cigarettes and people who smoke marijuana?
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Ms. Cynthia Callard: I know that is. In fact, when they do drug use surveys, there tends to be a clustering of all drug uses, so people who smoke marijuana are more likely to use cocaine than people who don't use marijuana or smoke or drink. There tends to be a coexistence of those behaviours.
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Mr. Randy White: I've heard lots of young people say that is not the case. I've heard lots of young people say they don't smoke cigarettes but they smoke marijuana. And it's not just a few people who tell me that. They see it as different. That's a dirty old habit, that cigarette thing, but this is not. This is a recreational thing that they do.
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Ms. Cynthia Callard: The belief is there that it's somehow different. That has been one of the most surprising things. People somehow feel that marijuana smoke is not evil in the way tobacco smoke is. Since we went public with this, I've had really hot e-mails from people insisting that marijuana smoke cures cancer, it doesn't cause it, and that this is a perfectly fine thing. There's a huge level of denial.
In terms of the actual overlaying of behaviour, though, Ontario's Centre for Addiction and Mental Health did a major survey of drug use. Their findings showed an overlap of people who engage in both.
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Mr. Randy White: I'd be curious to find out if our researchers could tell us whether or not there is some correlation there.
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Ms. Christy Ferguson: There has been some historically, but it might be changing now. When they've looked for epidemiological evidence for people who started smoking in, say, the 1960s, they have found a high coincidence, but it may be a changing trend.
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Mr. Randy White: Can you tell me the level of harm to the body that's related to cigarette smoking, marijuana smoking, crack, and heroin? If you smoked heroin, you wouldn't do that as often as you would smoke cigarettes, but if you did, would it be more damaging than smoking a package of cigarettes?
º (1635)
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Dr. Jim Walker: A number of issues come up there. First of all, it is probable—although not totally sorted out—that marijuana is not nearly as addictive as the other two from a physical addiction point of view. Marijuana doesn't contain nicotine, and it doesn't seem to affect centres the same way that opiates like heroin do. On the other hand, there's social and psychological addiction even if there isn't physical addiction.
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Mr. Randy White: I'm thinking more of the harm to the lungs.
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Dr. Jim Walker: In terms of the harm to the lungs, the equivalence has been made with tobacco, with a pack of cigarettes being equal to two or three joints of marijuana. That's partly due to the nature of the toxins in the marijuana, but also due to the way it is smoked. As Christy mentioned, it's held in the lungs longer and is inhaled more deeply.
Part of the problem that we get back to, though, is that the fundamental problem is that we don't know the answer to your question. The research has certainly not been done to the same degree with marijuana, and I don't pretend to be an expert on the other hard drugs.
If you look at the marijuana situation now in terms of knowledge, we're probably where tobacco was forty years ago. It was in 1962 that the first proper studies started to come out on tobacco, indicating that, yes, all those people who said it caused lung cancer were in fact right. In fact, the size of the epidemic has become increasingly obvious as more and more diseases are added to the tobacco list. We're probably at the 1962 level in terms of knowledge gained from proper studies on marijuana.
So the real answer to your question is that I don't think anybody knows.
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Mr. Randy White: I don't believe I've ever seen a “No marijuana smoking” ad, as opposed to the things you see from Health Canada about cigarettes. Is there such a thing?
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Ms. Cynthia Callard: There isn't, nor are there health warnings if you buy a zip-lock bag of dope on the corner. So as this committee looks at what the role of government is, I would suggest that one of the major roles of government is to fill this public health need. People don't know that smoking marijuana is dangerous. They don't know that if they want to use marijuana for medical or recreational purposes, they should seek safer ways of using it. I would suggest that really is a proper role of government: to help promote healthy behaviours in Canadians in this way. That would be consistent with the role it's taking on tobacco.
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Mr. Randy White: Finally, Madam Chair, there are many in this country who say you can't stop marijuana because it's all over the place. I come from British Columbia, the capital of this stuff.
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A voice: B.C. Bud.
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Mr. Randy White: Yes, B.C. Bud.
A lot more are saying that now that ecstasy is on such a rise, you can't stop that either. In fact, it's just a given that so much of this is in the country that you can't stop much of any of it.
I hear what you're saying. Basically, you're saying not to legalize marijuana because there's more to it than just the illegal aspect of it and cutting off profit. It's because you're smoking it. But what if marijuana were in a pill, like ecstasy? Would your organization recommend legalization of a product if smoking it wasn't involved? I don't know what your positions are. Because there's so much of this, we all know you can't stop the supply of it in society. Would you recommend that if it were put in a pill—because that's not smoking—that would be a way to do it?
