SNUD Committee Meeting

SPECIAL COMMITTEE ON NON-MEDICAL USE OF DRUGS

COMITÉ SPÉCIAL SUR LA CONSOMMATION NON MÉDICALE DE DROGUES OU MÉDICAMENTS

EVIDENCE

[Recorded by Electronic Apparatus]

Tuesday, December 4, 2001

• 0916

[English]

The Chair (Ms. Paddy Torsney (Burlington, Lib.)): I call to order this meeting of the Special Committee on the Non-Medical use of Drugs. We are constituted, pursuant to an order of reference from the House of Commons on May 17, to consider the factors underlying or relating to the non-medical use of drugs.

With us this morning is Donald MacPherson, from the City of Vancouver by way of Ottawa and Toronto. He is the drug policy coordinator from the social planning department.

Mr. MacPherson, we're very pleased to have you appear before us. We understand you're extremely knowledgeable about the issues here in Vancouver and perhaps even across the country. We look forward to your testimony, and following your testimony there'll be some questions from the members of Parliament at the table.

Mr. Donald MacPherson (Drug Policy Coordinator, Social Planning Department, City of Vancouver): It's an honour to be here this morning to present to you. Do you want to hear a bit and then proceed to questions?

The Chair: Sure.

Mr. Donald MacPherson: Five or ten minutes?

The Chair: Perfect.

Mr. Donald MacPherson: I'll try to restrain myself, then. I have a lot to say on the issue, and am very passionate about some of the issues you're looking at. I know the Mayor of Vancouver would like to have been here this morning. He is unable to be here, and he sends his apologies.

I have been out of town for the last five days and consequently do not have a written testimony for this particular meeting, but I have given you a copy of our City of Vancouver drug policy paper, which we've worked on extensively over the last year.

Perhaps I'll say a few words about that. I'm not sure if you're familiar with it or not, but it is a City of Vancouver document that was approved by city council on May 15 of this year. After about a six-month consultation we released a draft policy last November and had a series of consultations, public meetings, and smaller group meetings with whoever really wanted to meet and talk about it. The mayor attended many more of these, I attended many more, and this final revised version came to city council in May.

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

I attend conferences in Europe and people ask me what's happening in Vancouver. They've read about it in journals, they've read about it in media reports, and they know that something very serious is going on here. They know how many people have died in Vancouver. Our overdose death statistics still are high and were extremely high all throughout the 1990s, and there was the HIV epidemic in 1997.

• 0920

So I was at the corner of Main and Hastings at the Carnegie Centre, witnessing something changing in our city. Prior to that the downtown east side was not overwhelmed by a drug market, and was not overwhelmed by the number of deaths and HIV and hepatitis C cases among injection drug users. Something had changed in our environment. In the drug marketing, drugs became cheaper and purer, and cocaine came to town in a big way. We witnessed basically a public health disaster in the community. Anyone who's from around here is very well aware of it. There have been a great many media reports.

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

Slowly, over the nineties, anyone who worked or lived in the downtown east side became personally connected with someone who had died of a drug overdose and/or had become HIV positive as a result of injection drug use.

In 1997 an HIV epidemic was declared by the Vancouver-Richmond Health Board. In 1998 the chief provincial health officer released a report basically listing again a whole bunch of actions that could be taken.

I'm trying to put this paper in perspective. One of my favourite anecdotes is from the mid-nineties, when people were dying at a tremendous rate in our city. In the province at that time there was a hepatitis A scare. At Canada Place there was a staff person in a health food juice bar who they found out had hepatitis A. This was a huge concern. It's very serious to have people with hepatitis A working around food. Immediately the public health system mobilized, and ads were put in papers saying “If you've eaten at O'Toole's Juice Bar in the last six weeks, please come down and see us; we've had this case of hepatitis A.”

I was standing on the corner of Main and Hastings, in the downtown east side, watching people drop dead, and all we were doing was writing reports. Because of the illicit nature of the substances causing these deaths and the illicit activity surrounding it, we seemed to not be able to respond. And we're still very much in that place.

The city felt very strongly that we needed to take more leadership in this issue, that the municipality couldn't do it alone, and that we needed provincial assistance, and federal assistance. We started putting together this policy, and at the same time we started working through the Vancouver agreement, which was really all three levels of government saying, “We have a big problem here and we need to work together to solve this problem”. This is something that, at the city level, we hold a lot of hope for. We really believe the only way you will deal with issues of substance misuse in localities across the country is through a collaborative, coordinated approach, a multi-sectoral and intergovernmental one, because it's such a complex area.

The policy we came up with came basically from many of the reports that were written in the nineties. I worked on it for some time and then we did have the public process. We wanted to look at the areas we really need to pay attention to if we want to address substance misuse issues in Vancouver. We came up with the four pillars of prevention, treatment, enforcement, and harm reduction. We felt it was a good framing of the issue; it was very inclusive, it allowed for a comprehensive approach, it acknowledged primarily addiction as a health issue, and it acknowledged a very important role for enforcement in addressing these issues.

So we looked at prevention and we discussed issues of prevention with the community, and heard a lot about what's not working in prevention. First of all, there is very little prevention happening around illicit drug use. There are also all sorts of mythologies around prevention; there are the “just say no” philosophies and whether they work or not, and scare tactics and whether they work or not, and other harm reduction strategies around prevention.

• 0925

Prevention is not just primary prevention of keeping people from using drugs; there's also secondary and tertiary prevention. So it involves looking at preventing serious illness and disease. As well, a lot of debate and research in the prevention area really needs to be looked at and considered so that when we resource programs around prevention we maximize our bang for our dollar.

There were the same discussions around treatment. There are all sorts of different treatment approaches. We need to coordinate treatment. We need to figure out what are the best forms of treatment, what are the most efficient, and how to increase access to treatment.

Enforcement has clearly a very important role to play in looking at organized crime and minimizing the negative impacts of the drug trade in our cities. The drug trade takes many forms, and enforcement is very important to minimize damage from the drug trade.

With regard to harm reduction, we felt it very important that we break through this false dichotomy of harm reduction over here and everything else over here, it seems. I've just come from meetings in Ottawa and Montreal. Montreal has a very similar situation to Vancouver in terms of where they're at in discussions around treatment and prevention, and harm reduction and enforcement. It was very refreshing to be in another part of the country where the term “harm reduction” was not as politicized. It did not carry the baggage. It was basic. People talked it like they talked about drug treatment or school curriculum. They talked about harm reduction for what it is, trying to keep people healthy and alive so they can move to better situations.

We were in the middle of a big discussion about harm reduction because we have a very large needle exchange here, and some people were questioning whether it was working or not because we also had an HIV epidemic here. So we feel it is really crucial that harm reduction doesn't get marginalized, that we have the discussion about it, that we don't skim over that discussion. It's a complex discussion and an important one to have.

Some of my experience has come from visiting European programs where they have fully embraced harm reduction approaches as a way to minimize harm and to reach the most disadvantaged, marginalized, unhealthy individuals who are often in poor housing or on the street, and who don't have access to more mainstream treatment opportunities or aren't well enough to go into treatment.

So then we had that discussion. It was a very good discussion, and we had it in public and we had it at city council, and we arrived at the four pillars as being all integral, that you have to move forward with each pillar at the same time. It's not one or the other, it's a collaborative, coordinated approach.

Much of what's in this document will speak to the need for federal and provincial cooperation and municipal involvement. Even though the municipalities may not fund services, we have a large role to play. It's the municipal streets that are in disorder. At the end of the day it's neighbourhoods that are calling their local city councillors, and we need to have a very coordinated on-the-ground approach. We need to work very closely with our police, who work on the ground at the street level.

I think I'll stop there. I don't know how long I've been, but I'll stop there.

The Chair: You've been about 11 minutes, actually. We have lots of time for questions and answers.

We'll start with Mr. White.

Mr. Randy White (Langley—Abbotsford, Canadian Alliance): Thank you, Madam Chairman.

Canada has to develop a more effective national drug strategy. I don't think anybody would deny that at all, Donald. Because we're here in Vancouver, much has been said about the downtown east side. I've seen it, been there a number of times, but I certainly don't think that is the blueprint for the rest of the province or necessarily any other part of any other province.

• 0930

I'm wondering how much you think that four-pillar approach that was developed in Vancouver would be the blueprint for a national drug strategy.

Mr. Donald MacPherson: In reading the existing national drug strategy in Canada.... I'll just say, before I go on, that I was very disappointed in my meetings in Ottawa to find out that we don't really have a national drug strategy. We certainly don't appear to have any funding coming towards a national drug strategy. I think there is much to work out. It's great that we have this committee, and it's great that the Senate is doing what they're doing with their committee. There's a lot of stuff to discuss.

It's very discouraging, I must say, to be in Vancouver in the year 2002 after watching the scene develop in the late eighties. We're talking over 10 or 12 years of death and despair literally on the streets of this city. We're beginning to make a dent in it with the Vancouver agreement initiatives, but they're very small first steps.

As far as a blueprint goes, I look at the existing drug strategy document federally, and it's basically the same stuff. I look at the injection drug use paper that Health Canada has just released; it's basically calling for the same approaches. In Montreal, there are very similar dilemmas—high usage of cocaine, disorder in parks and in back alleys and in streets. In Ottawa, there are severe problems around homelessness and injection drug use, and Toronto, I think, for the larger cities for sure. I'm not as familiar with Charlottetown, St. John's, or Halifax, which I believe may be somewhat different, although cocaine is on the increase in the Maritimes.

I guess a blueprint in the sense of being a continuum of really acknowledging the important components of a comprehensive strategy.... That's what we try to speak about. We need a comprehensive approach. It's not just a treatment centre or just an enforcement effort or just a safe injection site or just a needle. It has to be embedded in a comprehensive approach where the different actors and players understand the relationship to the problem and work together towards reducing the harm.

Everything is to reduce harm—drug treatment, enforcement. Ideally we're trying to reduce the harm caused by a very small percentage of the population engaging in illicit drug use and creating a lot of harm for themselves, and consequently to our criminal justice and medical system, and to the community in terms of hurting the economy and disorder in neighbourhoods.

Mr. Randy White: It's interesting; I've always used the acronym RITE, which is rehabilitation, intervention, treatment, and enforcement. In this one here, one of them has been replaced by this concept of harm reduction.

You get asked so many times.... Harm reduction includes a, b, c, and d, but it's actually taken on the image of safe shoot-up sites and needle exchanges, which is a component of it, I guess. But it seems to be pervading the whole discussion. For instance, I've seen very little emphasis on rehabilitation. When you get into these discussions, it's about a safe shoot-up site. It worries me that the focus is becoming this concept of harm reduction, whoever developed it, as opposed to rehabilitation, which was one of the words in the acronym of RITE.

I wonder if you could just tell us about this concept of harm reduction. You also hear now about the concept of harm “extension”. If you're given a safe shoot-up site, is that harm extension or harm reduction? To a parent with a child on drugs, it may be harm extension, in their mind.

I wonder if you could just comment on your idea of this harm reduction and its image.

• 0935

Mr. Donald MacPherson: It's a false dichotomy. Harm reduction is rehabilitation. It can be connected to rehabilitation. Its whole point is to keep people alive, to increase their health so they can get to rehab programs. For very few people is illicit drug use or injection drug use something they do for 30, 40, or 50 years. The notion of harm reduction is that if people are going to use drugs, we may not like it and we may not approve of it, but let's try to keep them alive and as healthy as possible, and not see them get HIV and hepatitis C, so they can move into rehab programs and treatment programs and other sorts of programs. So it's a false dichotomy.

I agree with you that the language and the positioning are not healthy. In a paper I wrote previous to this, I basically said that if we keep this polarized debate up, we will not go anywhere; we will not move forward. We will be here in 2012 speaking about the number of people who have died in Vancouver, because we haven't really decided whether we understand or can live with harm reduction versus rehab. So I agree it's a problematic discussion. I'm troubled by it too, because I really do see it as just other types of initiatives.

Jurisdictions that have been successful in dealing with this problem have initiated a wide range, a wide array, of programs, approaches, and interventions that include all of what you said and include harm reduction approaches. I just think the evidence is very plain to see, and I encourage people in this committee to visit places in Europe that had problems much bigger than they do now. They've managed to bring these things under control.

Mr. Randy White: I'll just ask a short question. We have some time, so I'll get my colleagues in on this as well.

I've been looking at drugs in prison for some time, and they suggest that you can't stop drugs from being in prison. If you can't stop drugs from being in prison, I don't know how you could expect to stop drugs from being on the street. It would seem to me that it's somewhat of an unfair expectation to think that one could stop the flow of drugs. If that is the case, then in particular in downtown east side, where you can stop most anybody at any time and get some drugs from them, would you think that we might as well say let's legalize it, control it, control the quality, control the quantity, and get that debate over with as well?

Mr. Donald MacPherson: I guess the approach I've taken is to separate the debates. I think there are some immediate actions we can do now, tomorrow, that aren't that expensive and really shouldn't be that controversial. They have nothing to do with decriminalization or legalization of drugs. They are improvements across the four pillars, basically.

The debate about legalization, decriminalization, I think needs to occur. I think what we're seeing in terms of the medicalization of the research being done into prescribing heroin is something that is very interesting, that is showing some promising results. I think the drift in our society, and certainly in European society and in Australian society, of re-looking at cannabis is something that needs to be looked at and explored. But when the debate goes up to that level, it's going to take a while.

Meanwhile, over here, there are some interventions. That's what you're seeing in Vancouver. You're seeing a real tension. Why is there so much focus on harm reduction? Because there's so much harm happening right now. If we didn't have a hundred people a year dying of overdoses in the city, if it was only five or ten.... I hate to say that; it would be nice if it were zero. If we had much less harm occurring in the city, you would see much less emphasis on the polarization of this discussion. The polarization is actually leading us to immobilization, and we'll get the status quo. We won't decide anything, because we can't decide, and that will cost lives.

Mr. Randy White: Thank you.

The Chair: Thank you, Mr. White, and thank you, Mr. MacPherson.

Ms. Davies, please.

• 0940

Ms. Libby Davies (Vancouver East, NDP): Thank you.

First of all, Donald, thank you very much for coming this morning. For those who don't know you, I just want to tell the committee what an awesome job you've done in your experience at the Carnegie Centre and just being part of city hall and taking this on. This report is viewed as a real model of what can be put forth as a blueprint, as a road map for what we need to do. The work you've done has been really outstanding, and I think a lot of people recognize that.

