SNUD Committee Meeting

SPECIAL COMMITTEE ON NON-MEDICAL USE OF DRUGS

COMITÉ SPÉCIAL SUR LA CONSOMMATION NON MÉDICALE DE DROGUES OU MÉDICAMENTS

EVIDENCE

[Recorded by Electronic Apparatus]

Wednesday, October 3, 2001

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[English]

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

We have with us today representatives from Health Canada, who will talk to us about Canada's drug strategy and particular aspects of it. We're pleased to welcome Dr. Jody Gomber, who's the director general of the drug strategy and controlled substances program; we have Cathy Airth, who is the acting director of Canada's drug strategy office; and we have Carole Bouchard, directrice, Bureau des substances contrôlées.

Welcome. We are looking forward to your presentation. We've had presentations, as you know, from the justice department and from CCRA, and it turns out a lot of the questions are for you, actually, so we're going to be primed.

Who would like to start?

Dr. Jody Gomber (Director General, Drug Strategy and Controlled Substances Program, Healthy Environments and Consumer Safety Branch, Health Canada): Thank you, Madam Chair and members of the committee, for this opportunity to appear before the House of Commons committee on the non-medical use of drugs.

What I hope to do today is to provide you with an overview of Canada's drug strategy and the context, framework, and goals of Canada's drug strategy and those of our partners in this endeavour, and to talk a bit about the impact of substance abuse in Canada. Then I will go into a little more detail about the activities of Health Canada, the roles and responsibilities of my office in particular, and the activities of some of the other branches of Health Canada that have a role to play. Finally, we'll conclude with a very brief discussion of some of the issues and challenges facing us today.

As you mentioned, Madam Chair, Cathy Airth, from Canada's drug strategy office, is here with me, as is Carole Bouchard, from the controlled substances office, and they're going to help me answer your questions.

I believe you've just now received copies of the deck we'll be using for the presentation. It has been made available in both English and French. There are as well a number of documents that have been circulated, including the red and white book called Canada's Drug Strategy. We provided some copies in advance and have some additional copies today. As well, there's a booklet called Straight Facts About Drugs & Drug Abuse. We recently—just now, I think—circulated copies of a paper on reducing the harm related to injection drug use. This was a paper that was received and distributed at the ministers of health meeting this past week. In addition, we brought a small selection, only one copy each, of a number of publications that we have available in our office and that we will leave with the clerk. If additional copies are required, we'd be happy to make them available.

Just to go back over some context, I know that you heard Monday from my colleagues at the Department of Justice concerning the international drug convention. I think it's important just to go back over that a tiny little bit in order to say that we do in Canada place a high priority on international cooperation, and many countries look to Canada to be an active partner and to set standards in certain regards.

Canada is generally well respected for its balanced approach to the global drug problem. The three conventions that are listed on page 3 of your deck—the Single Convention on Narcotic Drugs, 1961, as amended by the 1972 protocol; the Convention on Psychotropic Substances, 1971; and the Convention Against Illicit Traffic in Narcotic and Psychotropic Substances, 1988—are the basic framework within which the control functions of our legislation were developed. These three conventions were designed to regulate the supply and movement of drugs so as to limit the production and the import and export of these substances to amounts that would be required for medical and scientific purposes.

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The next page talks about some of the more recent developments in terms of Canada's international commitments and our multilateral relationships. Only later in the international arena has there been more focus on demand reduction as opposed to supply reduction, which was really the focus of a lot of the earlier conventions. In the special session of the United Nations General Assembly on the drug problem in 1998, you see a number of commitments that were entered into by all of the parties.

There were commitments to develop regulations for the control of precursor chemicals and also amphetamine-type stimulants. There were commitments to strengthening judicial cooperation, to implementing measures to address money laundering, to supporting demand-reduction activities—and this is one of the first times you'll see that kind of wording in international fora—and to developing alternative approaches to treatment and rehabilitation. Canada, as one of the members of that meeting, will be required to report on its progress against those commitments in 2003 and in 2008.

With the adoption of a declaration of guiding principles on drug-demand reduction, which was part of that 1998 commitment, as well as an action plan for the implementation of the declaration, there has been greatly increased attention in the international community and through the multilateral organizations towards demand-reduction activities. Canada is largely looked upon as a leader in that regard.

As well, in the G-8 summit in Okinawa in 2000, the leaders committed to reducing demand, strengthening international cooperation to combat the illicit diversion of precursor chemicals for the production of illegal drugs, addressing the growing threat posed by the popularity of amphetamines and other synthetic drugs such as Ecstasy, and accelerating work to address the confiscation of assets.

And finally, most recently at the Summit of the Americas this spring, leaders committed to establishing what is called the multilateral evaluation mechanism of the Inter-American Drug Abuse Control Commission. This is, again, designed to address control, monitoring, and also demand reduction activities within this hemisphere.

Your next slide talks again about some of the international bodies that are involved in these activities. As I mentioned, there's the Inter-American Drug Abuse Control Commission. Canada is a strong supporter of this organization and has been instrumental in the creation of the multilateral evaluation mechanism that allows countries, on a comparative basis and in concert with each other, to look at what they are doing about the drug issue and to use comparable terms and measures.

The United Nations International Drug Control Programme is another of these bodies with which Canada is very active, as is the International Narcotics Control Board, which is a body of the UNDCP.

Now, all of that international framework essentially underpins the Controlled Drugs and Substances Act. Again, I believe that my colleague from the Department of Justice told you a bit of the history of the Controlled Drugs and Substances Act when he was here Monday evening. The Controlled Drugs and Substances Act was proclaimed in 1997 to modernize and consolidate the existing legislation and to provide police with additional tools to combat illicit drug-related activity. The CDSA focuses on fulfilling Canada's international obligations, which derive from the UN drug conventions, but also supports domestic drug abuse control policy.

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The Food and Drugs Act is also for Health Canada an important part of the set of acts and regulations that relate to this kind of activity. Health Canada is required under the Food and Drugs Act and its associated regulations to ensure that therapeutic drugs in Canada are safe, effective, and of high quality. The CDSA then supports that and also manages a regime that ensures those drugs that are internationally controlled are available for legitimate medical and scientific use; it also seeks to minimize the diversion of these drugs into the illicit market.

The framework Canada has adopted for its drug strategy is essentially a balanced approach between supply reduction and demand reduction. Canada believes that this is best accomplished through strong partnerships between the health and the enforcement sectors. The overarching principle of Canada's drug strategy, which was approved and published in 1988—this document was approved by cabinet—is that substance abuse is primarily a health issue. This is one of the reasons responsibility for the Controlled Drugs and Substances Act resides with the Minister of Health despite the fact that parts of its regulations obviously have to do with the control of police activities.

By considering substance abuse as primarily a health issue, Canada can consider the determinants of health and address such underlying factors as housing, employment, social isolation, and education.

Essentially, Canada's drug strategy is based on what the international community these days is calling the four-pillar approach to substance abuse. The four pillars are prevention, control and enforcement, treatment and rehabilitation, and harm reduction. It essentially operates on the assumption that your very first priority is to prevent the abuse of psychotropic substances. One way you go about doing that is by controlling their appearance on the streets and by having regulations such as the regulations under the Controlled Drugs and Substances Act and other legislative frameworks. These control the movement in and out of the country and also within the country of substances that might have a legitimate use but also could have a market on the street.

You prevent—or try to prevent—these substances from getting onto the street through some of your control and enforcement activities, your regulatory activities, and your permanent granting and licensing mechanisms. You also introduce prevention programs in which you try to explain to people why it's important to stay away from these substances and what the potential harm is of these things; you introduce them early and in the education system. So there are the first two pillars, prevention and control and enforcement.

However, you have to accept that there will always be drugs on the street. There is no control and enforcement regime that is 100% effective, and there is no prevention regime that is 100% effective. Recognizing that there will still be people who have substance-abuse problems, the third pillar is rehabilitation and treatment, where you try to help people who have substance abuse problems to deal with their problems and, hopefully, get off the drugs.

