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37th PARLIAMENT, 1st SESSION

Special Committee on Non-Medical Use of Drugs

COMMITTEE EVIDENCE

CONTENTS

Thursday, February 21, 2002

0905

The Chair (Ms. Paddy Torsney (Burlington, Lib.))

0910

0915

Mr. Remo Paglia (Operation Springboard)

0920

The Chair

Mr. Dennis Long (Executive Director, Breakaway)

0925

0930

The Chair

Mr. Elio Sergnese (Director, Caritas)

0935

Dr Joyce Bernstein (Vice-Chair, Toronto Public Health, City of Toronto)

0940

0945

0950

The Chair

Mr. Randy White (Langley--Abbotsford, Canadian Alliance)

Mr. Remo Paglia

Mr. Randy White

Mr. Remo Paglia

Mr. Randy White

Ms. Wnada McPherson (Coordinator, Diversion Office, Operation Springboard)

Mr. Randy White

Mr. Dennis Long

0955

Mr. Randy White

The Chair

Mr. Dennis Long

1000

The Chair

Dr. Joyce Bernstein

The Chair

Mr. Remo Paglia

The Chair

Mr. Randy White

Dr. Joyce Bernstein

Mr. Randy White

Dr. Joyce Bernstein

1005

The Chair

Mr. Ménard

Mr. Remo Paglia

Ms. Wanda McPherson

Mr. Ménard

1010

The Chair

Mr. Dennis Long

Mr. Ménard

1015

The Chair

Mr. Dennis Long

The Chair

Dr. Joyce Bernstein

1020

Mr. Ménard

Dr. Joyce Bernstein

The Chair

Mr. Dennis Long

Mr. Ménard

The Chair

Mr. Elio Sergnese

Mr. Ménard

Mr. Elio Sergnese

The Chair

1025

Mr. Derek Lee (Scarborough--Rouge River, Lib.)

Dr. Joyce Bernstein

Mr. Lee

Dr. Joyce Bernstein

1030

Mr. Lee

Dr. Joyce Bernstein

Mr. Lee

Dr. Joyce Bernstein

1035

Mr. Lee

Dr. Joyce Bernstein

Mr. Dennis Long

Mr. Lee

The Chair

1045

Ms. Wanda McPherson

The Chair

Ms. Wanda McPherson

1050

The Chair

Ms. Wanda McPherson

Mr. Dennis Long

The Chair

Mr. Dennis Long

1055

The Chair

Mr. Elio Sergnese

The Chair

Mr. Elio Sergnese

The Chair

Mr. Elio Sergnese

The Chair

Dr. Joyce Bernstein

1100

The Chair

Dr. Joyce Bernstein

The Chair

Dr. Joyce Bernstein

1105

The Chair

Wanda McPherson

The Chair

Randy White

Dennis Long

Mr. Randy White

Mr. Dennis Long

1110

Mr. Randy White

Mr. Dennis Long

Mr. Randy White

Mr. Dennis Long

Mr. Randy White

Mr. Dennis Long

Mr. Randy White

Dr. Joyce Bernstein

Mr. Randy White

Dr. Joyce Bernstein

Mr. White (Langley--Abbotsford)

1115

Dr. Joyce Bernstein

Mr. Randy White

Dr. Joyce Bernstein

Mr. Dennis Long

Mr. Randy White

Mr. Dennis Long

Mr. Randy White

The Chair

Ms. Wanda McPherson

Mr. Remo Paglia

Mr. Dennis Long

The Chair

Mr. Réal Ménard

1120

The Chair

Joyce Bernstein

The Chair

Mr. Dennis Long

Mr. Ménard

Mr. Dennis Long

1125

The Chair

Mr. Remo Paglia

Mr. Ménard

The Chair

Mr. Dennis Long

The Chair

Dr. Joyce Bernstein

Mr. Ménard

Dr. Joyce Bernstein

The Chair

1130

Mr. Lee

Mr. Elio Sergnese

Mr. Lee

Mr. Elio Sergnese

Mr. Lee

Mr. Elio Sergnese

Mr. Lee

Mr. Elio Sergnese

Mr. Lee

Mr. Elio Sergnese

Mr. Lee

Mr. Elio Sergnese

Mr. Lee

Mr. Elio Sergnese

Mr. Lee

Mr. Elio Sergnese

1135

Mr. Lee

Mr. Elio Sergnese

Mr. Lee

The Chair

Mr. Elio Sergnese

The Chair

Mr. Elio Sergnese

The Chair

Mr. Elio Sergnese

The Chair

Mr. Elio Sergnese

The Chair

Mr. Elio Sergnese

The Chair

Mr. Elio Sergnese

1140

Mr. Dennis Long

Mr. Elio Sergnese

Dr. Joyce Bernstein

Mr. Dennis Long

1145

The Chair

1150

1155

Mr. Raffi Balian (Co-founder, Illicit Drug Users Union of Toronto)

1200

1205

1210

1215

The Chair

Mr. Randy White

The Chair

Mr. Randy White

Mr. Raffi Balian

Mr. Randy White

Mr. Raffi Balian

Mr. Marc McKenzie (Volunteer, Illicit Drug User Union of Toronto)

1220

Mr. Raffi Balian

Mr. Randy White

Mr. Marc McKenzie

Mr. Raffi Balian

1225

Mr. Randy White

Mr. Raffia Balian

Mr. Randy White

Mr. Raffi Balian

Mr. Randy White

The Chair

Mr. Ménard

Mr. Raffi Balian

Mr. Ménard

Mr. Raffi Balian

Mr. Ménard

Mr. Marc McKenzie

1230

Mr. Ménard

Mr. Raffi Balian

Mr. Ménard

1235

Mr. Raffi Balian

Mr. Marc McKenzie

1240

Mr. Lee

1250

The Chair

Mr. Marc McKenzie

The Chair

Mr. Marc McKenzie

The Chair

Mr. Raffi Balian

The Chair

CANADA

Special Committee on Non-Medical Use of Drugs

NUMBER 025

1st SESSION

37th PARLIAMENT

COMMITTEE EVIDENCE

Thursday, February 21, 2002

[Recorded by Electronic Apparatus]

¿ (0905)

[English]

The Chair (Ms. Paddy Torsney (Burlington, Lib.)): I call this meeting to order.

We are the Special Committee on the Non-Medical Use of Drugs. We were struck as a committee in May 2001 with a mandate to consider the factors underlying or relating to the non-medical use of drugs and to report back to the House of Commons by November 2002.

¿ (0910)

This meeting today is part of a series of meetings. We've had some across the country--and we're hoping to continue--besides the meetings we've had in Ottawa.

I'll introduce my colleagues to you and give you their political affiliation. We were commenting even yesterday on how we're not that partisan compared with some committees.

My name is Paddy Torsney. I'm the member of Parliament for Burlington. Randy White is the vice-chair of the committee and the Canadian Alliance member for Abbotsford, British Columbia. Réal Ménard is the Bloc Québécois member for Hochelaga--Maisonneuve, which is probably a bit like the Queen Street east area of Montreal--c'est vrai? Derek Lee is the Liberal member for Scarborough--Rouge River. And we will have Dr. Hedy Fry from Vancouver Centre, also a Liberal, join us sometime later this morning.

We have our clerk and our researchers who keep us on track and a whole series of people who keep the meeting running properly. You don't need to grab the mikes; they'll take care of it.

I'll introduce our witnesses. From Operation Springboard we have Remo Paglia and Wanda McPherson from the Diversion Office. From Breakaway we have Dennis Long, the executive director. From Caritas we have Elio Sergnese; he is the director of that organization.

Remo, why don't we start with you and move to Dennis and then over to Elio?

¿ (0915)

Mr. Remo Paglia (Operation Springboard): Thank you and good morning.

Thank you for the opportunity to describe Springboard's work in Toronto with over 2,300 youth and adults charged with cannabis offences. For over 30 years Springboard has designed and delivered programs that work in preventing and reducing crime. Through 15 Ontario locations we engage over 400 volunteers each year in servicing over 9,000 youth and adult offenders and those at risk for criminal involvement.

In 1997, Bill C-41, section 717, recognized formal alternative measures for individuals charged with simple possession of cannabis. In May 1998, with Department of Justice Canada seed funding, Springboard began delivering an adult cannabis diversion program at Toronto's Old City Hall court. Justice Canada also supported a cannabis diversion program for youth aged 13 to 17 in April 2000.

With dedicated program supports, cooperation of the crown attorneys, and the identification of accountable alternatives such as public service placements, the use of diversion increased significantly. Typically, federal crown attorneys support post-charge diversion for first-time accused only; a second arrest will normally find the youth and adult criminally prosecuted.

Crown attorneys first screen and then refer appropriate diversion cases to a Springboard staff. With informed counsel from their lawyer or duty counsel, youth and adults are accepted into the program once they acknowledge responsibility for the offence and choose to complete 25 to 40 hours of public service.

Based on individual issues, diversion participants can access such services as drug counselling, employment, and educational training. When determining diversion conditions, any physical or mental issue and the cultural and linguistic backgrounds of the accused are taken into consideration.

Crown attorneys approve the diversion condition and the case is adjourned and monitored for two months to allow for the completion of the diversion arrangement. The individual returns to court, and if the requirements are completed, the charge is withdrawn; if not, the crown proceeds with prosecution.

We gained public support for cannabis diversion by incrementally involving people and groups and agencies not traditionally involved in the justice system. We focus on engaging neighbourhoods and groups in the design and supervision of public service projects and placements to service the homeless and disadvantaged.

Our own market research on public interests, commissioned in 1997 to Dr. Tony Doob of the University of Toronto's centre for criminology, confirmed that the public supports cost-effective alternatives to formal criminal justice measures such as court and jail, if they provide effective, meaningful, and accountable consequences and are satisfied by youth and adults.

Here are some program highlights from May 1, 1998, to December 31, 2001: the youth and adults served by the program are 2,341; the number of public service hours they've performed is 65,134 hours; the police witnesses who do not have to appear in adult court are over 4,000; community agencies and groups participating number 211; and compliance in completion of diversion requirements is at 94%.

Independent research funded by Justice Canada and undertaken by Ryerson Polytechnical University on 665 diversion cases confirmed that only 32 people, or 5%, incurred another criminal conviction--six for the same or for similar offences.

What does all this mean to this committee? The post-charge diversion model is effectively decriminalizing the simple possession of cannabis offences. Independent research confirms the success of and support for such an approach. With a community focus these programs also provide such satisfying outcomes as the following.

They provide a more timely response to criminal prosecution for violating Canadian laws without the consequences and stigmatization of a criminal record for employment and international travel. They enable early intervention in drug education. They benefit the community by the public service performed. They're a sort of catalyst to engage public support and participation in the criminal justice system. They provide individuals with opportunities to contribute and connect with their community resources, and they free up court resources to focus on more serious matters.

Springboard has also achieved a key program goal by securing support for an alternative police response to the likely arrest for cannabis possession. The Department of Justice Canada has approved a proposal for a Toronto Police Service referral program, which, instead of charging youth for such offences--simple marijuana possession, for example--police will refer them to Springboard for the design of an accountable consequence, such as drug education, public service, or counselling for problem areas.

As an alternative to formally charging youth, the Toronto Police Service youth referral program addresses the Toronto Police Service requirement to consider community options to the formal court process for youthful offenders as set out in the principles and objectives under the extrajudicial measures provision of the new federal Youth Criminal Justice Act.

Currently in its start-up phase, the program is establishing a centralized intake and assessment centre to provide the Toronto Police Service with a single point of access to a broad menu of accountable diversion service and program options at the pre-charge stage.

Through the active participation of Springboard's numerous community agency partners, assessments, prevention, and intervention services will focus on securing referrals to best practice programming designed to meet the needs of youth. Initially being offered in the Toronto Police Service 41 and 42 division catchment areas, the program will be replicated in other divisions, and eventually to all of Toronto.

There are more learned witnesses speaking to this committee on the implications of cannabis use and other matters now under study. In the meantime, we can offer the committee these four considerations and recommendations.

First, diversion programs and best practices should be supported, replicated, and funded as an alternative to criminalizing simple cannabis possession because they provide meaningful and cost-effective consequences that the public supports while avoiding the implications and stigmatization of a criminal record. The Commons committee can encourage broader use of diversion options under existing legislation, such as section 717 of the Criminal Code, and currently use discretion as well as support for provisions of the new Youth Criminal Justice Act for extrajudicial measures.

Third, existing federal criteria for alternative measures should be re-evaluated. The current exclusion of many first time accused, the inclusion of other controlled substances, such as ecstasy, crack or cocaine, and diversions availability to those subsequently suspected or charged with such offences are some examples requiring study.

Fourth, based on the successes of well-run post-charge diversion programs, the Commons committee could broaden support for police response at the pre-charge level for simple possession of cannabis offences. However, this approach will rely on the availability of alternative consequences and programs, such as drug education and police capacity, to quickly access them through collaborative service partnerships.

In closing, Springboard's diversion programs demonstrate sensible approaches for responding to cannabis offences outside the court system that do not challenge public concerns. These program strategies encourage local partnerships for prevention and will advance community capacity to tackle the problem use of other and more serious illegal drugs.

Thank you.

¿ (0920)

The Chair: Thank you very much, Remo.

First I'll introduce Dr. Joyce Bernstein from the Toronto Public Health Department with the Drug Prevention Centre. Then I'll go to Dennis Long, who is from Breakaway.

Mr. Dennis Long (Executive Director, Breakaway): Thank you, and thanks for the opportunity to address you today.

I want to describe my agency a little bit, then I want to talk about.... I pulled out your terms of reference and I really want to try to address some of the questions you've raised. You've raised an enormous amount of questions to be answered in five to seven minutes. But I will talk about the work we're doing.

Breakaway is an agency that provides four major programs in the city of Toronto.

We provide a day treatment program and a youth out-patient program to treat young people with drug-related problems and their families. More importantly to the work of this committee, we also provide a rather extensive street outreach program that provides needle exchange, condom distribution, and safe injection instruction, and works both on the streets and in the detention centres in Toronto. The final program is that we provide two levels of methadone service: a low-threshold program, which we do in partnership with the City of Toronto's public health department; and a full-service methadone program, which we operate in the west end of the city.

What I wanted to talk about was really to get to the core of what you're talking about, I hope. I've been working in this field for about 20 years now. When I read your questions, the thing that came to my mind was that the large amount of harm we see in our clients, particularly the street outreach clients and the methadone clients, is coming because the substance is illegal and not because of the effects of the substance itself. That's going to be the premise on which I want to make my remarks this morning.

You've asked what we should be doing. First, we really should be reforming the laws. My colleague talked about diversion and all kinds of things. We have all kinds of complicated things to deal with people who are charged with possession and so forth, when we probably should be moving this into a social and a medical field of work, so that people can get effective treatment for the kinds of problems they may be experiencing with the drugs, and people who are not experiencing problems with the drugs are left alone.

What does that mean? It means effectively that we need more money in the treatment and the prevention and health promotion aspects of the work. When I say prevention, I do not mean prevention that is focused on stopping people from using drugs, but prevention that is focused on the safe use of substances and a reasonable way to approach the use of substances.

I personally believe that substances such as marijuana and probably many of the other illegal drugs should not be illegal. They should be regulated and we should be controlling their use, but we should not be making them illegal. We are putting an enormous amount of resources and money into prohibition of substances. In my experience--and I think this is well supported by the data--it has been proven that prohibition does not work. It simply does not work.

The people in my agency who are clinicians follow a form of therapy called “brief solution focus therapy”. One of the precepts of that therapy is that if you find something that works, do more of it; if you find something that doesn't work, stop doing it. I think that needs to be applied to the field of drugs.

