Drug Abuse

CHAPTER SIX THE ISSUES—SOME INTERIM RECOMMENDATIONS

A. INTRODUCTION

385. Terms of Reference.

As set out more fully in Chapter One, the Commission is required by its terms of reference to inquire into and report on the effects, the extent and the causes of the non-medical use of psychotropic drugs and substances in Canada and to make recommendation to the Federal Government as to what it can do, alone or with other levels of government, to reduce 'the dimensions of the problems involved in such use'. The Commission has interpreted its terms of reference as applying to all drugs and substances which alter sensation, mood, consciousness or other psychological or behavioural functions in the living organism and to such use of these drugs and substances as is not indicated (or justified) for generally accepted medical reasons. As explained in Chapter Two, the Commission has classified these psychotropic drugs and substances into eight major categories: sedatives and hypnotics; stimulants; psychedelics and hallucinogens; opiate narcotics; volatile solvents; non-narcotic analgesics; clinical anti-depressants and major tranquilizers. The Commission is devoting particular attention at this time to the barbiturates, alcohol, the minor tranquilizers, the amphetamines, LSD, cannabis (marijuana and hashish), the opiate narcotics such as heroin, and the volatile solvents and gases.

386. The requirement of an interim report.

The Commission is required to make a final report within two years from the date of its appointment, but it is also required to make an interim report 'at the expiration of six months' from the date of the appointment of the Commission. It is left to the discretion of the Commission to determine the appropriate scope of the interim report. The Commission has interpreted this requirement to mean that there should be an initial period of inquiry of at least six months to serve as the basis for an interim report, and that the Commission should prepare its interim report upon the expiration of this period. The manner in which the issues have developed during the initial phase of the inquiry, as well as public and governmental expectations concerning the scope of the interim report, have suggested to the Commission that the interim report would have to be more comprehensive than was originally contemplated in order to meet the felt needs for perspective and information at this time. Accordingly, its preparation has taken longer than was originally planned, but the additional time has made it possible to take into consideration the submissions which the Commission has received in public and private hearings since the beginning of 1970. The interim report thus has a broader basis than would have been the case had it been confined to information obtained through public hearings and other means of inquiry up to the end of November 1969.

387. Function of the interim report.

As explained more fully in Chapter One, the Commission conceives of the interim report as helping to put the phenomenon of non-medical drug use in some perspective, identifiying the issues, and disclosing tentative findings or assumptions concerning the effects, extent and causes of such use. We also feel that it is appropriate, in the interim report, to make such recommendations as seem urgent and for which there is a sufficient basis at this time. But generally speaking, the interim report is primarily concerned with the statement of the issues and applicable principles, and the final report is to be concerned with the detailed application of these principles to the development of a satisfactory system of social response to the phenomenon of non-medical drug use. It is also hoped that the interim report will serve as a basis for further discussion and analysis, and by attracting opinion to our preliminary definition of the issues, assist us in arriving at a fuller and more informed understanding of this phenomenon.

We must emphasize two characteristics of the interim report:
(A) The preliminary nature of our findings at this time; and
(B) The selective treatment of the subject.

388. The problems involved in non-medical drug use.

The Commission is required by its terms of reference to identify the 'problems involved in' the non-medical use of psychotropic drugs and substances. These problems emerge from a study of the effects, the extent and the causes of non-medical drug use, as well as the social response to it. In the initial phase of our inquiry our attention has been drawn to many matters which are alleged to be problems involved in non-medical drug use. At the very outset, a fundamental question (which we attempt to deal with below) is formulated: to what extent is non-medical drug use in itself to be considered a problem? Beyond this general question our inquiry so far suggests that the following matters are among the most important to be considered as problems within the meaning of our terms of reference:
(a) the harm (whether personal or social) produced by certain non-medical drug use;
(b) the extent and patterns of such use, and in particular its increase among certain age groups in the population;
(c) the aspects of our personal relations and social conditions today which encourage such use;
(d) the proliferation and adulteration of drugs;
(e) the lack of sufficient scientifically valid and accepted information concerning the phenomenon of non-medical drug use;
(f) the lack of a coordinated and otherwise effective approach to the timely collection and dissemination of such information as does exist, including appropriate drug education programmes;
(g) our present approach to treatment and the other supportive services required to assist people suffering from the adverse effects of non-medical drug use; and
(h) the content and application of the criminal law in the field of non-medical drug use.

389. The concept of social response.

We see non-medical drug use generally as presenting a complex social challenge for which we must find a wise and effective range of social responses. We believe that we must explore the full range of possible responses, including research, information and education; legislation and administrative regulation; treatment and supportive services; personal and corporate responsibility and self-restraint; and, generally individual and social efforts to correct the deficiencies in our personal relations and social conditions which encourage the non-medical use of drugs. We attach importance to the general emphasis in this range of social responses. We believe that this emphasis must shift, as we develop and strengthen the non-coercive aspects of our social response, from a reliance on suppression to a reliance on the wise exercise of freedom of choice.
The problems involved in the non-medical use of psychotropic drugs and substances are one thing; the proper social responses are another. In other words, the identification of the problem does not necessarily indicate what the wise social response should be. However, some of the problems 'involved' in non-medical drug use today arise out of our present social responses. The responses are themselves problems in some cases. The role which the Federal Government will be able to play, alone or with other levels of government, in relation to the various aspects of the social responses required will vary considerably. In some cases it will be very direct; in others it will be indirect or remote; and in still others, there will be no apparant role for government to play. At the same time, we feel that our duty to report on the effects, extent and causes of non-medical drug use (including the related social factors), and by implication on the social responses to this phenomenon, requires us to suggest the action which may be taken by other institutions or agencies in our society.

390. The general attitude towards non-medical drug use.

It is necessary to decide how far the mere existence of nonmedical drug use is to be considered a problem. What is to be our general attitude towards non-medical drug use? Is such use to be regarded as wholly bad, or are there distinctions to be made? The concept of drug abuse as developed by the World Health Organization does not appear to be a helpful criterion of distinction among various kinds of non-medical use since it defines abuse with reference to 'acceptable medical practice'. One thing is clear: our society is very heavily involved in non-medical drug use of all kinds. It would therefore be unrealistic to condemn it all in principle. We drink coffee and tea, smoke cigarettes, drink alcohol, take tranquilizers and 'pep pills'. As adults, we are constantly setting an example of non-medical drug use to our children. From infancy we are conditioned to think that there is a pharmaceutical cure for every ailment. The full resources of modern advertising are used to reinforce the reliance on drugs of all kinds. The achievements of chemistry are constantly dramatized. We live in a chemical age, and drugs are a part of our life.

The medical use of drugs is one of the boons of this chemical age. Drugs of all kinds have enormously increased our capacity to cure illness and to relieve pain. One has only to think of penicillin and the other antibiotics to recall how much we owe to the medical use of drugs. Moreover, the line between the medical use and the non-medical use of drugs is often a difficult one to draw. Is not the relief of disease-producing tension a legitimate therapeutic purpose? Certainly, more and more adults think so. The widespread use of tranquilizers and sedatives is common knowledge. Is the moderate use of tranquilizers such a bad thing, particularly- for those whose tension might otherwise lead to heart trouble or other organic damage? Have we, as a society, taken a moral position against the tranquilizers? Obviously, we have not. At least, if we have, it is a very faint and hardly audible one.

Alcohol is a sedative which is widely used for the relief of tension. Have we taken a strong moral position against its use? Some have done so and still do, but they are obviously in a minority, and the vast majority of the society pays little attention to them. As for the stimulants, we take in enormous quantities of caffeine and nicotine. We stimulate our systems and modify our mood by cup after cup of coffee through the day. The nicotine in tobacco is clearly a psycho-tropic drug used to modify one's mood. Have we adopted a moral position against the use of caffeine and nicotine? Hardly. We are beginning to react against tobacco because of its clear danger to health, but the effect on sales is so far unimpressive.

We know that there is increasing use of the amphetamines by adults in all walks of life to overcome fatigue and to maintain energy and drive. Many can not face the challenge of daily life without their daily ration of 'pep pills'. Then there is also the use of the barbiturates—the `downers'—to permit the over-stimulated system to relax sufficiently for sleep. One could go on. The point is that there must be very few people who do not use some psychotropic drug for non-medical reasons. The general climate, therefore, is not one of moral condemnation of the use of drugs for mood-modifying purposes, but rather one of acceptance of such use.

At the same time, while the use of certain mood-modifying drugs has become an accepted part of our way of life, the prevailing opinion in society still reserves varying degrees of disapproval or condemnation for the non-medical use of other drugs. Nor is society overly embarrassed or deterred from this attitude by being told that it does not practice what it preaches; that there is a hypocritical gap between its moral condemnations and its actual behaviour. The general response to this charge assumes a variety of forms which boil down to the general proposition that the fact we are in trouble with certain drug use is no reason why we should increase the trouble merely to be consistent. Those who take this view do not attempt to justify the present excessive use of alcohol, for instance; indeed, they generally deplore it. They merely say that it is too deeply ingrained in our society to be suppressed. Similarly, it is conceded that if we were considering tobacco for the first time, in light of what we have reason to believe about its possible effects, we might adopt a much stricter attitude towards it than it is feasible to adopt now. Such discrepancies or inconsistencies in our social policy, often the result of historical factors, may give rise to a sense of injustice, but they can not be the determinants of future policy. There is more than the claim of consistency involved in considering social responsibility.

Society is not obliged to repeat its errors. On the other hand, such inconsistencies do place a particular burden on society to justify its current policies. It is generally assumed that the burden of proof is on those who seek any change in public policy, but it may be that apparent inconsistencies in current policy impose a special burden to demonstrate the merits of such policy, apart from the question of consistency.

What then should be the criteria of current social policy in respect of non-medical drug use? Our own view is that while we can not say that any and all non-medical use of psychotropic drugs is to be condemned in principle, the potential for harm of non-medical drug use as a whole is such that it must be regarded, on balance, as a phenomenon to be controlled. The extent to which any particular drug use is to be deemed to be undesirable will depend upon its relative potential for harm, both personal and social.

By personal harm, we mean the adverse physiological or psychological effect of the drug upon the user; by social harm we mean the general adverse effects of non-medical drug use upon society. Reference to some of the concerns that have been expressed may serve to illuminate the concept of social harm. Many have expressed the concern that non-medical drug use, if allowed to increase and spread unchecked, will result in a general impairment of individual economic and social utility—an undermining of the will and capacity for moral choice and decisive action—that will weaken and undermine our society. More particularly, the concern has been expressed that such use will impair the capacity of the society to sustain its political, social and economic viability. In addition to this more general effect, there is concern for the immediate burdens which the adverse effects of nonmedical drug use may place on individuals depending in some measure on the user and upon social agencies having some responsibility for his and their welfare.

In considering the relative potential for harm of any drug and the social response to its use which such harm would seem to justify, it is important to keep in mind the values which we seek to protect from harm. We must also remember that such values may be threatened by our social response to drug use, as well as by the use itself. We believe that most of these values can be related to two general conditions. They are vitality—that is, the condition of a person who is in command of his full capacity to act—and the opportunity for the full development of one's potential as a human being.

B—THE EFFECTS OF THE DRUGS

1. General

391. The Commission is required by its terms of reference 'to report on the current state of medical knowledge' respecting the effects of psychotropic drugs and substances. The task of the Commission, therefore, is to undertake a critical review of the literature rather than to engage in original experimental or clinical research. In the six months or so of active inquiry which the Commission has had as a basis for the Interim Report there has been little enough time for the review of a voluminous literature, but the Commission has been exceptionally fortunate in the experience, ability and effort which its research staff have been able to bring to bear on this subject, and in view of these special circumstances and the urgent call on every side for `more information', it has felt justified in issuing the preliminary statement on the drugs and their effects which is contained in Chapter Two. We recognize that this statement may have to be modified in some respects in the Final Report, because of new knowledge which comes to our attention. It is essential, however, if there is to be an Interim Report at all, that we disclose our assumptions at this stage concerning the effects of the drugs. We invite others to give us the benefit of their views during the ensuing year.

392. The drugs to be considered at this time.

It is not our purpose in this chapter to attempt to summarize the main conclusions of Chapter Two, but merely to identify certain issues concerning the effects of the drugs which seem to be particularly relevant for purposes of public policy and social response at this stage. Our treatment is therefore necessarily selective and tends to focus on matters which have assumed a certain urgency. This selectivity should not be mistaken for an over-all perspective or sense of priorities concerning non-medical drug use as a whole. These we hope to be in a better position to convey in the Final Report after we have had the opportunity of further study and reflection. The matters of effect which we select for comment here are those which indicate the need for certain action now. In terms of short-term public policy decisions, the drugs which call for special comment at this time are cannabis, and the other hallucinogens (particularly LSD), and the amphetamines. This is not to detract in any way from the relative importance of the other drugs described in Chapter Two, in particular, alcohol, the barbiturates, and the opiate narcotics, but there seems to be less urgency concerning public policy decision with respect to them. They are of immediate concern, though, in their possible relationship to the hallucinogens and the amphetamines, and in the place which they assume in the whole phenomenon of multiple-drug use.

2. Cannabis

393. The kinds of effects to be considered.

It is customary to distinguish between short-term or `acute' effects and the effects of long-term or 'chronic' drug use, and between physiological effects and psychological effects. There is also the distinction between the effects on the individual and the effects on third persons and society as a whole. The Indian Hemp Drugs Commission adopted the simple, three-fold classification of physical, mental and moral effects. We shall refer to physiological, psychological and social effects. Social effects will often be sufficiently considered in an estimation of the behavioural manifestations of physiological and psychological effect.

394. The problem of knowing what is being referred to.

Rational discussion of the drug generally referred to as 'marijuana' is frequently impeded by looseness of terminology and failure to identify the substance we are referring to. It is often difficult to compare studies and to generalize from them because of differences in substance, potency, and administration. When one adds to these variables, differences in the psychological and physiological make-up of the subjects, their socio-economic background, their expectation of the drug experience (the 'set') and the circumstances or environment in which the drug is taken (the `setting'), all of which have an important bearing on the drug's effect, it is no wonder that there is such confusion and conflict of opinion in the field. Most of the time, we simply do not know what we are comparing.

The term cannabis (although it is the name of the plant) is to be preferred to marijuana, to indicate this general class of drug, because it is more comprehensive and covers a number of substances and derivatives, of which marijuana is but one. Cannabis is the term used in the Single Convention on Narcotic Drugs, 1961. The Narcotic Control Act is less precise, using cannabis and marijuana somewhat interchangeably. We use cannabis here to refer chiefly to marijuana, hashish, cannabis extracts, and the active principles of these materials, such as tetrahydrocannabinol (THC). Marijuana is made up of the crushed leaves, flowers and other parts of the plant. It is generally smoked in the form of cigarettes, or in a pipe, but may be taken orally in foods and beverages. Hashish consists of the relatively pure resin and is several times more potent than marijuana. It is smoked usually on the tip of a cigarette or in a pipe, or it is ingested, and in the latter form, it is sometimes mixed with food. Tetrahydrocannabinol is an active element isolated from cannabis and recently synthesized. It could be incorporated into a tobacco but is usually administered orally. It is considerably more potent than either marijuana or hashish. The essential point of emphasis here is that the potency of the various cannabis products and derivatives may vary considerably. The potency of the cannabis plant, which depends in part on soil and climatic conditions, as well as certain genetic factors, varies considerably from one country to another. Thus it may be quite difficult to compare cannabis products from one country with those from another. In India there have been traditionally three kinds of preparations of varying strength: bhang, a comparatively mild marijuana preparation; ganja, a slightly stronger kind of marijuana-type preparation and charas, which is the Indian form of hashish. In evaluating studies of cannabis use it is essential to distinguish between the milder and stronger forms of preparation. Moderate use of the milder forms is one thing; excessive use of the stronger forms may be quite another. While bhang and ganja have been tolerated as relatively innocuous when used moderately, charas has been more generally condemned. The marijuana used in North America comes mainly from Mexico or the southern United States and is usually considered to be less potent than the products of certain varieties of cannabis plant grown elsewhere in the world. This is only one of the difficulties in applying the results of studies abroad to the North American context.

In their brief to the Commission, the R.C.M.Police emphasized the importance of keeping the distinction between marijuana and hashish in mind in considering the effects of cannabis. There is evidence of an increasing use of hashish. This may be attributable in part to shortage, from time to time, in the supply of marijuana, but also to the greater potency of hashish. It has been pointed out that there is a distinction between potency and power; that potency simply means the relative strength or concentration of the active principle by weight or volume of the carrier; and that a difference in potency does not necessarily mean a difference in power—that is, in the effects which the psychoactive substance is capable of producing when administered in sufficient strength or quantity. At the same time, the degree of intoxication will undoubtedly depend upon the total strength administered at a particular time, which in turn will be influenced by availability, form and route of administration, and general practices or fashions in use. The fact that the average preparation of hashish may be five or six times as potent as the average preparation of North American marijuana does not mean that a person is necessarily going to smoke sufficient marijuana to produce the effect that would be produced by ingestion of a given amount of hashish. While the 'power' potential of these substances may be similar, given the required quantities of each, the effects actually experienced in practice may be different if the difference in potency is not adjusted by difference in the quantities actually consumed. It appears that most experienced cannabis users in North America compensate for variations in potency in different samples by altering dose to achieve a certain level or intensity of effect. Heavy, chronic users seem to prefer the stronger forms, however.