So I'm glad you're here today. I also want to say you've provided probably the most succinct and straightforward definition of harm reduction we've heard. A lot of people have asked for a definition of harm reduction. I wrote down what you said, “keeping people healthy and alive”. That's really very much what it's about.

From that point of view, I guess we could say that providing good housing that's well managed is harm reduction; providing people with nutritious food is harm reduction; social support is harm reduction, as well as the things that are more controversial, like safe injection sites or heroin maintenance.

I know you visited Europe, and I believe your first report was based on your experience of going to Frankfurt and maybe Zurich, I think.

Mr. Donald MacPherson: Geneva and Frankfurt.

Ms. Libby Davies: One of the things that really caught people's attention when you came back was your triangle, which is on page 26, if anyone wants to look at it. When I first saw that it really explained a lot in terms of looking at the different kinds of interventions that need to be made. I think it would be helpful if you spoke a little bit about your triangle and what it means.

The second thing is that we have had some discussion here about treatment, but probably not enough. There's a whole other debate about treatment or rehabilitation. But the one thing I've learned is it's critical that users themselves be involved in giving feedback and critical analysis about treatment models, because I think we've also failed in that area. We don't have enough of it. We heard that yesterday. It's very hard to get into treatment if you want it, whether it's detox or long-term rehabilitation.

So that's an issue in itself. On the treatment itself, I've talked to a lot of users who feel that the models we use are set up in such a way that they almost set people up for failure.

It is a continuum. I've talked to enough users to know you may try, you may go to treatment, you may fail, and you may have to go back again, but each time you do it you may actually make progress. I think anyone who's tried to quit smoking understands what that's about. Very few people quit cold turkey. Some people do, but most of us, if we were smokers, might have given it up, and then something brought us back. That's the nature of an addiction. I really feel this has just not been explored enough, so even on the treatment side the public system has failed.

Then we tend to blame the users, and say they don't want treatment, they haven't tried hard enough, or whatever it might be. Right?

So I wonder if you could explore those two questions. The first is on just the levels of intervention, based on your triangle. Second, give us your comments on what you see as some of the issues of what we need to do around treatment.

Mr. Donald MacPherson: I just thought of one other, getting back to one of Mr. White's notions. He mentioned the notion of harm extension. I'm very familiar with that argument—harm “production”, other people call it. You may have heard that here yesterday, and you may hear it again today. I just think that's the ideological discussion, and it's not helpful.

I know parents whose children shoot up in the downtown east side, and damn it, they want their kids to have clean needles. They would prefer their children not be being doing it behind a dumpster, using water from a mud puddle to inject with.

So you can find people on all sides of this issue, if you want to stop the discussion.

• 0945

On the notion of the triangle Libby was talking about, I went to a conference in Geneva, Switzerland in 1999. After many years of witnessing what was going on in Vancouver, I attended this conference that the International Harm Reduction Association convened in Switzerland.

I don't know if people have had experience with the Swiss, but they're very methodical about what they do. I think the deputy minister of health was presenting to the conference, and he got up and said, “Yes, we had this big problem in Switzerland. We had these big open drug scenes. We had needle park in Zurich, which you've probably heard about. We didn't know what to do, and we looked at our system of care”. He drew a triangle on an overhead and said, “We had a very good system of care. The Swiss spend lots of Swiss francs on treatment systems. We had methadone. We had residential treatment centres.” They were all in the top of the triangle, and the street scene they were witnessing was below the triangle.

They realized—it struck me very clearly, as we had a similar situation, although slightly different—that people weren't accessing their treatment system because it was too high-threshold. It was too hard to get into. Basically middle-class Swiss, usually white, many alcoholics were in it. They weren't people who were marginalized. Street injection drug users from different ethnic groups, etc., were just not accessing those treatment slots, because you have to quit using drugs to get into treatment, which is the barrier. So they fleshed out the bottom of the triangle, and that's what you see on page 26.

That's how they impacted their street drug scene. That's another reason why you hear so much about it in Vancouver. We're very much in that situation where we need more treatment at all levels, but we haven't maximized our contact with that marginalized population. Therefore that population continues to be a problem. We're out of contact with them and can't get them into treatment. We can't keep them in treatment, and if they come out of treatment, they end up back at the street level in great difficulty.

So that was a real breakthrough for my thinking. This was happening in Switzerland, which actually invested a lot more in drug treatment than we did, and they had the same problem. Something said to me that we needed to look seriously at those types of what they call low-threshold services that bring people into contact with the health care system as soon as possible in their drug use. Then those people wouldn't have to stay out in the downtown east side, or in the shelters, or in the streets year after year. Our interventions would come much more quickly when someone started to have trouble using illicit drugs.

That's a common theme. In Montreal, people just talked about low-threshold services. They didn't take it from the Swiss. That's the way they talk about those types of services—they need to expand the low-threshold services. The population you're trying to contact is very mobile, and it's difficult. They often move a whole bunch of times because their housing is not secure. It takes some thinking to maintain contact and relationship with that population.

The other sort of notion about harm reduction is that low-threshold services are about building relationships with those people and bringing them into contact with productive discussions, productive services.

On treatment, what was the question, please?

Ms. Libby Davies: Treatment is very inadequate, and even the models we use make it very non-accessible to a lot of users. Have you learned anything from anywhere else about what we could be doing differently here—treatment on demand, or different models?

Mr. Donald MacPherson: We need more voluntary treatment. People need to be able to access treatment when.... You'll hear from many witnesses, I'm sure, that there are windows of opportunity when people are just fed up or for whatever reason want to make a healthy decision and move toward health. They either quit or slow down.

• 0950

Those are the opportunities we have to make interventions. It's really hard to intervene with someone who's on a cocaine binge. Maybe the best we can do is keep them as safe as possible. There are windows of opportunities when people make decisions about their lives, like all of us, and for those who are seriously addicted we need to have something to offer them when they make these decisions.

In our public consultations we found that many people think of treatment as a place you go: “We need more treatment beds, we need to take these people and put them in treatment centres, and they will get better.” Well, for one thing, that deals with a very small number of people. It deals with individuals, and you can only have 20, 30, or 40 beds. It also is not the way it works. People take 11 attempts to quit using—I think that's the provincial number—if they're seriously addicted. If someone is a serious addict, especially someone who has mental health problems or has been using for a long time, we know they're not going to quit with one treatment centre.

Treatment is an issue. You have to ask yourself, “What is treatment?” Treatment is a whole bunch of interventions and supports to help people. Maybe they've been to treatment. Relapse is a part of treatment—we know that; it's well documented. You run into parents who have a relapsing child, and they will say the treatment centre didn't say anything about relapse.

What do we do if someone relapses? People get kicked out of treatment centres if they start using. There's nowhere else for them to go, so they often go back into the scene.

Treatment is really a whole continuum of services, interventions, and supports so that if someone does relapse, they don't have to devolve into the drug scene again. There are some supports there to acknowledge them, to say, “Yes, relapse is part of the process. It's hard. It's difficult. But maybe you need to do this for a while and then work your way back into other types of rehab and treatment situations.”

That was very powerful in our discussions with the community, that treatment is not one thing; treatment is about supports. If you have a treatment centre you're spending hundreds of thousands of dollars on over here but someone doesn't have housing, they're going to get out of their treatment centre and back into a hotel or onto the street, and that's not productive in terms of actually helping that individual. What's more important to that individual may actually be the housing situation. You could bring some treatment supports to the housing situation. Having a support of housing situations might actually be a better expenditure of resources than a treatment centre.

That's just to say that treatment is a whole array of approaches and interventions.

Ms. Libby Davies: One aspect we have not covered really at all, which I think is critical—certainly in terms of the downtown east side, but also in other communities—is aboriginal people who are facing a very high and critical HIV infection rate. It seems to me that, there again, a whole debate needs to take place in terms of what is appropriate treatment. I know there are aboriginal groups who are working much more holistically on traditional models of healing, and factoring in broader issues around residential schools or abuse, because it's all part of what has led people to the point they're at as users.

Have you seen anything in terms of developments around the aboriginal community that give you signs of optimism that we're going in the right direction?

Mr. Donald MacPherson: It's not an area I feel highly qualified to comment on, although the statistics speak for themselves. Aboriginal people are overrepresented among those who have HIV as a result of injection drug use and overrepresented in drug overdose statistics. I know there is a strong feeling in the aboriginal community in Vancouver that they need to develop an appropriate type of healing approach—healing centres for aboriginal people—because of the complex of issues involved.

The Chair: Thank you, Ms. Davies.

Mr. LeBlanc.

• 0955

Mr. Dominic LeBlanc (Beauséjour—Petitcodiac, Lib.): Thank you, Madam Chairman.

I want to echo what Libby said, Mr. MacPherson. Congratulations on the difficult and good work you're doing in this area. I've learned a lot just in the last 24 hours of being in your city. I've also read previously some documents and a lot of media reports. You have a difficult problem, and the leadership you and your colleagues at city hall are showing I think deserves our support and our congratulations.

I want to touch on two aspects. You talked a bit in response to a question from Randy about decriminalization or legalization—and I recognize there's a difference—and said something like “it needs to be looked at and explored”. I'd be interested in your own personal view on the decriminalization—not to say legalization, but the decriminalization—of, for example, cannabis. From the research you've seen and the travels you've done, does that have a positive effect? What would be your view if Parliament were to look at decriminalizing, for example, possession of cannabis?

Mr. Donald MacPherson: I need to make clear that this is my personal view, because we had started to write a bit about cannabis and city council felt very clearly they wanted to keep the focus on what we consider the more serious situation involving heroin and cocaine use. You'll see references to alcohol in here and you'll see references to cannabis, but we did not want to get carried away with the cannabis discussion, because I think it's a different discussion.

My own personal view is that obviously cannabis should be decriminalized. I think we are criminalizing our youth. We're criminalizing many Canadians unnecessarily. People have voted with their feet on this issue, and it is a bit of a joke. My personal view is that our cannabis laws seem to be irrelevant, particularly for personal use.

I think the public is way ahead of the politicians on this issue. I don't have a lot of evidence from other jurisdictions. I know that is the way Europe is going; I know several American states are going that way, and Australia.

This brings up a question in relation to the other drugs. Many people will tell you, or have told you—I'm not sure—that the criminalization of the substance increases the difficulty of our reducing the harm. It's the context of the drug use. Drug use is not illegal. It's not illegal for me to use heroin. It's illegal for me to possess it, so essentially it's the same thing.

But certainly with a substance like cannabis it seems to me...and it's not saying you should promote its use, advertise it, or give it to Rothman's and Du Maurier. It's not saying that at all. It's just saying, well, why should we criminalize an activity that is happening and presumably not causing much harm relative to other harms in society—i.e., tobacco, alcohol, other legal substances, or prescription drugs? You could argue that cannabis use, in terms of our work in Vancouver, in terms of death and disease is really a very minor player. Alcohol is the big one, and tobacco. They run neck and neck. Of course, heroin and cocaine and other substances are beginning to be problematic.

I think I would be very interested—and you may get this information—in what Portugal has done around decriminalizing heroin and cocaine. They did that earlier this year, I believe, for small amounts. The reports were that they wanted to go further than the Dutch. They wanted to make it very clear that if you were a heroin addict or a cocaine addict you were not a criminal; you have a health problem.

• 1000

I don't know how that's going to play out, because dealing is still very severely enforced in Portugal. But there are other societies and other countries looking at these issues. If the criminalization of a substance actually increases the difficulty in our dealing with the substance and its use, then we should be looking at those types of measures without fear that we're opening some floodgates in society. Maybe it's just a management tool. We still can have the discussion about legalization at another time.

What is our goal here? What are our priorities? If our priorities are to save lives and prevent disease, then what are the measures we can take to do that? If our second priority is to talk about the legalization issues, philosophical issues, and things like that, then we can do that too.

It would seem to me reducing death and disease is the number one priority, and we may be able to do a fair bit fairly easily without major changes to the Criminal Code, etc., if we separate them. That's why I go to the separation of the discussion.

Certainly on cannabis, I think our policies are counterproductive. I get worried when I see young people in Pigeon Park in the downtown east side buying cannabis—that's where cannabis is sold down there—and they're cheek-by-jowl with cocaine and heroin dealers. That's somewhat worrisome, as well as the whole portrayal of illicit drugs all being in one lump. I think there are very different types of drugs and very different types of uses. People use them for different reasons and during different periods in their lives. Most use is not problem use. What we see in Vancouver is a severe number of problem users.

Mr. Dominic LeBlanc: Thank you.

Randy and Libby will have other questions, but I just want to touch briefly on one other thing. Yesterday we heard some discussion about coerced treatment, or legally....

What was the term?

Ms. Libby Davies: Forced treatment.

Mr. Dominic LeBlanc: Yes. In other words, sentencing an addict or a drug user to some kind of—

The Chair: Legally motivated.

Mr. Dominic LeBlanc: Yes, “legally motivated”, if that's not an oxymoron. You're legally motivated or you're going to prison; that's not a bad motivation.

What's your view on the effectiveness of legally motivating people, not to say sentencing them, to some form of treatment program?

Mr. Donald MacPherson: We have an action in here—I can't remember which number—that talks about exploring mandatory treatment options. It's something other countries have looked at, and we need to look at the research on it.

I recently attended a drug treatment court conference in Toronto. That's a more gentle form of legal coercion into treatment. From my perspective in Vancouver, yes, we need to look at all options. I think we need to look at the option over here, and that one over there.

Mandatory treatment is expensive. There isn't voluntary treatment available. The public is crying for more treatment, period. We need to have a wider array of treatment available.

I know in Holland they're doing what they call coerced treatment. It's for a very small...and again, they've done everything else. They have a wide array of programs. This forced treatment—and the jury is still out on whether it works or not—is for a very small percentage of individuals who are repeat offenders, who are just incorrigible criminals who have an addiction problem, and they're trying to hive off that small population and see if it works for them.

The drug treatment court data from the drug treatment court conference indicate they've had some success. Their success in actually achieving abstinence in their people is really a harm reduction approach, and they will say that very clearly. Their drug treatment court approach is very much a harm reduction approach. They don't consider alcohol or cannabis use as a reason for kicking you out of the program, and drug use has been reduced through the drug treatment court.

In terms of actually moving people into abstinence, their statistics are not tremendously high. Then again, it's just part of a lifelong process, and those people get a lot of benefit out of the contact they've had with the treatment.