Clearly, prohibition and the enforcement of ineffective drug laws is simply not working. It has had no effect whatsoever on consumption rates. It certainly has no effect on the number of people coming to my clinic. If anything, those numbers have increased. We are now running a six-month waiting list for the youth programs. So if it's supposed to be reducing the amount of drugs that people are using, it's simply not working. Maybe we should stop. We do need to take those resources, which are enormous, and place them into effective treatment and effective education.

We also need to look at a number of initiatives that are being tried in other jurisdictions. We are sort of tentatively moving around the edges in Canada. Such things as heroin prescription and safe injection sites are certainly ways that we need to go. They would be of great assistance to the people we currently work with, particularly those who are on the street, on the understanding that a lot of these folks are not going to stop using immediately just because someone passes a law or we come as helpers and say they have to stop using. We do need to be able to reduce the amount of harm to them as individuals, and to the community as a whole, that results from their use.

Initiatives such as prescribing heroin and providing safe places for people to inject would, in my opinion, go a long way toward reducing those kinds of harms to people and to the communities they live in, as we have done with methadone and with needle exchanges, particularly in the city of Toronto. I think we have proven that both of those initiatives work and work effectively. Over the last five years, we did increase the availability of heroin through prescription in Toronto, so that we eliminated a situation where we had a year-long waiting list for methadone.

¿ (0925)

We are now in a situation where people have to wait only a matter of weeks to get into a methadone program. It's a major improvement, and it has resulted in a significant drop in heroin deaths and other kinds of harm to people in the city who are heroin addicted.

I'm sure my colleague Joyce will be talking about the needle exchange program the city runs. It has been substantially effective.

We do need desperately to reform the drug laws in this country. It makes my job and the job of my clinicians extremely difficult. We are always trying to help people with their legal difficulties, and it takes away from helping people with what they really need help with, which is how to reconstitute their lives and learn to live in an effective and productive way within their communities.

In this province we are also being starved for resources. Not one of the addiction-servicing agencies in this province has received an operating increase in the past decade, with the result, of course, that we are now substantially behind where we were ten years ago in the number of services we can provide. In this year we are likely to see a number of services across the province close their doors for periods of time because they simply cannot meet the budget.

We have significant inequities in the number of services, availability, and accessibility on a provincial basis. People in the rural areas find it very difficult to access methadone. If there's only one doctor prescribing and that doctor leaves, closes up shop, or gets sick, they're out of luck. Sometimes that's for an area as big as a couple of hundred square miles.

Many areas of the province simply don't have the ability to provide the service. For example, in Cornwall, Ontario, there's no one prescribing methadone. People have to go to Ottawa or Kingston, which is not an insubstantial distance. For some people that would be a daily trip.

We have an inadequacy in the drug benefits programs to handle people being on methadone. Although the cost of methadone itself is very low, the cost of dispensing it is substantial. It could be up to $10 a day for individuals, and often that is not covered by a provincial drug plan.

The situation is substantially worse when we look at other parts of the treatment continuum. For example, residential services for young people who find themselves in difficulty with substances are virtually non-existent in the province, despite five years of lobbying on behalf of the need for residential capacity services for kids under 16.

That's just a snapshot in the time I have, which I'm sure is rapidly closing. I can give you only a little bit of it.

But I want to say that in this province--I can't speak for other provinces but I suspect they're in the same situation--we're approaching a crisis in the ability to provide effective treatment that is accessible and available to all. This needs to be rectified. We are still pumping an enormous amount of money into interdiction, which in my opinion is not working.

Thank you.

¿ (0930)

The Chair: Thank you very much, Mr. Long.

Mr. Sergnese.

Mr. Elio Sergnese (Director, Caritas): Good morning, and thank you for asking me to be here.

For those of you who are unfamiliar with Caritas, I have brought with me copies of more detailed information about it and its origins.

Caritas, which, incidentally, is the Latin term for love, is a non-medical, two-year residential recovery centre for substance dependency and for those who suffer from other social and mental health issues. It is registered as a non-profit charitable organization and it offers diversified programs to meet the needs of our clientele.

Currently, we have the capacity to hold 50 male residents in several houses within the greater Toronto area, a working farm in Orangeville, and a spiritual centre in King City. We also have a similar program for women called Mater Dei, which operates under the direction and supervision of the Passionate Sisters of Canada.

Most of Caritas' funding is derived from fundraising events, donations from both the private and corporate sectors of the community, and foundations. We also receive 30% of our funding from the Ontario Ministry of Health, which is allocated to our day program. Of these revenues, 83% is allotted to program operation and maintenance of residential houses. Volunteers play an integral role in helping to support our financial resources.

Currently, we have 13 full-time staff members, consisting of myself, one mental health consulting therapist on-site, four administrative personnel, and eight program coordinators. We have a general practitioner who comes to our centre once a month and a consulting psychiatrist for our clients with concurrent disorders.

We rely heavily on volunteer workers who are members of the Caritas family association, the community at large, and those who offer their professional expertise. Without seemingly appearing prejudiced, our mission and purpose are based on our belief and philosophy of providing a therapeutic environment commonly referred to as a school of life.

We believe the strengths of the program are based on the following: a two-year drug-free residential program with stringent rules and regulations, so our clientele learn self-discipline, life skills, interpersonal relationships, and communication skills; counselling for inside therapy, support, and guidance in staff relationships; weekly ongoing family support to individual and group discussion; inquiry group meetings for new applicants, so they may become acquainted with the program, and it also gives us an opportunity for initial contact; community education in the form of school presentations for drug awareness; and availability of community resources, publications, and community events.

Our admissions process is as such. The client may apply through referral from the community resources, the criminal justice system or correctional institutions, and personal and/or family consultation. The client must be detoxified for at least five days prior to admission. They must contact the director for initial contact and set an initial meeting together with their family members. The client is required to attend a weekly inquiry group meeting at least a month prior to admission. During this time assessment tools are applied. Upon admission an intake interview is conducted.

Currently we have a long-term residential program, a day program, and a transition program. We have several proposed programs, as you will notice in the handouts, that are under review. For the time being, we are unable to implement these due to lack of funding.

Within the context of our current program, we provide the following opportunities and experiences: residential community living, farming and livestock experience, sports and recreation, community outings, special social events, individual and group counselling, outreach and network programs through the family association, community education, introduction to vocational trades, follow-up and relapse prevention, weekly cultural day workshops, and horticultural courses.

The program is structured in four phases. I won't get into much of a discussion about the differences in the phases.

Some of the current issues and concerns that we are facing include funding. I guess all of my colleagues face the same problem. As it is, we are operating with very minimal funding, and with the proliferation of other clientele with concurrent disorders and methadone clients, we find it quite difficult to provide the necessary assistance that these clients deserve, although we try to do our best.

Clients with concurrent disorders require special attention and approach, almost an ongoing close supervision of well-trained staff in the area and monitoring of prescribed medication. We cannot always provide this.

Methadone clients also require special attention and approach with close supervision. We do not have the resources to accommodate these clients, to provide a slow tapering that many request, and we have discovered that we are not alone here. However, this leaves the methadone client who wants to rid him or herself of the addiction to methadone with nowhere to turn.

Adolescent clients have different needs in terms of growth and development but very limited options when it comes to residential substance abuse treatment. To my knowledge, there are only two residential treatment centres for adolescents under 16 years of age.

There are discrepancies and disciplinary measures between the goals of the program and the criminal justice system.

There is a lack of incentive and assistance related to trades training or retraining after completion of the program.

Finally, I'd like to speak to one last point. While it has been said that our program is quite strict and rigorous, we pride ourselves in that our success rate is about 70% to 80% recovery. Most of our clients now complete the program after the initial phase of anger and shock, satisfactorily reintegrate into society after the completion of the program, and continue to participate in our weekly support meetings and after-care meetings as well as other events.

Thank you.

¿ (0935)

Dr Joyce Bernstein (Vice-Chair, Toronto Public Health, City of Toronto): Thank you. Thank you for the opportunity to be here today. I apologize for being late.

Maybe it's a sign of the times. I'm listed as representing Toronto Public Health and the Drug Prevention Centre. The Drug Prevention Centre no longer exists due to lack of funding.

To briefly introduce myself, I've been an epidemiologist for Toronto Public Health since 1989. My responsibilities have included representing the organization on the Research Group on Drug Use, RGDU, as we call it, since 1990.

This group is a partnership of agency representatives concerned with local drug use. Along with Public Health, other members include the Toronto Police Service, the RCMP, the Office of the Chief Coroner of Ontario, and the Centre for Addiction and Mental Health, among others.

For the first part of my presentation I will address the longstanding relationship between the Research Group on Drug Use and Health Canada's CCENDU network. I've chosen the topic of CCENDU because it is a national organization that I didn't see mentioned too much in your briefing notes. I have not come here as a representative of CCENDU, but I think it's an initiative that should be preserved, should be expanded, and should be careful not to get into certain traps, which I'll also address.

Following these remarks I'd like to talk about a type of prevention programming that I think could be incorporated into the national CCENDU model.

And I'm afraid that's all time will allow.

I'll begin with CCENDU. For those of you who may not be familiar with CCENDU, the initials stand for the Canadian Community Epidemioliogy Network on Drug Use. CCENDU consists of representatives from local drug research groups, similar to the Toronto research group, from across Canada. Local groups that comprise the CCENDU network currently include Halifax, St. John's, Fredericton, Moncton, Ottawa, Toronto, Kingston, Edmonton, Calgary, Winnipeg, Regina, Vancouver, and even Whitehorse--and I may have missed a few.

Additional CCENDU network members include members of the national coordinating body. Each local site produces their own annual report on drug use, choosing the data from a variety of sources locally available and deemed useful by the group members who prepare the report.

Using Toronto as an example, local reports combine drug-related data from local surveys; records of police seizures; purity reports from Health Canada; data from provincial treatment monitoring systems; hospital emergency room data; coroners' reports of drug overdose deaths; and so on. As well as reports focusing on drug use in high-risk groups such as street use, pregnant women, and injection drug users, the Toronto report also utilizes reports from the city's needle exchange program, which Mr. Long was telling you about, as well as from street outreach workers who provide information on individuals who are under-housed or otherwise at high risk for serious problems relating to drug use.

While the CCENDU network provides an ideal vehicle for information sharing across the country, seven years of work have also revealed some potential problems to be avoided by this growing group, and I would like to address these briefly.

I'd also like to mention that I'm not a medical doctor, that I have a PhD in statistics, and I'd like you to use those qualifications in assessing the remainder of my remarks.

The first caution I have relates to the unnecessary and costly data expenditures that we often see. These include large projects devoted to developing nationally based data and monitoring systems. As a regular invited guest at the U.S. National Institute on Drug Abuse, I have had the opportunity to learn about the data collection systems of our U.S. counterparts.

While the DAWN system of monitoring drug use among hospital emergency department patients and the ADAMS system of estimating drug use among arrestees in the United States supply data to local sites and our national recording systems, there is tremendous dissatisfaction with these costly national systems and serious questions about the scientific validity of the data they provide. They do make headlines on CNN and USA Today, but I would contend that's about all they are useful for.

Speaking of costly projects, I know that others who have spoken to you have advocated for a national survey on substance abuse. Contrary to the conventional so-called wisdom, my own opinion as a statistician is that there is little to be gained and much to lose from such a cumbersome, costly, and scientifically biased national survey.

¿ (0940)

Such national projects do little to assist in planning or in service delivery. Don't be fooled into thinking that asking the same questions across the country ensures scientific results. The real information regarding where drug-related problems are being experienced, what the problems are, and how best to react is much more likely to be provided by local, focused, specific reports. As a statistical consultant, I can guarantee you there is little if any scientific merit for arguments supporting national undertakings. Alternatively, if national estimates are deemed absolutely essential, I would support a system where local data would be used to provide national estimates.

The first slide I have brought illustrates a second potential pitfall of national data systems. In ill-fated attempts to mathematically adjust survey responses for differences in response rates and other geographic factors, it has become customary to “adjust” the patterns of actual responses observed in surveys of large populations. More often than not, however, this means that those responses that are least representative of an underlying population will be weighted the most heavily by those controlling the survey.

Practically speaking, it means just what the man in the cartoon is telling us. Despite the long, carefully constructed, sophisticated formulas used, he is not sure what the final answers mean. Do they actually apply to anyone? Who is this average Canadian substance user? And thus the analogy with national estimates that combine and blur good local information into mysterious yet so-called standardized estimates.

But no matter, according to our friend on the next transparency, the obscurity of these indicators is part of their appeal. Basically what he's saying is that the beauty of these estimates is that nobody knows when he's making a mistake.

Compare the alternative of using agency data, which documents the number of individuals with specific drug-related problems requesting specific services. While direct service data also has its faults, we generally know what units of measure are being used. We can generally think about what some of the pitfalls might be and what biases we may be encountering in the data.

Along with producing or using overly cooked data, I would also urge the network to stay the course in promoting reports that focus on local prevention issues as opposed to a more academic approach to research. As you have likely discovered in your sampling of available literature, social science journals include a seemingly endless number of conceptual frameworks and other theoretical constructs to describe the highly complex issues of prevention and treatment. However, the utility of this growing body of literature documenting these theories is very difficult to understand.

Given that there is no shortage of reports documenting specific problems that have been mentioned by panellists today, which also include soaring rates of hepatitis C among injection drug users, the lack of residential treatment facilities, or the high percentage of traffic fatalities involving alcohol or other drugs, it is difficult to understand the utility of further academic studies in promoting action. And it is action that is sorely needed if the devastating problems we are all seeing are to be rectified.

I will use the few remaining minutes to speak about prevention. More specifically, I will briefly discuss the potential of school-based mentoring programs, a cheap, effective form of prevention programming spreading throughout North America, and with good reason.

The idea behind mentoring is to provide a consistent adult friend/role model for a youth deemed to be at high risk for any of a range of problems. The benefits of fostering a relationship with an adult who can be counted on for a degree of comfort and support at school are obvious to those familiar with studies of resiliency and youth.

The one-on-one mentoring program administered by a partnership among the City of Toronto Public Health, local school boards, the Centre for Addiction and Mental Health, the Boys and Girls Club of Toronto, and the Toronto Rotary Club currently provides mentors for 80 high-risk youths in Toronto.

¿ (0945)

The children who participate in the program, who we awkwardly call “mentees”, are never forced to accept a mentor, but much to our surprise and delight, having a mentor has not generally proven to be a stigma. In fact, it is widely considered to be cool.

Most of our past and present mentees have met either Barbara Hall, who initially approved the program and used to skate with us once a year, or Mel Lastman. Most have a photograph of themselves in a group with a mayor.

Mentoring programs are volunteer-based and thus cheap. They are among the most respected forms of drug prevention that focus on children living in high-risk situations. The structure of the programs is simple. School officials recommend mentees for the program. With parental permission, a trained and screened volunteer is matched with each participating child. Mentor and mentee pairs have lunch together once a week in school. The mentor is encouraged to plan some fun activities.

My 11-year-old mentee and I read the newspaper together over sandwiches and chocolate raisins. We also like to watch video footage of WNBA games and practices. We do art projects, play basketball, play on the computer, and talk about everything.

Participation in the program is, of course, no guarantee of a problem-free adolescence, but I can think of little else that has so much potential for helping youths at the highest of risk. The Toronto presentation of our one-on-one mentoring program at the 1999 CCENDU national meeting was very well received. The possibility of supporting a CCENDU initiative in mentoring is an idea that may be worth exploring.

