SNUD Committee Report

CHAPTER 2: USE AND HARMFUL USE OF SUBSTANCES, AND DEPENDENCE IN CANADA

As a physician, I am confronted daily with the severe health consequences of drug use, from the heroin junkie in withdrawal, to the crack smoker coming off a 72-hour binge, to the battered teenage girl who just had a bad date. There is something terribly wrong. I am convinced that it can’t be only the drugs. There is something about our response to drug use that makes a bad situation much worse than it has to be.⁵

Illicit drugs are an important issue for Canada because of their significant negative impact. The economic cost is estimated at $5 billion annually, including health care, lost productivity, property crime, and enforcement. Each year, more than 50,000 individuals are charged with drug offences, resulting in more than 400,000 court appearances. And finally, the sale of illicit drugs is a major source of funding for organized crime and for terrorism.⁶

1. WHAT DO WE KNOW ABOUT THE PREVALENCE OF USE AND HARMFUL USE OF SUBSTANCES, AND DEPENDENCE?

The use of psychoactive substances appears to be an almost universal phenomenon, which is complex and subject to emotional debates. Reducing the supply of and demand for illicit substances are challenges faced by almost every country. Harmful use of substances (mostly of psychoactive substances including alcohol) has been related to a wide variety of social and health issues, including HIV/AIDS, Hepatitis C, homelessness, family violence, prostitution, sexual exploitation, delinquency, crime, and child abuse and neglect. Overall, the Committee believes that the harmful use of substances, and dependence, are primarily public health issues that must be addressed within a public health framework.

Alcohol and tobacco are the most widely used psychoactive substances throughout the world. Current levels and patterns of use of these substances engender harm to health and costs to society that greatly exceed the harm from the use of illicit substances. However, the wide use of such substances would mandate in-depth individual studies beyond the scope of the work of the present Committee. The Committee thus decided to concentrate its efforts on the use of illicit substances and the non-medical use of prescription drugs.

It is important to note at the outset that most people who report having used drugs at least once in their lifetime have done so either experimentally or have used intermittently when they were adolescents and young adults. A relatively small percentage will continue to use drugs regularly later in life (around 20% and even less for illicit drugs) but more than 75% will continue using alcohol.⁷ An even smaller percentage will use substances in a pattern that is causing damage to their health or become dependent on substances.

Notwithstanding the fact that a small percentage of the population consumes psychoactive substances, we must not ignore that use is increasing and so is the potential for harmful use and dependence with devastating consequences for the users and society as a whole.

According to a 2002 United Nations report, cannabis was the illicit substance most widely used throughout the world in the late 1990s (some 147 million people or 3.5% of the global population aged 15 and above), followed by amphetamines (33 million people used methamphetamine and amphetamine, and 7 million used ecstasy), cocaine (13 million people), and opiates (some 13 million people, of whom about 9 million consumed heroin). The report also showed that: substance abuse is substantially more common among men than among women (particularly with regard to the abuse of heroin, crack-cocaine or methamphetamine); there is a correlation between unemployment and prevalence of substance use in many countries; and prevalence of illicit drug use is higher among younger age groups (18-25 years of age) in practically all countries.⁸ However, the harmful use of substances is not specific to any age group, class, ethnic group or gender.

Student surveys show that more and more adolescents are using illicit substances, mostly cannabis. Lifetime prevalence use of cannabis among youth is very high. According to the United Nations report, 42.8% of 10th graders in the United States and 23% of 15 and 16 year old students in Europe reported having used cannabis at least once. The report further indicates that lifetime prevalence of all drug use (including tranquilizers and inhalants) among 15 and 16 year old students is higher in the United States (46.2%) than in Europe (25.1%).⁹