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Ms. Cynthia Callard: We would probably be silent on the legal treatment of a pill form of marijuana, but we might not be, depending a little bit on what the health implications of its availability are. We'd take a look at what it might....
The point that we try to make is that these are legal issues for which the public health dimension should be well thought out. The current marijuana treatment regulations have come as a result of court decisions. The government didn't want to decriminalize it, which is a little bit different from legalizing it. I think there's a spectrum here, from decriminalizing to depenalizing, to legalizing, to commercializing. There's room there, and there are all the different regulatory regimes within those.
So that isn't a simple question to answer, but if it were put on the market in a way in which there were no health consequences, we would probably not raise any objection.
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Ms. Christy Ferguson: Just to add that, THC, tetrahydrocannabinol, is available in pill form in Canada. It's available as a pharmaceutical drug, and it has been tested and regulated as a pharmaceutical drug.
º (1640)
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Mr. Randy White: I would just suggest that there are health consequences to marijuana, ecstasy, heroin, and crack, in any event.
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The Chair: Did you want to comment on that? You don't have to.
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Dr. Jim Walker: Specifically, our major, most acute concern about the present problem is the issue of smoking, because we know it's harmful. There's a lot more ignorance about the other issues in terms of what the risks or potential benefits are. As Cynthia said, we would therefore have to make that assessment. But we know for sure that smoking it and government's essential promotion of the smoking of it are the wrong way to go. We can't tell you exactly what the right way to go is, but we know smoking is the wrong way to go.
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The Chair: Thank you very much. Now we have Réal Ménard for 10 minutes.
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Mr. Réal Ménard (Hochelaga--Maisonneuve, BQ): Thank you very much, Madam Chair.
In the last few weeks that we have been hearing from witnesses under the reference we received from the House of Commons, we have been told that the last national inquiry with respect to drug use dates back to 1994.
You still remember Ms. Beauchesne, the witness we heard from on Monday of this week, who is a specialist on the subject, has published two books and is a professor of criminology at the University of Ottawa. She told us that there had been no national study of drug use since 1994.
So what data are you using to make your estimates of marijuana use? Are they data from before 1994 or were they taken from a national population health survey?
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Ms. Cynthia Callard: The figures I referred to—the 7% and 2% of Canadians—came from a study published last year. I'm embarrassed that I didn't bring the abstract of the study with me, but it was an Ontario survey and I extrapolated its results to the national population. I can certainly provide the committee with the study's results in terms of usage.
It is true that one of our concerns is the lack of surveillance or monitoring of smoking patterns of marijuana and of tobacco. We have very good survey instruments for tobacco in the field right now, so it would not cost much to put one or two questions about marijuana use on those. We're hoping the government will do that.
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Mr. Réal Ménard: I want to be sure I understand correctly. The survey you are referring to was carried out in Ontario by an Ontario granting body, but the sample used came from all across Canada. Is that correct? It was not just an Ontario sample.
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Ms. Cynthia Callard: Yes.
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Mr. Réal Ménard: So you do not really have any data on Canada, but only on Ontario, which, of course, is not insignificant. However, we cannot say that we have data on use patterns since 1994. Thus, our witnesses were not incorrect when they told us that.
As you know as well, our mandate will be part of a broader review of the legalization or non-legalization of marijuana. What I understand from your testimony is that you are not opposed to legalization as such, but that what concerns you is the smoke, because it can be harmful to people's health. I remember speaking with you when we were studying the labelling of cigarette packages, and you raised exactly the same issue.
I come now to the arrangements to be made with respect to the exemption granted by Health Canada. Actually, before asking that question, I would like to raise a different matter. If we were to be consistent with your position and with the work of this committee, we should recommend that Health Canada conduct clinical studies on the primary and secondary effects of marijuana. Would you agree with me on that?
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Ms. Cynthia Callard: The studies must be done in accordance with research standards whereby people are not mistreated during the research project. For example, we now have some people taking part in studies who have to smoke a marijuana cigarette that contains no THC. In our view, it is not a good idea to require people to smoke something in order to study its effects.
º (1645)
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Mr. Réal Ménard: You would like it to be a control group that smokes, and one that uses the drug delivered in different ways. What type of research would you like to see?