Finally, in Canada more recently and, again, in many parts of the world people are recognizing that there is a need for a fourth pillar, which we've been calling the harm reduction pillar. Basically, that pillar recognizes that once again not only are control and enforcement not perfect and not only is prevention not perfect, but treatment and rehabilitation aren't perfect either.

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There will always be people who cannot or will not get past their drug problem, and for those people, at least, you want to prevent the kinds of medical, social, and psychological problems that are not necessarily associated with the drug themselves but are concomitants of the drug use. Essentially, the argument is that if you can prevent people from getting HIV, from getting AIDS, from getting hepatitis C, from losing their jobs and from living on the street, or various other of the ills that come with some of the substance abuse problems that we've seen, as a last resort, then this must be the approach that we take.

I want to talk briefly about the spectrum of substance abuse in Canada, the different kinds of things that we might be talking about when we talk about substance abuse.

At one end of the spectrum we have things that we would call narcotics for medical purposes. These are substances that are legally prescribed, that have a safe and effective use in Canada, but that sometimes also find their way into other channels.

We have things like alcohol, which are not illegal and are subject to provincial control. But we know when alcohol is abused, it can cause dreadful problems, both to the individual and to society. Fetal alcohol syndrome and fetal alcohol effects is one of the leading causes of preventable birth defects and developmental delays. Estimates of the proportion of the population who suffer from this are noticeably broad, but it has been estimated that between one and two out of 1,000 live births will be affected by fetal alcohol syndrome or fetal alcohol effects. This is increasingly becoming an issue in correctional settings and is also widespread among aboriginal young people.

Driving while impaired is an area of immediate and obvious concern. A survey done in 1998 found that 20% of drivers indicated that they had driven a vehicle within two hours of drinking alcohol; 11% of drivers believe they had driven while impaired during the past year. This would translate to some 2.3 million Canadian drivers who were operating a motor vehicle despite the fact that they believed themselves to be impaired. This doesn't take into account the people who think, Oh, I'm all right; I can drive.

Designer drugs have become a much more serious issue, both in Canada and in other parts of the world, probably in the last five to ten years. The recreational drug Ecstasy is riding a wave of popularity in Europe and North America. The use of Ecstasy wasn't even monitored before the 1990s. It has shown a massive increase. The presence of this drug is now well entrenched in Canada's drug habits, particularly among youth. In Ontario the rate of use among students has doubled between 1993 and 1995.

The amount of Ecstasy seized by the RCMP has increased from about 1,000 units in 1996 to about 2 million in the year 2000. Use of Ecstasy has been associated with some deaths and also with the use of various other substances. One of the problems with Ecstasy these days is that the young people often perceive it to be a benign, non-harmful drug, and this perception is only countered at present by a few uncoordinated messages from health authorities.

Ecstasy is, of course, only one of the designer drugs that has become very common today. I think all the amphetamine-type stimulants are a matter of some concern throughout the world. They're easy to make, and they're also easy to import. Canada is seeing within the country more and more clandestine labs where these manufactured drugs are being produced.

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In terms of injection drug use, estimates are that there are about 125,000 injection drug users in Canada. It's estimated that in 1999 over one third of new HIV cases were attributable to injection drug use. Likewise for hepatitis C, it has been estimated that 63% of new hepatitis C cases occurring in Canada are related to injection drug use.

The injection drug use problem is much bigger than simply the addiction. There is a major health problem surrounding injection drug use. The cost to society for simply the medical treatment for HIV, AIDS, and hepatitis C from these individuals, the transmission between injection drug users and their families and loved ones... these are major concerns.

The next slide refers to some quite old data, and I think this committee has actually seen the report on which it is based. This report was done in 1996, based on 1992 data that looked at the health, social, and economic costs of substance abuse.

Just to remind the committee of the order of magnitude we're talking about, again based on 1992 data, recognizing that the costs today would probably be much higher given the increasing prevalence of certain kinds of substance abuse in particular, but as a reminder, that study estimated that the social, economic, and health costs of alcohol abuse were $7.5 billion. That represented approximately 6,700 associated deaths and 86,000 hospital stays, which represented over $1 million in days of hospitalization.

The health, social, and economic costs again in 1992 of illicit drug use have been estimated at $1.4 billion, which included an estimated 732 associated deaths and 7,000 hospital stays, representing about 60,000 days of hospitalization.

The costs of corrections, including probation, associated with alcohol, tobacco and illicit drugs in that very same study were estimated at $513 million. That's an annual figure.

Police have estimated that the illicit drug trade in Canada is worth between $7 billion and $10 billion a year. How good that estimate is, I couldn't possibly tell you. I think you probably heard the same figure from our colleagues at Canada Customs and Revenue Agency. That's about the same figure you would hear from the RCMP as well.

It's very hard to get a good figure on the total of the illicit drug trade. If we knew where it all was, it probably wouldn't be there. But we do know that organized crime is heavily involved. They're heavily involved in importing and distributing many types of drugs. They are certainly heavily involved in the cultivation and distribution of marijuana, so we're talking about not only the import and distribution, but also the home-grown issues. They're certainly involved in the manufacture and distribution of some of the designer drugs. We know there are several groups active in the heroin trade and increasingly in cocaine trafficking, all the way from importing to street-level retail activity.

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Getting back to HIV/AIDS and hepatitis C, about which we talked a little earlier in terms of the cost of injection drug use, a 1998 study estimated that the direct and indirect costs of HIV/AIDS attributable to injection drug use will be $8.7 billion over six years if trends continue. An even higher figure applies to the medical costs of treating people with hepatitis C. When I say, as I did earlier, that about one-third of new HIV/AIDS cases and about two-thirds of new hepatitis C cases are related to injection drug use, you can see that this situation will have immediate implications for the costs to the health care system.

Finally, though, it's difficult to measure some of the other things, the social issues. I've included them on the cost page but I don't have dollar amounts beside them. We know that the physical and psychological harm associated with substance abuse is enormous. We know there is violence associated with it. We know there is sexual abuse associated with it.

The cost of productivity loss due to illness and death related to alcohol has been estimated as $4.1 billion. With respect to illicit drug use, the estimate for productivity loss due to illness and death is $823 million. But I can't emphasize enough those costs that we can't quantify—the costs to individuals, to their families, and to their communities.

Canada's Drug Strategy, the red and white book you see before you, was approved by cabinet in 1998. It was the work of a committee of 11 federal departments and a number of non-federal partners. Although I'm not sure how many of us were here at the time it was produced, I think it was quite a feat to reach a goal statement that all parties and all of the departments represented could agree to. The goal of Canada's drug strategy is to reduce the harm associated with alcohol and other drugs to individuals, families and communities.

If you look at slide 10 you'll see the federal government partners in Canada's drug strategy. These are the 11 departments that not only participated in producing that red and white book but are active with us on a regular basis in looking at drug policy and related issues.

Among the departments listed there, you will see blue ones and yellow ones. The blue departments are the ones Health Canada will be dealing with on a regular basis and that will also be dealing with each other on a regular basis. For example, Foreign Affairs will be dealing not only with Health Canada on overall drug strategy issues but also more directly on a day-to-day basis—on extradition matters, for example—with Justice Canada. Justice would be dealing on a regular day-to-day basis not only with Health Canada on drug strategy but with the RCMP on enforcement and prosecution matters. That's the reason we have blue and yellow circles on your chart.

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You can see the list is quite extensive. Some of them are obvious partners in Canada's drug strategy. Foreign Affairs and International Trade is there because of the global nature of the drug issue and because of our many international commitments. Justice is there, of course, because of its responsibility for prosecuting offences as well as other related criminal matters. The Solicitor General, the RCMP, and Correctional Service Canada are obvious partners in Canada's drug strategy, as is the Canada Customs and Revenue Agency. This is one of the reasons, I suppose, you spoke to them on Monday.

About some of the others, you may wonder what their involvement would be. Why, for example, is Canadian Heritage there? Canadian Heritage is responsible for doping in sports, and that's considered part of Canada's drug strategy. Human Resources Development Canada is our link, in Canada's drug strategy, with the homeless secretariat. Indian and Northern Affairs Canada has responsibility for provision of services to first nations communities, and substance abuse is one of the issues of concern to that department.