Substance use has become part of the lifestyle of many young people throughout the world, and young Canadians are no exception. According to a World Health Organization cross-national study on health behaviour in school-aged children conducted in Canada by Queen’s University, alcohol, tobacco and illicit substances (mostly cannabis) are widely used by youth. “[By] grade 10 over 90% of young people had tried alcohol.” Astoundingly, two-thirds (68%) of Grade 6 students had also tried alcohol. The percentage of grade 10 boys who reported drinking beer at least once a week went down from 30% in 1990 to 18% in 1998. Among girls, the reported use went down from 19% to 10% between 1990 and 1998. The study further shows a “sharp increase in hashish/marijuana use between 1994 and 1998. Interestingly this was associated with lower use of beer which may suggest a shift in substance use. Certainly marijuana is much more widely available at the present time than in the past and the cost is relatively low”.¹⁰ Forty-two percent of Grade 10 students reported having used marijuana three or more times in 1998 compared to 25% in 1990. Use of marijuana by Grade 8 students went up from approximately 10% in 1990 to 19% in 1998. Cocaine use by Grade 10 students nearly doubled between 1994 and 1998, going up from 3% to 5.5%. Adolescents usually use substances in the company of friends who also smoke, drink or use illicit drugs.¹¹

Why has there been such a substantial increase in consumption? An analysis of the 1977-1999 Ontario Student Drug Use Surveys suggest that increasing rates of use correlates with young people’s weakening perceptions of risk of harm in drug use, weakening moral disapproval of drug use, and increasing perceived availability of drugs.¹²

In Canada, national data on the prevalence of substance use among the general population 15 years of age and older was collected in the 1994 Canada’s Alcohol and Other Drugs Survey.¹³ The most commonly used illicit substance was cannabis with 7.4% of the respondents reporting use in the last 12 months (28.2% reporting lifetime use),¹⁴ followed by 1.1% reporting current use of LSD, speed or heroin and less than 1% reporting current use of cocaine.¹⁵ The 1994 survey did not assess the prevalence of ecstasy use but provincial data suggest that it is as prevalent in Canada as in other countries. Where injection drug use is concerned, recent studies estimate that there are between 90,000 and 125,000 injection drug users in Canada, of whom 25,000 inject steroids. The most commonly injected drugs are cocaine and heroin.

There is very limited data on the misuse of prescription drugs in Canada but the Committee has observed that such misuse is a concern throughout the country. A recent report of the Canadian Institute for Health Information indicates that “millions of Canadians take medications daily” and that “about 65% of Canadians 12 and older said they had taken painkillers in the last month”¹⁶; 5% had taken sleeping pills and tranquilizers and 4% antidepressants.¹⁷ The diversion of prescribed stimulants (e.g., Ritalin) is a concern among adolescents. A recent study of students in the Atlantic provinces concluded “[o]f the 5.3% or students who reported medical use of stimulants in the 12 months before the survey, 14.7% reported having given some of their medication, 7.3% having sold some of their medication, 4.3% having experienced theft and 3.0% having been forced to give up some of their medication.”¹⁸

With respect to alcohol and tobacco, the 2000-2001 Canadian Community Health Survey estimated that 21.5% of Canadians aged 12 and over were daily smokers and 20.1% were heavy alcohol drinkers (reporting drinking 5 or more drinks on one occasion, twelve or more times in the past year). Where young people ages 15 to 19 are concerned, the Survey estimated that 35.2% of males and 28.8% of females were drinking 5 or more drinks on one occasion, twelve or more times a year, and that 18.3% were daily smokers.¹⁹

Not enough is known of the economic costs associated with the use and harmful use of substances. In Canada, the most recent information on the health, social and economic costs associated with the use of psychoactive substances dates back to the 1996 publication by the Canadian Centre on Substance Abuse, The Costs of Substance Abuse in Canada, which analyzed data collected in 1992. The study estimated that substance abuse was costing more than $18.45 billion in Canada, 40.8% of which was attributed to alcohol. Tobacco related costs accounted for $9.56 billion, or more than half (51.8%) of the total cost of substance abuse. The economic costs of illicit drugs were estimated at $1.37 billion, of which approximately $823 million was attributed to lost productivity due to illness and premature death, and approximately $400 million was spent on law enforcement. Direct health care costs due to illicit drugs were estimated at $88 million.²⁰ In the 2001 Report of the Auditor General, the economic costs due to illicit substances, including health care, lost productivity, property crime, and enforcement were estimated to exceed $5 billion annually.²¹ More specifically, a 1996-1997 study²² of a cohort of 114 untreated illicit opiate users in Toronto concluded that the 1996 annual social cost generated by this sample was $5.086 million.²³ These costs were explained mostly by crime victimization (44.6%) and law enforcement (42.4%), followed by productivity losses (7.0%), and health care costs (6.1%).²⁴