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Ms. Cynthia Callard: A better case-controlled study would be one that looked at the effects of marijuana delivered in a safe form—in an inhaler, in a patch, or in an oral form—comparing those effects with a placebo in an inhaler, a patch, or a pill, exactly as you'd test any other drug. There is nothing special about marijuana as it compares to any other therapeutic product. If it's supposed to treat you, then it should be reviewed in the way in which all treatment drugs should be reviewed.
What's different this time is that the government initiated it, as opposed to a pharmaceutical company initiating it. The government initiated it because of the court cases, not because of any other rationale.
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Mr. Réal Ménard: Are the studies that are underway at the moment being carried out by Health Canada? I do not think there is a drug company doing any studies at the moment, is there?
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Ms. Christy Ferguson: Health Canada is not performing the studies itself, but it is funding the studies. There is a pharmaceutical component. A British pharmaceutical company is studying a sublingual spray and an inhaler. The government is also funding the trial at McGill that I referred to earlier—the one on smoked marijuana for pain relief-as well as an AIDS trial in Toronto. So the government is giving out money to fund trials. Those trials largely favour—and the call for funding actually favours—studies of smoking over studies of alternate delivery systems.
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Mr. Réal Ménard: I think we should invite Health Canada to appear before the committee, Madam Chair. Health Canada was one of our first witnesses, but we should invite them back to discuss the studies, and particularly the exemptions it provides.
I believe it was last week or in the last few days that the Canadian Medical Association took a stand quite similar to yours. We will not try to determine who influenced whom. We accept the traffic in intellectual influence. The fact remains that some individuals will be calling for on going exemption procedures. I think we should be inviting officials from Health Canada to appear to discuss these two matters, Madam Chair.
I met with the charming Mr. Lamontagne, a representative of the Collège des médecins du Québec. They feel very uneasy about the idea of exemptions, because they say that there are no serious studies on this and that they do not want to assume this responsibility. I therefore think it would be a good idea for the committee to meet with them.
In addition, as a committee, I do not think that we can focus solely on your type of concern, because a prohibitionist approach by society, with the resulting black market ... We have been told some horror stories about the drug market. Some witnesses have even told us that in British Columbia, Mr. Randy White's province, drugs are the second largest industry. I do not know whether you have looked at the implications of all of this for the black market or whether you have an opinion on that, but as members of Parliament, we must certainly take this factor into account in our recommendations to the House of Commons.
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Ms. Cynthia Callard: I don't think we're suggesting that the black market works in any way. The fact is that you have a system in which many people are smoking this drug but are not being informed of its effects, are not being protected in any way from the source of the product, and are not being given any consumer protection. That's not a good system either.
It's not as though we're suggesting that no action be taken because we don't have the perfect course. We're just suggesting that, as you look at this very complex issue, you factor in the public health consequences and look at ways to ensure that we do minimize the harm being done. I would say that even within just the narrow aspect of the physical health consequences, as opposed to perhaps the other addiction issues or other effects within which people tend to think of drug use.
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Mr. Réal Ménard: You will be interested in my last question, Madam Chair.
Do you think that everyone should try marijuana once in his or her life? You will see that the question is important, because some people think that drugs are one way to achieve self-awareness and self-fulfillment. Some researchers have proven—and you may disagree with this—that drugs, in limited quantities, Mr. White, may be a way of achieving self-actualization.
º (1650)
If everyone controlled themselves about that and tried drugs only once, do you think this could be a way of achieving self-actualization?
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Mr. Randy White: Throw in snorting cocaine, too.
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The Chair: [Editor's Note: Inaudible] your answer because I see there's a big bag there. But I do not think that is necessary. I think it was a cigarette for the others.
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Mr. Réal Ménard: He gave me a gift because I helped him. I was supposed to give it to the clerk. We will take it with us to the Maritimes. We will drink together. I will give this to the clerk. However, we do not want to distract you from the main point. Sometimes we give each other gifts, as members of Parliament, and sometimes we get into arguments as well. But in this case, this is a gift. So, please answer my question.
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The Chair: Self-actualization and marijuana, and whether or not everyone should try it.
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Ms. Cynthia Callard: It happens, you know.
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Ms. Christy Ferguson: I think we'd even recommend that if you were going to try it once, you should try it in a non-smoked form.
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The Chair: Very good. There should be extra pay for that researcher.
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Ms. Christy Ferguson: I like that.
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The Chair: Dr. Fry, for ten minutes.