In considering the few studies which have been made of the effects of cannabis on humans, one is struck by the possible significance of the distinction between inhaling and ingestion as routes of administration. This distinction is important, for example, in comparing the results of such studies as those of the Mayor's Committee on Marihuana (La Guardia Report) with the results of other reports. The mayor's committee's investigators, on the one hand, relied on the oral administration of a 'red-oil' concentrate from cannabis, in most instances (and employed smoked materials in only a few experiments) while Isbell and co-workers, on the other hand, administered various strengths of purified THC, both by smoking and ingestion to ex-opiate addicts in Lexington, Kentucky. One may well question the basis for comparing the effects of an orally administered concentrate or synthetic derivative with the effects of marijuana which is absorbed through inhalation. All this emphasizes the importance of dose and route of administration in evaluating the effects of a particular cannabis substance or derivative. Meaningful research can not be done on cannabis effects until we agree on a standardized substance and dose ranges which bear some reasonable resemblance to real and potential patterns of consumption under various conditions of availability in the North American social context. Such patterns may have little relationship to those which would develop if cannabis were more freely available. At the present time we do not know what should be regarded as a normal frequency of use. There are two problems: one is to be able to compare the results of different studies; the other, is to have studies that produce results which have some relevance to the conditions which are likely to be encountered in actual life. Standard cannabis research samples are being developed although it will not be possible to determine how useful or relevant they will be until we know more about the doses, route of administration, and frequency of use in the general population. What is important to remember now is that when we talk about marijuana we are talking about smoking the mildest form of cannabis preparation; when we talk about hashish we are talking about a more potent form of cannabis preparation that is also generally smoked but may increasingly (as people shy away from smoking for reasons already associated with tobacco) be ingested in the form of food-stuffs; and that when we talk about THC or other synthetics we are talking about a cannabis preparation that is apparently not yet used outside of a research setting. Thus, in discussing effects we shall attempt to bear these distinctions in mind.

395. The proper classification of cannabis.

There is universal agreement that cannabis is not a narcotic and should not be classified legally with the opiate narcotics. Such classification is misleading and undermines respect for the rationality of law. There is not such scientific agreement as to what its proper classification should be, but there seems to be a general consensus that if it is to be classed with any other group it may be regarded as a mild hallucinogen, although some point out that its character is rather that of an intoxicant than a hallucinogen. On the question of legal classification we agree with the Canadian Medical Association's suggestion that it has greatest affinity with the restricted drugs in Schedule J of Part IV of the Food and Drugs Act. We shall have more to say on this point in our interim recommendations for changes in the law.

396. Short-term physical effects.

After centuries of use in a great number of countries, and extensive opportunities for clinical observation, the short-term physical effects of cannabis which have been brought to the attention of trained observers and mankind in general are relatively insignificant. There is no record of fatality directly attributable to cannabis, nor of irreparable injury to organs or tissue. The short-term physical effects which have been reported or observed form a relatively short and innocuous list, including an increase in pulse rate (but not, in the opinion of most observers, in blood pressure), conjunctivitis or a reddening of the membranes around the eyes (but not as often stated, a widening of the pupils), and dryness of the throat. Effects on psychomotor abilities, insofar as these may be considered to have a physiological aspect, will be discussed below.

397. Short-term psychological effects.

The psychological effects of cannabis are so subjective and depend so much on a number of variables, including the dose level, the particular personality of the subject, the set, and the setting, that generalizations are difficult and of questionable value. It seems unnecessary here to dwell upon the allegedly positive or beneficial effects of cannabis. It is probably sufficient to observe that an increasing number of people in all age groups appear to find the experience a pleasurable one. Cannabis is an intoxicant and a euphoriant, and it generally acts as a relaxant. In this it resembles alcohol. Like alcohol, it is felt to reduce inhibitions and to facilitate social relations. It would appear to produce a more introspective, self-absorbed mood than alcohol. The social aspect of its use may be the enjoyment of its effects in the company of others, each sensing a common bond in the knowledge that the others are undergoing a similar experience. There may be less interaction than is stimulated by social drinking, although if often stimulates laughter and hilarity. Cannabis is reported to intensify sensory perceptions of various kinds, particularly the appreciation of colour and music. It also stimulates the appetite. It is not believed, as is sometimes contended, to be an aphrodisiac, although it is claimed to heighten the pleasure of sexual experience. It has been suggested that cannabis, like alcohol, brings out the fundamental traits of the personality. It heightens or emphasizes what is already there rather than adding something different, or producing a fundamental change in character. Thus the psychological predispositions and prevailing mood of the subject are likely to be reflected in the cannabis experience. Tad trips' (that is, panic or more serious psychological reactions) from cannabis are infrequently reported, and upon examination have generally been found to be unusual cases, involving a special set of predisposing factors, such as strong anxiety or feelings of guilt. Instances of 'cannabis psychosis' as a short-term effect would also appear to be very rare, and a reflection of very special personality difficulties in the subjects involved or exceptional dose levels. This observation would seem to apply particularly to the cases of psychosis reported by the La Guardia Report and by the Lexington study of ex-opiate addicts by Isbell and others. Several recent clinical reports suggest, however, that psychotic reactions may occur in some individuals without clear prior psychopathology.

398. Effect on cognitive functions and psychomotor abilities.

The most important issue concerning the short-term effects of cannabis would appear to be its effect on cognitive functions and psychomotor abilities—those capacities which affect learning, performance in an occupation, the operation of machinery and similar activity having significant social consequences. Whether or not a person is more excited or more relaxed under the influence of cannabis, whether his coordination is impaired, his perception and judgment of distance, speed and other relationships in space and time are affected, or his reaction time prolonged, are only a few of the factors of crucial importance for driving a car, controlling machinery, or performing many other functions in daily life. Unimpaired vigilance, that is, a high level of sustained attention, is even more important for such functions as controlling traffic on city streets, in rail yards and. at airports.

This issue is of particular importance with respect to cannabis at this time because (a) it is generally agreed that one can not tell if another person is 'high' on cannabis unless he tells you, and (b) as yet, no simple means has been devised for detecting the presence and dose level of cannabis in the blood although there is optimism that scientists will develop such techniques shortly. At present, cannabis intoxication is unrecognizable and undetectable. Existing scientific knowledge and opinion concerning the effects of cannabis on cognitive functions and psychomotor abilities is not of such an order as can be relied on at this time for purposes of public policy decision-making. Some of the existing opinion is quite impressive and at least raises a serious presumption as to the nature of such effects but more research is required to command the acceptance of the scientific community.

The report by the New York Mayor's Committee on Marijuana, (The 'La Guardia Report') notes that simple psychomotor functions were only affected slightly by large doses of marijuana, and negligibly or not at all by small doses. More complex functions, hand steadiness, static equilibrium, and complex reaction time were impaired by both doses. Generally, non-users were more affected by the marijuana than those with previous marijuana experience. Strength of grip, speed of tapping, and estimations of short time intervals and linear distances were unchanged. Although no statistical analyses were done in this section, it appears that marijuana produced impairment in some intellectual functions, little or no change in others and, in a few instances, may even have resulted in an improvement in performance.

Although the La Guardia study as a whole was well planned and its different sections assigned to competent authorities, the experimental designs are not up to modern standards: no double-blind or placebo controls were used in the clinical and psychological investigations; statistical evidence was usually not presented; the reporting of results (for example, in the section on Intellectual Functioning) was not entirely unbiased; the subject samples may have been too small in some of the studies (for example, on the occurrence of addiction) to draw valid conclusions; and the type of subjects (prison inmates) chosen for some of the investigations severely limits the extent to which we may generalize from the results. These reservations apply to both the positive and negative conclusions of the report—to the alleged existence, as well as non-existence, of harmful effects.

The experiment by Weil, Zinberg and Nelsen, in which two different doses of cannabis were administered to non-experienced subjects in a double-blind situation, (and a single dose given to chronic users) is, so far as it goes, an adequately controlled study to modern scientific standards. With respect to effects on intellectual functioning and psychomotor abilities the investigators found:

Marihuana-naive persons do demonstrate impaired performance on simple intellectual and psychomotor tests after smoking marihuana; the impairment is dose-related in some cases.
Regular users of marihuana do get high after smoking marihuana in a neutral setting but do not show the same degree of impairment of performance on the tests as do naive subjects. In some cases, their performance even appears to improve slightly after smoking marihuana.

The researchers caution that the apparent differences in the effects on experienced and non-experienced users must only be considered as trends since the testing situations were not strictly comparable for the two groups. Furthermore, they suggest that the commonly observed tendency for many marijuana users to lose their train of thought when very 'high' might be considered a temporary reduction in 'short-term' memory.

Clearly, the Weil study can not be considered an adequate basis for generalizations regarding effects on driving ability. On this point the authors observe:

Although the motor skills measured by the pursuit rotor are represented in driving ability, they are only components of that ability. The influence of marijuana on driving skill remains an open question of high mcdical-legal priority.

Crancer and associates of the Department of Motor Vehicles, State of Washington, studied the effects of cannabis and alcohol (at a single dose of each) on driving ability in a laboratory simulated driving test. When subjects experienced 'a social marijuana high', overall performance was not different from the control. Furthermore, no significant change was observed when four subjects were retested at three times the original marijuana dose. However, on this limited data little can be asserted regarding a dose-response effect of marijuana on driving. It seems likely that if the dose were pushed high enough some impairment would occur, although this has not been empirically demonstrated.

The investigators caution that the study does not necessarily indicate that marijuana will not impair driving.

However, we feel that, because the simulator task is a less complex but related task, deterioration in simulator performance implies deterioration in actual driving performance. We are less willing to assume that non-deterioration in simulator performance implies non-deterioration in actual driving

The subjects were also tested after a relatively large dose of alcohol (probably more than required for an ordinary 'social alcohol high') which did produce significant impairment in driving ability. However, it is clear that a general comparison between alcohol and marijuana can not be based on a single quantity of each, and a more complete dose-response relationship for both drugs would be necessary for a meaningful assessment of either individual or relative effects on driving skills.

399. Long-term effects.

There is hardly any reliable information applicable to North American conditions concerning the long-term effects of cannabis. Because of the likelihood of significant differences in the many variables determining drug effects (physiological and psychological condition of subjects; conditions of nutrition, sanitation, climate and the like; potency, dose levels and frequency of use, as well as other drug use) the results of studies in other countries are of highly questionable applicability to North American conditions. Much further investigation is required to determine the extent to which the experience in other countries with cannabis might be utilized by properly controlled retrospective studies to yield results that would have relevance for North America.

The existing opinion as to the long-term effects of cannabis use presents an unclear picture. The conclusions of the Indian Hemp Drugs Commission (1894) include the following statements regarding the effects of cannabis in India:

... Speaking generally, the Commission are of the opinion that the moderate use of hemp drugs appears to cause no appreciable physical injury of any kind. The excessive use does cause injury.

In respect to the alleged mental effects of the drugs, the Commission have come to the conclusion that the moderate use of hemp drugs produces no injurious effects on the mind.... It is otherwise with the excessive use. Excessive use indicates and intensifies mental instability ... It has been shown that the effect of hemp drugs in this respect has hitherto been greatly exaggerated, but that they do sometimes produce insanity seems beyond question.
' In regard to the moral effects of the drugs, the Commission are of the opinion that their moderate use produces no moral injury whatever... Excessive consumption, on the other hand, both indicates and intensifies moral weakness or depravity . . . apparently very rarely indeed, excessive indulgence in hemp drugs may lead to violent crime. But for all practical purposes it may be laid down that there is little or no connection between the use of hemp drugs and crime.

In their report of an eight year study of 1,238 cannabis users in India, as well as 600 cases of mental illness attributed to the use of cannabis, R. J. Chopra and G. S. Chopra came to similar general conclusions—that moderate use of cannabis, particularly of the milder form like bhang, was not harmful, but that excessive use, particularly of the stronger forms like ganja and charas, was harmful. The evidence of possible connection between cannabis use and various psychiatric disorders, as well as criminal behaviour, is far from clear. It would appear that excessive cannabis use may emphasize or aggravate a predisposition to psychiatric disorders or criminal behaviour, rather than being the direct cause of them. In her excellent critical review of the Chopras' study, 0. J. Kalant observes that its chief weakness and source of possible error is the absence of data from a control sample of non-users, as well as differences in routes of administration and the psychological and social characteristics of the two groups of users (moderate and heavy) which were compared. She sums up the conclusions of the study as follows:

Despite the foregoing reservations it can be concluded that, in general, the moderate users of bhang were reasonably healthy, well-adjusted individuals whose use of the drug resulted in a pleasant and mild degree of intoxication which did not interfere with their routine activities. On the other hand, the smoking of ganja and charas, particularly in excess, was unquestionably correlated with a higher incidence of ill effects, the most conspicuous of which were diseases of the respiratory and digestive systems, a lower than normal number of offspring in their families, and emotional and social maladjustment. In addition, the degree of intoxication sought and achieved by ganja and charas users was much more intense than in the case of bhang users. It was not conclusively demonstrated that all characteristics of the former group were attributable to the specific pharmacological action of cannabis. Thus, the respiratory illnesses might have been caused by other components of the smoke, or by the smoke of tobacco origin, and the emotional and social maladjustment might have been, at least in part, the cause rather than the result of habitual intoxication.

With respect to long-term effects, the Mayor's Committee on Marihuana (the LaGuardia Report) concluded:

... marihuana users accustomed to daily smoking for a period of from two and a half to sixteen years showed no abnormal system functioning which would differentiate them from the non-users.
There is definite evidence in this study that the marihuana users were not inferior in intelligence to the general population and that they had suffered no mental or physical deterioration as a result of their use of the drug.

The report on Cannabis in 1968 of the Advisory Committee on Drug Dependence of the United Kingdom (the Wootton Report) concluded:

Having reviewed all the material available to us we find ourselves in agreement with the conclusion reached by the Indian Hemp Drugs Commission appointed by the Government of India (1893-1894) and the New York Mayor's Committee on Marihuana (1944), that the long-term consumption of cannabis in moderate doses has no harmful effects.

Recently, Robins and associates reported a retrospective study of the long-term outcome of marijuana use in a group of 235 negro men in St. Louis, Missouri. The characteristics of such a population may have limited applicability to present marijuana use in Canada. Persons in this sample who had used marijuana (and no other drug except alcohol) as adolescents differed significantly from non-marijuana users, in that the users had more often: drunk heavily enough to create social or medical problems, failed to graduate from high school, reported their own infidelity or fathering of illegitimate children, received financial aid, had adult police records for non-drug offenses, and reported violent behaviour.

The heavy use of alcohol by those who used marijuana complicates the interpretation considerably: 47% had 'medical or social problems attributable to drinking' and 38% of the users were alcoholics. When those subjects who were classified as alcoholics were eliminated from the data the only statistically significant difference between the marijuana users and the non-users was with respect to financial aid received in the past five years. Non-significant trends remained which were generally similar to the earlier differences, however. Subjects who used 'harder' drugs (e.g. heroin, amphetamines and barbiturates) in addition to marijuana were significantly more deviant than the nonusers, even after the alcoholics had been eliminated from the sample.
A possible causal relationship between marijuana use and problem drinking, or vice-versa, or a possible third set of factors predisposing certain individuals to alcoholism, marijuana use and other deviant behaviours can not be established or denied on the basis of the present data. The authors point out that in this study, ". . . marijuana could not be demonstrated to be harmless".

On the whole, then, the existing evidence, such as it is, affords no clear guidance for predicting what would be the long-term effects of cannabis use at various levels of dose and frequency. It is probably fair to say, however, that such evidence as there is affords the basis for a cautious rather than an optimistic approach. There is no way of telling how the 'moderate use' referred to in the Indian Hemp Commission and Wootton Reports would compare with the levels of use that might be established in North America under conditions of free availability and social acceptance. We would not hazard a guess as to what might be the average daily intake of hashish by inhalation or ingestion.

As has been found elsewhere, the difficulty with research into long-term effects, whether retrospective or prospective, is to find a suitably matched control group of non-users. As Weil has observed, this may become increasingly difficult as marijuana use spreads through the society.

The priorities of research into long-term effects would appear to include the possibility, at levels of dose and frequency of use likely to be attained under conditions of free availability and social acceptance, of (a) personality change, particularly in adolescent users; (b) impairment of mental capacity; (c) psychosis and other psychiatric disorders; (d) lung cancer or other serious effects on the bronchial and respiratory system; and (e) psychological and physiological dependence.

3. LSD

400. The problem of knowing what is being referred to. LSD, which stands for d-lysergic acid diethylamide-25 and, in the idiom of the user, is usually referred to as 'acid', has been studied widely by pharmacologists, psychiatrists and psychologists since the startling psychotropic properties of this synthetic drug were accidentally discovered by the Swiss pharmacologist, Hofmann, in 1943. Several thousand scientific papers have been published on LSD during the last 27 years. Although the drug had been put to occasional non-medical and nonscientific use during the 1950's, its general adoption by the non-medical drug users, as the principal representative of the psychedelic-hallucinogenic class of drugs, took place only during the last decade.

Since 1963 the Canadian Government has controlled the distribution of LSD, making it available only for scientific and medical purposes, and in 1969 possession of LSD without authorization was made a criminal offense. Thus, any supply of the drug for non-medical drug users has to come through illicit channels and is, almost without exception, either imported illegally or produced in clandestine laboratories by private entrepreneurs. The drug is not as easily produced as the amphetamines, but can be made by a person with some chemical knowledge who has the equipment and the basic material available. Because of the constantly growing demand by the drug community for illicit LSD, the supply is often relatively limited, and much of the drug that is sold on the illegal market is not pure. Chemically, LSD is an ergot derivative, and street samples frequently contain other chemical compounds also related to ergot, but possessing pharmacological properties which differ from those of LSD. Although most street samples in Canada which were analysed contained some LSD, many were also mixed with these chemical impurities resulting from poorly controlled procedures of production. On rare occasions street samples have proven to contain powerful chemicals with atropine-like effects. Furthermore, amphetamines ('speed') have been alleged to be added to some illicit LSD samples, which combination may potentiate or considerably change the effect of LSD. Such contaminated samples may often be responsible for tad trips' but they are by no means their only cause. Furthermore, the admixture of chemicals with atropine-like properties to LSD changes the response to the usual antidotes to LSD which may, under these circumstances, instead of lessening the effects of a 'bad trip', actually increase the toxic reaction. Thus, for the proper medical treatment of LSD reactions which have gone out of control, it is very important, though often not feasible, to know the real composition of the alleged 'LSD' sample which has been consumed.