Finally, activities related to supply reduction result in ever-increasing burdens on the law enforcement and control system. In 2001, there were more than 90,000 incidents of impaired driving reported by law enforcement agencies with about 71,000 people charged. There were 91,920 incidents related to the Controlled Drugs and Substances Act reported by police in Canada that same year. Cannabis offences accounted for approximately three-quarters of all drug-related offences.²⁵ The phenomenon of residential marijuana growing operations is a particular concern. “There has been an observed increase in organized and sophisticated multi-plant profit-oriented operations. The illicit profits generated are enormous and the involvement of organized crime is integral to these operations.”²⁶

The huge growth of hydroponic marijuana sites in the southwest Ontario region presents a wide spectrum of policing issues. In fact, this is a country-wide or North America-wide situation. Police officers are required to be familiar with specialized equipment and the handling practices. The equipment and its upkeep is expensive, and the sheer volume of sites is a considerable drain on policing resources and a very significant safety hazard to all the emergency providers, police and all those who respond, including hydro personnel.

Hydroponic marijuana prosecutions result in sentences in the range of six months to one year, hardly a deterrent to the organized criminal groups that can bring in $400,000 per year from 400 marijuana plants. It is also believed in the policing community that the funds derived from these operations are being used to fund other drug importation, such as that of heroin, MDA, and ecstasy, and other criminal enterprises. A large majority, over 80%, of the criminal organizations are involved in drug trafficking. Illicit drugs are the staple commodity of organized crime enterprises.²⁷

2. ILLICIT SUBSTANCES

This section will give a brief description of the main illicit substances under the Controlled Drugs and Substances Act (1996, c. 19), their sought-after and short-term effects,²⁹ long-term effects and a very broad idea of the prevalence of their use and/or harmful use. These substances fall into three main groups: central nervous system depressants (e.g., heroin), stimulants (e.g., cocaine) and hallucinogens (e.g., LSD). Cannabis is in a class of its own as it has depressant effects and may also cause hallucinations on rare occasions when consumed in very large doses. It is important to note that the psychoactive effects and other consequences of substances on users are determined by a variety of factors: the concentration of psychoactive agents; mode of intake; circumstances in which the substance is taken; mental state of the user; expected effects; history of substance use; individual physiology and whether the substance is used in combination with other mood-altering substances.

What are the main substances used by persons treated for harmful use, and dependence, in North America and some countries of Europe? Among those in treatment, opiates and cocaine appear to be the primary substances for which people sought treatment followed by cannabis and amphetamines. In Canada, information dating back to 1995-1996 shows that 63.3% of users were treated for problems with cocaine-type drugs (including cocaine, crack and basuco³⁰), 45.3% for heroin, 5.3% for amphetamines and 18.3% for cannabis. In 1999, in the United States, 27.7% were treated for problems related to heroin use, 26.8% for abuse of cocaine-type drugs, 26.3% for cannabis and 8.5% for amphetamines.³¹ In 1999, in Germany, 64.7% of individuals were treated for opiates, 7.7% for cocaine, and 22.2% for cannabis. That same year in the Netherlands, 63.2% were treated for opiates, 21.2% for cocaine, 10% for cannabis and 2.6% for amphetamines. In 1998, in Sweden, 32% were treated for opiates and 7% for cannabis.

(a) Cocaine

… the HIV epidemic in Vancouver is driven mainly by injection cocaine use. Although poly-drug use, including heroin, crack cocaine, marijuana, alcohol, and a range of other drugs, is widespread, it is the pattern of injectable cocaine use that poses the highest risk of HIV and hepatitis transmission. Cocaine is also associated with a high incidence of injection-related infections.³²

Cocaine and crack (a freebase form of cocaine) are stimulants that produce a quick temporary increase of energy by stimulating the central nervous system. Cocaine is prepared from coca leaves or can also be synthesized in a laboratory. It is usually sniffed, snorted, smoked or injected. Crack can be injected or smoked (freebasing).