I'm not going to go through all of those departments and describe their responsibilities, but we would be happy to reply to any questions about why they're on the chart.

The next slide shows some of the external partners in Canada's drug strategy. An obvious partner is the provinces and territories. Many of the issues related to drug strategy have to do with the provinces and in fact in some cases fall under provincial jurisdiction. Prevention and education are within provincial jurisdiction. Treatment is largely a provincial issue. There are many important reasons that we link very closely with the provinces.

All of the departments that you saw on the previous slide have their own federal-provincial-territorial committees and are thus networked in that way. As well Health Canada chairs a federal-provincial-territorial committee directly on alcohol and other drug issues, and it has a number of working groups.

So we try to link very closely with the provinces in this regard. The non-governmental organizations are also key to our ability to function within the drug strategy. For example, the Canadian Centre on Substance Abuse, which is a federally funded arm's-length charitable organization, provides a national focus for efforts to reduce health, social, and economic harm associated with substance abuse and addictions.

Various other non-governmental organizations are involved also. We work very closely with a number of professional associations: the Canadian Medical Association; the Canadian Pharmacists Association; the Canadian Society of Hospital Pharmacists.

The private sector is involved: the Brewers Association of Canada; the distillers; the Non-prescription Drug Manufacturers of Canada; the Wholesale Drug Association; the Industrial Hemp Association—the list goes on and on.

We work very closely with law enforcement as well. Particularly we have representatives from a number of federal departments who sit on the committee on substance abuse of the Canadian Association of Chiefs of Police. We also participate in an organization called Health and Enforcement in Partnership.

I haven't mentioned in any detail the community groups, the multilateral organizations, the licensing bodies that are also key players in anything Canada does with respect to substance abuse.

I shall focus now a little more on Health Canada, at slide 12 in your deck.

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Health Canada, as I mentioned previously, is considered to be the lead department on Canada's drug strategy. We do have responsibility for the Controlled Drugs and Substances Act and its regulations. Within Health Canada, however, there are several branches that in one way or another have an involvement with respect to the drug strategy.

My branch is the healthy environments and consumer safety branch, and we are the focal point for Canada's drug strategy within Health Canada, and again, between Health Canada and other departments. However, the population and public health branch of Health Canada has concerns to do with AIDS, hepatitis C, seniors, mental health, child development, and those kinds of things, and we often work in concert with them and find synergistic ways we can both achieve our objectives.

The first nations and Inuit health branch of Health Canada provides services directly to populations on reserve, and that's another area where there are alcohol and drug treatment programs provided directly to first nations populations.

And there's the health products and food branch, where normally therapeutic products, therapeutic drugs, go through a preliminary review and final approval. If they're controlled drugs, then the Controlled Drugs and Substances Act will be invoked, as well.

Within the healthy environments and consumer safety branch, my program is called the drug strategy and controlled substances program. As you can see on slide 13, there are four main offices that contribute to this program: the office of controlled substances, whose main role is to administer the Controlled Drugs and Substances Act to ensure controlled drugs and substances are monitored and controlled in such a way that they remain in legal channels and are not diverted to illegal uses, but in a way that won't interfere with their valid medical, scientific, or industrial uses; the office of Canada's drug strategy, which provides national leadership and coordination with respect to prevention, treatment and rehabilitation, harm reduction, and drug policy activities; the drug analysis service, which provides analyses of samples seized by police and law enforcement agencies for prosecution purposes, and also assists in the investigation and dismantling of clandestine labs that are producing illegal drugs; and finally, the office of Canada's medical access, which developed and administers the marijuana medical access regulations. This is a compassionate measure that allows individuals suffering from grave and debilitating illnesses to receive authorization to possess and/or cultivate marijuana for medical purposes. This office also coordinates the development of related policies and initiatives, such as the medical marijuana research program and the establishment of a reliable Canadian source of medical research-grade marijuana.

I think there are a number of slides following that go into more detail about the offices within Canada's drug strategy. I would be happy to skip over them and come back, if there are further questions.

Perhaps I'll close, then, with a little bit about what the issues and challenges are. You'll see there are only three bullets on that last slide. If only life were that simple. What we were trying to do was find a way to squeeze down and group what are some of the primary issues. I'm sure there are many more, but these were the ones that struck us as being the most salient and creating the most problems.

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The first issue I call “knowledge”, and that's knowledge in many ways. In Canada we really are lacking knowledge about the prevalence and incidence of substance abuse. The last Canada-wide survey was done in 1994. We know that patterns of substance abuse have changed since then, but we don't actually have good knowledge of who is using drugs, when they're using them, what drugs they're using and how often, when they start, when they stop, and how it affects their lives. Knowledge in that regard—pretty basic stuff—is really lacking.

There's knowledge also in terms of what works—what works in prevention, in treatment and rehabilitation, in enforcement and control, and in harm reduction. The scientific literature is quite weak in all of these regards, so there are a lot of pious intentions. There are also a lot of promising avenues to explore, but I would say at this point there is no really good knowledge about what works in each of these four areas.

The other thing, of course, is recognizing that substance abuse is a multi-factorial issue. It's actually very hard to evaluate what works. I think one of the reasons there is such a dearth of good scientific knowledge is not because of lack of interest, intent, or goodwill, but because it is so difficult to tease out the issues—the social issues, the economic issues, and the other health-related issues. I don't think we should stop trying, but I think we're a long, long way away from having good information.

The other thing in the knowledge issue is even when you do look at the population and ask questions about who is using drugs, what drugs they're using, how often, when and where, when they start, and when they stop, you don't necessarily have a population that's anxious to answer your questions. You don't have a population that's necessarily going to answer your questions truthfully, and finally, there's a large part of the population of substance abusers that surveys never find, such as people who live on the streets, or people who don't read, who are illiterate—very, very hard populations to survey.

So when I say lack of knowledge is one of the main issues and challenges, I think you can see that actually wraps up a whole number of issues that are important but not easily solved.

I put public opinion in here really just because I wanted to highlight—I'm sure you're aware of it—the really strong schisms in public opinion around drug issues. People have strongly felt beliefs, they believe them strongly, and the differences from one group to another are really quite profound. I think you're all aware of the recent Léger & Léger poll that looked at questions around legalization or decriminalization of marijuana. Essentially, you saw almost a 50-50 split. One of the things that relate back to the knowledge issue is that the more people know, the more likely you may be to find some developing unity of opinion. So there is a real need for public education and growing public understanding.

The other one I mentioned in here was international considerations. By that I didn't simply mean some of the international pressures. You all know we've been criticized by the U.S. as being a source of marijuana for their population. I personally take that with a grain of salt. The bulk of the marijuana used in the United States comes from the United States. But international considerations are important, because drug use is a global issue. There are no closed borders. When issues such as what's going on in Afghanistan happen, the price of heroin drops enormously. That will someday affect use in Canada. So the international situation affects us directly, and there are things about it that are completely out of our control. Drugs move around the world, and attitudes also are affected around the world.

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The last thing I wanted to say was that there are a number of departments, as I mentioned, involved in Canada's Drug Strategy. There are, in addition to those eleven federal departments that are directly involved, ten provinces, three territories, and a lot of municipalities and non-governmental organizations. Every one of them has a part to play, every one of them has a jurisdictional as well as a goodwill role, a role they undertake willingly. In order to effectively address such complicated issues, which involve so many different players in so many jurisdictions, you must have strong leadership and coordination, and you must have sustained funding and attention.

With that, Madam Chair, I or my colleagues will be happy to take questions.

The Chair: Thank you very much, Dr. Gomber.

We do have a number of people lined up for questions. Colleagues, if I can just remind everybody that if a phone call is really important, this line is available and the number is always on your sheets that outline the agenda. So if everyone could turn off their cellphones, that might be helpful.

The first questioner is Mr. White.

Mr. Randy White (Langley—Abbotsford, Canadian Alliance): Thank you, Dr. Gomber, for coming here.