The nationally based RCMP has been a vital partner in CCENDU projects across the country. Using this relationship to assist in the development of local school-based mentoring programs could facilitate more mentor-mentee matches, as well as help restore vital prevention services and personnel, such as school nurses, social workers, and guidance counsellors, who are quickly disappearing from our public schools.

I'll stop here. Thank you again for the time.

¿ (0950)

The Chair: Thank you for your presentation.

We'll now turn to questions from the members of Parliament. Mr. White, for ten minutes.

Mr. White may ask a question to somebody specifically, but if other people indicate that they would like to answer, I'll keep track.

Mr. Randy White (Langley--Abbotsford, Canadian Alliance): Thank you, Paddy.

Good morning to you all. I think we have time for a couple of rounds. I have questions for each one of you.

Joyce, you just blew a couple of my theories out of the water.

I want to ask Mr. Paglia about cannabis. You spent basically all of your time on cannabis issues. Many people have told us we should just either decriminalize or legalize cannabis. Could you tell me whether or not you think cannabis is addictive?

Mr. Remo Paglia: With our presentation in terms of Springboard, we're not purporting to have clinical, medical answers in and around that. I'm not qualified to speak to the addiction element of it.

Mr. Randy White: Okay. I've had addicts say it is and that it's a springboard and it's a gateway drug and all that sort of thing. I just wanted to get your opinion of that.

Mr. Remo Paglia: I'm going to ask my colleague, Wanda McPherson, to respond.

Mr. Randy White: Don't be shy. I'm not trying to trick you into anything.

Ms. Wnada McPherson (Coordinator, Diversion Office, Operation Springboard): Wonderful.

As the coordinator of the program, I'm working pretty closely with the individuals who are coming through. We've reported the numbers who are coming through as over 2,000 since we started the program. It's been my experience that very few of these people present with issues surrounding addiction. For the very small percentage who would have, this is an excellent opportunity for us to provide them with referrals to get that kind of service. But generally, the people who seem to be coming through this program aren't presenting as addicts.

Mr. Randy White: Thank you.

Mr. Dennis Long: Yes, I think I would support that statement. Classically, addiction is something where you get sick if you stop, essentially--to make it very simple--and it is very difficult to develop a withdrawal syndrome from marijuana. You'd have to smoke heroic amounts to find that syndrome anywhere, and I've not, in 20 years of clinical experience, seen it. So I think the answer is no, it's not addictive, but it certainly is psychologically dependency-creating, and people can get themselves into a situation where they think they can't get through the day without smoking some.

That is equally difficult to treat as a full-blown addiction, and in some cases even more difficult, depending. But in most cases, I would say that the vast majority of people who we see with so-called marijuana problems generally have other life issues that are more significant, and the actual work to help them reduce their use is relatively simple compared with that of other drugs, for example, cocaine or tobacco.

¿ (0955)

Mr. Randy White: That was my warm-up. Damn. You four--three in particular--have presented a situation that's been presented to us numerous times. This is that we need more rehabilitation. Some people say we need some safe injection sites, we need needle exchanges--we need, we need, we need. Canada is in a health care crisis where we can't really provide the best health care nationally because of the shortage of resources, and the expense of it, and that sort of thing.

This committee has to make some recommendations by this November to the House of Commons, and I am still perplexed at how it is going to be possible to address all of these issues. In the areas you work, each one of you almost basically said that funding is short. How on earth do you think it's going to be possible to put this whole program of drugs together, given that there is a scarce set of resources out there, and probably not a priority on drugs in the nation at the moment, although there's a heightening awareness? Certainly we have aging seniors, and we have cancer, and we have HIV, and so on and so forth. Can you tell me whether you think you're flogging a dead horse at this point?

The Chair: I'll start with Mr. Long, and then Dr. Bernstein.

Mr. Dennis Long: We're absolutely not flogging a dead horse, and let me just go backwards through what you said.

Yes, you're right. The health care crisis that's looming, or already here, in this country relates to a number of factors, the aging population being probably one of the most significant. Being at the leading edge of the baby boom myself, I've been looking around at the health care problems of my friends and neighbours and seeing that this is going to be a major problem.

However, we do need to take a really hard look at...and a lot of times people just don't understand how much of an impact drug-related problems have. There's an estimate floating around in Ontario about a $9 billion cost, including productivity loss and health care costs, for the use of substances in this province, legal and illegal. That's not an insignificant amount, and I would probably stand quite firmly behind the number. Somewhere in the neighbourhood of 20% of hospital admissions are related to substance use of one form or another, and 20% is a significant amount of the health care dollar. It goes on and on, and I could certainly spend a lot of time running through the figures.

I don't think people are aware of just what it costs us to have people using substances at problem levels in this country. However, we are engaged in a very expensive--probably less expensive than the Americans', but still a significantly expensive--war that has the idea that if we enforce laws rigidly enough and we bring enough enforcement people to bear on the problem, we will be able to restrict the amount of supply in this country, and it has flat out and completely failed.

Maybe we should take some of these resources and put them into health care and put them where they belong, because this is not working.

I'll give you a personal example. I was sitting on my cottage dock this past summer one day. It was a very beautiful summer morning and I heard this wackita, wackita, wackita sound, like in Apocalypse Now, and a helicopter went over and then went back and forth and back and forth. This helicopter was looking for dope in people's backyards. When I asked in town, they said the helicopter was costing $8,000 a day to fly back and forth to find small patches of marijuana in people's backyards. I wondered about the effectiveness of that.

À (1000)

The Chair: Thank you.

Dr. Bernstein.

Dr. Joyce Bernstein: It's certainly a very difficult question, and I don't envy you your task. However, I do have a couple of recommendations that, given my remarks, won't surprise you.

There is a lot of junk science related to drug abuse, and researchers get away with it. Look at the consultants' reports you will be collecting. Look especially at academic reports theorizing resiliency, preventive factors, things that make people resilient and otherwise vulnerable to drug use, and all sorts of other academic exercises.

I come from the world of academics. I spent time there before my current stint in public health. I can tell you, there is a blurring between the university world, the academic consultants, and public health issues that needs to be sorted out. A lot of money is not being used wisely.

Included in this, I would say, are reports that estimate the dollars spent on different aspects of the drug abuse problem. I don't think we need any more studies like that. It's like buying a new computer; as soon as you buy it, as soon as you complete it, it's obsolete.

As well, I wouldn't start by trying to map out the entire national drug abuse problem. I think that's a tremendous problem when we go from local problems to a national solution. There are definitely ways, and I've mentioned a few of them, where a national group can help in monitoring and directing local and provincial activities. However, I would be very discouraged if I saw coming out of this group recommendations to conduct more national surveys. If the surveys and reports we have now aren't enough to lead us into certain directions.... Maybe they're not the ideal programs, and maybe they're not the absolute end in framework and prevention methods, but they are a start. And we need to start.

The Chair: Mr. Paglia.

Mr. Remo Paglia: [Inaudible—Editor]...feel that by the replication of such programs as diversion from minor cannabis offences and any expansion to ecstasy, the amount of dollars saved from law enforcement, as an example, could in fact be beneficial to the taxpayer. We've talked about saving the time and money involved in police officers testifying in court for these minor cases. We show that these types of programs can actually offer some relief in terms of their ability to perhaps have that money go to other areas.

The Chair: Mr. Sergnese, any comment?

Mr. White.

Mr. Randy White: I have a quick one here.

Joyce, we just have to talk. I've been planning all along to...or on the idea that there needs to be a national survey. In fact, many people have told us that it is necessary. I think the last one was done in 1997.

The researcher is saying 1994. Well, that's even worse.

I sense the situation's getting worse. We know it is, but we don't know how much worse. Are harder drugs and cocaine in elementary schools today, where they weren't before, and in high schools more than they were before? How bad is the situation? Where is it going? Who's involved, and what's needed? It's that type of thing I have difficulty appreciating.

What I hear you say is that a national survey would serve no use. In fact, you did say that. How does one tell where one is without doing a check on it?

Dr. Joyce Bernstein: As I said, you have local reports from groups entirely across the country.

Mr. Randy White: No, no, let me clarify that. That is not necessarily the case. I know in my community, and in other communities I've been in, community services might do a bit of a survey but the city does not, or the province does not. It's far from consistent in this country.

Dr. Joyce Bernstein: But do you feel it's necessary to interview every person in the country on their drug use in order to have the estimate that would lead to some action? I think what you have to do is consider some of the reports that exist.

Take, for example, the recent provincial study on substance abuse done by the Ontario provincial government, based on the Ontario Health Survey.

They went into the homes of 49,000 people in Ontario and wrote a special report on substance abuse, the major finding of which was that substance abuse is affected by social, economic, and individual factors. This was the overwhelming conclusion of the report. I have it on my desk. I can supply you with copy.

You'll see this in large-base reports all over. They either focus nationally on phoning people--and then you get no information on street use, no information from people in hostels, people on the streets and so on....

I would bet your national survey is going to be a vary biased look at the healthiest Canadians you can find. That's the first obvious problem with it. If you say well, we're going to combine it with more focused reports on various groups, we have those. Those exist. There are tremendous local studies everywhere you look, though maybe not in your particular village or city.

But wouldn't it be more advisable, much more economical, and much more of a way of pointing to definite action to perhaps have a provincial overseer looking at where we are lacking information in a particular area of the province? This person could talk to the local experts in this area and find out what its major problems are. I will tell you that this will give you much more information than any telephone survey you can conduct. You'll also have variable response rates across the country. You'll be weighting data, I can guarantee it.

The Toronto Public Health Department was never able to receive the raw data from the Ontario Health Survey. Why? Well, our suspicions were that the data was not very good. But it was so cooked and so manipulated by those responsible for administering this survey that the numbers we were given really pointed us in no direction at all. They were so general and such averages of apples and oranges that they were in fact totally useless to us.

À (1005)

The Chair: Thank you.

Mr. White, Mr. Ménard.

Mr. Réal Ménard (Hochelaga--Maisonneuve, BQ): I am going to ask my questions in French.

[Translation]

This is our 25^th meeting since this committee was created and, believe it or not, each meeting brings a whole new parade of questions. So can you imagine, if we keep going until the month of June, how many things we'll have to untangle?

I am starting from two premises for participation in the work of our committee. The first premise is that the best solution to the problem of addiction is going to come from the community.

My second premise is that we should not look at things from the point of view of morality. These are the two markers I had set for myself to try to ponder these questions.

I address my first question to Operation Springboard. Did I understand correctly that once people have gone through a program with you, that they have participated in some hours of public service, the Crown can still lay charges, after the youth's community service has been performed?

[English]

Mr. Remo Paglia: Once the public service hours are completed the charges are withdrawn. If the youth do not follow through with their required sanction, which is usually public service, the crown may proceed with the charges.

Ms. Wanda McPherson: However, if I may interject, we actually represented two separate programs here. One is the post-charge diversion program. It is driven by, and eligibility is determined by, the crown attorney. If the young person or adult complies with the sanctions, the charges are withdrawn.

But we also presented a pre-charge model that we're working on with the police, where a charge won't actually be laid. Instead, they'll be referred to us as a social service agency. We will look at what might be required there as a community solution, and again, if the person complies, the charge will never go forward.

So there are two different programs in essence decriminalizing cannabis.

[Translation]

Mr. Réal Ménard: I understand.

At the beginning of our work, we met our colleague, Senator Nolin who gave us a study - I don't know whether or not the clerk will be able to send you a copy--which was based on a great deal of research that had been carried out in Great Britain, in the United Kingdom, which proved on paper, in a fairly scientific way, that cannabis did not have any adverse implications when consumed, that it did not create any dependence. It seems to me that a question is going to be asked of this committee. If we have fairly clear data on cannabis, which comes to us, and I repeat myself, again, from the United Kingdom, we also have data which imply that for ecstasy, heroin, the so-called hard drugs...

However, there is a professor at the University of Ottawa who told us that we should make no distinction between hard drugs and soft drugs, but, just for the purposes of our exchange, let us say that is what I am going to do.

What are you, as clinicians, trying to get me to understand. I am addressing myself in particular to Mr. Long, but as well to anyone else who would like to respond.

Do you believe that we have to make that distinction, that, as parliamentarians, we could undertake on one hand to make recommendations about cannabis, but maintain the fairly formal prohibitions and a fairly rigorous legislative framework for the other types of drugs?

À (1010)

[English]

The Chair: Mr. Long is next, and anybody else who would like to comment.

Mr. Dennis Long: I think your question is a good one, and I'm going to answer it on two levels.

First, I like your premise, going into this work, that the best solutions are community-based. The second one, which I heartily endorse, is that we shouldn't adopt a moral stance here.

My own opinion, and one we should probably be striving for, is that drug use should be approached from a value-neutral approach; in other words, it's neither good nor bad, but simply part of human existence. If we accept that as a premise, we begin to be able to think more clearly about how to address the problem of drugs within our society.

If we are always coming from the moral stance that using drugs is a bad thing and something that makes the user less morally correct than the rest of us, I think we always run into difficulties in being able to apply appropriate laws and measures toward controlling the harms that result from that use.

Having said that, I would agree with you--and whoever it was in England who made that study--that the harmful impact of marijuana on our societies is certainly negligible, when compared with certain other substances, for example, alcohol and tobacco.

I would also agree there is a powerful argument that the laws we currently have on the books that prescribe the use of marijuana are based on morals and values, as opposed to any kind of practical application and whether or not they protect us from any harm.

My own opinion is they do not. They just create more difficulties and make it much more difficult to deal with the relatively small minority of people who experience difficulties with that drug.

Personally, and from a very theoretical level, I would approach all other drugs in the same way. I would agree with whomever it was from Ottawa who said you shouldn't be making distinctions between hard and soft drugs. It would make it a lot easier for us to deal with all the other drugs if they were not prescribed and we did not have to deal with the rather cumbersome mechanisms of the courts and laws, and so forth, as we try to address problems that are essentially personal and social.

I think, however, the real politic of that is probably something else. It might be very difficult to convince Canadians that the decriminalization of heroin, for example, would be a good thing and beneficial overall to our society, which I believe is true.

However, from a practical perspective, we probably need to start with the legalization of marijuana, move ahead with that, and try to at least take that drain off our resources, because we're simply using an enormous amount of money and energy on what are essentially ineffective laws.

[Translation]

Mr. Réal Ménard: For example, yesterday, we lived through an experience which we are going to remember for a long time. I am the member for Hochelaga-Maissonneuve, which is a fairly disadvantaged area. Obviously, it is not just a disadvantaged area but also one where there is a question of dependence. Yesterday, we were in Burlingon, which is upper-middle class, and we met some community stakeholders who are involved in a needle exchange program. I asked a question about the profile of their clientele and I understood clearly that the somewhat simplistic link that we sometimes make between disadvantage areas and drug use does not stand up to analysis, since drug use affects all segments of the Canadian population.

Earlier, you said prescribing heroin might have results. We can hardly equate marijuana and heroin. What did you have in mind when you said that prescribing heroin could produce results?

Secondly, I have a question for all the witnesses. There is a controversy among us, fellow members. We don't agree on one point. In communities where there is a needle exchange program, does this lead to increased use?

We asked the question. We received many different answers. What is your point of view?

À (1015)

[English]

The Chair: Mr. Long.

Mr. Dennis Long: I'm going to let Joyce do the needle exchange thing. I do run a small needle exchange; her department runs a rather large one. My answer would be no, but I'll let her do the basics of it.

What we see in our clients is that it has absolutely no effect on the amount they use if people can get clean needles.