401. The proper classification of LSD.

LSD belongs clearly in the category of psychedelic-hallucinogen drugs. It may, in fact, be considered the most characteristic representative of this psychotropic drug class. Because of its almost incredible potency, extremely small quantities of the drug will produce powerful effects which are typical of drugs of this classification. In the same category is mescaline which is found in peyote, the flowering heads of a cactus (lophophora williamsii), whose habitat is the desert areas of southern USA, Mexico and other parts of Central and South America. DMT (dimethyltryptamine), DET (diethyltryptamine) and other synthetically produced compounds are also in this category.

402. Short-term physical effects.

The most importat effects of LSD manifest themselves in the psychological sphere. Physical effects of the drug are less pronounced and occur mainly in the early phases of an LSD reaction, when the drug produces a stimulating effect on many autonomic nervous functions. It increases heart-rate and blood pressure, enlarges the pupils, may increase body temperature and blood sugar level and, not uncommonly, also induces nausea, vomiting and headache in the early stages of the drug reaction. It increases the electrical activity of the brain (as indicated by the EEG), blocks sleep and rarely, in high doses, produces convulsions. Surprisingly, in spite of its great potency, pure LSD is of low physical toxicity, and no human fatalities due to overdosage have been reported to date. (The human organism may be particularly resistant to the physical effects of LSD, since an elephant was killed by a dose which was calculated on the basis of the human dose multiplied by the different weight factor.)

A few years ago, a possible adverse effect of LSD on human chromosomes was described. Studies to test this finding have yielded conflicting results. In some studies, the finding has been confirmed, but in several others it has not. Several recent, well controlled prospective studies with clinically pure LSD administered to humans under laboratory conditions produced little or no evidence of significant chromosomal change. However, due to the seriousness of the possible consequences if such damage should occur, research in this area must continue until the following issues are unequivocally settled:

1. Does LSD damage human chromosomes in users?
2. Does such damage, if it does occur, predispose the affected person to cancer or other serious diseases, or otherwise produce any adverse effects?
3. Does chromosome damage, if it does occur, produce malformation in the children born of parents affected in this manner?

Furthermore, there is evidence that large doses of LSD, injected during pregnancy, can produce deformities in the offspring in certain strains of rodent but not in others. Although such effects have not been clearly demonstrated in humans, the possibility must be given careful consideration.

403. Short-term psychological effects. LSD, like all drugs classified in the psychedelic-hallucinogenic category, disorganizes normal mental activity. One of its earliest effects is a distortion of space perception and a profound disturbance of the normal time sense. Profound alterations in the detail and quality of sensory impressions occur. Colours are greatly intensified, sounds and visual perceptions may fuse, so that the sounds are 'seen' and colors are 'heard' (synesthesia), feelings of insight and lucid thoughts occur, and illusions and, more rarely, hallucinations may be experienced by a person under the effects of LSD. Since such profound disturbances of perceptual processes are hardly ever observed, except in naturally occurring mental disease (psychosis), the LSD reaction is sometimes referred to as a `model psychosis'. On the other hand, this change in normal mental function is called an 'expansion of the mind' by many of those who advocate this experience.

Some clinical observers who have worked with hallucinogenic drugs suggest that these substances may induce a regression to more basic types of psychological functioning, weaken normally prevailing defense mechanisms, facilitate the emergence of ordinarily forgotten or repressed memories and render the individual under the influence of these drugs more dependent on the persons and circumstances in his immediate environment.
Some LSD users, but by no means all, may have 'true' psychedelic experiences, that is, transcendental 'peak' experiences which have been compared to mystical states and to religious ecstasy. As with all true mystical states, these experiences can not be clearly communicated to others by means of verbal description, but remain at an intensely private, introspective level.

Others may have a 'bad trip' and suffer the agonizing anxiety of doubting that they are alive or that they will ever become normal again. To some extent it is possible to control the type of reaction a person will have under the influence of LSD, but in most cases it is impossible, even for an expert, to predict whether or not a person under the effects of LSD will experience a 'bad trip'. Even the fact that a person may already have had several gratifying experiences with LSD is no guarantee that he will not suffer a horrifying experience the next time.

Many persons under the influence of LSD refuse to be tested by the usual psychological procedures and lack the motivation to cooperate with a standard clinical, systematic assessment of their psychological functions, because they feel that these tests are meaningless. However, most persons who have been tested while under the effects of LSD have revealed a definite impairment of coordination and of many other psychomotor functions.

Their cognitive functioning is even more affected. Their verbal fluency may be reduced and they may show marked impairment of their critical faculties, but particularly of the ability to analyze perceptions and concepts. They are also often severely handicapped in their capacity to synthesize appropriate behavorial patterns. Because of this impairment of cognitive functions, persons under the effects of LSD not infrequently lose their contact with 'reality', become irrational and may develop delusions of persecution or other strange beliefs, such as not being subject to the force of gravity or of being invulnerable. Thus, it is evident that the judgment of a person under the effect of LSD may be greatly impaired, along with his ability to protect himself against common dangers.

404. Long-term effects.

One of the most important issues concerning the non-medical use of drugs is their long-term effect. What happens in the long run after a person has taken a drug once or twice, or perhaps many times? LSD is capable of producing lasting effects on the personality structure and, for this reason, has been used by psychiatrists for the medical treatment of such personality disorders as alcoholism and chronic neuroses. Notwithstanding some early enthusiastic reports on the therapeutic value of LSD in these conditions, it is still doubtful to what extent and in what conditions—if at all—LSD may be of value in the treatment of psychiatric illness. But there is no doubt that LSD frequently has produced profound changes of personality. Especially if somebody has had a true psychedelic experience, he might experience a change in his whole attitude toward life, which may at times be as momentous as that associated with a religious conversion. However, the drug-induced psychedelic state is still only poorly understood and remains to a considerable extent uncontrollable. Once such an experience has occurred, there is often little anyone can do to direct its future influence on the person. This influence could, indeed, range from a rapid, profound and lasting beneficial change to a fleeting, insignificant impact—or to a shattering mental breakdown. While it is true that many who have used LSD claim that they have gained new and better insights into the essential issues of life and have acquired greater sensitivity and a more genuine way of interacting with other people, it is also true that many have suffered such critical adverse effects as suicidal or accidental death, severe panic, prolonged depressive and psychotic episodes, for which they had to be treated in mental hospitals, and disturbing recurrences of the LSD experience without a new exposure to the drug (`echo effect'; 'flash-backs').

Statistical evidence for the incidence of lasting effects of self-administered LSD on the personality structure is still very sketchy, but there is perhaps more clinical support for the unfavorable than for the favorable changes. It appears, however, that under expert psychological or psychiatric supervision the risk of an unpleasant LSD experience can be reduced, since a limited measure of control is possible under these conditions.

No physical dependence occurs with LSD, although there are reports of individuals who have become psychologically dependent on the drug. An acute tolerance to the effects of LSD develops which is dissipated after a few days. There is usually no tendency for users to increase dose.

On balance, it may be concluded that the significant incidence of very serious unfavorable effects, coupled with the impossibility of predicting or effectively controlling the effects of self-administered LSD, constitute, at present, serious potential dangers. One must also consider the risk that even a single administration of LSD might be highly traumatic to emotionally unstable persons, and especially to adolescents whose personality structure is still in a critical stage of development.

4. Amphetamines

405. The problem of knowing what is being referred to.

The quality and potency of the drugs sold as amphetamines (`speed') on the illicit market, are apparently less variable than are those of cannabis or LSD. Amphetamines have been in wide medical use for more than 30 years and are legally produced in large quantities by the pharmaceutical industries. Thus, the problems of illegal production and quality control which beset cannabis and LSD are much less in evidence with the amphetamines. It appears that a large proportion of the amphetamines available on the illicit market has simply been diverted from authorized industrial production into illegal channels of importation and distribution.

Many of the orally administered tablets and capsules of prescription drugs such as dextroamphetamine (Dexedrine*), and the great variety of amphetamines contained in 'diet pills' [e.g., phenmetrazine or (Preludin*) I which are prescribed for weight control are legally produced. This also applies to methylphenidate (Ritalin*), or pipradol (Meratran*) which are pharmacologically closely related to the amphetamines.

But there is some evidence that much of the amphetamine which is most frequently used by the 'speed freaks' for intravenous injection (e.g., methamphetamine or Methedrine*) is produced in small clandestine laboratories which may sometimes be run by amateur chemists. In these cases, there is little adequate quality control and the user can not be sure of the chemical nature of the drug alleged to be methamphetamine, or of its dose.

It is important to keep these different forms of amphetamines or `speed' in mind:

1. Pure prescription amphetamines (e.g., Dexedrine*) or closely related drugs, (e.g., Ritalin*).
2. Prescription amphetamines in combination drugs (e.g., 'diet pills').
3. Illegally produced and distributed amphetamines (e.g., methamphetamine) in tablet or powdered form.

While there is a dependence problem with the prescription amphetamines and the 'diet pills', this is usually not the same as the newer `speed' problem. 'Speed freaks' are almost without exception young, under 25 years of age, and 'shoot' (inject) amphetamines intravenously in very large doses (e.g. from several hundred to several thousand milligrams). Amphetamine-dependent persons who use prescription drugs, tend to be older, between 30 and 50 years of age, take the drug orally and use much smaller doses (e.g., from 10 to 100 milligrams).

406. The proper classification of amphetamines.

Amphetamines and drugs with amphetamine-like effects are generally classified in the pharmacological category of stimulants, although one might find them occasionally included in the category of anti-depressants. It was assumed originally, when these drugs were introduced into clinical medicine in the 1930's, that amphetamines would be useful in the treatment of morbid depression, because they frequently induced euphoria in normal subjects. But it was soon observed that in severely depressed persons these drugs would often not elevate the mood and thus did not serve as true anti-depressants, but simply increase tension, restlessness and insomnia. Today, amphetamines and amphetamine-like drugs are used only occasionally in the treatment of severe depression; drugs more frequently used for this therapeutic purpose are those generally classified as anti-depressants (see classification table in Chapter Two) and are used almost exclusively on a medical basis. Many stimulants, on the other hand, enjoy wide non-medical use. Amphetamines are controlled drugs under Schedule G of Part III of the Food and Drugs Act.

407. Short-term physical effects.

More than 30 years of medical use have allowed for thorough investigation of the short-term physical effects of the amphetamines. Moderate doses produce EEG signs of electro-physiological arousal of the central neverous system and peripheral effects indicative of activation of the sympathetic (adrenalinlike) part of the autonomic nervous system, which manifest themselves as increased pulse rate, increased blood pressure, dilatation of the pupil and some relaxation of smooth muscle (e.g., in the gastrointestinal tract). Another regular, immediate effect is suppression of appetite (anorexogenic effect), produced through some action on the appetite-regulating centres in the brain.

408. Short-term psychological effects.

Typical short-term psychological effects are a feeling of increased energy, drive and initiative, often leading to an awareness of greater vitality and heightened self-confidence, and thus often resulting in a mood change in the direction of euphoria. Fatigue and boredom are diminished, pre-existing drowsiness is overcome and prolonged wakefulness is induced. In general, persons under the influence of amphetamines find it easier to tackle cognitive and emotional problems, work faster and often more efficiently—although they may be somewhat more easily distracted—and experience a facilitation of their interaction with other people.

It should be noted, however, that these effects occur by no means regularly in everyone exposed to the drug. Individuals who are chronically anxious or temporarily under stress, and therefore irritable and tense, frequently react to amphetamines with a further increase of anxiety, tension or irritability. Under these circumstances, they experience, of course, no euphoria, and their general functioning tends to be impaired rather than improved.

Test performance on simple mental tasks is frequently improved under the effects of amphetamines, particularly when rapidity of response, staying power and speed of sustained activity are being tested, and when the subject is fatigued or bored. General intelligence, however, is not improved by amphetamines when measured by the usual tests except perhaps very occasionally, and in a secondary way, through a temporary increase of motivation. A person's judgment is, as a rule, not affected by moderate doses of amphetamines, but when high doses are administered, as by the 'speed' user, judgment may be greatly impaired. Also, with higher doses, it becomes increasingly difficult for the subject to concentrate, and thus a marked deterioration of cognitive functioning might result.

Psychomotor abilities may be temporarily facilitated, and athletic performance might improve under the influence of moderate doses of amphetamines. This fact has recently made it necessary to enforce strict regulations against 'doping' with these drugs in those taking part in athletic competitions.

With extremely high doses of amphetamines, which the 'speed' user might employ (up to 1000 times the therapeutic dose) all mental activity loses its focus, concentration becomes impaired, all critical faculties are seriously reduced and the person's judgment becomes blurred. Psychomotor coordination suffers, as well, once this state has been reached, and emotional control is often lost. Nevertheless, the person under the influence of these extremely high doses of amphetamines, far from being aware of his mental limitations, experiences a 'rush' of pleasant feelings and becomes convinced that he is more capable and more powerful than ever. This sequence of drug-induced psychological events, creating unrealistically inflated feelings of self-confidence, self-righteousness and power, might lead to delinquent behavior, as the result of 'acting out' of latent aggression and hostility.

409. Long-term effects.

If moderate doses of amphetamines, such as are prescribed for medical purposes, are taken over long periods of time, three different categories of outcome may be observed:

1. No adverse effects may occur, and the person for whom the drug was prescribed or who took it without medical authorization, but in moderate doses, may go on for months or even years, taking the same dose regularly and suffering no ill effects from it. Many mildly depressed or chronically fatigued people ('tired housewife syndrome') who obtain their amphetamines on prescription, fall into this category. Also, in this category are a sizable number of persons who feel the need for mild stimulation of the amphetamine type at regular intervals because of the special kind of stress their work is placing on them, e.g., journalists, commercial artists, public speakers or performers who are required to work to deadlines, or 'produce' original ideas on demand. There is considerable evidence—though little systematic documentation—of the existence of a large group of such people who regularly use amphetamines, often without a prescription.

2. More frequently, however, a person who has started taking an amphetamine, with or without medical prescription, becomes dependent, not only on the therapeutic effects for which the drug has been taken originally (e.g., a reduction of appetite, to facilitate weight loss), but even more so, on its 'fringe benefits', such as the feelings of euphoria and increased energy produced by the drug. Tolerance to these particular effects of the amphetamines develops rapidly in most people, with the result that they are inclined to increase their doses. Although this might enable them to extend the period of time during which they can experience the particular drug effects on which they have become dependent, they now also induce a number of highly undesirable effects which are the result of the prolonged ingestion of doses of amphetamines which are considerably higher than those with which they started.
These new undesirable effects consist primarily of insomnia, loss of appetite and general nervousness, which often make it necessary for the person thus affected to take gradually increasing doses of sedatives, setting up in this way, a vicious cycle of forced stimulation and sedation—of ups and downs—which greatly disrupts his normal rhythm of functioning. If continued for several months, this pattern often results in general debilitation and exhaustion and might finally lead to a psychotic breakdown. At this stage. the chronic amphetamine user has become irresponsible, expresses delusions of persecution and requires treatment and hospitalization for mental illness.
There is, unfortunately, no reliable way of predicting which persons will fall into the first category and be able to take amphetamines regularly without increasing their dose (and thus with relative impunity) and which persons will become dependent on the drug, develop tolerance, increase dose and then invariably suffer effects destructive to their physical and mental health. Since the risk that this might occur is high, amphetamines should not be taken without close medical supervision, nor should they ever be prescribed by physicians who are not thoroughly informed about the dependency potential of amphetamines.

3. The third category of amphetamine users is constituted of `speed freaks' usually young persons who most often inject intravenously extremely large quantities of the drug. Users in categories 1 and 2 may start taking amphetamines for medical reasons and could continue obtaining amphetamines on prescription, which then might later be used for non-medical purposes; but, the 'speed freaks' rarely start the drug under medical supervision and rarely, if ever, begin use through legitimate prescription channels.
To this date there is little evidence that the slogan 'speed kills' has concrete applicability. The disastrous effects of massive doses of 'speed' on the user's physical and mental health, appearance arid behaviour either cause him to quit using the drug on his own initiative, or to be hospitalized for physical or mental breakdown, or to be arrested for delinquent behavior, long before his drug habit has killed him. This interruption of his exposure to the toxic effects of 'speed' may save his life, and may help him to give up amphetamines, while his body can still repair the damage he has inflicted on it. There seems to be little doubt, however, that nobody could survive a long, uninterrupted exposure to the devastating effects of high 'speed' doses of amphetamines on his cardiovascular system, his resistance to infection and his central nervous system.

5. Multiple Drug Use

410. In Chapter Two we have touched on possible relationships between the various drugs under study—in particular the phenomenon of cross-tolerance and cross-dependence and the extent to which the use of certain drugs may predispose one towards the use of others. (See paragraphs 57-58, 74-75, 86, 104, 140, 172-176, 245-246, 266).