Each time I hear a department come in here and talk about drugs, I tend to think the departments speak through a rose-coloured glass, I guess, seeing things as a lot better than they really are. I do a lot of work with people on the street with drugs. I don't have quite the optimistic viewpoint you do on these things. Your goal, for instance, in Canada's drug strategy, to reduce the harm associated with alcohol and other drugs—how do you measure that from a department's point of view?

Dr. Jody Gomber: First, I want to say I actually don't believe I was presenting a rose-coloured view of the situation.

Mr. Randy White: Okay.

Dr. Jody Gomber: But I think the question of how we measure our activities is a good one, and a very difficult one. Canada's drug strategy phase one—and that was 1987-92—had some specific goals and targets and a specific amount of funding associated with it. Likewise, the second phase had specific goals and targets and funding associated with it. When the funding for those projects ran out, Canada's Drug Strategy, the document, was published, but unfortunately, there was not a great deal of funding available to do things like evaluate the effectiveness of the activities that had gone on. So I agree with you that it's important to evaluate those things, but unfortunately, there has not been much opportunity to do that.

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Mr. Randy White: This is one of the difficulties I have, actually, not just with the goal, but with the document. In fact, if you look at the document that was produced by the Conservatives at the time, or Health Canada under the Conservatives, some of these things are basically overlay of that previous document. If you look at even the wording of it, it's very similar. At the time I looked at both of them I wondered why there wasn't an emphasis on how things have changed, because things have certainly changed since that 1987-88 document.

And I might tell you that I believe marijuana is about the second largest income crop in British Columbia, so it certainly is a big crop there.

Since Health Canada is concerned with the health and welfare of Canadians—I guess that must be somewhere in your goals or your mandate, your vision statement, something like that—I wonder what you think, if there is not a contradiction, of safe shoot-up sites? If there is a concern about the health and welfare of individuals, does providing safe shoot-up sites match up with that goal or does it contradict it? I'm not trying to trick you into saying anything, I'm curious.

Dr. Jody Gomber: As I mentioned earlier, one of the harms associated with injection drug use is blood-borne diseases, HIV AIDS, drug overdose, site infections, those kinds of things. We know, for example, that if people are shooting up with friends and they go into an overdose situation, their friends are often reluctant to go for help, because it's illegal. So people are left to die for reasons that don't necessarily have to do directly with the drug, that have to do with the circumstances under which they're using them. In a harm reduction scenario what you want to do is try to deal with those other things that right now are surrounding the injection drug use, not necessarily direct consequences of the drug itself.

Mr. Randy White: Health Canada, I believe, is supporting the funding of needle exchanges. Is there a contradiction between not funding needles for diabetics, for instance, and saying we think a needle exchange is good, and buying needles and giving them to addicts is a good idea? It's a question I often get from diabetics.

Ms. Cathy Airth (Acting Director, Office of Canada's Drug Strategy, Drug Strategy and Controlled Substances Program, Healthy Environments and Consumer Safety Branch, Health Canada): I guess it comes down partly to provincial and federal responsibilities. Provision of needles for diabetics is done under provincial health care plans, from what I understand. The other aspect to that would be again that we're looking at the spread of blood-borne pathogens, so reducing the harm with respect to injection drug use. These are often marginalized people who would not have access to safe needles otherwise.

As to the earlier comment you made with respect to needle exchange programs, those are also supported by provincial governments, as you probably know, in various provinces.

Mr. Randy White: Actually, that's not entirely accurate. There's federal funding going in there.

Ms. Cathy Airth: I said they're supported as well by provincial governments.

Mr. Randy White: I'm not sure whether you answered it, because the tax system could cover diabetic needles as well.

Ms. Cathy Airth: I guess I was deferring to the provinces on that one. I believe the needles for diabetics come under the purview of the provinces.

Mr. Randy White: Finally, do you think this is working?

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I look at it from my perspective. I see the growth of addicts in the lower mainland of British Columbia just extending itself. I see across the country, wherever I go, to be honest with you, more and more more kids... Ecstasy, as you say, has expanded substantially. Do you think this is effective? Is it working?

Dr. Jody Gomber: I think a lot more needs to be done. It's very difficult to talk about whether it works or not from the number of addicts or the number of users... The RCMP or police forces in general, both in Canada and the U.S., will say that the higher the number of seizures or the higher the number of interdictions at borders, the more effective they are. Can you say that? Maybe the higher number of seizures means there are more and more drugs getting in. As I said earlier, I don't think we have a very good handle on how to measure the effectiveness of substance abuse and drug policies.

Mr. Randy White: Thank you.

[Translation]

The Chair: Mr. Bachand, you have seven minutes.

Mr. André Bachand (Richmond—Arthabaska, PC/RD): I will take just one minute, because we have to share our time.

This committee was established to examine all issues surrounding non-medically used drugs, and it has broad terms of reference. I would like to come back to what you just said, and to what you said at the beginning of your presentation. Any action taken, any good idea the committee could put forward, would still be of very little use because we do not have the resources or the means to see whether our activities are indeed effective.

If I understand you correctly, I gather that since 1995 there has been no national study or update on the use of illegal drugs and alcohol. In other words, since 1995 there has been no proper study to justify the documents created since that date. Am I right in saying there have been no studies?

[English]

Dr. Jody Gomber: Just to clarify, the last Canada-wide survey of drug use was in 1994. So what we don't have since 1994 is any consistent measure across the country of who's using what drugs when.

[Translation]

Mr. André Bachand: When we receive reports—even those occasionally sent by Statistics Canada—what are the figures in them based on?

[English]

Dr. Jody Gomber: I'm sorry. Could you ask that one more time?

Mr. André Bachand: Statistics Canada released some numbers about drug use in Canada.

Dr. Jody Gomber: The Statistics Canada figures, I believe, are based on arrests and charges as well as criminal convictions.

[Translation]

Ms. Cathy Airth: Sometimes individual provinces conduct studies as well. For example, studies are conducted in Ontario somewhat more frequently than at the federal level. We found that a bit difficult, because we had no study for Canada as a whole. So that is the problem. There are areas for which we do have information, but we do not have it for Canada as a whole.

[Editor's Note: Inaudible]

Mr. André Bachand: ...Mr. Saada can have more time.

[English]

Dr. Jody Gomber: I just wanted to add one other note. Even with respect to the Statistics Canada figures, for example, the most recent set of data I looked at was of court data, and that depends on the willingness of the provinces to contribute those data. The most recent set was missing three provinces. So although it talked about drug offences and court cases and dispositions and those kinds of things, it was actually missing information from three provinces.

[Translation]

Mr. André Bachand: So once again, if I understand correctly, we do not know whether our efforts are effective, in spite of the measures and energy invested, in police, legal, medical and legislative efforts. I think that we will have to do our homework on this.

Increasingly, we find ourselves talking about two things: decriminalizing and legalizing cannabis. Most of all, we talk about decriminalizing cannabis use.

• 1635

Has your department examined the issue to see whether decriminalization would result in greater use, or similar use? Have you considered how decriminalizing or legalizing cannabis may jeopardize the fight against illegal drugs?

[English]

Dr. Jody Gomber: My department has not actually done that kind of research. But, as you know, a number of countries are looking at similar issues.

I imagine that some representatives from the Netherlands will come and talk to you at some time in the not too distant future. You will see in the published literature all kinds of different views about what happened in the Netherlands after they adopted the policies they adopted.

Within Canada, of course, it would be very difficult to try to project what might happen. The only way you can actually do so is to try to look at what the situation is in other places.

Some states in the United States as well as certain countries have effectively decriminalized—not necessarily in legislation—the possession of small quantities of marijuana.

The literature, as far as I understand it so far, seems to suggest that usage doesn't change between those countries and their neighbouring countries or those states and their neighbouring states.

[Translation]

The Chair: Thank you. Mr. Saada, the floor is yours.

Mr. Jacques Saada (Brossard—La Prairie, Lib.): Are there means—and I am not asking what those means are—of measuring prevention activities, or the impact of preventive measures? Can that impact be quantified? You were talking about four pillars: prevention, control, and so on. But are there any scientific measurements that make it possible to determine the real impact of preventive measures?