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Ms. Hedy Fry (Vancouver Centre, Lib.): I was just wondering if my colleague Monsieur Ménard is suggesting that this committee conduct some practical, experiential...is that what you're suggesting?
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The Chair: He went to Montreal just to collect a few favours.
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Ms. Hedy Fry: What I'm hearing you say—and I just want to see if I got it right—is that you're concerned about the mode of transmission or the mode of use, which is smoking first.
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Dr. Jim Walker: To answer that question, yes, that's our first and most immediate concern, but there are other concerns.
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Ms. Hedy Fry: Your second concern is that there has been no real research done on the long-short, short-term, or medium-term negative effects of this drug as a drug per se, or on its use. The only research, you said, has been found in terms of pain in epileptic seizures. That's all that has ever been documented. The rest, you think, hasn't be researched enough. Is that what you're suggesting?
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Ms. Christy Ferguson: There has been research on short-term effects of marijuana smoke, but we don't have as much as we like in terms of what would be long-term or human studies.
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Ms. Hedy Fry: The Canadian Medical Association has suggested that one of the problems they have with the use of cannabis is the fact that the way in which we try to prevent use or try to stop people from using it is a coercive one and that it has criminal sanctions. They felt we should move to something that is not a criminal sanction, to something like a fine. However, they were talking about how, in moving to that, the normalization of use can be discouraged at the same time, which is what I understand you to be also concerned about.
They're suggesting that a fine will discourage normalization of use. Do you think that's the a way to go? Do you think removing the criminal sanctions for the use of the drug and putting in a fine, as the CMA suggested, is one way to go in order to remove the criminal component while not creating normalization?
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Dr. Jim Walker: This isn't really what we consider to be part of our mandate, at least at the present time. This is not something we've looked into, so I'm not sure we can give you a worthwhile, meaningful opinion on it. We're looking at the individual and—more importantly—public health effect of what can result from the current proposals.
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Ms. Hedy Fry: Of smoking?
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Dr. Jim Walker: Of smoking for sure, and of the other unknowns of marijuana.
To make the comparison to the tobacco epidemic again, it's true that smoking cigarettes is probably the most dangerous way to use tobacco, but chewing tobacco also has dangers too. But that knowledge takes time to develop. There's a forty-year lag here if you compare the science on tobacco to the science on marijuana.
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Ms. Hedy Fry: You suggested that some more research done in the same way that research is done on other drugs put under the CPS, for instance, before we talk about use of marijuana for medicinal purposes.
There is an oral use. It's in the form of a pill. It's obviously not the organic product, but it is made by a pharmaceutical company. There therefore had to have been some medical indication in order to have allowed it to be accepted for use as a pill. It's my understanding that the push from people who wanted to bring about the smoking of marijuana for medical purposes has been the argument that some of them can't keep the pill down. When they're terminally ill and there is nausea and vomiting, the pill doesn't stay down. Other drugs have other modes of use if you can't keep pills down. You have suppositories, you have intramuscular, you have intravenous injection, and you're saying there are also inhalers.
Do you have a comment on that? The fact is that it is already in the CPS as a pill.
º (1655)
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The Chair: Dr. Fry, could you just spell out for us what CPS means? I know it's blue, but I can't remember what it's called. It's a compendium or something like that.
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Ms. Hedy Fry: The CPS is the Compendium of Pharmaceuticals and Specialties, a compendium of pharmaceutical drugs. It mainly is the book that doctors use for prescribing. It lists the side effects, the indications for use, dosages, etc.
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The Chair: Thank you.
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Ms. Christy Ferguson: Madam Chair, there are a few things to say about that. The pill that's available is called dronabinol. It's a THC capsule, and the indication is for nausea and vomiting associated mostly with chemotherapy and with AIDS wasting syndrome. In both of those cases—although not necessarily for chemotherapy; it was mostly brought in for AIDS patients—the indication is for a terminal illness. Those patients did make some appeals to have a form of drug that they wouldn't have to swallow because of their nausea, and smoking was considered possibly appropriate for that use.
The other complaints about the pill have been that it takes too long to act—smoking delivers the drug to the system much faster—and that THC is not necessarily the most important active ingredient. It depends on what conditions you're treating. For epilepsy, for example, it seems that CBD may be the active ingredient, or it maybe a combination. We don't really know.
To get back to the smoking for the AIDS patients, it was possibly indicated or allowed for compassionate use. Now, though, smoking is being recommended and used for a wide variety of conditions, many of which are chronic. You can have someone using it daily from the time they're 20, for years and years. What we want to see are more distinctions.