• 1005

I'm not that familiar with the research in Canada around mandatory treatment. There is some research available. From what I've read and seen, again, the jury is out on whether this is really a cost-effective way of going.

Certainly you'd be reaching a very small segment of your population if you went this way. It would be an expensive intervention with a small segment of your population. I think our bias has been on the kinds of services that we can maximize our interventions with to maximize the contact with the population of addicts, and provide access to the majority of people who actually do want to move toward health.

So we're very much at the stage that we need to open more doors for people who want to be healthier.

Mr. Dominic LeBlanc: Thank you.

The Chair: Thank you.

I have a couple of questions. First of all, you've broken down your report and clearly identified at the beginning, on pages 10, 11, 12, exactly who's responsible for what.

In your appendix, where you've summarized all your goals and actions—and there are about 36 recommendations—you've identified clearly which level of government is responsible, and where some things need legal changes and what have you.

Are you getting anywhere on these initiatives since you passed this in May?

Mr. Donald MacPherson: Oh, oh. Well, I just got back from Ottawa, and I don't know.

The Chair: Okay. We'll find out when we get back next week whether you got somewhere.

Mr. Donald MacPherson: Are we getting anywhere? I think we are. I think we've had a tremendous response from Ottawa. We've had good relations with the previous provincial government. We're beginning to have discussions with the current provincial government.

To the mayor's credit, he has gone to Ottawa several times now. He has sort of waved the paper around, saying we need to do something and we can't do it alone, etc.

I'm finding very much that the discussion is moving forward. This is always a difficult point to make to people on the street, that we, as a society, are moving. Certainly in Vancouver but also across the country there's a lot of discussion about this issue. I think we have to keep pushing ourselves and each other.

All of the reports that came out of the province here—our report, the Lower Mainland municipal association report, the provincial report, Weaving the Threads Together, and the federal injection drug use report—basically say the same thing.

I think Canadians are basically on the same page, agreeing on some bottom-line principles. One is that addiction's a health issue, so let's bloody well increase access to health services for addicts. Two is that enforcement has a role. Let's use enforcement judiciously and in the appropriate way so we maximize enforcement interventions.

I think as a society—and the work of this committee will presumably help that—we are all on the same page, so on some days I ask what the big debate is about. What's the problem here? We all seem to agree on so much. And most of it is motherhood stuff. We need beds for youth. We need housing.

People go to the controversial stuff. The media love to go to the controversial stuff, which sometimes, as we discussed earlier, doesn't produce productive discussions. But we agree on so much. I hear this across the country. We've done a fair bit of travelling, and it was just astounding in Montreal to be speaking with people who are speaking the very same language around addictions.

Ms. Libby Davies: In French?

Mr. Donald MacPherson: Yes, except in French.

Are we getting anywhere? In answer to your question, I think we are. But it's like the Vancouver agreement initiatives we've been working on for the last couple of years—we're getting somewhere, but with small steps.

That's why I started off this session somewhat discouraged after being in Ottawa, knowing that much of the hope we had for a comprehensive federal drug strategy was knocked off by September 11. And I understand that, but there's a budget in December, and I suspect most of that will be security money.

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The links between organized crime, terrorism, and drug use are there. We need to be constantly.... Well, for our part in Vancouver we will continue to push our federal partners and our provincial partners to work with us. We've made a small step, and it is a step, but we have a long way to go.

The Chair: I notice you've updated, and have these funky little revised actions or new action arrows, but is there a process? Will this be reviewed on an annual basis with an X checked off for where there's been activity? What's going forward from this report?

Mr. Donald MacPherson: You betcha. Another thing you'll hear in this discussion and from the witnesses you see is that many people will talk about evidence and evaluation. I think we say it in here several times, that we need to get away from the polarized ideological debate. We need to look at the evidence of programs that exist in other places and programs that exist here. Our city council is very interested in evaluation in terms of, how can we ensure that we're making a difference; can we ensure that money spent here wouldn't be better spent over here?

So we're putting in place...much of this work will be happening through the Vancouver agreement. The Vancouver agreement has subcommittees, and one of them is the health and safety subcommittee. This document is part of the health and safety initiatives of the Vancouver agreement. We are looking at an evaluation process and at performance monitoring over the next several years. As we implement projects and initiatives, let's not make mistakes we might have made in the past by not being rigorous with our evaluation.

The Chair: Is there also a process of evaluating progress against the 36 actions identified?

Mr. Donald MacPherson: Yes. Certainly, city council will be asking me to provide them with updates.

The Chair: Yesterday we heard an offhand comment from one of the witnesses to the effect that when you look at what sort of background or life experience some of the people have had, your reaction is sort of, well, no wonder they're doing drugs. It was almost, you know, if you have these various things happen in your life, it's inevitable that you'll become a drug addict.

I don't think they actually meant it quite that way, but it clearly pointed out that there were social determinants that need to be dealt with if we're going to prevent more people from thinking that it's the only outcome. If we're going to solve the problem upstream—if you want to make a parallel with the environmental movement—maybe you should turn off some of the flow, address some of the social determinants or factors that lead to this, so you don't have to deal with the problems just on the Vancouver east side. Can you talk a bit about that?

Mr. Donald MacPherson: I think there's certainly some truth in that. Obviously, there are experiences in people's lives that lead them towards a more marginal type of existence. One of our actions in here is looking at 8- to 13-year-olds in neighbourhoods that are defined as inner-city neighbourhoods. That's a very vulnerable population, and the action really speaks to a desire to increase the connections of those youth and their families to the community. That may be a very powerful prevention strategy, one that isn't really talking about drug use. It's shoring up a community's vulnerable at-risk youth and their families.

So there's definitely that. On the other hand, there are well-educated high school youth and parents we've met throughout consultation who don't seem to have the same demographics as some other folks. Libby mentioned the aboriginal folks in residential schools experiencing sexual abuse. Obviously, a lot of that plays into...addiction becomes just another problem. People have mental illness.

Then you have people—your kids, my kids—who take risks. Some of them end up getting into trouble with drugs, and yet they often don't have the socio-economic disadvantages other groups have.

• 1015

But I think you're right, and I think that's where much of the prevention focus needs to go. It's not about prevention when we're talking to grade 3 students about drug use, it's about self-esteem, communication, and support before they get into the language of substances. Much of our prevention work is not necessarily substance-misuse prevention, it's strengthening community and our youth.

The Chair: There were some issues related to strengthening the attachment to the labour force, improving housing, and what have you. That seemed to be based on some of the European examples you have in here as well—trying to stop the marginalization of people.

Mr. Donald MacPherson: We're getting back to the rehabilitation discussion we were having earlier, and that's a key part. Connecting people with meaningful activity is very important.

Addicts, especially if they're more marginalized, have a lot of time on their hands. They don't have employment. They may live in a hotel, so they don't want to go to their room. They have a lot of time on their hands, and even very preliminary or low-level activities, ones that are meaningful and ones where people can make a little money, take up time, create involvement, and provide positive reinforcement for them. It's an absolutely critical point you raised earlier.

The Chair: Okay. We have some time and are in good shape for some more questions.

Mr. White.

Mr. Randy White: Thanks, Paddy.

I just want to follow up on a couple of things Paddy asked. The question was, is it working?

I'll just share some of my observations over the past number of years. I can recall a methadone clinic where the fellow in charge said, well, they won't get off methadone, and we'll basically just keep them on it forever. That's one reason the clientele just grows and grows. I could picture a bureaucracy arising there, and in fact I even questioned the philosophy of people being on it forever.

I have also observed numerous social service groups overlapping in their work, and I thought they were getting too large and bureaucratic. I've also seen one group berate another group, saying, “You're not doing that well, and we're doing better”. The concept I get from various places is that it's becoming an industry in and of itself, with various groups fighting for the turf and perhaps for the dollars.

I wonder, when you bring A Framework for Action into a big city like this, how you organize it so you don't get that overlapping and fighting and so you don't get one group saying, “Well, this is okay, but that's not the way we're going to do it; we're going to do it a little differently, and I'm going to start my own group”. I've witnessed this, and I see it as having a lot to do with victims' rights in this country, with each group saying, “That doesn't satisfy us, so we'll do this over here, and we'll go after the money”.

I wonder how the City of Vancouver is going to make this a success, getting all groups to buy into a single idea—a philosophical approach, not necessarily the same way of doing things—without creating a large bureaucracy, an empire all fighting for those resources, all hitting up federal and provincial governments, and so on. How do you make it work?

Mr. Donald MacPherson: That's an absolutely critical issue. I think we see that in our day-to-day work with a variety of groups.

There are a couple of issues I think are important. Part of it stems from a lack of government leadership in that programs were not held accountable, yet we need a provincial framework on addictions to guide us.

Then we have situations where we have recovery houses that are meant to take people who are on methadone but don't. The policy is that they do, but they don't because they disagree with the policy.

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And I'm not saying who is right or wrong. It's just that, to my mind, we haven't had strong leadership in recent history at the provincial and federal levels. That's what we're hoping for with the drug strategy, and I think that will go a long way to setting...not standards, perhaps, but guidelines.

That's certainly what the Weaving the Threads Together report was talking about, creating a centre where we have some sense of what works and what doesn't, what the evidence is, and what the research says. Then we don't get into these discussions where we have one group saying “That doesn't work, we want to do it this way”. We have to look at the best evidence and at best practices in the field to have something we can go to and check things against. That's been a big problem. Definitely, it's an issue, this competing for funding.

I think the goals of programs haven't been that clear. Again, it gets back to what are the absolute, bottom-line priorities we need to establish here? If it's saving lives and preventing disease, what does that mean? If it's providing a full array of treatment programs, what does that look like? Then you get funding to work with others in achieving this. We're acknowledging that you need a multi-sectoral approach to begin with, so presumably the sectors have to work together towards the same goal.

Definitely, I agree with you that it's been a big problem. City council's way of dealing with that was to call for a single, accountable agent. This arose from their frustration because of the seeming disarray in the field, where you have doctors disagreeing on this and that and you have other people in the field disagreeing with the medical people.

To my mind, this is not rocket science. There is a lot of evidence that says we can do some basic stuff and get on with it fairly quickly, stuff that will help. It will not be the end of the world. It would help to do that if we could have some consensus around some very bottom-line principles.

Mr. Randy White: This committee is responsible for making recommendations to Parliament by November 2002. Those recommendations will be pretty far-reaching, I would think, in all these areas—rehabilitation, intervention, treatment, enforcement, and so on. Here comes the million-dollar question: If you were to leave this committee with an impression of two really vital things for a national drug strategy that is going to work, what to your mind should this committee be recommending as a priority? There could be 30, 40, 50, or 60 recommendations, but overall, globally, where from the federal point of view do you see the need to get involved and do something productive?

Mr. Donald MacPherson: To get on with it. If you look at the provincial documents that have been created by addiction commissions in Alberta, British Columbia, and Quebec, they all say the same thing. They generally agree on looking at addiction as a health issue. Our problem is that we're not able to implement anything because this is thorny stuff, and that's why I think we need federal and provincial leadership. It's difficult for municipal politicians to take all the heat. Even going into a community to establish a recovery house for middle-class alcoholics is problematic because of the baggage we have around addiction.

I don't think it would take long to pull together the relevant provincial documents, which all basically say the same thing, and build a coherent drug strategy that has some bottom-line principles. We need to get on with it. It's great that this committee exists, but frankly, when some of us saw it was going to be created, we said “Oh, that means we won't have a drug strategy until after the committee”. I mean, we who thought we would have a drug strategy this September realized that your important work would mean we would now have to wait another year. And that's fine. I think what you're doing is good; don't get me wrong.

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So my initial response, Randy, is just let's get on with it. This is not rocket science. We know what it costs to put police on the street; we know what it costs to build housing; we know what it costs to do all these things. We are wasting money year after year after year while this discussion goes on.

There's a lot we can do tomorrow. I've seen the political realities of moving this agenda forward, and I know it's not easy. It's very easy to get shot down as a politician when you start advocating on behalf of services to injection drug users. It's a challenge.

I guess the other thing I would say—it may not be as concrete as you want—is that when I moved from the Carnegie Centre to “up the hill”, as they say in the downtown east side—to city hall—I knew in my mind, because I've seen all these reports from Vince Cain, etc., that absolutely nothing would happen without political leadership. It doesn't matter; we file these reports that sit on the shelf.

This just happened to be at the same time as the mayor of Vancouver was really interested in this issue. And good on him, he took the leadership at the municipal level—great—and he's gotten a lot of kudos across the country for doing it. So that's the other thing, I'd say, political leadership. If no politician leads on this issue, then I guarantee you we will be here in 10 years having the same discussion.

The Chair: Thank you.

Ms. Davies.

Ms. Libby Davies: Thanks, Paddy.

In actual fact, I think a lot of the leadership has come from the grassroots. In Vancouver it's been organizations who have ploughed through all the reports and put all the pieces together; the leadership has come from the grassroots.

I wanted to pick up on something else you said earlier. What I've learned in politics is the easy part is knowing what you want to do; the hard part is trying to figure out how you do it. I think we have a pretty uphill battle—precisely for the reasons in the comment you made about post-September 11.

I actually find it very frightening that so quickly we now have four pieces of legislation, four bills, going through the House on one notion of security, in terms of tightening our borders and dealing with public security zones and all of those things—dealing with terrorist activities. And yet if you think about, more Canadians have died from drug overdoses than have been targets of a terrorist attack. We're talking about thousands, just in B.C. alone. I think that is a very big issue. How do we move forward on a political agenda that says this really is a priority? In fact, we have to make sure the whole global security agenda doesn't actually take over the idea of common security, whether it's through jobs or housing or healthy communities and all that.

I've talked to a lot of groups across the country who are very fearful about what's going to happen in the next federal budget and whether or not there will be a massive diversion of funds from social programs or commitments that were made into security measures that won't help people in the downtown east side and won't help a lot of people in this country.

The question I have is this. In your recommendations and all the proposed actions, what is very evident is that there are many players involved, in in terms of federal departments, provincial departments, attorneys general, police departments, health boards—I mean, it's huge. To somehow bring that together and develop a coherent strategy that actually is going to be implemented systemically with the resources needed is, I think, a very big issue to take on.