[English]

Dr. Jody Gomber: I think there are. But they are very difficult to quantify. For example, if you are looking at using prevention programs in the schools, and you want to measure not just the amount of messaging, but also what impact it actually has on behaviour, then how do you control for all of the other influences around them?

Mr. Jacques Saada: My question.

Dr. Jody Gomber: Yes. So they are difficult to do. But I believe techniques within social science will allow you to at least get close to that. But it requires a certain amount of sophisticated research.

[Translation]

Mr. Jacques Saada: I have a question that may be a little more controversial.

In the area of health—and I mean just in the area of health, aside from the social and criminal implications—can we justify the fact that alcohol is legal when some other drugs are not? I am talking about the health impact only. In other words, I am not asking you to make a policy statement. I am talking solely about the health impact.

[English]

Dr. Jody Gomber: I'm not sure I can answer that question.

Mr. Jacques Saada: Maybe I can put it in other words.

Dr. Jody Gomber: Sure.

Mr. Jacques Saada: I suppose we know the health impact of most drugs on the market. Have some drugs been proven to be less dangerous to health than alcohol—or tobacco for that matter—such as marijuana, for instance?

Dr. Jody Gomber: I am not aware of any direct comparisons between alcohol, tobacco, marijuana, cocaine, heroin, for the sake of argument. We do know that there is some evidence that alcohol can have beneficial effects in certain health regards.

• 1640

Mr. Jacques Saada: And we don't have the same things concerning drugs.

Dr. Jody Gomber: We have certain drugs that have been approved for particular uses.

Mr. Jacques Saada: For medical purposes, for instance.

Dr. Jody Gomber: Yes.

Mr. Jacques Saada: When we talk about one of the dangers of alcohol—and you refer to that—we have some means, for instance, for testing the degree of alcohol in the blood. It can be done with different types of techniques. Do we have, or are we on the verge of having, something similar for drug intoxication?

Dr. Jody Gomber: I actually don't know the answer to that question.

Ms. Cathy Airth: I don't know whether we are on the verge, but I know people are working on that issue, especially through Transport Canada and the Department of Justice. They are looking at developing the tools to measure that type of effect.

Dr. Jody Gomber: But let me add a thought to that, because certainly one substance that has been of concern with respect to driving while impaired is marijuana. It is very difficult to specify an impairment level, because marijuana stays in the blood stream for so long that you can still be showing THC effects in the blood long after you have smoked the marijuana. Therefore, it's hard to identify the level within the blood that would be directly associated with impairment.

Mr. Jacques Saada: Thank you.

[Translation]

I have one last, brief question.

Does Health Canada have a listing of drugs on the market, ranked in order of the seriousness of their health impact? I'm not talking about medical drugs, but about illegal drugs.

For example, we might say that cannabis would be less dangerous than heroin, which in turn would be less dangerous than... Is there some sort of ranking established on the basis of health impact? In other words, are there scales that measure the impact of drugs on health?

Ms. Carole Bouchard (Director, Office of Controlled Substances, Drug Strategy and Controlled Substances Program, Healthy Environments and Consumer Safety Branch, Health Canada): I will try to answer your question. One of the brochures you have on the benefits and problems of drugs provides categories or different kinds of drugs. In this brochure, some types of drugs are targeted. There are also psychotropic drugs, as well as drugs that have a medium- and long-term impact on health. Potential dependence and tolerance are also indicated. The table of course gives a very broad perspective, and provides a lot of detail.

In the schedules to the Controlled Drugs and Substances Act, we do find listings that rank the kinds of impact drugs can have. For example, Schedule one contains drugs that are narcotics, like opium, rather than drugs like morphine, which have a more intense impact.

The schedules thereafter contain drugs with lesser impacts. For example, Schedule IV contains tranquilizer-type drugs. It also includes anabolic steroids. The schedules are associated with the kinds of penalties to be imposed for breaching provisions.

Mr. Jacques Saada: Madam Chair, I do not think I really have a question. But I do have a brief comment.

One of the objectives I would like this committee to pursue is to say that, all things considered, with integrity, we have allowed and will allow the sale of alcohol, we allow the sale of tobacco, and we should be able to allow the sale of this, that, or the other thing, if that is indeed possible. If not, I would like us to have clear and comprehensive reasons to justify our decision.

So far, and please correct me if I'm wrong—I believe we have taken on a very difficult task. The fact that we authorize certain drugs and ban others is primarily a political, rather than a genuinely scientific decision—at least, that is what I conclude by reading between the lines of your statements.

• 1645

When I say "authorize" I understand that we would be making a distinction between decriminalization and legalization. There is of course a third avenue we could take: we could do what the Netherlands have done. Their approach is unofficial tolerance.

Am I right in saying that the debate is almost exclusively political, because there is no way of actually determining what I would like to determine on the basis of logical rationales?

[English]

Dr. Jody Gomber: I think drug policy by its very nature is drug policy. In other words, it is up to Parliament, to the government, to determine what drug policy should be.

We are happy to provide whatever scientific information we have in order to inform the debate, but surely one of the roles of legislators is to take into account all of the many factors that go into this kind of decision.

The Chair: Thank you, Mr. Saada.

I have two things. On page 49 of this document there is some information about detection of some of these substances and the length. But if it's urinalysis, I guess you were referring to some kind of drinking and driving measure such as a blow that you can do for alcohol. And secondly, the other option is maybe we could recommend banning alcohol and tobacco.

Mr. Jacques Saada: Can I quote you?

The Chair: I wasn't suggesting it. I was just taking an alternate view for a second. Prohibition here, no.

Mr. Sorenson, five minutes.

Mr. Kevin Sorenson (Crowfoot, Canadian Alliance): First of all, this is basically the second meeting I've been to, so I'm not pretending to be an expert in any of this.

You head a government department, is that correct? What's the budget of the department?

Dr. Jody Gomber: I'm the director general of the drug strategy and controlled substances program within Health Canada. The budget of my program is $33 million a year.

Mr. Kevin Sorenson: Yet you said that it's hard to evaluate what's working. It's hard to evaluate a strategy. We're in charge of a strategy, yet there's no way of evaluating the effectiveness of the strategy. Do you take into consideration the number of convictions? Do we see an increase in drug use? Do we see a decrease in drug use? Perhaps that might be a starting point for evaluation of a drug strategy.

You say that some of these drugs are well entrenched in society, especially among youths, with regard to Ecstasy and a few other drugs. Isn't it a fact that our drug strategy isn't working? I visit prisons. We talked at the last meeting about drugs in prisons. People go into prisons for robbery and they come out drug addicts. Kids go to school. Even in some of our smaller communities now, drugs are more and more rampant all the time. Isn't it just a fact that the drug strategy is not working and that we need perhaps to do an in-depth evaluation and come up with a strategy that does work?

Dr. Jody Gomber: It's an interesting question. The fact that more and more young kids may be using drugs in school may be an indication that the drug strategy isn't working. It may be an indication that the drug strategy is working for some of them and not for others. Maybe the numbers would have been even higher. In fact, it's not really an indication of anything.

• 1650

I think we're seeing a worldwide trend of more drug use. There are very few countries that aren't suffering from the same kinds of increases—at least in those countries that will let you see their figures. So I don't necessarily think it's a sign that it works or doesn't work.

I guess at this point I'm suggesting that I don't think there's a magic bullet. I don't think if we just did this one thing we'd solve the drug abuse problem in Canada. I really believe we need to have an integrated approach. We need to address matters on all fronts, and we need to have a coordinated approach. That's probably what has been lacking, to some extent.

I just want to go back for a minute and talk about the $33 million my program spends, because it sounds like a lot of money. It sounds like some money anyway.

Mr. Kevin Sorenson: It sounds like a lot of money, but we don't know if it's working or not. Maybe it's not enough money. I'm certainly not suggesting it's too much money, but my problem is it's $33 million and we don't know if it's going to work. We don't even know if there's a grid... if we'll ever know if it's going to work.