In the R.C.M.P. brief to the Commission, one of the contentions of the law enforcement authorities put forward in defence of their position to maintain the present legal status for cannabis is that it leads to the use of stronger drugs eventually leading the user to 'hard' drugs, such as heroin. This contention, often referred to as the 'steppingstone' theory, assumes the character of a contagion theory. The R.C.M.P. drug law enforcement experts envisage this contagion operating in a multiple drug use context, and not merely as a simple, direct progression from cannabis to heroin.

The multiple drug-use-contagion theory is a general one of multiple drug use to which the use of cannabis is said to be a predisposing factor. What the contention amounts to is—that the use of one of these psychotropic drugs increases the probability of the use of others. The R.C.M.P. do not contend that drug progression occurs as a result of a kind of pharmacological action, but rather it is the result of exposure to, and involvement in, a drug sub-culture which encourages experimentation with drugs and a search for new and increasingly potent drug experiences. The R.C.M.P. base the theory on a 'two-year study of this problem' from which they conclude:

... documented evidence proves indisputably that in many cases a transition to heroin does take place, but not necessarily directly and certainly not in every case. The transition is generally from marijuana to hashish to methamphetamine and LSD and then to the opiates.

We are not able to find either the documented evidence for this conclusion nor the study to which the Force alludes.

In its Annual Summary for 1969, the Narcotic Addiction Foundation of British Columbia noted a "marked increase in the number of young people (125) who had become involved in multiple drug use, including heroin". The Foundation reported that this group, of which 81 were in the age range of 16 to 23, were users of "a wide variety of drugs from marijuana, LSD, amphetamines and barbiturates, prior to heroin use". This report does not specify what proportion of these young people who sought the help of the Foundation were addicted to heroin and what proportion were occasional users. Data published by the Narcotic Control Division of the Department of National Health and Welfare for the year 1969, report only 44 additional addicts under the age of 25 in British Columbia.

However, there may be significance in the fact that from 1959-69, 99 younger aged people reported a history of multiple drug use prior to heroin use, to the Narcotic Addiction Foundation, while in 1969 alone, the number reporting such use reached 81.

411. Several hypotheses might be advanced to support the contention that the use of one drug leads or predisposes an individual to experiment with others. In the general view and among drug users, drugs are ranked in a hierarchy of increasing psychotropic potency and of potential danger, running from cannabis, the least potent and dangerous, through the amphetamines to the opiate narcotics which are believed to be the most potent and dangerous. It is reasonable to believe that the notion of hierarchy attracts some individuals to work toward drugs higher on the scale. A number of motives might be suggested: the search for greater 'kicks' or more intense pleasures; the thrill of taking new and greater risks; a desire for attention from other drug users or a high reputation among them; a wish to show increasing disdain or contempt for the values of our society. Some people may be attracted to the drugs which have a dangerous reputation either because they have personality problems and tendencies to self destruction, or because they lack foresight and compulsively seek new experiences and thrills.

We also find it reasonable to think that the users of one drug might be led to the use of other drugs simply by their presence and use among their friends and their availability from the dealers they patronize. It must be recognized that an increasing number of persons have multiple drug experiences in society. They can influence others to similar drug use patterns by their mere presence and by reporting their pleasures in other drug use, and by attributing value to their use, or by the fact that any untoward effects of their multiple drug use may not be clearly visible.

It is reasonable to be concerned that many younger drug users may experiment with a number of drugs because they lack knowledge of their dangers and may not be concerned with harmful but distant consequences. The tendency of some youth to stress feeling and emotion rather than reason emphasizes their desire for immediate gratification.

Frequently and plausibly it has been suggested to us that the belief that young people are being 'lied to' about the dangers of cannabis has led them to shrug off or deny the warnings about other drugs given to them by traditional authority figures.

It may be that the first drug experience is a greater step and a more difficult one to take than to move on and experiment with other drugs. Once having taken this first step, there may be a strong attraction for many to try more potent and exotic substances.

We think too, that the presence of a drug fad in society encourages multiple drug use and we recognize that in many groups there is probably a pressure on those who seek acceptance by the group to take part in drug experimentation.

We have also been told that the shortage of one drug, such as cannabis, 'forced' those who would use drugs to accept other drugs from the dealers. We feel we must take seriously the fact of multiple drug use and further investigate the contention of drug contagion or drug progression. At the present time there is evidence of multiple drug use, but not of a type to establish a causal link or specific pattern between the use of one drug and the use of others.

6. Drugs and Crime

412. Various relationships between the use of drugs and criminal behaviour have been suggested to us, particularly by the R.C.M. Police and the Solicitor General's Department. It has been put to us by the R.C.M.Police that the use of drugs such as cannabis is or will be related to subsequent criminal activity. The Solicitor General's Department has drawn our attention to the fact that a large number of convicted heroin addicts had records of non-drug criminal activity prior to their drug convictions. It has also been asserted that some crimes are committed by individuals while under the influence of drugs.

The R.C.M.Police stated: "We are inclined to believe that most users will eventually be convicted for an offence not related to drugs." With reference to cannabis, they report that users of this drug are found in possession of firearms more frequently than are those who use heroin. The Solicitor General's Department note that this is also true of users of and traffickers in heroin. Apart from this, the R.C.M.Police say that while they "lack evidence of crimes committed in Canada by cannabis users" such evidence is available from other societies. They cite studies in India (the Chopras'),' Greece (Garthkas)2 and in the United States (Eddy,' Blumquist` and Mille?).

The R.C.M.Police, and others, referred to a number of criminal acts alleged to have been committed by individuals under the influence of drugs. They report a number of cases of nudity and other nuisance by those under the influence of LSD. Those who have taken this drug are also reported by the R.C.M.P. to have committed 'vicious assault', and to have endangered or lost their lives by believing they could fly or that they were impervious to injury. They also drew attention to a large number of suicides and attempted suicides by users of barbiturates. They report that there have been a number of arrests of individuals who had used alcohol and barbiturates concurrently.

The amphetamines have a widely accepted reputation for producing aggressive and violent behaviour. Cocaine has been said to be used by criminals to produce false courage. Alcohol has long been recognized to be highly criminogenic.

Our attention was drawn, by the Solicitor General's Department, and the R.C.M.P., to the number of criminal addicts who have records of earlier criminal behaviour. It was reported that 85% (3,450 of a sample of 3,804) of persons convicted of drug offences, who were addicted to hard drugs, had 'criminal antecedents'. It was also reported that 567 of 583 addicts in penitentiaries had committed at least one crime prior to conviction for a drug offence.

We were also told that individuals dependent on heroin are often moved to crimes such as theft and prostitution to meet the high cost of buying drugs.

We feel that at present there is a lack of adequate evidence to support the contention that the use of drugs under discussion lead significantly or generally to other forms of criminal activity with the exception of the heroin user's criminal behaviour to 'support his habit', We feel it would be dangerous to draw general conclusions from the records of prison inmates insofar as they can not be considered to be a representative sample of the present population of drug users.

The Commission intends to investigate further the allegations of relationship between drug use and other criminal activity.

C—EXTENT AND PATTERNS OF NON-MEDICAL DRUG USE

413. At this time only general statements can be made about the extent of non-medical drug use in Canada. There can be no doubt that it is widespread. Clearly there has been growing interest in and use of the psychoactive drugs by the young and indeed by all ages.

The Commission has gathered epidemiological information from a number of sources: governmental records, police statistics and estimates, various surveys of drug use among students and the informed and sensitive opinions of experts, drug users and distributors. While this information, taken together, gives the Commission some sense of the extent of the phenomenon, it does not provide the basis for any detailed or specific epidemiological statements. A major research project is being carried out on behalf of the Commission. It is expected that the results of this study will provide a basis for more accurate estimates of the extent of drug use in Canada.

Alcohol has been and remains the most popular psychoactive drug among Canadians of all ages and classes. Its use continues as our most serious drug problem. However, during the early 1960's, the acceptance and use of other psychoactive drugs such as cannabis and LSD began to be noteworthy. Marijuana had been used previously but its use had been confined to a small number of musicians and entertainers. The spread of the use of the drug appears to have begun among university students and among the mobile, alienated out-of-school young people of the cities. It did not take long for it to appear in the high schools and its use probably spread more rapidly there than in the universities. While the phenomenon began in the larger cities, it also appeared relatively quickly in smaller urban centres and in rural communities.

It seems reasonable to think that probably more than 8 or 10% of high school students have used cannabis. Some studies have found much higher proportions. For instance, a recently published British Columbia study estimates the level of cannabis use in the schools which were studied at 20%. In the hearings we have heard extreme estimates.- Many parents and teachers provide low estimates and strongly contend that the extent of use has been grossly exaggerated. Students, notably those who use drugs, suggest that as many as 60 or 70% of their fellows have smoked cannabis. At the university level, the data we have seen suggest that more than 25% of students have at least experimented with it. There is not as great a tendency to deny widespread use among college students as there is to deny it at the secondary school level.

The use of LSD seems to have emanated from the 'hip' subculture of the cities. Its spread began somewhat later than that of cannabis, but today its use has probably reached virtually the same population, although involving fewer individuals. Initially, the acceptance of LSD use was inhibited by the statements of a probable medical and genetic risk. The persuasive force of these statements seem to have been greatly attenuated during the past year or 18 months. An increasing repertoire of other new hallucinogenic drugs has appeared, and has been accepted for use by the drug communities. It is more difficult than in the case of cannabis to estimate the extent of use of these drugs. In large part this is due to the fact that their use is much more recent and there have been virtually no current attempts at measurement by surveys. However, we have heard estimates that in some high schools as many students have now used LSD as have smoked cannabis and there seems to be an awareness in the public of an increased use of hallucinogenic drugs, notably LSD, by both high school and university students.

The non-medical use of stimulants, particularly the high dosage administration of the amphetamines, is a matter of serious concern. There are conflicting reports of the extent of the so-called 'speed' phenomenon but there can be little doubt of a rapid increase in the use of these dangerous drugs in recent years. This increase seems to have taken place after the spread of cannabis and LSD. The intravenous use of amphetamines does not appear to have a wide following among university students, but these drugs seem to have achieved their greatest popularity for oral use among high school students and for intravenous use among out-of-school young people. The use of this drug has been deplored in virtually all quarters, including the cannabis and LSD communities. We have heard estimates that several thousand young people were making dangeously regular high dose use of amphetamines in Toronto. Such estimates have been accompanied by forecasts of anticipated high death and disease rates among the users.

It has come to the Commission's attention that an increasing number of young drug users are probably using or experimenting with a wide variety of drugs or drug combinations. Unfortunately, there is little survey data to indicate the extent or the pattern. We have considered the causes of multiple drug use above.

It is quite clear that many students at the high school and college levels have had drug experiences, notably with cannabis and LSD. There is no evidence that the number involved is diminishing, or that the frequency of use is lessening. Among high school and school drop-out users, there seems also to have been an increase in multiple-drug use.

The system of distribution of cannabis and LSD appears to differ significantly from that of heroin. There does not appear to be an organized crime involvement at this time, although hashish distribution might be attractive to organized crime in the future. In many cities there are large importers of marijuana, hashish, and LSD who supply a multi-levelled network of distributors. Most of the distributors at the street level can not properly be thought of as pushers in the sense of the traditional heroin pushers. There is also a large number of smaller importers. Much of the distribution of these drugs seems to be informal and even casual. They often seem to move among friends in a fashion similar to alcohol or tobacco in 'straight' society. It is probable that the most important factor in the rapid development of this phenomenon has been the influence of one individual upon another—the reporting of one's own drug experiences to friends and acquaintances.

The use of heroin and the other opiate narcotics has been a problem in Canada for a number of years. However, the last available government statistics indicate that the proportion of addicts in the total population has declined.' The Commission is concerned, however, by reports in Canada and the United States of the increasing use of heroin, particularly by young people.

It is important to realize that the non-medical use of psychotropic drugs has been increasing among adults as well as among the young. We have cited statistics to show the increase in the use of alcohol and such drugs as the barbiturates, stimulants and minor tranquilizers. We have also heard much about the purported increased use of cannabis by adults for recreational purposes.

D--CAUSES OF NON-MEDICAL DRUG USE

414. The Commission feels that one of its most important responsibilities is to provide some reasonable explanations of non-medical drug use and to give the Canadian people assistance in understanding at least some of the major causes and causal patterns. There are causal forces involved at the individual, the group and the society-wide levels. Our primary concern is with those pressures to drug use that have a wide applicability, although we do not ignore the idiosyncratic.

We feel that it is important to stress that there is no single or simple explanation available—nor is one likely to be found. Motives vary widely between users and groups of users. The motivation of the individual user may vary through time. Motivation is also a function of the real and expected effects of the various drugs.

There has been some tendency to think of the motives for drug use as pathological or as reflecting a pathological psychological condition. This is shown by the tendency to turn to the physician, and particularly to psychiatrists, for help in understanding the drug phenomenon. There is no doubt that some drug users are to some degree mentally ill. However we are convinced that the vast majority fall within the normal range of psychological functioning.

Probably the most important single factor that has encouraged an increase in the use of cannabis has been the description by one individual to another of the drug's effects as being pleasant, fun, interesting or exciting. The search for fun, pleasure and excitement is also probably the most important factor favouring the continued use of this drug. While newspapers, magazines and the popular music industry have played a role in creating an interest in drug use and experimentation and have provided information about the effects of the drugs, it seems likely that their influence has been far less than that of individuals upon each other. There is also now a fad of drug-taking and experimentation.

The smoking of marijuana and hashish is primarily a group practice, although there are solitary smokers. While it is often said that smoking cannabis aids communication, lessens inhibitions, and causes laughter and gaiety, there is also much emphasis on its capacity to alter perception and enhance the enjoyment of music. LSD is much more an individual experience and there is a stress on new insights into the self and existence that are said to follow its use. We are told that both drugs provide the user with new perspectives of reality and new contexts in which to absorb experience. LSD is often spoken of almost as a sacrament. Its effects are said to be essentially indescribable and hence capable of being understood or fully appreciated only by those who have experienced the drug.

The introspection, the search for meaning within the self, the desire to explore what are said to be new frontiers of the mind seem to be related to a collapse of many traditional explanations of existence including religious expressions and syntheses of experience. In the past, when ideologies or religions lost their appropriateness, man has similarly turned inwards to find meaning and satisfaction within the self.

There also seems to be a relationship between drug use and the concern of the young for the future. Many appear to have lost faith not only in a traditional God but in the power and capacity of human reason. They fear that reason can not cope with the problems of nuclear arms, pollution, over-population, poverty and racial hostility. Their doubt of man's capacity to survive and their loss of faith in reason seem to have encouraged an emphasis on feeling and emotion and on life and pleasure in the here-and-now.

The general affluence of our society has also been a factor. This affluence has paradoxically become a source of boredom from which drugs provide an escape. It also permits the luxury of time for instrospection to a large number. There is also a rejection of the life style characteristic of the affluent society with its emphasis on striving for material gain and competitive success and its perceived willingness to place material gain above the psychological and spiritual needs of the individual. Drugs are said to have the capacity to help liberate the user from these moulds and structures.

Many have used the term alienation in trying to explain the sources of drug use to us. This is not an easy word to define. But as used in our hearings it has tended to refer to what some feel to be an estrangement from the institutions, processes and dominant values of the society, a sense of powerlessness to affect the future of the society or of themselves within it, and a lack of belief that a full and meaningful life is available for them in the society.

Some of the young seem fearful that they can not live up to the expectations that have been set for them or feel that to do so would demand too much sacrifice of their personalities.

The increased use of 'speed' has been interpreted as symptomatic of a widespread depression and sense of powerlessness.

We make no full attempt at this stage to present a statement of the causes of the spread of non-medical drug use. In Chapter Four, we point to some explanatory themes that we feel might help to illuminate the phenomenon.

E—SOCIAL RESPONSE

1. Research, Information and Education

415. The relative lack of adequate information concerning the nonmedical use of drugs.

There is general agreement that we lack sufficient reliable information to make sound social policy decisions and wise personal choices in relation to non-medical drug use. The Commission has heard repeatedly of the desire for more information. Not only citizens, but administrative officials, legislators, physicians and scientists have confessed to feeling that they have an inadequate basis for judgment on this subject.

416. The state of research.

Until recently, research on certain of the psychotropic drugs, such as cannabis, has been impeded or discouraged by several factors: the lack of clearly established medical uses for the drug, the lack of previous wide-spread non-medical use in the Western World, the illegal character of the drugs and the reluctance of government agencies to authorize such research. Although it has been possible for governments, under the terms of the United Nations Single Convention on Narcotic Drugs, to authorize the possession of cannabis for medical or scientific purposes, there is reason to believe that such steps as have been taken nationally, and internationally, have not substantially encouraged such research. Public policy on this point would appear to have been heavily influenced by the attitude of law enforcement authorities rather than by scientific advisors. With the increasing concern over the spread of cannabis use, the relative ineffectiveness of the criminal law as a deterrent, and the mounting demand for the 'legalization' of cannabis, there has been some change in the attitudes of government towards research with this drug. Both the Canadian and American governments have indicated their willingness to support such research. The Canadian government, through the Department of National Health and Welfare, has invited applications for research authorization. The American government has initiated a program of research through the National Institute of Mental Health.

We hope that the necessary care which governments must exercise in the approval of projects for research into the effects of cannabis and other psychotropic drugs upon humans will not place unnecessary difficulties in the path of such research and discourage those who are willing and able to undertake it.

There is a fundamental question concerning the responsibility of the scientist to provide information to society regarding the benefits and risks of the use of different drugs. Many scientists interested in such research have expressed feelings of dissatisfaction and frustration with governmental research policy. They have stated to the Commission that they have been unable to carry out such work under their own authority as scientists in the present atmosphere of restraint. They say that they have been frustrated by the administration of the formal and unwritten governmental policies which surround the right to undertake research in this field. An important public policy question to be answered is: "To whom should the scientific researcher be primarily accountable?" What are his responsibilities to government authorities, his peers in the scientific community and to society in general?