However, to go back to your original question on the prescription of heroin, we would strongly endorse this. What I said in my remarks at the beginning of today's meeting was that the large majority of harms people experience as a result of their drug use are related to the legal situation, to the fact that the drugs aren't prescribed. By that I mean they may get impure, varying dosages; they have to deal with criminals in order to obtain their drug; they often find themselves in various subcultures that are violent and difficult. The trade itself breeds violence and socially detrimental situations. All of that relates not to the drug, which is, if you'll forgive me, a relatively safe drug, if used properly.... I can see the skeptical look. That is in fact true.

If you can get a clean, well-titrated supply of heroin, you can live a long, happy, and very healthy life using heroin on a daily basis. And I would contend you could not do that using rather large amounts of alcohol or tobacco. In comparison, those two are different in terms of safety. Heroin itself is relatively safe. It is not safe in the current way it is provided to people, because people get varying dosages, they don't know what it's been cut with, they don't know what strength it is, they don't a lot of things they should know about using the drug, and they have to buy it from somebody who is living below the law.

On the other point you made, of whether it cuts across all areas of society, our methadone program has people with law degrees coming in Mercedes, as well as people who are homeless, and everybody in between. I would contend that drug use pervades every aspect of society, and the use of heroin, in particular, is not restricted to those people who are poor and destitute, but covers every level of society. You'd be quite surprised.

So I would contend that the prescription of heroin would be a very positive and beneficial harm-reduction approach.

The Chair: Dr. Bernstein.

Dr. Joyce Bernstein: Thank you.

I would say that the name “needle exchange” may be somewhat obsolete. These programs were started in the late nineties to deal with the spread of HIV and hepatitis among injection drug users, but what they have evolved into is a wonderful tool to reach out to people who otherwise would not receive health services, counselling services, or other social services.

One of the main needle exchanges operates in the building I work in. If you go downstairs to the needle exchange at any time during the day, which I often do, you will see a lot of clients there, most of whom are not there to receive needles. They're there to receive counselling from our nurses, to receive testing, to be referred to other agencies, or to get help finding housing, so much so that I am advocating--and this will probably raise some of your eyebrows--the distribution of crack pipes for addicts in our area, because crack is currently the number one problem of addiction in Toronto.

Again, I don't care if anyone ever uses these pipes. That's not the purpose. The purpose is to say to people that if they use crack, they can still get health services. In fact, we feel these health services are perhaps more urgent for them than for anyone else.

À (1020)

[Translation]

Mr. Réal Ménard: There is a question on which I would like your point of view. We, as a committee, are fairly sensitized to the operations of needle exchange sites, but where we don't agree, is on the following question. In a community which acquires a needle exchange site, does this lead to increased drug use, in your opinion?

For example, if tomorrow morning, we set up needle exchange sites in 10 Canadian cities where there are none, would there be a higher incidence of use in those communities?

Yesterday, in Burlington, we were told no.

[English]

Dr. Joyce Bernstein: There are some excellent international reports on needle exchange. One that highlights earlier needle exchanges is from the University of California at Berkeley. It was done in the early 1990s. It's quite an excellent report, and it definitively says that needle exchange does not increase drug use among individuals.

Now, does it increase drug use among any individuals? Maybe. Maybe there's someone who was down to their last needle and wouldn't have injected one more time if they hadn't been able to get a syringe at needle exchange. But I would submit to you that this is the exception rather than the rule. For all the other reasons, needle exchange is fine.

The Chair: Mr. Long.

Mr. Dennis Long: Just to add to what Joyce has said, whether it increases use or not is certainly debatable. I would say it probably does not. However, one thing it does do is make it more visible. It certainly brings drug use more to our attention. We see more users and we get more. If people are not coming for needles, we don't see them. When they do come for needles, then we know who they are.

As Joyce has said, I think that's a very important point about needle exchanges. It's a connection with users that is helpful and very beneficial, but it also means that we know more about who is using than we would without running the needle exchange.

[Translation]

Mr. Réal Ménard: I have one last short question for Mr. Elio.

Is the approach you described to us inspired by the harm reduction model? You seem to be saying that the people who come to you must be clean or abstinent for five days, that your program has four stages, that you have a success rate of 76%, that you even offer training in various trades. Can we say that your way of doing things is an approach inspired by the harm reduction model?

[English]

The Chair: Mr. Sergnese.

Mr. Elio Sergnese: I've been sitting here listening to the panel answer many of the questions, and for me, because of the perspective I come from, some of your questions have been very difficult.

In answer to your question, our program and our philosophy is based on abstinence. Up until four or five years ago we were very rigid in our approach. You had to be drug-free, detoxed, before you came in. We understand, more so today, that this can be a problem for many people, or for a group of people.

We run into problems, for example, when people come in who are trying to get off methadone. Depending on the dosage of methadone, they may or may not be able to get into a detox centre. So they're left--stuck. In the past we've had to take them in and help them with tapering. However, we don't necessarily have the resources to do that. It wasn't the safest thing for us to do either, and we can't continuously do it without making changes.

[Translation]

Mr. Réal Ménard: I would like to end on that point, Madame Chair.

Can we say that the difference between your approach and those of some of colleagues described today is definitively the presence of a pastoral component in your approach?

[English]

Mr. Elio Sergnese: If your question relates to the fact that the founder of the organization is a Roman Catholic priest, then the answer is no. He doesn't impose his religious beliefs on anybody. The program was founded 20 years ago and modelled on therapeutic communities around the world, predominately in Italy.

[Translation]

The Chair: I would like to thank both you and Mr. Menard.

Now, it's your turn, Mr. Lee.

À (1025)

[English]

Mr. Derek Lee (Scarborough--Rouge River, Lib.): Thank you.

I think you'll all accept that policymakers, in the category of people in government, need information before they can make decisions. The purpose of reaching out and bringing in information and data is so we can have that kind of information.

I know many of you and a lot of the other witnesses are very connected to the field we're discussing and know a great deal about what you're working with. But the policymakers usually do not, so that's why we need information. That's why before we, as elected members of the House, decide what we're going to recommend, we have to go out and familiarize ourselves with what's happening. That's why you're here. Thank you for being here.

We've had dozens of witnesses whose work, careers, and pursuits in life--volunteer or professional--are all targeted at remediating the dysfunction or bankruptcy of the current criminal justice prohibition model of dealing with the drug problem.

They're paddling upstream against circumstance, a social paradigm, a moral paradigm, government institutions, government policies, the Criminal Code, law enforcement, almost all of which is dysfunctional, ineffective, and bankrupt. Maybe we don't all see it the same way as politicians, but I think a lot of us do, and we need information.

I want to go to Ms. Bernstein and go back on the issue. You gave the impression of being negative about the so-called national survey--the huge data collection, the huge vacuum cleaner. Before you take the stuff out of the vacuum cleaner bag, it's all resorted and packaged, and maybe it doesn't give a true picture. But if we don't have the vacuum cleaner, we may end up with no picture, with zero.

Is it possible that somewhere between your jaded view of the huge dysfunctional expenditure on the national survey and the area you work in, where you have a whole ton of local and regional data, there is room for a clearing-house function nationally that would assist policymakers? At least there would be some credible data. We can't go with nothing. We have to have some information.

Dr. Joyce Bernstein: Can I ask you what you mean by a clearing-house function?

Mr. Derek Lee: It means we would have to spend tax dollars to have people telephone, write, and e-mail people like you, bring in data in hard copy and electronic format, and decide whether it was credible and usable or not. They would reshuffle the deck and give it to people like us and say, “Here's a picture of drug use, or whatever, in Moose Jaw”.

Dr. Joyce Bernstein: It's a complicated question. I guess a big part of the clearing-house question is, who would be running the clearing house?

You might have a researcher like the fellow in the second cartoon, who loves to calculate long formulas--and I've seen this in the local CCENDU network we have--and something called “attributable fractions” that this individual is convinced give a clear picture of costs of various treatment services and problems for any group you might imagine. This person could probably sell that idea to anyone, if he were leading the clearing house.

So one danger is the bias of the folks in the clearing house. If nobody is going to question the methodology used in the clearing house, that's going to be a screen, and you're only going to receive information from those individuals--good information, in their opinion.

I would suggest you need something other than that. You need information, but you need quality information. Masses of information are not going to help you. Information coming from a clearing house is not going to help you. You do need some way of gathering, from what I read in your notes, a sampling of the research. I was glad to see a sample where you didn't try to read everything. You need a way to sort and evaluate what does exist.

Again, proceeding to the next step, I think a national survey would probably give a lot of people comfort. Now we know everything. Now we've looked at the whole country.

When you look at the statistics, 2% of the people we called in Canada say they have a problem with cocaine. Does it tell you anything about where to start? It's, again, going to be people in households. It's going to be an estimate that really gives you no information about the nature of the problem, things they have tried, life situation, employment, and so on.

Yes, you'll have a nice set of national numbers that people will think is great. I would submit to you the information is not always good information.

À (1030)

Mr. Derek Lee: Yesterday we were in the Halton region, in a community health clinic. We have some data from there. We have the statistics, or whatever you want to call it, on incidents obtained from local surveys, or however they put together their information. They know what they're doing.

One of the areas they looked at was the extent of drug use of various types of drugs by various age categories. I thought it was pretty useful. The picture was a snapshot of Halton region, if it was accurate. I don't know if it's accurate. In order to determine if it's accurate, you have to have someone who is professionally trained at assessing how the data comes in and is multiplied, divided, averaged, or whatever, like the formula you showed earlier. I think we still need it.

I hear what you're saying. We could spend $50 million on a national survey for two or three years and end up with weak information, I suppose. It's what you're suggesting. We could have perhaps got away with spending $10 million and spent the other $40 million on something a bit more direct. Is it what you're saying?

Dr. Joyce Bernstein: Yes. I'm not saying all local data is good. When you have data, one of things that I think will be of assistance is if you can look at a set of data and know it represents what people said in terms of age, specific substance, and whatever information was collected. You can then judge for yourself. You don't need a high-priced statistician or epidemiologist to find out if the data was cooked in the right way, as opposed to a national survey, where, again, you're going to have highly cooked numbers. I maintain they will not point you in any direction.

Mr. Derek Lee: On the issue of harm reduction, you made a comment about the usefulness of distributing crack pipes. Would you care to link the suggestion with actual, tangible, harm-reduction benchmarks?

I'm sure there are benchmarks, but the record doesn't show it. What is there that would be associated with the distribution of crack pipes that would yield a tangible harm reduction?

Dr. Joyce Bernstein: There are numerous focus groups and studies that have been done with current drug users. They've been done all over the world. There is a mass of reports that say people who use so-called hard drugs do not receive health services. I think it's pretty much as simple as that.

I should also say, during a recent union strike in Toronto, I was privileged to be able to take the part of one of our union workers and drive the needle-exchange van through the streets of Toronto between 12 midnight and 2 a.m. My kids took a picture.

All you need is the testimony of these people who come up to the van and who thank you. Sixteen-year-old prostitutes on Jarvis Street who come to get condoms, who come to get an appointment for an HIV test, who would not receive medical help if they had to walk into a traditional doctor's officer--they couldn't make an appointment; they don't have phones. If they had to walk into one of the walk-in health clinics that exist in the suburbs, they wouldn't get the treatment. They wouldn't have any connection to health services. So very simply, to me, that's what this service would encourage.

À (1035)

Mr. Derek Lee: The distribution mechanism would enhance the likelihood of access of connection between a drug user in need of health services or social services and the people who could refer to providers. This builds up some trust and allows the community to access community health problem areas. That's what you are saying.

Dr. Joyce Bernstein: Absolutely.

Mr. Dennis Long: I'd just like to add something to that, which maybe really illustrates what Joyce was saying.

The incidence of infection with hepatitis C amongst our clients in the methadone program and the street outreach program is in excess of 90%. And it's in excess of 90% only because a lot of people have been with us for a very long time and came to us before the hepatitis C epidemic hit. Now in new intakes into both methadone and to street outreach, virtually 100% of the people we see are hepatitis C positive. They are not getting adequate health care.

They are spreading the disease. Part of what they've been doing in terms of spreading the disease is because of ways of smoking crack, where you have cracks and fissures in your lips and use crushed up pop cans or whatever and then take that directly one user to another. This is a way of spreading hepatitis C, amongst other diseases.

Those kinds of things, both in terms of getting people to effective health care at an early stage of the disease, so they can be treated effectively, and if they don't, at least we can prolong their healthy period with the disease, are not happening unless we have ways of connecting with people and also effective ways of trying to at least reduce some of the spread of the infection.

Mr. Derek Lee: Thank you.

The Chair: Thank you.

Colleagues, I'm going to propose a five-minute break for a quick step across the hall or to get a new cup of coffee or whatever you want to do, and we'll come right back.

À (1041)

The Chair: I bring this meeting back to order. Just before I go to a second round, colleagues, I do have a couple of questions specifically for Operation Springboard.

What kinds of offenders are not admitted to the program? If possession for small amounts of marijuana was decriminalized, then your entire program would not exist and a great deal of community work would not be done with all these community service hours. Perhaps you can tell me about that.

Also, is there anything you've learned from your clients that would help us in either preventing people from using marijuana in the first place or in delaying their use of it to a more appropriate time in their lives? Is there something we can do on the harm reduction model?

To Mr. Sergnese as well I'll be asking if there is anything your clients have told you that would be helpful in either preventing people from using illegal drugs or in helping them adopt a healthier lifestyle earlier on so we can use those components in designing a better prevention program.

So first to Operation Springboard.

À (1045)

Ms. Wanda McPherson: I'm going to address who doesn't get the program. The way it's set out currently, the crown attorneys determine eligibility. Factors they consider to be aggravating when someone is found to be in possession of marijuana that can lead to people not getting the program are being on school property, in a motor vehicle, or in a public park where there are children around. They consider those factors to be aggravating and quite often will not allow somebody access to our program based on those factors.

The Chair: Yes, but I thought those were the only reasons one was ever charged with possession of small amounts of marijuana. So who's getting charged?

Ms. Wanda McPherson: Everyone's getting charged, youth predominantly. Young people are a huge part of our client group because they don't own a home where they can sit and smoke marijuana without being arrested.

But no, these are considered to be aggravating factors and these people are being deemed inappropriate for this kind of a harm reduction education program. They're being denied access to it.

Since the inception of this program, something we've always been looking at is how to really broaden the eligibility. It really has come a long way since we first started, and we're going to continue to look towards having those aggravating factors be looked upon a little differently. Again, when we talk about people's morals getting involved, I think this is what's happening.

For instance, a lot of young people hang around at a school yard. That's where they're going to be. So if they're stopped for some reason and searched and found to be in possession of marijuana--they weren't smoking the marijuana in front of a young person and trying to be an influence on them at all, but I think that's how it's interpreted when it gets to court.

It's the same as when they're passengers in a motor vehicle. The Department of Justice is now slowly starting to look at how, if the marijuana isn't being smoked, then perhaps they can gain access to the program. But we're always looking at ways to get more people involved.

À (1050)

When you're talking about ways we can delay use or provide information or education, the more people get access to this program through the court system, the more people are getting an opportunity to look at their drug use; to look at the harm it may or may not be causing them personally; to look at the harm it may be causing the community, i.e., high-crime areas where a lot of drug dealing and that sort of thing happens. By doing their community service work, they get an opportunity to see that piece of it.

We're able to explain the implications of a criminal conviction with regard to this charge, and the implications are pretty harsh when you're looking at...the smallest amount I've had is 0.02 grams of marijuana. But a conviction is a conviction, and crossing the border becomes difficult; getting certain jobs becomes difficult. Really, the stakes are quite high on conviction for the use of what we're calling “soft drugs”.