We know that we have 8,600 days in hospitals from alcohol. We know that we have 7,000 days in illicit drug use in hospitals. We know that we have 700 deaths from alcohol and 732 from illicit drug use. There have been 60,000 lost days just from the one... yet nobody wants to say it's not working.

When you take a look at what this brings out on the economic side of things, it lowers our productivity big-time.

There's all this beautiful blue and yellow paper here—

The Chair: You have another question, I think, and this witness hasn't finished. You'll have to come back on the second round, because you're already over five minutes.

Do you have more to say?

Dr. Jody Gomber: I just want to say that of the $33 million that is spent within my program, a fair chunk is legislatively mandated. We have six drug analysis labs across the country at the moment. They're staffed by chemists and technicians who analyse drug samples for police to take to court. Right now we have a legislative responsibility to do that, so a chunk of the money goes there.

We have responsibility to operationalize the regulations of the Controlled Drugs and Substances Act. We have to issue import and export permits. We have to license manufacturers and distributors. There are a number of things that are mandatory activities that basically eat up a big chunk of that $33 million.

So I don't want to leave the impression that we're just sitting here with a bunch of discretionary money.

The Chair: Thank you, Mr. Sorenson. There will be another round.

Mr. Harb.

Mr. Mac Harb (Ottawa Centre, Lib.): Just on that very briefly, how much of your overall budget do you spend on prevention?

Dr. Jody Gomber: We actually spend very little. Again, thinking about who all of the players are in Canada's drug strategy, a large part of prevention activity is provincial. It becomes the province's responsibility through the school system. It becomes the province's responsibility through a number of other community kinds of organizations. So we spend very little ourselves on prevention.

Mr. Mac Harb: How does that compare with tobacco's prevention, in terms of how much money we spend on fighting tobacco at the federal level, versus fighting the use of illicit drugs?

Dr. Jody Gomber: I actually don't have the tobacco figures.

Mr. Mac Harb: That's okay, but I think that would be useful, since it's part of what we are dealing with.

• 1655

I have a couple of questions here. First, do we have any information on recreational drug users? Who are they? What percentage of your data represents recreational users, who may not be included with those who are illiterate, abused, underprivileged, and so on? We would like to get those statistics, if you have them. You don't have them? Okay.

On my second question, it seemed to me, from statistics we saw the other day, that as the economic situation improved, drug use increased. I found it exceptionally odd that from 1977 to 1982 it seemed to go up; from 1982 to 1990 it went down; and from 1992 to 2000 it went up again. In retrospect, when you look at the economic cycles, we had the recession in the 1980s, so not a lot of people were using drugs; we had a boom in the 1990s, and people start using them more. That's why I asked about the recreational element. I'm just curious here.

Dr. Jody Gomber: Can I ask a question about those figures? I haven't had the benefit of looking at what you're looking at. Are they based on arrests, charges, or convictions?

Mr. Mac Harb: That's a good question. They were in a briefing book we got. There are probably more copies of them here. You can look at one, at your leisure.

Dr. Jody Gomber: Sorry, I don't want to interrupt, but I asked that question because arrests, charges, and convictions don't necessarily reflect use; they reflect police priorities.

Mr. Mac Harb: But in the absence of actual hard-core data, we all seem to be working on sort of guesstimates. Simply put, I understand that's because we're talking about a business that is totally underground, by and large. So when you want to look into it, you can really only look at it from one angle, to a large extent. We can never see the overall picture.

We spoke here about international treaties, and there are a number of treaties. This committee was asked to look at this whole issue of drugs, and I want to find out whether there is a spectrum of operations, with all of those international treaties, to help us come up with some sort of substantial recommendations that fit within the overall strategy of government, but are creative enough to really get to the bottom of the problem. We need your guidance on that.

If you want to share that with us later, whether through discussion with the chair or with the committee, that's fine.

Do you have any comment on that?

Dr. Jody Gomber: I won't try to go into any great detail and depth about the international conventions, but certainly there has been a lot of talk about what the conventions allow or don't allow signatory countries to do. There is a certain amount of dispute about what the conventions allow or don't allow signatory countries to do.

One of the things I'll perhaps pass on to the research staff is a fairly good review by the EU—I don't know if you've seen that—on what the conventions might or might not allow and where they stand. So that's one thing.

Mr. Mac Harb: Okay, that will be useful.

I have a final question, with the permission of the chair, on when we have a situation and prescribe a solution to a problem. We rarely see a doctor, for example, telling a patient to smoke or drink to deal with their problem or solve their problem. But we seem to see a lot of doctors in the medical community prescribing drugs.

I think this is a very interesting point. A number of my colleagues have been trying to raise the issue of whether or not there is room here for manoeuvring. We could at least look at the possibility of controlling part of this whole industry and trying to manage it, in a sense, where we would still fulfill our commitment on the international scene, but would deal with the substantial problem at hand.

We really don't know how bad it is. Looking at the figures in terms of the people with blood-borne diseases and the amount of illicit drugs that exist, it is in the billions. Frankly, we'll probably never have a clear idea in terms of what's going on unless we either have a pilot project of some sort where we say we want to look at it for one, two, or three years, or just come up with some sort of a creative solution. I need your comment on that.

• 1700

Dr. Jody Gomber: I'm not exactly sure whether you were referring to all drugs in general or particularly injection drugs at this point. I suspect probably the latter.

I am very pleased that you've now received a copy of the report called “Reducing the Harm Associated with Injection Drug Use” that was received by ministers of health, because what that represents is a consensus among provinces, territories, and the federal government about certain priorities that need to be undertaken with respect to injection drug use.

You will find in that document a number of recommendations around looking at, through pilot projects, the use of prescription drugs for drug addicts, for example, or supervised injection sites, those kinds of things. They're not saying this is a great thing, so just go out and do it. They're saying we really need to look at these in a scientific way and establish whether they would be useful in a Canadian context.

Mr. Mac Harb: Thank you very much.

The Chair: Thank you.

For your information, witnesses, the information that Mr. Harb was quoting came from the 1999 Ontario student drug use survey. It reported that the use of cannabis among students in grades 7, 9, 11 and 13 dropped significantly between 1979 and 1991. However, recent statistical data from the same survey showed a steady increase in the use of several drugs, including cannabis and alcohol, since 1993.

I think there have been other reports, perhaps a little too anecdotal, about cocaine use being on the increase among certain communities.

Dr. Jody Gomber: What I was reacting to was the notion that it was counter-cyclical, because especially if you're looking at enforcement data, it may well be that when times are good and police forces have money, they have more enforcement.

Mr. Mac Harb: It's like fishing: if you have more fish, you catch more fish.

The Chair: Mr. White.

Mr. Randy White: Mac, I don't think I've ever heard a doctor prescribe a good shot of rum to fix something, yet it's a good point you make.

My comment about rose-coloured glasses had nothing to do with your presentation. It's a thing I have about us up here saying this is what's going to fix things, and yet down on the street they're a million miles away from it—and it's sad when you see it.

I have two questions. If you take a $33 million budget, I would be willing to triple or quadruple that if, as Kevin says, I knew what it was going to. I personally think we are very short of rehab facilities in this country—detox more than most, but we have more than the others. We have more short-term care. But if you get into intermediate and long-term care, there's almost nothing in this country.

Then we get into this wrangle about provincial-federal business. I hope at the end of the day, when we make recommendations, there's something in there that says, look, from a federal perspective, we'd like to see some coordination of this and have this many in this province and this many in another, and so on, and not just short-term facilities. I've worked with some that basically threw kids out the door into foster homes or onto the street after 12 or 14 weeks, and they couldn't even get back in then. I think that's a travesty, and I think that's something we have to look at and it should be part of your operations.

• 1705

That being said, this committee has a responsibility to report back to the House of Commons and hopefully bring some substantive recommendations. Given the wide scope that this committee has to make recommendations, I wonder if there is any particular field that Health Canada is interested in seeing this committee tackle, because basically this is going to be the only committee probably for the next decade or two, since the Le Dain commission in 1974. Now is your chance to say where you think we should be headed more concretely in this area. I'd be interested in finding out what you think we should be looking at.