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We've had some debate here about whether you come up with one big national strategy or devise a strategy that has much more of a local component in terms of what is appropriate within a local community—i.e., what works in Vancouver would be different from what works in Abbotsford or Charlottetown or Montreal. I don't know whether you have any thoughts on who you see taking the lead in that.

I agree the political will has got to be there. That's number one, and we haven't really had that. We've had lots of reports that have called for it, but we haven't had it yet at the federal level. But if we are putting together all these recommendations, do you see it as being more of a national strategy, with one department like Health Canada taking the lead, or do you see it as some other kind of strategy that is more locally based?

Mr. Donald MacPherson: I see it definitely as a national strategy with the ability of localities and municipalities to develop what is appropriate for their locality. I think the national strategy is really important, though, because there are issues we need help with. If there are changes to the law—legislation at the federal level—we need a national strategy to lay out some basic principles based on the evidence we have before us as a country and evidence from other jurisdictions.

With that, I really think a drug strategy or a substance misuse strategy will only work at a local level, because it's the people on the ground—the organizations you mentioned, such as the police and the users themselves—who know the dynamics of the local scene. Our scene is so different from Halifax's scene. I couldn't prescribe a program for Halifax. We're a major point of entry for heroin and cocaine on the west coast. Halifax has other problems, more around prescription drugs and some cocaine.

The importance of both the federal drug strategy and provincial frameworks is they allow municipalities to not have to reinvent the wheel, not have to do all the research. If the leadership is taken at the national and the provincial level with regard to health and the involvements of the Attorney General, etc., then municipalities have some signposts on the highway. We at the municipal level will obviously need to work with federal and provincial people, but even within our own jurisdictions there are many players.

It's really establishing the framework and bottom-line principles and getting beyond some of these unproductive discussions, just saying, “This is what works, and this is how we do it”. Localities are very critical in developing a plan that actually works.

Ms. Libby Davies: Did the Big City Mayors' Caucus not endorse the framework when Mayor Owen came to Ottawa?

Mr. Donald MacPherson: They did.

Ms. Libby Davies: So that has been endorsed by the 10 major cities across Canada?

Mr. Donald MacPherson: That has been endorsed, yes.

The Chair: On that issue, isn't the framework broad enough that each of the communities could adapt it for themselves and—

Mr. Donald MacPherson: Yes. North Vancouver has a drug strategy they've just released—it's basically the four pillars—from their own process. Richmond has developed the Mayor's Task Force on Substance Abuse with all sorts of players involved, and they again have the four pillars. They did it independently of us, but it's generally looking—

The Chair: A little more of this, a little less of that.

Mr. Donald MacPherson: Yes; different contexts. They have different problems, different communities. That's why I'm saying there's a lot of consensus, and for us to move forward a consensus piece is absolutely critical. I think there's a lot of consensus on a lot of issues. Where there isn't we have to really isolate what the problem is about and why there is not consensus on it.

The Chair: You can have one quick one.

Ms. Libby Davies: Has there been any work on a cost-benefit analysis? Yesterday Martin Schechter told us that for each new case of HIV infection we're talking about $200,000 of downstream medical costs.

Mr. Donald MacPherson: Yes.

Ms. Libby Davies: If we're not going to deal with this on compassionate grounds—and hopefully we will—but just in terms of the economics, has anything been costed in terms of the city's report that would give us an idea what the cost is vis-à-vis the benefit in long-term savings to the health care system, or the enforcement system, the judicial system, and the prison system?

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Mr. Donald MacPherson: For this particular document that's something we're beginning to work on now. Particularly post-September 11 we realize we have to make a very strong economic argument as well as a compassionate argument.

The numbers, I think, are irrefutable if you look at the costs. They're a relatively small group of people in society. It's not 80% of society who use heroin and cocaine; it's a very small group. And that's across the board, including in the European countries. It's a small group of people who cause a lot of economic costs to the health care system.

Martin Schechter and people at the Centre for Excellence in HIV are beginning to look at those types of numbers, and as I say, it's not rocket science. We can save significant amounts of money if we intervene earlier and better.

But you're right, that really is an area in the whole addiction field that I don't think has been well enough articulated and researched.

Ms. Libby Davies: Thank you.

The Chair: Thank you.

Mr. LeBlanc.

Mr. Dominic LeBlanc: Mr. MacPherson, to follow up a bit on what Libby said and what you said, I share your view and the view of others who have sat at this table that political leadership is needed at all levels—at the national level, as well—and I think you've described well a role for the national government, conscious of provincial and local differences.

But things get onto the national political agenda because there is the perception of, or the reality of, a large public concern or interest. September 11 is a great example. Seven or eight years ago environment was what everybody talked about in Ottawa. Now it's security. There are these different phases of interest in the political agenda, and one of the things those of us who sit at this table are going to try to do is bring some concerted political debate at the national level that will lead to solutions on the ground, in your communities and in our communities across the country, to improve what is a very difficult situation.

What advice would you have for us in terms of making political arguments—I don't mean partisan political arguments, but arguments that will attract the attention of...? It's become a bit of a joke at this table, but my riding of rural New Brunswick is a long way from the downtown east side of Vancouver. The 60-year-old retired schoolteacher in my community has a hard time with her grandchildren using marijuana in college—let alone a safe injection site, which would just shock that person.

The challenge is to bring those people, and all different kinds of people in the country, to understand that this is a problem. The economic argument is interesting. Yesterday, that $200,000 figure for somebody who ends up with HIV or AIDS gave a very compelling reason to minimize the number of people who contract this terrible disease. If that's not compelling, I don't know what is, because these same people want to pay lower taxes. Well, if we can save all that money on health care.... It's all tied up.

What political advice would you have for those of us who want to try to advocate some of these solutions in communities that are a long way from the one you serve?

Mr. Donald MacPherson: I think what you say is difficult. Not that rural New Brunswick doesn't have its share of addiction problems; it's just probably that alcohol and tobacco are the main ones. I guess it's an overall approach we have to arrive at, an approach to people with addiction problems.

We seem to acknowledge and accept that people are addicted to tobacco or people are addicted to alcohol. We need to accept that people will be addicted to heroin and cocaine, a very small percentage—and maybe a smaller percentage in New Brunswick than in other places—but they're just other substances. To move to the next step, the public education we've had to do because of our terrible situation here has been absolutely critical in demystifying the topic, in getting people talking.

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I don't know, if you go to rural New Brunswick or cities in New Brunswick, you can probably find people who have varying degrees of experience in even talking about addiction issues, and varying degrees of shame if their family members are addicted.

I think all of those processes we've been forced to go through here because of the headline-making situation we have, which is not good...but all of those situations are the same. I certainly hear it from people I deal with in New Brunswick. They have innovative approaches in New Brunswick, just as they do in other parts of the country, and it's all about coming to terms with denial, the shame of addiction.

I think it's worth having a national strategy that acknowledges this as an issue for all Canadians because, you know, we did not see crack cocaine and cocaine on the oil rigs ten years ago. It's a big problem on the oil rigs in Alberta now. It's a big problem up north. The distribution of illicit drugs is much broader than it used to be. It used to be only in the big cities.

We have tremendous problems in Prince Rupert, in Nanaimo, and Prince George, tremendous problems. So “coming to a neighbourhood near you” may be part of my answer. If we don't have a good, solid federal strategy—and I've seen this happen many times—people come to the table, and they don't know much about the complexity of the addiction issue, but they know what they like and they know what they don't like. They'll start in by saying that you shouldn't do or that, and “Just say no” or whatever, and within five or ten minutes of actually having a discussion with someone who is a user, or some parent who has a different perspective, the complexity of the issue will evolve.

I think we have been forced to have that discussion more than others, and we're in the middle of it. In a rural New Brunswick town there may be.... I know from my literacy work, the experience of coming out as an illiterate in a farm community is very hard. While people may understand it, it's very difficult to go to an adult education class. And coming out as an addict in a conservative environment, where people may know it but no one talks about it, is difficult.

So I think you'll see those discussions taking place. It's much more difficult in rural settings where there's no anonymity. If you're an addict here, you can go to a program. No one knows you. You can be quite open, in a way. In a rural setting, it's quite different, much more complex, much more risky for someone to acknowledge these issues. But I think that with a federal-provincial framework, you will be able to help service providers in those outlying areas.

Mr. Dominic LeBlanc: Thank you.

The Chair: Thank you.

Building on that, from the European examples you've highlighted here, I thought it was interesting to hear that Frankfurt had 147 deaths, and I think that's the number we had in Vancouver last year.

Mr. Donald MacPherson: No. Last year, I believe, it was 91 or 94. This year we're on target for about the same, in the 90s, maybe 100.

The Chair: Okay. I thought I saw something that had that number.

Mr. Donald MacPherson: In the report, authored in 1993, it says we had an average of 147 per year.

The Chair: I found it interesting that it would be the same number that, I guess, was the breaking point in Frankfurt when they decided to do something.

You mentioned political will and you mentioned some of the community development that needs to go on before you can implement some of these ideas. Are there other things that were critical to the European example? Yesterday we heard from someone who mentioned that Switzerland had many, many referenda before they finally got to the place they're at, that it was part of a long political discussion. Perhaps some could argue that's taking place in Canada and that we are definitely part of that. Did other things occur that were catalysts for action in Europe?

Mr. Donald MacPherson: Yes, there were many other things. Off the top, one of the biggest was when Frankfurt accepted it had a problem. It was sort of like Frankfurt as an individual was out of denial. It was sort of, as you may hear from Drug Free America at some point, this notion of a drug-free society.

In Frankfurt, one of the first things they did was a public education campaign in the city, the literal translation of which is “Living with Addicts”. In other words, we are a community. A certain number of our people are addicts and we need to take care of them. It was acknowledging their problem. I have heard it from people in Australia, too, that the first step of a municipality is to acknowledge it has a problem and acknowledge that it will have a problem.

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We joke here in Vancouver—I'm sure many people have heard the joke—that, oh, if we could only move it to Surrey, or if we could only sort of enforce it out of our municipal boundaries....

Where are you from, Randy?

The Chair: Don't go there.

Mr. Donald MacPherson: So the attitude is if we could only enforce it to another jurisdiction, then we'd be fine.

That was a really significant campaign for the City of Frankfurt. It actually went on a public education campaign, saying, “Look, folks, we have this problem, and we'd better deal with it”. That was the beginning of their efforts.

The other key thing was the police. The police came and said “We're fed up. We've chased the problem around our community for ten years already, and we don't think it's a good use of resources.” The police bought in, big time, and when I spoke to the drug squad of the Frankfurt police, they said it was like night and day: “Finally, our enforcement strategies make sense. We have somewhere to send people. There's a shelter they can go to. There's an injection site. There's a low-threshold program.” They were able to change the rules of engagement on the street. Dealing was not accepted and using was not accepted. It was “Users, you go here, and dealers, we will try to catch you.”

It was very simple, and they seemed to really understand that fine line of discretion between who is a problematic dealer and who's not. Actually, dealing is not tolerated. They were able to articulate a strategy they could actually achieve, as opposed to, in an enforcement context, our front-line police officers, who are in a dilemma. They're not sure what the best decision is, whether to arrest someone and go off to the police station for two hours and fill out all the paperwork and find out they'll be out in ten minutes, or whether to not do that and do something else, follow another strategy.

Another thing was the recognition of the need for low-threshold services. The three things that come to my mind right off the top, very clearly, are the public education piece, the police support, and the recognition that you must have some place for people to go.

The Chair: In this community, what kind of support have you seen from the chamber of commerce, the board of trade, or those kinds of organizations? Are they at the table?

Mr. Donald MacPherson: Absolutely. We've had meetings with the board of trade. They have a committee on the downtown east side. I've met with them a couple of times. One of our public forums was sponsored by the board of trade last spring. Various business organizations are involved. They are just part of the dialogue.

The Chair: Okay.

Finally from me, then we'll go to Mr. White, and we'll see if anyone else has another question.

When we were in Montreal, both at the port of Montreal and following at a presentation in Ottawa that we had from the ports people working on the organized crime task force and working on the ports issue, it would seem clear that we need some changes in our ports. One of those would be to actually get some control on the ports in terms of who is staffing which area, which stevedore picks which load, the piloting issue.

Is that part of the discussion here in Vancouver? Has anyone tackled any of that issue? Certainly, containers are a primary method of getting the product into the country, yet the way we've structured our ports and who controls which organizations really facilitates a lot of that activity.

Mr. Donald MacPherson: It's part of the discussion. It's not a huge part of the discussion. Through the Vancouver agreement, the RCMP is at the table. And the RCMP has a strategy. What I hear from RCMP in Ottawa is that there's a serious concern about organized crime in the country, and that this is where their energy should be going.

• 1050

On the issue of the port, we've had preliminary discussions, let's say. It's not an area I feel I have the expertise to comment on.

The Chair: It just struck me as interesting that the employees who have access to all of the containers are not background-checked and to a large degree they're not bonded. There's very little security, really, at our ports. Whether it's drugs or other products, it seems we could do some things to make changes there.

Mr. White.

Mr. Randy White: I think it is fair to say that there are people who do oppose, however, A Framework for Action, right?

Mr. Donald MacPherson: Oh, yes, absolutely.

Mr. Randy White: I've met with a number of them.

Mr. Donald MacPherson: Consensus is always difficult to achieve, but it's what we strive for. The debate continues. The discussion continues and our interest is in having more discussion and dialogue around evidence-based information, trying to keep it away from the ideological discussions.

Mr. Randy White: So let's say for a moment we make recommendations and the House of Commons says “You know, A Framework for Action looks pretty good. We think we could use that as the basis for a national drug strategy.” That is all well and good, but a national drug strategy in a document is worth what it's written on, is it not?

What other things are you then looking for from Ottawa other than a document that says, “You know, ours was pretty close to yours, and we agree with this”? You'd be looking for more than just some written material.

Mr. Donald MacPherson: Yes, definitely.

Mr. Randy White: When you say “get on with it”, what do you want them to get on with?

Mr. Donald MacPherson: Well, there's $420 million in the red book.

Mr. Randy White: Now we're getting somewhere. I'm an accountant, by the way.

Mr. Donald MacPherson: That is a statement the current government...and the hope of many across the country has been that the $420 million for the drug strategy will start to flow from the federal government in areas within your jurisdiction that are appropriate to fund. This is what we want to get on with.

We are ready as a municipality. We don't have 100% agreement, and we'll never achieve that, but we have a high degree of consensus. We can send you polling results. As I say, a lot of this is motherhood-issue stuff.