So I think these programs do assist with that. Then you're saying, what if marijuana is legalized, decriminalized, and I say hooray, we can start looking at other drugs. We can start using these programs a lot more effectively, if we're looking at different....

The community is there right now, and the community is ready to embrace these people. The community is ready to take responsibility for people, and that's exemplified through the 211 community organizations that currently participate with this program. They provide volunteer placements. They also provide services to people to feel connected in their community--settlement services for newcomers to our country, employment services for youth and adults who aren't currently employed.

So, really, this program is addressing a lot more than just being charged with marijuana. We're looking at whether there are some core problems there that we can address. And in a lot of the cases with these charges, there aren't a lot of people who are having huge amounts of difficulty.

So I think decriminalization would be wonderful. Then we could focus on different drugs and get more people into the program.

The Chair: Do you have some stats on who is typically charged, for what, and under what circumstances? The information we're getting is that most police departments are not bothering to charge for small amounts, and the only time they have to charge is under the circumstances you gave us, in which case they don't qualify for your program. So there are 2,300 people who have somehow been charged by police forces when we've heard they don't do that.

Ms. Wanda McPherson: Yes, they do, from what I'm seeing coming through the door. Anybody who is in possession of marijuana can be charged for it. Quite often, for instance, a group of younger males--and what I'm considering youth is between 13 to 24--if they're standing around in any kind of group--and that consists of three people--the police will stop them, it seems, to question them, to see if anything is going on, and they may get arrested that way.

Some people get arrested for possession of marijuana when they're arrested for another offence, for instance, shoplifting or something, when in the process of being searched they're found to be in possession of marijuana.

But, you know, we have all kinds of people in all kinds of different circumstances just stopped. Police feel they have reasonable grounds to stop the person, they search them, and find them to be in possession. Or they've seen them somewhere off to the side smoking a marijuana cigarette or that sort of thing.

But no, as I was saying, the smallest amount I had was 0.02 grams. That person was charged and brought to court. Huge amounts of court resources are wasted on that. The person who is charged needs...they say to conclude a matter in court, you need to come an average of six times. If that's what we're looking at, 0.02 grams of marijuana, it's quite frustrating.

So when we were talking earlier about where the money was going to come from, this is where the money can come from--all of the resources that are currently being spent on these types of charges, when we have a community that we're proving is ready to provide responses to these types of offences.

Mr. Dennis Long: Could I just add to that, because I think this is one of the really important issues about decriminalization--and prohibition--that I don't like, which is that it tends to victimize the most vulnerable. My contemporaries and my friends who smoke marijuana are probably relatively immune from prosecution; they're not going to get busted.

The Chair: They have houses.

Mr. Dennis Long: They have houses, cars--BMWs--and other kinds of stuff, and they're not going to get stopped on a whim by a cop on the street because they look threatening, because they don't, even those who are of different ethnic populations. But street kids, people who are street involved, the vulnerable in our society who find themselves without resources, yes, they're going to get charged.

They're often going to get charged simply because the cop doesn't like the way they look and is looking for some kind of charge to lay and finds a little bit of marijuana. So it really is inequitable and unfair.

À (1055)

The Chair: Thank you.

Mr. Sergnese.

Mr. Elio Sergnese: Before I address your question, may I just speak to something Dennis just said. It's the point about the street kids and decriminalizing marijuana. I just want to add that sometimes for street kids the charge can be a critical turning point.

With regard to your question to me, my clients are not necessarily the people who go through the other programs. Many of them have deeply rooted problems. Our focus is not necessarily on the drugs or the alcohol, but on their behaviour and attitude. After going through a long-term program and coming to understand the root of their problem, they also come to understand that while the drugs and alcohol are symptoms, they cannot use them again because it could trigger the behaviour and the attitude all over again.

Also, many of my clients began their drug-abusing career with marijuana.

The Chair: We don't have an age range for your clients. Do you think you could send that information to us? You don't have to have it right this minute. It would be helpful to have a profile of who is using your services, both male and female.

Mr. Elio Sergnese: It's 16 to 60.

The Chair: With regard to the self-analysis, what are some of the things they've told you that would be helpful, such as, if only someone had told me, if only I had realized, or if only I had a better set of skills? What are some of the factors we could influence that would contribute to some change or to them not getting mixed up with drugs?

Mr. Elio Sergnese: My answer to your question is probably not very helpful. I would say that an emphasis has to be placed on the family and the situation within the family. That's ultimately what led them. Our parents are our first teachers.

If I were to ask my clients what could have stopped them from using drugs, I don't think they would be able to answer that question. They talk about the conflict in their homes, such as living in a home where there's no love between their mother and father; single-parent families and the conflict there; and sexual, physical, and emotional abuse and not being able to deal with it as they grow older.

The Chair: Dr. Bernstein, I hear you on the need to collect or have access to information that's more relevant, such as community resources. If you looked at the program in Halton, you would say that there weren't any heroin users until they brought in this program and they finally had contact with people who were using the needle exchange. Then they found out who some of the people were and what other services they needed.

That information is helpful in moving forward. It's also helpful if you're going to measure trends or changes. It's helpful in measuring success, whether it's the success of not spreading HIV or hepatitis C, of having people use less, or of having them lead healthier lives. Surely there is a fair bit of statistical information that is helpful in that process.

Dr. Joyce Bernstein: I would encourage you again to look at any of the CCENDU reports from the local sites. The one I'm most familiar with is the Toronto report. It's not the only one or the be-all and end-all.

We've been writing this report on drug use for 11 years, so we have data that in many cases go back to the 1970s. We have long trend lines. No particular piece of data is the best piece and no piece is the one we rely on exclusively, but taken together in this report, I think it begins to outline the important dimensions of a problem.

You may notice my great frustration when I talk about these national estimates. When I use the words “junk science”, people sort of look at me, so perhaps I can try to clarify that.

When I first started working for the City of Toronto, I was asked to use the results of a survey of Toronto residents. I believe 50,000 residents were contacted. It was to help with some internal planning. One of the stats I came across, or one of many, was that more than 50% of Torontonians eat six servings of vegetables a day. And pertaining to drug use, the stats showed that no adolescent women in the city smoked tobacco, which I found quite interesting.

The point is, you may have this set of statistics that's comforting--you know, here's something to base things on--but what does it really mean? Have people been telling you the truth? That's what I'm trying to get across. There are too many problems in the large sets of stats to sort things out. With sets of local stats that have been tracked for a while, you can more or less get a handle on where the problem is going, what the trends are, and some ideas towards prevention and treatment.

Á (1100)

The Chair: One of the challenges we have as a committee is that certain people who have contacted the Vancouver east side or who are working there, or who have ever been through it, recognize that there's a problem. Certainly Queen Street East neighbours in Toronto recognize that there's a problem.

Some of the things that we might suggest to help alleviate that problem, or to help prevent people from coming from the suburbs to these areas, could raise the hackles of people living in some other communities where they think there is no drug problem, and we'd asked, “How dare you do these things?” Recommending to some people that there might be safe injection sites would be the equivalent of saying that every kindergarten kid should get heroin with their breakfast.

So we have to help people understand the scope of the problem and why some of these things are taking place. Otherwise, we don't get to continue making the changes and improving things. And one of the ways to get people to focus on it is to figure out what is going on in the country. While there may be some great local information, it seems to me there's a real dearth of information in other areas that would help people understand. Perhaps the focus should be on the Auditor General going through and saying, “Look at how much money you spent on interdiction. Are you getting anywhere? And look how much you're not spending on prevention and treatment.” That kind of pulling together of information could be really helpful.

So I guess I need to understand a little bit about what you think is really missing that would help people understand that we need to do a better job, that there needs to be perhaps more options for Caritas programs or youth programs or whatever. What information is good, that we should be collecting but isn't there, and what do we need to do less of?

Dr. Joyce Bernstein: It's hard. Probably the foremost type of information that to your mind you need is the big picture. Again, I don't think you're going to find a set of numbers that gives you the big picture. I think it's a matter of looking through what's available and assessing for yourselves what you believe--talking to people, understanding the problems, arriving at a starting point, and taking action in that way.

If you wait to have the big picture, the definitive study, the right numbers, I think you're fooling yourselves. It might be comforting to have that piece of paper that says we should spend this amount on cocaine, this percentage on heroin and so on. It will provide a basis, but you have to decide whether you believe that's a valid basis and the way to proceed.

The Chair: You don't have to answer this today, but perhaps you can tell us what is missing from the statistical information, or from even a qualitative--

Dr. Joyce Bernstein: I don't think anything is missing. I think it's the will to pick a starting place.

The Chair: Okay, but assume that we're going to recommend some action in places. Is there something down the road that would be helpful for either measure? Is there something missing in any of the information-collecting processes out there?

Dr. Joyce Bernstein: To the extent that it's possible to obtain accurate and reliable information, you can always get more numbers, but I don't think there's anything missing to prevent a proper start and proper action from being taken on many fronts to immediately begin to help people.

Á (1105)

The Chair: Lastly, Springboard, do you work with the drug court or are you quite separate from it?

Ms. Wanda McPherson: We are separate but do some work with the drug treatment court, which is the pilot in the old city hall court, where we are stationed as well. We do some partnering work with them.

We assist with hooking up people who need to do some community service or volunteer work in the community.

The Chair: Do you get a lot of community service hours?

Ms. Wanda McPherson: Yes. It's a little different and it's wonderful. I wanted to spend just three minutes on defining community service as it relates to us and to this program.

I was quoting you the hours and the information we provided of community service performed by our clients. Community service is doing volunteer work for non-profit organizations in the city of Toronto. A wide variety of tasks is completed for volunteer organizations.

Within that I also include times when I refer somebody to a youth employment program to get a job, or when I refer someone to anger management, for instance, or any other social service or counselling, or settlement services and different programming. I include those in community service because we define them as very valuable in assisting the person to live a more law-abiding life and address the root causes of why they may have found themselves in court as well.

The Chair: Okay, thank you.

Mr. White, do you have more questions?

Mr. Randy White: Thank you.

I've been involved in this area of drugs for a number of years. Often I find I have to retrain myself or refocus on some of the issues.

One of the things, by the way, I wouldn't mind getting--I think you may have asked for it, Betty--is more information on these marijuana charges. It rather disturbs me that it's happening. But now I'm curious. How extensive is it? Is it just in Toronto or is it in every city? I've been told all along it's not the case.

So I have to retrain and refocus, and one of the basic premises upon which I could begin to work is the concept that heroin is a relatively safe drug. Do you think that would be a premise upon which I could work--or we should all work?

Mr. Dennis Long: Yes, I do actually, and I'm not trying to be controversial. I think it's a well-established fact that heroin as a substance pharmacologically acts on receptor sites in the brain--only, as a matter of fact--and is relatively benign to the rest of the body.

Alcohol, for example--or tobacco is another good example--acts and affects a whole bunch of systems in the body. If you abuse alcohol for 10 to 15 years, your digestive system will probably start to deteriorate; you're susceptible to esophageal cancer, ulcers, all kinds of things; your neurological system will probably start to break down; you won't be able to remember things; your short-term memory will be severely affected, probably permanently; your liver will have scarring; you may develop cirrhosis, which is a fatal disease; and so on.

If you were to use an opioid, of which heroin is one, and used it with good clean supply and good titration of dose so you knew exactly how much you were taking, you could live a long and very healthy life. And there are examples. I can't remember the guy's name off hand, but there was a professor of medicine from the United States some years ago who was a leading surgeon. He was a morphine addict all his life. He used it daily and lived a very long, very productive life as a very healthy man, who died, I think, of a heart attack, or something from unrelated causes, in his late life.

I don't think it's arguable: it is a relatively safe drug. Yes, of course, you can overdose.

Mr. Randy White: We could advertise that on television, let's say: “Take heroin in reasonable amounts; it's safer than a cigarette”.

Mr. Dennis Long: I would certainly not do it. I think the point needs to be made that the legal substances we're currently struggling with in this country are, in many ways, much more damaging than those that are illegal.

A lot of people ask if heroin addicts die frequently from an overdose. And it is, to a certain extent, true: why do they die from an overdose? Most heroin addicts do not set out to die from an overdose, but they have a varying strength in supply. We see a lot of people die in Toronto on a regular basis because a stronger supply hits the street than was normally there. The users don't know, use it in a normal way, and die.

Á (1110)

Mr. Randy White: I'll tell you what bothers me about the concept. I'm 53 years old. It has taken me many years to get to the point where I'm almost thinking we may be able to dispense with marijuana in another way. Then along comes another advocate saying, well, yes, that's okay, we have the marijuana, but let's not forget, heroin is a relatively safe drug.

I worry about goalposts.

Mr. Dennis Long: I understand.

Mr. Randy White: I need your help with something on goalposts. Define “harm reduction” for me. This is the goalpost I think we're moving into and moving along the way. I'll try to do it for you. Correct me if I'm incorrect.

These are the components of harm reduction. I'm not trying to trick any of you. I'm just trying to get a concept here. Harm reduction is needle exchange, condom distribution, crack pipe distribution, heroin distribution, methadone maintenance, and safe shoot-up sites. Is that what we can say are basically the components of harm reduction, not the definition but the components of it?

Mr. Dennis Long: I think it's a part of the components of harm reduction, clearly.

Mr. Randy White: Would you add others?

Mr. Dennis Long: Frankly, I think we need to reform the laws. As I said earlier, I think part of harm reduction is an advocacy against laws that increase the harm to individuals who are using.

In the case of heroin, right now, I would say well over 90% of the harm resulting from the use of heroin is directly related to the fact that it's an illegal substance. If that's the case and we're going to be effective at harm reduction, then we have to change the laws so the individual is not exposed to harm because the substance is illegal. If the laws were effective, in some kind of world where we could prohibit effectively the use of heroin, no one would use and it would be effective, obviously. It's not the case.

Mr. Randy White: Do you have other examples of components of harm reduction? Do any of you?

Joyce?

Dr. Joyce Bernstein: One example that is quite practical for Toronto Public Health is, although we know approximately 30% of high school youths smoke marijuana, we are prohibited from doing any type of prevention activities, such as encouraging people who may have smoked to use the designated driver system. We can do it. We can encourage people who may have had alcohol in high school to do it, although it's probably illegal for most of the kids to be drinking as well, with the age of 19 as the legal age. We can't mention marijuana or designated drivers in the same sentence when we go into the schools.

To me, the harm reduction approach would be to acknowledge that it is an illegal substance we're talking about. We are not advocating that you, as students, use this drug. However, if you know of someone who has used the drug, don't get into a car if the person is behind the wheel. It's not safe. To me, it would be a form of harm reduction.

Mr. Randy White: Are there any other components that I have left out of this definition? Actually, this discussion is important for us because we have to try to define what you mean by harm reduction.

Dr. Joyce Bernstein: Harm reduction shouldn't be defined by the programs. Harm reduction is a very simple concept. It just means for any given activity, you'd like to reduce the harm.

I have a friend who is a consultant, who is now writing a paper on the definition of harm reduction and will make $40,000 when the paper is handed in.

Again, back to the academics. It's such a difficult concept to talk about. It's astounding for many of us who think of harm reduction not as the programs that it may result in but the concept itself. We're just trying to reduce harm.

Mr. Randy White There are some who would say that harm reduction, in the form of heroin maintenance or a safe shoot-up site, is harm extension.

Á (1115)

Dr. Joyce Bernstein: Yes, and there are great debates on the subject.

Mr. Randy White: You're not reducing harm; you're just extending harm.

Dr. Joyce Bernstein: That's debatable.