Dr. Jody Gomber: As you know, these are tough questions. The committee has a very difficult job.

I want to back up for one second and talk again about my $33 million, and point out, of course, that my $33 million is only one part of funding or spending federally, provincially and municipally, on substance abuse issues. I couldn't agree with you more that there is a real lack of treatment facilities. We know there are parts of the country where voluntary treatment seekers are having to wait to get treatment, and we also know it's always best to give treatment when it's sought. So I agree that there is a real lack in that area.

I also agree that there is insufficient attention paid to prevention programs, and certainly there is a need for more coordination in all those regards.

Finally, in terms of the committee, a number of the questions—some of them more directly, and some less directly—have been around issues of what is or should be legal, what shouldn't be legal, and what penalties should or shouldn't be. I think there is a need for that kind of discussion and for the committee to be able to make recommendations to the House, because there is so much discussion and debate on it in the public domain today and so much confusion around it. I think that would be a very useful function that the committee could perform.

The Chair: Thank you very much, Madame Carroll.

[Translation]

Ms. Allard.

Ms. Carole-Marie Allard (Laval East, Lib.): Thank you, Madam Chair. I thank our witnesses for being here today.

From your presentation, I conclude that since the health ministers' meeting in St. John's, injectable drugs in Canada have been targeted as a serious and urgent problem. Is this indeed true? It says here that the use of injectable drugs is an urgent problem. However, if it is indeed an urgent problem and we need both short- and long-term measures, I do not see how the measures that have been advocated—dialogue, committees and co-operation—are going to be truly effective. Could we not envisage doing something else? For example, have you considered the option of giving drug users access to drugs? Do you understand what I mean?

You seem to agree that this is an urgent problem, but the measures indicated here include dialogue and co-operation. What I am asking is whether this is enough. If drug users are addicted to injectable drugs, we all agree that they cannot be helped without therapy. In your studies, have you considered providing drug users with access to substances that they require?

Dr. Jody Gomber: Ms. Airth chaired the committee which drafted this report. I will therefore let her answer your question.

Ms. Cathy Airth: If I may, I will answer your question in English.

[English]

I think the results of this work need to be viewed as a framework for action—and I'm using that term advisedly, because we know that's a term that has been used by the Province of British Columbia, in consultation with Vancouver City Council, to look at a framework for moving ahead. It doesn't tell you how we're going to do all this.

• 1710

It is a tremendous amount of collaborative work building consensus between different levels of government and many jurisdictions. It represents police, enforcement agencies, social services, health, justice, and corrections. It's a tremendous level of support at the various levels of government and also between the various sectors, looking at injection drug use as a health issue.

So I think we have to take this forward and move forward with jurisdictions. But if you look at what has gone on in Vancouver, they have a report with very similar recommendations. They are not ready to put everything in place tomorrow. They know it's going to take more time, looking at what sorts of permits you need to take this forward, and talking to business people who have businesses in areas where you might be looking at putting more comprehensive services for injection drug users.

So it is going to take time—it is hot off the press, released last week—but I think we have to view this as a document we now take forward and say that we have had a tremendous level of consensus and now let's get down to brass tacks and see if we can put together a strategy to really put something in place.

[Translation]

Ms. Carole-Marie Allard: But there are areas that are not necessarily under provincial jurisdiction. On page 25, the report states:

In the study conducted with a focus group of inmates, one author has indicated that 25% of those people studied said they injected drugs for the first time while incarcerated.

So there are areas in which we—the federal government—could act quickly.

The other question I had was on your statements on page 35, where you mention the "drug treatment court" established in Toronto.

The Chair: This is on page 35 of the English report, and page 40 of the French report. We have to be able to find it in our own version. What is the title of this section?

Ms. Carole-Marie Allard: The section is entitled: "Diversion Programs". It seems that a pilot project was established in 1998, and is working very well. We are now in 2001, and I do not know whether we have experimented with other measures in Canada. Have we experimented with other measures, or is the only pilot project in Toronto?

Ms. Cathy Airth: This is the only project at present, and we expect a study on it in the fall. This is being conducted by Justice Canada, however. I think another project is slated for Vancouver, but it has not been implemented yet.

[English]

Dr. Jody Gomber: I would like to add a thought to that as well. I think this is an excellent question and it highlights some of the things we were saying earlier.

The Toronto Drug Treatment Court pilot took an enormous amount of work to get up and running. It involved a number of jurisdictions, federal and provincial, and a number of departments. The Vancouver pilot, which we hope is imminent, took a long time to get up and running.

Some of these projects related to injection drug use are difficult for anybody to do by themselves. They are difficult not only legally, but they are difficult with respect to public opinion. Nobody really wants to be the only one. Nobody really wants to be the first. There are dangers of displacement as well. So the real benefit of this federal-provincial-territorial report is that it is an activity the group has agreed on, and they have agreed to support in a number of places.

So what you have, as Cathy said, is something that then allows you to move forward with the comfort that any jurisdiction that's ready to go knows it's not going to be left out there by itself.

Ms. Carole-Marie Allard: I find it very interesting, because when I talk to people regarding les détenus, people in prison, I am told that 75% of these people have a drug addiction problem. That is tremendous. So we should ask ourselves, is it really the place to treat these people to put them in jail? It's not really because they are in contact with other drugs.

Anyway, I think it's a very interesting point that I can read in this report.

Dr. Jody Gomber: I assume you'll have a...

The Chair: We are going to be meeting at the drug court. Yes.

Mr. Lee.

• 1715

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

I've enjoyed your presentation. It's useful background. I'm struck by the extent to which what you described as the context is driven by international conventions and treaties. My constituents are simply saying that we have a problem here. But Health Canada is saying no, the context is really international; it's like the Geneva and the Stockholm accord and the commitments made in the Inter-America... You have three pages of context in international agreements, but what we have here is a drug problem.

I'm curious about that. You don't have to answer that, because it's what you've been handed by fifty years of history. I want to struggle to escape from that, because to me it's a Canadian thing. The drug taker is right here. I realize there's a ton of international influences. I've heard all about globalization. I've heard about organized crime. I know all this. But I think we should be taking our instructions from ourselves and devising our own program.

You may want to comment on that. That's the first thing I was struck by. The other was the huge amount of cost associated with alcohol abuse in relation to what are put forward now as the costs of drug abuse. I'm struck by that. It makes the drug abuse people look like pikers in terms of the public purse and the drain on society. I'm beginning to think maybe the costs of drug abuse are understated, like we haven't added them all up. We haven't added up some of the provincial things. We haven't added up property losses. We haven't added up corruption costs. Do you think we have all of the costs? In fact, you have mentioned an element of the cost that would be HIV and hepatitis transmission rates through injection drug use, and those numbers may not show up here.

I want a cost figure, a harm cost figure. I'm not getting it yet. Can you help me out there?

Dr. Jody Gomber: I think the harm cost figure you see there, as I said, was based on a 1996 study that was based on 1992 data. So first of all it recognizes that the data on which it's based is out of date.

The methodology that was used in that study is evolving. There have been a number of efforts actually internationally to arrive at a good, well-accepted methodology around the world so that we can all measure the same things and be able to compare activities in that way.

So my sense of it is that the methodology there is pretty good, but it's not perfect. But we're also talking about the very old data.

Mr. Derek Lee: How can we as a committee be sure we have an all-in cost figure? We had the Department of Justice in the other night, and they took care of their piece of the pie and then they said we'd have to ask Health Canada about the other piece of the pie. Then there's another piece somewhere else. Your ministry's the lead ministry on the drug strategy. I'm going to suggest that maybe your ministry should have all the costs nailed down, or at least be able to provide a guesstimate.

Dr. Jody Gomber: When you talk about cost now you're actually talking—

Mr. Derek Lee: Harm costs, social cost. Unfortunately, you have to put a number on a dead body or something. I'm looking for the cost so we can determine how economically important it is for us to consider significant changes in policy. If we're going to change policy in a significant way, we'd better have a good reason. Dollars and money and cost is one of those reasons, motivating factors.

Dr. Jody Gomber: Let me separate two parts to the question and also the answer.