In the initial phase of our inquiry, reference has been made on several occasions to the impossibility of obtaining authorization for research in cannabis and other psychotropic drugs in Canada, and a certain scepticism has been expressed as to whether recently announced policy changes (for example, the Food and Drug Directorate's "Policy Statement On Use of Cannabis Preparations for Research Purposes") will really facilitate such research. The Commission invites scientists interested in research on psychotropic substances to comment on such protocols and regulations which may affect their research, their planning of new projects and the public communication of results.

417. The need for research.

The need for the research referred to above in the section on effects is very urgent. The public, including interested scientists, are justly dissatisfied and impatient with the present state of research. The public does not know whom to blame, but it will not lightly tolerate an indefinite reliance on inadequate knowledge to justify a social policy which is coming under increasingly severe criticism. Moreover, it is essential that we provide accurate information to the Canadian people on which to base their own exercise of personal choice. In our opinion, research into the effects, the extent, the causes, and the prevention and treatment of dangerous aspects of non-medical drug use should be pursued with all possible vigour in an environment of flexibility and freedom.

418. Some current research on cannabis. In Canada a number of surveys, including those of the Commission, are being conducted into the extent and patterns of use of cannabis and other psychotropic drugs. In addition, the Addiction Research Foundation is conducting a behavioural and physiological study of regular cannabis users and is planning an experimental study on the effects of cannabis on humans.

The United States National Institute of Mental Health (NIMH) has informed the Commission of various plans for research into the chemical, physiological, psychological and legal aspects of cannabis. The present emphasis in the United States is on the qualitative and quantitative chemical composition of cannabis and on effects in animals. There is little ongoing human research, although much is planned. Several projects are concerned with cannabis effects on some perceptual and cognitive functions and on driving skills.
Some additional information on current research projects is presented in Appendix E. The Commission intends to maintain close contact with, and critically evaluate, research in these areas and to report thereon.

419. Expectations of current and proposed cannabis research during the following year.

As a result of ongoing research in North America and abroad, it appears that by the spring of 1971 we may have a good deal more information on the chemistry, basic pharmacology and toxicology of cannabis in animals. A few human studies may be conducted which might provide new data on the short term effects of cannabis on driving skills, and on some elementary cognitive, perceptual and psychomotor functions. Furthermore, it is feasible that more definite information could be available by that time, on the potential of cannabis to produce tolerance and/or dependence with extremely heavy chronic use, although no such investigations are underway.
On the other hand, it may well be a decade or more before we have adequate information on a number of possibly important issues: longterm physiological effects of cannabis on respiratory function and on the central nervous system; the possibility of effects on chromosomes and developing offspring; long-term psychological effects of social and psychiatric importance; the frequency and characteristics of potential patterns of moderate and extreme cannabis use in North America.

420. The role of the Federal Government in relation to research.

We recommend that the Federal Government actively encourage research into the phenomenon of non-medical drug use, and in particular, research into the effects of psychotropic drugs and substances on humans. The Government should not only give its approval to such research, upon reasonable conditions, but should encourage, solicit and assist it with financial support in the form of research grants. We reserve our opinion, for the present, as to the extent to which the Federal Government should itself carry out such research. This raises the question, which we consider below, as to whether there should be a new federal agency for the collection and evaluation of data in the field of non-medical drug use. We also comment below on the field for cooperation and coordination in respect of research between the federal and the provincial governments.
It is recommended that the Federal Government make available to researchers, as soon as possible, standard preparations of cannabis and pure cannabinols. While cooperation with scientists and government authorities of other countries would clearly be advisable, it is recommended that Canada take the initiative to develop a separate and independent research program at this time. Under the present circumstances this calls for government-controlled cultivation, production and standardization of cannabis and cannabinols in Canada.
It is further recommended that experimental investigation into the effects of cannabis on humans, as well as animal and basic chemical research, be encouraged and financially supported by the Federal Government immediately. Although a certain amount of this work might be conducted by governmental personnel, it is recommended that independent scientists (in university laboratories, for example) be significantly involved in the overall research effort. Applications to the Federal Government for research authorization should be evaluated by independent scientists as well as civil servants, and the basis for governmental decisions made public.

421. The problem of collecting and exchanging data.

There is at present no national system for the collection and exchange of data on non-medical drug use. There is no coordinated approach to the problem of documentation. There is urgently needed some coordinating mechanism at the national level to collect data from all over the country. There is also a need for cooperation in the development of a uniform system of classification and indexing of information.

422. The need for an evaluation and authenticating process.

There is a need for a national system whereby information on non-medical drug use can be evaluated for scientific validity. There must be some source of disinterested and authoritative opinion to which those seeking information can turn for guidance to determine what can be relied upon for public policy and drug education. This system must be one which commands widespread confidence because of its independence from political pressures, its competence, and its reputation for objective evaluation. People are confused by the babble of voices on non-medical drug use and by the conflict of opinion among respectable authorities. Someone must be given the responsibility to sift out and clarify.

423. The need for timely information.

The proliferation of drugs and the rapid change in patterns of drug use make it difficult to provide timely information. Witnesses have impressed upon us the problems created by the new drug technology. The possible combinations of new drugs are infinite, and the speed with which they can be manufactured and brought to distribution is astonishing. We are told that the illicit facilities for drug manufacture dispose of technical skill equal to, and in some cases, exceeding that of legitimate manufacturers. Physicians can not be sure of what they are required to deal with in drug cases unless they have access to timely information on the kinds of drugs that are available and being consumed locally. We further believe that if we are serious about seeking to control and reduce the harm caused by non-medical drug use, such information should be made available to drug users and potential drug users. This is particularly important with respect to drug adulteration, about which many witnesses have testified. This raises a question about the desirability of local or regional drug analysis laboratories.

424. The need for decentralized analysis of drug samples.

It is clear that the facilities of the Food and Drug Directorate in Ottawa can not meet the requirements of the country for the analysis of drugs in non-medical use. It is hardly possible for the Directorate to meet the requirements of the R.C.M.P. for forensic chemical analysis. There has been some decentralization of Food and Drug Directorate and R.C.M.P. laboratory facilities, but the overall capacity remains inadequate, and it is not a timely or an appropriate source of information for those involved with treatment. Several witnesses before the Commission have proposed that the Federal Government support the establishment of local or regional drug analysis facilities for the purpose of providing timely information to all who may seek it.
It is feared by some that such facilities and information may encourage the use of drugs by advertising their availability and reducing dangers. It has been further suggested that distributors will take advantage of these facilities to have their products tested and, as it were, approved. Whatever force there may be in these arguments; they are outweighed, it would seem, by the necessity of a thorough and effective commitment to know as much as possible about what is happening in non-medical drug use and to make such knowledge available for the benefit of those who may be prudent enough to be guided by it. We have more to fear from willful ignorance than we do from knowledge in this field. In this risk-taking generation, young people are going to continue to experiment with drugs, regardless of what we do. It is better that they should see the whole sordid picture of fraud, adulteration and crass commercial exploitation. In its own pretensions to idealism, the drug culture tends to conceal from itself the extent to which it has become infected with many of the evils which it deplores in the established society. Sample analysis and wide dissemination of the results can only serve in the long run to deglamourize drugs and drug-taking.
We recommend that the Federal Government actively investigate the establishment of regional drug analytical laboratories at strategic points across the country. There is reason to believe, however, that the problems of staffing and financing, to assure an adequate service for quantitative as well as qualitative analysis, might have been underestimated by persons who have urged the establishment of such services. Such laboratories should not be connected with government or law enforcement, and should be free from day-to-day interference by public authorities. It is sufficient for the government to retain ultimate control through the necessity of its approval which may be withdrawn for cause. The Commission will also study the matter. The location, financing and staffing of such a psychotropic drug assay service could well be a matter of federal-provincial cooperation. In the meantime, we would recommend that, pending our final report, arrangements be made where possible through universities and other agencies for the provision of laboratory facilities to render such service.

425. Problems in the dissemination of drug information.

Not only is there a problem of timeliness of information in a rapidly changing scene, but there is also a problem of the credibility of the sources of information. Many witnesses have testified to this problem. We have no doubt that it may sometimes be exaggerated to justify the claim of a particular group or individual to some special role in drug information or education, but we believe that it is a real problem. There is evidence that young people lack confidence in certain sources of information. This is partly because they feel they have been misinformed and misled by certain kinds of approach to drug information and education. It is our impression that the development and evaluation of reliable data may be one thing and its effective dissemination another, and that these two functions may best be carried out by different agencies or individuals. There may be grounds for supporting the dissemination of drug information by local groups or individuals—for example, those involved in Innovative Services—who have high credibility with young people. There have to be strong, well-informed points of local contact with the drug scene if there is to be effective data collection and dissemination.

426. The role of the media.

In the initial phase of its inquiry the Commission has heard conflicting opinion on the role and performance of the media in relation to the phenomenon of non-medical drug use. Some have criticized the media for sensationalism and even for drawing undue attention to the subject. Others have commended the media for arousing public concern and helping to fill the information gap. There is no doubt that the media have an important role to play in reporting the news in as objective and balanced a manner as possible, and in providing a forum for the exchange of information and opinion. We recommend that the Federal Government keep the media as fully informed as possible of its own information about non-medical drug use.

427. Drug education.

The capacity of this society to learn to live wisely in a world in which chemicals and chemical change will increasingly be significant will depend, in very large measure, on the understanding our citizens have of both themselves and the effects, dangerous and beneficial, of an ever-growing list of chemical corn-pounds. In this context, the necessity for effective drug education is paramount.
In the Commission's view, the notion of drug education implies more than a mere random conveying of information; it implies selection, system, purpose and perspective. And in this definitional setting, we have discussed with many witnesses the general approach to drug education. From this dialogue, a number of requisites have emerged. For one thing, there has been a general insistence that any drug education programme must provide a full disclosure of all facts concerning the drugs, whether these be positive or unfavourable, There has also been a general agreement by those to whom we have spoken that the whole truth be told as far as is humanly possible. We have been advised, particularly by the young, that education about drugs will be ineffectual unless moralizing and patronizing attitudes are changed. The facts, we have been told, must be presented with a proper sense of proportion and perspective so that the overall impression conveyed is truthful and realistic. Witnesses have complained that the overall impression is sometimes a distorted or misleading one in which alleged dangers are either overdrawn or understated. We ourselves can testify to the difficulty of achieving the necessary balance. The attempt to state the facts will often reflect some reaction (and sometimes over-reaction) to what are felt to have been excesses or deficiencies in previous statements. It is probably impossible to exclude some bias, conscious or unconscious, from one's purpose in conveying drug information. Clearly, the universal conviction that we need drug education implies some assumption as to purpose and effect. We believe that the purpose must be to provide the basis for informed and wise personal choice. The ultimate effect that we would hope for is reasonable control and even overall reduction in the non-medical use of drugs. But in our opinion that effect is unlikely to be achieved by exhortation or propaganda, but rather by helping people to see where their real personal interest lies—in the long run. Drug education that is not based on a realistic view of human motivation is doomed to failure. We can no longer rely on the appeal to a sense of morality. In the long run the issue is: Does non-medical drug use enhance or impair one's capacity for effective and satisfying life? What counts with the individual is its effect on vitality, self-development and self-realization. The individual will remain the judge of this on the basis of his own experience and the information which is brought to his attention. Drug education should be merely an aspect of general education and should be directed to the same general objective: the kind of understanding that will permit an individual to live wisely, in harmony with himself and his environment.
Many of the young people who have appeared before us have been critical of the drug education to which they have been exposed. In particular, they have said that the attempts to use `scare tactics' have `backfired' and destroyed the credibility of sound information. On the other hand, there is reason to believe that many young people have been deterred from the use of LSD and the amphetamines by the presumptive evidence of their potential for harm. In other words, despite their spirit of risk-taking, they are responsive to serious evidence of the probability of harm. One of the most heartening aspects of the present drug situation is that despite the depression and lack of belief in the future that is reflected in some drug users, young people are concerned to preserve their own capacity to have healthy children and not to visit the consequences of their own risk-taking upon another generation. The conclusion we draw from the testimony we have heard is that it is a grave error to indulge in deliberate distortion or exaggeration concerning the alleged dangers of a particular drug, or to base a programme of drug education upon a strategy of fear. It is no use playing `chicken' with young people; in nine cases out of ten they will accept the challenge. What we have to ask is whether drug use is the Way to life; the way to the greater vitality, consciousness and sense of self-worth which they seek.
Opinion differs as to whether drug education should be a separate course taught by specialists or whether it should be taught more pervasively as part of the general health and physical education programme. There appear to be two considerations to reconcile here: the need for some special training to give the regular teacher a sufficient background and competence; and the desirability of having the subject taught as an aspect of general education. On balance, we believe that there will have to be some degree of specialization if drug education is to command the respect of young people. They themselves are already very knowledgeable, and the teacher must show at least a comparable degree of sophistication if he or she is to hold their interest.
It has been suggested that young people may themselves make effective teachers on the subject of non-medical drug use. It is felt that they are likely to have more credibility with their peers, particularly where they have had experience of drug use. We believe that serious consideration should be given to training young people for participation in drug education.

428. The need for a nationally coordinated system of information and education.

All of the above needs—research, evaluation, local data collection and dissemination and drug education—would appear to call for a coordinated system on a national scale. On the basis of the preliminary information the Commission has received regarding a number of existing drug education programmes, it is evident that no national or regional coordination exists, although provincial and municipal governments, as well as a number of non-governmental institutions have devised programmes to provide drug education. We are not yet able to perceive the precise outlines, much less the detail of the system which should be established, but we strongly recommend that the development of an appropriate system be given high priority as a matter of Federal-Provincial cooperation. We venture at this interim stage to suggest some of the considerations to which further study and discussion may be directed.
The Canadian Medical Association has recommended the formation of regional multi-disciplinary groups or `teams' to develop an adequate understanding of and community response to the phenomenon of non-medical drug use. These would be non-governmental groups composed of representatives of the various disciplines and services having a special contribution to make in this field. It is contemplated that the community could turn to such a group for reliable information, policy guidance and service of various kinds. There is much that is attractive in this recommendation—particularly the non-governmental, regional and multi-disciplinary character of the proposed groups—but it is not yet clear where the initiative will come from to establish them and how their representative character is to be assured. The danger is that such a group, having to be representative of all specialties and interests connected with drug use, may tend to be filled up by established professional figures and `leading citizens' and to have an inadequate representation of young people. In this way, it can quickly take on an `establishment' colour that can undermine its effectiveness. In the course of our public hearings we noted that one provincial 'task force', although a commendable initiative along the lines suggested by the Canadian Medical Association, was composed in this way with little or no independent representation of youth. This may well be the inevitable result of attempting to develop a sufficiently representative provincial or regional body. It will turn out to be representative of the various professions and institutions having some involvement in non-medical drug use, instead of a 'grass-roots' activity in which the people most directly affected can have a true sense of participation. We therefore approve the Canadian Medical Association recommendation with some reservation or caution, and we hope to have an opportunity in the ensuing year to observe how effective it can be. There is some ambiguity as to the precise role of these multidisciplinary teams. It is doubtful if regional groups can be as effective as a national body in the development of reliable data. Their effectiveness as a local source of information will depend upon the kind of credibility which they can establish with those most concerned. This credibility will also be affected by the role which they assume in the development of regional policy on non-medical drug use. Finally, it is unlikely that such a group can play any direct role in treatment or rehabilitation, although they may be able to perform a referral service if they command sufficient confidence with drug users.
The Canadian Medical Association brief contemplates a kind of federation of such regional bodies with federal coordination. The function of the regional bodies would be "to marshal information from all concerned disciplines and subsequently apply or direct the application of this information towards the problems of non-medical drug use". The federal body would "centralize information disbursal" and "act as a catalyst in the interaction between the provincial bodies."
The issue here is whether the Federal Government should assume some clear initiative and establish a national agency for data collection and dissemination or whether coordination at the federal level should be left to non-governmental initiative. In our opinion, the system contemplated by the Canadian Medical Association does not exclude an important role for Federal Government initiative. We believe that the need for an acceptable system of evaluation and authentication on which the entire country can rely calls for the establishment of a national agency to stimulate and coordinate research, and to collect, evaluate and disseminate the resulting data.
We have not yet come to precise conclusions as to the form this agency should take, nor what its relationship should be to the federal and provincial governments. We presently contemplate, however, that it would be established as a result of federal-provincial consultation, and that both levels of government would participate in the constitution of its membership, but that once established it would be independent of government and free from political interference. It would have to be a body of pre-eminent scientific authority.
We believe that the stimulation and coordination of research and the evaluation of data are best carried out by an independent agency that has no connections with the responsibility for law enforcement. It is our impression that the intimate association of the law enforcement and scientific functions in the past has prejudiced research and the credibility of scientific performance. The government preoccupation with policy, heavily influenced by law enforcement considerations, makes it desirable that the scientific function be given an independent status.
The federal role with respect to drug education presents more complex issues. It is assumed that the information collected and evaluated at the national level would constitute the material to be put into suitable educational form. The development of these educational materials would require close federal-provincial consultation and cooperation because of the provincial responsibility for education. It is probable that in addition to the national scientific agency there should be a Federal-Provincial institution for the development of drug education materials. The collection and evaluation of information is really a separate process from its utilization in an educational process, and the two are not necessarily compatible or capable of being carried out by the same agencies. There might be some overlapping of scientific personnel in these two bodies, but the development of effective educational devices and techniques calls for a variety of other professional skills that would not be involved in scientific research and evaluation. Education today is a major specialization calling for utilization of a variety of techniques of communication. The drug education agency would also be the forum for serious considerations of educational policy which are better separated from the process of scientific evaluation. For example, it has been suggested that we may require at least four kinds of drug education: education for children, education for users, education for non-users, and education for parents. Be that as it may, there are probably important distinctions to be drawn between education for pre-adolescents and education for others.
Many existing agencies, among them the National Film Board, have indicated an interest in developing effective drug education materials. There is no doubt that a federal-provincial drug education institution would be able to draw on a variety of technical resources in the country.
There is obviously a provincial role with respect to research, and this is presently reflected in the work of addiction research foundations. It is contemplated that a national scientific agency might carry out some research directly, but (in addition to its function of data collection and evaluation) would be chiefly concerned with the development of a coordinated national programme of research and the evaluation of research proposals for federal government financial support.

