The purpose of a forum held Jan. 19 at R.D. Parker Collegiate's Letkemann Theatre was to provide concerned citizens with information about fentanyl, but most of the questions directed at the panel of law enforcement, addictions experts and medical personnel that closed out the evening concerned a drug that far more people are familiar with: marijuana.
As Dr. Sheri Fandrey of the Addictions Foundation of Manitoba (AFM) pointed out near the beginning of her presentation on fentanyl and related opioids, most people are unlikely to ever encounter them outside of medical facilities.
"There's really a fairly small number of people who will ever be involved with fentanyl compared to the rest of the population," said Fandrey. "There are other drugs like alcohol and marijuana that many more people will encounter and encounter challenges and harm related to those so just try to get a little bit of perspective in terms of how big this problem is and where it fits in terms of some of the other drugs."
And while fentanyl has been found mixed with other drugs, the only evidence that that is the case with marijuana comes from unproved anecdotes and could be the result of carelessness rather than malice.
"There haven't been any laboratory confirmed cases of fentanyl being added to marijuana," Fandrey said. "There have been some random kind of anecdotes that that might be happening. I think it's a little bit more likely right now that there could be some transferrence from dealers who are weighing out fentanyl powder on a scale one day – they tend to be fairly not a one product kind of drug dealer – so they'll be weighing out cannabis another day and if they haven't cleaned up all the powder residue then the cannabis could be picking up residue from the scale. So there is at least a possibility and we have to be aware that cannabis could contain traces of fentanyl that may be harmful."
When it came to time for questions from the audience, however, the concerns were with marijuana as it already is and with what might happen if the federal Liberal government fulfills a campaign promise to decriminalize or legalize marijuana.
The first pot-related question addressed the ages at which marijuana use begins.
"Most often there's a range between the ages of nine to 13," said Dr. Ginette Poulin, the AFM's medical director, originally from Thompson. "They might have tried cigarettes, maybe some alcohol, marijuana and then things will often progress but definitely as young as eight, nine."
A follow-up inquiry asked if there was data on the issue specific to Thompson.
"There's a youth behaviour survey that's done every two years within our school district and that's done starting with Grade 7 and up and they basically get information about all different types of behavioural concerns including drug use, mental health concerns, suicide, sexual activity, a lot of different concerning behaviours that we want to be able to address," said Patti Baird-Millar, a Northern Regional Health Authority clinical services co-ordinator for northern crisis services for youth. "It was recently done again this fall so there would be data available that would say. It starts at Grade 7 so we wouldn't be getting those really young kids but we definitely see that use of marijuana at certain ages seems to change throughout and actually it looked like the data was saying that some of the drug use is being reduced which, great, we're doing some great work together with the various programs that are out there and parents because it sounds like some of our kids are deciding no."
A subsequent question addressed whether legalization of marijuana would lead to more addictions.
"It's pretty much readily available as it is now," noted Thompson MLA Kelly Bindle in response. "The problem is it's unregulated on what people are buying so there's an argument that it's safer but what we are looking at is how we regulate the amount of THC and the amount of cannabinoids."
Poulin said regulation is important because modern strains of marijuana have as much as 15 to 30 per cent THC, which is what makes users feel high.
"When you look back in the 70s or 60s the THC content was three per cent," she said.
Fandrey responded to a question about parents smoking marijuana around young children by saying that public health agencies are examining that.
"It's not just second hand smoke but third hand which is the residue of smoke that gets left on surfaces can also pose risks to very small children, for example toddlers, so it's definitely something from the public health perspective. Most, I would say all, public health and medical agencies across Canada are advocating for a very strong public health approach to the outcomes of legalization of marijuana so that would include education, that includes that kind of messaging, restrictions on where cannabis might be used, for example, so those are definite things that have been brought to the attention of legislators. What ends up happening with them is still very much up in the air."
NRHA medical officer of health Dr. Michael Isaac said collecting data is an important tool for assessing medical effects of marijuana use.
"I think it's important that we make sure we track some of the harms from marijuana use," he said, noting that the difficulty lay in designing systems to track that data. "We need to have a very good surveillance system for those things. You have to build a surveillance system almost from scratch so you need to think about where you're going to get your data. Is it going to come from the province and, if so, where is it? We have emergency room data so you have to think about all the different data sources, think about what indicators or outcomes you want to track over time and make sure you do that."
The final marijuana-related questioned was about the effects of smoking pot during pregnancy on a fetus.
"I think that would take time and we'll see in the future what exactly those effects would be," said Poulin.
Fandrey said there likely are effects but that they are less obvious than those from the worst substances for expecting mothers to use or abuse.
"None of the drugs taken during pregnancy are as bad or produce as intense effects as alcohol or solvent abuse do," she said. "Those are the two that have the most devastating and most intense effects on the developing fetus. There are some observational studies done on mothers who have used marijuana during pregnancy. The effects are more subtle but their do seem to be some behavioural effects possibly. There haven't been noted any effects on intellect but possibly some learning disorders that might appear but again they're much less intensely developed than the effects with alcohol are. I think what we can say with confidence is that there are effects on the developing fetus."