Sought-after effects of cocaine are:

feelings of physical and mental well-being, exhilaration and euphoria;

increased alertness and energy;

decreased appetite; and

diminished sleep.

Short-term effects of cocaine include:

rapid breathing and heart rate;

increased blood pressure and body temperature; and

bizarre, erratic and sometimes violent behaviour.

Higher doses of cocaine may cause:

hallucinations;

talkativeness;

a sense of power and superiority;

restlessness, hyperexcitability and irritability;

panic; and

paranoid thoughts.

Excessive doses of cocaine may lead to:

convulsions and seizures;

stroke;

cerebral haemorrhage; or

heart failure.

Long-term effects of cocaine vary with the mode of intake and may include:

destruction of the tissues in the nose;

respiratory problems;

infectious diseases;

abscesses;

malnutrition;

paranoid psychosis;

disorientation, apathy and confused exhaustion;

depression; and

death from respiratory failure, which may occur during the “crash.”33

Chronic excessive use of cocaine causes tolerance and may lead to strong psychological dependence. Cocaine is the second most common substance for which users seek treatment throughout the world.³⁴ In Canada, a significant proportion of injection drug users are now injecting cocaine, increasing considerably the risk of HIV seroconversion, of contracting Hepatitis C, and of overdose death. This situation is particularly evident in Vancouver and other large urban centres.³⁵ According to the 2002 United Nations report on global illicit drug trends, 70% of all reported cocaine use takes place in the Americas and some 22% in Europe (mostly in Western Europe) globally affecting 13.4 million people in the late 1990s.³⁶ However, cocaine use across Europe is increasing and is becoming far more widespread than opiate use, even though opiates remain the primary substance for which users seek treatment.³⁷

(b) Heroin and other opioid analgesics

During the ten years from 1991 to 2000, there were 2,748 illicit drug deaths in the province of British Columbia. Most of these deaths occurred within the city of Vancouver. … In unpublished work on 990 deaths from three years — 1997 to 1999 — of coroners’ files of B.C. illicit drug deaths, 74% of these deaths were found to involve opiates, while cocaine caused or contributed to 49%. Ethanol was a contributing factor in 17% of illicit drug deaths during the same time period. Methadone caused or contributed to 17 deaths, or 2% of the total, from 1997 to 1999.³⁸

Heroin is part of the opium family. It is a semi-synthetic opiate synthesized from morphine, like hydromorphone (Dilaudid) and oxycodone (found in Percodan and Percocet). Methadone is also a synthetic opioid currently being used to treat heroin addiction. Heroin can be injected, inhaled (chasing the dragon), smoked, sniffed or snorted. Other means of use include eating or stuffing (squirting heroin solution into the rectum with a syringe barrel). Poly-drug use is common among opiate users.

Opiates have numerous important medical uses as painkillers (e.g., morphine, MS-Contin); cough suppressants (e.g., codeine). They are also used to treat diarrhoea and are currently under investigation for the maintenance therapy of heroin addicts. The use of opioids to treat severe pain should not be hindered by concerns of their potential to cause dependence. Prescription use should always be based on a medical evaluation balancing adequate pain relief with other possible side effects.

Sought-after effects of opiates include:

reducing tension, anxiety and depression;

inducing euphoria, warmth, contentment;

relaxed detachment from emotional as well as physical distress; and

relief from pain.

Short-term effects of opiates are:

nausea and vomiting;

drowsiness;

inability to concentrate;

apathy; and

decreased physical activity.

Regular use of opioids causes psychological and physical dependence and withdrawal from heroin engenders severe physical symptoms. Overdose deaths are common.

My experience in Vancouver has been that I’ve been working with the city for 14 years, since 1987, and 10 of those years from 1987 to 1997 were at the Carnegie Centre at the corner of Main and Hastings. From the corner of Main and Hastings at the Carnegie Centre I had a very good vantage point to witness what was clearly a public health disaster, one for which our city has become known around the world.