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Dr. Jim Walker: If I could make a comparison to something that's commonly used, it's nitroglycerin for heart disease. For people who have angina due to insufficient blood flow to the heart, they either take sublingual or inhaled nitroglycerin because the problem with taking it orally is that it's not delivered quickly enough to give relief. It's very quick for it to go through the lung and to the heart, though. Short of an intravenous injection, that's as quick as it can be, yet they've never considered marketing to smoke nitroglycerin. They'd put it in a proper spray or a proper sublingual application simply because there are tablets of long-acting nitroglycerin, but it doesn't work for immediate relief.
Again, the first problem is the delivery system. Smoking is not the right delivery system. It's definitely toxic. There are definitely going to be long-term problems if it's promoted for chronic disease. If smoked marijuana was just being promoted for terminal illness, we probably wouldn't be here. We see a compassionate issue there. But when it's also being promoted for chronic disease and for the third category, “everything else”, with soft indications, then we see a real danger.
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Ms. Hedy Fry: Thank you.
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The Chair: Thank you.
Madame Allard.
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Ms. Carole-Marie Allard (Laval East, Lib.): Thank you, Madam Chair.
My interest is your organization, Physicians for a Smoke-Free Canada. Do you have any members in Quebec?
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Ms. Cynthia Callard: Yes.
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Ms. Carole-Marie Allard: And all three of you are doctors?
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Ms. Cynthia Callard: No.
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Ms. Carole-Marie Allard: You represent the association.
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Dr. Jim Walker: I'm a physician.
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Ms. Carole-Marie Allard: How many members do you have in Canada?
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Ms. Cynthia Callard: We have about 1,500 physicians in our membership base. I would say we have about 500 members who renew every year, so we're depending on active memberships or people who stay current.
Quebec is probably one of the areas where we're less represented, partly because we work very strongly in a coalition with the Quebec Coalition for TobaccoControl, which is the major coalition body in Quebec. We don't really add anything by having a separate organization there, because they very capably handle Quebec's situation.
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Ms. Carole-Marie Allard: From whom do you obtain your funding?
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Ms. Cynthia Callard: Health Canada gives us some money, our members give us some money, and private foundations give us some money. We receive money from one pharmaceutical company for an outreach program, and we have received money from pharmaceutical companies in the past.
Our finances are on our website. You can go—
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Ms. Carole-Marie Allard: I know. That is fine. Thank you very much.
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The Chair: Just before I go into a second round, I have two things. The first one would be the Carol Chafe question.
A whole series of U.S. veterans returned from Vietnam with chronic pain and addicted to marijuana, or they were heavy consumers of marijuana. They may not have been perfect trials, but have there been studies done of U.S. vets to try to tease out some of the information on what's related to the long-terms health effects of their marijuana use? The effects may be hard to pick out if they're also smokers and were exposed to Agent Orange, but were there any studies years ago when they were starting to come home?
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Ms. Christy Ferguson: I don't think there have been any major studies, although I have read that some people have attempted to use that example. A couple of problems, as you say, were the high rate of tobacco use, and other environmental factors. There was some evidence that those soldiers did have unusually severe cancers that developed at an age that was unusually young. This was a very small sample, but some cases were written up because their damage was so severe at such a young age.
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Dr. Jim Walker: I don't know what prior knowledge this committee has, but I think it's important to mention that the gold standard for studying something in medicine—pharmaceuticals in particular—is a double-blind, placebo-controlled trial. Maybe that's all repetitive to you, I don't know, but these hearsay studies in which some vets came home from Vietnam or in which these people with epilepsy did that, you basically have a numerator, but you don't have a denominator and you don't hear anything else about it. It hasn't been controlled for the negatives or for other confounding variables, so there are all kinds of biases in that. So what those studies mean, we really don't know. Whether it was the Agent Orange that caused them to have cancer, whether it was the marijuana, or something else, I don't know.
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The Chair: Yes, but with respect, Dr. Walker, while they may not, I was asking if they even exist. I appreciate that there could be a whole series of other things that I included in my question. I appreciate that there could be lots of others. But if we had all these Vietnam vets coming home, if all of them were smoking marijuana and they all have the same cancers, I would think that would be of interest to some researchers.
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Dr. Jim Walker: It sure would, and that would trigger a proper trial or study.
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The Chair: Right.