2. The Law

429. The Commission's Terms of Reference.

As indicated above, although the Commission's terms of reference do not refer expressly to law, they clearly invite a consideration of its role in relation to the phenomenon of non-medical drug use. The nature and application of the law in this field is one of the social factors presently related to drug use, and it is also an essential factor to be considered in determining what the Federal Government may do to reduce the problems involved in such use. It would be idle to seek recommendations for governmental action if a consideration of law were to be excluded.

430. International framework.

As indicated in Chapter Five, federal law in relation to non-medical drug use fulfils international obligations arising under the Single Convention on Narcotic Drugs, 1961. Canada is required by this Convention to make the manufacture, distribution, and possession of certain drugs for non-medical (or non-scientific) purposes a penal offence, although considerable cliscre- . tion is left as to the choice of appropriate penalties. The Convention can only be amended by agreement; if a country can not secure amendment it must abide by the Convention as it is or withdraw from it altogether by denouncing it.

431. Constitutional framework—The criminal law basis of Canadian legislation.

Canadian legislation in this field, consisting principally of the Narcotic Control Act and the Food and Drugs Act (more fully described in Chapter Five), rests constitutionally on federal legislative jurisdiction with respect to the criminal law. The prohibitions in these statutes are as much a part of the criminal law as the Criminal Code of Canada. The offences created under both stautes are criminal offences. There is no way in which a federal legislative prohibition, violation of which is punishable by fine or imprisonment, can be considered as other than criminal law.

432. Canadian legislative policy is to make certain drugs available for medical or scientific use, under strict controls, but to prohibit the distribution, and in some cases the possession, of some drugs for other purposes. A violation of any of the legislative prohibitions, whether applicable to drugs for medical or non-medical purposes, is a criminal offence. The regulatory aspects of quality control, licencing, inspection, information returns, and the like, merely establish the conditions on which certain conduct is permitted. Conduct which does not comply with these conditions is prohibited as a matter of criminal law. This, at any rate, is a rationale for treating Canadian food and drug legislation as resting on criminal law power rather than on jurisdiction over trade and commerce, which, being limited to interprovincial and international trade, is too restrictive for the control of transactions taking place wholly within a province.

433. Within the present international and constitutional framework, the legislative options—that is, the choice of general approaches to legal regulation of non-medical drug use—are not very wide. Unless it is possible, because of the national dimensions of the problem of non-medical drug use, to find a new constitutional basis for such regulation in the general power (or 'Peace, Order and Good Government' clause) it would appear that federal regulation must continue to rest on the criminal law power, as directed to the prevention of harm from dangerous substances.

434. The appropriateness of the criminal law in relation to nonmedical drug use.

In the initial phase of this inquiry, serious questions have been raised concerning the appropriate role, if any, of the criminal law in relation to conduct in the field of non-medical drug use. Some witnesses have asserted that the criminal law should not concern itself at all with the manufacture, distribution, possession or use of drugs for non-medical purposes, although witnesses taking this extreme position suggest that the state has a responsibility for seeing that its citizens are properly informed of the dangers of drugs produced and distributed under these conditions. Other witnesses take an intermediate position that the state has a responsibility to restrict the availability of harmful drugs and substances (and that at the federal level this necessarily involves criminal sanctions) but that the criminal law should not be applied to prevent an individual from doing alleged harm to himself. In other words, this view would concede the role of the criminal law in prohibiting the distribution of harmful drugs, but would deny it any application to simple possession for use. A third view that has been put before us is that the criminal law may be properly applied against possession for use but only on a clear showing of serious potential for harm to the individual concerned. In fact, this view is indistinguishable in principle from that which holds that the effective restriction of availability (justified on the ground of potential for harm) requires the prohibition of possession for use.

435. These contentions, and others to be referred to below concerning the present administration of the law, require us to consider the nature of the criminal law and its general appropriateness and effectiveness in relation to the phenomenon of non-medical drug use. A radical challenge has been laid down to the philosophic basis of the law in this area.

436. The John Stuart Mill thesis.

Those who contend that the criminal law has no application to the conduct involved in the manufacture, distribution and possession of drugs for non-medical use rest their case, for the most part, on the notion that the prohibited conduct is an example of crime without a victim. They contend that the criminal law should be reserved for conduct which clearly causes serious harm to third persons or to society generally and that it should not be used to prevent the individual from causing harm to himself. They often invoke John Stuart Mill's celebrated essay On Liberty as philosophical authority for their position. In it, Mill states as his central proposition:7
The object of this Essay is io assert one very simple principle, as entitled to govern absolutely the dealings of society with the individual in the way of compulsion and control, whether the means used be physical force in the form of legal penalties, or the moral coercion of public opinion. That principle is, that the sole end for which mankind are warranted, individually or collectively, in interfering with the liberty of action of any of their 'limber, is self-protection. That the only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others. His own good, either physical or moral, is not a sufficient warrant. He can not rightfully be compelled to do or forbear because it will be better for him to do so, because it will make him happier, because, in the opinions of others, to do so would be wise, or even right. These are good reasons for remonstrating with him, or reasoning with him, or persuading him, or entreating him, but not for compelling him, or visiting him with any evil in case he do otherwise. To justify that, the conduct from which it is desired to deter him, must be calculated to produce evil to some one else. The only part of the conduct of any one, for which he is amenable to society, is that which concerns others. In the part which merely concerns himself, his independence is, of right, absolute. Over himself, over his own body and mind, the individual is sovereign.
Mill goes on, in a passage which is not as often quoted, to make an exception to this doctrine where persons below the age of maturity are concerned:
It is, perhaps, hardly necessary to say that this doctrine is meant to apply only to human beings in the maturity of their faculties. We are not speaking of children, or of young persons below the age which the law may fix as that of manhood or womanhood. Those who are still in a state to require being taken care of by others, must be protected against their own actions as well as against external injury.
What he would justify in the way of coercion to prevent the young from causing injury to themselves is not clear. But it is clear that his doctrine necessarily assumes the capacity for truly free and responsible choice. This is an important qualification insofar as the problems presented by non-medical drug use are concerned.

437. Mill argues against restrictions on the availability of allegedly dangerous substances as an interference with the liberty of the individual who may seek to use them, but once again he makes an exception in favour of protection of the young. Pertinent passages on this point include the following:

On the other hand, there are questions relating to interference with trade, which are essentially questions on liberty; such as the Maine Law, already touched upon; the prohibition of the importation of opium into China; the restriction of the sale of poisons; all cases, in short, where the object of the interference is to make it impossible or difficult to obtain a particular commodity. These interferences are objectionable, not as infringements on the liberty of the producer or seller, but on that of the buyer ... when there is not a certainty, but only a danger of mischief, no one but the person himself can judge of the sufficiency of the motive which may prompt him to incur the risk: in this case, therefore (unless he is a child, or delirious, or in some state of excitement or absorption incompatible with the full use of the reflecting faculty) he ought, I conceive, to be only warned of the danger; not forcibly prevented from exposing himself to it.

438. Mill meets head on the argument that there is no such thing as harm to oneself that does not cause some harm to third persons or society in general.
The distinction here pointed out between the part of a person's life which concerns only himself, and that which concerns others, many persons will refuse to admit. How (it may be asked) can any part of the conduct of a member of society be a matter of indifference to the other members? No person is an entirely isolated being; it is impossible for a person to do anything seriously or permanently hurtful to himself, without mischief reaching at least to his near connections, and often far beyond them ...
I fully admit that the mischief which a person does to himself may seriously affect, both through their sympathies and their interests, those nearly connected with him, and in a minor degree, society at large. When, by conduct of this sort, a person is led to violate a distinct and assignable obligation to any other person or persons, the case is taken out of the self-regarding class and becomes amenable to moral disapprobation in the proper sense of the term ... Whoever fails in the consideration generally due to the interests and feelings of others, not being compelled by some more imperative duty, or justified by allowable self-preference, is a subject of moral disapprobation for that failure, but not for the cause of it, nor for the errors, merely personal to himself, which may have remotely led to it. In like manner, when a person disables himself, by conduct purely self-regarding, from the performance of some definite duty incumbent on him to the public, he is guilty of a social offence. No person ought to be punished simply for being drunk; but a soldier or a policemen should be punished for being drunk on duty. Whenever, in short, there is a definite damage, or a definite risk of damage, either to an individual or to the public, the case is taken out of the province of liberty and placed in that of morality or law.
But with regard to the merely contingent, or, as it may be called, constructive injury which a person causes to society, by conduct which neither violates any specific duty to the public, nor occasions perceptible hurt to any assignable individual except himself; the inconvenience is one which society can afford to bear, for the sake of the greater good of human freedom. If grown persons are to be punished for not taking proper care of themselves, I would rather it were for their own sake, than under pretense of preventing them from impairing their capacity of rendering to society benefits which society does not pretend it has a right to exact. But I can not consent to argue the point as if society had no means of bringing its weaker members up to its ordinary standard of rational conduct, except waiting till they do something irrational and then punishing them, legally or morally, for it. Society has had absolute power over them during all the early portion of their existence; it has had the whole period of childhood and nonage in which to try whether it could make them capable of rational conduct in life.

439. The Hart-Devlin controversy.

The principles affirmed by Mill have been a point of reference for divergent legal philosophies concerning the conduct which is appropriate for criminal law sanction. The issue is often referred to as one of law and morals'. The two leading exponents of the contending points of view in modern times have been the English legal philosopher, H.L.A. Hart and the English judge, Lord Devlin. Hart has expressed various ways in which the issue has been put as follows:
Is the fact that certain conduct is by common standards immoral, sufficient to justify making that conduct punishable by law? Is it morally permissible to enforce morality as such? Ought immorality as such to be a crime?
Hart's answer is no, as is Mill's, but he adds that "I do not propose to defend all that Mill said; for I myself think there may be grounds justifying the legal coercion of the individual other than the prevention of harm to others." (Law, Liberty and Morality")
Devlin's answer is yes, on the general ground that "Society is entitled by means of its laws to protect itself from dangers, whether from within or without." (The Enforcement of Morals')

440. As Hart himself points out, however, the expression of the issue as one of law and morals is not strictly appropriate to the drug crimes, in which the concern is the protection of the individual from physical and psychological harm, albeit harm to which he may voluntarily expose himself. It is not the suppression of conduct simply on the ground that it fails to conform to an established code of morality, although moral judgment on the deviant character of the conduct is no doubt involved to some extent. Hart refers to this protection of the individual against himself as 'paternalism'. He says:
"tut paternalism—the protection of people against themselves—is a perfectly coherent policy. Indeed, it seems very strange in mid-twentieth century to insist upon this, for the wane of laissez faire since Mill's day is one of the commonplaces of social history, and instances of paternalism now abound in our law—criminal and civil. The supply of drugs or narcotics, even to adults, except under medical prescription is punishable by the criminal law, and it would seem very dogmatic to say of the law creating this offence that 'there is only one explanation', namely, "that the law was concerned not with the protection of the would-be purchasers against themselves, but only with the punishment of the seller for his immorality." If, as seems obvious, paternalism is a possible explanation of such laws, it is also possible in the case of the rule excluding the consent of the victim as a defence to a charge of assault.

441. Hart finds Mill's argument against restriction of the availability of harmful substances extreme, and inapplicable now in the light of the far-reaching paternalism of the modern state. On this point he says:

Certainly a modification in Mill's principles is required, if they are to accommodate the rule of criminal law under discussion or other instances of paternalism. But the modified principles would not abandon the objection to the use of the criminal law merely to enforce positive morality. They would only have to provide that harming others is something we may still seek to prevent by use of the criminal law, even when the victims consent to or assist in the acts which are harmful to them.

442. The right of the state to restrict the availability of harmful substances. Thus it is important to keep in mind, and particularly in view of the exception which Mill makes to his own doctrine in favour of protection of the young, the distinction which Hart makes between paternalism and 'legal moralism'. In our opinion, the state has a responsibility to restrict the availability of harmful substances—and in particular to prevent the exposure of the young to them—and that such restriction is a proper object of the criminal law. We cannot agree with Mill's thesis that the extent of the state's responsibility and permissible interference is to attempt to assure that people are warned of the dangers. At least, this is our present position, particularly in the light of such recent experience as the thalidomide tragedies. Obviously the state must be selective. It can not attempt to restrict the availability of any and all substances which may have a potential for harm. In many cases it must be satisfied with assuring adequate information. We simply say that, in principle, the state can not be denied the right to use the criminal law to restrict availability where, in its opinion, the potential for harm appears to call for such a policy.

443. The right of society to protect itself from certain kinds of harm. Without entering into the distinction between law and morality, we also subscribe to the general proposition that society has a right to use the criminal law to protect itself from harm which truly threatens its existence as a politically, socially and economically viable order for sustaining a creative and democratic process of human development and self-realization.

444. The criminal law should not be used for the enforcement of morality without regard to potential for harm. In this sense we subscribe to what Hart refers to as the 'moderate thesis' of Lord Devlin. We do not subscribe to the 'extreme thesis' that it is appropriate to use the criminal law to enforce morality, regardless of the potential for harm to the individual or society.
If we admit the right of society to use the criminal law to restrict the availability of harmful substances in order to protect individuals (particularly young people) and society from resultant harm, it does not necessarily follow that the criminal law should be applied against the user as well as the distributor of such substances. There is no principle of consistency that requires the criminal law to be used as fully as possible, or not at all, in a field in which it may have some degree of appropriateness. We do not exclude in principle the application of the criminal law against the user since it is a measure which can have an effect upon availability and the exposure of others to the opportunity for use, but the appropriateness or utility of such an application must be evaluated in the light of the relative costs and benefits.

445. As indicated in Chapter Five, the law enforcement authorities and the courts have tended to see the offence of simple possession as related to the effective suppression of trafficking. The officers of the RCMP have testified that law enforcement against trafficking is more difficult without a prohibition against simple possession.
The judicial approach is reflected in the reasoning of the British Columbia Court of Appeal in the Budd and the Hartley and McCallum cases, in which the Court saw the suppression of use as the most effective means of suppressing trafficking. "If the use of this drug is not stopped," the Court said, "it is going to be followed by an organized marketing system."

446. During the initial phase of the inquiry we have received recommendations for changes in the law respecting the offence of simple possession. Some have proposed the repeal of the present prohibition against the simple possession of marijuana. Others have suggested that the simple possession of the amphetamines without a prescription should be made a criminal offence. These proposals and the experience so far with law enforcement in the field of non-medical drug use oblige us at this time to consider the merits of the offence of simple possession.

447. The present state of our empirical studies of law enforcement in the field of non-medical drug use does not permit us to express a considered opinion of the operational relationship between the offence of simple possession and the offence of trafficking. We are unable to estimate the relative effect on enforcement against trafficking of the absence of an offence of simple possession. We are unable, for example, to draw comparisons, in this respect, between the enforcement against trafficking in narcotics, cannabis, and restricted drugs, and enforcement against trafficking in controlled drugs, for which there is not an offence of simple possession. We do not know if meaningful comparisons of this kind can ever be drawn, in view of the many other factors in each case which may influence the patterns of trafficking and their detection. At the present time we are not convinced of the necessary relationship between the offence of simple possession and trafficking, or of the necessity of such an offence for effective law enforcement against trafficking. We do feel, however, that further study and consideration must be given to the contention of the law enforcement authorities on this point, and for this reason we are not prepared AT THIS TIME to recommend the total elimination of the offence of simple possession in respect of non-medical drug use.

448. At the same time we have very serious reservations concerning the offence of simple possession for use which prompt us, as an interim measure, to recommend a change in the law respecting it. Our reservations apply to the offence of simple possession generally in the field of non-medical drug use and not to any one or more of the psychotropic drugs, in particular. In effect, while we feel the offence of simple possession should be retained on the statute book, pending further investigation and analysis, which we hope to carry out in the ensuing year, its impact on the individual should be reduced as much as possible.

449. Our basic reservation at this time concerning the prohibition against simple possession for use is that its enforcement would appear to cost far too much, in individual and social terms, for any utility which it may be shown to have. We feel that the probability of this is such that there is justification at this time to reduce the impact of the offence of simple possession as much as possible, pending further study and consideration as to whether it should be retained at all. The present cost of its enforcement, and the individual and social harm caused by it, are in our opinion, one of the major problems involved in the non-medical use of drugs.