[…]

We watched as Vince Cain, the chief coroner, released a report — in September 1994, I believe — calling for action. That was the year close to 400 people died in British Columbia of illicit-drug overdose deaths. We watched throughout the nineties, and at the Carnegie Centre we began to do more and more memorial services. We are the community centre for the neighbourhood, and we were doing memorial services every couple of weeks for people who had overdosed and died.³⁹

Long-term effects of opiates vary with the mode of intake and may include:

infectious diseases;

constipation;

abscesses;

respiratory problems;

malnutrition;

menstrual irregularity; and

chronic sedation and apathy, leading to self-neglect.

Excessive use of opiates causes serious health problems worldwide reflected in high rates of mortality and morbidity. As well, it is associated with mental health disorders, socio-economic dysfunction, and criminality. It is estimated that 0.3% of the global population aged 15 and above were using opiates in the late 1990s. Heroin abuse was estimated to affect 0.2% of the population.⁴⁰ Opiate injectors are particularly vulnerable to the most serious drug-related harms to health (e.g., overdoses) and life-threatening infectious diseases, such as HIV, AIDS, Hepatitis B and C and tuberculosis. Opiates, mainly heroin, account for more than 70% of all requests for treatment in Europe.⁴¹ However, most of the Western European countries are observing stabilization or a decrease in the abuse of heroin. In the United States, the use of heroin was reported to be stable in 2000, affecting some 0.5% of the population aged 12 and above, and representing 30.3% of all admissions to treatment, excluding alcohol, in 1999.⁴² In Canada, studies published in 1997-1998 estimated that 60,000 to 100,000 individuals or some 0.3% of the population were illicit opiate users.⁴³ All these percentages likely underestimate the number of opiate users, as this population is largely marginalized, stigmatized and difficult to reach through general population surveys.

In Canada, a 1996-1998 study of a cohort of 114 untreated illicit opiate users in Toronto indicated that these individuals were regular poly-drug users: alcohol (70.2%), crack/cocaine (57.9%), and benzodiazepine (60.5%). Many had serious health problems (54.4%), had no permanent housing (51.8%), had multiple overdose experiences in the last twelve months (50%), had visited an emergency room for a drug-related problem (62.3%), were involved in illegal activities for income generation (67.5%), were arrested for a drug or property offence in the last year (51.4%), and were incarcerated (42.1%).⁴⁴

(c) Amphetamine-type stimulants

Amphetamine-type stimulants are a family of artificial stimulants that include substances commonly known as “uppers,” “bennies” and “pep pills.” Methamphetamine is a derivative of amphetamine and is known on the streets as speed, crystal, crank or ice. These substances may be taken orally, sniffed or injected. They activate, enhance or increase activity of the central nervous system.

Sought-after effects of amphetamine-type stimulants are similar to cocaine and include:

feelings of physical and mental well-being, exhilaration and euphoria;

increased alertness and energy; and

improved performance at manual or intellectual tasks.

Short-term effects of amphetamine-type stimulants are:

loss of appetite;

faster breathing;

increased heart rate and blood pressure;

increased body temperature and sweating;

dilation of pupils; and

bizarre, erratic and sometimes violent behaviour.

At larger doses, the effects of amphetamine-type stimulants include:

hallucinations;

hyper-excitability;

irritability;

sense of power and superiority;

panic; and

paranoid psychosis.

Long-term effects of amphetamine-type stimulants are similar to those associated with cocaine use and vary with the mode of intake. They include:

destruction of tissues in the nose;

respiratory problems;

infectious diseases;

abscesses;

malnutrition;

disorientation;

apathy;

confused exhaustion;

development of tolerance and strong psychological dependence;

paranoid psychosis; and

depression.

(d) Ecstasy

Ecstasy and amphetamine-type stimulants are closely related in their chemical structure. However, the predominant pharmacological effect of ecstasy is somewhat different from amphetamines as ecstasy also has hallucinogenic effects. Ecstasy is produced through chemical synthesis in illicit laboratories. It is usually ingested, sometimes snorted, but rarely injected.