When you look at simply federal government expenditures for the sake of argument, and this has been an interesting question in the not too distant past, you will probably see some reference to an Auditor General's report in December.

• 1720

The mandate of this committee looks at the non-medical use of drugs. My program and Canada's drug strategy in general include considerations of medical use of drugs, and consider as well things like alcohol. If you were to ask me to go though my budget and separate out the dollars that are spent on illicit drugs versus the dollars that are spent on alcohol versus the dollars that are spent on, for the sake of argument, benzodiazepines, it would not be easy for me to do that. Benzodiazepines are drugs that have a medical purpose but are also controlled under the Controlled Drugs and Substances Act

Even in terms of bald expenditures, trying to say most drug treatment programs treat people who have a problem with alcohol or drugs... They themselves don't even necessarily keep those figures separate. Many abusers are multiple substance abusers. Many people with alcohol problems also have drug problems, so even on the very basic plane of how much we spend on the non-medical use of drugs, it's not easy to answer.

Mr. Derek Lee: I have one last question, and it is a really short question.

The Chair: Please do it very quickly.

Mr. Derek Lee: In reading about all of those international commitments and treaties, I am inferring that the main theme, the bedrock core objective and function, is prohibition. I'm asking you, is that true? If it is, I thought we had moved away from prohibition a long time ago as a means of dealing with this kind of problem—something like 70 years ago. Am I right, that it's prohibition, and that we're stuck somehow with prohibition—though who knows whether we're stuck? But if it's the theme, I don't like it. I'm interested in your view about my view. Am I correct?

Dr. Jody Gomber: My view is that the international conventions, and more recently some of the international meetings in particular, have taken a much broader approach than simply prohibition. They have been, obviously... The early conventions talked about control. Control is not the same thing as prohibition.

I'm going to ask Carole to expand on this a bit.

[Translation]

Ms. Carole Bouchard: I will speak French, if that's all right?

I have a few comments on international agreements, particularly those you mentioned in your initial remarks, where you stated that the issue was really an international one. Obviously, international agreements impose certain obligations on all countries that are signatories.

However, the Controlled Drugs and Substances Act is a national statute, a Canadian statute. We must consider some of the requirements we have to establish—I will give more details on them later—and we must also consider our national, or domestic, problem. What are the needs here in Canada, the needs of our police forces, of our law enforcement authorities, the agencies that apply the legislation? What do they need to do their work? Our legislation has to cover all those areas.

There are of course obligations under international agreements, but among other things those agreements make it possible to engage in transactions with products throughout the world. The agreements establish a framework to oversee drug movements from one country to another, and all signatories provide estimates of their own annual drug consumption for medical and scientific purposes.

There are very specific objectives that must be met: first, we must ensure that we have enough drugs and controlled substances for genuine medical use. Second, we must ensure that drugs which are moved remain within genuinely legal channels and do not become diverted into areas where we do not wish to see them used.

This of course requires control, but it is a form of control that will not prevent exemptions, that will not prevent medical and scientific drug use, and in some cases industrial drug use as well.

The agreements should not necessarily be considered as a whole, as an obstacle, but rather as a helpful framework. If Canada were not a signatory to the agreements, within the current context, we might in one year or another underestimate our required consumption, other countries would rely on the figures we provided, and might decide to stop sending us the drugs we need. There would be repercussions on the health care system and our ability to meet the needs of Canadians.

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[English]

The Chair: Thank you.

I have a couple of questions you're going to have to get back to us on, because this meeting is going to end in five minutes.

First of all, earlier in your presentation, Dr. Gomber, you mentioned that we're a leader. We're a leader in these international circles, but why? Is it that we're a land of great people, is it that we have examples of great things that work, or is it that we start a great dialogue? Why have we been distinguished in this way?

Secondly, you've talked a bit in response to Mr. Lee about breaking down your $33 million budget. Specifically, we're interested in the numbers on the prevention of drug use and in what you do to support control activities. You mentioned that the lab costs are probably a big chunk of your budgets, so that's the control and interdiction side again. What are you doing on the prevention side?

We'd like some information on your tobacco prevention and on the department's tobacco prevention budgets, as well as on the FAE/FAS prevention budget, because, again, that's largely targeted at aboriginal communities. That's our budget. Where, if you cannot provide it, can we get some information on the total prevention budget across the country: what the provinces are spending and what we're spending? Part of this is motivated by a concern that we're spending a lot of money on control and enforcement, yet we don't really know if it's working.

You mentioned that to determine whether or not the money we're investing is working, it would take some sophisticated research. What kind of research are you talking about? Is it expensive? Is it difficult? What kind of research would determine whether or not we are in fact spending wisely?

I wonder if you could get back to us on whether you think you have access to the necessary scientific evidence to inform your policy making? France has a scientific college to create, collect, and coordinate data and its analysis. I gather they do a lot of coordination of these activities. Do we have something equivalent in Canada? Would it be a good idea for us to have something like that, and would it help inform our policies?

You mentioned in your slides that we use a population health approach. I'd be particularly interested in seeing the breakdown of your activities on that population health approach, particularly in the area of prevention. What are we targeting at the prenatal stage? What are we targeting with juveniles? Adolescents? Adults? How do we break down the messages?

There are eleven different departments involved. I'd be interested in finding out how you get together, when you get together, and what level of people are involved in those meetings, as well as your assessment of whether that's working or not.

As part of that leadership question, too, it would be interesting to see how you would rate our drug strategy in comparison, perhaps, to the strategies of European and other countries—the Netherlands, France, Germany, and Australia—and see if there is any sort of comparison. Do you think that we ought to adopt certain things they have or eliminate things they don't? Are we doing better or worse? Again, the contexts are slightly different, but are they doing anything that you would like to see done in Canada?

It's a little hard for a bureaucrat, perhaps.

Mr. White, a quick question.

Mr. Randy White: I'm just going to add another question in with yours.

Are you a medical doctor, by any chance?

Dr. Jody Gomber: No.

Mr. Randy White: You're not.

Would it be possible to get back from Health Canada—I've read a bit about this—some kind of proof that, in their minds and from a medical perspective, marijuana does or does not lead to an addiction to coke, heroin, or other drugs? In other words, is it actually a gateway because of the drug culture, or is it a gateway because someone has taken drugs and now wants more, wants to try this and more of this and this and this? I'd like to hear an answer from a medical point of view. I'm not looking for...

• 1730

The Chair: Perhaps our researchers could help us out on that, because there's certainly a lot of research into that area. I'm not sure if Health Canada has further studies.

Dr. Jody Gomber: No. We have access to the same studies your researchers would.

The Chair: Okay.

The only other thing you raised that was topical concerned the Taliban. I thought they had eliminated poppy production and opium. Is there something recent in the news to the effect that they have released a whole bunch of product? I would have thought that in light of the recent events the price of heroin would have gone up, not down.

Dr. Jody Gomber: No. In fact, it appears—now everybody is going on whatever information they have—that the Taliban banned the production of the opium poppy, that much is true, in recent years. It is not clear whether they themselves or other people have been sitting on stockpiles. What has become more clear in recent days is that whoever it is who has been sitting on stockpiles is getting rid of it and that the price of opium at the borders has dropped significantly.

The Chair: Okay.

I don't know whether it comes from independent police forces or whether Health Canada feeds it to them, but certainly from time to time you'll hear warnings on the radio saying there's a particularly strong strain of cocaine, heroin, or something right now; please be careful if you're a user. Where does that information come from, and can you tell us what that process is like? I ask because that's part of harm reduction, not killing or trying not to kill people who are addicted.

Thank you very much for coming before us today. I'm sorry that we've now sent you off with more work than you started with, but as you can see, we're trying to get the information.

Lastly, when you're sending us all that stuff, if there is an area you think this committee should be focusing on or if there's something you think we could be looking at to help you in your work on behalf of Canadians, we would be very happy to hear about that. We wish you lots of good work on behalf of Canadians.

Thank you.

Dr. Jody Gomber: Thank you. We're very glad to have come, and we wish you lots of good luck.

The Chair: Thanks.

This meeting is adjourned.