Mr. Dennis Long: I would submit that they're completely and utterly wrong.

Mr. Randy White: I would suggest that Elio's...it is a form of harm reduction.

Mr. Dennis Long: To a certain extent I think that's true, but it's not the limit of harm reduction. I can't see how some services, like safe injection sites, the prescription of heroin, and so forth extend harm in any way. They make it safer for people who are using and for whatever reason are unlikely to stop using.

If we could be assured that we would be able to stop those people from using, I would certainly support whatever initiative would do that. But that is simply, flat out, not going to do it, and I've been treating people with substance abuse for 20 years. There are some people who, for good reasons and bad, will not stop using.

Mr. Randy White: Are you a medical doctor?

Mr. Dennis Long: No, I'm not.

Mr. Randy White: Could I just then capsulize--

The Chair: Sorry, just a second. A couple of other people want to answer your earlier questions.

Mr. Randy White: Oh, good.

Ms. Wanda McPherson: On the way we're viewing the harm reduction our program is able to provide--again bearing in mind what they're saying is absolutely true--I would just add that being able to provide individuals with information about drugs, information about their use, and an opportunity for them to look at why and how often they're using drugs is of benefit to identifying if they need more resources in the community.

Harm reduction for us is also explaining the criminal process, the court process, and supporting people through that. It's also providing them with information on the implications of their drug use socially, criminally, etc., so that in the future they can make informed decisions.

They now have all the information they need, and if they choose to continue to use marijuana, they at least have made an informed decision, or a more informed decision than prior to entering into this program.

That's basically how we're looking at it. We're also plugging them into the community to deal with other areas. Marijuana can be a gateway drug. For some people it's not, but we are providing them with opportunities and plugging them into their communities. I can't state enough that the communities are taking some responsibility.

Mr. Remo Paglia: Any legislation or policy that prohibits the dissemination of information is going to be counterproductive, and I think that's really what we're hitting on the head here big time. Information must get out, it must get to the youth early, and the education system must be involved in that.

Mr. Dennis Long: To add another sort of plane to this, as Joyce has been saying all morning, data collection becomes very difficult when a substance is prohibited. We know, for example, how much alcohol people drink in this country pretty much down to the drop because it's all produced and distributed under government supervision, with some slippage, obviously. But by and large, we have a pretty good handle on that.

We have no idea how much heroin is in this country and how much is distributed. We will never know, because people who are selling it are certainly not going to send a report every month to the government saying they sold three ounces this month. It just makes all of that work very difficult.

The Chair: Thank you. Unfortunately, we have run out of time.

Monsieur Ménard.

[Translation]

Mr. Réal Ménard: When we started our work, in May, each of the members of this committee had access to a certain number of studies which I think had been consolidated by our researchers. The studies evidently start with the 1994 enquiry and they talk about the Canadian Centre on Substance Abuse. There are three or four studies. Health Canada apparently carried out some as part of a national enquiry into the health of the population. I remember reading that very seriously and what came out of those studies, was that, contrary to what we might think, we were not living in a society where people were consuming more and more drugs. There was a certain stagnation in the studies that were brought to our attentions. For cannabis, they said that we had gone from 4.4 percent to 8 percent of people who smoke cannabis. As for the rest, for the hard drugs, let us say, for the purpose of our exchange, that there is stagnation.

I am interested in understanding the following. What leads people to use drugs is not easy to understand. It is not linked to social class, it is not necessary linked to levels of wealth. The pain of life can strike anybody. Maybe in five years, I may be the one developing a drug dependency. We never know in life what circumstances will trigger a situation where we find ourselves in distress and where we want to give meaning to life, through drugs.

So, our work, as legislators, in my opinion, is to ensure that those who use drugs do so in conditions that are as safe as possible. If I had the choice, on a strictly moral level...I never smoked in my life. I have never even held a cigarette in my hands. It is not something that attracts me, but we cannot place ourselves on a moral plane. We must position ourselves from a point of view where we can intervene with a large number of people and have ways of reaching people and making sure that people do so in the safest manner.

The model which has been proposed to us, is that of harm reduction and that model, we are told, has produced results on the issue of safe practices and the safest possible practices. So, this is the premise, if you will, on which I am basing my reasoning.

I think that it was Elio who said that earlier but I just want to make sure that I understood correctly. Can we maintain that a person who uses cannabis is likely to experience a ripple effect and want to try other kinds of drugs? Is there a statistical correlation between smoking cannabis and experiencing the ripple effect leading to heroin or other kinds of drugs? That is my first question. Is it clear?

Á (1120)

[English]

The Chair: Thank you.

Dr. Bernstein.

Dr. Joyce Bernstein: I would make a start at that by noting that we estimate about 30% of junior high and high school students use marijuana. We estimate that approximately 1% of mainstream adults use cocaine, less than that use heroin or any other hard drug. And the 30% is probably an under-estimate because students under-estimate their use on a written survey perhaps.

At any rate, I think these two results tell you that the large proportion of people who do try marijuana never go on to have problems with any other of these so-called harder drugs.

The Chair: Mr. Long.

Mr. Dennis Long: I treat a large number of heroin addicts. I have yet to hear somebody saying, well, if I hadn't smoked that first joint I wouldn't be here today. Virtually nobody in our client group attributes their heroin addiction to smoking marijuana. Conversely, I'm 53 as well and I was in my early twenties in the 1960s and 1970s and most of my friends smoked dope; I'm not going to speak for myself right now. I look around and try to figure out--

The Chair: Like us, you had to be surveyed by the Globe and Mail.

Mr. Dennis Long: Exactly. I definitely wouldn't even go there.

I look around and try to see if any of them are now addicted to heroin or other kinds of substances, and the answer is no. So I think this is an old issue. Yes, there are gateway drugs, possibly; the concept to me is very difficult. People smoke tobacco, they drink alcohol, and so forth. Nobody says, well, if you drink alcohol you go on to harder drugs. It doesn't seem to compute as a concept.

[Translation]

Mr. Réal Ménard: Your remark is very interesting because, as a legislator, I was a member of the Health Committee which reviewed the whole issue of tobacco products, labelling tobacco products and the whole question of advertising. We live in a society where there is a fairly good consensus on the fact that we must dissuade people from smoking and we have very accurate profiles of who smokes. For example, among Canadians, women smoke more than men. Young people, between the ages of 18 and 30, smoke more than their elders. Among all the sectors, those who have stopped smoking the least, are the young people.

So sometimes, as legislators, we are often asked the question: Why do we have campaigns to dissuade people from smoking, on the one hand, while, on the other hand, we would allow marijuana to be legalized.

How do you respond to that, when you are asked that question?

[English]

Mr. Dennis Long: We should. I just want to make a point, because earlier somebody reacted to the idea of legalization and decriminalization. Decriminalization just does not make sense to me.

If you legalize a substance, you have the ability to control and regulate its distribution. If you decriminalize it and still make it a criminal activity to distribute it, then you have a foot on the dock and a foot on the boat. This is not a comfortable place to be because you are in a situation where it's still illegal to possess for trafficking. So anybody who's using, although they may not be a criminal, has to go talk to a criminal in order to get a supply. I would contend that the best way to go ahead is to fully legalize it and regulate it and tax the hell out of it.

Á (1125)

The Chair: Mr. Paglia wanted to speak to something else.

Mr. Remo Paglia: I just want to briefly speak to the point of values and stigmas. It's a very important point that you did bring up.

The idea of attempting to put together a national or even a local drug strategy without addressing the stigmatization that comes with labelling, that comes with a criminal record, is critically important. Working with our youth, the whole reason we introduced them back into the community is to reiterate the idea that these are valued members of our community and that stigmatization is what quite often keeps them from advancing forward. We wanted to make the salient point that the value has to be incorporated, that these are community members.

[Translation]

Mr. Réal Ménard: Mr. Long did not answer my question. I know that he did not do that deliberately but, in conclusion, what we can say is that on all the basis of the data available to us, we can, as parliamentarians, affirm the fact that smoking marijuana does not lead to other types of drugs. You are all categorical about that.

Secondly, it is more harmful to smoke tobacco that to smoke marijuana. When, as parliamentarians, we are questioned on the fact that we have adopted legislative measures to discourage people from smoking, what we can answer is that based on available scientific data, it is more harmful to smoke cigarettes than to smoke marijuana. I understand that is the answer we have to give. Perfect.

[English]

The Chair: You have to actually say something for the record. Nods aren't recorded.

Mr. Dennis Long: I would certainly agree with what you've said. I think it goes back to the point Joyce made earlier, which is that you cannot do health promotion on an illegal substance. It's almost impossible to do effective health promotion and harm reduction work with an illegal substance. As she indicated, she can't talk about marijuana and safe driving because it's an illegal substance, and that becomes a problem. You can't talk to people about the safeties of marijuana if it's illegal. It becomes a real problem in terms of doing effective health promotion and prevention work. We can do effective health promotion and prevention work with tobacco because it's legal.

The Chair: Dr. Bernstein.

Dr. Joyce Bernstein: I just have one quick comment. I am also a proponent of the idea of legalizing marijuana, but to make the jump to say that it is less harmful than tobacco smoking is not something we're ready to do yet based on medical evidence. I think the Health Canada trials that are currently going on in medical marijuana use will be a wonderful boost for the research that can be conducted, but right now there's been very little actual long-term, quality research on the physical effects of marijuana. There are many people who have lung cancer, throat cancer, etc., but we do not have accurate histories of people's past marijuana use, so we cannot yet make that jump.

[Translation]

Mr. Réal Ménard: [Drafter's note: Inaudible] the data from Great Britain.

I believe, Madame Chair, that we should send a copy of the document that Senator Nolin gave us. I don't remember the name of the doctor. Remember the 200-page red document that was given to us in our third session, with Senator Nolin. The studies from the United Kingdom Britain were categorical about the non-harmful nature of marijuana. I do not know if there are any studies in Canada. We should meet with Health Canada at some point.

The Chair: Now, that's a study.

Mr. Réal Ménard: Yes, it is a study from the United Kingdom, not from Canada.

[English]

Dr. Joyce Bernstein: I'd like to see it. Again, it's one study. I can't comment further.

The Chair: Thank you.

Mr. Lee.

Á (1130)

Mr. Derek Lee: I was going to spend some time on the issue of this alleged gateway drug focus, but I think I'll pass on that. It's been well discussed.

I wanted, in the event the record didn't have it, to canvass with Mr. Sergnese the usefulness of the longer-term treatment model as an exit strategy for those who wanted to remove themselves from their dependence on a drug or drugs. My impression in talking to others is that it's a fairly pricey concept, but a lot less pricey than keeping somebody in jail for a year or two, where there still has to be treatment anyway. Or hopefully there's treatment; perhaps there isn't always.

In any event, I think you told us how many individuals your particular program was able to treat, or process, or accommodate over a year. Could you go through that again? How many people are you able to accommodate over a year or two?

Mr. Elio Sergnese: We have space for 50 people. At the same time, I think it's fair to say that if the demand increased it wouldn't take much for us to rent another home, and we could easily put another 10 people in there.

Mr. Derek Lee: Do you have any approximation of the cost? Let's say somebody stays for a full term. Perhaps not all of your clients do stay for a full term, but let's say the person does go through what you regard as a full term, a full program. Do you have a reasonable estimate of the cost for that particular person?

Mr. Elio Sergnese: The cost to the client?

Mr. Derek Lee: No, the cost of the program. How much does it cost to deliver the program to that person?

Mr. Elio Sergnese: I didn't come prepared with that specific statistic or fact. I can tell you that we charge our clients $450 a month.

Mr. Derek Lee: How much was it?

Mr. Elio Sergnese: Four hundred and fifty dollars.

Mr. Derek Lee: Four hundred and fifty per month.

Mr. Elio Sergnese: Yes. So over the span of 25 months it works out to approximately $10,000.

Mr. Derek Lee: Well, that sounds pretty reasonable.

Mr. Elio Sergnese: That's to the client. Then again, we are partially funded from the Ministry of Health, and the rest of the money comes through donations. So in many respects it's the community that's helping. The community gets involved.

Mr. Derek Lee: No one expects that everyone who goes through the program is going to be successful in achieving their own personal objectives. But if society's or the community's goal is to allow some people to attain some control of their drug dependence and either exit totally through abstinence or at least be in control of their lives so that when they leave they don't have to come back but can get on with their lives, what kind or percentage of success do you see yourself having? Is it half of the people who go through? Is it a quarter, or ten percent? It's a very tough area to work in, we realize that. Do you have a sense of how successful you would be in getting your clients to get through to an end game and gain control over their dependency?

Mr. Elio Sergnese: So that they are completely abstinent?

Mr. Derek Lee: No, I wouldn't even say that. You must have a sense, when somebody leaves the program, whether they've gotten there. I mean, an A would be a mark between 75 and 100 marks or something. How many people would you give an A to? Even though they may not have achieved complete abstinence or full control, at least when they leave they're going back into a situation where they can go back and work, or go back with a family, or something like that.

Mr. Elio Sergnese: I think I understand your question, but I'm not exactly sure my answer is going to satisfy you.

I can't exactly put a figure on it, largely because success is not necessarily defined by whether or not you abstain. That's what we push, yes, in the same way that a teacher would push you to strive for 100%. So if we get 80%, I'm satisfied with that.

Success is defined to some extent on an individual process, an individual basis. So we look at the individual and compare what they were like when they came in to what they're like when the leave.

What I'm trying to say is the focus is on change and how much of it they've made.

Á (1135)

Mr. Derek Lee: So how are you doing? How is Caritas doing in that challenge?

Mr. Elio Sergnese: The longer they stay the better the results. So among those who complete the program, eight out of ten are successful.

Mr. Derek Lee: Good. That sounds like a pretty good rate of success.

I don't have any further questions on that.

The Chair: Further to your question, the client pays $450 per month and the province pays how much per month?

Mr. Elio Sergnese: The province gives us 33% of our funding. So it works out to $324,000 per year.

The Chair: So $324,000 a year divided over 50 beds.

Mr. Elio Sergnese: Yes.

The Chair: So they don't give you a per person, per bed, monthly payment?

Mr. Elio Sergnese: No.

The Chair: All right. So it's a bit harder to calculate.

And you said that if you had more demand you would increase the number of beds. But is it that you don't have more demand for your program or that there aren't more people seeking treatment? Everything we've heard suggests that it's really hard to find treatment if you're ready to get yourself to change your behaviour.

Mr. Elio Sergnese: It depends on what treatment you're looking for.

The Chair: Right.

Mr. Elio Sergnese: The demand for ours has decreased, especially when you have approaches like harm reduction. So where maybe 20 years ago the heroin addicts were coming to us, afterwards they started going towards the methadone, which is understandable. At the same time, now we're dealing with the unsuccessful methadone clients. These are the ones who have been in the program for a number of years who are still at high dosages and who continue to use other illegal drugs as well. They want to free themselves of everything.

I've classified them in that way, but I guess the true classification is that we are dealing with the irresponsible people. If you look at addicts in terms of those who use drugs and are functioning members of society as being one group, the other group would be those who use drugs and are not functioning members; they are completely irresponsible. That's the group we deal with.

So for the other group approaches like harm reduction and some of the other approaches, short-term programs or day programs or just weekly meetings work for them, or can work for them.

The Chair: We could probably spend the rest of the day debating “irresponsible”. But I would argue that in some ways what you're doing is harm reduction. If 80% of the people never use drugs again, for them, that's 100% harm reduction related to drugs. For the 20% of people who may have a relapse, you've given them other tools. You've reduced the harm in that perhaps if you gave them skills, they're working and they're able to support their habit differently than otherwise, or they know there are things they can run through to try to get them back on perhaps the straight and narrow or being responsible or something.