Sought-after effects of ecstasy include:

enhanced communication skills;

increased sense of sociability and closeness to others; and

increased physical and emotional energy.

Short-term effects of ecstasy include:

restlessness;

increased blood pressure and heart rate;

sweating;

nausea and vomiting;

grinding of the teeth;

anxiety, fatigue and sometimes depression after use is stopped; and

pronounced hallucinations at higher doses.

Long-term effects of prolonged regular use of ecstasy include the same effects as with other synthetic stimulants and may also cause permanent chemical changes in the brain as well as liver damage.

In the late 1990s, the proportion of the population aged 15 and above using amphetamines was estimated at 0.8% in North America and 0.5% in Europe, representing respectively 2.6 million and 3.3 million people. It has been estimated that some 33 million people, or 0.8% of the global population, abused amphetamines. On average, amphetamines account for some 10% of treatment demand worldwide.⁴⁵ Where ecstasy is concerned, it was estimated that 0.2% of the global population (7 million people) used this substance in the late 1990s. Western Europe and North America together account for almost 85% of global consumption.⁴⁶ In Europe, the annual prevalence of abuse as a percentage of the population aged 15 and above was highest in Ireland and in the United Kingdom with 2.4% and 1.6% of their respective population abusing ecstasy in the late 1990s. In Canada, the annual prevalence of abuse was 1.5% of the population aged 15 and above in 2000.⁴⁷ Among high school students (8th, 10th and 12th graders) in the United States, the annual prevalence rate of ecstasy use has increased significantly since 1996 from 3.8% to 6.3% in 2001. In Ontario, the annual prevalence rate of ecstasy use among high school students (age 13 to 18) also increased from 0.6% in 1993 to 6% in 2001.⁴⁸

(e) Hallucinogens

The term hallucinogen from the Latin word “allucinari” meaning “to dream, to wander in the mind,” is used to describe any substance that may produce distortions of reality and hallucinations. LSD, PCP, mescaline and psilocybin (magic mushrooms) are hallucinogens. Depending on the hallucinogen, the substance may be smoked, orally ingested, sniffed or snorted.

Sought-after effects of hallucinogens include:

alterations in thought, mood and sensory perception;

mind expansion;

out-of-body experiences;

empathy;

enhanced communication skills; and

increased sociability.

Short-term effects of hallucinogens are:

distorted perception of depth and time, size and shape of objects;

distorted perception of movements of stationary objects;

intensified sensory perception; and

increased risk of injuries related to such distortions of reality.

Unpleasant reactions of hallucinogens may include:

anxiety;

depression;

dizziness;

disorientation; and

paranoia.

Physical effects of hallucinogens may include:

nausea and vomiting;

profuse sweating;

rapid heart rate; and

convulsions (rare).

“Flashbacks” of a previous hallucinogenic experience without using the substance again may occur days, weeks or even months after taking the last dose leading to disorientation, anxiety and distress. Some chronic users of hallucinogens may experience symptoms of psychological dependence — symptoms of physical dependence have not been observed.

Very little data is available on the use of hallucinogens at a global level. In Canada, the 1994 Alcohol and Other Drugs Survey did not include specific questions related to hallucinogens. The use of “LSD, speed or heroin” was reported by only 1% of respondents. However, student surveys reveal a much higher use of hallucinogens among youth. For example, according to the Ontario Student Drug Use Survey, 11.4% of students (Grade 7-OAC) reported past year use of hallucinogens in 2001.⁴⁹ A similar drug use survey of high school students in Quebec revealed 15.6% of students reported past year use of hallucinogens in 2000.⁵⁰

(f) Cannabis

Dealing with cannabis itself, and simple possession of cannabis in particular, 21,000 people were charged with simple possession of cannabis in 1999. That’s 11% more than in 1995. If you look across Canada, you’ll see that charging patterns vary significantly from police force to police force, from a low of 25 per 100,000 for cannabis possession in Vancouver in 1998, to a high of 210 per 100,000 in Thunder Bay.⁵¹

Cannabis refers to the flowering or fruiting tops of the cannabis plant, Cannabis sativa (Latin for cultivated hemp). The term cannabis is commonly used as a generic name for a variety of preparations obtained from the cannabis plant, which include commonly known substances such as marijuana, hashish and hash oil. Delta-9-tetrahydrocannabinol (THC) is the major psychoactive ingredient in cannabis products. Cannabis acts upon specific receptors in the brain. Cannabis products are usually smoked or orally ingested (food or tea).