How long does a proper trial take?
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Dr. Jim Walker: It depends on what you're looking for, and whether it's for short-term or long-term effects. It also depends on how many people you can mobilize and how many...I'm not an epidemiologist primarily, but you have to figure out the number of participants needed in the study in order to have significance and power in that study.
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The Chair: You're asking us to encourage the government to commit to some long-term studies and to some short-term studies, I gather, so what scope would you see in that recommendation?
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Dr. Jim Walker: If we're talking about a number of years, I would certainly have to consult with an epidemiologist to answer your question directly. Again, though, I want to emphasize that probably none of the arms of that study should involve smoked marijuana because we know it's harmful.
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The Chair: And there's an ethical issue there.
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Dr. Jim Walker: Yes, there's an ethical issue because we know it's harmful.
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The Chair: On the reason that there's so much more tar and benzo[a]pyrene in the smoke, is that because they're not filtered, whereas cigarettes are generally filtered?
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Dr. Jim Walker: I think it's mainly because it's a different plant.
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The Chair: Okay, but it also produces tar and benzo[a]pyrene?
» (1705)
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Dr. Jim Walker: Yes.
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The Chair: Ms. Callard, you were concerned that no one's even talking about some of the concerns about marijuana. While it may be a benefit, there's a concern that it's being smoked. I have to tell you that we actually heard Dr. Doug Gourlay, from Mount Sinai Hospital in Toronto, expressing concern about how any physician in this day and age could actually sign off on smoking anything. So we have heard some testimony, and we have heard from some people about this.
I read a great, big article in the Globe and Mail about what the delivery method of this particular benefit to Canadians was going to be, how they were going to do some of the trials, and what the things they actually distributed were going to be from the products that have been grown in the Prairies. So I think there's a little bit of discussion out there, even though there may not be much.
Certainly, amongst young people, I'm frankly a little more concerned about the fact that they think smoking marijuana is better than drinking and driving, so there's a whole series of things that they need in terms of their information set. Perhaps it would be extremely important that the government embark on some kind of communications plan. Having said that, though, we're apparently the least believed or something like that, so I'm not sure it should be us. But your testimony certainly helps in getting that message out.
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Ms. Cynthia Callard: Well, Health Canada is very much believed. Health Canada is very credible. All the polling that I've seen shows that the message from Health Canada about health effects is well received.
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The Chair: If only we could convince young girls of that, they'd stop smoking cigarettes.
Mr. White, did you have any further questions?
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Mr. Randy White: It's just a brief one.
I certainly agree with your position. I could never understand why anybody would want to legalize the smoking of marijuana when we spend hundreds of millions of dollars every year telling people smoking is a bad thing to do, that it's unhealthy.
When I look at this whole issue, I wonder if countries that legalize it, with more formalized suggestions of marijuana cigarettes, are not doing it out of a panic. They feel it can't be stopped and it's raising money for criminals, so they therefore just do it and look for the quick fix.
As I understand what you said, first of all, I do agree that we do have to study this. I'm not one to study studies and do that sort of thing, but I do understand what you said. We really don't know the real physical effects of smoking marijuana. We certainly don't know the effects of ingesting ecstasy because it's so new on the market, or heroin, I wouldn't think, or crack.
I just want to ask a rhetorical question. You feel we don't know enough about any of these issues, about the physical effects of smoking any of these products, to make a qualified decision on them, is that what you're saying?
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Dr. Jim Walker: We do not know enough about the beneficial effects.
If I can step back, it depends on the level of truth and evidence that you're looking for. There is certainly subjective evidence or anecdotal evidence that there are benefits from marijuana, and those benefits are something that should be investigated. That's how we discover new products. But in terms of the additional benefits that the plant may contain, or some purified substance or compound that the plant may contain, and especially in terms of the risks, no, we don't know.
Again, if you look at tobacco, forty years ago we said we thought it caused cancer and chronic obstructive lung disease. Over that next forty years, we learned that more people die from tobacco due to heart disease than die from lung disease. And then we also learned it causes bladder cancer, pancreatic cancer, and other things that are distant from the obvious site of impact of the smoke, meaning the lung. And now breast cancer is at a higher risk.
So there are all kinds of other scenarios that you don't think of immediately when you study the substance over a longer term. If we went back forty years and had the chance to look at tobacco in 1962 instead of marijuana now, we were doing everything we could under our current state of knowledge to curb its use. From a health point of view, and hopefully from a political point of view, I certainly think we're that much more advanced, in that we have an opportunity to learn from the tobacco epidemic and be smarter this time around.