So you are part of harm reduction for those people for whom that's going to work or who want that kind of harm reduction, aren't you?

Mr. Elio Sergnese: I don't necessarily disagree with you. I'm just not sure that others would look at my program or my approach as falling under the category of harm reduction.

I do want to know from you who are on the front line, in terms of recommending to your clients, if they do want a residential program, what is out there, and are there statistics on what is out there? I've heard two different references this morning. It's either two youth programs or one youth program. I'm not sure how many beds there are or how frequently they're available. Whatever information you can give us would be helpful.

Á (1140)

Mr. Dennis Long: Let's talk briefly about the youth program situation. It has been a chronic and difficult one for a long time. There's one youth program in the province that serves under 16-year-olds. That's the Smith Clinic in Thunder Bay. There's another one called Alwood, south of Ottawa, which will do as young as I think 18. They do on occasion take people younger than that, but it's also a very different type of program--much more similar to Elio's program in its approach.

My agency, for example, could send to residential treatment, on average, about two to three people per month of the people who come in. We can't say to a kid from downtown Toronto, you're going to go to Thunder Bay. In many cases they just go.... Plus it compromises completely any kind of effective family work, which is really indicated in all of these cases, because they're several hundred miles away from their family.

The Chair: But they're the 17-year-old and 18-year-old kids.

Mr. Dennis Long: These would be under 16. We have been lobbying for increases in those kinds of residential capacities for about nine years now.

The Chair: And how many beds are there?

Mr. Denis Long: I couldn't tell you offhand; I think there are about 12. The problem is they have a local catchment area they have to serve, to which they give priority. We get about one person every six months in there.

The Chair: And you have two to three kids per month.

Mr. Dennis Long: Yes, who clinically are indicated to need a residential program. We can't put them in there, so we have to cobble together something that might work.

The Chair: And Portage in Aurora works for kids who've come in conflict with the law.

Mr. Dennis Long: Exactly. And we can't get kids who don't have a significant...they really have to go through the corrections and the judicial systems to get them there.

The Chair: And for many of your kids it doesn't take too long to end up interfacing with the corrections people.

Mr. Dennis Long: Almost all of them, almost all the time. But it is difficult to get kids into Portage, and that's a problem. You know, we don't use Portage with.... We can't make a direct referral to Portage from our agency.

The Chair: Okay, thank you.

Elio and Remo.

Mr. Elio Sergnese: Quite often we get adolescents coming in, mostly because the family members start attending our support groups. There's this sense of urgency of doing something for their children.

In the past we have taken in 14-year-olds, only because the 18-year-old brother was there and also because Children's Aid was aware of it. It doesn't necessarily work because...I guess it's obvious. You have 14-year-olds and 30-year-olds and 60-year-olds all mixed together and it's difficult for them to relate. Where one wants to play with Lego the other one is thinking about the businesses that failed and so on.

For me, it is extremely difficult to see a mother come repeatedly, week after week after week, crying because her son is just steps away from getting into trouble with the criminal justice system. It doesn't mean he hasn't broken the law yet, because he has, but the parents haven't reported it or pressed charges because they're afraid.

So I can't get them into Portage--actually I can, through the route of the client having to pay, and it's just too expensive.

The Chair: Mr. Paglia, Ms. McPherson, do you want to add...? No? Dr. Bernstein, in terms of clients who want a residential program, either youth or adult...?

Dr. Joyce Bernstein: The only comment I'd make, because I'm not technically a front-line worker, is because I do have a lot of contacts with street youth.

Obviously, there are many street youth who have very serious drug addiction problems and you can't get better on the streets. So for these youths, the absence of residential treatment is also a major problem.

Mr. Dennis Long: Just to add, because you asked about both youth and adults and we didn't talk at all about adults, we do have significantly more residential capacity in this province for adults, but even that is overstretched. Most of the residential programs are reporting extensive waiting lists of six months or more.

Probably the best place to go to get the data you might need on this would be the DART system, the drug and alcohol registry of treatment, which is in London. It could give you very good data on what the capacity is and, to a certain extent, a read on what the waiting-list situation looks like.

Á (1145)

The Chair: Well, thank you all very much on behalf of all the committee members, both the ones who are here and the ones who get to read this on paper or on a computer screen.

This committee will be hearing from people across the country and internationally until probably about the end of June. If there's something you want to refer to us, a comment you want to make, clients you have who want to participate in the process--we're particularly interested in hearing from young people; I think participating in this democratic process could be part of their community service--we would encourage you to e-mail us. It's snud@parl.gc.ca. That's the Special Committee on Non-Medical Use of Drugs. It has to be something that works. This information will be distributed.

Carol Chafe, our clerk, will distribute it. If you have references to things such as a study somewhere, Chantal Collin and Marilyn Pilon are very good at helping us to source those, so we're very happy to hear about it.

On behalf of all of us, you're doing really important work in each of your areas of expertise. We encourage you and thank you for that and we wish you continued success, however it's measured. We thank you very much for the time you've put into both preparing your presentations and the time you've spent with us this morning. It really does make a huge difference. So thank you very much.

We'll suspend just long enough for the new witnesses to come to the table.

Á (1149)

The Chair: I'll call this meeting back to order.

We are the Special Committee on the Non-Medical Use of Drugs. We have representatives from different political parties here today.

I'm Paddy Torsney, the member of Parliament for Burlington. Mr. White is the vice-chair of the committee and the member of Parliament for Abbotsford, British Columbia. Monsieur Ménard is a Bloc Québécois member from Hochelega--Maisonneuve, which is the east side of Montreal. Mr. Lee is a Liberal member from Scarborough--Rouge River.

And you are from the Illicit Drug Users Union of Toronto, Raffi Balian, co-founder, and Marc McKenzie.

Á (1150)

Mr. Balian, we would suggest that you speak to us for about seven or ten minutes, whatever you like, but I might stop you at about ten minutes just so we can ask some questions. You don't have to speak for the whole time if you don't want to. We really appreciate you coming before us today to give us the benefit of your information.

Á (1155)

Mr. Raffi Balian (Co-founder, Illicit Drug Users Union of Toronto): Thank you for inviting me. I want to make a couple of statements.

One, I apologize for having gum in my mouth. My mouth gets parched dry all the time because I'm on methadone right now. The other thing is that I want to make a response to one of the questions that was asked with the witnesses here before.

To make change is a difficult undertaking. Otherwise, every person would have a doctorate, or would be in shape or be self-actualized. Change is almost impossible when you have all kinds of historical and social forces conspiring against you. Many of our members, drug users, are severely marginalized in that category. You can keep a person in treatment as long as you want, you can have as many counsellors as you wish, but if you put this person back into the same environment that he or she was in, only time stands between her or him and illicit drug use.

As a preamble to my presentation, I have made several points. You have my notes.

One of the first things I learned about Canadians is their trait to compromise. This is a great thing and it has served Canadians very well. But one cannot compromise with viruses. One cannot compromise with disease. Unless you fight it out with all the arsenals you have, it is going to beat you.

The point is that illicit drug use and HIV and all the side effects of illicit drug use are non-conventional issues. Any programs or strategies to combat that in a conventional way alone are doomed to failure. I will expand on that later.

Harm reduction existed way before it became mainstream. Drug users have been doing this for ages. When drug users tell each other that this dealer is violent or the other dealer sells for less money, for drug users, that's harm reduction. But what troubles me personally is that harm reduction has become mainstream for all the wrong reasons. It's good to do harm reduction to prevent HIV, but we embraced harm reduction only when society noticed that drug users were not an island unto themselves and that their disease was going to be, at the largest, a community's disease. I'm here to tell you that illicit drug users can be good citizens--many of them are--and that their health has to be the reason to change policies, to make the society a more compassionate society for all.

For illicit drug users, having the context of the criminal nature of drug policies, morality has become a good concept only for people who can afford it.

When moral standards are so high for a certain population and those moral standards are legislated into law, that population is totally criminalized. Of course, criminalization is a double whammy for drug users. It's very well known among workers in this field that most of the harm that comes to illicit drug users is through the criminalization of drugs.

There is a question in one of the terms of reference where you ask if there should be research to show the amount of harm in terms of illicit drug use. I think that research should do that, but it should also look at the percentage of drug users who use illicit drugs without harm to themselves.

I live on a street where there is one of the biggest shelters, and there is a lot of drug trade down that street. If you were to come to our place on Fridays and Saturdays, you would see all the people in BMWs buying drugs. Most of them do it with impunity and are able to keep their job because they have all the other tools to protect themselves. The drug laws marginalize most of the already marginalized people.

If we knew about illicit drugs what we know about food, we could make a case, using the prohibitionist logic, to criminalize egg yolks and a lot of the sweets.

I'm sorry for the typo in my brief. Just take out the numbers. My computer was acting up.

What has to be done? Of course, if you ask any drug user, they will tell you that criminalization is the number one problem. I am sure you have heard about this over and over again, and I'm not going to rehash it unless you have questions for me around that.

There will come a time when people will look back at these laws and shake their head in disbelief. I know it's a challenge to legislate something that people are so passionately opposed to and to have all these uneducated opinions. But the challenge is to do the right thing and not to do what public opinion, especially uneducated public opinion, pushes you to do. That's the only way to have a compassionate and equitable society.

People who have gone to law school--and I'm assuming some of you have--know the rule of ostrakon, where people were judged by the public and they started to throw bones when they deemed people to be guilty. A lot of people were mistakenly condemned.

Â (1200)

The other thing is I urge you to help illicit drug users organize ourselves. We know; we are the experts. We know what is best for us. We know what to prioritize. We know what questions to ask and what urgent research has to take place.

For example, there is a dearth of real research on methadone. There is no research on methadone and pregnancy. There is no research on methadone and what it does to your teeth, your bones.

Also, for example, one can get a different strength of methadone from one pharmacy to another because of how it's distributed, how it's made. There is no legislation around that.

We know what our issues are, and there are models that we can now follow. For example, the Danish Drug Users Union are very well-organized. They have forged partnerships with police, politicians, and addiction treatment centres, and they do serve their membership quite well.

The other thing is there has been report after report to include illicit drug users in programs, to make programs user-driven. At best, at this time, programs are user-centred, where a user is in the middle and the decisions are made for the user, rather than user-driven. The user has at least some power to decide what to do and how to do it.

The other thing is tokenism. Right now in funding there are peer projects, and of course the language itself, “peer”, makes the person's wage. It has to be less than $15, although many people are more competent than many others, but they don't get paid equitably. Not only that, some organizations feel that it's their mandate, that it's a quota they have to do. They have given up on drug-using workers and they do not trust them with any of the real work.

As a service provider, and this comes as a surprise to many, the most frequently asked question to me is this: Do you have a job for me? Most illicit drug users want to work. Unfortunately, either there is this tokenism, or even when there is work, the laws and rules, the schedules, conspire against them. For example, if someone is on methadone and he or she has to go to the pharmacy every morning to get his or her methadone, it is impossible for that person to be able to come to work at 9 o'clock. There have to be some kinds of schedules, timetables, taking the user's reality into consideration.

Legislation to protect the injections, illicit drug-using employees, and using or non-using front-line workers...this is very important. There are some reported cases where people were hired for being drug users and fired for being drug users. So if they had something they didn't like about this person, the drug use, it's a very easy target; the drug user could be targeted.

In some cases, and I am including myself in this...I started using on the job, like five other people before me. There was no training; there was no support. And I am one of the lucky ones because I'm still here and I'm doing this. One of my colleagues killed himself and another died of an overdose.

Â (1205)

You have also heard about safer shooting or smoking galleries. Over 18 months I lost four assistants from the program. I coordinate a program that's run by and for drug users. Over those 18 months, even though these people knew everything about drug use, two of them died of HIV/AIDS complications, one died of an overdose, and one died of septicemia. The septicemia was from a small wound on his toe and he had diabetes. We didn't know about the seriousness of diabetes and abscesses, and he died of a heart attack related to the infection.

That is so prevalent among our members that sometimes I berate myself for not having emotions any more when people die, because you have to protect yourself.

On the subject of shooting galleries, something not very well known is that there are a lot of moms...and drug-using women have their own issues and needs. One of the things is that a lot of men target a woman's reproduction. For example, if they're jilted lovers, they threaten to go to the Children's Aid Society, or they keep them in total dependence, in terms of scoring, shooting, injecting. So a lot of women stay in really bad and abusive situations because they can't afford to have their partners leave.

The other thing is that a lot of unofficial shooting galleries exist. The husband of one of my former assistants used to have a shooting gallery. Once she started to learn and had access to tools and information, she changed that place and made it almost foolproof to infection.

One of the problems in shooting galleries is there are a lot of people shooting at the same time, and injection drug use, especially injection cocaine use, is often a social thing. A lot of people come together, things get crazy, and people start mixing up which needle is theirs, or whether they have used that needle before or not. So this person made a station with new needles, shot containers, and alcohol swabs, with information in front. So even that unofficial gallery was a great harm reduction strategy.

The last thing I want to say--I'm writing an article about this and I was hoping to have it ready, but too many things have happened--is a lot of injection drug users have no veins left. They have collapsed veins and are at risk of overdosing or not getting emergency medical treatment because health workers, nurses, are not able to find veins that work.

This is the first time I have brought this up, and I know this will happen in the future, but one of the things I'm proposing is that for certain injection drug users--especially long-time injection drug users--catheters be put in because they'll need fewer needles.

Â (1210)

That prevents overdose. I know this seems odd, but what happens with people with collapsed veins is they know that only a certain percentage of what they shoot is going to get into their system, so they usually put two or three times the usual strength in the needle. But sometimes they do get the whole thing. It doesn't happen many times, but it happens. Then all of a sudden they go into overdose. And that's a huge problem.

The other problem, as I said, is they may go to the hospital for other reasons such as accidents--or again, say, a heroin overdose--and need to have that.... What's the name of the...?

The Chair: An antidote?

Mr. Raffi Balian: It's an antidote, but there's a name for it. Anyway, some nurses are not able to get time to give the antidote, and often they give it in the arteries; that's one problem.

The other is, of course, that the amount of blood involved in injection drug use for people who have collapsed veins is phenomenal. I've seen people put newspapers around themselves because so much blood is involved, especially with injection cocaine use. Usually when a person has good veins, there are 10 injections for a gram of cocaine. But I've known people to inject about 100 to 150 times to get a gram of cocaine into their system, because they can't find veins and they go from one vein to another. This creates a risk for people around that person in terms of all kinds of diseases. This is another way of keeping people from transmitting diseases to others.

I'm going to stop now.

Â (1215)

The Chair: Thank you.

Maybe I can turn to some questions.

Mr. White?

Mr. Randy White: Are we going to hear from Mark?

The Chair: Mark might answer a question if he's interested.

Mr. Randy White: I want to go back to a question I had yesterday. For somebody who experiments with heroin or crack--for the first time, we'll say--how many injections would it take them to get to the point where they actually need it or are considered addicted to it?

Mr. Raffi Balian: You have to work at it to get dependent. It takes quite a while. Injection, often, is at the end. People start with snorting. But as the body starts to get resistant to the drug, it becomes only a matter of time, because economical stuff will force the person to go to injections, as you need more and more. And the price of heroin is quite expensive; right now it's about $200 in Toronto, much cheaper than it used to be but still very expensive, and inaccessible for many people. So it would take time.

It also depends on the person and on social factors such as how many of his or her friends are heroin users. There are so many factors, you can't say. For me it took six to nine months. As I said, I started on the job; I was a teacher before that, with no addiction.