Mr. Randy White: This $420 million doesn't reach my community of Abbotsford or Langley. It doesn't reach Prince George or Halifax.

Mr. Donald MacPherson: It could. We would like to see more municipal involvement and municipal pilot projects.

The Federation of Canadian Municipalities is looking at bringing together a coordinated drug strategy for 10 municipalities across the country. The first meeting is in mid-December. There could be federal support for pilot projects in municipalities, in bringing together municipalities with similar problems. A whole range of things within your jurisdiction could help the debate. A lot of the problem with this dilemma is coordination.

Mr. Randy White: There are some who disagree with this, but if the national government bought into this or something similar, would it not make sense to have an organization to coordinate it somehow? Instead of every department having funds and the squeaky wheel getting greased and so on and so forth, wouldn't it make sense to have an overall, four-pillar organization to coordinate with other organizations and provinces and to make sure Vancouver doesn't get all of the money going to British Columbia?

Ms. Libby Davies: That would be a change.

Mr. Randy White: You're not getting more than my communities this time.

No, you shouldn't, because in proportion to the communities, Vancouver has a few million people; but there are smaller communities with addicts, too, and proportionately I would suggest it may be the same.

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So wouldn't it make sense to have some organization coordinating something as opposed to all communities doing their own thing?

Mr. Donald MacPherson: I would agree that it would be essential for there to be some level of coordination at the federal level. You don't want to create a huge bureaucracy. This would be the fear, the creation of some big centralized bureaucracy lumbering along at Ottawa's pace—no offence.

I know there's such good work happening at the different provincial levels. My eyes were opened when I went to Quebec, to Montreal. I know there's really good stuff happening there that I would not have heard about had I not gone there and talked to people.

So there's a role for bringing together the diversity of the country under some coordinating body but also to cross-fertilize. When I came back from Montreal, I asked myself why I would go to Zurich or Frankfurt again. We should get Montrealers to come here and tell us what they're doing, because it's very similar, and they have similar problems. They've done some things we can learn from.

That's very powerful, and I think there's a real role for the federal government in doing this, certainly in the coordination and the moving forward of the research agenda, the pilot projects. It's hard for even a municipality or province to take some steps in a controversial direction. It's nice to have some federal support for this, some well-thought-out, documented, evidence-based support for what the municipality wants to do. Some of these ideas—and I'm not even talking about the harm reduction stuff—are controversial in some village in Newfoundland, but they may be very powerful interventions that could happen.

So, yes, I think there would be a role.

The Chair: Thank you.

Toward this model, I wonder if you might spend five minutes on the Internet looking at both the National Crime Prevention Council, which is set up as a sort of clearing house for information with this idea of sharing and helping communities set things up, as well as a clearing house on family and senior violence that's been set up. This might be another place. If this kind of model would work and would be something we could add to the report we'd be happy for your input on it.

Mr. Donald MacPherson: There's also the role of the Canadian Centre for Substance Abuse.

The Chair: Right, they're a clearing house.

Mr. Donald MacPherson: I have used them a fair bit in getting information and it would be helpful if they had—

The Chair: Money.

Mr. Donald MacPherson: Well, if this is the model you decide to go with, it would be helpful if it had some more support.

The Chair: You mentioned polling. I wonder if you might share this with us.

Mr. Donald MacPherson: Yes. I don't have the information with me, but I can send it to you.

The Chair: Okay.

Thank you very much for giving us the benefit of your advice. Our colleague, Stephen Owen, was with yesterday, but he had to get back to Ottawa for some votes today. We've really appreciated receiving a very warm welcome in Vancouver, facilitated by our fine MPs from the Vancouver area. Thank you very much.

If there are other things you think of or additional things you wish you'd remembered to say, please circulate them to our clerk. She'll make sure we all get a copy in both official languages.

Thank you very much, Mr. MacPherson, for your testimony.

Mr. Donald MacPherson: Thank you very much. I was only prepared for 10 minutes, so I'm quite honoured to have had such time to talk about this.

The Chair: It's good there was a lot to tap into in your brain.

We will suspend for a few minutes, colleagues.

• 1059

• 1117

The Chair: I'll bring this meeting back to order. We are the Special Committee on the Non-Medical use of Drugs, and we are here considering the factors underlying or relating to the non-medicinal use of drugs.

Our next witness is Mark McLean, who is the associate medical health officer and the CCENDU site coordinator from the Vancouver/Richmond Health Board.

Dr. McLean, I believe you have written testimony.

Dr. Mark McLean (Associate Medical Health Officer, Vancouver/Richmond Health Board; Site Coordinator, Canadian Community Epidemiology Network on Drug Use): Yes, I do. It should take less than ten minutes for me to read it.

The Chair: Perfect.

Dr. Mark McLean: Then I understand you may have some questions.

The Chair: I imagine we will.

Dr. Mark McLean: I am an associate medical health officer with the Vancouver/Richmond Health Board. I'm a specialist in community medicine, and the Vancouver site rep on the Canadian Community Epidemiology Network on Drug Use. I've been working with B.C. coroners' data on illicit drug deaths for two years in those capacities.

Regarding the problem of illicit drug use in British Columbia, I will restrict my comments to that portion of illicit drug use that's been associated with the most severe health outcomes, namely injection drug use, and in particular the problem of heroin overdose.

I offer my personal opinions based on observations I've made using epidemiological data and data from the United Nations Drug Control Programme. This work is not yet published and is therefore not necessarily the opinion of my employer, nor other agencies collaborating with us on these issues.

The high life expectancies in Vancouver and B.C. compare with the best rates in Canada and the world. At the same time, the life expectancies observed in these larger populations obscure discrepancies among small-area population life expectancies within Vancouver, which are among the highest and lowest rankings in Canada on this measure. Illicit drug use and the health outcomes associated with it are responsible for a substantial portion of the discrepancy among small-area life expectancies within Vancouver.

During the ten years from 1991 to 2000, there were 2,748 illicit drug deaths in the province of British Columbia. Most of these deaths occurred within the city of Vancouver. The data on B.C. illicit drug deaths come from the Office of the Chief Coroner of B.C. An illicit drug death is defined as any death that is attributed to an illicit drug or an illicitly obtained drug. In practice, most of these deaths are due to heroin and/or cocaine.

In unpublished work on 990 deaths from three years—1997 to 1999—of coroners' files of B.C. illicit drug deaths, 74% of these deaths were found to involve opiates, while cocaine caused or contributed to 49%. Ethanol was a contributing factor in 17% of illicit drug deaths during the same time period. Methadone caused or contributed to 17 deaths, or 2% of the total, from 1997 to 1999.

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Examination of the annual number of illicit drug deaths in B.C. reveals immediately that there has been wide variation over time in the annual number of deaths. Vancouver had a peak of 201 deaths in 1993. They dropped to 116 in 1995, increased to 191 in 1998, and since have decreased to 90 in 2000, dropping below 100 deaths per year for the first time since 1992. It is notable that two other B.C. sub-regions—one the rest of the lower mainland and capital region, and the other the rest of British Columbia—also experienced higher death rates in 1993 and 1998 and smaller death rates in 1995 and 2000.

The most likely explanation for these synchronous increases and decreases in drug overdose deaths by area relates to heroin supply factors. Whereas at the level of the individual, heroin purities can be a primary determinant of probability of overdose, at a population level it is probable that heroin supply is an important determinant of the number of drug deaths in British Columbia.

The annual global production of heroin increased greatly from the mid 1980s until 1999, with opium cultivation and heroin production in the late 1990s being concentrated in Afghanistan and Myanmar, formerly Burma. In 1999 and 2000, there were signs that the world production of opium and heroin was decreasing. In 1999, almost 75% of the world's opium production occurred in Afghanistan, about 20% in Myanmar, and the remaining production came from other countries in Southeast Asia, Mexico, and Colombia.

Late in 1999, the Taliban in Afghanistan issued a decree ordering poppy farmers to reduce opium cultivation, with the resultant decreased production verified by the United Nations International Drug Control Programme. In Myanmar, the UNDCP claimed success in achieving agreements in 1999 with some regional groups to decrease opium production—that point came from Vincent McLean of the UNDCP, when I spoke to him in April 2001—although severe drought in Myanmar may also have played a role.

Work at the UNDCP shows that from 1980 to 1998, more heroin was seized by police forces around the world during years in which a greater amount of opium was produced, with a very tight correlation of 0.948. This correlation makes intuitive sense to most people.

Related work at the UNDCP from the World Drug Report 2000—from a gentleman named Thomas Peitschmann in Vienna—shows that in the European Union from 1985 to 1997, more drug-related deaths occurred during years in which greater amounts of heroin were seized by the police. The correlation was 0.97. While this result may seem paradoxical to some, illicit drugs seized by police can represent only a small percentage of the total trafficked, rendering the amount of drugs seized to be a better indicator of drug supply than of societal protection.

Because the work at UNDCP found very strong correlations between opium production and heroin seizures, and between European heroin seizures and drug deaths in Europe, I became interested in drug supply issues as they relate to illicit drug deaths in B.C. Since B.C. has a high number of drug deaths and only one source of heroin supply, we are in a unique position to study the relationships between heroin supply factors and overdose deaths.

Since the early 1990s, B.C. heroin has originated almost exclusively from Southeast Asia. The fact that there is only one source of heroin for British Columbia enables us to learn interesting facts about heroin supply in its relationship to overdose deaths.

The annual opium production in Burma more than tripled from 490 tonnes in 1985 to 1,544 tonnes in 1989 and remained above 1,500 tonnes annually from 1989 through to 1997. That's UNDCP data. The influx of Southeast Asian heroin into British Columbia around 1990 displaced heroin coming from other sources, so Vancouver and British Columbia heroin has been almost exclusively of the China white variety since that time, while Mexican or black tar heroin is no longer seen in Vancouver and B.C.

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The size of the heroin drug use problem in Vancouver and British Columbia increased around 1990, in synchrony with the increased opium production in Burma. The annual number of illicit drug deaths in British Columbia increased from 26 in 1987 to 361 in 1993, and has remained above 240 since then.

The annual number of illicit drug deaths in British Columbia from 1987 to 1999 correlates very strongly with seizures of opiates—which are opium and heroin in opium equivalent—in east and Southeast Asia. The temporal peaks in seizures of opiates in China in 1993 and 1998, with an intervening trough in 1995, fit with the temporal pattern in annual illicit drug deaths in British Columbia and are congruent with what is known about trafficking routes for opium and heroin.

I think there are a number of policy implications from these findings. First, these findings should undergo further critical analysis, and the relationship should be monitored over time.

Second, since there is evidence that the global supply of opium may be at a multi-year low and there is evidence of destabilization in areas that have historically been producers of opium, Canada should prepare for population-level effects of future increases in the global opium supply.

Third, since there is evidence that the recent two-year decrease in Southeast Asian opium production may have been caused to some extent by drought, Canada should prepare for population-level effects of future increases in the Southeast Asian opium supply associated with future weather improvements.

Fourth, since current interdiction efforts in both Southeast Asia and Canada are not effective in protecting our population against heroin reaching the British Columbia market and the deaths resulting from its use, Canada therefore should reconsider whether the strategic focus of resources it devotes to drug enforcement issues is in the right place. Discussions on the supply side must address drug production issues and not be restricted to local Canadian enforcement considerations.

Fifth, it is reasonable to believe that the heroin supply entering B.C. will continue and may increase; therefore, increases in harm reduction measures and treatment are essential for population protection. The evidence presented here indicates that most heroin intended for the British Columbia market actually gets here and is trafficked. Necessary methods of protecting our population against heroin deaths, therefore, include providing appropriate tools to enable people to protect themselves, including especially information and specific harm reduction strategies.

Effective specific harm reduction strategies, primarily need exchanges, have been implemented to decrease the transmission of blood-borne infections. For data on this you should see the B.C. Centre for Disease Control stats on newly identified HIV infections by risk factor. But specific measures for drug overdose prevention in IDU populations are still comparatively underdeveloped.

The Vancouver/Richmond Health Board, in collaboration with the community, has provided information sessions to drug users about what happens during an overdose, as well as to how to prevent, recognize, and treat overdoses. Related to this initiative, a number of user groups have been taught cardiopulmonary resuscitation, and community members now patrol the back alleys of the downtown east side looking for persons in need of resuscitation.

As a response to the clustering of deaths that sometimes occur in the downtown east side around the time of monthly social service payments, a Wellness Wednesday campaign increases awareness in the community about the heightened risk of overdose for some people at this time. The impact of these interventions in Vancouver is not yet known, as they have only been recently implemented and not yet evaluated.

Sixth, treatment is also harm reduction. Timely treatment may prevent a person from heading too far down the slippery slope of drug use to addiction and its associated severe outcomes. While treatment options and capacity are being developed in Vancouver as part of the city's health and safety initiatives, the existing services, unfortunately, remain inadequate for the need.

Harm reduction strategies that include a variety of treatment options, as well as specific measures to prevent harms associated with drug use, are likely the best use of resources within Canada to combat the problem of drug use. Environments providing for safer non-medicinal drug injection may favourably impact the number of illicit deaths. Implementation of treatment and harm reduction will remain essential in order to protect the population against future possible supply increases of new drug use trends.

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Canada could play an important role in the post-September 11 world in the area of international cooperative efforts to decrease production of illicit drugs. If heroin supply control is considered an objective, the best place to control supply likely is at source. Canada has a history of peacekeeping, and since military actions can destabilize nations and leave environments ripe for production and trafficking of illicit drugs, we are poised to lead in the area of negotiated and monitored cuts in illicit drug production, including, for example, subsidized alternative crop programs.

Canada should approach the UNDCP and the Southeast Asian nations in which opium and heroin are produced to work together to identify and quantify the health and social outcomes associated with opiates in the region of origin, the regions through which opiates are trafficked, as well as the destination regions impacted by the use of heroin. This work will inform international policy development.

Thank you for the opportunity to present these facts and views to the House of Commons Special Committee on Non-Medical Use of Drugs.

The Chair: Thank you very much, Dr. McLean. You've certainly taken a different approach from what we've heard to date, so it's going to be quite interesting for us to ask you some questions.

Mr. White.

Mr. Randy White: Thank you, Madam Chair.

I'd like to refer you to your comment at the bottom of page 4 of your presentation. You say:

Harm reduction strategies that include a variety of treatment options as well as specific measures to prevent harms associated with drug use likely are the best use of resources within Canada to combat the problem of drug use.