Just because some other country has legalized it, that doesn't mean we should follow suit. We have the opportunity to look at it in a proper, constructive way. I appreciate that there are legal concerns and liability concerns, but the number one thing we have to do is look at the health issue.
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The Chair: Monsieur Ménard, do you have any more questions? No?
Mr. White.
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Mr. Randy White: Amongst the medical profession, it is considered that secondary marijuana smoke is maybe not as harmful, as it is from cigarettes. Is that the case? You ought to sit in my backyard in British Columbia some nights and smell the fumes coming from the neighbours' yard.
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The Chair: Actually, that's why Randy's sitting outside in the backyard.
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Mr. Randy White: Does secondary marijuana smoke have the same effects as secondary cigarette smoke?
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Ms. Christy Ferguson: There have been no studies of that, but the evidence that we do have would lead us to believe there probably would be a similar damaging effect.
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Ms. Cynthia Callard: When you're smelling it, what are you smelling? You're smelling particles going into your lungs. Among those particles are many cancer-causing substances. The more cancer-causing substances you're exposed to, the greater your lifetime risk of getting cancer.
One of the ironies is that you read in the paper of a compassionate care smoke house that people can go to in Vancouver to smoke marijuana cigarettes. All other workers in British Columbia in that part Vancouver are protected from second-hand smoke. You can't go...it's crazy. We have totally incoherent policies, even in Vancouver, on whether or not you have a smoke-free workplace. Yes, you are protected from second-hand cigarette smoke, but if you happen to be a worker in one of these compassionate care places, you don't have protection from second-hand marijuana smoke.
I would say that, at this point, we have enough reason to say that exposure to secondhand marijuana smoke, tobacco smoke, and other forms of semi-combusted materials is dangerous, and people should be protected from that smoke and protect themselves from it.
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The Chair: Thank you.
Dr. Fry.
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Ms. Hedy Fry: For some of the questions I would have liked to ask, they don't feel they are able to answer, so, no thanks, I have no others.
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The Chair: That's fine.
Madame Allard?
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Ms. Carole-Marie Allard: I would like your position to be clear. You say you are opposed to smoke. You say that Health Canada's marijuana distribution program should not exist because smoking is harmful to people's health. That is what you say.
We are here to study drug use. That means that you are not opposed to people being given these drugs to provide relief provided they are delivered someway other than cigarettes, because you are against smoking.
Are you against the legalization of drugs? Do you have a position on heroin, and cocaine—the substances that are not smoked? Do you take a position on these...?
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Ms. Cynthia Callard: Nor do we have a position on the legalization of marijuana, heroin, or anything else. We're not here to talk about the legal treatment of it, we're here just to raise issues concerning the health consequences of its use. Hopefully you'll be able to get the advice of other witnesses about which legal treatment will lead to the minimum public health impact.
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Ms. Carole-Marie Allard: It's restricted to smoking.
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Ms. Cynthia Callard: Smoking, yes.
People do smoke other substances, but we haven't—
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Ms. Carole-Marie Allard: Like hashish.
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Ms. Cynthia Callard: Hashish is mari—
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Ms. Carole-Marie Allard: Well, it's different, but you're against it, too, because you take it by smoking it.
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Ms. Cynthia Callard: Yes.
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Ms. Carole-Marie Allard: Thank you.
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Dr. Jim Walker: We're not saying, though, that it's safe to take it in other ways, we're saying there's a great state of ignorance.
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Ms. Hedy Fry: Actually, I do have a question. It's one of principle. It is safe to ask it because this committee is looking at the non-medical use of drugs.
There is no drug, it is safe to say, that does not have a negative consequence or side effect. None whatsoever. When you are prescribing a drug for medical use, you weigh its good effects therapeutically, curatively, and in other ways, against its negative and side effects, and you monitor the patient to see when those side effects become...when the cure is worse than the disease. That's all you do.
When you talk about how you use substances, one would have to decide whether it's indeed used as a substance outside of a medical use for therapeutics, pain relief, and all that. If you just use it for a recreational purpose, there is no corresponding, positive effect of that drug other than the fact that it makes you feel good. You'll only end up getting the negative effects of that drug, however, and there is no way of monitoring the use of that. That's why some drugs used in medicine can be used illicitly or for recreational purposes without any controls, and then the addictive components start to take hold and they become chronic users, etc. I think it's safe to say that.