Mr. Randy White: I understand it's faster for crack.

Mr. Raffi Balian: It probably is. Mark can probably say better.

Mr. Marc McKenzie (Volunteer, Illicit Drug User Union of Toronto): It typically is. I haven't heard of anyone who is now in a situation of being addicted to that substance for whom it's taken six to nine months to get there. That having been said, again there is some variance from individual to individual. One of the important factors is the sort of skill set the person brings with him or her as she or he first engages a drug.

At the bottom, fundamentally, people use drugs as a form of escape, so it's not a moral issue but a drug dilemma to the extent that although one might have initially engaged this drug under the auspices of recreation, the chemical, physiological, and the predisposition might kick in. Still, if one is able to take one's emotional stuff to a safer venue for management, then to some extent in the early stages a person may not use as frequently.

Let's put it this way. If everyone who used crack were just to sit down and use crack, I would think that probably by the end of a week you would be hooked. But in my experience, using it doesn't occur in isolation; there is everything we know about it, at least what we've been told about it going in, and that plays a part.

For me, for instance, the day after my first use I had a huge emotional crisis. My God, here is this drug that if anyone--I was 35 when I first took that drug--had ever told me I was going to try this thing an hour before I tried it, I would have said no way in hell. However, I did, and that was that night.

The next day I had huge issues with it. Had I felt that I had a safe place to take this in discussion for the facilitation, to talk about my emotions and so on, I may never have gone back to it or I might have forestalled going back to it for some time. That's what I'm trying to get across.

So biochemically, biologically, I suppose with crack if you use it consistently within a week, you're hooked, probably within a matter of days. But using isn't just that isolated factor; there are many other factors involved.

Â (1220)

Mr. Raffi Balian: Actually a lot of crack users, or heroin users for that matter, do it socially. Studies in Europe have shown that the overwhelming majority of elicit drug users do it socially. I know a lot of people actually who do crack just on certain weekends and don't do it other times. So it's not a prerequisite.

As Mark was saying, there is all the other stuff, what kinds of coping mechanisms you have.... If you don't have good coping mechanisms, or access to good coping mechanisms, for example, sport, if you don't have access to a gym, or good food.... Anyway, without some kind of better coping mechanism, the likelihood of you getting hooked is much more....

Mr. Randy White: Why bother with crack or heroin? Why not stay with marijuana or rum?

Mr. Marc McKenzie: It depends on what one's system.... Let me put it this way. I didn't do any sort of drug, including alcohol, until I was 20 or 21 years old. At 20 I got into smoking pot. By 30 I'd stopped smoking pot. I didn't drink much. I'd burned out on smoking pot. It didn't do for me what I wanted it to do . At 35, on the edge of an emotional and mental breakdown, I tried cocaine. That wasn't the first time. I'd seen it around and so on, but basically, I don't know, maybe my system went through a change or what have you, but suddenly I had an appetite for this drug, which previously didn't do anything for me, because I had tasted it once or twice before.

There's a progression in the life of addiction in the system; there is a progression that goes on. What I may not have had a taste for formerly, down the road I find I have a taste for.

Mr. Raffi Balian Why bungee jumping? Why mountain climbing? People cope in different ways, and sometimes it's just what's available to you. What are other people doing around you? And why rum? Rum is quite harmful to your liver. Actually, it's really hard to rationalize why people do alcohol and yet are not allowed to do opiates. When even the most conservative researchers categorized harm, they found alcohol and tobacco at the top, followed by cocaine. They didn't know where to put opiates, because they couldn't see long-term harm.

Right now I'm on a dose of methadone that could kill a horse, but I'm still able to come and do this, go to work, and be a good father and husband. Methadone should be an indication that with legalization, people can be functional and can be good members of society.

Â (1225)

Mr. Randy White: Should we legalize marijuana, cocaine, and heroin?

Mr. Raffia Balian: Everything, yes, definitely. Most of the ills that happen to people are due to the criminalization of these drugs.

Mr. Randy White: But you two didn't take heroin and cocaine because it was illegal; you took it because you wanted to use it. Would that be fair to say?

Mr. Raffi Balian: Yes, but my problems started when I told other people that I was using. All of a sudden I had no space to negotiate between safe and unsafe drug use. For example, when I told my wife I was using, I also told her what the side effects were. She then knew exactly when I was high, so I binged when she was working or when I had two hours of free time.

I've seen this with parents who are totally against their children smoking and yet the children have decided to smoke. The smoking becomes much more harmful then, because they binge in the washroom, smoking two cigarettes at once as opposed to doing it rationally. As well, it's a challenge for rebellious youth to do something that people are always telling them not to do.

Mr. Randy White: Thank you.

The Chair: Thank you, Mr. White.

Mr. Ménard.

[Translation]

Mr. Réal Ménard: I join our Chair in welcoming you. I didn't quite get what your association's role is exactly. Could you remind me of the exact role of your association?

Mr. Raffi Balian : I apologize but I am going...

[English]

Mr. Réal Ménard You can say it in English.

Mr. Raffi Balian: I was going to say it in French, but I need more practice.

Our association's mandate is to advocate for the rights of drug users and to try to have the same rights and privileges that users of licit drugs take for granted. We also want to make sure that our members are not hired and fired arbitrarily and not thrown out of their housing. We want to educate the public around these issues and educate our members around issues with regard to safer use.

By bringing our members together, we also give them the opportunity to support each other. For example, recently one of our members, a single mom, was going through withdrawal, and other members took turns looking after the child. So we perform a lot of functions.

[Translation]

Mr. Réal Ménard: Is Mr. McKenzie intervening as a specialist in the fight for harm reduction or as a user?

[English]

Mr. Marc McKenzie: I am not currently an intravenous user. I'm a former user. However, I can tell you that harm reduction as a concept has been a foundational piece in my getting to a place in my life where I no longer use. I'll tell you why.

First of all, to engage in any powerful stimulant that takes me out of my conscious being, I go there to the extent that I feel a need to because of some sort of emotional crisis going on. I already feel marginalized to some extent. This is in my using place within myself. Then I see this idea of myself reinforced in the wider culture around me, because basically, people in a situation where they are using drugs are marginalized by the general population.

There's an isolation that goes on emotionally. Harm reduction, as an idea and as something that lives in our culture, when I was really in pain, made me find within myself the idea that maybe I'm actually worth saving. There were agencies out there that offered me care in spite of, or in the face of, my using.

Psychologically, it was a small, very subtle, yet powerful seed. It's like an acorn having the potential of an entire tree within it. It became the very impetus for me to turn to myself and see there was external representation for me, when I couldn't find it from within, that in spite of my using, I was deserving of care. At some critical point, I began to accept this, own this, and step into it. Not necessarily every user will do this. Some may use it lifelong. I feel it's an invaluable form of an agency to offer.

I'll stop there for the moment.

Â (1230)

[Translation]

Mr. Réal Ménard: After all...

[English]

Mr. Raffi Balian: The helpful thing about harm reduction, and it's a very important thing, is the propensity of people to deal with drug users in spite of their use and to not look down on them in a patronizing way. Right now, any other treatment agency would intervene only when you're ready to quit.

Some people are not ready to quit. Some of our assistants, like Mark, have stopped, have gone on methadone after being associated with us, or found full-time employment. We have two people who have found full-time employment. For two years now they have been working.

[Translation]

Mr. Réal Ménard: All in all, what you are inviting us to understand this morning, is that one can be a drug user, not only of marijuana but of slightly harder drugs and still function in society, have a job, be a father, have responsibilities, that we have to shatter the myth that if one uses hard drugs, one is automatically de facto dysfunctional and cannot be a good citizen. This is the testimony you are giving this morning and, for me, it is valuable because I believe it is the first time that we are directly in the presence of people who are users. That is my first question.

My second questions is as follows. How can we try to understand, not to judge but simply for an intellectual understanding, as parliamentarians, what the triggering factor is?

Marc, you spoke of an emotional crisis. Raffi, you said you were a former teacher and that you had no support in your professional community. So, I would like you to give us your point of view as to what the triggering factor might be.

Â (1235)

[English]

Mr. Raffi Balian: There are as many triggers as there are illicit drug users; everyone has their own. Mine was, again, the support. I have written an article about this actually, which was published. One of the things is...it was boundary maintenance stuff.

In our job, when you start to, time and time again, come up against walls and you can't do anything for your clients or service users, what happens is you develop a solidarity with them and you identify with them. There was this subcultural solidarity in the first few months I was working there.

Then, for front-line workers, it's a dead-end job. There is nowhere to go after it. This again is tied to the subcultural solidarity. You want to feel like you are one of them; you want them to feel that you are genuinely interested in their health.

There are other reasons. In my program--and I still do this--all my workers get training. If we go in to exchange in the homes of users, it is very helpful because we can make interventions according to what we see. However, we also get desensitized around injections.

For example, there is a huge fear of using needles, of injecting--and I've seen the changes in the faces a few times here this morning--but this disappears. When you see it happening again and again in front of you, a huge psychological barrier is passed and you go to the next step, which is of course that you get much higher much more quickly, which also creates psychological dependence.

And yes, drug users can be functional. Actually, most illicit drug users are extremely resourceful people. We have to be, given the criminalization of drugs. Otherwise we'd all end up in jail or dead.

Mr. Marc McKenzie: In my experience...and I agree with Raffi that there are as many triggers as there are users, and then within each person, each person being a complex unto him or herself.... My triggers are a complex of...there's a whole coalition of things going on.

What Raffi was alluding to just now about the desensitization one gets with seeing needles and so on, I liken this to anyone in any other aspect of health care, a nurse or practitioner who has administered x number of insulin shots, for instance, to save someone's life. At some point the blood stops bothering you, you get over the squeamishness, and you are able to go directly to the problem-solving, whatever the crisis of the moment calls for.

Actually, in my own experience--and needles were never part of my using, but they've become for me...they serve me as a sort of place I don't want to go. I see how the damage is done, and yet at the same time see it in a non-judgmental way because I certainly know the using experience. I've chosen to step out of it at this time, but I can empathize with what is going on with the individual.

For the part of the question on whether a user can be functional and so on, well, the evidence is represented here. I would tell you that, given the criminal nature of drug using at this time, an awful, an inordinate amount of energy is given towards just getting one's drug. I remember, while high on crack cocaine, asking myself were it not for the fact that I have to give over so much energy to my fear of being caught and so on....

I was functional in society. I've worked for an airline for ten years and dealt with corporate clients and all of that. I was in protection mode. I was protecting that, protecting my home environment and all those sorts of things because of the illicit nature and all of the further implications of this social stigma.

I began to ask myself, if I weren't giving over so much energy to protecting that because of the stigma, what quantities of energy would I have left over to put toward positive pursuits, which were still within my capacity and my interests? But because of the overbearing fear of being caught and the further implications of that--an awful lot of my energy--that became a degenerative situation for me. I think it plays much the same on the psyche of anyone using at this time.

The Chair: Thank you. Merci beaucoup.

Mr. Lee.

Â (1240)

Mr. Derek Lee: Could either one, or both, of you comment--don't feel like you have to, because I'm not going to insist on an answer--on your own personal connection or interface with the criminal justice system? In other words, has there been an interface, and if there was, how intensive was it? Have you been so criminalized that a big chunk of your life has been spent with Her Majesty or--

The Chair: Just before you answer, if you want to tell us the information but you don't want it recorded, or if you want to tell us anything further, if you want us to go in camera so that it's not recorded for the public, you can ask us.

Mr. Derek Lee: Yes, we could do that. We could go in camera, if you prefer to do that.

Mr. Raffi Balian: Not for me. It's fine for me, but it may be problematic--

The Chair: So why don't we go in camera.

Mr. Derek Lee: Yes, let's go in camera. It won't be on the record.

[Proceedings continue in camera]

[Public proceedings resume]

Â (1250)

The Chair: We're back.

So it's $5 for one cigarette?

Mr. Marc McKenzie: A client actually told me that fairly recently. He had been recently released from jail, and he said it had been as high as $5 of commissary money for a cigarette.

The Chair: Thank you.

Mr. Marc McKenzie: Briefly, on my comments about the treatment centre thing, when I heard it spoken to in the previous panel, what struck me was that one just said “treatment centre” like a blanket term. There are treatment centres and there are treatment centres. Some are operating from the abstinence model and some from the harm reduction model. That is the critical point, in my experience. I have been a client of both approaches. I will tell you that, at least for me, the harm reduction model has been far more effective. It has offered me a place where I can begin to foster some sort of compassion.

Rather than step out of the guilt and shame, the very psychology that fed my using in the first place, to go into that in a structured environment, an institutional environment, to try to effect some sort of healing, really was working at cross-purposes. I broke down around that one.

The harm reduction thing brought me to the understanding that this is a process. I had that understanding, but there was an external structure that also held the same view and was prepared to hold a space for me. Therefore, like a child, it was safe to stand up and try to learn how to walk. I will fall down, but I'm not going to be thrown back into jail for it. The parent will come along again and help me to do that. And thus began that process.

It's the same mechanism when one is learning to do anything. So it was consistent with everything I've learned from the time I was born.

The Chair: Mr. Balian, to conclude.

Mr. Raffi Balian: I know this treatment issue was touched on before. Harm reduction, the name itself, is the reduction of drug-related harm. Harm reduction is about drug users.

There is a very good practical reason to differentiate between abstinence and harm reduction. You cannot have abstinence-based harm reduction. I'll tell you why. As a service provider, when the goal is to quit using drugs, anything other than that is a failure. That kind of failure, you've tried it yourself, you've tried it at other places, with counsellors, psychiatrists, psychologists.... I've seen them all. And every time I fail--first of all, it's really difficult to convince myself that I have failed. It's really traumatic in one way. Then to tell my counsellor, who has put in all that effort to help me stop using drugs, is also going to be difficult.

What used to happen with my clients, with the users I used to serve when I used to do abstinence-based counselling, was that I'd hear from his friends or her friends that he or she was using again. But he or she was not accessing the harm reduction service, the needle exchange, or the other things that will help this person.

You've lost this person, because you are into the treatment mode.

I've stopped doing that. As soon as the person talks about stopping the use of drugs, I say it's a good option but that I will refer them to an expert in that area, and I refer them to an abstinence-based counsellor. That's very important.

Right now harm reduction is the in word. Even the police are using it. Only 5% of the money allotted to drug use is for harm reduction. If some of that 5% is going to go to the police and other abstinence-based organizations that prefer to be harm reduction, it causes unfair competition.

I was talking about the concentration of drug use and the lack of tools. I'm sure you've had people from PASAN speak to you. I heard you did and that this point was made. In the inmate committee I've seen two people sitting at a table. One is mixing the drugs and the other is taking the money. The first person comes and pays the money. There is one needle. You're just hoping the person who has hepatitis C or HIV is at the back of the line, because if that person is at the front of the line, everybody following that person is going to get infected. This is a reality in Canadian penitentiaries.

The Chair: Thank you to both of you, Mr. McKenzie and Mr. Balian, for taking the time to come and tell us about your issues. I apologize for being about 50 minutes late. If there are other things you would like to share with us, we have an e-mail address and we'll be happy to have the benefit of your experience. If you have friends or colleagues who would like to provide input into this committee's work, we will be hearing from people all the way through until the end of June.

Your testimony today is invaluable for the work we're trying to do and for us to understand what's going on across Canada.

We wish you continued good work in reducing harm and in helping people to be in a better place and to feel empowered to make some changes. Congratulations for the work you're doing, and on behalf of the committee, please keep up the good work. Thank you very much.

The meeting is adjourned until 2 o'clock.