Recent research and anecdotal evidence point to potential therapeutic uses of cannabis including managing pain, relieving nausea and vomiting caused by cancer chemotherapy, stimulating appetite and relieving the AIDS wasting syndrome, alleviating intraocular pressure associated with glaucoma, decreasing muscle spasms associated with generalized epilepsy and relieving spasticity arising from multiple sclerosis. Health Canada’s Office of Cannabis Medical Access provides direct funding to support clinical trials into the safety and effectiveness of smoked and non-smoked marijuana and cannabinoids for medical purposes. The five-year research plan established in 2001 will provide a better understanding of the therapeutic uses of cannabinoids.

Sought-after effects of cannabis include:

a sense of well-being, euphoria, relaxation; and

enhanced sensory experiences.

Short-term effects of cannabis include:

increased appetite;

increased pulse rate;

cognitive and psychomotor impairment;

talkativeness;

perceptual alterations (colours and sounds are sharpened); and

time distortion.

At very high doses, the effects of cannabis can be similar to those of hallucinogens. Regular heavy use of cannabis may lead to tolerance and heavy, long-term use, can cause dependence.

Long-term effects of cannabis include:

a loss of drive and interest in sustained activity; and

a risk of lung cancer, chronic bronchitis and other lung diseases if cannabis is smoked.

Cannabis is the most widely used illicit substance in the world, with 3.5% of the world’s population reporting use in the late 1990s. Treatment demand for cannabis is significantly lower than for opiates or cocaine, but far from negligible. On average 15% of all treatment demand at the global level is attributed to problem use of cannabis and this percentage is on the increase as levels of consumption increase and as cannabis with higher THC levels becomes more available. In the late 1990s, the prevalence of cannabis use in the general population was 6.6% in North America and 4.9% in Europe, representing respectively 20.4 million and 31.1 million people.⁵²

3. COMMITTEE OBSERVATIONS - USE AND HARMFUL USE OF SUBSTANCES

The Committee observed the following:

In Canada, there is an alarming lack of information on the prevalence of use and harmful use of substances, trends and overdoses, which impedes the development of sound drug policymaking.

The harmful use of substances and dependence are chronic relapsing diseases requiring public health strategies. Our approach must be health-based and embrace all substances in use now and be prepared to deal with substances still to be developed.

The harmful use of substances is not limited to the use of illicit substances. Harmful use of tobacco, alcohol, inhalants, prescription drugs and over-the-counter drugs is also prevalent and a serious concern to this Committee and many Canadians.

While there are differing substance use patterns across communities in Canada, the harmful use of substances causes huge social, economic and health costs and has a devastating impact on individuals, families and neighbourhoods.

There are alarming trends in use of substances: onset of use at a younger age; new synthetic drugs regularly coming on the market; and increased prevalence of use of substances by young people.

The licit or illicit status of substances has little impact on their use.

It is astounding that cannabis offences accounted for approximately three-quarters of all drug-related offences in 2001.

The social and human tragedy associated with the harmful use of substances and the links to prostitution and exploitation of vulnerable groups were among the most compelling things that this Committee observed.

There is a disturbingly high incidence of mortality and morbidity among injection drug users.

Canadians must work hard to avoid the social havoc and costs associated with the use and harmful use of substances in other countries. Proactive measures invested in now will reap rewards in the future.

We cannot ignore the impact of the pervasive use of substances on Canadian society. This is not someone else’s problem. All orders of government and the private sector must work harder to reduce the use of substances and ensure Canadians enjoy healthy, safe lives.