Could you elaborate on that a bit? I'm at a bit of a loss on where you're coming from in terms of rehabilitation, facilities, detox centres, etc. Are they part of that statement? What about education? Could you just verify these for me?

Dr. Mark McLean: Yes. If you take my five-page statement in its entirety, I am using the term “harm reduction strategies” in a large sense. I include treatment and education for the population as measures that will enable the harms associated with drug use to be decreased. I am also taking into account the findings I have presented regarding the correlation between seizures of opiates in Southeast Asia and drug deaths in British Columbia, indicating that it's likely the enforcement measures currently in use are not effective in reducing the flow of drugs into British Columbia, with the result that there is a correlation between seizures and deaths.

Considering resources from many different departments together, I would recommend devoting more resources toward protection of the population through health services, including harm reduction services, as opposed to the traditional enforcement measures that are currently in place.

Mr. Randy White: It's unfortunate, but when we talk to a number of people we seem to get drawn into this terminology of harm reduction, which I'm going to deliberately try to avoid because I'm getting really mixed signals on what harm reduction is from virtually everybody I ask. I think Libby came up with a definition from our last speaker that I was a little more comfortable with until you started to talk. Now I'm back to where I was before.

Would you define for me succinctly what harm reduction is?

Dr. Mark McLean: Harm reduction is anything that reduces harm. I think if we evaluate interventions, whatever they may be, on the basis of whether the intervention has had an impact on indicators that we are monitoring, then we can decide with that evidence whether or not the intervention was likely to have reduced harm.

Mr. Randy White: Would an effective way to reduce harm be to take a police service into a classroom to talk about the DARE program?

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Dr. Mark McLean: I think if there's evidence that education reduces the initiation into or the amount of drug use, then yes, it would be considered a harm reduction measure as far as I'm concerned. But I think the key would be being able to identify evidence that indicates it is effective in the way you suggest.

Mr. Randy White: That is a different concept from what many have talked to this committee about.

Dr. Mark McLean: I think harm reduction is an evolving concept. I think initially harm reduction had a narrower definition and was considered in a narrow sense. And really, it was developed more for transmission of blood-borne diseases, as I have suggested.

I think harm reduction measures for overdose are not yet well developed, and I don't think harm reduction for one outcome would necessarily be harm reduction for another outcome. A good example of that is needle exchange. I do not believe needle exchange is an effective harm reduction measure for overdose prevention.

Mr. Randy White: Thank you.

The Chair: Thank you.

Ms. Davies.

Ms. Libby Davies: Thank you very much for coming. I didn't realize your brief had been handed out on the table, and you kind of dashed through all those numbers, so I'm not sure I got everything.

Just so you know, the person Randy was referring to was Donald MacPherson, who was here just before you. I'm sure you know him. He's the city's drug policy coordinator.

We've had lots of discussion about how harm reduction is part of the four-pillar approach, and people keep trying to break it apart. I'm sure we're going to hear more about that later, but he came up with a very simple, straightforward definition, which was that harm reduction is about keeping people healthy and alive. That's fairly broad, but it really focuses as well on those low-threshold services that can get people to the point where they can start going to treatment and rehabilitation and so on.

I have two questions. A number of years ago, when I first started working on this issue with a lot of groups, one of the things I was appalled at was the number of overdoses. I became aware that the number of overdoses was also related, of course, to what was hitting the streets and that people didn't know what they were taking.

In fact I remember one particular winter, maybe it was 1999. I can't remember, but you might recall. Allan Rock was about to come to Vancouver for some consultations, and we had six overdoses—or maybe it was a dozen, I can't remember. But there were a whole number of overdoses in a period of two days. And they weren't just in the downtown east side; they were all over the lower mainland and involved people who—it was heroin—were using for recreation. It really dramatized what happens when a particular batch hits the streets—people don't know what they're taking, and they're dead.

I began calling for drug testing, which some people thought was terrible, but I thought it was a fairly common sense thing to do. Health care professionals like street nurses, IDEAS, and and other groups could be aware.... The RCMP apparently does do testing in their labs. I actually tried to follow the route it takes, and I even got information from the DEA in the United States about how they do drug testing. I thought, why isn't this information being made available?

If some of these health care providers on the street know something has come into town, wouldn't we be giving people that information, saying “Look, you have to be really careful. This is pure heroin and if you take too much, you're going to be gone.” Needless to say, it never went anywhere.

But the idea of actually doing testing and providing some sort of public disclosure about the testing seemed to me to be part of a strategy of trying to keep people alive and helping people start to make healthier choices about what they're doing.

You're a public health officer with the health board. Has there been any discussion about that possibility, about providing that kind of information to people?

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Dr. Mark McLean: Yes, there's been some discussion. To mention a point related to what you said about the overdose deaths occurring in clusters, we're aware of that occurring in patterns over time. At the level of the individual, it seems like heroin purity may be a significant factor. Therefore, if people know the purity of what they are injecting, they have a better chance of not overdosing.

However, the facts that I was presenting seem to indicate that at a population level, increased drug supply or increased heroin supply means there would be more doses of higher pure-grade heroin around. So we would get the clustering of deaths happening when the supply goes up. There's just more heroin of higher grade around.

Ms. Libby Davies: When the supply goes up?

Dr. Mark McLean: Yes, in the source country. And when the amount of traffic goes up.

The intervention area you mentioned is an example of a specific harm reduction strategy that would possibly impact the number of overdose deaths, either by providing information to drug users about the average purity of heroin and cocaine that's on the streets at the present time, or by providing drug testing of the drugs people have for their own personal use. Those are areas that are very controversial, especially if a person brings in a drug, gets it tested, and then injects it.

It's also possible to approach that at the population level by sampling drugs that are available on the street. I understand that police purchase drugs in undercover operations on the street. Those samples could be tested and then we would have an idea as to what the average current purity is on the street. That information could be made public.

Ms. Libby Davies: Yes, that's exactly my point. I found out that routine testing is being done, both in the States and within B.C. In fact, we have even heard that the DEA is going to open an office in British Columbia, I presume in Vancouver. So we know that's being done. But to me it seemed illogical that information that is apparently there is not being given to health care providers to make them aware of what's happening for their clients. Anyway, that's one thing.

Just to get back to your main point, though, I have to confess I'm not sure if I really got it. I'm sorry to be ignorant. You're saying that there's a correlation between increased seizure and the number of deaths. I'm sorry; I didn't quite understand why. Maybe everybody else did.

Dr. Mark McLean: These are seizures in Southeast Asia, because that's where the data come from. I haven't used drug seizure data from Canadian police forces in this analysis.

Many people think that when the amount of seizures goes up, when the police are seizing more drugs, that means the population is more protected. But if you consider that the police may only be seizing a small percentage of the available drug that's being trafficked through an area, then when the amount of seizures goes up, the amount that's not seized also is going up. That's the part that's getting through to the population. That's probably why the number of deaths in the province of B.C. correlate very strongly with the amount of heroin that's seized in Southeast Asia.

Ms. Libby Davies: Okay, I understand now. Thank you for explaining that.

In terms of an enforcement strategy, we've talked a lot at the committee about how to go more upstream, how to get more to the source of what's going on. Certainly the UN program on interdiction and all the international covenants supposedly tried to focus on production at source and all that. I actually attended a parallel conference when the UN had its special session on drugs, and it was people from Colombia who were talking about their difficulty in actually having resources to set up alternative production so that they weren't involved in the drug trade.

• 1145

It's a huge other debate, which we haven't gotten into. From our point of view in Canada, we're sort of at the receiving end. Where do you think the enforcement should be placed?

We heard the Vancouver Police Department, I think yesterday, say that they're trying to get to the mid-level trafficker dealers, who are basically people who are using as well. In fact, he said 63% of the dealer traffickers are actually on income assistance. So they're people who are just part of this vicious cycle.

Where do you see enforcement coming in?

Dr. Mark McLean: I'm not an expert in enforcement. What I see, though, is that it's likely that present enforcement practices only catch a small percentage of what's coming our way.

Ms. Libby Davies: And it's usually at the very bottom, right?

Dr. Mark McLean: I don't know what you mean by the bottom.

Ms. Libby Davies: The easiest enforcement is right at the street level. You can have these big police scoops and just scoop people up and send everybody off to jail, and they're back out again.

Dr. Mark McLean: I think that may be related to the fact that traditionally our enforcement is located within our own borders. Whatever is caught by enforcement is caught within Canada, for the most part, although I have read about and am aware of cooperative efforts where Canada has worked with Hong Kong and there have been seizures there. There are groups that have been tracked from other countries and perhaps arrested in British Columbia, but may have been arrested in Hong Kong and the drug was known to be destined for British Columbia, or vice versa.

In a very simple way, if we are aware that the amount of drug that is being seized is the vast minority of the drug that is being trafficked, then it seems to me to make sense to focus on the actual production of the drug. In the case of heroin, you then look at the fact that the way it's produced these days is that it is grown as opium, and we know where it's grown. That would be an area that I would explore.

I'm aware that the UNDCP has alternative crop programs. I think Canada participates in those. I wonder if there are opportunities to increase our involvement and increase our support in those programs, since they may be very cost effective. I might add that it seems as if the western world may now be more involved in international affairs than we have been in the past with regard to issues that are global in nature.

The Chair: Thank you.

I have two quick questions. It's been my experience that on the radio in Toronto, for instance, you would hear warnings about there being some really hot stuff on the streets and people dying, all addicts beware. Is that kind of warning issued here?

Ms. Libby Davies: After the fact.

The Chair: It's not during, it's after?

Dr. Mark McLean: Yes. Usually the headline in the paper is that there were six to eight overdose deaths on the weekend. We hear about it after.

The Chair: So it's too late.

Dr. Mark McLean: I guess it may not be too late for the ones that were prevented, but at least it was too late for the initial cluster, and sometimes clusters.

The Chair: So the cluster happens so quickly that it's hard to even figure out.... I mean, with one or two you wouldn't necessarily say it looks like it's a really high strain or a really pure strain of heroin. You don't have that chance to say it's been one or two. It's that there are six all of a sudden, and then you realize.

Dr. Mark McLean: Sometimes it happens over a number of hours. There have been times in the past decade where it was difficult to get an ambulance available because more than five of them were responding to overdoses in the downtown east side at the same time.

The Chair: Just on the overdose one, I guess we'll see some of it tomorrow. Well, hopefully we won't see any overdoses, but we'll see some of the people on the street level. Do they outfit people who are working in the street areas with the antidote so that they can administer it quickly?

• 1150

Dr. Mark McLean: Do you mean health outreach workers?

The Chair: Yes.

Dr. Mark McLean: I don't know. I think the ambulance attendants have Narcan. I think it would be a good policy for the needle exchange van to have Narcan.

Related to that, I'm aware that there is research going on in two areas in the United States that is using an intervention to distribute Narcan to drug users in pairs. I don't believe the results on that are in yet, as to whether they have been able to resuscitate each other and decrease the death rate.

The Chair: Thank you.

You mentioned cash crop replacement. I guess one of the challenges is the price of the crop. The value of the opium is so high that it's hard to find a replacement that would match that. So a local farmer is caught with a choice between feeding their family and growing something else. You've obviously been following this issue. Are there things that you would point to immediately that we should be pushing a little more toward, or is it more “Figure that stuff out yourselves; I'm telling you this is the way we need to go”?

Dr. Mark McLean: Well, I've suggested at the end of the written presentation that I think more needs to be known about this. That end of things is really not my area of expertise.

I do think more work could be done to identify the costs, not only to Canada's population and the amount we spend on health and enforcement, but also the costs to other nations that may be impacted by the heroin that's grown in Southeast Asia. It would be possible to identify and quantify health and social outcomes associated with the growth and production of opium. It may be that an international collaborative effort that is informed by that new information would be made cost effective by the tallying of the costs on the outcome side.

The Chair: Okay.

Mr. LeBlanc, did you have a quick question?

Mr. Dominic LeBlanc: Yes, thank you, Madam Chairman. Libby had followed up on some of the enforcement things I wanted to ask Dr. McLean.

In your international research, I'm impressed with the international context that you've put some of these supply issues in for us. I remember—and this is anecdotal in a sense—that the American media, certainly in the Reagan and Bush administrations, made a lot of the U.S. going into the supply countries, be it Colombia or Southeast Asia, and trying to get at the supply of drugs. This is my own editorial, but there was a lot of denial in their own country about the use, so they made a big virtue out of going into many of these other countries, be it with the DEA or other American authorities, and trying to control the supply and production of some of these drugs, or do the interdiction before it left these other countries for the United States or other transit points.

This may be anecdotal, but are the U.S. authorities still investing a lot of effort in trying to control drugs at the supply level, at the production level? We don't seem to hear as much talk about DEA officers running around in the jungles of Central America any more.

Dr. Mark McLean: I believe they are. Under the Clinton administration, the U.S. increased their effort in Colombia. A lot of that was related to the equipment that was provided to the Colombian government and the Colombian military to fight against sources of drug supply.

I think the U.S. is aware.... It seems that from a number of different areas lately I've heard that the U.S. was involved in the last Soviet venture in Afghanistan 10 or 15 years ago. In the wake of that, Afghanistan became a major producer of heroin in the world. I think they have indicated that they will continue to be involved in that country for many reasons. One of the reasons would be because of that historic problem of opium production that happens in Afghanistan.

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My personal belief? I don't think there is evidence that a heavy-handed policy in that international area is effective. That's why I recommend a process of developing information in this area and building the international political will to deal with this. I don't think it can be an external observer that monitors production decreases by itself. It would need to be a cooperative effort, working with governments and working with communities, working with regions that are the producers, and looking at the issue as to why they are producers.

It may be that in some cases, if the production is related to funding criminal activity or funding armies, it cannot be a cooperative venture. In some cases it may be that a cooperative venture may work. It might not necessarily be alternative crop programs. There may be other economies or other economic activities that could be put in place that would give other options to people in those nations. To find some way to support them in developing their own economies so that they do not see the option of producing opium as a viable alternative, as much as they presently do....

Mr. Dominic LeBlanc: Thank you.

The Chair: Dr. McLean, this committee is going to continue to do its work probably until about June. So if you have other issues that come up in the next couple of months that you'd like to send us information on, or if you have colleagues in the field who want to send us information about ideas for how we can recommend changes to the government...our report is due November 2002. So you have to back that date up a couple of months.