So what you're suggesting is that before any government should say a drug is safe to use, period, there should be the complete, double-blind, proper studies done to see clearly its positive and its negative effects.
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Ms. Cynthia Callard: In a therapeutic setting, yes.
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Ms. Hedy Fry: In a therapeutic setting.
Does that mean you think we should medicalize the use of cocaine, crack, and all that in that way, then?
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Ms. Cynthia Callard: They are medicalized. You can—
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Ms. Hedy Fry: Do you think that would be one way of dealing with the people who are currently using it? We have to still deal with people who are currently using it. We can prevent others from using it down the road, but how do we deal with the current users?
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Dr. Jim Walker: In the short-term, the major consideration, as Cynthia was saying earlier, is education about the fact that the little bag of drugs doesn't come with a warning, so it's really not informed use in terms of the risks at which these people are putting themselves and probably others by using them.
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Ms. Hedy Fry: But that doesn't deal with the current users. I'm talking about the people who are already using and are addicted to or habituated to a particular drug.
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Ms. Cynthia Callard: There have been similar proposals to medicalize tobacco, for example. Some people have suggested that you should have to have a doctor's prescription and that there should be controlled access to it as a drug. For tobacco, we have rejected that as being either not feasible at the moment or as not really handling the problem. I think that might be a question the committee wants to look at.
By and large, though, what we have now is a situation in which they have medicalized marijuana in order to respond to the court treatment. We feel that was a bad decision, so I don't think further medicalizing is likely to work unless we have it as part of a coherent policy or set of policies that integrates with therapeutic concerns.
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Ms. Hedy Fry: We have to have other checks and balances to it.
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Ms. Cynthia Callard: Yes.
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The Chair: On that point about cigarettes and changing their distribution method, though, the reasons why people are talking about smoking marijuana for medical use are that it is currently the fastest, easiest, cheapest delivery method, and it's so widely available in B.C. and other parts of the country.
To answer in part to your answer to Dr. Fry's earlier question about everything having benefits and drawbacks, all drugs have drawbacks. You were saying it's not the end of the world for terminal patients. They're going to die anyway, so you're not as worried about them getting lung cancer if they smoke it.
For those terminal patients, it's really no different from cigarettes in terms of the distribution in smoking, but the greatest concern is for the chronic patients. We have to find a new delivery method if it is proven to be something that works.
You're all nodding. Good.
I have to say I was a little bit concerned about the cake and whether it was actually some kind of a specific brownie, but we did appreciate it nonetheless.
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The Chair: I was wondering if this was an experiment or something.
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The Chair: Are there any other questions? No?
On behalf of the entire committee, I thank you for your presentation today. Just to keep you posted, this committee is going to hear testimony until sometime in June. We'll then be in a position to work on our report and will report back to the House in November 2002. If there are other things that come up, if there are some studies that somebody comes across, and you want to communicate with us, we'd be very happy to hear from you. Carol Chafe is our clerk—that's who you communicate with—and she'll make sure we get everything in both official languages.
Again, I apologize for being late. Between the tributes in the House on a historic day in the House of Commons, and a whole lot of other things, I do apologize sincerely. I really appreciate that I got a chance to hear your testimony as well. Thank you.
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Dr. Jim Walker: I think it's quite appropriate that when Herb Gray was first elected as an MP, the level of knowledge we had about tobacco was about at about the level we have for marijuana now. So it all fits in very nicely.
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The Chair: Yes, and I was also going to comment earlier that I've seen some of the ads from the 1960s in which doctors used to advertise their favourite brand of cigarettes.
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Dr. Jim Walker: Yes, that's right.
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Ms. Cynthia Callard: The tobacco companies used doctors to advertise their favourite brands.
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The Chair: They participated, yes.
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Dr. Jim Walker: I still have the article that says “More doctors smoke Camels than any other cigarette”.
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The Chair: Yes, that's right. What a horrible thing to have participated in.
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Mr. Randy White: So it's your fault I started smoking.
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Dr. Jim Walker: I take full responsibility, but you have to give me credit for your—
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Mr. Randy White: —quitting, yes.
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The Chair: Of course, in 1962, I had zero knowledge of any of it, and neither did Ms. Ferguson.
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Dr. Jim Walker: [Editor's note: Inaudible]
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The Chair: Yes, that's right, but I do appreciate it.
We wish you well. Good luck with your work. Thank you.
The meeting is adjourned.