450. Insofar as cannabis, and possibly the stronger hallucinogens like LSD, are concerned, the present law against simple possession would appear to be unenforceable, except in a very selective and discriminatory kind of way. This results necessarily from the extent of use and the kinds of individual involved. It is obvious that the police can not make a serious attempt at full enforcement of the law against simple possession. We intend during the ensuing year to attempt to determine the relative cost in actual dollars and allocation of time of the enforcement of the drug laiws, but it is our initial impression from our observations so far that it is out of all proportion to the relative effectiveness of the law. Although accurate statistics are not available to us at this time of either the extent of cannabis use or the number of cases of simple possession of cannabis cleared by the law enforcement authorities during the past year, conservative estimates of both suggest that the total number of cannabis users brought to court may be under one per cent.
The law which appears to stand on the statute book as a mere convenience to be applied from time to time, on a very selective and discriminatory basis, to 'make an example' of someone, is bound to create a strong sense of injustice and a corresponding disrespect for law and law enforcement. It is also bound to have an adverse effect upon the morale of law enforcement authorities.

451. Moreover, it is doubtful if its deterrent effect justifies the injury inflicted upon the individuals who have the misfortune to be prosecuted under it. It is, of course, impossible to determine the extent to which the law against simple possession has deterrent effect, but certainly the increase in use, as well as the statements of users, would suggest that it has relatively little. The relative risk of detection and prosecution may be presumed to have a bearing upon deterrent effect.

452. The harm caused by a conviction for simple possession appears to be out of all proportion to any good it is likely to achieve in relation to the phenomenon of non-medical drug use. Because of the nature of the phenomenon involved, it is bound to impinge more heavily on the young than on other segments of the population. Moreover, it is bound to blight the life of some of the most promising of the country's youth. Once again there is the accumulating social cost of a profound sense of injustice, not only at being the unlucky one whom the authorities have decided to prosecute, but at having to pay such an enormous price for conduct which does not seem to concern anyone but oneself. This sense of injustice is aggravated by the disparity in sentences made possible by the large discretion presently left to the courts.

453. Finally, the extreme methods which appear to be necessary in the enforcement of a prohibition against simple possession—informers, entrapment, Writs of Assistance, and occasionally force to recover the prohibited substance—add considerably to the burden of justifying the necessity or even the utility of such a provision.

454. Despite these reservations, the Commission is not prepared to recommend the total repeal of the prohibition against simple possession without an opportunity to give further study and consideration to:
(a) The possible effect of permitted use on the nature and development of trafficking; and
(b) The possible effect of the lack of an offence of simple possession on the effectiveness of law enforcement against trafficking.

455. At the same time the Commission is of the opinion that no one should be liable to imprisonment for simple possession of a psychotropic drug for non-medical purposes. Moreover, it believes that the discretion as to whether to proceed by way of indictment or summary conviction should be removed. Accordingly, the Commission recommends as an interim measure, pending its final report, that the Narcotic Control Act and the Food and Drugs Act be amended to make the offence of simple possession under these acts punishable upon summary conviction by a fine not exceeding a reasonable amount. The Commission suggests a maximum fine of $100. Such a change would in fact reflect, and bring the law into closer conformity with recent sentencing practices, at least for first offenders, in cases of simple possession of cannabis or LSD.
Furthermore, this change would be within the scope of Article 36 of the Single Convention on Narcotic Drugs, 1961, which only requires "imprisonment or other penalties of deprivation of liberty" (see Chapter Five, Paragraph 366) for 'serious offences'.
The Commission also recommends that the power conferred by section 694(2) of the Criminal Code to impose imprisonment in default of payment of a fine should not be exercisable in respect of offences of simple possession of psychotropic drugs. In such cases, the Crown should rely on civil proceedings to recover payment.

456. The Commission would further recommend that the police, prosecutors and courts exercise the discretion entrusted to them at various stages of the criminal law process so as to minimize the impact of the criminal law upon the simple possessor of psychotropic drugs, pending decision as to the whole future of possessional offences in this field.

457. During the initial phase of its inquiry the Commission has received representations from several witnesses, including some who have differed strongly on the proper legal treatment of cannabis, that the simple possession of the 'controlled' drugs in Schedule G of the Food and Drugs Act—particularly, the amphetamines and methamphetamines—be made a criminal offence. The Commission is not disposed to make this recommendation at the present time. Apart from its general reservations concerning the offence of simple possession, it sees particular problems with respect to such an offence in the case of the controlled drugs.
Unless we are prepared to prohibit some or all of the controlled drugs altogether, whether under prescription or not, as some countries have done, we see serious difficulties (perhaps even greater than those which have arisen with cannabis) in attempting to enforce a criminal law prohibition against simple possession for non-medical use. In the first place, it would not be practicable to impose or attempt to enforce such a prohibition for possession of drugs obtained under prescription, even though the use might no longer be justified on generally accepted medical grounds. The same would apply to members of the same family or to friends to whom such drugs might be given for non-medical use. In other words, the extent to which these drugs can presently he obtained and used under prescription by the adult world—and indeed are used, if we are to draw the logical inferences from production figures—is such that the enforcement of a prohibition against simple possession for the non-medical use of such drugs would inevitably involve even greater discrimination and sense of injustice than that which is bringing the law with respect to cannabis into disrepute. Since such a prohibition might be expected to be directed and enforced mainly against what the police considered to be excessive use by young people it would be a further cause of youthful alienation and resentment of the older generation. This would only be reinforced by increasing use of amphetamines and barbiturates by adults.
Further, in view of the paranoia associated with the excessive use of amphetamines and methamphetamines (the level of use which characterizes the 'speed freak'), we do not think it would be socially helpful or desirable to attempt to apply the criminal law and the enforcement methods which seem to be necessary to the simple possession of these drugs for non-medical use. We believe that such a course could lead to a substantial increase in violence and other undesirable social effects. We place much more hope and confidence in education and cultural controls as a means of reducing the use of 'speed'. There is reason to believe that such controls may be beginning to operate effectively through the influence of peer group opinion and the judgment Of leading opinion formers in the drug culture.

458. We fully share the general concern which has been expressed to us concerning the extent and effects of amphetamine and methamphetamine use, but we do not feel that we have a sufficient understanding of the phenomenon at this time to make long-term recommendations with respect to it. In the first place, we do not have a reliable impression of its extent, although there are reasonable grounds for believing that it has in recent years been steadily increasing. But is it still increasing, or is it levelling off, or is it declining? We do not know. Is 'speed' likely to be a temporary phenomenon which will burn itself out in a relatively few years, as a result of the problems which it creates and the general contempt in which it is held by large sections of the youthful drug culture? Who can say? We do not at this time have any real sense of conviction about the probable future pattern and extent of amphetamine use in Canada. Other countries, such as post-war Japan, have experienced amphetamine epidemics. Because of very extensive use, and particularly use by adults, Sweden has seen fit to proscribe their use altogether. We have not yet been able to judge how successful they have been and what the social effects of such repression are, although we understand from preliminary impressions that there is now an extensive illicit traffic in such drugs from neighbouring countries such as Germany and the Netherlands, and that the unlawful possession of amphetamines has become a middle-class status symbol with conspiratorial overtones, which history has shown to be the inevitable consequence of the prohibition of a substance which a large proportion of the population desires.
It would not appear that the excessive use of amphetamines by young people has assumed the same relative importance in Scandinavia as it has here. The emphasis is rather on excessive adult use. Are we moving in Canada into a similar pattern of excessive adult use? It has been suggested to us that this may be the case, but we do not feel confident about expressing an opinion on this possibility at the present time. We would want to give further consideration to the conditions which have produced this phenomenon in other countries during the post-war period, and to compare them with present conditions in this country. It is our impression at this time that the government would not be warranted in following the example of other countries in a total prohibition of amphetamines or barbiturates without clear evidence that such a step is warranted by the extent and levels of use. We doubt very much if such a step would ever be justified in Canada. At the present time, we advocate closer controls on the availability of these drugs, including controls on production, importation and prescription.

459. Strong representations have been made to the Commission during the initial phase of its inquiry for radical changes in the law respecting cannabis. In particular, many witnesses have urged the `legalization' of marijuana—that is, that this drug be made legally available through government-licensed or operated channels of production and distribution. Several witnesses have urged that if the Commission is not prepared to recommend such legalization at the present time, it should at least recommend a 'moratorium' or suspension of all marijuana prosecutions pending publication of its final report. The Commission has also frequently heard the proposal that cannabis should be removed from the Narcotic Control Act and placed under the Food and Drugs Act.

460. Several arguments are advanced for the legalization of marijuana. They may be summarized as follows:
1. The use of marijuana is increasing in popularity among all age groups of the population, and particularly among the young;
2. This increase indicates that the attempt to suppress, or even to control its use, is failing and will continue to fail—that people are not deterred by the criminal law prohibition against its use;
3. The present legislative policy has not been justified by clear and unequivocal evidence of short term or long term harm caused by cannabis;
4. The individual and social harm (including the destruction of young lives and growing disrespect for law) caused by the present use of the criminal law to attempt to suppress cannabis far outweighs any potential for harm which cannabis could conceivably possess, having regard to the long history of its use and the present lack of evidence;
5. The illicit status of cannabis invites exploitation by criminal elements, and other abuses such as adulteration; it also brings cannabis users into contact with such criminal elements and with other drugs, such as heroin, which they might not otherwise be induced to consider.
For all of these reasons, it is said, cannabis should be made available under government-controlled conditions of quality and availability.

461. It should be observed that many of the witnesses who have advocated the legalization of cannabis have also advocated an age limit under which it should not be available, similar to the prohibition against the sale of alcohol to minors. Eighteen and over has been an age limit frequently suggested. Thus, even among those who advocate the legalization of cannabis, there are those who have reservations about its use among young people, and the implications of criminal law proscription of it, insofar as they are concerned, are among the chief problems involved in such use today. A 'legalization' of cannabis which continued to prohibit its sale to persons under 18 years of age would be one which favoured adults rather than young people, and although it would undoubtedly have the indirect effect of making cannabis more easily available to young people, it would leave the issue of the use of cannabis by the young essentially unresolved. We think it is significant that a number of those who advocate the legalization of cannabis are sufficiently concerned about its potential for harm to young people to advocate an age limit for its availability. This obviously deepens as one seeks to ascertain what is considered to be the appropriate age limit—is it 18, 17, 16, 15, 14, 13, 12, 11, 10, 9, 8, 7? We do not mean to suggest that such concern necessarily justifies the maintenance of the present legal status of cannabis, but merely that it throws additional perspective on the debate concerning its potential for harm.

462. This is, of course, the essential question with respect to cannabis at this time. It is idle to pretend that cannabis was brought under its present criminal law proscription on the basis of clear and unequivocal scientific evidence of its potential for harm. Although the precise historical reasons for the decision to suppress its use are somewhat obscure, there is no evidence that scientific judgment played a leading role. There did, however, develop an international climate of official opinion, strongly opposed to its use. This opinion was based in part on the experience of certain countries, but it was also strongly influenced by American insistence. Thus it is fair to say that Canadian policy found increasing support in the opinion of the international community. The spread of the use of cannabis, particularly among the young, and the effects of the criminal law attempt to suppress it now call for a fresh look at the justification of the law, and in particular, at the alleged personal and social harm caused by such use.

463. The issue now is whether Canadian policy is to turn on potential for harm, or whether it is to turn on the extent of use and the apparent incapacity of the law to prevent the spread of such use. It is a difficult judgment to make. The law has had to throw up its hands in the past, as in the case of the failure to enforce the prohibition against alcohol. It is not clear, however, that we are yet at this point with cannabis. The debate and the perception of the issues have turned on a difference of opinion as to the potential for harm. At this point, it is not possible to give assurance concerning potential for harm. We refer to the section on cannabis in Chapter Two and to the section on effects in this chapter as indicating the lack of essential knowledge on pertinent issues.
The question is: How long can society wait for the necessary information? It is very serious that the scientific information concerning cannabis lags so far behind the rapidly developing social problem caused by its illegal status. It is useless to apportion blame. We have referred above to the necessity of research and a fundamental change in the attitude of government towards research. Given a sufficiently comprehensive and aggressive program of research, when are we likely to know enough, one way or the other, to justify a decision on legalization on the basis of potential for harm? It may be that we shall not be able to learn enough in time, at least with respect to potential for long-term harm, before we are obliged to take a decision on another basis—that is, on the basis of calculated risk, or the lesser of
evils.
At this time, we do not feel that Canadian perceptions of this problem or our knowledge warrants a recommendation by us on the basis of calculated risk or the lesser of evils.

464. For the following reasons we are not prepared at this time to recommend the legalization of cannabis:
1. First, it is our impression that there has not yet been enough informed public debate. Certainly there has been much debate, but too often it has been based on hearsay, myth and ill-informed opinion about the effects of the drug. We hope that this report will assist in providing a basis for informed debate not only as to the effects, but as to other issues, including the extent to which science is capable of providing a basis for public policy decision on this question.
2. There is a body of further scientific information, important for legislation, that can be gathered by short-term research—for example, the effects of the drug at various dose levels on psychomotor skills, such as those used in driving.
3. Further consideration should be given to what may be necessarily implied by legalization. Would a decision by the government to assume responsibility for the quality control and distribution of cannabis imply, or be taken to imply, approval of its use and an assurance as to the absence of significant potential for harm?
4. A decision on the merits of legalization can not be taken without further consideration of jurisdictional and technical questions involved in the control of quality and availability.

465. The proposal for legalization raises important issues of international and constitutional law, although these have not determined our judgment on the merits of legalization at this time.
If Canada were to decide to legalize cannabis or any of its derivatives, it could not do so without violating its international obligations under the Single Convention on Narcotic Drugs, 1961, unless it obtained international agreement to an amendment to the Convention or withdrew from the Convention by giving the notice described as `denunciation'. It will be recalled from Chapter Five that the Convention presently requires the parties to prohibit, with penal consequences, the production, distribution and possession of cannabis for other than medical and scientific purposes. Denunciation by the required notice of six clear months, to take effect on any January 1st, would not, of course, be in violation of international obligations since it is a right expressly provided for in the Convention. It would however, take Canada out of the framework of international agreement with respect to narcotic drugs. We do not speculate on the effect which the legalization of cannabis might have on Canada's international relations through its effect on the enforcement policies of other countries, such as the United States.
Insofar as constitutional law is concerned, the proposal to legalize cannabis raises a question as to the kind of control of availability and quality which would be constitutionally possible for the Federal Government. The proposals for legalization have generally contemplated a government monopoly of production and distribution. We have not considered the necessity or merits of this degree of government intervention because of our judgment on the general issue of legalization at this time, but justifiable public concern about commercial exploitation of psychotropic drugs could well make such a degree of control necessary if a decision were taken to make any particular cannabis preparation or preparations legally available. Such an intervention would appear to involve a regulation of trade and commerce in the provinces that would have difficulty finding constitutional support within the present range of federal power, as judicially interpreted, particularly if legalization were decided on the basis of a judgment as to relative absence of potential for harm. Although we do not exclude the possibility of finding a constitutional basis for an effective control of availability and quality in the general power (Peace, Order and Good Government' clause) of the federal parliament, in view of the national importance which a controlled use of cannabis would be deemed to have assumed if legalization were considered necessary, the difficulties at first impression are such that we would presume any such decision would be preceded by federal-provincial consultation. There would appear to be good political reasons for this procedure as well. In effect, legalization would appear to involve the abandonment of the present criminal law basis of federal regulation and the necessity of finding another constitutional basis for it. It is doubtful if there is a sufficient basis at this time for a federal system of regulation similar to the provincial regulation of alcohol. We would, therefore, assume that any such scheme would require provincial action.

466. The proposal that there be a 'moratorium' or suspension on prosecutions in respect of cannabis offences pending publication of the final report is indistinguishable, as a practical matter, from a decision to legalize. It would amount to de facto legalization without government assumption of responsibility for control of availability and quality. It would be virtually impossible to reverse should it be decided later to be ill-advised in any particular. At best it would create an intolerable uncertainty as to the ultimate application of the criminal law. We do not believe that a 'moratorium' is a practical measure. At the same time, we have recommended (see paragraph 456) that discretion be exercised by police, prosecutors and judges in such manner as to minimize the impact of the criminal law in respect of the offence of simple possession of cannabis.

467. Since cannabis is clearly not a narcotic (see paragraph 147) we recommend that the control of cannabis be removed from the Narcotic Control Act and placed under the Food and Drugs Act. Since it is generally considered to be a mild hallucinogenic or intoxicant, it would not be inappropriate to classify it with the restricted drugs in Schedule J of Part IV of the Food and Drugs Act, although it could be given a separate classification of its own. This change can be made by the Government without the necessity of legislation in virtue of Section 14 of the Narcotic Control Act which provides that "The Governor-in-Council may, from time to time, amend the Schedule by adding thereto or deleting therefrom any substance, the inclusion or exclusion of which, as the case may be, is deemed necessary by him in the public interest" and the provision to the same effect which is applicable to Part IV of the Food and Drugs Act. Changes in the penalties governing drug offences will of course require legislation.

468. Considerable concern has been expressed during the initial phase of our inquiry over the severity of the penality and some of the sentences for trafficking in cannabis, particularly for the marginal trafficking of a relatively petty nature which takes place between users. We share this concern. Under the Narcotic Control Act trafficking is defined very broadly not only to include giving but also offering to give, and a person convicted of trafficking or possession for the purpose of trafficking in cannabis is liable to life imprisonment. A person convicted of importing or exporting cannabis is liable to imprisonment for a minimum of seven years and for as much as fifes These penalties are obviously grossly excessive, in view of what we now know of the likelihood of harm and the patterns of use and distribution of cannabis. They would no longer apply if cannabis was brought under the control of Part IV of the Food and Drugs Act. Certainly, there is no reason why the penalties for trafficking in cannabis should exceed those for trafficking in LSD. The question is whether they should be as severe. Part IV of the Act provides that trafficking or possession for the purposes of trafficking in a restricted drug is punishable upon summary conviction by imprisonment for eighteen months or upon conviction on indictment, by imprisonment for ten years. We wonder if the penalty for trafficking in the restricted drugs should not be confined to that which is provided upon summary conviction. In any event, we would recommend that this be the case with trafficking or possession for the purpose of trafficking in cannabis.
We further recommend that the definition of trafficking be amended so as to exclude the giving, without exchange of value, by one user to another of a quantity of cannabis which could reasonably be consumed on a single occasion. Such an act should be subject at most to the penalty for simple possession.