We appreciate your coming before us today.

We're a little off schedule, colleagues. Perhaps I could suspend for one minute and get the next two witnesses on, and then we'll be in a better timeframe to finish at 12:25 p.m.

Do you have another question?

Mr. Randy White: It's all right; I'll pass.

The Chair: If we do have other questions, we can forward them to you and get the response back.

Dr. Mark McLean: Please do. Thank you very much for your time.

The Chair: Thank you very much for your time, Dr. McLean. Good luck.

Colleagues, we'll suspend for one minute.

Perhaps the other witnesses who have been waiting in the room could come forward.

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• 1200

The Chair: I'll call the committee back to order. As I've said several times now, we're the Special Committee on Non-Medical Use of Drugs. We have two individuals before us today. As you can see, we're roughly 25 minutes to half an hour off.

We have appearing as an individual, Joan Gadsby, and appearing on behalf of the International Drug Education and Awareness Society, we have Lynda Bentall. We can go first in either order.

Ms. Gadsby, you're listed as first. Would you prefer that Ms. Bentall go first?

Ms. Joan Gadsby (Vice-President, International Benzodiazephine Awareness Network): First of all, I'd like to correct the statement. I'm not appearing as an individual. I'm also appearing on behalf of the hundreds of thousands of Canadians who have become accidental addicts to prescription drugs. I'm vice-president of the International Benzo Awareness Network and also the author of a book.

The Chair: Okay. It's in there.

If you would like to go first, we have ten minutes for each of you and then an opportunity for some questions.

Ms. Joan Gadsby: I'm going to start. First of all, I'm the author of a book internationally endorsed by experts in the field, and I'm going to pass that on to Libby. I'm also a survivor of prescription drugs that were prescribed after my son died with a brain tumour. For twenty years I did go through an unintentional overdose. I've rebuilt.

In the last eleven and a half years it has cost us $2 million personally.

This is a television documentary I did with Jack McGaw, formally of W5, which is aired across Canada on CTV. I'll pass this up as well.

I am recognized as an international speaker on the subject. I've presented in London, England, and I have presented to the World Assembly for Mental Health here in Vancouver with a thousand people from around the world. I've also been asked to speak at the World Forum on Drugs, Dependencies and Society, which is coming up next fall.

Essentially what you have in front of you is a little of the information. I have a motion here. I had a call yesterday from the Women's Liberal Commission out of Ottawa to present to this particular committee. What you have in front of you is only part of the material I faxed through. It's a motion regarding benzodiazepines, which are tranquillizers, sleeping pills, and antidepressants prescribed by doctors.

Doctors in this case are the pushers. The majority of people do not give informed consent to the use of these drugs.

I'd like to go through this resolution. Basically, I'm referring to Ativan, Rivotril, Valium, Dalmane, Serax, etc., and I want to point out to this committee the very serious side effects of these drugs. We have seniors who have been given these drugs for years and years who end up with dementia. We have people cognitively impaired. About 51% of the people who get prescribed these drugs suffer gradual intellectual deterioration.

I might mention that my background is as a marketing executive for four of Canada's largest companies. I grew up in Ontario. I'm a graduate of Western and undertook MBA studies at UBC. I worked with Colgate-Palmolive, Scott Paper, Kelly Douglas & Company Limited. I'm very familiar with the fact that the repeat prescribing of drugs puts money into the pharmaceuticals' pockets. It also means that once you have people hooked, they repeat visits to doctors' offices.

In terms of other side effects of the drugs, you were talking about overdoses earlier with respect to illegal drugs. The problem of legal drugs is ten times the problem of illegal drugs in terms of absolute numbers. In North America, 200,000 people die in a given year from the effects of these prescription drugs. Also heroin and cocaine are nothing by comparison in terms of withdrawal to benzodiazepines. Generally speaking, for every year they're prescribed these drugs, people go through one month of protracted withdrawal.

In my case it was two years. Part of my rebuilding has involved neuropsychological testing and going through major cognitive retraining.

I might also state that in my background is 13 years as an elected poll-topping councillor in North Vancouver district. I fully understand the political process.

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Let me go back to the adverse side effects. We have cognitive impairment. We have suicidal ideation, which creates the unintentional overdoses. People are not going out and overdosing intentionally on these drugs. We have psychiatric symptoms caused by these drugs. In the DSMIV guidelines it says substance-induced anxiety disorders, substance-induced mood disorders, substance-induced depression. What happens here is people get in the mental health stream who were never in the mental health stream before and end up...and it's a progression: benzodiazepines, antidepressants, neuroleptics, and anti-psychotics.

I brought with me today something to show you.

Randy, this young woman, 20 years of age, happens to be an example.

I never ever tried illegal drugs, nor would I.

This young woman, 20, started out with illegal drugs. She went into the methadone program and then she ended up on benzodiazepines and antidepressants, some 10 different listed prescribed drugs in her system.

There's a coroner's inquest on this young woman next week...and it's also criminal intent in terms of the doctor.

I'm also going to pass around to you my own story, To hell and back, which appeared in Southam papers across the country. I have done nine hours of national television. I was on Canada A.M. and others.

Okay, what other aspects are there? In May, when the issue was being dealt with in the House of Commons and I had letters from Bonnie Brown, who is the chair of the Standing Committee on Health, I asked to present. Four and a half years ago, April 1997, I presented on this issue and nothing happened. It's all documented in the book.

Additionally, as you will note from the material I've given you, I presented to the Senate on October 18. Fortunately, Senator Lucie Pépin raised the issue in the Senate a year ago in the fall.

The point I was making here is that the House of Commons was dealing with labelling for alcohol products. I immediately contacted a number of members of Parliament. I said, what about floppy baby syndrome? Benzo babies? The babies of these mothers who are prescribed these drugs are born with withdrawal symptoms very similar to fetal alcohol syndrome, and in the long term their lives can be seriously affected.

Now what's different here? These mothers have been prescribed these drugs by the doctors. They haven't gone out and sought illegal drugs.

In my case, in 1970, my youngest daughter, who is now 30, was born. She was 10 pounds, 4 ounces. I was on Librium. No doctor told me I shouldn't be on Librium. He prescribed them. My daughter was put in the equivalent incubator at 10 pounds, 4 ounces. It's all documented in the book. The book documents what the hell I went through in terms of withdrawal. I dropped 25 pounds. One hour's sleep a night. Hallucinations. Paranoia.

I am a single parent but very good friends with my former husband.

I was prescribed the drugs, as you heard me say, after my son died with a brain tumour. I just lost my oldest daughter with breast cancer. That young woman, who was one of the brightest women you could ever find, saved my life from overdoses three times.

She grew up in our household with me under the effects of these drugs and with the horrible stress of all of that. She saved my life. She pulled me off the second-floor deck of my home. People on these drugs go through paradoxical reactions.

What did I do? I hit the front page of the Vancouver Sun by throwing a suitcase through an airport door in Kelowna. A paradoxical reaction. What else did I do? I bit a policeman's finger. It was totally out of context. I might add that I have been off these drugs for eleven and a half years, and you can see my determination and my passion to do something about the problem.

On impaired driving, I've been in touch with Mothers Against Drunk Drivers. People are not told they can't drive a car. Some 40% of the people who are affected by these drugs are in car accidents, and it's in my television documentary. Under the effects of these drugs in their system people are driving, not only affecting their own lives but also those of other people.

So what's the problem here? Health Canada...and Allan Rock has read my book. He has done nothing.

You have in front of you a letter I wrote to Jean Chrétien, which is only part and parcel of the materials you have. I gave personally to Jean at a board of trade luncheon here in Vancouver a copy of my book. I wrote this letter dated October 1, 2000. Since that time, I am personally aware of 45 deaths.

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What I said here, and I put it in writing when I faxed it to you people, is, who's listening? Who's doing something about this? There has been no action to date. I've been to meetings with Allan Rock, and to fundraisers, and so on.

I will mention simply this. In my letter to Jean Chrétien I said this situation is analogous to the Red Cross blood scandal. My efforts for change have been very constructive, but unfortunately many people have lost everything.

I've asked the Prime Minister not to put this in a deep, black hole with a delay in action, stonewalling, bureaucracy, and politics. But sadly, that seems to be where it's going.

Four and a half years ago I presented on this subject. I have been lobbying, I have written my book, and I have the television documentary out. I'm not going away, because I relate to this young woman.

All the material you have is on the website out of the U.K., www.benzo.org.uk. I want to draw to your attention the lack of action and accountability about benzodiazepine. However, I want to also bring to your attention that the anti-depressants today, Prozac, Paxil, Zoloft, and Luvox, are simply the follow-ups to the benzodiazepines, 25-plus years later.

When I was in Washington, D.C., I met with the health research group. In regard to these young women who are hurting their children, the school shootings, the Columbine High School shooting, you find out that these people were not on these drugs before. In most cases they did not go through these personality changes until they went on the drugs.

The Chair: Thank you, Ms. Gadsby.

Ms. Joan Gadsby: I just want to—

The Chair: No. Actually that will have to come up in the questions and answers.

Ms. Joan Gadsby: Okay.

I just want to say that my brother Paddy lives in Burlington.

The Chair: Thank you.

Ms. Joan Gadsby: There are 5,000 lawsuits in the U.K., and in respect to alcohol, people who did not drink alcohol before being put on these drugs will become cross-addicted to other drugs, mostly alcohol, because of the mini withdrawal between pills.

There's a lot more I could say, but I am here because this needs your help.

The Chair: Thank you. We'll have some time to debate that in the questions and answers.

Ms. Bentall.

Ms. Lynda Bentall (President and Chief Executive Officer, IDEAS (International Drug Education and Awareness Society)): Thank you very much.

I'm here today with some notes, not because I need them, but because I need to control myself with a ten-minute limit. I have my passions as well and have been known to speak for four or five hours without notes. So these are for me, not for you.

I'm here today not to give you a scholarly or scientific paper, but only to tell you what I know. What I know is what I see and what I experience daily as we run a program for disadvantaged kids in the lower mainland. It's call the Ailanthus Achievement Centre, and it's absolutely unique in the world. It's unique in terms of the scope of what it provides for the kids, it's unique in that we personally fund it to the tune of $3 million a year, and it's unique in that it's in fact probably the only effective program for disadvantaged kids in the world. It will be featured very soon in a 90-minute documentary being done by Academy Award-winning documentary filmmakers from the U.S.

Let me now just talk about what I see. I work there seven days a week, 12 hours a day, and I am totally devoted and passionate to the children. We see children whose lives are generally dominated by drugs. With over 150 of the kids we serve each year, we're very close and have very intimate knowledge of their lives and the circumstances that made them qualify for our program.

With only limited time available here today, I'm just going to summarize a few basic issues.

First, well over 90% of the kids' primary caregivers, parents, and guardians, use proactive drugs, psychoactive drugs, on a regular basis. These are not downtown east side parents. These are families living in homes in Surrey, New Westminster, Vancouver, and Burnaby. In fact, not only are psychoactive drugs a large part of their families' lives, but they define their lives every minute of the day.

In the majority of cases, we hear of parents using this assortment of drugs daily, partying at home and outside of the home regularly, disappearing for days on end, leaving young children unattended with no food in the house and no certainty as to when a grown-up will show up. This often leads to—and it's a very common experience—10- and 12-year-olds, as the eldest in the family, staying at home to tend to the younger siblings because there's no grown-up at home.

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We hear of the frequent violent, drug-centred parties, or moms bringing home dangerous people who harm children in every imaginable way. We hear this on a daily basis. All of this is supported by welfare, and all of these things have no consequences. In a province like this, which has such a weak child protection service, the children lose.

We hear also every day about teachers and government workers who join the kids in smoking marijuana. We hear about the smoke pits that exist in every high school, where an entire spectrum of drugs are sold, bought, and used, sometimes on school property. We hear every day about the raves, about the use of ecstasy being considered normal as a party drug, and about the accidents and violence that kids experience while on drugs. We must never forget that these children are the parents of the future and they are the future of our country. Their fate is clear. It is destined that they will become just like their parents: uneducated, drug-dependent, neglectful, and with destroyed potential.

But one of the saddest things I know about and hear about frequently is the very large number of teenage deaths attributed to accidental drug overdoses, and they are not really that at all. They compile your statistics, but these are not accidental drug overdoses at all. They are suicides. The kids tell us that. They tell us of studying various drug overdoses that they witness in their friends in order to determine which one they will use to die.

So unless a child leaves a suicide note, which most apparently do not, the death is considered accidental. But the kids laugh at this information when they read it in the paper, because they know the truth. So when we attempt to solicit instruction from social workers or health workers, they now tell us that they have been instructed by their superiors that they are no longer allowed to tell a child not to use drugs. They are now instructed only to give advice on safe ways to do drugs.

But I think anyone who cares about a child or cares about life knows that drugs can never be safe. As I am sure you find as you travel and do your studying, no one in the country will start off the discussion about drugs with a premise that psychoactive drugs are somehow good for children. I think every citizen in this country will begin by saying drugs are not good for children, and that is where we have to begin.

But it looks like, as a society, somehow we have given up and said, well, there's nothing we can do about it.

We have built a beautiful $7-million facility at the corner of 14th and Commercial. Outside my window every day I see drug deals conducted in open view on the street corner. I see teenagers going into The Compassion Club across the street, the so-called medical marijuana facility. We see known drug dealers, who are highly recognizable, going in there too, coming out with large takeout cartons. They run a service there like a McDonald's takeout, and when we ask police officers, who often use our building to observe crime in action, what they're going to do about it, they generally shake their heads and say there's nothing they can do about it. They have been instructed not to make any drug arrests, either for possession or for dealing. They have been instructed not to do anything. When you ask a police officer how he feels about that personally, he generally looks quite distressed.

The standard answer we hear everywhere about drug availability and drug use and the fact that it's killing our children is “There's nothing we can do about it.” But of course there is. We need to have the political and social will to institute prevention programs and to increase law enforcement. Those are the best forms of harm reduction, and there are no other forms.

When we need to provide treatment for those severely afflicted, we need to look about and say, what kind of treatment are we currently offering? It's not that there's a shortage of funds. We read the propaganda in the newspaper about the shortage of treatment centres. That is not consistent with our daily and weekly experience. We see a lot of treatment programs; they just don't happen to be any good. We see the swinging-door, six-week programs that even their administrators scoff at. One of the children in our program has a father who has been in a Vancouver treatment centre 17 times in the last five years. One has to ask the question, why isn't it working?

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This is why we and a group of friends decided to form IDEAS. There's going to be a conference. We're calling it the International Drug Education and Awareness Symposium. We created a new society, and we are funding it privately in order to bring together Canadians of influence to learn more about this topic. Everywhere we go we find that, generally, everyone seems to have the same information, and, from our point of view, it's erroneous information. So we decided to organize a conference so that they could hear about valid research and learn about experiences in other countries, not just in Canada. They would have an opportunity to ask good questions. They could share information about topics such as why Sweden, which was well on its way and then changed its path, is now virtually drug free. Sweden is a country that is winning the war on drugs, and we are bringing people from Sweden to tell us how they did it.

Australia was following the same liberalized path as Canada and was farther down that path. It has had a lot of its permissive policies highlighted. We've just learned that following the election, it is about to attempt to turn the situation around. In fact, the government won the election on that particular position.

We believe that Canadians are not getting proper information. They're getting propaganda. It's our hope that with proper information, Canadians will choose to turn our path around as well.

I invite all of you here today to attend our conference, which will take place over three days in May, and I thank you for inviting me here today.

The Chair: Thank you. That took nine minutes and 15 seconds. Thank you for condensing your comments.

I'll now turn to Mr. White for five minutes.

Mr. Randy White: I compliment you on your timing. I don't think I could have done better than that.

Ms. Lynda Bentall: Thank you.

Mr. Randy White: I'd like a very quick clarification. You mentioned 150 kids a year. Exactly what does the centre do? I think you said $3 million a year is spent operating a $7 million centre. Where are you getting your money?

Ms. Lynda Bentall: We fund it privately.

Mr. Randy White: I'd like you to be brief, because I have another important question.

Ms. Lynda Bentall: I have some material on the program. If members are interested, I'll leave it with you.

My husband and I fund it privately from our personal wealth. We're dedicating all of our wealth to this. We've done it for 11 years, and we'll do it for 21 more years. Then the money will run out.

Mr. Randy White: I thought that was the answer. Now I know which Bentall you are. I didn't want to ask you that question, but I got to it indirectly.

Ms. Lynda Bentall: Yes, the notorious one.

Mr. Randy White: What do you think of safe shoot-up sites?

Ms. Lynda Bentall: I think it's ridiculous. I think it's an employment scam and that it is driven by propaganda. I think a lot of the so-called harm reduction movement is really aimed at creating a higher level of comfort in our society with the whole issue of drugs and drug treatment, somehow making it seem as if it's acceptable, that it's just another illness and we have to be humanitarian and all of that. I don't believe there can be such a thing. It's an oxymoron to say that you could have a safe drug injection site. There's nothing safe about drugs or injection.

Mr. Randy White: Thank you. The 150 young people who go through there in a year, are they drug addicted when they go in? What's the result?

Ms. Lynda Bentall: No, they're not drug addicted. Because of the drug addiction and drug dependency in their homes, they usually end up having difficulty at school. They don't have proper nutrition and proper care. They end up having to stay home to take care of younger babies. They're looking for their parents. There's violence and chaos in the home. They don't sleep or eat. The criteria for selecting them is that they've already begun to wander out on the street. They begin sofa surfing in order to find places to stay that are safe. Of course, that interferes with school.

We have never met a child who by the age of 13 has not used marijuana. It is free and available. All of our children at least by the age of 15 have been introduced to the older people who they say give them drugs free on the street and who are on the edge of the sex trade that's connected with the drug trade for kids.

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They've all used drugs. But we have a zero tolerance rule. So the moment they start in our program, they're no longer allowed to use them. Even if they become hung over, they're kicked out of the program.

They then make a decision. We give them support. We use a world-class level of performing arts to build confidence and courage. But our real objective is school, so we get them back on track with school. We have our own full-time and after-school programs. Our goal is that they will all be college and university graduates, so we support them academically. We also support them personally. We have to provide dental care, medical care, all of these things, because these children have never been taken care of.

So yes, they've used drugs, but that was just the destructive part of their life. The larger destruction in their life was the level of inattention and chaos in their homes because their parents were drug addicts. But you could see what happens. As that pattern begins, the kids drop out of school. They're on the street. They're trying to make a different life, because no one is taking care of them. They end up being part of the very large drug constituency. Then they become the parents of the future, and the cycle repeats itself.

We see the cycle repeating and repeating, and there's only one commonality. It's certainly not poverty. We get a little disturbed about the fact that every time there are problems with the disadvantaged sector of society, it always comes down to, well, they're poor. What we have seen is that these people are abusing welfare. There are usually two or three welfare cheques. They drive nice cars. They are not at all poor. They get sufficient funds to take care of their family, but they choose not to do so. Instead, when there is a drug dependency problem, all of the money goes toward drugs.

Mr. Randy White: I don't have any more time, I'm sure, but I want to thank you for the job you're doing. The people who have money and spend it well are the ones who help so much in our society.

Could you just confirm whether or not that is residential?

Ms. Lynda Bentall: We work really hard at trying to find other relatives or family members who might be able to take care of the kids. In the cases where there just isn't a safe place, where the kids have been in and out of group homes and foster homes and in and out of very dangerous situations, if they're prepared to adopt the kind of boarding school attitude our residence has, they can join us. At present we have 16 kids who live with us full time.

Mr. Randy White: Good for you.

The Chair: Does the B.C. government make them wards of your organization?

Ms. Lynda Bentall: No. Parents sign them over. All of the parents are drug addicts. What's interesting is that, as they give us a document saying that we can act as guardians, which they can do to anyone, they have never asked us a question except for, will it affect our welfare child benefit if we turn the kid over? Our answer to them always is, we are not in any way connected to the government. We get no government money, and we have absolutely no information about your financial relationship with the government. Then they say okay. So they continue to get the $500 or $600 a month child benefit, which usually relieves them of any sense of responsibility for their child. So they can just go and buy more drugs. It's all about drugs.

The Chair: Thank you.

Next is Ms. Davies for five minutes.

Ms. Libby Davies: Thank you.

I wanted to pick up on one of the comments you made in your presentation, Lynda, where you said that we've given up. I really wanted to take issue with that. I think there really is an incredible debate taking place where, on the contrary, there has been a much greater exposure to the issues and challenges we're facing through the City of Vancouver's report, A Framework of Action, and a whole number of reports that have come forward. The people I talk to every day have not given up in terms of trying to support healthy communities and providing people with better information about the choices they make. Maybe you think some people have given up, but I feel that more and more people—

Ms. Lynda Bentall: Every official we speak to tells us that.

Ms. Libby Davies: —I have not finished yet—have not given up, actually.

I wanted to ask you about your conference. I note that it's in partnership with the Drug Free America Foundation. I wondered if their policy is not to invite people who don't agree with your point of view. You say very clearly that this is not a conference that intends to explore all sides of the issue. Then you say advocates of harm reduction have been heard and you make no apology for their exclusion. So I'm curious to know what the involvement of the Drug Free America Foundation is in terms of their financial support for your conference and whether or not their policy is, like yours, to exclude people from engaging in an open debate. If people cannot afford the $425—I think that's what the registration is—how do you intend to ensure that people have some access if they can't afford your conference? Or is your purpose not to invite them?

• 1230

Ms. Lynda Bentall: We have three sources of income for the conference. Number one, we are charging $425 including GST for those who attend, and that will cover the cost of meals and materials. Drug Free America is covering the travel costs of seven speakers and we, personally, are covering the rest.

Ms. Libby Davies: Who has selected the speakers?

Ms. Lynda Bentall: I've worked with them and we have checked resources around the world. Drug Free America, because they put on conferences throughout the U.S., were familiar with a lot of those we're bringing. We checked out curricula vitae and they've sent us tapes and videotapes of people they know. We've selected from a few of those who we thought were really impressive speakers and would effectively cover the topics we want covered. Through other resources we have within the RCMP...a lot of those individuals have been to conferences around the world. They've given us other names they thought were impressive speakers and all of that, so we've selected from some of the ones they have had experience with and that the RCMP officials have had some experience with.

Ms. Libby Davies: Are the RCMP in B.C. supporting your conference?

Ms. Lynda Bentall: The Drug Awareness Unit is, yes, of course.

Ms. Libby Davies: Mr. Chuck Doucette, is he a part of this as well?

Ms. Lynda Bentall: He's been an adviser. We've had meetings with him. Yes, I think anyone who would like to see fewer drugs in our society would support this conference.

You asked about who we invite. Because we can only accommodate 500 people in the hall and because there has never been such a conference in Canada, we've had to limit who could come. We didn't want it to turn out to be a community argument or a brawl, so that's why we've invited senators, every member of Parliament, every MLA in B.C. and Alberta, and MLAs and ministers in all the other provinces. We've invited all the judges and magistrates in B.C. We've invited the heads of major foundations who fund educational programs, superintendents of schools, and health officials who lead health boards across Canada.

We've gone with a selection of those who we call Canadians of influence, those who may be asked an opinion or may be participating in a debate in their community about what kinds of strategies they're going to undertake. That's why it's limited.

Ms. Libby Davies: Will your conference be looking at the City of Vancouver's report, A Framework for Action, which was produced by the mayor?

Ms. Lynda Bentall: It's not specifically going to be there, but the general topic—

Ms. Libby Davies: Why wouldn't you do that?

Ms. Lynda Bentall: Because it's not specifically about Vancouver and it's not—

Ms. Libby Davies: But it has been endorsed by ten major cities across the country—

Ms. Lynda Bentall: Yes.

Ms. Libby Davies: —and it has been presented to the federal government. It's a very major document. Why would you exclude information or that perspective from your conference?

Ms. Lynda Bentall: Because it's not a sophisticated document. We've compared it with others in other cities. It's not a sophisticated document and it's not about Vancouver. It is one of the sources of concern to us that that document, developed here, was in fact sent to other Canadian cities, who said if Vancouver has done its job well and is doing this, then this must be what we'll do too. That's why we're doing—

Ms. Libby Davies: In what way is it not sophisticated?

Ms. Lynda Bentall: I believe it's superficial. The emphasis is on harm reduction, which most authorities will agree is not the place to end.

Ms. Libby Davies: That's not the—

Ms. Lynda Bentall: Well, that is what they're doing.

Ms. Libby Davies: It's about four pillars.

Ms. Lynda Bentall: Yes, I understand the four pillars. What I'm saying is that treatment prevention, law enforcement, and harm reduction have to be looked at and examined and implemented in a particular order. If you do them in the wrong order, which is what Vancouver is doing, in my opinion—doing harm reduction first—it actually interferes with the development of the other three.

Ms. Libby Davies: Where do you get the idea that they're doing that? What we heard this morning is that they're very much implementing the four pillars as an integrated approach and that one is not separated from the other. If you don't understand that, I really question what the purpose of your conference is.

Ms. Lynda Bentall: I do understand that—police officers in Vancouver tell us they have been instructed not to make any drug arrests because of possession and that they're not to do any drug arrests for dealing, even at the intermediate level. Those are their instructions and that's part of the Vancouver plan.

Ms. Libby Davies: That's not what we heard yesterday.

Ms. Lynda Bentall: Well, that's—

Ms. Libby Davies: You can read the testimony from yesterday.

Ms. Lynda Bentall: All right. But I'm saying that is our information.

The Chair: Thank you very much. That concludes that round.

Mr. LeBlanc, did you have any questions?

Mr. Dominic LeBlanc: No.

The Chair: Thank you.

I'm not sure if there are any questions, but we are at the end of this session.

Ms. Gadsby, there weren't any questions specifically directed to you at this point. You've given us this book, which we—

Ms. Joan Gadsby: No, I haven't given it to you.

The Chair: Oh, I'm sorry, I—

Ms. Joan Gadsby: I have to pay for them too. I gave it to you to have a look at.

The Chair: Thank you. We'd be happy to purchase one for the committee to read because—

Ms. Joan Gadsby: That would be helpful with respect to the TV documentaries and the video.

The Chair: I noticed the price of the book. I didn't notice the price of the video, so we'll talk about that afterwards.

Ms. Joan Gadsby: Okay.

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The Chair: What I wanted to say to you clearly was that the issue you brought to us wasn't strictly within the framework of what we were supposed to be discussing. However, you have given us some food for thought and a lot of information. If we have further questions, we will be happy to get back to you.

I think you have raised an issue that is of concern to all of us around the table, but not necessarily one that was specifically part of our mandate. Whether that's a good thing or a bad thing, it's there. I appreciate you coming before us today and the effort you put into your presentation, as well as the work you're doing. I wish you much success.

I call this session to an end. We are suspending until we board the bus at 2 o'clock.

Ms. Joan Gadsby: Can I ask you a question?

The Chair: Yes.

Ms. Joan Gadsby: I didn't think it was either, but when I had the call yesterday I was told...I had your clerk send the terms of reference and it does make reference to prescription drugs. The issue of the crossover between illegal and legal drugs is a major thing. The point Lynda is making here...I have oodles of stuff on that. You know, turning kids into prescription drug junkies is the same thing—Ritalin, anti-depressants.

The Chair: Yes.

Ms. Joan Gadsby: If it is one of the issues that may be outside your mandate, how come this is happening?

The Chair: Right. I would be happy to have a copy of those, if you would like to.... You don't have to send them to us. You could send us the references and we'll source a clean copy ourselves.

Ms. Joan Gadsby: Okay. The other thing I'm sorry I didn't have a chance to mention is this little booklet that was produced in 1982—

The Chair: I can't read it from here.

Ms. Joan Gadsby: —called The Effects of Tranquilization: Benzodiazepine Use in Canada. I talked to Monique Bégin when I was presenting in Victoria recently. She was the minister at the time. This went out to all doctors across the country. It basically identified, almost 20 years ago, some of the points I mentioned in terms of side effects. This document, it is anticipated, will be the basis for a major class action lawsuit in Canada—I'm not involved with that—on behalf of thousands of Canadians.

The Chair: Okay.

Ms. Joan Gadsby: It's not a document that I've referenced, but you may want to have a look at it.

The Chair: Okay, we'll get a copy of that for the committee members. I really do appreciate your efforts and am quite impressed by your recovery. Congratulations to you.

Ms. Bentall, good luck with your conference.

Ms. Lynda Bentall: Thank you.

The Chair: We appreciate you taking the time to appear before the committee and the efforts you make for our communities. We wish you good luck.

Thank you. This meeting is adjourned.