469. Many of the criticisms of the criminal law in respect of the offence of simple possession for use (see paragraph 453 above) may appear to apply equally to the other drug offences—in particular, trafficking and possession for the purpose of trafficking. We refer to methods of enforcement which are considered necessary as a result of the fact that there is seldom, if ever, a third party complainant. During the initial phase of our inquiry, we have heard bitter complaints and criticisms of the use of entrapment and physical violence to obtain evidence. We have not verified the particular circumstances of these complaints and criticisms, so that we make no charge of any kind at this time but we deplore the use of such methods to the extent they may be resorted to on occasion. We believe that such methods are not only a serious violation of respect for the human person, but they are counter-productive in that they create contempt for law and law enforcement. The price that is paid for them is far too great for any good that they may do.
We recommend that instructions be given to police officers to abstain from such methods of enforcement, and that the RCMP use its influence with other police forces involved in the enforcement of the drug laws to try to assure that there is a uniform policy in this regard. Because of its primary identification with enforcement of these laws, the Force may sometimes be unfairly associated with such methods when it has not, in fact, been guilty of them.

470. We have also heard criticisms of the Writ of Assistance under which the police are empowered at any time to enter and search a dwelling (using force to effect such entry) and of the employment of undercover agents and informants. Since these methods are apparently necessary because of the extreme difficulty of detecting and securing evidence of drug violations, we make no comment on them at this time other than to observe that they reflect a part of the special price which society must pay for enforcement of the drug laws. As we have indicated, the price may be altogether too high in the case of the offence of simple possession. We reluctantly concede its continuing necessity so long as there must be a serious effort to control trafficking.

471. The same observations apply to another aspect of the drug laws which has attracted critical comment during the initial phase of our inquiry—namely the extent to which the traditional burden of proof is shifted to the accused. The primary burden to prove the fact of possession in a charge of simple possession is on the Crown, but the burden is on the accused to prove any exception, exemption, excuse or qualification prescribed by law which operates in his favour—for example, that such possession is authorized by the Act or
regulations.
In the case of the offence of possession for the purpose of trafficking, once the Court has found, in what amounts to the first trial, that the accused was in possession within the meaning of the Act, the burden is on the accused to show that such possession was not for the purpose of trafficking. The Crown may establish the inference of intent to traffic from such circumstantial evidence as the quantity of drugs found in the possession of the accused, implements or devices suggesting distribution, and contacts of the accused with others, and the burden on the accused is a difficult one to discharge.
In fact, however, proof of possession does not by itself establish intent to traffic, so that there must be some evidence of intent to justify a conviction. What the burden on the accused does, in most cases, is to compel him to testify, which is contrary to the general principles of criminal justice. Is this departure from our general standards of protection of the accused really justified by the evil to which the law is directed and the special difficulties of enforcement? The parliament of Canada has said that it is. We find it difficult to believe that this is so.

472. Great concern has been expressed during the initial phase of our inquiry concerning the serious effects of a criminal conviction and record upon the lives of drug users, particularly the young. These effects are cited, in the case of cannabis, as indicating that the harm caused by the law exceeds the harm which it is supposed to prevent. A criminal record may mar a young life, forever being an impediment to professional or other vocational opportunity and interfering with free movement and the full enjoyment of public rights. We believe this reasoning applies to all criminal convictions, and we do not believe that there should be a special rule in favour of drug offenders. For this reason, we recommend the enactment of general legislation to provide for the destruction of all records of a criminal conviction after a reasonable period of time.
In addition to legislation which is actually pending, we would urge the adoption of the recommendation of the Canadian Committee on Corrections with respect to records of summary convictions which is as follows:'"
(a) That criminal records resulting from summary conviction be annulled automatically after a crime-free period of two years from the end of the sentence;
(b) That 'end of a sentence' be taken to mean, in the case of a fine or other punishment not involving probation or prison, from the date of conviction; in the case of probation, from the end of the probation period; in the case of prison, from the end of the prison sentence; in the case of parole, from the end of the parole period;
(c) That an annulled record of summary conviction not be activated in the event of any later conviction, which would be dealt with as a first offence.
The above recommendation deals with the removal of a criminal record after some reasonable period of time, but we believe the courts should have discretion to avoid a conviction in certain cases where an offence has been established. For this reason we recommend the adoption, at least for first offenders in cases of simple possession of psychotropic drugs, of the recommendation of the committee in favour of absolute discharge, which reads as follows:
The Committee recommends that where a person, not having previously been given an absolute discharge, is charged, the trial court or the court that hears the appeal, although finding that the charge has been proved, after considering the evidence and having regard to the circumstances including the nature of the charge and the character of the accused may, without conviction, make an order of absolute discharge with or without conditions; that when a person named in an order of absolute discharge with conditions has violated any of the conditions therein, the court may convict the person and, on the basis of evidence heard at the original trial, make whatever disposition it could have made when the matter was originally heard; that either the offender or probation officer be empowered to request and have heard an application to reconsider and/or vary the conditions of the order; that an order of absolute discharge with conditions be in effect for a period of up to one year.

3. Treatment and Supportive Services

The Commission has not yet been able to examine in detail the various complex aspects of the treatment response to non-medical use of drugs. For this interim report, therefore, the Commission wishes merely to draw attention to what it believes are two urgent and pressing situations that require immediate response. It also identifies other areas of concern that it intends to examine in detail in the ensuing year.

Problems of immediate urgency

473. Medical response to immediate short-term toxic effects of drug use. The Commission has been repeatedly informed by members of the medical profession, parents and drug users, that there are insufficient facilities and staff available to persons in need of immediate crisis treatment for drug effects. This problem is said to be compounded by a lack of patience, and sometimes even by expressed hostility towards the drug user by both physicians and hospital staff. We have been told that all too often medical practitioners may lack the knowledge to treat a particular drug crisis.
The number of persons, both old and young who are in need of short-term treatment for acute drug effects threatens to outstrip the available number of hospital spaces in this country if it has not already done so. This, of course, adds to the interpersonal frustrations on all sides.
The Commission suggests that the medical profession, through its regional medical associations and licensing bodies, undertake immediate negotiations with provincial departments of health for the development of special facilities to treat the short-term toxic effects of drug use. These facilities could be developed within existing hospital complexes.
The Commission also suggests that special care be taken in the recruitment and training of the personnel to staff these facilities. The qualities of empathy, understanding and tolerance generally required of hospital staff, are especially important in dealing with patients suffering from adverse drug effects.

474. Innovative services*.

* For definition and fuller description of these services, see Appendix F.

The Commission has been very favourably impressed by the response of young people in developing innovative services to deal with the many problems faced_ by youth all over Canada. Although these innovative services are not solely concerned with the phenomenon of drug use, they are very much involved in the treatment of adverse drug effects. At this time the Commission makes the following recommendations with respect to these services based on the analysis in appendix F:
1. That the Federal Government recognize the necessary and im-
portant role to be played by innovative services in communities
across the country. Where possible, federal facilities should be
made available to assist them in informing the public of their existence and of the services they are providing. They should enjoy the whole-hearted moral support and official recognition of the Federal Government.
2. That the Federal Government examine, with the provinces, the possibility of providing more direct financial assistance to innovative services to meet the problems of funding discussed in Appendix F.
3. That the Federal Government, with the provinces, encourage the early establishment of joint coordinating committees to serve as intermediaries for the receipt and distribution of financial support for innovative services in the larger communities. These committees should be comprised of a representative membership drawn from the community agencies and individuals having a particular interest in the work of innovative services. Such committees could be given a discretionary 'reserve fund' to help with the financing activities of its member innovative services. The criteria governing the eligibility for such assistance would have to be the subject of discussions between the various services themselves and the appropriate levels of government.
4. That the Federal Government consult with the provinces and, through them, with the municipalities on matters of municipal zoning, public health regulations and police practices as they affect innovative services. It is further suggested that the municipalities in which innovative services are located examine their programs in detail and, once satisfied that they are providing a necessary service, do whatever is in their power to facilitate the operations of such services.
5. Noting the risks involved to the innovative services in sheltering runaway youngsters who are afraid to present themselves to other more formal institutions, the Federal Government should urge upon the provinces the need to examine the problems arising from the rigid interpretation and enforcement of existing child protection statutes.
6. As pointed out earlier, young people in need of medical or psychiatric treatment as a result of drug use are frequently afraid to avail themselves of existing facilities in their communities. Therefore, it is recommended that representatives of the medical profession, (including psychiatrists, and hospital emergency staffs), psychologists and other members of the counselling professions, establish some system of continuing consultation and assistance with the innovative services in their areas.

475. Street clinics. A medically focussed innovative service which has grown out of new concepts of community medicine has involved the setting up of street clinics (`store-front clinics', `walk-in clinics').
Such facilities make it possible for anyone in a stressful situation and in need of immediate help to be seen without delay, and if indicated, to receive emergency medical treatment. If the treatment required surpasses the capacity of the street clinic, all necessary arrangements for immediate transfer to a more fully equipped hospital facility can then be expedited with a minimum of strain and confusion.
Such street clinics also function as centers for continuing therapeutic relationships, either through treatment at the clinic or through appropriate referral to other resources.
The Commission recommends that the Federal Government examine with the provinces, the possibility of providing more direct financial assistance to such street clinics.

Other areas of concern

476. Physical dependence. Treatment and cure are available from the medical profession for physical addiction resulting from the use of opiates, barbiturates, tranquilizers and alcohol. Although withdrawal from some of these drugs can sometimes carry with it serious dangers, it is in most cases possible to effect a satisfactory physical withdrawal from any of these drugs within two to six weeks.
The major problems in this area appear to be:
Many individuals who are physically dependent on one of the drugs mentioned above do not seek help for this problem.
Of those who do seek assistance for physical addiction, many are not sufficiently motivated to abstain from further excessive use. Thus, in a few weeks or months, they may again be physically dependent.
At this time the Commission has no specific recommendations on this problem other than to draw attention to the urgent need of sufficient, short-term facilities for those who wish to avail themselves of established treatment procedure.
Psychological dependence. We refer to what has already been said (Chapter Two, Para. 40) concerning the elusive character of this concept, which is underscored by the following observation of the Addiction Research Foundation of Ontario:'
Psychological dependence is merely a descriptive label for a pattern of behaviour which can vary from a trivial and inconsequential reliance on some generally harmless substance or practice, such as one's morning paper or coffee, to an intensive need for a drug which dominates virtually the whole pattern of an individual's life.
Those seeking to deal with 'psychological dependence' resulting from chronic drug use range from prison staff in wilderness forest camps to private psychoanalysts and group therapists. They also include the ex-users of drugs who utilize encounter techniques in 24-hour a day self-help halfway houses that are often modelled after the Synanon Program in California.
There are also psychiatric treatment facilities in Canada and abroad which utilize high and low dosage methadone treatment. This is a treatment using the long-term administration of an opiate substitute which prevents the person from experiencing the euphoric effect of heroin, or suffering the discomfort of any withdrawal symptom. A large scale trial of this treatment appears to be yielding positive results.
In the coming year the Commission intends to examine in detail both the concept of psychological dependence and the treatment programs that have evolved, both in Canada and abroad.

477. Compulsory treatment. There have been suggestions from groups, including the Canadian Medical Association, that consideration be given to legislation that would provide for the compulsory treatment of chronic heavy drug users. The Commission is aware of the highly complex and controversial nature of these proposals. We have been told that many users are baffled as to their supposed need for 'treatment'. Some have stated to the Commission that they wonder if it is any more feasible to treat drug dependency in a compulsory fashion than it is to treat neurotic behaviour in this manner. Concern has also been expressed that involuntary commitment programs could be used as a meanseof removing 'undesirable people' from society. Not the least of the difficulties is the question as to, whether or not there is in fact any method of treatment that can be imposed on a drug user that will offer any real hope of treating a phenomenon as imprecisely defined as 'psychological dependence', unless the drug-dependent user is very strongly motivated in this direction.
The Commission recognizes that one of its major tasks in the preparation of its final report will be a thorough examination of the proposals for legislation that would result in compulsory treatment of heavy chronic drug users.

478. The proper relationship of treatment to other community services. The Commission has received a number of briefs which have concerned themselves with the question of how drug treatment programs can best be located in particular communities. Some have urged the development of highly specialized drug treatment centres where ongoing research and treatment experimentation could take place. This might compound the difficulties of drug users who often feel themselves to be outside the larger community. Moreover, some experts in the public health and social welfare fields have strongly urged that any treatment facilities developed for drug users should be part of multi-purpose social service centres in order to make the most efficient use of resources.
The Commission intends to study this question and to make specific recommendations in its final report with regard to the form and organization of treatment facilities for drug users.

4. Prescribing Practices and Controls

479. Medical associations and many individuals appearing before the Commission deplored the 'loose' prescription writing habits of many physicians in Canada. At the present time, all prescriptions for controlled drugs are recorded by federal authorities (a branch of the Food and Drug Directorate, Department of National Health and Welfare), but there is at present no effective system of record analysis. Also, the Directorate does not receive reports of all prescriptions issued in Canada, but only those involving certain opiate narcotics or controlled drugs. The present system does not include reports of tranquilizer prescriptions, although these psychotropic drugs are among the most widely used of all drugs, both medically and non-medically.

480. There appear to be three areas of concern in this respect, involving the patient, the pharmacist and the physician.
If someone wants to take a certain drug for non-medical reasons, he may build up a supply by obtaining prescriptions from several different physicians. Or he may persuade someone else (a friend, perhaps, or a member of his family) to obtain a prescription on his behalf.
To cope with this problem, a number of measures would appear to be in order. Every physician could be required to record his medical license number, as well as the patient's Social Insurance Number on all prescriptions he writes, thus rendering forgery more difficult and allowing positive identification by the authorities for record analysis. At the same time, everyone presenting a physician's prescription might similarly be required to produce his Social Insurance Card, which would then also be noted on the prescription itself.
It is generally acknowledged by physicians that unless there are cogent reasons to the contrary, it is inadvisable to prescribe stimulants or sedative drugs for periods of more than two or three weeks, since any accumulation of such drugs by the patient is considered potentially dangerous because of the increased risk of accidental or deliberate overdosage. Also, the risk of inducing psychological or physical dependency might be greatly increased.
But it was pointed out during the public hearings that physicians are too often inclined to prescribe the 'easy pill' for insistent and persistent patients to whom they would otherwise have to allocate more time for a personal visit or a therapeutic interview. More specific professional education is needed to make every practicing physician aware of these potential hazards in his prescribing patterns. The Commission recommends that the Federal Government urge all provincial medical licensing bodies to implement such an education program for all practicing physicians.
In addition, the question of drug prescription by telephone should be examined. Although some form of control in this area is needed, it should be kept in mind that any outright prohibition of such a practice would impose a certain hardship on many patients. It would mean that each time they needed a prescription, they would have to make a trip to the physician's office. Perhaps telephone prescriptions might be permitted in cases where the prescribing physician is personally known to the pharmacist. Also, the possibility of some electronic identification could be investigated. However, a general policy to require prescription for all therapeutic drugs would not be reasonable because of the inconvenience in time and expense which would be caused to the individual.

Over-the-Counter Drugs

481. The Canadian Medical Association and the College of Pharmacists of the Province of Quebec both asked that measures be taken to restrict the dispensing of certain antihistamines, cough and cold remedies, analgesics, etc., to licensed pharmacists. It was noted that the prolonged excessive use of some analgestics (those containing phenacetin) is known to have resulted in kidney disease in some cases.
The Commission recommends that a systematic study be undertaken of all over-the-counter drugs and that those found to be especially hazardous be dispensed only by prescription.

DISAGREEMENT

March 15, 1970.

I find myself in disagreement with my colleagues on the Commission in respect of the offence of simple possession of cannabis. In my opinion the prohibition against such possession should be removed altogether. I believe that this course is dictated at the present time by the following considerations: the extent of use and the age groups involved; the relative impossibility of enforcing the law; the social consequences of its enforcement; and the uncertainty as to the relative potential for harm of cannabis.
Marie-A. Bertrand

REFERENCES
1. Chopra, I. C., and Chopra, R. N. The use of the Cannabis drugs in India. Bull. Narc., 1957, 9, 23-.
2. Gardikas, C. G. Hashish and crime. Engephale, 1950, August), 5-.
3. Eddy-, N. B., Halbach, H., Isbell, H., and Seevers, M. Drug dependence: Its significance and characteristics. Bull. WHO, 1965, 37, 1-12.
4. Blumquist, E. R. Marihuana. Beverly Hills: Glencoe, 1968.
5. Miller, D. E. What a policeman should know about marijuana. Eighth annual conference report. International Narcotic Enforcement Officers Association, 1967.
6. Department of National Health and Welfare, Division of Narcotic Control. Total addict population in Canada for 1969.
7. Mill, John Stuart. On liberty. Indianapolis: Bobbs-Merrill, 1956.
8. Hart, H. L. A. saw, liberty and morality. Stanford, Calif.: Stanford University Press, 1963.
9. Devlin, Patrick. Enforcement of morals; seven essays. London: Oxford University Press, 1968.
10. Canadian Committee on Corrections. Report. Ottawa: Queen's Printer, 1969.
11. Addiction Research Foundation of Ontario. Preliminary brief submitted to the Commission of Inquiry into the Non-Medical Use of Drugs. December, 1969.

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